Using a chain of models to predict health and environmental impacts in Norway from a hypothetical nuclear accident at the Sellafield site.

When a nuclear accident occurs, decision makers in the affected country/countries would need to act promptly to protect people, the environment and societal interests from harmful impacts of radioactive fallout. The decisions are usually based on a combination of model prognoses, measurements, and expert judgements within in an emergency decision support system (DSS). Large scale nuclear accidents would need predictive models for the atmospheric, terrestrial, freshwater, and marine ecosystems, for the connections between these in terms of radionuclide fluxes, and for the various exposure pathways to both humans and biota. Our study showed that eight different models and DSS modules could be linked to assess the total human and environmental consequences in Norway from a hypothetical nuclear accident, here chosen to be the Sellafield nuclear reprocessing plant. Activity concentrations and dose rates from 137Cs for both humans and the environment via various exposure routes were successfully modelled. The study showed that a release of 1% of the total inventory of 137Cs in the Highly Active Liquor Tanks at Sellafield Ltd is predicted to severely impact humans and the environment in Norway if strong winds are blowing towards the country at the time of an accidental atmospheric release. Furthermore, since the models did not have built-in uncertainty ranges when this Sellafield study was performed, investigations were conducted to identify the key factors contributing to uncertainty in various models and prioritise the ones to focus on in future research.

ICRP Publication 142: Radiological Protection from Naturally Occurring Radioactive Material (NORM) in Industrial Processes.

The purpose of this publication is to provide guidance on radiological protection in industries involving naturally occurring radioactive material (NORM). These industries may give rise to multiple hazards and the radiological hazard is not necessarily dominant. The industries are diverse and may involve exposure of people and the environment where protective actions need to be considered. In some cases, there is a potential for significant routine exposure of workers and members of the public if suitable control measures are not considered. Releases of large volumes of NORM may also result in detrimental effects on the environment from radiological and non-radiological constituents. However, NORM industries present no real prospect of a radiological emergency leading to tissue reactions or immediate danger for life. Radiological protection in industries involving NORM can be appropriately addressed on the basis of the principles of justification of the actions taken and optimisation of protection using reference levels. An integrated and graded approach is recommended for the protection of workers, the public, and the environment, where consideration of non-radiological hazards is integrated with radiological hazards, and the approach to protection is optimised (graded) so that the use of various radiological protection programme elements is consistent with the hazards while not imposing unnecessary burdens. For workers, the approach starts with characterisation of the exposure situation, and integration, as necessary, of specific radiological protective actions to complement the protection strategy already in place or planned to manage other workplace hazards. According to the characteristics of the exposure situation and the magnitude of the hazards, a relevant reference level should be selected and appropriate collective or individual protective actions taken. Exposure to radon is also treated using a graded approach, based first on application of typical radon prevention and mitigation techniques, as described in Publication 126. A similar approach should be implemented for public exposure through the control of discharges, wastes, and residues after characterisation of the situation. If the protection of non-human species is warranted, it should be dealt with after an assessment of radiological exposure appropriate for the circumstances, taking into account all hazards and impacts. This should include identification of exposed organisms in the environment, and use relevant derived consideration reference levels to inform decisions on options for control of exposure.

ICRP Fukushima dialogue seminars: joint learning at many levels.

The Norwegian Radiation Protection Authority and representatives from the CERAD Centre of Excellence participated at the majority of the International Commission on Radiological Protection dialogue seminars in Fukushima between 2011 and 2015. The open and sharing structure of the seminars contributed to an unprecedented understanding of the challenges faced by the general public affected by radioactive contamination due to an accident at a nuclear power plant. Most importantly by presentations from people in Fukushima, but also by presentations from lay people in Norway and Belarus who shared their experiences from the Chernobyl accident at several seminars. The seminars created new friendships and connections, which inter alia led to several exchange visits between affected people in Norway and Japan where worries and experiences could be shared in an open and reflective manner. The mix of actors (various experts, authorities, local populations) created joint learning across sectors and levels, representing an invaluable source of knowledge for organisations involved in nuclear and radiological emergency preparedness and planning.

