Partitioning and transmutation strategy R&D for nuclear spent fuel: the SACSESS and GENIORS projects

Processes such as PUREX allow the recovery and reuse of the uranium and the plutonium of GEN II/GEN III reactors and are being adapted for the recycling of the uranium and the plutonium of GEN IV MOX fuels. However, it does not fix the sensitive issue of the long-term management of the high active nuclear waste (HAW). Indeed, only the recovery and the transmutation of the minor actinides can reduce this burden down to a few hundreds of years. In this context, and in the continuity of the FP7 EURATOM SACSESS project, GENIORS focuses on the reprocessing of MOX fuel containing minor actinides, taking into account safety issues under normal and mal-operation. By implementing a three-step approach (reinforcement of the scientific knowledge => process development and testing => system studies, safety and integration), GENIORS will provide more science-based strategies for nuclear fuel management in the EU

A historical vertebrate collection from the Middle Miocene of the Peruvian Amazon

The Miocene aquatic and terrestrial fossil record from western Amazonia constitute a clear evidence of the palaeoenvironmental diversity that prevailed in the area, prior to the establishment of the Amazon River drainage. During the Miocene, the region was characterized by a freshwater megawetland basin, influenced by episodic shallow-marine incursions. A fossil vertebrate collection from the middle Miocene strata of the Pebas Formation is here studied and described. This historical collection was recovered in 1912 along the banks of the Itaya River (Iquitos, Peru), during a scientific expedition led by two scientists of the University of Zurich, Hans Bluntschli and Bernhard Peyer. Our findings include a total of 34 taxa, including stingrays, bony fishes, turtles, snakes, crocodylians, and lizards. Fishes are the most abundant group in the assemblage (~ 23 taxa), including the first fossil record of the freshwater serrasalmids Serrasalmus, and Mylossoma, and the hemiodontid Hemiodus for the Pebas system, with the latter representing the first fossil be discovered for the entire Hemiodontidae. The presence of a representative of Colubroidea in the middle Miocene of Iquitos supports the hypothesis of arrival and dispersal of these snakes into South America earlier than previously expected. This fossil assemblage sheds light on the palaeoenvironments, and the geographical/temporal range of several aquatic/terrestrial lineages inhabiting the Amazonian region

Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series report

Background: “Neuroleptic malignant syndrome” (NMS) is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system. Between 0.5% and 1% of patients exposed to antipsychotics develop the condition. Mortality rates may be as high as 55% and many risk factors have been reported. Although rapid escalation of antipsychotic dose is thought to be an important risk factor, to date it has not been the focus of a published case series or scientifically defined. <p/>Aims: To identify cases of NMS and review risk factors for its development with a particular focus on rapid dose escalation in the 30 days prior to onset. <p/>Methodology: A review of the literature on rapid dose escalation was undertaken and a pragmatic definition of “rapid dose escalation” was made. NMS cases were defined using DSM-IV criteria and systematically identified within a secondary care mental health service. A ratio of titration rate was calculated for each NMS patient and “rapid escalators” and “non rapid escalators” were compared. <p/>Results: 13 cases of NMS were identified. A progressive mean dose increase 15 days prior to the confirmed episode of NMS was observed (241.7mg/day during days 1-15 to 346.9mg/day during days 16-30) and the mean ratio of dose escalation for NMS patients was 1.4. Rapid dose escalation was seen in 5/13 cases and non rapid escalators had markedly higher daily cumulative antipsychotic dose compared to rapid escalators. <p/>Conclusions: Rapid dose escalation occurred in less than half of this case series (n=5, 38.5%), although there is currently no consensus on the precise definition of rapid dose escalation. Cumulative antipsychotic dose – alongside other known risk factors - may also be important in the development of NMS

Evidences for a Paleocene marine incursion in southern Amazonia (Madre de Dios Sub-Andean Zone, Peru)

This article presents new biostratigraphic dating, facies analysis, organic geochemical data and Nd–Sr isotopic provenance from five outcrops of southern Amazonia (MD-85, MD-177 MD-184, MD-255 and MD-256) to document for the first time the presence of a shallow marine ingression in the Paleocene of southern Amazonia basin. The co-occurrence of a selachian assemblage encompassing Potobatis sp., Ouledia sp., and Pristidae indet. with the ostracod Protobuntonia sp. and the charophytes Peckichara cf. varians meridionalis, Platychara perlata, and Feistiella cf. gildemeisteri suggests a Paleocene age for the studied deposits (most likely Thanetian but potentially Danian). Fifteen facies have been recognized and have been grouped into three facies assemblages. Facies association A corresponds to the sedimentary filling of a tide-influenced meandering channel formed in the fluvial–tidal transition zone. Facies association B is related to more distal tidal-flats, little channelized tidal inlets and saltmarsh deposits. Facies association C corresponds to a stressed shallow marine environment such as a bay or a lagoon. The d13CTOC value (- 23.4‰) of MD-184 is enriched in 13C compared to the other samples suggesting the presence of substantial amounts of marine organic matter in MD-184. The d13CTOC values of samples from other outcrops (- 27.3 to - 29.8‰) indicate a mixed organic matter origin, from terrestrial to brackish environments. The analyzed sediments have similar Nd–Sr isotopic compositions as those of the Cenozoic sediments of the Altiplano (eNd(0) values from - 6.2 to - 10.7 and 87Sr/86Sr compositions from 0.712024 to 0.719026) indicating a similar volcanic source. This multidisciplinary dataset documents the presence of a tide-dominated estuary sourced by the proto-Western Cordillera debouching into a shallow marine bay during Paleocene times. This transgression might be explained by subsidence created in response to the proto-Western Cordillera loading. Similar to Miocene marine incursions affecting the Pebas megawetland, Paleogene marine incursions in the Amazonian foreland basin associated with Andean uplift may have played a role in the Neotropical biodiversity dynamics in favoring biogeographical isolation and promoting allopatric speciation for terrestrial organisms

