Specific Risk Assessment Research Articles

Study on Unsafe Behavior Pre-control Method Based on Accidents Statistic

Analyzing the characteristics and influencing factors of unsafe behavior based on incidents in coal mine can be more direct and in-depth. Through studying the 1203 major accidents in Chinese coal mine and 5 years’ incidents in one coal company, it finds that performing the specific risk assessment of unsafe behavior, finding the common cause of unsafe behavior, mastering and settling the unsafe behavior of key time, key region, key position can effectively pre-control unsafe behavior. Secondly, Enterprises should pay attention to evaluating and improving the managers’ and key safety staffs’ safety behavior ability to avoid wrong command .In addition, developing advanced safety culture and concept will help to improve the safety situation fundamentally. Lastly, the role of reducing labor intensity and improving the work environment to lessen unsafe behavior should not been overlooked.

Musculoskeletal disorder prevalence and risk factors in ambulance officers

This review explores the prevalence and determinants of musculoskeletal disorders in ambulance officers, and the limitations of the current epidemiological evidence to inform the development of interventions. Relevant studies were selected using defined word search terms and inclusion criteria. Existing research shows a high annual prevalence of back, neck and shoulder musculoskeletal disorders in ambulance officers and emergency medical technicians, whilst limited research has demonstrated significant associations between individual, physical and psychosocial demands, and musculoskeletal disorders of the low-back and neck-shoulder area. However, methodological issues will need to be addressed in future epidemiological research in order to inform the development of industry specific risk assessment tools that will assist in identifying the complex array of interactive risk factors involved in ambulance work. The accurate identification of risk factors will in turn, better inform the establishment of multifaceted interventions to reduce the prevalence of musculoskeletal disorders in ambulance officers.

Ecological vulnerability in wildlife: Application of a species‐ranking method to food chains and habitats

Nature development in The Netherlands is often planned on contaminated soils or sediments. This contamination may present a risk for wildlife species desired at those nature development sites and must be assessed by specific risk assessment methods. In a previous study, we developed a method to predict ecological vulnerability in wildlife species by using autecological data and expert judgment; in the current study, this method is further extended to assess ecological vulnerability of food chains and terrestrial and aquatic habitats typical for The Netherlands. The method is applied to six chemicals: Cd, Cu, Zn, dichlorodiphenyltrichloroethane, chlorpyrifos, and ivermectin. The results indicate that species in different food chains differ in vulnerability, with earthworm-based food chains the most vulnerable. Within and between food chains, vulnerability varied with habitat, particularly at low trophic levels. The concept of habitat vulnerability was applied to a case study of four different habitat types in floodplains contaminated with cadmium and zinc along the river Dommel, The Netherlands. The alder floodplain forest habitat contained the most vulnerable species. The differences among habitats were significant for Cd. We further conclude that the method has good potential for application in mapping of habitat vulnerability.

Landfill sustainability and aftercare completion criteria

Although many countries are increasing their efforts to recycle and to re-use waste materials, landfilling will still be needed in order to dispose of wastes which cannot be recycled or treated in other ways. Since landfills will most probably be present for a long time, measures will have to be taken to reduce their (long-term) emissions. The European Commission has delegated the competent authorities to decide to end aftercare and several member states have provided regulations for this purpose. However, there is currently no guidance for long-term risk assessment to support an aftercare completion procedure for landfills. The aim of this study is to provide examples of current regulations and to demonstrate an alternative approach for a quantitative risk assessment of landfill leachate. The presented modelling approach clearly demonstrates the added value of site specific risk assessments of the long-term emissions from landfills and might provide a basis for application when the acceptance criteria for landfill will be revisited in the future. In addition, the modelling approach can be used as one of the toolboxes to perform assessments of the long-term emissions from landfill leachates and might help the competent authorities to decide whether the remaining emission potential is acceptable or not. Moreover, the results imply that local environmental conditions contribute to the acceptability of landfill emissions and are important factors in choosing a landfill location.

