Hirnschlagrisiko nach transient ischämischer Attacke (TIA)

Eine transiente ischämische Attacke (TIA) kann Vorbote eines drohenden Hirnschlags sein und sollte rasch abgeklärt werden. In einer Studie hat das BIHAM untersucht, ob das Risiko eines Hirnschlags nach TIA unter Haus- und Spitalärzten richtig eingeschätzt wird und wie bezüglich weiterer Abklärungen vorgegangen wird. Eine Studie von Hausärzten über Hausärzte – Was lief dabei gut, was weniger?

Risk Factors for Intracranial Haemorrhage in Accidents Associated with the Shower or Bathtub

BACKGROUND There has been little research on bathroom accidents. It is unknown whether the shower or bathtub are connected with special dangers in different age groups or whether there are specific risk factors for adverse outcomes. METHODS This cross-sectional analysis included all direct admissions to the Emergency Department at the Inselspital Bern, Switzerland from 1 January 2000 to 28 February 2014 after accidents associated with the bathtub or shower. Time, age, location, mechanism and diagnosis were assessed and special risk factors were examined. Patient groups with and without intracranial bleeding were compared with the Mann-Whitney U test.The association of risk factors with intracranial bleeding was investigated using univariate analysis with Fisher's exact test or logistic regression. The effects of different variables on cerebral bleeding were analysed by multivariate logistic regression. RESULTS Two hundred and eighty (280) patients with accidents associated with the bathtub or shower were included in our study. Two hundred and thirty-five (235) patients suffered direct trauma by hitting an object (83.9%) and traumatic brain injury (TBI) was detected in 28 patients (10%). Eight (8) of the 27 patients with mild traumatic brain injuries (GCS 13-15), (29.6%) exhibited intracranial haemorrhage. All patients with intracranial haemorrhage were older than 48 years and needed in-hospital treatment. Patients with intracranial haemorrhage were significantly older and had higher haemoglobin levels than the control group with TBI but without intracranial bleeding (p<0.05 for both).In univariate analysis, we found that intracranial haemorrhage in patients with TBI was associated with direct trauma in general and with age (both p<0.05), but not with the mechanism of the fall, its location (shower or bathtub) or the gender of the patient. Multivariate logistic regression analysis identified only age as a risk factor for cerebral bleeding (p<0.05; OR 1.09 (CI 1.01;1.171)). CONCLUSION In patients with ED admissions associated with the bathtub or shower direct trauma and age are risk factors for intracranial haemorrhage. Additional effort in prevention should be considered, especially in the elderly.

Bilateral Accidents with Intrinsically Interdependent Costs of Precaution

The standard economic model of bilateral precaution postulates an interdependency between the care taken by injurers and victims that operates through the effects of each on the expected accident loss. This paper considers situations in which each party's precaution affects not only expected accident loss, but also directly affects the other party's cost of taking precaution. Generalizing the economic model of tort law in this way allows for a more complete analysis of when standard tort rules can and cannot induce optimal precaution. When this additional externality is introduced into a model of unilateral harm (where all accident losses are borne by the victim), none of the standard tort liability rules induces socially optimal behavior by both parties. Moreover, under a contributory negligence rule, the only equilibrium is in mixed strategies; this gives rise to the possibility of litigation in equilibrium. A 'tort-like' liability rule that induces socially optimal behavior by both parties is then characterized; this involves a payment by victims to non-negligent injurers whenever an accident occurs. The model is then extended to consider the case of bilateral harm (where both parties suffer accident losses). It is shown that, as long as both parties can sue to recover their accident losses, all negligence-based tort rules lead to socially optimal behavior by both parties.

