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This paper presents the results of the development and implementation of a company-wide risk register, based on a clear set of data structures. A case study from an electricity generation company is presented and the process followed is described. The results of the case study indicated areas where the concept of risk registers could be extended to make better use of existing data and to support continuous improvement of risk management. Six key areas are discussed (1) aggregation of risks across the business, (2) supporting controls over mitigation measures, (3) improved estimation of event likelihood, (4) integrating with critical asset registers, (5) improving risk communication, and (6) linking with day-to-day operational practice. The paper concludes with a framework for placing risk registers at the heart of Process Safety.

With constant pressure to reduce maintenance costs as well as short-term budget constraints in a changing market environment, asset managers are compelled to continue operating aging assets while deferring maintenance and investment. The scope of the paper is to get an overview of the methods used to evaluate risks and opportunities for deferred maintenance interventions on aging equipment, and underline the importance to include monetised risk considerations and timeline considerations, to evaluate different scenarios connected with the possible options. Monetised risk values offer the opportunity to support risk-based decision-making using the data collected from the field. The paper presents examples of two different methods and their practical applicability in two case studies in the energy sector for a company managing power stations. The use of the existing and the new proposed solutions are discussed on the basis of their applicability to the concrete examples.

This paper presents the needs and the challenges encountered in developing a company-wide risk register in the energy sector. The study presented comes from an electricity generation company and it was useful to indicate areas where the concept of risk registers could be extended to make better use of existing data and to support continuous improvement of risk management. Six key areas are discussed 1) aggregation of risks across the business, 2) supporting controls over mitigation measures, 3) improved estimation of event likelihood, 4) integrating with critical asset registers, 5) improving risk communication, and 6) linking with day-to-day operational practice. The paper concludes with a framework for placing risk registers at the heart of Process Safety.

In order to assess the feasibility and outcome of using prehospital thrombolysis in acute myocardial infarction in a rural community, we performed an open randomized study of patients with symptoms of acute myocardial infarction of less than 6 hours. One hundred and forty-five patients with acute myocardial infarction were allocated to receive IV streptokinase prehospital by means of a mobile coronary care unit (MCCU) (n = 43) or to receive IV streptokinase in hospital (n = 102). The mean delay time to treatment was 138 minutes (MCCU group) and 172 minutes (hospital group) (p less than 0.02). Reperfusion time was 88 minutes for the MCCU group and 92 minutes for the hospital group. Mortality at 14 days was 2.3% for the MCCU group and 11.7% for the hospital group (p less than 0.05). Six month mortality was 4.9% for the MCCU group and 17.3% for the hospital group (p = 0.03). Mortality at 1 year was 6.1% for the MCCU group and 20.0% for the hospital group (p = 0.04). There were no significant adverse events in either treatment group. Thus, prehospital thrombolysis by streptokinase is feasible and allows significant reduction in the delay time to treatment initiation. There are encouraging improvements in both short- and long-term survival with no apparent reduction in safety profile.

There is considerable variation in use of pain relief for managing pain or discomfort of femoral sheath removal. Efficacy of pain relief to promote comfort during this procedure or to reduce the incidence of vascular and procedural complications has not been established.Assess efficacy of pain relief used to manage pain of femoral sheath removal in adults after interventional cardiology.Determine if pain relief influences rate of complications associated with this procedure.Databases searched in August 2007: Cochrane Pain, Palliative and Supportive Care Group Trials Register, Cochrane Heart Group Trials Register, Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, PubMed, Australia's Australasian Medical Index, National Research Centre, Web of Knowledge and Digital Dissertations.Randomised studies comparing opioid, local anaesthetic, anxiolytic, no treatment or placebo administered for alleviation of pain or discomfort of the femoral sheath removal procedure, were sought.Two review authors assessed trial quality and extracted data. Weighted mean differences (WMD) were calculated where meta-analysis of pain score data was feasible. Adverse effects information was collected.Four trials involving 971 participants were included. All results were reported using a zero to ten pain scale. Three trials (four treatment arms) involving 498 participants compared subcutaneous lignocaine with control; with no significant difference between pain scores; WMD 0.12 (95% CI -0.46 to 0.69). Two trials (three treatment arms) involving 399 participants compared intravenous pain regimens with control. A significant reduction in pain score with an intravenous pain regimen (opioid and anxiolytic) was observed when compared with placebo; WMD -0.90 (95% CI -1.54 to -0.27). One study involving 60 participants compared levobupivacaine with placebo. Longer-acting local anaesthetic significantly lowered pain score by -1.10 (95% CI -1.26 to -0.94). Data is insufficient to identify any influence of pain regimens on incidence of vascular and procedural complications. No trials reported appropriate blinding for treatment arms. The largest trial, comprising 661 participants was unblinded with a quality score of two out of five.Intravenous pain regimens and levobupivacaine may have greater efficacy when compared to control for the management of pain related to femoral sheath removal. However, a definitive study is still required because the clinical difference is small. There is no evidence to support the use of subcutaneous lignocaine for the relief of femoral sheath removal related pain. There is insufficient evidence to determine if pain relief influences the rate of complications.