Diagnostic validity of the care dependency scale as a screening tool for pressure ulcer and fall risks in Dutch and German hospitals

Abstract Pressure ulcers and falls are frequent adverse events with negative impacts for hospital patients. Guidelines recommend risk assessment as the first step in prevention. Care dependency correlates with falls and pressure ulcers and the Care Dependency Scale showed a diagnostic validity comparable to that of specific risk assessment tools. The aim of this study was to establish a simple and valid screening index for the risk of falls and pressure ulcers in hospitals by using the Care Dependency Scale and to evaluate this index within two validation samples from different countries. Quantitative, cross-sectional data from two German surveys and one Dutch survey were analysed. A total of 305 Dutch and German hospitals with 21,880 patients took part. The diagnostic validity of the Care Dependency Scale was evaluated by computing receiver operator characteristics curves, the areas under the curves, sensitivity, specificity and positive and negative predictive values.The Scale demonstrated a good diagnostic validity for pressure ulcer risk screening in Dutch and German hospitals. The diagnostic validity regarding the risk for falls was satisfying in Germany and moderate in the Netherlands. Using the Care Dependency Scale for risk screening could reduce the necessity of further assessment by more than a half.

Comparison of Batch Mode and Dynamic Physiologically Based Bioaccessibility Tests for PAHs in Soil Samples

A fed state in vitro methodology capable of use in commercial testing laboratories has been developed for measuring the human ingestion bioaccessibility of polyaromatic hydrocarbons (PAHs) in soil (Fed ORganic Estimation human Simulation Test- FOREhST). The protocol for measuring PAHs in the simulated gastro-intestinal fluids used methanolic KOH saponification followed by a combination of polymeric sorbent solid phase extraction and silica sorbent cartridges for sample cleanup and preconcentration. The analysis was carried out using high pressure liquid chromatography with fluorescence detection. The repeatability of the method, assessed by the measurement of the bioaccessibility of 6 PAHs (benz[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, benzo[a]pyrene, dibenz[ah]anthracene, and indeno[1,2,3-c,d]pyrene) in eleven gas works soils, was approximately 10% RSD. The method compared well with the results from an independent dynamic human simulation reactor comprising of the stomach, duodenal and colon compartments tested on the same soils. The measured bioaccessible fraction of the soils varied from 10-60% for soils containing 10-300 mg kg(-1) PAH (the sum of the six studied) with total organic carbon concentrations in the soils ranging from 1-13%. A multiple regression model showed that the PAH bioaccessible fraction could be explained using the PAH compound, the soil type and the total PAH to soil organic carbon content. The method described here has potential for site specific detailed quantitative risk assessment either to modify the risk estimation or to contribute to the risk evaluation.

293 Risk assessment for radiation-induced cancer after Interventional Cardiology procedures

The increased use of interventional cardiology (IC) procedures, while providing important benefits to patients, also contributes to their radiation exposure. Radiation is a relatively weak carcinogen and demonstrating a radiation-induced cancer risk remains difficult. Only very crude results of lifetime risk assessment of cancer after IC procedures have been presented elsewhere, but the age distribution of population, technical procedures actually applied and target organs are also important to consider. Based on a previous detailled description of clinical features and dosimetric data (absorbed organ doses: lung and bone marrow) of an adult French population undergoing IC procedure, and the latest radiation risk models (BEIR VII), a specific risk assessment for lung cancer and leukaemia mortalities was realized. We considered patients having undergone either a coronary angiography or cumulating coronary angiography and angioplasty, at age 40-75 years, and followed until 85 years. Based on different scenarios of radiation exposure and delivered-doses, the number of deaths from lung cancer or leukaemia due to radiation per 1,000 general population spontaneous lung cancer or leukaemia deaths respectively, was estimated. Preliminary results show that the risk of specific radio-induced cancer in patients undergoing IC procedure exists even if it remains relatively limited. Moreover, depending on patients’ age and type of IC procedure, additional procedures appeared to increase the lifetime risk estimates. This study provides evidence of the potential radio-induced cancer risk in IC. The limitations of such calculations are due to the difficulty to take into account patients’ possible shorter life prognosis than in general population, partly explained by comorbidities and coronary disease. Because of numerical evolution of IC procedures, interventions to promote delivered-doses optimization and “ALARA” requirements may prevent or limit this risk.