Long-term hyperexcitability of sensory and motor axons in Aplysia californica: Induction by axotomy, serotonin, and transient depolarization

Neuropathic pain is a debilitating neurological disorder that may appear after peripheral nerve trauma and is characterized by persistent, intractable pain. The well-studied phenomenon of long-term hyperexcitability (LTH), in which sensory somata become hyperexcitable following peripheral nerve injury may be important for both chronic pain and long-lasting memory formation, since similar cellular alterations take place after both injury and learning. Though axons have previously been considered simple conducting cables, spontaneous afferent signals develop from some neuromas that form at severed nerve tips, indicating intrinsic changes in sensory axonal excitability may contribute to this intractable pain. Here we show that nerve transection, exposure to serotonin, and transient depolarization induce long-lasting sensory axonal hyperexcitability that is localized to the treated nerve segment and requires local translation of new proteins. Long-lasting functional plasticity may be a general property of axons, since both injured and transiently depolarized motor axons display LTH as well. Axonal hyperexcitability may represent an adaptive mechanism to overcome conduction failure after peripheral injury, but also displays key features shared with cellular analogues of memory including: site-specific changes in neuronal function, dependence on transient, focal depolarization for induction, and requirement for synthesis of new proteins for expression of long-lasting effects. The finding of axonal hyperexcitability after nerve injury sheds new light on the clinical problem of chronic neuropathic pain, and provides more support for the hypothesis that mechanisms of long-term memory storage evolved from primitive adaptive responses to injury. ^

Dietrich de Freiberg, Oeuvres choisies, vol. I : Substances, quidités et accidents, textes latins traduits et annotés par Catherine König-Pralong, avec la collaboration de Ruedi Imbach, Introduction de Kurt Flasch, Paris, Vrin, 2008 (Bibliothèque des textes philosophiques), 222 p. ; ISBN 978-2-71116-1983-2

Fil: Ocampo, Fernanda.

Transient Holocene experiments under orbital forcing using the comprehensive global climate model CCSM3 (Community Climate System Model 3)

The Southern Hemisphere Westerly Winds (SWW) have been suggested to exert a critical influence on global climate through wind-driven upwelling of deep water in the Southern Ocean and the potentially resulting atmospheric CO2 variations. The investigation of the temporal and spatial evolution of the SWW along with forcings and feedbacks remains a significant challenge in climate research. In this study, the evolution of the SWW under orbital forcing from the early Holocene (9 kyr BP) to pre-industrial modern times is examined with transient experiments using the comprehensive coupled global climate model CCSM3. Analyses of the model results suggest that the annual and seasonal mean SWW were subject to an overall strengthening and poleward shifting trend during the course of the early-to-late Holocene under the influence of orbital forcing, except for the austral spring season, where the SWW exhibited an opposite trend of shifting towards the equator.

Non-linear gain - look-up table based approach for modeling a family of DC to DC converters based on transient response analysis

The purpose of this work is to propose a structure for simulating power systems using behavioral models of nonlinear DC to DC converters implemented through a look-up table of gains. This structure is specially designed for converters whose output impedance depends on the load current level, e.g. quasi-resonant converters. The proposed model is a generic one whose parameters can be obtained by direct measuring the transient response at different operating points. It also includes optional functionalities for modeling converters with current limitation and current sharing in paralleling characteristics. The pusposed structured also allows including aditional characteristics of the DC to DC converter as the efficency as a function of the input voltage and the output current or overvoltage and undervoltage protections. In addition, this proposed model is valid for overdamped and underdamped situations.

Stability and Transient Performance Assessment in a COTS-Module-Based Distributed DC/DC System

This paper introduces a method to analyze and predict stability and transient performance of a distributed system where COTS (Commercial-off-the-shelf) modules share an input filter. The presented procedure is based on the measured data from the input and output terminals of the power modules. The required information for the analysis is obtained by performing frequency response measurements for each converter. This attained data is utilized to compute special transfer functions, which partly determine the source and load interactions within the converters. The system level dynamic description is constructed based on the measured and computed transfer functions introducing cross-coupling mechanisms within the system. System stability can be studied based on the well-known impedance- related minor-loop gain at an arbitrary interface within the system.

