Measuring Resilience.

OBJECTIVE: As human factors and ergonomics (HF/E) moves to embrace a greater systems perspective concerning human-machine technologies, new and emergent properties, such as resilience, have arisen. Our objective here is to promote discussion as to how to measure this latter, complex phenomenon. BACKGROUND: Resilience is now a much-referenced goal for technology and work system design. It subsumes the new movement of resilience engineering. As part of a broader systems approach to HF/E, this concept requires both a definitive specification and an associated measurement methodology. Such an effort epitomizes our present work. METHOD: Using rational analytic and synthetic methods, we offer an approach to the measurement of resilience capacity. RESULTS: We explicate how our proposed approach can be employed to compare resilience across multiple systems and domains, and emphasize avenues for its future development and validation. CONCLUSION: Emerging concerns for the promise and potential of resilience and associated concepts, such as adaptability, are highlighted. Arguments skeptical of these emerging dimensions must be met with quantitative answers; we advance one approach here. APPLICATION: Robust and validated measures of resilience will enable coherent and rational discussions of complex emergent properties in macrocognitive system science.

Nuclear disasters and health: lessons learned, challenges, and proposals.

Past nuclear disasters, such as the atomic bombings in 1945 and major accidents at nuclear power plants, have highlighted similarities in potential public health effects of radiation in both circumstances, including health issues unrelated to radiation exposure. Although the rarity of nuclear disasters limits opportunities to undertake rigorous research of evidence-based interventions and strategies, identification of lessons learned and development of an effective plan to protect the public, minimise negative effects, and protect emergency workers from exposure to high-dose radiation is important. Additionally, research is needed to help decision makers to avoid premature deaths among patients already in hospitals and other vulnerable groups during evacuation. Since nuclear disasters can affect hundreds of thousands of people, a substantial number of people are at risk of physical and mental harm in each disaster. During the recovery period after a nuclear disaster, physicians might need to screen for psychological burdens and provide general physical and mental health care for many affected residents who might experience long-term displacement. Reliable communication of personalised risks has emerged as a challenge for health-care professionals beyond the need to explain radiation protection. To overcome difficulties of risk communication and provide decision aids to protect workers, vulnerable people, and residents after a nuclear disaster, physicians should receive training in nuclear disaster response. This training should include evidence-based interventions, support decisions to balance potential harms and benefits, and take account of scientific uncertainty in provision of community health care. An open and joint learning process is essential to prepare for, and minimise the effects of, future nuclear disasters.

Health effects of radiation and other health problems in the aftermath of nuclear accidents, with an emphasis on Fukushima.

437 nuclear power plants are in operation at present around the world to meet increasing energy demands. Unfortunately, five major nuclear accidents have occurred in the past--ie, at Kyshtym (Russia [then USSR], 1957), Windscale Piles (UK, 1957), Three Mile Island (USA, 1979), Chernobyl (Ukraine [then USSR], 1986), and Fukushima (Japan, 2011). The effects of these accidents on individuals and societies are diverse and enduring. Accumulated evidence about radiation health effects on atomic bomb survivors and other radiation-exposed people has formed the basis for national and international regulations about radiation protection. However, past experiences suggest that common issues were not necessarily physical health problems directly attributable to radiation exposure, but rather psychological and social effects. Additionally, evacuation and long-term displacement created severe health-care problems for the most vulnerable people, such as hospital inpatients and elderly people.

A review of post-nuclear-catastrophe management.

The purpose of this paper is to make radioactive risk more generally understandable. To that end, we compare it to smoking tobacco. Further, we show that the concept of loss of life expectancy permits a quantitative comparison between various aggressions. The demystification of radioactive risk should lead to basic changes in post-catastrophe management, allowing victims to choose whether or not to leave contaminated areas. A less emotional appreciation of radioactive risks should lead to the adaptation of legal practices when dealing with probabilistic situations.

Prolonged Living as a Refugee from the Area Around a Stricken Nuclear Power Plant Increases the Risk of Death.