A Preliminary Examination of Specific Risk Assessment for Sexual Offenders Against Children

Specific risk questions concerning sexual offending, such as risk of offending against male victims given identified female victims, have seldom been discussed in the child sexual abuse literature. Two approaches to specific risk questions are described: (a) conditional probability calculations, and (b) the development of risk assessment instruments. It is concluded that specific risk questions should be addressed by the use of established instruments for assessing risk of general sexual recidivism rather than by the development of additional specific risk assessment instruments. Research supporting risk assessment instruments and cautions about their use are discussed. Finally, the application of risk assessments for sexual offenders and assessments of risk to siblings of incest victims is discussed.

Application of the concept of relative photomutagenic potencies to selected furocoumarins in V79 cells

Furocoumarins are phototoxic and photomutagenic natural plant constituents found in many medicinal plants and food items. Since plants contain mixtures of several furocoumarins, there is a need for a comparative risk assessment of a large number of furocoumarins. Previously, we have introduced the concept of relative Photomutagenicity Equivalency Factors (PMEFs) derived from the slope of the concentration–response curve of photomutagenicity of individual furocoumarins in V79 cells using the HPRT mutation assay in the presence of UVA irradiation at 125 mJ/cm 2. Here we have applied this method to the furocoumarins bergamottin, isopimpinellin and psoralen using 5-methoxypsoralen (5-MOP) as a reference compound with a PMEF of 1.0. We found that neither bergamottin nor isopimpinellin, two furocoumarins abundant in plants, food etc., exerted any significant photomutagenicity while psoralen was clearly photomutagenic with a PMEF of 0.36. Similarly, isopimpinellin was not phototoxic in V79 cells, while bergamottin showed some cytotoxicity which, however, was completely independent of UVA irradiation. Only psoralen was photocytotoxic showing a similar concentration–response relationship for photomutagenicity, and for photocytotoxicity (at 72 h after irradiation). Data from the micronucleus assay for DNA damage at 20 h after irradiation were in complete agreement with the HPRT mutation data. Our findings indicate that individual furocoumarins differ enormously in their photomutagenic potency, and that a specific toxicological risk assessment is required for each furocoumarin instead of an assessment based on the sum of furocoumarins in a given sample.

Nutritional Status and Gastrointestinal Microbes Affect Arsenic Bioaccessibility from Soils and Mine Tailings in the Simulator of the Human Intestinal Microbial Ecosystem

In vitro gastrointestinal models, used to measure the metal(loid) bioaccessibility for site specific risk assessment, are typically operated under fasted conditions. We evaluated the hypothesis that fed conditions increase arsenic bioaccessibility on three reference soils (NIST 2711, NIST 2709, and BGS 102) and the bulk and <38 mum size fractions of a mine tailing. The three nutritional states included a fed state with a carbohydrate mixture, a second fed state with homogenized crowberries (Empetrum nigrum), and a fasted state. The carbohydrate mixture increased arsenic bioaccessibility from four of five samples in the simulator of the human intestinal microbial ecosystem (SHIME) stomach but only three of five samples in the SHIME small intestine and colon. In contrast, crowberries increased arsenic bioaccessibility from four of five samples in the SHIME small intestine but had variable affects in the SHIME stomach and colon. The effect of nutritional status on arsenic bioaccessibility was potentially mediated via ligand-promoted dissolution in the SHIME stomach and small intestine. The displacement of arsenic with phosphate was potentially present in the SHIME small intestine but not the SHIME stomach. Microbial activity increased arsenic bioaccessibility relative to sterile conditions from four of five samples under fasted conditions and three of the five samples under fed conditions, which may suggest that in vitro gastrointestinal (GI) models operated under fed conditions and with microbes provide a more conservative estimate of in vitro bioaccessibility. However, for some samples, the arsenic bioaccessibility in the SHIME colon (with microbial activity) was equivalent to values observed in a separate physiologically based extraction test under small intestinal conditions (without microbial activity). These results suggest that the incorporation of microbial activity into in vitro GI models does not necessarily make estimates of arsenic bioaccessibility more protective than those generated using in vitro models that do not include microbial activity.

