Activities in Divertor Reflector and Linear Plates Using WCLL and HCPB Breeding Blanket Concepts

In fusion devices, such as European Demonstration Fusion Power Reactor (EU DEMO), primary neutrons can cause material activation due to the interaction between the source particles and the targeting material. Subsequently, the reactor’s inner components become activated. For safety and safe performance purposes, it is necessary to evaluate neutron-induced activities. Activities results from divertor reflector and liner plates are presented in this work. The purpose of liner shielding plates is to protect the vacuum vessel and magnet coils from neutrons. As for reflector plates, the function is to shield the cooling components under plasma-facing components from alpha particles, thermal effects, and impurities. Plates are made of Eurofer with a 3 mm layer of tungsten, while the water is used for cooling purposes. The calculations were performed using two EU DEMO MCNP (Monte Carlo N-Particles) models with different breeding blanket configurations: helium-cooled pebble bed (HCPB) and water-cooled lithium lead (WCLL). The TENDL–2017 nuclear data library has been used for activation reactions cross-sections and nuclear reactions. Activation calculations were performed using the FISPACT-II code at the end of irradiation for cooling times of 0 s–1000 years. Radionuclide analysis of divertor liner and reflector plates is also presented in this paper. The main radionuclides, with at least 1% contribution to the total value of activation characteristics, were identified for the previously mentioned cooling times.

Building Resilience in Temporary Organizations: Lessons from a Shipyard

This chapter discusses the organizational and occupational dimensions of resilience in temporary organizing contexts and how these contribute to sustained reliable performance. When dealing with issues related to high levels of safety in complex settings, longstanding organizations with strong organizational routines are often described as the most appropriate forms of organizing. However, temporary forms of organizing are developing and little is known on how actors engaged in such contexts can enhance and sustain resilience when facing uncertainty in safety-critical contexts. This chapter addresses this gap in the literature by demonstrating that temporary organizations, such as project-based ones, can also deal with major safety issues, and that temporary forms of organizing can help complex projects to be efficiently and safely carried out. We examine this proposition by studying the case of an inter-organizational and safety-critical project: the construction by a shipyard of a series of ships. Looking at the meso-level, i.e. the occupational groups involved in the project, we show how temporary forms of organizing and occupational groups together contribute to the resilience of the whole project. We highlight that the ability of the project to coordinate temporary organizing forms is key in achieving (safe) performance.

The Effect of Educational Intervention on the Improvement of Nontechnical Skills in Circulating Nurses

Background. Nontechnical skills are necessary for clinicians’ safe performance and prevention of errors in the operating room. Educational intervention is a useful way to improve these skills, which are a vital area for improvement. Circulating nurses are surgical team members whose work depends heavily on using nontechnical skills. This study is aimed at assessing the effect of an educational intervention on the improvement of circulating nurses’ nontechnical skills. Methods. This semiexperimental study was conducted on 300 circulating nurses divided into the intervention and no intervention groups each containing 150 participants. The nontechnical skills were assessed using the circulating practitioners’ list of nontechnical skills. Then, the intervention group received training regarding these skills, and the two groups were evaluated again. After all, the data were entered into the SPSS 24 software and were analyzed using descriptive statistics and Wilcoxon and Mann–Whitney tests. Furthermore, Kendall’s tau, independent sample t -test, and one-way ANOVA were used for assessment of relationship between median scores and demographics. Results. The results revealed a significant improvement in the scores of all domains of nontechnical skills in the intervention group ( p < 0.05 ). The highest and lowest improvements were observed in teamwork (42%) and situational awareness (16.7%), respectively. After the intervention, the scores of some of the behaviors were still below the average level or were not improved significantly. Conclusions. Circulating nurses’ nontechnical skills can be improved by educational interventions. However, regarding the low scores or no improvements in the scores of some behaviors, other intervention types such as policymaking and correcting the existing hierarchies in the operating room can be useful to complete the educational interventions.

Anatomical Challenges during Pancreaticoduodenectomy for Adenocarcinoma Head of Pancreas in Presence of Intestinal Rotation Abnormalities: A Report of Two Cases

Purpose Pancreaticoduodenenctomy is a complex surgery and the sequence of steps is affected by anatomical variations involving small intestine and major vascular structures. This article depicts our approach to two such cases and highlights the importance of identifying these variations preoperatively on imaging, so as to modify the surgery plan accordingly. Cases We report following two cases of pancreatic head adenocarcinoma (1) one with incomplete intestinal rotation with a replaced right hepatic artery and (2) one with intestinal nonrotation. In both cases, the small bowel was aggregated on the right side of the abdomen, making duodenal mobilization challenging. The surgical approach was modified to prevent injury to these vessels. A superior mesenteric artery (SMA)-first approach helped in early isolation of vascular structures especially when vascular anomaly was also present. Interbowel adhesiolysis, limited kocherisation, tracing all vessels to its origin before division, paracolic anastomotic limb after a longer jejunal limb resection in nonrotation cases, and modification in retropancreatic tunnel creation are few of the key surgical adaptations. Conclusion Asymptomatic Intestinal malrotation is rare in adults and must be identified on preoperative imaging. Resultant intestinal and vascular anatomical variations need meticulous surgical planning and modification of conventional surgical approach for safe performance of PD.

