Application of root cause analysis and TEAMSTEPPS post intravesical gas explosion during transurethral resection of the prostate: a rare case report.

BACKGROUND: An intravesical gas explosion is a rare complication of transurethral resection of the prostate (TURP). It was first reported in English literature in 1926, and up to 2022 were only forty-one cases. Injury from an intravesical gas explosion, in the most severe cases appearing as extraperitoneal or intraperitoneal bladder rupture needed emergent repair surgery. CASE PRESENTATION: We present a case of a 75-year-old man who suffered an intravesical gas explosion during TURP. The patient underwent an emergent exploratory laparotomy for bladder repair and was transferred to the intensive care unit for further observation and treatment. Under the medical team's care for up to sixty days, the patient recovered smoothly without clinical sequelae. CONCLUSIONS: This case report presents an example of a rare complication of intravesical gas explosion during TURP, utilizing root cause analysis (RCA) to comprehend causal relationships and team strategies and tools to improve performance and patient safety (TeamSTEPPS) method delivers four teamwork skills that can be utilized during surgery and five recommendations to avoid gas explosions during TURP to prevent the recurrence of medical errors. In modern healthcare systems, promoting patient safety is crucial. Once complications appear, RCA and TeamSTEPPS are helpful means to support the healthcare team reflect and improve as a team.

Mixed burn injury to thigh secondary to D-cell lithium battery explosion.

There is an increasing trend globally of fire incidents as a direct consequence of battery failures[1-6], but a dearth of reporting in medical literature regarding injuries associated with primary lithium cell explosions. We present the case of an electrical engineer referred to the burns team as a chemical burn secondary to a D-cell lithium battery explosion. Initial assessment revealed an entry wound on the anteromedial thigh leaking contaminated fluid. Orthogonal X-rays demonstrated the battery casing lodged within the posterior thigh compartment. The wound was managed similar to that of a ballistic injury with staged debridement, washout and delayed primary closure. This is the first reported case of a lithium-thionyl chloride battery explosion causing injury. The case highlights various issues for attending teams, including appropriate first aid for chemical burns, consideration of significant soft tissue trauma deep to seemingly innocuous wounds and safeguarding concerns surrounding domestic explosive devices.

Modeling Highly Repetitive Low-level Blast Exposure in Mice.

Exposure to explosive blasts is a significant risk factor for brain trauma among exposed persons. Although the effects of large blasts on the brain are well understood, the effects of smaller blasts such as those that occur during military training are less understood. This small, low-level blast exposure also varies highly according to military occupation and training tempo, with some units experiencing few exposures over the course of several years whereas others experience hundreds within a few weeks. Animal models are an important tool in identifying both the injury mechanisms and long-term clinical health risks following low-level blast exposure. Models capable of recapitulating this wide range of exposures are necessary to inform acute and chronic injury outcomes across these disparate risk profiles. Although outcomes following a few low-level blast exposures are easily modeled for mechanistic study, chronic exposures that occur over a career may be better modeled by blast injury paradigms with repeated exposures that occur frequently over weeks and months. Shown here are methods for modeling highly repetitive low-level blast exposure in mice. The procedures are based on established and widely used pneumatic shocktube models of open-field blast exposure that can be scaled to adjust the overpressure parameters and the number or interval of the exposures. These methods can then be used to either enable mechanistic investigations or recapitulate the routine blast exposures of clinical groups under study.

The causal effect of mental health on labor market outcomes: The case of stress-related mental disorders following a human-made disaster.