Ecological vulnerability in wildlife: An expert judgment and multicriteria analysis tool using ecological traits to assess relative impact of pollutants

Nature development in The Netherlands often is planned on contaminated soils and sediments of former agricultural land and in floodplain areas; however, this contamination may present a risk to wildlife species desired at those nature development sites. Specific risk assessment methods are needed, because toxicological information is lacking for most wildlife species. The vulnerability of a species is a combination of its potential exposure, sensitivity to the type of pollutant, and recovery capacity. We developed a new method to predict ecological vulnerability in wildlife using autecological information. The analysis results in an ordinal ranking of vulnerable species. The method was applied to six representative contaminants: copper and zinc (essential metals, low to medium toxicity), cadmium (nonessential metal, high toxicity), DDT (persistent organic pesticide, high toxicity), chlorpyrifos (persistent organophosphate insecticide, high toxicity), and ivermectin (persistent veterinary pharmaceutical, low to medium toxicity). High vulnerability to the essential metals copper and zinc was correlated with soil and sediment habitat preference of a species and with r-strategy (opportunistic strategy suited for unstable environments). Increased vulnerability to the bioaccumulating substances cadmium and DDT was correlated with higher position of a species in the food web and with life span and K-strategy (equilibrium strategy suited for stable environments). Vulnerability to chlorpyrifos and ivermectin was high for species with a preference for soil habitats. The ecological vulnerability analysis has potential to further our abilities in risk assessment.

Estimation of the cancer risk to humans resulting from the presence of cyclophosphamide and ifosfamide in surface water

Anti-tumour agents and their metabolites are largely excreted into effluent, along with other pharmaceuticals. In the past, investigations have focused on the input and analysis of pharmaceuticals in surface and ground water. The two oxazaphosphorine compounds, cyclophosphamide and ifosfamide are important cytostatic drugs used in the chemotherapy of cancer and in the treatment of autoimmune diseases. Their mechanism of action, involving metabolic activation and unspecific alkylation of nucleophilic compounds, accounts for genotoxic and carcinogenic effects described in the literature and is reason for environmental concern. The anti-tumour agents cyclophosphamide (CP) and ifosfamide (IF) were not biodegraded in biodegradation tests. They were not eliminated in municipal sewage treatment plants. Degradation by photochemically formed HO radicals may be of some relevance only in shallow, clear, and nitrate-rich water bodies but could be further exploited for elimination of these compounds by advanced oxidation processes, i.e. in a treatment of hospital waste water. Therefore, CP and IF are assumed to persist in the aquatic environment and to enter drinking water via surface water. The risk to humans from input of CP and IF into surface water is not known. The local and regional, i.e. nationwide predicted environmental concentration (PEC(local), PEC(regional)) of CP and IF was calculated for German surface water. Both compounds were measured in hospital effluents, and in the influent and effluent of a municipal treatment plant. Additionally, published concentrations in the effluent of sewage treatment plants and surface water were used for risk assessment. Excretion rates were taken into account. For a worst-case scenario, maximum possible ingestion of CP or IF by drinking 2 L a day of unprocessed surface water over a life span of 70 years was calculated for adults. Elimination in drinking water processing was neglected, as no data is available. This intake was compared with intake during anti-cancer treatment. Intake of CP and IF for anti-cancer treatment is typically 10 g within a few months. Under such conditions, a relative risk of 1.5 for the carcinogenic compounds CP and IF is reported in the literature. In the worst case, the maximum possible intake by drinking water is less than 10(-3) (IF) and 10(-5) (CP) of this amount, based on highest measured local concentrations. On a nationwide average, the factor is approx. 10(-6) or less. The additional intake of CP and IF due to their emission into surface water and its use without further treatment as drinking water is low compared to intake within a therapy. This approach has shortcomings. It illustrates the current lack of methodology and knowledge for the specific risk assessment of carcinogenic pharmaceuticals in the aquatic environment. IF and CP are directly reacting with the DNA. Therefore, with respect to health effects a safe threshold concentration for these compounds cannot be given. The resulting risk is higher for newborns and children than for adults. Due to the lack of data the risk for newborns and children cannot be assessed fully. The data presented here show that according to present knowledge the additional risk of cancer cannot be fully excluded, especially with respect to children. Due to the shortage of data for effects of CP and IF in low doses during a whole lifespan, possible effects were assessed using data of high doses of CP and IF within short-term ingestion, i.e. therapy. This remains an unresolved issue. Anyway, the risk assessment performed here could give a rough measure of the risks on the one hand and the methodological shortcomings on the other hand which are connected to the assessment of the input of genotoxic and carcinogenic pharmaceuticals such as CP and IF into the aquatic environment. Therefore, we recommend to take measures to reduce the input of CP and IF and other carcinogenic pharmaceuticals. We hope that our manuscript further stimulates the discussion about the human risk assessment for carcinogenic pharmaceuticals in the aquatic environment. CP and IF are carcinogens. With respect to newborn and children, reduction of the emission of CP and IF into effluent and surface water is recommended at least as a precautionary measure. The collection of unused and outdated drugs is a suitable measure. Collection of patients' excreta as a measure of input reduction is not recommended. Data suitable for the assessment of the risk for newborn and children should be collected in order to perform a risk assessment for these groups. This can stimulate discussion and give new insights into risk assessment for pharmaceuticals in the environment. Our study showed that in the long term, effective risk management for the reduction of the input of CP and IF are recommendable.

