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PubMed1997

Planning for a bomb threat.

A bomb threat must always be taken seriously. It is important to have specific response plans in place, especially in a healthcare facility, where patients may be particularly vulnerable both to danger and to the threat of danger. Also, the facility may be judged in the community by how it responds to a threat. A prudent risk manager will plan in advance, setting up a chain of command and specific procedures, and familiarizing all who take on bomb threat duties not only with their responsibilities, but also with one another. There should be a familiar and easy relationship among those required to work together in stressful situations.

Disaster Planning↗
PubMedDate not supplied

Risk factors for primary breast cancer in Japan: 8-year follow-up of atomic bomb survivors.

BACKGROUND: Findings from the Life Span Study (LSS) of the health effects of exposure to atomic bomb radiation have documented a strong dose-response relation between radiation exposure and breast cancer incidence. PURPOSE: We analyzed data from the LSS cohort to identify nonradiation risk factors for breast cancer and to determine whether these factors were independent of the effects of radiation on breast cancer occurrence. METHODS: Breast cancer incidence was ascertained among a cohort of 22,200 residents of Hiroshima and Nagasaki, Japan, who had completed a mail survey between 1979 and 1981 to study nonradiation risk factors for disease. During the subsequent follow-up period (average 8.31 years), 161 cases of primary breast cancer were identified through population-based tumor registries in the two cities. RESULTS: The risk of breast cancer was inversely related to age at menarche and weakly positive in relation to age at menopause and years of menstruation. A significant negative association of full-term pregnancy against breast cancer was observed, although the number of pregnancies beyond the first was not related to the rate of breast cancer in the cohort. Women having their first full-term pregnancy before age 30 were at decreased risk of breast cancer relative to older women, but there was no trend. A nonsignificant, positive trend in risk was associated with increasing weight and body mass (kg/m2). The risk of breast cancer among women with a history of estrogen use was 1.64 (95% confidence interval 1.02-2.64) and with diabetes 2.06 (95% confidence interval 1.27-3.34). It was not possible to distinguish among additive and multiplicative models of the joint association of radiation dose and various non-radiation-related exposures (age at menarche, full-term pregnancy, female hormone preparations) identified in this analysis. CONCLUSIONS: Nonradiation risk factors for breast cancer among Japanese atomic bomb survivors were consistent with those identified among other populations of women, although the prevalence of common risk factors was low. Reproductive factors and hormone use appear to act independently of radiation exposure on the risk of breast cancer among this population.

Aged↗
PubMed1994

A case-control interview study of breast cancer among Japanese A-bomb survivors. I. Main effects.

Women with breast cancer (cases = 196) and without the disease (controls = 566), selected from the Life Span Study sample of A-bomb survivors and nonexposed residents of Hiroshima and Nagasaki, Japan, and matched on age at the time of the bombings, city, and estimated radiation dose, were interviewed about reproductive and medical history. A primary purpose of the study was to identify strong breast cancer risk factors that could be investigated further for possible interactions with radiation dose. As expected, age at first full-term pregnancy was strongly and positively related to risk. Inverse associations were observed with number of births and total, cumulative period of breast feeding, even after adjustment for age at first full-term pregnancy. Histories of treatment for dysmenorrhea and for uterine or ovarian surgery were associated positively and significantly with risk at ages 55 or older, a finding that requires additional study. Other factors related to risk at older ages were the Quetelet index (weight [kg]/height [cm]2) at age 50, history of thyroid disease, and hypertension. Neither age at menarche nor age at menopause was associated significantly with risk. Subjects appeared to be poorly informed about history of breast cancer or other cancer in themselves or in their close relatives; this finding suggests that innovative strategies may be required when studying familial cancer patterns in Japanese populations.

Adult↗
PubMed1994

A case-control interview study of breast cancer among Japanese A-bomb survivors. II. Interactions with radiation dose.

Three breast cancer risk factors were evaluated in terms of their interactions with radiation dose in a case-control interview study of Japanese A-bomb survivors. Cases and controls were matched on age at the time of the bombings and radiation dose, and dose-related risk was estimated from cohort rather than case-control data. Each factor--age at first full-term pregnancy, number of deliveries, and cumulative lactation period summed over births--conformed reasonably well to a multiplicative interaction model with radiation dose (the additive interactive model, in which the absolute excess risk associated with a factor is assumed to be independent of radiation dose, was rejected). An important implication of the finding is that early age at first full-term pregnancy, multiple births, and lengthy cumulative lactation are all protective against radiation-related, as well as baseline, breast cancer. Analyses by age at exposure to radiation suggest that, among women exposed to radiation in childhood or adolescence, a first full-term pregnancy at an early age following exposure may be protective against radiation-related risk.