Although it is well known that the Great East Japan Earthquake (March 11, 2011) resulted in a large number of disaster-related deaths, it is not common knowledge that the number of disaster-related deaths continues to increase, even four years after the earthquake, in Fukushima Prefecture, where the nuclear power plant accident occurred. There has been a lack of a minute and critical analysis for the causes for this continuous increase. In this report, the causes for the increase in disaster-related deaths in Fukushima Prefecture were analyzed by aggregating and comparing multiple data released by public organizations (the Reconstruction Agency, the National Police Agency, and Fukushima Prefecture), which may also have implications for developing response strategies to other disasters. The disaster-related death rate, the dead or missing rate, and the refugee rate (the number of disaster-related deaths, dead or missing persons, and refugees per 1,000 people) in each prefecture in stricken areas, and also each city, county, town, and village in Fukushima Prefecture, were calculated and compared with each other. The populations which were used for the calculation of each death rate in the area were based on the number of dead victims who had lived in the area when the earthquake occurred, regardless of where they were at the time of their death. The disaster-related death rate was higher than the dead or missing rate in the area around a stricken nuclear power plant in Fukushima Prefecture. These areas coincide exactly with the Areas under Evacuation Orders because of unsafe radiation levels. The external and internal radiation doses of most of the victims of the Great East Japan Earthquake have appeared not to be so high to harm their health, until now. The psychological stress associated with being displaced from one's home for a long time with an uncertain future may be the cause for these disaster-related deaths. There is an urgent need to recognize refugees' stressful situations, which could even cause death, and to provide them with high-quality medical treatment, including care for their long-term mental health

What have we learned from a questionnaire survey of citizens and doctors both inside and outside Fukushima?: survey comparison between 2011 and 2013.

The disaster at the Fukushima Daiichi Nuclear Power Plant (FDNPP) remains unresolved because the estimated time to decommission a nuclear reactor appears to be approximately 40 years. The number of workers exposed to radiation doses ranging from 1 to 100 mSv continues to increase. To understand the accident progression at Fukushima and to anticipate what we should do in the future for occupational and environmental health, we performed a survey of citizens and doctors who lived inside and outside Fukushima in 2011 and 2013. In a comparison of these 2 years, the citizens inside Fukushima continue to suffer anxiety, although those living outside Fukushima tended to feel less anxious. Medical students who had recently studied radiation biology showed much less ongoing anxiety compared with other groups, suggesting that learning about the effects of radiation is essential to understanding one's own circumstances objectively and correctly. The lack of trust in the government and in the Tokyo Electric Power Company (TEPCO) in 2013 remains high in all groups. Therefore, long-term forthright explanations from the government, TEPCO, and radiation experts are indispensable not only to establish trust with people but also to alleviate psychological stress.

Developing a practical algorithm for a pediatric emergency department's response to radiological dispersal device events.

OBJECTIVE: In the aftermath of the detonation of a radiological dispersal device (RDD), or "dirty bomb," a large influx of children would be expected to present to the emergency department, including many patients not directly affected by the event who present with concerns regarding radiation exposure. Our objective was to develop an algorithm for efficiently and effectively triaging and appropriately treating children based on the likelihood of their having been contaminated or exposed. METHODS: The hospital's disaster preparedness committee with the help of disaster planning experts engaged in an iterative process to develop a triage questionnaire and patient flow algorithm for a pediatric hospital following an RDD event. The questionnaire and algorithm were tested using hypothetical patients to ensure that they resulted in appropriate triage and treatment for the full range of anticipated patient presentations and were then tested in 2 live drills to evaluate their performance in real time. RESULTS: The triage questionnaire reduced triage times and accurately sorted children into groups based on the type of intervention they required. Nonmedical personnel were able to administer the triage questionnaire effectively with minimal training, relieving professional staff. The patient flow algorithm and supporting materials provided direction to staff about how to appropriately treat patients once they had been triaged. CONCLUSIONS: In the event of the detonation of an RDD, the triage questionnaire and patient flow algorithm presented would enable pediatric hospitals to direct limited resources to children requiring intervention due to injury, contamination, or exposure.