Análisis Integrado de Seguridad de un accidente de SGTR en un reactor nuclear tipo PWR

El accidente de rotura de tubos de un generador de vapor (Steam Generator Tube Rupture, SGTR) en los reactores de agua a presión es uno de los transitorios más exigentes desde el punto de vista de operación. Los transitorios de SGTR son especiales, ya que podría dar lugar a emisiones radiológicas al exterior sin necesidad de daño en el núcleo previo o sin que falle la contención, ya que los SG pueden constituir una vía directa desde el reactor al medio ambiente en este transitorio. En los análisis de seguridad, el SGTR se analiza desde un punto determinista y probabilista, con distintos enfoques con respecto a las acciones del operador y las consecuencias analizadas. Cuando comenzaron los Análisis Deterministas de Seguridad (DSA), la forma de analizar el SGTR fue sin dar crédito a la acción del operador durante los primeros 30 min del transitorio, lo que suponía que el grupo de operación era capaz de detener la fuga por el tubo roto dentro de ese tiempo. Sin embargo, los diferentes casos reales de accidentes de SGTR sucedidos en los EE.UU. y alrededor del mundo demostraron que los operadores pueden emplear más de 30 minutos para detener la fuga en la vida real. Algunas metodologías fueron desarrolladas en los EEUU y en Europa para abordar esa cuestión. En el Análisis Probabilista de Seguridad (PSA), las acciones del operador se tienen en cuenta para diseñar los cabeceros en el árbol de sucesos. Los tiempos disponibles se utilizan para establecer los criterios de éxito para dichos cabeceros. Sin embargo, en una secuencia dinámica como el SGTR, las acciones de un operador son muy dependientes del tiempo disponible por las acciones humanas anteriores. Además, algunas de las secuencias de SGTR puede conducir a la liberación de actividad radiológica al exterior sin daño previo en el núcleo y que no se tienen en cuenta en el APS, ya que desde el punto de vista de la integridad de núcleo son de éxito. Para ello, para analizar todos estos factores, la forma adecuada de analizar este tipo de secuencias pueden ser a través de una metodología que contemple Árboles de Sucesos Dinámicos (Dynamic Event Trees, DET). En esta Tesis Doctoral se compara el impacto en la evolución temporal y la dosis al exterior de la hipótesis más relevantes encontradas en los Análisis Deterministas a nivel mundial. La comparación se realiza con un modelo PWR Westinghouse de tres lazos (CN Almaraz) con el código termohidráulico TRACE, con hipótesis de estimación óptima, pero con hipótesis deterministas como criterio de fallo único o pérdida de energía eléctrica exterior. Las dosis al exterior se calculan con RADTRAD, ya que es uno de los códigos utilizados normalmente para los cálculos de dosis del SGTR. El comportamiento del reactor y las dosis al exterior son muy diversas, según las diferentes hipótesis en cada metodología. Por otra parte, los resultados están bastante lejos de los límites de regulación, pese a los conservadurismos introducidos. En el siguiente paso de la Tesis Doctoral, se ha realizado un análisis de seguridad integrado del SGTR según la metodología ISA, desarrollada por el Consejo de Seguridad Nuclear español (CSN). Para ello, se ha realizado un análisis termo-hidráulico con un modelo de PWR Westinghouse de 3 lazos con el código MAAP. La metodología ISA permite la obtención del árbol de eventos dinámico del SGTR, teniendo en cuenta las incertidumbres en los tiempos de actuación del operador. Las simulaciones se realizaron con SCAIS (sistema de simulación de códigos para la evaluación de la seguridad integrada), que incluye un acoplamiento dinámico con MAAP. Las dosis al exterior se calcularon también con RADTRAD. En los resultados, se han tenido en cuenta, por primera vez en la literatura, las consecuencias de las secuencias en términos no sólo de daños en el núcleo sino de dosis al exterior. Esta tesis doctoral demuestra la necesidad de analizar todas las consecuencias que contribuyen al riesgo en un accidente como el SGTR. Para ello se ha hecho uso de una metodología integrada como ISA-CSN. Con este enfoque, la visión del DSA del SGTR (consecuencias radiológicas) se une con la visión del PSA del SGTR (consecuencias de daño al núcleo) para evaluar el riesgo total del accidente. Abstract Steam Generator Tube Rupture accidents in Pressurized Water Reactors are known to be one of the most demanding transients for the operating crew. SGTR are special transient as they could lead to radiological releases without core damage or containment failure, as they can constitute a direct path to the environment. The SGTR is analyzed from a Deterministic and Probabilistic point of view