As disasters increase due to climate change, population density, epidemics, and technology, information is needed about postdisaster consequences for people's mental health and how stress-related mental disorders affect multiple spheres of life, including labor-market attachment. We tested the causal hypothesis that individuals who developed stress-related mental disorders as a consequence of their disaster exposure experienced subsequent weak labor-market attachment and poor work-related outcomes. We leveraged a natural experiment in an instrumental variables model, studying a 2004 fireworks factory explosion disaster that precipitated the onset of stress-related disorders (posttraumatic stress disorder, anxiety, and depression) among individuals in the local community (N = 86,726). We measured labor-market outcomes using longitudinal population-level administrative data: sick leave, unemployment benefits, early retirement pension, and income from wages from 2007 to 2010. We found that individuals who developed a stress-related disorder after the disaster were likely to go on sickness benefit, both in the short- and long-term, were likely to use unemployment benefits and to lose wage income in the long term. Stress-related disorders did not increase the likelihood of early retirement. The natural experiment design minimized the possibility that omitted confounders biased these effects of mental health on work outcomes. Addressing the mental health and employment needs of survivors after a traumatic experience may improve their labor-market outcomes and their nations' economic outputs.

Experimental study on the methane explosion suppression by ultra-fine water mist containing bacteria under degradation for five times.

In a semi-closed visualization pipeline, this experiment studied the inhibitory effect of ultra-fine pure water mist, ultra-fine water mist containing inorganic salt and ultra-fine water mist containing bacteria-inorganic salt on 9.8% methane explosion under five different quality of spray volume. Combined with the methane explosion suppression experiment, the ability of methane-oxidizing bacteria to degrade 9.8% of methane was studied in a simulated pipeline. Experiments showed that the addition of inorganic salt and the degradation of methane-oxidizing bacteria could improve the suppression explosion effect of ultra-fine water mist, and the suppression explosion effect was related to the volume of water mist. Under the same ultra-fine water mist condition, with the increase of the volume of water mist, the explosion suppression effect was improved. Compared with pure methane, pure water ultra-fine water mist, and inorganic salt ultra-fine water mist, the maximum explosion overpressure and flame propagation speed under the condition of bacteria-inorganic salt ultra-fine water mist were significantly reduced. Compared with the explosion of pure methane, due to the degradation of methane by methane-oxidizing bacteria, when the degradation time was 10 h, and the volume of ultra-fine water mist containing bacteria-inorganic salt was 12.5 mL, the maximum explosion overpressure dropped significantly from 0.663 to 0.343 MPa, a decrease of 48.27%. The appearance time of the maximum explosion overpressure was delayed from 208.8 to 222.6 ms. The peak flame velocity was 4 m s-1, which was 83.3% lower than that of 9.8% pure methane explosion. This study will contribute to the development of efficient ultrafine water mist synergistic inhibitors for the prevention of methane explosion disasters.

Crystal clear connections - database matching unknown glass fragments to reference glass from ATM explosions.

This paper introduces the concept of an operational reference glass database, specifically designed for broken glass fragments from ATM attacks, jewelry store robberies, and ramraids on high-end clothing stores. The database, initiated in 2014, is used to compare glass traces from organized crews involved said criminal activities. Utilizing LA-ICPMS, this study establishes a methodology for collecting reference glass samples from the scenes of the aforementioned crimes, thus creating a comprehensive database containing over 3500 reference glass samples from crime scenes. The operational database is employed to match trace elemental profiles of glass fragments from suspected items to known reference samples, offering specificity and accuracy. Analysis of results, while ongoing due to the nature of active cases, find matches of trace materials in over 50 % of case requests since 2019. Challenges such as database scalability and continuous updating are acknowledged, and future directions include technological advancements to enhance precision and the application into other areas of forensic material analysis. The paper emphasizes the efficacy of this specialized approach in chemical profiling, providing a potent tool for linking glass traces to specific criminal contexts and providing intelligence and investigative leads into individuals involved in ATM-related crimes.

Effect of blast orientation, multi-point blasts, and repetitive blasts on brain injury.