Adult↗
PubMedDate not supplied

Case finding and mental health services for children in the aftermath of the Oklahoma City bombing.

The 1995 Oklahoma City bombing killed 168 people, including 19 children, and injured hundreds more. Children were a major focus of concern in the mental health response. Most services for them were delivered in the Oklahoma City Public Schools where approximately 40,000 students were enrolled at the time of the explosion. Middle and high school students in the Oklahoma City Public Schools completed a clinical assessment 7 weeks after the explosion. The responses of 2720 students were analyzed to explore predictors of posttraumatic stress symptomatology, functioning, and treatment contact. Posttraumatic stress symptomatology was associated with initial reaction to the incident and to bomb-related television exposure. Functional difficulty was associated with initial reaction and posttraumatic stress symptomatology. Only 5% of the students surveyed had received counseling. There was no relationship between posttraumatic stress symptomatology and counseling contact for students with the highest levels of posttraumatic stress. Implications for school-based services are discussed.

Child↗
PubMed1983

Multiple primary cancers: with reference to atomic bomb survivors in Hiroshima.

We treated 44 patients with multiple primary cancers, at the Second Department of Surgery, Hiroshima University, during the 14 year period from 1968-1981. The total number of malignant tumors was 1,934 during this period, thus the incidence of multiple primary cancers was 2.3 per cent. Nine of the 44 were atomic bomb survivors in Hiroshima and were characterized by the frequent incidence of the second tumor about 30 years after exposure to the atomic bomb. In addition, the second tumor tended to develop later in patients prescribed radiotherapy for the first tumor. As for the site of tumor, there was no tendency of more frequent development of tumors in organs highly sensitive to radiation other than the thyroid.

Adolescent↗
PubMed2003

Modelling of carcinogenesis and low-dose hypersensitivity: an application to lung cancer incidence among atomic bomb survivors.

Lung cancer incidence among the atomic bomb survivors from Hiroshima and Nagasaki was analysed with the two-step clonal expansion (TSCE) model of carcinogenesis. For the baseline incidence, a new set of model parameters is introduced, which can be determined with a higher precision than the parameter sets previously used. The effect of temporal changes in the smoking behaviour on the lung cancer incidence is modelled by allowing initiation, inactivation and division rates of intermediate cells to depend on the year of birth. The TSCE model is further developed by implementing low-dose hypersensitivity in the survival of lung epithelial cells. According to the model fit to the data, the acute gamma exposure of the atomic bomb survivors does not only result in the conventional initiating effect, but also in a promoting effect for lung cancer. Compared to the model in which radiation acts merely on initiation, the new model is in better agreement with the age-at-exposure dependence in the data, and it does not predict an unexpected increase of the excess relative risk (ERR) at 40 years after exposure. According to the new model, the ERR at low doses increases non-linearly with dose, especially during the first 10 years after exposure to older persons.

Age Factors↗
PubMed2005

The Hiroshima thermal-neutron discrepancy for (36)Cl at large distances. Part I: New (36)Cl measurements in granite samples exposed to A-bomb neutrons.

The long-lived radioisotope (36)Cl (half-life: 301,000 years) was measured in granite samples exposed to A-bomb neutrons at distances from 94 to 1,591 m from the hypocenter in Hiroshima, by means of accelerator mass spectrometry (AMS). Measured (36)Cl/Cl ratios decrease from 1.6 x 10(-10) close to the hypocenter to about 1-2 x 10(-13), at a distance of 1,300 m from the hypocenter. At this distance and beyond the measured (36)Cl/Cl ratios do not change significantly and scatter around values of 1-2 x 10(-13). These findings suggest that the (36)Cl had been predominantly produced by thermalized neutrons from the A-bomb via neutron capture on stable (35)Cl, at distances from the hypocenter smaller than about 1,200 m. At larger distances, however, confounding processes induced by cosmic rays or neutrons from the decay of uranium and thorium become important. This hypothesis is theoretically and experimentally supported in a consecutive paper. The results are compared to calculations that are based on the most recent dosimetry system DS02. Close to the hypocenter, measured (36)Cl/Cl ratios are lower than those calculated, while they are significantly higher at large distances from the hypocenter. If the contribution of the cosmic rays and of the neutrons from the decay of uranium and thorium in the sample was subtracted, however, no significant deviation from the DS02 calculations was observed, at those distances. Thus, the Hiroshima neutron discrepancy reported in the literature for (36)Cl for samples from large distances from the hypocenter, i.e., higher measured (36)Cl/Cl ratios than predicted by the previous dosimetry system DS86, was not confirmed.

