Late reporting incidents

Although this form of corrosion has been known for many years, the reported incidence (and therefore awareness) of white rust corrosion on new galvanized steel cooling towers has grown significantly since the late 1980s and early 1990s. 

Antivenom treatment can be complicated by early reactions (anaphylaxis), pyrogenic reactions, or late reactions (serum sickness-type). The incidence and severity of early reactions is proportional to the dose of antivenom and the speed with which it enters the blood stream (1,2). These reactions usually develop within 10-180 minutes of starting antivenom therapy. The reported incidence of early reactions after intravenous antivenom in snakebite patients, which ranges from 43% (3) to 81% (4), appears to increase with the dose and decrease when refined antivenom is used and administration is by intramuscular rather than intravenous injection. Unless patients are watched carefully for 3 hours after treatment, mild reactions can be missed and deaths misattributed to the envenoming itself. In most cases symptoms are mild urticaria, nausea, vomiting, diarrhea, headache, and fever however, in up to 40% of cases severe systemic anaphylaxis develops, with bronchospasm, hypotension, or angioedema. However, deaths are rare (5). 

Overah, the reported incidence of tacrolimus-associated nephrotoxicity varies from 18 to 42% in liver transplant patients among 128 patients who had early and late episodes of renal allograft dysfunction (1-156 weeks after transplantation) requiring biopsy, tacrohmus nephrotoxicity was estimated to account for only 17% of cases... 

The late reporting of incidents can be a difficult trend to reverse. First of all, no one likes to be the bearer of bad news, and a concerned management team will consider any accident bad news. Second, if your culture is known for accepting late reports without consequences, the trend will probably continue. There probably are a variety of reasons why any particular incident is not reported within the required time frame. A classic excuse still used with some measure of success is that the injured or reporting person was not aware that the incident was a reportable incident until after the acceptable reporting period had lapsed. For personal injuries, maybe an event occurred some weeks ago that was thought to be minor. Maybe the team member reported the injury but did not feel that it warranted incident status. Or maybe the team member failed to report the injury because the injury was believed to be minor at the time of the occurrence. 

Another unacceptable excuse used to justify late reporting of acci-dents/incidents is the lack of understanding by the safety department. For instance, if the safety department does not accept or gives back acci-dent/incident reports that are incomplete and deemed unacceptable, supervisors have been known to use this as an excuse for late reporting. From the supervisor s point of view, there is little reason to turn in a report that is incomplete when that supervisor realizes that the report will be kicked back by the safety department when the shortcoming is realized. In this case, the supervisor might wonder why the report should not just... 

Late reporting of incidents indicates a need for culture development. Incident reporting should be performed within the required time frames with no room for late reporting. When a team member mentions even the most minor of incidents, the supervisor must realize the potential for this report to change over time. The procedures for reporting such an incident must be adhered to. Even if there is no provision for formally reporting a minor incident, the supervisor should jot down the informal report in his or her planner and note the event for future reference. 

A number of endocrine factors have been linked to the incidence of breast cancer.5,6 Many of these relate to the total duration of menstrual life. Early menarche (prior to age 12) and late menopause (after age 55) increase a women s breast cancer risk. Similarly, investigators have reported that bilateral oophorectomy prior to age 35 reduces the relative risk of developing breast cancer. Nulliparity and a late age at first birth (greater than or equal to 30 years) have been reported to increase the lifetime risk of developing breast cancer twofold. 

There are reports that the use of robotic milking systems will significantly reduce mastitis, linked at least partially to the machines more efficient teat disinfection compared to human operators. However, the more frequent visit to be milked and more gentle application and removal of milking equipment from the teats may also contribute to reduced mastitis incidence. On the other hand, the absence of human operators in robotically milked herds may lead to late detection and treatment of mastitis. However, this may be overcome by the introduction of conductivity detection systems which allow early signs of mastitis to be detected (Hogeveen and Meijering, 2000). 

Reason J., 1991. Too little and too late a commentary on accident and incident reporting systems, in Schaaf van der, et al. (Eds.), Near miss reporting as a safety tool, Butterworth Heinemann, Oxford. 