Achieving Organisational Alignment, Safety and Sustainable Performance in Organisations

When looking at socio-technical systems from a systems thinking and systemic perspective, it becomes clear that mental models govern the behaviours and determine the achievements of socio-technical systems. This is also the case for individuals, being systems themselves and, as such, being elements of those socio-technical systems. Individual behaviours result from individual perceptions (mental models). These individual behaviours ideally generate the desired outcomes of a system (team/organisation/society) and create value. However, at the same time, mental models and the associated individual behaviour also bring about unwanted consequences, destroying or diminishing value. Therefore, to achieve safety and to attain sustainable safe performance, understanding and managing mental models in organisations is of paramount importance. Consequently, in organisations and society, one needs to generate the required mental models that create successes and, at the same time, to avoid or eliminate damaging perceptions and ideas in order to protect the created value. Generating and managing mental models involves leadership; leadership skills; and the ability to develop a shared vision, mission and ambition, as this helps determine what is valuable and allows for aligning individual mental models with those that preferably govern the system. In doing so, it is possible to create well-aligned corporate cultures that create and protect value and that generate sustainable safe performance. To achieve this aim, a systemic organisational culture alignment model is proposed. The model is based on the model of logical levels of awareness according to Dilts (1990), Argyris’s ladder of inference (1982) and the organisational alignment model proposed by Tosti (1996). Furthermore, ISO 31000 (2009, 2018) and its guidance are proposed as a practical tool to accomplish this alignment and sustainable safe performance in organisations. Altogether, these elements define Total Respect Management as a concept, mental model and methodology.

Digital Planning on Guided Endodontics Technology

The aim of this review is to discuss the digital planning and the use of guided technology in Endodontics. The complexity of the root canals anatomy and the challenges in the microorganism’s control represent risk factors for failure after the infected root canal’s treatment. Scientific improvements associated with technological advances have enabled better predictability of therapeutic procedures results. The development of efficient and modern devices provided safer root canal treatments, with shorter clinical visits and greater patient comfort. Digital endodontics incorporated different tools and developed its own, advancing even further in resolving complex cases. The faithful copy of the internal anatomy provided by the advancement of CBCT devices and software’s, associated with the digital resources of 3D planning and printing, enabled the advent of guided endodontics. This technique is used at different stages of endodontic treatment, with specific indications and greater result predictability. Therefore, this study critically reviewed the potential clinical application of this guided access technique, and the operative steps for its safe performance in managing complex endodontic cases. The main indications are accessing calcified root canals, performing endodontic surgeries in difficult access areas, removing fiberglass posts, and accessing teeth with developmental anomalies. In summary, guided endodontics has been a precise strategy, effective, safe, and clinically applicable. This procedure represents incorporating technological resources and digital planning in the Endodontist clinical practice, increasing predictability to complex cases.

Covid and Regional Anaesthesia

Currently we are at the peak of the second wave of pandemic. Availability of beds & oxygen is at nadir. The patients coming to us for surgery are the ones where surgery cannot wait. Mainly the load is obstetric. As a matter of COVID pandemic policy we are using regional anaesthesia unless contraindicated or the surgery demands general anaesthesia. The aim is to avoid/reduce aerosolization which is part & parcel of GA, despite the efforts to minimise it. The policy is to protect the anaesthesiologists, surgeons, OT staff & other patients as well. The present manuscript is to review the role of regional anaesthesia & its safe performance.

Magnets and self-retractable wire for endoscopic septotomies: From concept to first-in-human use.

Background and study aims: A medical device that allows simple and safe performance of an endoscopic septotomy could have several applications in the gastrointestinal (GI) tract. We developed such a device by combining two magnets and a self-retractable wire to perform a progressive septotomy by compression of the tissues. We describe here the concept, preclinical studies, and first clinical use of the device in symptomatic epiphrenic esophageal diverticulum (EED). Materials and methods: The MAGUS was designed based on previous knowledge of compression anastomosis and current unmet needs. After initial design, the feasibility of the technique was tested on artificial septa in pigs. A clinical trial was then initiated to assess the feasibility and safety of the technique. Results: Animal studies showed that the MAGUS can perform a complete septotomy at various levels of the GI tract. In two patients with symptomatic EED, uneventful complete septotomy was observed within 28 and 39 days after the endoscopic procedure. Conclusions: This new system provides a way to perform endoluminal septotomy in a single procedure. It appears to be effective and safe for managing symptomatic EED. Further clinical applications where this type of remodeling of the GI tract could be beneficial are under investigation.

Personnel safe work training using the methods of pedagogical testing at the enterprises

The paper considers the dependence of the prevention of erroneous actions of the companys personnel at work on the degree of training. A scheme of safe human actions when a problem situation occurs has been designed, it is used to develop a technology for training safe actions. This scheme allowed creating comprehensive teaching techniques using a simulator based on concept-oriented pedagogical tests and instructions on safe performance of work with the help of standard-oriented pedagogical tests. A mini-alternative methodology is proposed for the development of skills and abilities to ensure safe work. To assess the effectiveness of this training method, an efficiency criterion is proposed. The authors present a concept of training for safe operations, taking into account the risks, and defining the employees responsibilities in case of emergences. The developed organizational structure of the instructions on safe operations with the use of computer technology includes the blocks that characterize the test activity, the reference base, extra materials and tests. The system of safe operation training has been tested at a number of enterprises in the Samara region and received a positive assessment from specialists.