The STRATEGY project: decision tools to aid sustainable restoration and long-term management of contaminated agricultural ecosystems.

The STRATEGY project (Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems) aimed to provide a holistic decision framework for the selection of optimal restoration strategies for the long-term sustainable management of contaminated areas in Western Europe. A critical evaluation was carried out of countermeasures and waste disposal options, from which compendia of state-of-the-art restoration methods were compiled. A decision support system capable of optimising spatially varying restoration strategies, that considered the level of averted dose, costs (including those of waste disposal) and environmental side effects was developed. Appropriate methods of estimating indirect costs associated with side effects and of communicating with stakeholders were identified. The importance of stakeholder consultation at a local level and of ensuring that any response is site and scenario specific were emphasised. A value matrix approach was suggested as a method of addressing social and ethical issues within the decision-making process, and was designed to be compatible with both the countermeasure compendia and the decision support system. The applicability and usefulness of STRATEGY outputs for food production systems in the medium to long term is assessed.

Extracorporeal perfusion for acute respiratory failure: recent experience with the spiral coil membrane lung.

Selection criteria, clinical data, and physiological measurements obtained during five extracorporeal membrane lung perfusions for acute respiratory insufficiency are presented. Four patients died and 1 survived. A new technique of femoral artery cannulation to allow aortic arch perfusion is described. When properly monitored, this route provides improved oxygen delivery to the brain during venoarterial (VA) perfusion. The importance of monitoring the equivalent of carotid artery Po2 during VA perfusion is emphasized. Recognition of the effects of high cardiac output in limiting the quality of extracorporeal perfusion, plus the use of hypothermia to reduce output, are stressed. We have confirmed that perfusion can be accomplished with small quantities of heparin, so that bleeding is reduced, but thrombocytopenia and occasional hemorrhage continue to be persistent problems.

A critical evaluation of the strategy project.

The STRATEGY project (sustainable restoration and long-term management of contaminated rural, urban and industrial ecosystems; www.strategy-ec.org.uk) addressed the need for a holistic decision framework for the selection of optimal remediation strategies for long-term sustainable management of contaminated areas in Western Europe. The project considered both technical and social aspects of implementing restoration strategies for urban and rural environments. The importance of considering socially relevant objectives in addition to the dose reduction was emphasised. A critical evaluation was carried out on 101 selected countermeasures, (including rural waste disposal options), a model was developed to aid optimising countermeasure strategies and a method of carrying out participatory decision-making suggested. The outputs of the project are described and critically evaluated.

Evaluation of environmental sensitivity of the marine regions.

The knowledge about environmental sensitivity of the marine regions to radionuclide release can be used for the development of response strategies and improvement of design-maker systems. The present results are based on the consequences analysis after potential Russian submarine accident involving a modern vessel. The radioecological consequences are based on modelling of potential releases of radionuclides, radionuclide transport and uptake in the marine environment. The sensitivity analysis is based on the comparison of the results of simulations with the recommendations and criterions for protection of the human population and the environment. The results show that the doses to marine organisms living in the sea sediment near the accident location, and dose rates to the critical group are the most sensitive state parameters (endpoints) for describing the consequences to the marine environment in the present evaluation.

Advances in NORM management in Norway and the application of ICRP's 2007 recommendations.

