Cost effectiveness of community leg ulcer clinics: randomised controlled trial

Objectives: To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression bandaging versus usual care provided by district nurses. Design: Randomised controlled trial with 1 year of follow up. Setting: Eight community based research clinics in four trusts in Trent. Subjects: 233 patients with venous leg ulcers allocated at random to intervention (120) or control (113) group. Interventions: Weekly treatment with four layer bandaging in a leg ulcer clinic (clinic group) or usual care at home by the district nursing service (control group). Main outcome measures: Time to complete ulcer healing, patient health status, and recurrence of ulcers. Satisfaction with care, use of services, and personal costs were also monitored. Results: The ulcers of patients in the clinic group tended to heal sooner than those in the control group over the whole 12 month follow up (log rank P=0.03). At 12 weeks, 34% of patients in the clinic group were healed compared with 24% in the control. The crude initial healing rate of ulcers in intervention compared with control patients was 1.45 (95% confidence interval 1.04 to 2.03). No significant differences were found between the groups in health status. Mean total NHS costs were £878.06 per year for the clinic group and £859.34 for the control (P=0.89). Conclusions: Community based leg ulcer clinics with trained nurses using four layer bandaging is more effective than traditional home based treatment. This benefit is achieved at a small additional cost and could be delivered at reduced cost if certain service configurations were used

Overview of safety and environmental issues for inertial fusion energy

This paper summarizes safety and environmental issues of Inertial Fusion Energy (IFE): inventories, effluents, maintenance, accident safety, waste management, and recycling. The fusion confinement approach among inertial and magnetic options affects how the fusion reaction is maintained and which materials surround the reaction chamber. The target fill technology has a major impact on the target factory tritium inventory. IFE fusion reaction chambers usually employ some means to protect the first structural wall from fusion pulses. This protective fluid or granular bed also moderates and absorbs most neutrons before they reach the first structural wall. Although the protective fluid activates, most candidate fluids have low activation hazard. Hands-on maintenance seems practical for the driver, target factory, and secondary coolant systems; remote maintenance is likely required for the reaction chamber, primary coolant, and vacuum exhaust cleanup systems. The driver and fuel target facility are well separated from the main reaction chamber

Risk from a compressed toxic gas system: Part 1, Dispersal probability

At the Lawrence Livermore National Laboratory, we have prepared a Safety Analysis Report for the Department of Energy on our Building 332 Plutonium Handling Facility. This SAR includes an analysis of potential accident scenarios which could lead to offsite consequences to the public having not only radiological exposures, but also exposures to toxic gases such as chlorine. This paper presents a risk analysis of pressurized chlorine gas system proposed for use at Building 332. The focus of the analysis is to calculate the predicted frequency of an unmitigated leak of chlorine from the system which could result in the dispersal of the entire contents of the gas cylinder to the environment. Modeled are postulated valve leaks or pipe ruptures occurring anywhere in the distribution system, as well as the potential failure of leak mitigation. The fundamental credibility of this type of accident is established. The importance of a reliable leak mitigation system is demonstrated, and the dependence of the results on less than optimal data is discussed in the context of uncertainty and sensitivity analyses

BICCO-Net II. Final report to the Biological Impacts of Climate Change Observation Network (BICCO-Net) Steering Group

• BICCO-Net Phase II presents the most comprehensive single assessment of climate change impacts on UK biodiversity to date. • The results provide a valuable resource for the CCRA 2018, future LWEC report cards, the National Adaptation Programme and other policy-relevant initiatives linked to climate change impacts on biodiversity

Methodology for the relative risk assessment in the LDF safety analysis report

This document provides the methodology used for the relative risk assessment performed in the LDF Safety Analysis Report. The safety analysis for a facility of the hazard level of the LDF Complex (Buildings 490L, 492 are low hazard) should be mostly qualitative. This was the approach taken for the LDF risk assessment, where qualitative descriptors were assigned to event consequences and frequencies. The event consequences and frequencies were then combined using a risk matrix to obtain an assessment of the relative risk presented by each event to LDF workers and to the public. The development of the risk matrices is the main subject of this report. The matrices have been applied in the LDF SAR (LLNL, 1997)

National Ignition Facility Risk Management Plan

The NIF Risk Management Plan has been prepared in accordance with the DOE Life Cycle Asset Management Good Practice Guide to support Critical Decision 3 of the NIF Project. The objectives of the plan are to: 1) identify the risks to the completion of the Project in terms of meeting technical and regulatory requirements, cost, and schedule, 2) assess the risks in terms of likelihood of occurrence and their impact potential relative to technical performance, ES&H (environment, safety and health), costs, and schedule, and 3) address each identified risk in terms of suitable risk mitigation measures. The documents that form the basis for this risk assessment are as follows: 1. Final Programmatic Environmental Impact Statement for Stockpile Stewardship and Management (DOE, 1996a) and Record of Decision (DOE, 1996b), 2. Preliminary Hazards Analysis (Brereton, 1993), 3. Fire Hazards Analysis (Jensen, 1997), 4. Preliminary Safety Analysis Report (LLNL, 1996a), 5. Reliability, Availability and Maintainability Report, 6. Radiation Protection Evaluation, 7. Primary Criteria and Functional Requirements (LLNL, 1996b), 8. Project Execution Plan (DOE, 1996c), 9. Schedule Risk Assessment, 10. Construction Safety Program (LLNL, 1997), 11. Title I Design Media, 12. Congressional Data Sheet. The process used in developing this plan was to form a Risk Assessment team of knowledgeable project personnel. This included: Assurances Manager, Systems Integration Manager, Project Control Manager, a Risk Management consultant, Deputy Associate Project Engineer for Activation and Start-up (Co-chairperson), and Lead Engineer for Safety Analysis (Co-chairperson). They were familiar with the risk basis documents and developed a list of the key risk elements. A methodology for assigning likelihoods, consequences, and risks was developed. Risk elements were then reviewed, and likelihoods, consequences, and risks were assigned. Risk mitigation measures were then developed. Comments were obtained, resolved and incorporated, and this document presents the results of the assessment

Hazard classification methodology

This document outlines the hazard classification methodology used to determine the hazard classification of the NIF LTAB, OAB, and the support facilities on the basis of radionuclides and chemicals. The hazard classification determines the safety analysis requirements for a facility