A new perspective on severe nuclear accidents.

The reactions of the public in Korea to the nuclear accident at the Fukushima Daiichi plants in Japan, particularly over-reactions, are reviewed, with the conclusion that significant radioactive contamination of a small country could lead to a severe national crisis. The most important factor is the socio-economic damage caused by stigma, which in turn is caused by a misunderstanding of the radiation risk. Given that nuclear power is an important choice in the face of the threat of climate change, the public's perceptions need to be changed at any cost, not only in those countries operating nuclear power plants but globally as well.

The recommendations of the ICRP vis-à-vis the Fukushima Dai-ichi NPP accident aftermath.

The International Commission on Radiological Protection (ICRP) created a Task Group (ICRP TG84) on the initial lessons learned from the nuclear accident at the Fukushima Dai-ichi NPPs vis-à-vis the ICRP system of radiological protection. The ICRP TG84 is expected to compile lessons learned related to the efforts carried out to protect people against radiation exposure during and after the emergency exposure situation caused by the accident and, in light of these lessons, to consider ad hoc recommendations to strengthen the ICRP system of radiological protection for dealing with this type of emergency exposure. The Chairman of ICRP TG84 presents in this paper his personal views on the main issues being considered by the group at the time of the Fukushima Expert Symposium. ICRP TG84 expects to finalize its work by the end of 2012.

The Fukushima nuclear accident temporarily increased patients reluctance for nuclear medicine investigations.

Only mentioning the word "nuclear" already creates anxiety and distress. We attempted to assess the impact of the media hype about the Fukushima event on patients admitted in nuclear medicine units to undergo diagnostic investigations. The number of patients denying scintigraphic studies over half a year after the Fukushima accident was compared with the same period of the 2 previous years 2009 and 2010. Data were separately analyzed into thyroid vs. other organ scintigraphies. Physicians' referrals to nuclear medicine showed no decline. Patients undergoing various organ scintigraphies asked questions related to the accident but only few of them denied the investigation. Questioning and denial for nuclear medicine tests were more frequent in females as compared to males and especially in child-bearing females. Among patients referred in the initial post-event phase for thyroid function tests, more than 10% denied thyroid scintigraphy and 2.75% questioned this test. Again, questioning and denial was higher with females, especially in child-bearing age. In conclusion, this study showed that nuclear accidents and perhaps irresponsible media reports may affect behaviour of patients referred for nuclear medicine studies and in particular for thyroid scintigraphy even if these accidents had no radioactive effect to them.

[Contemporary legislation and importance of psychophysiologic examination in system of medical support for workers engaged into production with radiation and nuclear danger].

In accordance with contemporary legislation, the article covers materials on specification and approbation of concept model for psychophysiologic examination in medical establishments during medical examination of workers engaged into production with raidation and nuclear danger. The authors defined methodology, examination methods and designed an order of psychophysiologic examination. The psychophysiologic examination and purpose-oriented rehabilitation appeared efficient.

[Immunity and health: the accelerated aging of immune system in veterans of extra risk divisions].

This article presents the data about state of health and immunity in veterans of extra risk divisions. The increased morbidity and immunity infringement in the remote terms after nuclear tests, and also while liquidation of consequences of radiating failures on nuclear submarines are shown. Changes of humoral factors of nonspecific protection, concentration of immunoglobulinums, in blood whey, a sensitization of lymphocytes to respiratory viruses, humoral and cellular autoimmune shifts are registered. Some of the revealed changes (complement, lysozyme, concentration of immunoglobulinums) are a consequence of advanced age and accompanying diseases in the people surveyed, and others (autoimmune shifts, a sensitization to respiratory viruses) can be connected with carrying out of tests of the nuclear weapon. Some of immunological changes are apparently a consequence of joined actions of radiating and not radiating factors. Among the last ones stress plays the essential role. For the characteristic of a state of health in 20-40 years after carrying out nuclear tests and possible radiating influence the estimation of autoimmune changes has a great value. The important role of such changes in morbidity of veterans of extra risk divisions is shown.

