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• Human errors in Isotope Separation On-Line (ISOL) facility is performed. • Integrated approach of Hierarchical Task Analysis and Human Reliability Analysis is used. • A modified HEART approach is proposed. • HEART, SPAR-H, and CREAM are compared to each other. SPES (Selective Production of Exotic Species) is a second-generation Isotope Separation On-Line (ISOL) facility for advanced nuclear physics applications, currently under construction at INFN (National Institute of Nuclear Physics) of Legnaro, Italy. Despite the potentially important safety implications of human errors for ISOL facilities, only a limited number of studies addressing this issue have been performed worldwide. This paper tries to address this need by means of an integrated approach of Hierarchical Task Analysis (HTA) and three human error quantification methods: HEART (in an enhanced version), SPAR-H, and CREAM. The application of multiple Human Reliability Analysis (HRA) methods adds credibility to the analysis results and, for the present paper, this is required because the methods are applied to different performance conditions than typical, i.e. for operators in a nuclear power plant control room. The study emphasizes the potential range of task failure probabilities obtained in the analyses, rather than best-estimate values. Since the facility is being constructed, with elements such as the human-machine interface still undergoing design, some of the inputs typically required by HRA methods were not available; consequently, the produced HEP estimates may not fully represent future performance. The obtained results allowed informing some safety-enhancing recommendations that, coming at early stage, could be considered for implementation by the facility designers and managers. [ABSTRACT FROM AUTHOR]

• Evaluate the suitability of a site for nuclear installations. • A Meteorological Pressure Index (MPI) is developed to identify sites with resilience capacity in terms of atmospheric transport phenomena. • Natural wind actions on a regional scale is taken into account. • MPI is able to aggregate meteorological data on a regional level and create maps. Today, the evaluation of a site for innovative nuclear installations represents a fundamental step in supporting the implementation of a sustainable nuclear power program. One major concern is the potential for radioactive releases and their effects on the biosphere, particularly on human health. To address this issue, a new Meteorological Pressure Index (MPI) has been developed to identify sites with resilience capacity in terms of transport phenomena correlated to natural wind actions on a regional scale. The MPI utilizes a fuzzy approach that combines data on 3D wind speed, direction, and frequency, providing maps that are useful in the site selection process. The application of MPI in the Sicily region of Italy has allowed to identify bordering areas that that are more affected by efficient air mass transport mechanisms. Consistency analyses have been conducted among MPI maps, observed wind distributions using wind rose charts, and stagnation S and recirculation R factors. The results confirm the MPI's ability to aggregate meteorological data on a regional level, making it a suitable tool when compared to disaggregated data that may not always provide a comprehensive viewpoint. [ABSTRACT FROM AUTHOR]

Purpose: Tunneled indwelling central venous catheters (CVC) are essential in the management of children with cancer, hematological, nephrological disorders and for parenteral nutrition. The aim of this study is to present the experience of a single center of the transition from traditional open surgical cut down procedure (OSC) to ultrasound (US)-guided percutaneous CVC insertion, focusing on learning curve and related complications.Methods: All CVCs inserted between April 2008 and November 2009 in children at the Gaslini Children Hospital were revised, and data on methods of cannulation, intraoperative and device-related complications and re-intervention were recorded.Results: 194 CVCs were positioned in 188 patients. 128 out of 194 CVCs were positioned through an OSC technique, whereas the remaining 66 CVCs were inserted percutaneously with US guidance. Of the 27 recorded complications, 15 were mechanical events, 7 cases developed infection, whereas the remaining 5 (2.6%) were classified as intraoperative complications. A second surgical procedure was described in 23 (11.8%) cases.Conclusion: Shifting from OSC to US-guided percutaneous CVC insertion inevitably involves a challenging learning curve which is generally associated with high complication rates. Complications progressively decrease once a good experience in US guidance and percutaneous technique has been obtained. [ABSTRACT FROM AUTHOR]

Purpose: Mechanical complications in tunneled indwelling central venous catheters (CVCs) often involve a risk of displacement. Fixation procedures are, therefore, of primary importance. We prospectively evaluated the incidence of CVC-related mechanical and infectious complications observed in devices fixated with the Sri Paran technique.Methods: All CVCs inserted in children with cancer at our Institution from October 2005 to January 2007 were prospectively monitored for device-related mechanical and infectious complications. The Sri Paran fixation technique was used in all cases. The complication rate per 1,000 days was calculated as 1,000 times the number of complications divided by the total number of catheter days.Results: Ninety-five CVCs were positioned in 84 children. The overall length of observation ranged between 41 and 482 days for a total of 18,618 catheter days. Mechanical complications occurred in 5% of the devices (specific rate 0.27); infections were observed in 6% of the devices (specific rate 0.32). No complications were observed during the first 30 days after CVC insertion.Conclusions: The results, we obtained with the Sri Paran technique are extremely encouraging. Yet, randomized studies are required to prove these preliminary data. [ABSTRACT FROM AUTHOR]

