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PubMed2002

Immigrants from Chernobyl-affected areas in Israel: the link between health and social adjustment.

The concept of cumulative adversity is a useful tool in the study of migration under chronic stress from past traumas. Drawing on this concept, the study explored long-term health and psychosocial effects of past radiation exposure among survivors of the Chernobyl nuclear disaster who immigrated to Israel during the 1990s. Self-rated health status and indicators of social adjustment were compared in two groups of Russian immigrants: 180 persons from Chernobyl-affected areas and 200 immigrants from other areas of the former USSR. The semi-structured questionnaire was administered by Russian-speaking sociology students and analyzed by both quantitative and qualitative methods. In line with earlier research, both the somatic and mental health of Chernobyl survivors were significantly worse than in other immigrants of the same gender and age; a significant share of reported health problems were probably psychosomatic. Depression, sense of stigma and cancer-related anxiety were more prevalent in the study group. Immigrants from contaminated areas tended to use more health services (both conventional and alternative), but were less satisfied with their quality and providers' attitude. The link between perceived health impairment and poorer social accommodation in the host country has been confirmed: Chernobyl-area immigrants experienced more severe occupational downgrading and were more disappointed with the results of their resettlement than other immigrants.

Adult↗

PubMedDate not supplied

Chernobyl radionuclides in a Black Sea sediment trap.

The Chernobyl nuclear power station accident released large quantities of vaporized radionuclides, and, to a lesser extent, mechanically released small (less than 1-10 micron) aerosol particles. The total release of radioactivity is estimated to be out of the order of 1-2 x 10(18) Bq (3-5 x 10(7) Ci) not allowing for releases of the xenon and krypton gases. The 137Cs releases of 3.8 x 10(16) Bq from Chernobyl can be compared to 1.3 x 10(18) Bq 137Cs released due to atmospheric nuclear weapons testing. Chernobyl-derived radionuclides can be used as transient tracers to study physical and biogeochemical processes. Initial measurements of fallout Chernobyl radionuclides from a time-series sediment trap at 1,071 m during June-September 1986 in the southern Black Sea are presented. The specific activities of 137Cs, 144Ce and 106Ru in the trap samples (0.5-2, 4-12 and 6-13 Bq g-1) are independent of the particle flux while their relative activities reflect their rates of scavenging in the order Ce greater than Ru greater than Cs.

Accidents↗

PubMed1998

Transgenic plants are sensitive bioindicators of nuclear pollution caused by the Chernobyl accident.

To evaluate the genetic consequences of radioactive contamination originating from the nuclear reactor accident of Chernobyl on indigenous populations of plants and animals, it is essential to determine the rates of accumulating genetic changes in chronically irradiated populations. An increase in germline mutation rates in humans living close to the Chernobyl Nuclear Power Plant site, and a two- to tenfold increase in germline mutations in barn swallows breeding in Chernobyl have been reported. Little is known, however, about the effects of chronic irradiation on plant genomes. Ionizing radiation causes double-strand breaks in DNA, which are repaired via illegitimate or homologous recombination. We make use of Arabidopsis thaliana plants carrying a beta-glucuronidase marker gene as a recombination substrate to monitor genetic alterations in plant populations, which are caused by nuclear pollution of the environment around Chernobyl. A significant (p<0.05) increase in somatic intrachromosomal recombination frequencies was observed at nuclear pollution levels from 0.1-900 Ci/km2, consistent with an increase in chromosomal aberrations. This bioindicator may serve as a convenient and ethically acceptable alternative to animal systems.

Animals↗

PubMed1997

Fitness loss and germline mutations in barn swallows breeding in Chernobyl.

The severe nuclear accident at Chernobyl in 1986 resulted in the worst reported accidental exposure of radioactive material to free-living organisms. Short-term effects on human populations inhabiting polluted areas include increased incidence of thyroid cancer, infant leukaemia, and congenital malformations in newborns. Two recent studies have reported, although with some controversy, that germline mutation rates were increased in humans and voles living close to Chernobyl, but little is known about the viability of the organisms affected. Here we report an increased frequency of partial albinism, a morphological aberration associated with a loss of fitness, among barn swallows, Hirundo rustica, breeding close to Chernobyl. Heritability estimates indicate that mutations causing albinism were at least partly of germline origin. Furthermore, evidence for an increased germline mutation rate was obtained from segregation analysis at two hypervariable microsatellite loci, indicating that mutation events in barn swallows from Chernobyl were two- to tenfold higher than in birds from control areas in Ukraine and Italy.