Explosions in the battlefield can result in brain damage. Research on the effects of shock waves on brain tissue mainly focuses on the effects of single-orientation blast waves, while there have been few studies on the dynamic response of the human brain to directional explosions in different planes, multi-point explosions and repetitive explosions. Therefore, the brain tissue response and the intracranial pressure (ICP) caused by different blast loadings were numerically simulated using the CONWEP method. In the study of the blast in different directions, the lateral explosion blast wave was found to cause greater ICP than did blasts from other directions. When multi-point explosions occurred in the sagittal plane simultaneously, the ICP in the temporal lobe increased by 37.8 % and the ICP in the parietal lobe decreased by 17.6 %. When multi-point explosions occurred in the horizontal plane, the ICP in the frontal lobe increased by 61.8 % and the ICP in the temporal lobe increased by 12.2 %. In a study of repetitive explosions, the maximum ICP of the second blast increased by 40.6 % over that of the first blast, and that of the third blast increased by 61.2 % over that of the second blast. The ICP on the brain tissue from repetitive blasts can exceed 200 % of that of a single explosion blast wave.

The dynamic response of human lungs due to underwater shock wave exposure.

Since the 19th century, underwater explosions have posed a significant threat to service members. While there have been attempts to establish injury criteria for the most vulnerable organs, namely the lungs, existing criteria are highly variable due to insufficient human data and the corresponding inability to understand the underlying injury mechanisms. This study presents an experimental characterization of isolated human lung dynamics during simulated exposure to underwater shock waves. We found that the large acoustic impedance at the surface of the lung severely attenuated transmission of the shock wave into the lungs. However, the shock wave initiated large bulk pressure-volume cycles that are distinct from the response of the solid organs under similar loading. These pressure-volume cycles are due to compression of the contained gas, which we modeled with the Rayleigh-Plesset equation. The extent of these lung dynamics was dependent on physical confinement, which in real underwater blast conditions is influenced by factors such as rib cage properties and donned equipment. Findings demonstrate a potential causal mechanism for implosion injuries, which has significant implications for the understanding of primary blast lung injury due to underwater blast exposures.

Gas explosion characteristics and spray control mechanism in underground square.

The spray system mechanism during a gas explosion in an underground square pipeline is complex. In this paper, the underground square of Fuxin City is selected as the research object. FLACS numerical simulation software is used to analyze the spatial and temporal distribution characteristics of a gas explosion in an underground square pipeline with an unopened spray system using combustion and combustion rate models. Different spray pressures were compared and analyzed to determine the optimal spray control pressure, and the spray system mechanism was clarified. The results revealed that the gas explosion overpressure is divided into the overpressure gentle, overpressure rising, and overpressure decay stages, corresponding to a trend of rapid growth and slow decline. The influence of spray pressure on the gas explosion exhibits a promotion-inhibition-promotion trend, corresponding to 0-0.2 MPa, 0.2-0.6 MPa, and 0.6-1.6 Mpa, respectively. The peak overpressure and overpressure propagation rates are the lowest at 0.6 MPa, and the explosion suppression effect is the most pronounced. The spray system mechanism varies with the explosion overpressure stages. Generally, the time to peak value, that is, the peak time, the overall duration of the explosion, and the duration of the explosion stage decrease, whereas the peak explosion overpressure decreases.

Comparison of Adult Female and Male PMHS Pelvis and Lumbar Response to Underbody Blast.