Risk assessment model of occupational exposure to nanomaterials

Recent development of nanotechnology allows precise assessment of the risks workers are exposed to. To assess the risks, a specific risk assessment model has been developed with reference to workplaces where nanoparticles are present. This model allows identification and quantification of the health hazards for workers. The use of nanomaterials presents some uncertainties regarding effective level of danger, and risk assessment takes this into consideration with the help of an appropriate index. An evaluation algorithm considers both normal work conditions and abnormal/emergency situations. Evaluation outcome consists of several risk levels with several subdivisions. For each single level, it is possible to develop specific behavioral guidelines. The present evaluation model has been implemented in research laboratories. The results are middle to high-level risks.

Growth analysis of individual abdominal atherosclerotic calcified deposits

1 Computer Science, University of Copenhagen, Copenhagen, Denmark Abdominal calcifications can be used as a clinical indicator of atherosclerosis and can be used to predict atherosclerotic plaques in the coronary arteries. Usually the degree of severity of atherosclerosis is given by the amount of calcifications along the aorta walls (AC24 score). In this study we take a look at the development of the individual calcifications over time. Our hypothesis is that the prediction of the growth of calcifications can give insight about the progression of atherosclerosis. Therefore we investigate different growth descriptors of the calcifications. Our study is based on x-ray images due to their advantages in large scales studies e.g. a low cost, a fast examination time, and a low radiation exposure compared to other image modalities. Our data set consists of 103 women with annotated x-ray images at two time periods (baseline at 1992-93 and follow-up in 2000-01), which have lumbar aorta visible in both images and have calcifications at baseline. We made a TPS registration of the follow-up to the baseline images to align the calcifications and find suitable matches between baseline and follow-up calcifications. From the one-to-one correspondent matches we have derived simple geometric measures that describe the growth of the calcifications. The growth descriptors are derived based on idealized coordinate systems that capture the direction of the blood flow. This way we can describe the growth of the calcifications based on how they have evolved along and perpendicular to the aorta wall. We describe the growth of the calcifications by their height, width, area and the center of mass movement. Our results show that the calcifications grow longitudinally, so they will occupy more of the aorta wall. The overall growth in area is 40.35 % and the calcification grows 34.83 % longitudinally (in the direction of the blood flow) and 34.63 % in the direction perpendicular to the blood flow. This is based on 35.7 % one-to-one correspondent matches out of 633 baseline calcifications Atherosclerotic growth patterns based on X-ray are able to give an insight in the progression of atherosclerosis. The longitudinal analysis of simple geometric descriptors of individual calcified deposits can be used to increase the clinical knowledge about atherosclerosis in the calcified stages. The growth pattern analysis could also be used to give a patient specific risk assessment.