In Norway, the largest reported quantities of radioactive discharges and radioactive waste containing naturally occurring radioactive material (NORM) come from the oil and gas sector, and smaller quantities of other NORM waste are also produced by industrial or mining processes. The Gulen final repository for radioactive waste from the oil and gas industry from the Norwegian continental shelf was opened in 2008 and has a capacity of 6000 tonnes. As of 1 January 2011, a new regulation was enforced whereby radioactive waste and radioactive pollution was integrated in the Pollution Control Act from 1981. This means that radioactive waste and radioactive pollution are now regulated under the same legal framework as all other pollutants and hazardous wastes. The regulation establishes two sets of criteria defining radioactive waste: a lower value for when waste is considered to be radioactive waste, and a higher value, in most cases, for when this waste must be disposed of in a final waste repository. For example, waste containing ≥ 1 Bq/g of Ra-226 is defined as radioactive waste, while radioactive waste containing ≥ 10 Bq/g of Ra-226 must be disposed of in a final repository. Radioactive waste between 1 and 10B q/g can be handled and disposed of by waste companies who have a licence for handling hazardous waste according to the Pollution Control Act. Alternatively, they will need a separate licence for handling radioactive waste from the Norwegian Radiation Protection Authority. The goal of the new regulation is that all radioactive waste should be handled and stored in a safe manner, and discharges should be controlled through a licensing regime in order to avoid/not pose unnecessary risk to humans or the environment. This paper will elaborate on the new regulation of radioactive waste and the principles of NORM management in Norway in view of the International Commission on Radiological Protection's 2007 Recommendations.

Serial intravenous doses of dezocine, morphine, and nalbuphine in the management of postoperative pain for outpatients.

Adult patients who had arthroscopic surgery under general anesthesia and requested postoperative pain relief were randomized to receive treatment in a double-blind protocol with 5 mg of intravenous dezocine (20 patients), morphine (22 patients), nalbuphine (18 patients), or saline (24 patients). At 10-min intervals, starting with the first dose of analgesic, patients could choose up to three additional doses of the primary treatment, or choose an alternative analgesic if the primary drug was unsatisfactory. One to four doses of morphine were given as the alternate treatment if the initial treatment was dezocine or nalbuphine, and one to four doses of dezocine were given if the initial treatment was saline or morphine. The proportion of patients treated successfully by the initial treatments (i.e., not requesting alternate treatment), with P value for difference from placebo treatment, were saline 25%, nalbuphine 33% (P = 0.048), morphine 54% (P = 0.04), and dezocine 75% (P = 0.003). Dezocine and morphine are more efficacious than nalbuphine in the management of early postoperative pain. As an alternate analgesic in this study, dezocine required fewer doses to achieve patient satisfaction and was thus more efficacious than morphine. The incidence of treatment-related, adverse effects was different from that of saline or other treatments only for nalbuphine-related pain or burning on injection and dezocine-related facial itching. With respect to analgesic actions and side effects, dezocine seems more like morphine than nalbuphine.

Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery: a randomized, prospective, double-blind study.

The effect of 20 mL of intraarticular bupivacaine (0.25%, with or without 1:200,000 epinephrine), morphine (0.03%, with or without 1:200,000 epinephrine), or normal saline on postoperative analgesia after arthroscopic knee surgery was studied in a randomized, prospective, double-blind trial in ASA I-III outpatients receiving general anesthesia (n = 112) or regional anesthesia (n = 27 [spinal (n = 25) or epidural (n = 2)]). The visual analogue pain scores in the postanesthesia care unit and 3, 6, 12, and 24 h after surgery, time to first analgesic use, and total 24-h analgesic requirements were recorded. In those who received general anesthesia, the visual analogue scores were significantly lower in the bupivacaine group compared with both the morphine- and placebo-treated patients (P less than 0.05). The time to first analgesic use was longer in both the bupivacaine and morphine groups when compared with the control group (P less than 0.05). No significant differences were detected in total 24-h analgesic requirements among the groups. Patients who had received regional anesthesia had lower visual analogue scores compared with patients who had received general anesthesia irrespective of the intraarticular treatment (P less than 0.05). Our results indicate that intraarticular injection of bupivacaine after arthroscopic knee surgery provides prolonged analgesia but that there is no significant prolonged analgesia provided by intraarticular morphine.