The goal of this study was to gather and compare kinematic response and injury data on both female and male whole-body Post-mortem Human Surrogates (PMHS) responses to Underbody Blast (UBB) loading. Midsized males (50th percentile, MM) have historically been most used in biomechanical testing and were the focus of the Warrior Injury Assessment Manikin (WIAMan) program, thus this population subgroup was selected to be the baseline for female comparison. Both small female (5th percentile, SF) and large female (75th percentile, LF) PMHS were included in the test series to attempt to discern whether differences between male and female responses were predominantly driven by sex or size. Eleven tests, using 20 whole-body PMHS, were conducted by the research team. Preparation of the rig and execution of the tests took place at the Aberdeen Proving Grounds (APG) in Aberdeen, MD. Two PMHS were used in each test. The Accelerative Loading Fixture (ALF) version 2, located at APG's Bear Point range was used for all male and female whole-body tests in this series. The ALF was an outdoor test rig that was driven by a buried explosive charge, to accelerate a platform holding two symmetrically mounted seats. The platform was designed as a large, rigid frame with a deformable center section that could be tuned to simulate the floor deformation of a vehicle during a UBB event. PMHS were restrained with a 5-point harness, common in military vehicle seats. Six-degree-of-freedom motion blocks were fixed to L3, the sacrum, and the left and right iliac wings. A three-degree-of freedom block was fixed to T12. Strain gages were placed on L4 and multiple locations on the pelvis. Accelerometers on the floor and seat of the ALF provided input data for each PMHS' feet and pelvis. Time histories and mean peak responses in z-axis acceleration were similar among the three PMHS groups in this body region. Injury outcomes were different and seemed to be influenced by both sex and size contributions. Small females incurred pelvis injuries in absence of lumbar injures. Midsized males had lumbar vertebral body fractures without pelvis injuries. And large females with injuries had both pelvis and lumbar VB fractures. This study provides evidence supporting the need for female biomechanical testing to generate female response and injury thresholds. Without the inclusion of female PMHS, the differences in the injury patterns between the small female and midsized male groups would not have been recognized. Standard scaling methods assume equivalent injury patterns between the experimental and scaled data. In this study, small female damage occurred in a different anatomical structure than for the midsized males. This is an important discovery for the development of anthropomorphic test devices, injury criteria, and injury mitigating technologies. The clear separation of small female damage results, in combination with seat speeds, suggest that the small female pelvis injury threshold in UBB events lies between 4 - 5 m/s seat speed. No inference can be made about the small female lumbar threshold, other than it is likely at higher speeds and/or over longer duration. Male lumbar spine damage occurred in both the higher- and lower lower-rate tests, indicating the injury threshold would be below the seat pulses tested in these experiments. Large females exhibited injury patterns that reflected both the small female and midsized male groups - with damaged PMHS having fractures in both pelvis and lumbar, and in both higher- and lower- rate tests. The difference in damage patterns between the sex and size groups should be considered in the development of injury mitigation strategies to protect across the full population.

Freezing pre-treatment improves radio frequency explosion puffing (RFEP) quality by altering the cellular structure of purple sweet potato [Ipomoea batatas (L) Lam.].

Radio frequency explosion puffing (RFEP) is a novel oil-free puffing technique used to produce crispy textured and nutritious puffed snacks. This study aimed to investigate the effects of freezing at different temperatures (-20 °C, -40 °C, -80 °C) for14 h and freezing times (1 and 2 times) on the cellular structure of purple sweet potato and the quality of RFEP chips. The analysis of cell microstructure, conductivity, and rheology revealed that higher freezing temperatures and more freezing times resulted in increased damage to the cellular structure, leading to greater cell membrane permeability and decreased cell wall stiffness. However, excessive damage to cellular structure caused tissue structure to collapse. Compared with the control group (4 °C), the RFEP sample pre-frozen once at -40 °C had a 47.13 % increase in puffing ratio and a 61.93 % increase in crispness, while hardness decreased by 23.44 % (p < 0.05). There was no significant change in anthocyanin retention or color difference. X-ray microtomography demonstrated that the RFEP sample pre-frozen once at -40 °C exhibited a more homogeneous morphology and uniform pore distribution, resulting in the highest overall acceptability. In conclusion, freezing pre-treatment before RFEP can significantly enhance the puffing quality, making this an effective method for preparing oil-free puffing products for fruits and vegetables.

Dropping a bombshell: Acoustic characterization of blast fishing in Todos os Santos Bay, Brazil, and its implication for marine conservation.