Laughing it off? Humour, affect and emotion work in communities living with nuclear risk.

Over the past two decades, an increasing number of risk researchers have recognized that risks are not simply objective hazards but that the meanings of risk are discursively negotiated, dynamic and embedded within the wider social relations that constitute everyday life. A growing interest in the complexity and nuances of risk subjectivities has alerted sociocultural researchers not only to what is said in a risk situation, but also to how it is said and to what is unsaid and even, in a particular context, unsayable; to the intangible qualities of discourse that communicate additional meanings. Humour is both an intangible and marks such intangible meanings, yet it has largely been ignored and insufficiently theorized by risk researchers. In this paper, we draw upon insights from the humour literature - suspending the belief that humour is inherently good - to analyse and theorize humour as a way of examining the meanings and functions of risk. We show how humour can both mask and carefully reveal affectively charged states about living with nuclear risk. As such, it helps risk subjects to live with risk by suppressing vulnerabilities, enabling the negotiation of what constitutes a threat, and engendering a sense of empowerment. We conclude that humorous talk can be serious talk which can enrich our understandings of the lived experience of risk and of risk subjectivities.

Nothing to fear but fear itself?

As radiation levels around the crippled Fukushima Dai-ichi nuclear plant in Japan increase, the Japanese people as well as individuals around the world have expressed fear of radiation that some experts say could be more unhealthy than the levels of leaked radioactive contamination. This article addresses why individuals fear radiation and provides resources occupational health nurses can consult when answering clients' questions.

Willingness to Respond to Radiological Disasters Among First Responders in St. Louis, Missouri.

During radiological disasters, firefighters and emergency medical services personnel are expected to report to work and engage in response activities; however, prior research exploring willingness to respond to radiological disasters among first responders has considered only radiological terrorism scenarios and not nonterrorism radiological scenarios. The goal of this study was to compare willingness to respond to terrorism and nonterrorism radiological disaster scenarios among first responders in St. Louis, Missouri, and to explore determinants of willingness to respond. Firefighters and emergency medical services personnel were surveyed about their willingness to respond to a dirty bomb detonation (terrorism) and a radioactive landfill fire (nonterrorism). McNemar's tests were used to assess differences in individual willingness to respond between the 2 scenarios and differences if requested versus required to respond. Chi-square tests were used to identify significant individual predictors of willingness to respond. Multivariate logistic regressions were used to determine final models of willingness to respond for both scenarios. Willingness to respond was lower for the dirty bomb scenario than the landfill scenario if requested (68.4% vs 73.0%; P < .05). For both scenarios, willingness to respond was lower if requested versus required to respond (dirty bomb: 68.4% vs 85.2%, P < .001; landfill: 73.0% vs 87.3%, P < .001). Normative beliefs, perceived susceptibility, self-efficacy, and perceived barriers were significant predictors of willingness to respond in the final models. Willingness to respond among first responders differed significantly between terrorism and nonterrorism radiological disasters and if requested versus required to respond. Willingness to respond may be increased through interventions targeting significant attitudinal and belief predictors and by establishing organizational policies that define expectations of employee response during disasters.

Emergency preparedness: Ionising radiation incidents and medical management.

Military personnel risk being exposed to ionising radiation through a variety of means, including industrial accidents with Ministry of Defence equipment, inadvertent exposure while on operations, terrorist activities and nuclear war. The aim of this review is to outline the possible acute health effects and immediate management of radiation casualties in the context of different exposure scenarios. It emphasises the most important principles for managing irradiated, and/or contaminated casualties, in the operational environment, as well as providing details of key references and other sources of reach-back support.