Albinism↗

PubMed2006

RET rearrangements in post-Chernobyl papillary thyroid carcinomas with a short latency analysed by interphase FISH.

Tissue samples from 13 post-Chernobyl childhood thyroid tumours that occurred within a short period of time (4-8 years) after the Chernobyl accident have been investigated by interphase FISH analysis for rearrangements of RET. In all, 77% of cases showed RET/PTC rearrangements and a distinct intratumoural genetic heterogeneity. The data were compared to findings on 32 post-Chernobyl PTCs that occurred after a longer period of time (9-12 years) after the accident. In none of the cases from either group were 100% of cells positive for RET rearrangement. In addition, the pattern of RET-positive cells was different in the two groups (short vs longer latency). A significant clustering of aberrant cells could be detected in the long-latency subgroup, whereas the aberrant cells were more homogeneously distributed among the short-latency tumours. The findings suggest that oligoclonal tumour development occurs in post-Chernobyl PTCs. This pattern of different clones within the tumour appears to become more discrete in cases with longer latencies, suggesting either outgrowth of individual clones or development of later subclones with time.

Adolescent↗

PubMed2002

Has fallout from the Chernobyl accident caused childhood leukaemia in Europe? A commentary on the epidemiologic evidence.

BACKGROUND: According to radiation risk estimates uniformly adopted by various official organizations, exposure to Chernobyl fallout is unlikely to have caused any measurable health risk in central Europe. METHODS: A re-evaluation of ECLIS (European Childhood Leukaemia and Lymphoma Incidence Study), a large IARC-coordinated project in the context of various published studies. RESULTS: ECLIS revealed a slightly higher leukaemia incidence in the most contaminated European regions, and an increasing trend with estimated cumulative excess radiation dose. The excess corresponds to 20 cases of childhood leukaemia in the study area up to 1991. More recent evidence from Greece and Germany indicates significantly higher risks in the cohort of children in utero at the time of the initial fallout. In Greece, a positive trend was observed over three regions of increasing average fallout contamination. CONCLUSION: Chernobyl fallout could well have caused a small, but significant excess of childhood leukaemia cases in Europe. The etiologic mechanism might include an induction of chromosome aberrations in early pregnancy. Increased risks in the birth cohort exposed in utero correspond to 11 excess cases in Greece and another 11.4 excess cases in Germany. Exposure misclassification and underascertainment of incident cases render post-Chernobyl risk estimates probably too low. If indeed Chernobyl fallout has caused childhood leukaemia cases in Europe, we would also expect an increased incidence for other childhood cancers and excess malignancies in adults as well as non-malignant diseases of all ages. Neither of these endpoints has as yet been systematically studied.

Adolescent↗

PubMed1999

Evaluation of the impact of Chernobyl on the prevalence of congenital anomalies in 16 regions of Europe. EUROCAT Working Group.

BACKGROUND: Surveillance data from population-based congenital anomaly registers in 16 regions of Europe (mainly Western Europe) were analysed to assess the impact of the Chernobyl accident on the prevalence of selected congenital anomalies. METHODS: Three cohorts of pregnancies were defined: those exposed during the first month following Chernobyl (External Exposure Cohort), the first year (Total Exposure Cohort) and the two subsequent years (Control Cohort). Expected numbers of congenital anomalies in these cohorts were calculated from 1980-1985 baseline rates. Registries were grouped into three exposure categories according to first-year exposure estimates. RESULTS: There was no overall or dose-related increase in prevalence in the two exposed cohorts for Down's Syndrome, neural tube defects, other central nervous system defects or eye defects. There was a statistically significant overall 22% (95% CI: 13-31%) excess of Down's Syndrome in the Control Cohort, with no dose-response relationship. CONCLUSIONS: Chernobyl had no detectable impact on the prevalence of congenital anomalies in Western Europe, suggesting that in retrospect the widespread fear in the population about the possible effects of exposure on the unborn fetus was not justified. An increasing prevalence of Down's Syndrome in the 1980s, probably unrelated to Chernobyl, merits further investigation.