Blast fishing is an illegal fishing method that not only affects fish populations and the marine ecosystem, but also local food security and local economy. Despite its effects, blast fishing continues to persist in many coastal regions around the world, including Todos os Santos Bay (BTS - Baia de Todos os Santos) in Northeastern Brazil. This study provides the first acoustic record of underwater explosions along this region. The acoustic data were collected between 2016 and 2018, from a boat-survey platform, using a portable system consisting of an HTI-90 min hydrophone (sensitivity of about -165 dB re 1 V/µPa) connected to a TASCAM DR-40 digital recorder (combined frequency response up to 30 kHz), recording at 7 m depth. The acoustic analysis was performed using both RAVEN 1.6 and MATLAB 2021a softwares. The results revealed a distinctive underwater explosion signal detected in the BTS, indicating evidence of blast fishing activities. The acoustic characterization of blast fishing in BTS provides crucial information on its occurrence and extent of this destructive practice worldwide.

Numerical simulation of rock blasting under different in-situ stresses and joint conditions.

High primary rock stress can limit the generation of rock cracks caused by blasting, and blasting usually shows different rock breaking states under different primary rock stress conditions. There are a large number of naturally formed joints in rock mass, due to the limitations of laboratory tests, a numerical model of jointed rock mass was established using LS-DYNA software to investigate the evolution of blasting damage under various in-situ stresses and open joints. In this simulation, using the Lagrange-Euler (ALE) procedure and the equation of state (JWL) that defines explosive materials, the study considered different joint thicknesses (2cm, 4cm, and 6cm), joint angles (0°, 30°, 60°, and 90°), and in-situ stress conditions (lateral stress coefficients of 0.5, 1, and 2, with vertical in-situ stresses of 10MPa and 20MPa), through stress analysis and damage area comparison, the relationship between damage crack propagation and horizontal and vertical stress difference is explored. The research aimed to understand the mechanisms underlying crack initiation and propagation. The results show that: (1) The presence of joints exerts a barrier effect on the expansion and penetration of cracks. When explosion stress waves reach the joint surface, their propagation is impeded, leading to the diffusion of wing cracks at the joint ends. When the lateral stress coefficient and joint angle are the same, an increase in initial in-situ stress results in a reduction in the area of the blasting damage zone. (2) Under the same initial in-situ stress conditions, the area of the blasting damage zone initially increases and then decreases with an increasing joint angle. However, it remains larger than that without a joint, and there exists an optimal angle that maximizes the damage area. In the simulated conditions, the area of damage cracks is greatest when the joint angle is 60° dip angle. (3) The presence of initial in-situ stress has a certain impact on the initiation and expansion of blasting cracks. The degree and nature of this influence are not solely related to the lateral stress coefficient but also depend on the joint's angle and thickness. When in-situ stress is present, the initial in-situ stress field's pressure is not conducive to the initiation and propagation of blasting cracks. However, the existence of a joint has a noticeable guiding and promoting effect on crack propagation, and the pattern of crack propagation is influenced by both joint and in-situ stress conditions.

History and investigation of the chemical odors and explosion in the University Avenue sanitary sewer.

During the summer of 2022, a fire and explosion occurred in a sanitary sewer tunnel adjacent to the University of Minnesota Twin Cities campus, propelling utility maintenance covers several meters into the air and jeopardizing the safety of the public and emergency responders. The investigation into the explosion highlighted the complex variables involved in the response to sanitary sewer events. This case study outlines current approaches and proposes recommendations for agencies to be better prepared to prevent, detect, and respond to sewer-related incidents in the future. Our recommendations include the following: (1) proactive use of remote volatile organic compound (VOC) and lower explosive limit (LEL) monitoring in sanitary sewer tunnels, especially downstream of waste discharge sites; (2) incident responders should have access to instruments that measure oxygen, LEL, VOC concentration, carbon monoxide, and hydrogen sulfide; (3) better characterization of the relationship between sewer pressurization, elevation profiles, and vapor movement; (4) verification processes for oil/water separators used by industrial facilities discharging into the sanitary sewer system; (5) installation of ventilated or anchored pressure relief utility maintenance covers where allowed by code; and (6) building maintenance protocols that include regular drain flushing to keep drain traps filled. These measures are recommended to protect infrastructure and the health and safety of the public and the responders.