Biophysical Phenomena↗
PubMed1999

Relative risks of radiation-associated cancer: comparison of second cancer in therapeutically irradiated populations with the Japanese atomic bomb survivors.

In this paper the radiation-associated relative risks of second primary cancer incidence in groups treated for first primary cancer by radiotherapy are compared with radiation-associated relative risk estimates in the Japanese atomic bomb survivor cancer incidence data. For four cancer sites, namely lung cancer, bone cancer, ovarian cancer and leukaemia, the relative risks in the comparable (age at exposure, time since exposure, sex matched) subsets of the Japanese data are significantly greater than those in the majority of second cancer studies. Even when the differences between the relative risks in the Japanese atomic bomb survivors and the medical series do not approach conventional levels of statistical significance, relative risks tend to be higher in the Japanese data than in the second cancer studies. At least for leukaemia, the discrepancy between the Japanese and second cancer risks can be largely explained by cell-sterilisation effects. There are few indications of modification of radiation-associated second cancer relative risk among those treated with adjuvant chemotherapy, nor are there strong indications of modification of radiation-associated relative risk by heritable genetic factors. If anything, there is evidence that second cancer relative excess risks are lower among those patients with cancer-prone disorders than among non-susceptible patients. However, the higher underlying cancer risk in some of these medically exposed populations should also be considered, in particular for those with cancer-prone conditions, so that the absolute excess risk is sometimes higher than in the Japanese data.

Female↗
PubMed2005

Lifestyle factors, radiation and gastric cancer in atomic-bomb survivors (Japan).

OBJECTIVE: To examine the association between the incidence of gastric cancer and lifestyle factors such as cigarette smoking, alcohol drinking, and diet as well as atomic bomb radiation exposure. METHODS: Longitudinal study including 38,576 atomic-bomb survivors in Hiroshima and Nagasaki, Japan, followed-up between 1980 and 1999. Individual radiation dose was estimated according to the Dosimetry System 1986 (DS86). Lifestyle determinants were based on the responses to a mail survey sent at baseline. 1270 incident carcinomas of gastric cancer were identified during the 485,575 person-years of follow-up. Poisson regression was used to estimate incidence rate ratios. RESULTS: Ionizing radiation exposure, male gender, age, and smoking were significantly associated with an increased risk of stomach cancer. No association was suggested between the frequency of consumption of fruit, vegetables, green tea, and soy products and gastric cancer. CONCLUSIONS: In this Japanese population, although radiation and smoking were strong determinants of stomach cancer, no supportive evidence could be shown for the effect of dietary factors.

Adult↗
PubMed1975

Analysis of fractures treated in the Royal Victoria Hospital, Belfast, in 1972, with special reference to gunshot wounds and bomb blast injuries.

The total number of patients admitted to the Fracture unit in the Royal Victoria Hospital in 1972 is recorded and classified according to cause. Fractures resulting from gunshot wounds and bomb injuries are examined more closely together with associated injuries and complications. These groups are compared briefly with the open fractures resulting from road traffic accidents. Treatment of fractures in gunshot wounds and bomb injuries is discussed. Reference is made to the mechanisms of injury by gunshot and explosions.

Accidents, Home↗
PubMed1993

Lessons from the Musgrave Park Hospital bombing.

In November 1991 the Military Wing of Musgrave Park Hospital, Belfast, was the target of a terrorist bomb. Nine of the small military staff were killed or injured. The initial response was coordinated by doctors. The protocol for controlling the scene of a bomb is discussed, together with the overall management of the incident; the problems experienced when a hospital's treatment facility is severely disrupted are highlighted. Lessons for major incident planning and execution are reiterated. Blast injury and the immediate care of blast victims are reviewed.

Blast Injuries↗
PubMed1995

Mutant frequency at the HPRT locus in peripheral blood T-lymphocytes of atomic bomb survivors.

The mutant frequency at the hypoxanthine-guanine phosphoribosyltransferase locus in peripheral blood lymphocytes was measured for 254 atomic bomb survivors (171 exposed and 83 control survivors) by a colony assay using recombinant human interleukin-2. Weak but significant effects were detected for atomic bomb radiation dose and smoking status at the time of examination but not for age and sex. However, the slope of the dose-response curve is quite small, and the smoking effect would not have been significant without the inclusion of data from just three individuals with extremely high mutant frequencies. The weakness of the dose response is at least partly due to the time lapse of 50 years since radiation exposure. Among the 254 survivors, 23 had chromosome aberration data in lymphocytes and the dose response was highly significant. However, the correlation between the mutant frequency and the proportion of cells with aberrations was not significant. It was concluded that the lymphocyte mutation assay is presently not sensitive enough for biological dosimetry of radiation exposure in the survivors.