Trials of cisplatin-based chemoradiation have not yet demonstrated any dramatic increase in the incidence of major late complications with the addition of concurrent cisplatin. However, most of these trials did not have sufficiently mature follow-up at the time of publication to permit full evaluation of the comparative risks. Thomas et al. (35) reported a significantly higher rate of serious late bowel complications in patients who received mitomycin with or without fluorouracil than in patients who received fluorouracil alone (p = 0.004). However, Roberts etal. (27) have not yet reported an increased rate of late complications with chemotherapy in their Venezuelan study of radiation alone vs radiation plus mitomycin C and fluorouracil. Long-term follow-up of the randomized trials will be needed to improve our understanding of the influence of concurrent chemotherapy on late complications. 

Selective COX-2 inhibitors have also been shown to prevent early and late forms of colorectal neoplasia in rat models. Reddy et al. showed that administration of celecoxib inhibited aberrant colonic crypt foci (ACF) induction and multiplicity by about 40-49% in an azoxymethane-induced ACF rat model (81). Later the same investigators also showed that dietary administration of celecoxib can inhibit both the incidence and multiplicity of colon tumors by about 93 % and 97 %, respectively in the same rat model (82). Other researchers reported similar results with the Min mouse model (52). There is little data on human clinical trials with selective COX-2 inhibitors for colorectal tumor prevention. Recently Steinbach et al. conducted a double-blind, placebo-controlled study with 77 patients with FAP, and reported that treatment with celecoxib, a selective COX-2 inhibitor, for 6 mo led to a significant reduction (28%) in the number of colorectal polyps in these patients (50). Collectively, COX-2 nonspecific or specific NSAIDs appear to have chemopreventive activity against colorectal cancer development. Selective... 

Schizophrenic patients tend to be born during the late winter or early spring in the Western hemisphere, an observation that suggests the possibility of a viral infectious process in the mother and the fetus, most probably during the first trimester (19). A recent epidemiological report, however, indicates that viral exposure in utero may not be as critical. Rather, postpartum stressors in relationship to the number and age distribution of siblings may be more important ( 20). Although women have an onset of illness about 6 years later than men and the course of illness is somewhat milder, they have an increased incidence of illness onset at menopause, so the lifetime incidence is essentially identical. 

Jaundice as a result of oral contraceptive treatment has been repeatedly described. Whereas in the Swedish population figures between 1 100 and 1 4000 were published when the early high-dose formulations were still in use (213), the overall incidence was estimated in 1979 at about 1 10 000 (9), and the current incidence is certainly further reduced. When such hepatic symptoms occur, they usually do so within the first month of medication (214), and jaundice may be accompanied by anorexia, malaise, and pruritus. Very few cases arise after the third month of medication and those reported are regarded by some as unlikely to be due to oral contraceptives. Microscopic examination of the liver shows intrahepatic cholestasis. When medication is stopped, symptoms usually disappear rapidly and the reaction does not seem to leave any sequelae (215). Genetic components seem to be important for the development of the reaction women who have experienced jaundice or severe pruritus in late pregnancy seem to be especially susceptible to jaundice or gallbladder disease when using... 

It just does not intuitively seem clear that if what appears as only bracket bolts are removed, the valve stem will be ejected by pressure within the piping. The proper procedure is very clear to me now, but I did not identify the problem at first. I have heard two other reports in the late 1970s or early 1980s within Louisiana of incidents caused by improper valve actuator removal complete with ejecting of the stem that did not result in as serious situations. 

The U.S. Chemical Safety and Hazard Investigation Board (CSB) matured in the late 1990s, and their mission is to promote the prevention of chemical accidents. The foci of the CSB are on-site and off-site chemical safety, determining causes and preventing chemical-related incidents, fatalities, injuries, and property-damage, and enhancing environmental protection. The CSB started investigations of selected important chemical plant and refinery incidents in about 1998, and also provide reports on the internet at http //www.chemsafety.gov/reports/. [1]... 

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