Direct causes

This type of scanning produces positioning data which is false in both x- and y-direction caused by the fact that acqusition software operates assuming that the shape of the test object is cylindrical. 

In some cases, the loss of utility supply is not a direct cause of overpressure, but... 

At the next organizational level are factors directly causing error 1) job characteristics such o Complexity, time stress, noise, lighting, environment, or mental requirements, and 2) individual factors such as personality, and team performance. These, collectively, are called performance-influencing factors, or PIFs. 

Core damage can result most likely from heat imbalance. Figure 6.3-3 is an example from the Indian Point PRA that uses heat imbalance to approach completeness. This diagram shows that cote damage may result from either a loss of cooling or excess power (or both). The direct causes of insufficient heat removal may be loss of flow, makeup water, steam flow, or heat extraction by the turbine. Indirect causes are reactor trip or steam line break inside or outside of containment. Cau.ses of excess power production are rod withdrawal, boron removal, and cold water injection. 

Elimination of the position of maintenance supervisor on the second and third shifts (this was a direct cause of the failure to install the blind flange)... 

When an explosion occurs, however, it can directly cause injury. A substantial cloud of gas can accumulate before the combustible limit reache.s an ignition source. The force of the explosion as the cloud ignites can be substantial. 

Fragments flying in all directions caused the deaths of four persons. Within an area of 150 m (500 ft) around the tank yard, many people were injured. Among them were fifteen who suffered from serious injury by freezing and the impact of fragments. 

Measures to reduce human error are often implemented at an existing plant, rather than during the design process. The decision to conduct an evaluation of the factors that can affect error potential at an existing plant may be taken for several reasons. If human errors are giving rise to unacceptable safety, quality or production problems, plant management, with the assistance of the workforce, may wish to carry out a general evaluahon or audit of the plant in order to identify the direct causes of these problems. 

In the shorter case studies, only the immediate causes of the errors are described. However, the more extended examples in the latter part of the appendix illustrate two important points about accident causation. First, the precondihons for errors are often created by incorrect policies in areas such as training, procedures, systems of work, communications, or design. These "root causes" underlie many of the direct causes of errors which are described in this section. Second, the more comprehensive examples illustrate the fact that incidents almost always involve more than one cause. These issues will... 

It is therefore useful to distinguish between active and latent errors or failures. An active human error has an immediate effect in that it either directly causes a hazardous state of the system or is the direct initiator of a chain of events which rapidly leads to the imdesirable state. 

Corrosion (direct cause) due to Design error (basic or root cause) not recovered by Inspection (failure of recovery)... 

Incident reporting systems, designed to identify underlying and direct causes for larger numbers of incidents with relatively minor causes... 

With regard to this issue, it can be argued that a knowledge of the psychological processes imderlying error may not be necessary in order to carry out effective incident analyses. If the direct causes of errors are identified, in the form of the PIFs that were present when the error occurred, then it may appear to be unnecessary to try to evaluate the actual mental processes that occurred. 

Management and Policy Influences on Error and Accident Causation As has been emphasized in Chapters 1,2, and 3, the system-induced error view states that it is insufficient to consider only the direct causes of errors. The underlying organizational influences also need to be taken into accoimt. However, most of the available techniques stop when an immediate cause has been identified, such as less than adequate procedures or poor equipment design. The questions of why the procedures were poor, or why the equipment was badly designed, are rarely addressed at the level of policy. Kletz (1994a)... 

At typical indoor concentrations, COj is not thought to be a direct cause of adverse health effects however, COj is an easily-measured surrogate for other occupant-generated pollutants. Eye, nose, and throat irritation headaches lung cancer may contribute to heart disease buildup of fluid in the middle ear increased severity and frequency of asthma episodes decreased lung function. ETS is also a source of odor and irritation complaints. 

This type of disease occurs in families and begins unusually at early age (i.e., onset below the age of 60). Approximately 10% of Alzheimer s disease are familial and are inherited in an autosomal dominant manner with high penetrance. Deterministic genes directly cause the disease. Mutations in three different genes encoding for the amyloid precursor protein (APP) and the presenilins 1 and 2 (PS1 and PS2) have been identified to be responsible for early-onset familial Alzheimer s disease. 

Once essential hypertension develops, management of this disorder becomes a lifetime task. When a direct cause of the hypertension can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks first, with tumors or other abnormalities of the adrenal glands following. In malignant hypertension the diastolic pressure usually exceeds 130 mm Hg. In secondary hypertension,... 

A positive feedback between vegetation and atmospheric CO2 will occur if biomass declines. This will happen to the extent that climatic warming causes increased water stress, either through decreased precipitation or increased evap-otransporation, particularly on soils of low water-holding capacity. Decreases in soil nutrient availability, either directly caused by drought or indirectly caused by replacement with taxa with more recalcitrant litter, may further decrease the net release of carbon from the biosphere to the atmosphere. Positive feedback will also arise if the current standing biomass of trees is replaced by small trees, shrubs, and herbs that store less carbon. 

Brain-injured patients commonly experience fever, and hyperthermia may correlate with poor outcome in these patients, although a direct causative link has yet to be established. The impact of fever on patients in a neurocritical care unit has been evaluated, and after controlling for severity of illness, diagnosis, age, and complications, increased body temperature was found to strongly associate with an increased length of ICU and hospital stay, as well as higher mortality and... 

Since the histogram gives a probability density function of the particle position, the correlation in the velocities Vy and V2j in the j-direction causes the change in the shape of the histogram plotted against Vy and V2j, due to the different coefficient y — Pj in... 

One eritical factor that has been neglected in considering mechanisms of cardiac fatalities is the timeframe for various types of toxicities. For example, a majority of cocaine-related fatalities and near fatalities reported from emergency rooms are attributed to one or more types of cardiac ischemic or hypertensive episodes (Isner et al. 1986). Thus, these studies may discount the cocaine-induced arrhythmias and conduction defects as important direct causes of fatalities. Yet, if coroner reports are used as data sources (Virmani et al. 1988 Wetli and Wright 1979 Mittleman and Wetli 1984), there are great numbers of deaths in which pulmonary effusion and lack of evidence for coronary occlusion, acute myocardial infarction, or... 

Determine if drug therapy may be contributing to ARF. Consider not only drugs that can directly cause ARF (e.g., aminoglycosides, amphotericin B, NSAIDs, cyclosporine, tacrolimus, ACE inhibitors, and ARBs), but also drugs that can predispose a patient to nephrotoxicity or prerenal ARF (i.e., diuretics and anti hypertensive agents). 

Initiation factors, which directly cause CKD. These factors are modifiable by pharmacologic therapy. 

The mean survival time of persons with AD is reported to be approximately 6 years from the onset of symptoms until death. However, age at diagnosis, severity of AD, and other medical conditions affect survival time.8 Although AD does not directly cause death, it is associated with an increase in various risk factors which often contribute to death such as senility, sepsis, stroke, pneumonia, dehydration, and decubitus ulcers. 

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