Accident In Year Research Articles

Case Report: The Development of Delusional Jealousy Following Metal-on-metal Bilateral Hip Implant with Chronic Cobalt Toxicity

<h3>Introduction</h3> More than 1 million arthroplasties are conducted annually worldwide, with 65% of patients aged 65 years and older. Complications include infection, dislocation, hypersensitivity reactions to metal implants, often requiring surgical re-intervention causing significant distress. Neuropsychiatric symptoms including dementia and depression secondary to chromium and cobalt toxicity with metal-on-metal implants have also been reported. These symptoms may persist even after removal of defective metal prostheses. Here we present a 51-year-old woman with delusional jealousy. She underwent bilateral hip arthroplasty following avascular necrosis X-12 years ago, with nine follow-up surgeries for complications. After getting lost in the orthopedist's office, and reporting memory lapses ultimately leading to a car accident in year X-2, she was diagnosed with neurocognitive disorder secondary to cobalt toxicity and depression by her orthopedist. Documented perioperative cobalt levels ranged from 5.6 to 14.9 µg/L (>1.0). She was treated with bilateral removal of the metal-on-metal implants. Ten months post-intervention, she attempted suicide by overdose on a lethal amount of pentazocine and naloxone. She claimed the overdose was secondary to stress caused by her husband's multiple romantic affairs. In the past 1-2 years, the patient had installed cameras in the house, accused her husband of hiding a girl under the table while washing dishes, repeatedly filed for divorce, and destroyed a motorcycle based on this claim. The patient was admitted to the psychiatric ward after medical clearance. <h3>Methods</h3> Case report. <h3>Results</h3> No significant focal deficits on her neurological examination. No major findings on her brain imaging. Her Montreal Cognitive Assessment was positive for mild neurocognitive deficits. Patient was started on lurasidone 20mg by mouth at bedtime. She refused any psychotropic medication treatment at discharge. <h3>Conclusions</h3> The final DSM-5 diagnosis was Delusional Disorder, Jealous type. Patient had metal-on-metal implant for 10 years with multiple complications prior to onset of neuropsychiatric symptoms. She had no prior psychiatric history other than mentioned above. The pathophysiology of delusional disorder may be associated to both organic and psychological stressors. Most commonly linked neurologic diseases are those affecting the basal ganglia and limbic systems. PET imaging studies in arthroprosthetic cobaltism have shown significant brain hypometabolism in these areas. Chronic, static damage by metallosis and multiple complications may have contributed to the delusional disorder. The dangerousness of delusional jealousy is also noteworthy. More research is necessary to understand the link between arthroplasty complications and delusional disorder. <h3>Funding</h3> None.

Do therapists with fewer years of clinical experience encounter more accidents? The relationship between number of years of clinical experience and number of accidents in a year.

This study sought to determine whether therapists experience more accidents annually with increased clinical experience, and whether experiencing an accident in the first year of practice is associated with accidents in the second year of practice. We categorized 642 therapists into five groups based on years of clinical experience (first, second, third, fourth, and 5-20 years; n=138, 112, 117, 58, and 217, respectively) and tallied the accidents they reported over an 8-year period. The difference between the five groups in the number of accidents per person per year was subjected to multiple comparisons testing using Kruskal-Wallis tests. Significant differences were revealed between the first year group and the 5-20 years group (p<0.01), between the second year group and the 5-20 years group (p<0.05), and between the third year group and the 5-20 years group (p<0.05). Specifically, participants in the 5-20 years group encountered fewer accidents than those in the other groups. Therapists who encountered an accident in their first year, compared with those who had not, had significantly more accidents in their second year. Therapists with 1-3 years of clinical experience are more likely to encounter an accident than therapists with >5 years of clinical experience. We conclude that young therapists who have experienced accidents are prone to future accidents. These findings inform the optimal allocation of educational resources to reduce the number of accidents encountered by therapists.

ENERGY SECURITY, RESILIENCE AND CRITICAL INFRASTRUCTURE PROTECTION: SPANISH PUERTOLLANO REFINERY CRISIS

Critical Energy Infrastructures can suffer different impacts from accidents and natural disasters which concern the whole energy system and specific functional aspects of Energy Security as well. A negative energy event -i.e. a strategic refinery blockade due to an accidentcan provide useful experiences which demonstrate the connection among logistic efficiency, resilience and Energy Security. Spanish refinery Puertollano suffered an accident in year 2003 which stopped oil logistics in a significant part of the country. Military oil refined products logistics in Spain are managed by CLH oil products logistic company -operating in the framework of a Public-Private Partnership and civil-military cooperation modeland then this enterprise facilitated the implementation of a resilience measures aimed to guarantee the operation of oil products logistic chain in the affected area. Management of Puertollano refinery crisis in 2003 showed positive results for ensuring National Energy Security, market and business normal function, system stability and infrastructure re-adjustment. This crisis advanced criteria and lesson learned for Critical Energy Infrastructure Protection and business continuity planning.