Modeling and simulation on spontaneous detonation of ammonium nitrate explosive induced by sulfide ores.

In this work, the characteristics of the exothermic reaction between ammonium nitrate and sulfide ores were explored using COMSOL Multiphysics. This reaction can cause an increase in temperature within the blast holes of sulfide mines and can potentially induce premature explosions of the explosives. Initially, simulations were conducted to observe temperature variations in blast holes before and after the loading of explosives. Then, the impact of blast hole diameter and initial temperature on the thermal environment was assessed. Subsequent analysis focused on the fluid field's dynamics, examining flow rate changes and the concentration of signature gases produced by the reaction. Additionally, the influence of blast hole diameter on these parameters was evaluated. The results show that the blast hole temperature is positively related to its diameter and initial temperature. When the diameter of the blast hole is 120 mm and 165 mm, a significant change in flow rate is observed, with a trend of being rapidly increased and then rapidly decreased. The production of NH3 is always found to be greater than that of the other two gases. As for NO and SO2, their production is characterized by an approximate ratio of 1:2. The numerical simulation results can provide important theoretical guidance for the spontaneous detonation of blast hole in sulfide mines.

Impact of the economic crisis, COVID-19 and the Beirut explosion on ophthalmology training in Lebanon: an observational cohort survey-based study.

OBJECTIVES: The objective of the study is to investigate the effects of the COVID-19 pandemic, the economic crisis and the Beirut explosion on the training and work of ophthalmology residents and faculty in Lebanon. DESIGN: This is an observational cohort survey-based research conducted between January and December 2022. SETTING: The study targeted all ophthalmology residents and core faculty in Lebanon. PARTICIPANTS: A total of 52 participants, including 27 residents and 25 core faculty members, completed the survey. PRIMARY OUTCOME MEASURE: Primary outcomes comprised the subjectively reported effect of the three major external stressors on the training and well-being of ophthalmology trainees and educators in Lebanon. RESULTS: The study found that the majority of ophthalmology residents and core faculty members were significantly affected by the COVID-19 pandemic, Beirut explosion and the economic crisis in Lebanon. Significant percentage reported financial burden, decrease in outpatient and surgical load and educational activities. Furthermore, most participants reported higher levels of stress, anxiety and depression during the time of crises. CONCLUSIONS: This study emphasises the need to support healthcare professionals during times of crisis, as they are on the frontlines and can experience high levels of stress, anxiety and depression. By providing support and resources to healthcare professionals, they can better cope with the challenges they face and continue to provide essential care to their patients.

24Model-based comparative analysis of two catastrophic hazardous chemical pipeline accidents.

Objectives. This study conducted a comparative analysis of two catastrophic pipeline accidents in China in order to identify some common mistakes and lessons learned to prevent similar accidents. Methods. The 24Model was used in this study, which provides a universal pathway for accident analysis from the individual level to the organizational level. Results. There were similarities between the two cases in the aspects of the occurrence, development, emergency and causation at different levels: both were caused by leaks of pipelines and evolved into multiple explosions during emergency response; both leaks were caused by the corrosion of pipelines in the confined space of a damp or salt-spray environment; both were classified as 'responsibility accidents', and unsafe acts, such as the failure to identify hidden hazards of pipelines that were the direct cause of accidents, reflected the shortcomings of individual safety habitual behaviour in terms of knowledge, awareness, habits and psychology; weaknesses in the organizational management mainly concerned hazard identification, pipeline maintenance, emergency disposal, etc.; and there is not a good safety climate within the organization. Conclusions. Organizations should develop a closed-loop management system and strengthen the construction of safety culture, and the government should supervise the implementation of procedures.