Study design:Thirty-six patients with unsatisfactory treatment of neurogenic bowel dysfunctions (NBD) were enrolled from Spinal Units and Rehabilitation Centers in Italy. Treatment was for 3 weeks using a newly developed integrated system with an enema continence catheter for transanal irrigation (Peristeen, Coloplast A/S Kokkedal Denmark).Objectives:To evaluate the effects of Peristeen Anal Irrigation on NBD and patient quality of life (QoL).Setting:Italy.Methods:Lesion level, ambulatory status and hand functionality were determined in all patients. NBD symptoms and QoL were evaluated before and after treatment, using a specific questionnaire. Statistical analysis was performed using McNemar Test and Sign Test.Results:Thirty-six patients were enrolled, and 32 patients completed the study. At the end of the treatment, 28.6% of patients reduced or eliminated their use of pharmaceuticals. Twenty-four patients became less dependent on their caregiver. There was a significant increase in patients' opinion of their intestinal functionality (P=0.001), QoL score (P=0.001) and their answers regarding their degree of satisfaction (P=0.001). A successful outcome was recorded for 68% of patients with fecal incontinence, and for 63% of patients with constipation.Conclusion:Peristeen Anal Irrigation is a simple therapeutic method for managing NBD and improving QoL. It should be considered as the treatment of choice for NBD, playing a role in the neurogenic bowel analogous to that of intermittent clean catheterization in bladder treatment.Spinal Cord (2008) 46, 517–522; doi:10.1038/sj.sc.3102167; published online 4 March 2008 [ABSTRACT FROM AUTHOR]

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The aim of this article is to highlight the impact of mass ski tourism on the environment in the Dolomites (Italian Alps), where in winter the principal activities are snow sports. In implementing this development model the Dolomite region has achieved important results in terms of numbers of tourists and economic development for entire localities. Nonetheless, some weaknesses in this model have come to light in terms of environmental, economic, and social sustainability. The eTourism research group (University of Trento, Italy) has carried out two field projects with a view to understanding: 1) the importance of the variable "quality of environment" for the winter tourist when deciding on a destination, and similarly 2) how the major actors on the supply side approach local environmental issues. The results were used to formulate hypotheses regarding possible alternatives to the mass ski model of development for new or developing destinations within the region. [ABSTRACT FROM AUTHOR]

Background: Neuroblastoma in the adult is rare. No established therapeutic guidelines exist for these patients and the literature on this issue is scant and contradictory., Materials and Methods: Between 1986 and 2011, 21 adults (18 to 38 y; median, 23) diagnosed with neuroblastoma were referred to our hospital. Three of the 21 were classified as neuroblastoma, not otherwise specified, 13 as neuroblastoma, schwannian stroma-poor, and 5 as ganglioneuroblastoma, nodular. Nine patients had a resectable (stage 1/2) and 6 an unresectable primary tumor (stage 3); 6 had disseminated disease (stage 4)., Results: Of 9 stage 1/2 patients, 6 underwent surgery alone (2 survive, 4 died), 2 received adjuvant chemotherapy (both survive), and 1 received radiation therapy (alive). Four of the 6 stage 3 patients received chemotherapy and died, 1 underwent partial tumor resection only and died, and 1 received radiation therapy after partial tumor resection and is alive. The 6 stage 4 patients received chemotherapy with/without radiotherapy, and all died. Event-free survival at 10 years was 33.3% for stage 1/2, 16.7% for stage 3, and 0% for stage 4 patients. The 10-year overall and event-free survival rates were 39.8% and 19.1%, respectively., Conclusions: The outcome of neuroblastoma in adults is poorer than in younger patients at all stages. The clinical course seems modestly influenced by therapy.

Aim: Adrenocortical tumors are very rare in children. The distinction between adenoma and carcinoma is complex because of their clinical/histological characteristics. The analysis of the cases registered in two consecutive Italian Studies is described, in order to provide additional insight into their nature and possibly identify benign and malignant lesions., Materials and Methods: The analysis includes patients registered from?? 1.1982 to 6.2011 into two consecutive Italian protocols., Results: Fifty-eight children (age 2-210months) were evaluated. Endocrine manifestations were the most frequent symptoms. Stage distribution at diagnosis was: ST I 35, ST II 17, ST III 1, ST IV 5. Treatment consisted in mitotane for ST II, mitotane+chemotherapy for ST III/IV. Forty-four patients are alive without evidence of disease, 1 is alive with disease, 12 died of disease and 1 because of cardiomyopathy. The Wienecke score system was applied in 24 patients with good significance. A p53 mutation was found in 7 cases, and it was diagnostic for Li-Fraumeni syndrome in 2 benign tumors., Conclusions: The results highlight the importance of a complete excision to obtain the cure of patients. The efficacy of chemotherapy is controversial, however it was able to control the disease in 4 patients in ST II. The value of the Wienecke score system in predicting patients' outcome was confirmed. p53 mutation was more frequent in malignant tumors and represented the sentinel of the Li-Fraumeni syndrome., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Aim: Presenting features, treatment and outcome of 134 newborns with neuroblastoma diagnosed over a 27-year period are described., Methods: Analyses were performed on the entire cohort and on patients distributed over three periods of diagnosis., Results: Twenty-seven tumours (20.1%) were detected prenatally. Localised disease prevailed (65.7%) with an increase of stage 1 patients over time from 18.8% to 46.5%. Disseminated disease accounted for 34.3% of tumours with only one stage 4 and 45 stage 4S. Five-year overall survival (OS) of the entire cohort was 88.3%. Five/88 patients with localised disease died, including three who died of complications (OS, 95.3%). The only stage 4 patient survived. Eleven/45 stage 4S patients died, including 7/18 symptomatic and 4/27 asymptomatic (OS, 74.1%)., Conclusion: The outcome of neuroblastoma in newborns is excellent. In localised tumours, surgery-related deaths outnumbered deaths due to disease. Symptomatic stage 4S patients were at greater risk of dying.