in the Safety Analysis, although the assumptions of the different approaches regarding the operator actions are quite different. In the beginning of Deterministic Safety Analysis, the way of analyzing the SGTR was not crediting the operator action for the first 30 min of the transient, assuming that the operating crew was able to stop the primary to secondary leakage within that time. However, the different real SGTR accident cases happened in the USA and over the world demonstrated that operators can took more than 30 min to stop the leakage in actual sequences. Some methodologies were raised in the USA and in Europe to cover that issue. In the Probabilistic Safety Analysis, the operator actions are taken into account to set the headers in the event tree. The available times are used to establish the success criteria for the headers. However, in such a dynamic sequence as SGTR, the operator actions are very dependent on the time available left by the other human actions. Moreover, some of the SGTR sequences can lead to offsite doses without previous core damage and they are not taken into account in PSA as from the point of view of core integrity are successful. Therefore, to analyze all this factors, the appropriate way of analyzing that kind of sequences could be through a Dynamic Event Tree methodology. This Thesis compares the impact on transient evolution and the offsite dose of the most relevant hypothesis of the different SGTR analysis included in the Deterministic Safety Analysis. The comparison is done with a PWR Westinghouse three loop model in TRACE code (Almaraz NPP), with best estimate assumptions but including deterministic hypothesis such as single failure criteria or loss of offsite power. The offsite doses are calculated with RADTRAD code, as it is one of the codes normally used for SGTR offsite dose calculations. The behaviour of the reactor and the offsite doses are quite diverse depending on the different assumptions made in each methodology. On the other hand, although the high conservatism, such as the single failure criteria, the results are quite far from the regulatory limits. In the next stage of the Thesis, the Integrated Safety Assessment (ISA) methodology, developed by the Spanish Nuclear Safety Council (CSN), has been applied to a thermohydraulical analysis of a Westinghouse 3-loop PWR plant with the MAAP code. The ISA methodology allows obtaining the SGTR Dynamic Event Tree taking into account the uncertainties on the operator actuation times. Simulations are performed with SCAIS (Simulation Code system for Integrated Safety Assessment), which includes a dynamic coupling with MAAP thermal hydraulic code. The offsite doses are calculated also with RADTRAD. The results shows the consequences of the sequences in terms not only of core damage but of offsite doses. This Thesis shows the need of analyzing all the consequences in an accident such as SGTR. For that, an it has been used an integral methodology like ISA-CSN. With this approach, the DSA vision of the SGTR (radiological consequences) is joined with the PSA vision of the SGTR (core damage consequences) to measure the total risk of the accident.

Transient heat conduction problems using B.I.E.M

A method, using boundary elements, is presented as a solution to plane transient heat conduction. The proposed method considers the governing equation to be a Helmholtz's equation and solves the problem of time variation using step by step integration. A numerical procedure is developed and its effectiveness verified. Several examples are provided and their results compared with the theoretical ones.

The interurban DRAG-Spain model: the main factors of influence on road accidents in Spain

This paper presents the results of applying DRAG methodology to the identification of the main factors of influence on the number of injury and fatal accidents occurring on Spain’s interurban network. Nineteen independent variables have been included in the model grouped together under ten categories: exposure, infrastructure, weather, drivers, economic variables, vehicle stock, surveillance, speed and legislative measures. Highly interesting conclusions can be reached from the results on the basis of the different effects of a single variable on each of the accident types according to severity. The greatest influence revealed by the results is exposure, which together with inexperienced drivers, speed and an ageing vehicle stock, have a negative effect, while the increased surveillance on roads, the improvement in the technological features of vehicles and the proportion of high capacity networks have a positive effect, since the results obtained show a significant drop in accidents.