An overview of solvent extraction processes developed in Europe for advanced nuclear fuel recycling, Part 2 — homogeneous recycling

The hydrometallurgical separation concepts for the recycling of irradiated nuclear fuels developed in Europe are presented and discussed. Whilst Part 1 of the review focused on concepts for heterogeneous recycling of minor actinides, this article focuses on group recycling of transuranic actinides, which would support homogeneous recycling scenarios. Most of these concepts were developed within European collaborative projects and involve solvent extraction processes separating all the actinides (U-Cm) in two cycles. The first cycle uses a monoamide extractant to recover uranium leaving all the transuranic actinides in the aqueous raffinate with the fission products. The second cycle aims for a group recovery of the transuranium elements and several strategies have been proposed for this stage. In this review article, the various solvent extraction processes are summarised and the key features of the process schemes are compared

Ten Years of Experience Training Non-Physician Anesthesia Providers in Haiti.

Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource-limited countries. Often non-physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non-existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post-hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non-physician anesthetists is a feasible and important way to scale up surgical services resource limited settings

Comparison of glottic views and intubation times in the supine and 25 degree back-up positions

Background: We explored whether positioning patients in a 25° back-up sniffing position improved glottic views and ease of intubation. Methods: In the first part of the study, patients were intubated in the standard supine sniffing position. In the second part, the back of the operating table was raised 25° from the horizontal by flexion of the torso at the hips while maintaining the sniffing position. The best view obtained during laryngoscopy was assessed using the Cormack and Lehane classification and Percentage of Glottic Opening (POGO) score. The number of attempts at both laryngoscopy and tracheal intubation, together with the use of ancillary equipment and manoeuvres were recorded. The ease of intubation was indirectly assessed by recording the time interval between beginning of laryngoscopy and insertion of the tracheal tube. Results: Seven hundred eighty one unselected surgical patients scheduled for non-emergency surgery were included. In the back-up position, ancillary laryngeal manoeuvres, which included cricoid pressure, backwards upwards rightward pressure and external laryngeal manipulation, were required less frequently (19.6 % versus 24. 6 %, p = 0.004). The time from beginning of laryngoscopy to insertion of the tracheal tube was 14 % shorter (median time 24 versus 28 s, p = 0.031) in the back-up position. There was no significant difference in glottic views. Conclusions: The 25° back-up position improved the ease of intubation as judged by the need for fewer ancillary manoeuvres and shorter time for intubation. Trial registration: ClinicalTrials.gov Identifier: NCT02934347 registered retrospectively on 14th Oct 2016

Post-stroke infection: A systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p><b>s</b>troke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the pooled post-stroke infection rate and its effect on outcome.</p> <p>Methods</p> <p>MEDLINE and EMBASE were searched for studies on post-stroke infection. Cohort studies and randomized clinical trials were included when post-stroke infection rate was reported. Rates of infection were pooled after assessment of heterogeneity. Associations between population- and study characteristics and infection rates were quantified. Finally, we reviewed the association between infection and outcome.</p> <p>Results</p> <p>87 studies were included involving 137817 patients. 8 studies were restricted to patients admitted on the intensive care unit (ICU). There was significant heterogeneity between studies (P < 0.001, I²= 97%). The overall pooled infection rate was 30% (24-36%); rates of pneumonia and urinary tract infection were 10% (95% confidence interval [CI] 9-10%) and 10% (95%CI 9-12%). For ICU studies, these rates were substantially higher with 45% (95% CI 38-52%), 28% (95%CI 18-38%) and 20% (95%CI 0-40%). Rates of pneumonia were higher in studies that specifically evaluated infections and in consecutive studies. Studies including older patients or more females reported higher rates of urinary tract infection. Pneumonia was significantly associated with death (odds ratio 3.62 (95%CI 2.80-4.68).</p> <p>Conclusions</p> <p>Infection complicated acute stroke in 30% of patients. Rates of pneumonia and urinary tract infection after stroke were 10%. Pneumonia was associated with death. Our study stresses the need to prevent infections in patients with stroke.</p

Comparison of the Airtraq® and Truview® laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins

<p>Abstract</p> <p>Background</p> <p>Paramedics are frequently required to perform tracheal intubation, a potentially life-saving manoeuvre in severely ill patients, in the prehospital setting. However, direct laryngoscopy is often more difficult in this environment, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Airtraq^®and Truview^®laryngoscopes may reduce this risk.</p> <p>Methods</p> <p>We compared the efficacy of these devices to the Macintosh laryngoscope when used by 21 Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Airtraq^®and Truview^®laryngoscopes, each participant took turns performing laryngoscopy and intubation with each device, in an easy intubation scenario and following placement of a hard cervical collar, in a SimMan^®manikin.</p> <p>Results</p> <p>The Airtraq^®reduced the number of optimization manoeuvres and reduced the potential for dental trauma when compared to the Macintosh, in both the normal and simulated difficult intubation scenarios. In contrast, the Truview^®increased the duration of intubation attempts, and required a greater number of optimization manoeuvres, compared to both the Macintosh and Airtraq^®devices.</p> <p>Conclusion</p> <p>The Airtraq^®laryngoscope performed more favourably than the Macintosh and Truview^®devices when used by Paramedics in this manikin study. Further studies are required to extend these findings to the clinical setting.</p