Should we protect the most sensitive people?

The recommendations of the International Commission on Radiological Protection (ICRP)are based on a population average, rather than on the available data for subpopulations.From an ethical point of view, this approach is far from unproblematic. Strong reasons canbe given in support of a right for each radiation-exposed person to have the best possibleinformation about the risk to himself or herself, which is often group-specific information.Risk exposures have to be defensible from the perspective of each identifiable group forwhich a specific risk assessment can be made. Exposing a person to a high risk cannot bejustified by pointing out that the risk to an average person would have been muchlower. There are two major ways to protect a sensitive group: special standardsfor the group (differentiated protection) and general standards that are strictenough to protect its members (unified protection). Some major factors thatare relevant for the choice between these two protective strategies are identified.

Uptake, bioaccumulation, and biodegradation of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) and its reduced metabolites (MNX and TNX) by the earthworm ( Eisenia fetida)

Uptake and accumulation kinetics of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) and its two major N-nitroso metabolites, hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX) and hexahydro-1,3,5-trinitroso-1,3,5-triazine (TNX), in earthworms was investigated. Results indicated that RDX and its N-nitroso metabolites were rapidly absorbed into earthworms ( Eisenia fetida), reaching the highest concentrations within a few days. Accumulation of RDX was greater than its N-nitroso metabolites, as evidenced by a higher bioconcentration factor (BCF); BCFs were 1.86, 0.39, and 0.05 for RDX, MNX, and TNX, respectively. RDX and its N-nitroso metabolites were also rapidly eliminated from the earthworm and/or transformed to other metabolites, as evidenced by the rapid decrease of test compounds in earthworms after reaching their highest concentrations. The uptake of MNX and TNX increased as exposure concentration increased. Although these earthworms might (anaerobically) degrade RDX to MNX and MNX to TNX, it is hypothesized that this process would be slow. Other biotransformation pathways may be involved in biodegradation of RDX and its N-nitroso metabolites due to the fact that concentrations of tested compounds decreased in both soil and earthworms. It is hoped that these data can be used to refine environmental management strategies for RDX and for performing specific risk assessments of RDX and its N-nitroso metabolites.

S27-01 Gender specific and structured approach to violence risk assessment - the Munich Prognosis project (MPP)

A clear structured approach to violence risk assessment that is both, evidence-based and gender specific- is high on the political and mental health agendas. The individual risk of perpetrators depends on several parameters that are incorporated into assessment instruments. Most data about risk factors included in risk assessment instruments were derived only on male offenders.This study is part of Germany's biggest risk assessment study, -the Munich Prognosis project (MPP) - and focuses on factors included in risk assessment instruments associated with criminal and violent recidivism in a sample of male and female delinquents referred for forensic-psychiatric evaluation prior sentencing. The predictive validity of four instruments (HCR 20, ILRV, VRAG and PCL-R) for violent and general repeat offenses was analyzed.When comparing the predictive validity of the four instruments for male offenders, the results were in favor of the PCL-R, i.e. PCL-R Factor 2 when focusing on violent recidivism.For female offenders ROC analysis found superior results of the HCR 20-R items (AUC .793 p&lt; .05), the ILRV D variables (AUC .814), p&lt; .05) and the VRAG (AUC .864, p&lt; .05) for violent recidivism. They were in favor of the PCL-R Factor 1 (AUC .666, p&lt; .05) when focusing on general recidivism.The importance of gender specific violence risk assessment will be discussed.

Assessment of specific risks for the recurrence of deep vein thrombosis: a case report