Adult↗
PubMed1993

Clonal fibroblastic cell lines established from a heavily exposed atomic bomb survivor.

Two clonal fibroblast cell lines with simple chromosome aberrations-one with del(3)(p24) and the other with t(1;16)(q21;q11.2)-were established from a high dose (5.14 Gy) female atomic bomb survivor by serial culture of skin fibroblasts. These two types of clonal cells showed a more extended life span than did the cells with 44 other types of chromosome aberrations and normal cells. In addition to these results, a prominent clonal population was observed in the peripheral blood cells in this subject. It is assumed that these clonal populations arose in vivo as a result of radiation exposure to the atomic bomb.

Aged↗
PubMed1989

Atomic bomb and accident dosimetry with ESR: natural rocks and human tooth in-vivo spectrometer.

ESR dosimetry of some construction materials at Hiroshima and Nagasaki was carried out to determine the A-bomb radiation dose. Some minerals exposed to low-level natural radiation over a given geological time period can be also used to determine the intense A-bomb radiation dose. Finally, an ESR cavity and a special NdBFe (Neomax) magnet system for in-vivo measurement of radiation dose of a human tooth without extraction is designed and manufactured.

Accidents↗
PubMed2006

Plutonium isotopes derived from Nagasaki atomic bomb in the sediment of Nishiyama reservoir at Nagasaki, Japan.

The source of plutonium in sediments deposited at Nishiyama reservoir at Nagasaki was characterized by their (240)Pu/(239)Pu atom ratio. The average ratio was approximately 0.03, except in two layers. The main source of the plutonium was the Nagasaki atomic bomb. The plutonium continues to flow into the reservoir even now. The (240)Pu/(239)Pu atom ratios in two layers were higher than the average, which showed that plutonium in these layers were made of those of nuclear tests added to those of the atomic bomb.

Cesium Radioisotopes↗
PubMed2006

Infection in acute burn wounds following the Bali bombings: a comparative prospective audit.

INTRODUCTION: Bacterial colonisation and invasive bacterial infection remain the major causes of mortality and morbidity following severe burn thus ongoing surveillance of patients and monitoring of infection facilitates early intervention to minimise the risk of sepsis. The circumstances of the Bali bombings in October 2002, provided an opportunity to analyse the ramifications of lengthy transfer times, delayed resuscitation and topical treatment, on the primary incidence of burn wound infection (BWI). METHOD: This prospective clinical audit investigated the primary incidence of BWI between the usual burn patients admitted to the Burn Unit at Royal Perth Hospital, Western Australia, and a number of survivors from the Bali bombings during a 3-month audit period in 2002. BWI was identified using the Peck et al. proposed definitions for the surveillance of burn wound infections. These include impetigo, surgical wound related infection, cellulitis and invasive infection of unexcised wounds. RESULTS: The incidence of primary BWI in the Bali-tourist group (68.2%) compared with the standard WA group (18.2%) was significant (p=0.001). CONCLUSION: Sensitive assessment criteria allowed for early identification of wound infection. A clinically significant difference in the Bali-tourist group is probably related to the circumstances of their injury.

Adolescent↗
PubMed2005

Ookinete-induced midgut peroxidases detonate the time bomb in anopheline mosquitoes.

Previous analysis of the temporal-spatial relationship between ookinete migration and the cellular localization of genes mediating midgut immune defense responses suggested that, in order to survive, parasites must complete invasion before toxic chemicals ("a bomb") are generated by the invaded cell. Recent studies indicate that ookinete invasion induces tyrosine nitration as a two-step reaction, in which NOS induction is followed by a localized increase in peroxidase activity. Peroxidases utilize nitrite and hydrogen peroxide as substrates, and detonate the time bomb by generating reactive nitrogen intermediates, such as nitrogen dioxide, which mediate nitration. There is evidence that peroxidases also mediate antimicrobial responses to bacteria, fungi and parasites in a broad range of biological systems including humans and plants. Defense reactions that generate toxic chemicals are also potentially harmful to the host mounting the response and often results in apoptosis. The two-step nitration pathway is probably an ancient response, as it has also been described in vertebrate leukocytes and probably evolved as a mechanism to circumscribe the toxic products generated during defense responses involving protein nitration.

Animals↗