Pain relief for removal of femoral sheath after cardiac procedures Procedures for the non-surgical management of coronary heart disease include balloon angioplasty and intracoronary stenting. At the start of each procedure an introducer sheath is inserted through the skin (percutaneously) into an artery, frequently a femoral artery in the groin. This allows the different catheters used for the procedure to be exchanged easily without causing trauma to the skin. At the end of the procedure the sheath is removed and, if the puncture site isn't "sealed" using a device closure, firm pressure is required over the site for 30 minutes or more to control any bleeding and reduce vascular complications. Removing the sheath and the firm pressure required to control bleeding can cause pain, although this is generally mild. Some centres routinely give pain relief before removal such as intravenous morphine, or an injection of a local anaesthetic in the soft tissue around the sheath (called a subcutaneous injection). Adequate pain control during sheath removal is also associated with a reduced incidence of a vasovagal reaction, a potentially serious complication involving a sudden drop of blood pressure and a slowed heart rate. Four studies were reviewed in total. Three trials involving 498 participants compared subcutaneous lignocaine, a short acting local anaesthetic, with a control group (participants received either no pain relief or an inactive substance known as a placebo). Two trials involving 399 people compared intravenous opioids (fentanyl or morphine) and an anxiolytic (midazolam) with a control group. One trial involving 60 people compared subcutaneous levobupivacaine, a long acting local anaesthetic, with a control group. Intravenous pain regimens and subcutaneous levobupivacaine appear to reduce the pain experienced during femoral sheath removal. However, the size of the reduction was small. A significant reduction in pain was not experienced by participants who received subcutaneous lignocaine or who were in the control group. There was insufficient data to determine a correlation between pain relief administration and either adverse events or complications. Some patients may benefit from routine pain relief using levobupivacaine or intravenous pain regimens. Identifying who may potentially benefit from pain relief requires clinical judgement and consideration of patient preference. The mild level of pain generally experienced during this procedure should not influence the decision as some people can experience moderate levels of pain.

Thrombolytic therapy improves mortality in acute myocardial infarction especially in those who receive treatment early. Pre-hospital therapy can reduce the time to treatment.Open, randomized study of patients with acute myocardial infarction of less than six hours duration in a rural community. Pre-hospital thrombolysis was administered using a mobile coronary care unit (MCCU) and all patients received IV streptokinase.Two-hundred and forty-eight patients were studied, 82 in the MCCU and 166 in the hospital group. The mean delay time to treatment was 136 minutes (MCCU group) and 196 minutes (hospital group) (p0.001). Reperfusion time was 116 minutes for the MCCU group and 118 minutes for the hospital group. Mortality at 30 days was 4.9% for the MCCU group and 15.7% for the hospital group (p = 0.014). Mortality at one year was 9.8% for the MCCU group and 23.5% for the hospital group (p = 0.009). Mortality for patients followed up to five years was 17.7% for the MCCU group and 35.2% for the hospital group (p = 0.005). There were no significant adverse events in either treatment group.Pre-hospital thrombolysis by MCCU is feasible and allows significant reduction in the delay time to treatment initiation. There are encouraging improvements in short- and long-term survival with no apparent reduction in safety profile.

The CEBAF Large Acceptance Spectrometer at the Thomas Jefferson National Laboratory was used to study the reaction e + p {yields} e{prime} + K{sup +} + {Lambda}(1116) for events where {Lambda}(1116) subsequently decayed via the channel {Lambda}(1116) {yields} p + {pi}{sup -}. Data were taken at incident electron beam energies of 2.5, 4.0, and 4.2 GeV during the 1999 E1C run period. They hyperon production spectra span the Q{sup 2} range from 0.5 to 2.8 GeV{sup 2} and nearly the entire range in the center of mass angles. The proton angular distribution in the {Lambda}(1116) rest frame is used to deduce the recoil polarization of the hyperon, and the W and cos {theta}{sub cm}{sup K+} dependence of the recoil polarization will be presented. The data show sizeable negative polarizations for the {Lambda}(1116) as a function of both cos {theta}{sub cm}{sup K+} and W.

The extracellular globular domain of the mumps virus fusion (F) protein (amino-acids 28-481) has been overexpressed from GS115 his4 Pichia pastoris cells following the generation of a recombinant clone. The heterologous protein was directed for secreted expression by in-frame cloning with the S. cerevisiae alpha-factor secretion signal. The expressed protein was observed to secrete into the culture medium. An expressing clone was obtained initially by small-scale induction, metabolic labeling and immunoprecipitation. Expression analysis of the chosen clone was confirmed by western blotting with F protein specific polyclonal serum. The effects of culture volume, temperature and methanol concentration on the levels of expression, were studied. The results indicate that there is a balance required between the induction temperature and methanol concentration to achieve maximal expression. In addition, the presence of designated monomeric (47 K), dimeric (85-90 K) and trimeric (140 K) forms are dependent upon the induction conditions. Estimated secreted protein expression levels of1 mg/L were obtained in these studies. Further, the experiments demonstrate that the complete reconstruction of the KEX2 protease cleavage site is not necessary to facilitate secretion.

Hurricane Carol in August 1954 caused damages of $300,000,000 and the loss of 60 lives in New England, and triggered authorization of a hurricane survey of the Atlantic and Gulf Coasts. This paper describes some of the basic data and engineering methods used in the relatively new field of hurricane protection planning in the New England area, and especially for New Bedford and Narragansett Bay.

This paper presents the results of studies of average rainfall and runoff, developed in the Office of the Division Engineer, New England Division, United States Corps of Engineers, in cooperation with the District Engineer, United States Geological Survey, and prepared in connection with flood-control studies of the Connecticut and Merrimack River basins.

Hurricane flooding has emerged as one of the major coastal engineering problems of the Atlantic and Gulf Coast areas of the United States. Engineering and scientific investigations have been made to determine the fundamental mechanics of the hurricane surges that cause inunda tion of coastal areas and to develop practical and economical protection. Mathematical models and large hydraulic models were used for the Narragansett Bay studies of two major projects. The discussions presented herein are limited to the hydraulic studies of barriers at the mouth of the bay, known as the Lower Bay Barri Plan, and a brief description of this plan and the Fox Point Hurricane Barrier which is now under construction.