IntroductionVenous thromboembolism is a multifactorial disease defined by multiple interactions between genetic and environmental components. It is managed by oral anticoagulation with warfarin sodium (Coumadin), a drug that targets the vitamin K epoxide reductase to prevent the recycling of vitamin K epoxide to the reduced form of vitamin K. The reduced form of vitamin K is an essential cofactor in the formation of active clotting factors II, VII, IX, X and regulatory factors protein C, and cofactor protein S through gamma-glutamyl carboxylation. The duration of Coumadin treatment, three to six months or life-long, should be based on the individual risk for recurrent deep vein thrombosis and on the associated increased risk for bleeding complications.Case PresentationA previously healthy 50-year-old white male developed a deep vein thrombosis consequent to surgical placement of a titanium rod to correct a fracture of the femur and he was maintained for over a year on daily oral doses of Coumadin 9 mg and aspirin 325 mg. When he began to bruise spontaneously with multiple large hematomas appearing without provocation, he requested that his primary care physician reconsider the anticoagulation. Because of his age, sex, and the possibility of an inherited or acquired anticoagulant protein deficiency he was maintained on Coumadin and a thrombophilia work up was ordered. Test results were interpreted as deficiencies in both protein C and protein S and he was instructed that life-long therapy with Coumadin was necessary. Is this a correct evaluation by his primary care physician?ConclusionThis case illustrates that Coumadin, a vitamin K agonist, was exerting a therapeutically acceptable negative influence on plasma activity levels of vitamin K-dependent protein C and protein S. Relying on the outcome of a thrombophilia work-up for a decision to maintain or cease Coumadin treatment of patients at risk for recurrent deep vein thrombosis has pitfalls that can be avoided. The use of real-time B-mode venous ultrasonography to verify complete restoration of venous flow before ceasing Coumadin treatment is not always considered in the long-term management of a patient with a first thrombosis, despite the well documented significant risk of deep vein thrombosis recurrence associated with an unresolved thrombosis.

Prévenir les troubles musculosquelettiques chez les soignants : connaître les expositions et étude des outils d’aide à la manutention

Summary Aim of the study The occupational hazard evaluation and prevention program aimed to propose specific hospital programs and risk assessment tools for the French University Hospitals networks. Studies regarding the prevention of musculoskeletal disorders (MSDs) were mostly based on the combined expertise in ergonomics, epidemiology and industrial medicine of the University Hospitals of Angers and Grenoble. Method An initial epidemiological study identified the main risk factors for upper-extremity MSDs and low back pain in the hospital healthcare workers. The second study focused on the ergonomic assessment of assistive equipments for patient handling. Results Hospital workers were exposed to 2.4 of the 19 documented risk factors (3.5 for the general population of the region), but did not suffer from more MSDs of the upper limbs than salaried workers of the Pays de la Loire region. However, exposure to manual handling of heavy loads during patient care was more frequent. The technical equipment available to assist in-patient handling were most often not adapted to the criteria of patient dependence and/or the work organisation of the health services. The patient–equipment relationships, the usability of the devices and the psychological point of view of the hospital workers must be taken into account for the prevention. Conclusion This pilot investigation involved biomechanical processes forming part of a multidisciplinary preventive approach integrated into institution policy.

Effects, uptake, and fate of 2,4,6‐trinitrotoluene aged in soil in plants and worms

The present study was aimed at providing data to be used at predicting exposure-based effects of 2,4,6-trinitrotoluene (TNT) aged in soil on endpoint organisms representing two trophic levels. These data can be used to define criteria or reference values for environmental management and conducting specific risk assessment. Long-term exposure tests were conducted to evaluate sublethal toxicity and uptake of aged soil-based explosives, with TNT as the main contaminant. In these tests, plants were exposed for 55 d, and biomass and explosives residues were determined. Worms were exposed for 28 and 42 d, and biomass, number, and tissue residues were determined. Biomass of Lolium perenne significantly decreased with soil-TNT concentration, and an effective concentration causing a 20% decrease in biomass (EC20) for TNT metabolites of 3.75 mg/kg was calculated. The concentrations of TNT metabolites in shoots and roots were significantly related to concentrations in soil, as were concentrations of hexahydro-1,3,5-trinitro-1,3,5 triazine (RDX) and octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX). The mean bioconcentration factors, indicating the potential of a chemical to accumulate in an organism, were 0.9 for TNT metabolites, 71.8 for RDX, and 12.2 for HMX in L. perenne shoots. Biomass of Eisenia fetida adults significantly decreased with soil-TNT concentration, and an EC20 for TNT of 3.70 mg/kg was calculated. The TNT, RDX, and HMX levels in E. fetida were below detection.