Abnormalities, Radiation-Induced↗

PubMed2000

Schizophrenia spectrum disorders in persons exposed to ionizing radiation as a result of the Chernobyl accident.

We studied schizophrenia spectrum disorders in Chernobyl accident survivors by analyzing Chernobyl exclusion zone (EZ) archives (1986-1997) and by conducting a psychophysiological examination of 100 patients with acute radiation sickness (ARS) and 100 workers of the Chernobyl EZ who had worked as "liquidators-volunteers" for 5 or more years since 1986-1987. Beginning in 1990, there has been a significant increase in the incidence of schizophrenia in EZ personnel in comparison to the general population (5.4 per 10,000 in the EZ versus 1.1 per 10,000 in the Ukraine in 1990). Those irradiated by moderate to high doses (more than 0.30 Sv or 30 rem), including ARS patients, had significantly more left frontotemporal limbic and schizophreniform syndromes. We hypothesized that ionizing radiation may be an environmental trigger that can actualize a predisposition to schizophrenia or indeed cause schizophrenia-like disorders. The development of schizophrenia spectrum disorders in overirradiated Chernobyl survivors may be due to radiation-induced left frontotemporal limbic dysfunction, which may be the neurophysiological basis of schizophrenia-like symptoms. Persons exposed to 0.30 Sv or more are at higher risk of schizophrenia spectrum disorders. An integration of international efforts to discuss and organize collaborative studies in this field is of great importance for both clinical medicine and neuroscience.

Adult↗

PubMed1996

The results of selective cytogenetic monitoring of Chernobyl accident victims in the Ukraine.

Selective cytogenetic monitoring of the highest priority groups of Chernobyl disaster victims has been carried out since 1987. In 1992-1993, 125 liquidators (irradiated mainly in 1986) and 42 persons recovering from acute radiation sickness of the second and third degrees of severity were examined. Cytogenetic effects (an elevated level of unstable as well as stable markers of radiation exposure) were found in all groups, which showed a positive correlation with the initial degree of irradiation severity even 6-7 y after the accident. Comparative scoring of conventional staining vs. G-banding in 10 liquidators showed the identical rate of unstable aberrations. At the same time, the yield of stable aberrations for G-banded slides exceeded the frequency for conventional staining. In order to study possible mutagenic activity of chronic low levels of irradiation, the cytogenetic monitoring of some critical groups of the population (especially children and occupational groups--tractor drivers and foresters) living in areas of the Ukraine contaminated by radionuclides was carried out. In all the examined groups, a significant increase in the frequency of aberrant metaphases, chromosome aberrations (both unstable and stable), and chromatid aberrations was observed. Data gathered from groups of children reflect the intensity of mutagenic impact on the studied populations and demonstrate a positive correlation with the duration of exposure. Results of cytogenetic examination of adults confirmed the importance of considering the contribution of occupational radiation exposure to genetic effects of Chernobyl accident factors on the population of contaminated areas. Results of our investigations demonstrated the possibility of evaluating the mutagenic impact of acute and long-term irradiation of different intensities on somatic cells of persons undergoing radiation exposure due to the Chernobyl accident and confirmed the need to introduce new informative genetic methods [especially fluorescence in situ hybridization (FISH)] for reliable retrospective cytogenetic dosimetry of radiation exposure in Chernobyl accident victims.

Adult↗

PubMed1996

Incidence of neoplasms in ages 0-19 y in parts of Sweden with high 137Cs fallout after the Chernobyl accident.

The incidence of neoplasms in childhood and adolescence in northern and central Sweden before and after the radioactive fallout from the Chernobyl accident was investigated in an ecologic study, 1978 to 1992. The study included all parishes in the six most contaminated counties classified after aerial mapping of ground radiation from 137Cs and investigated 746 cases of neoplasms in ages 0-19 y, diagnosed in the six counties. Incidence and relative risks of neoplasms were compared in areas with high, intermediate, and low contamination after versus before the Chernobyl accident in 1986. A continuous increase of brain tumor incidence in the ages 0-19 y during the period 1978-92 without clear relationship to the Chernobyl fallout was discovered. No clear relationship between the incidence of brain tumor and the exposure to varying levels of radiation from 137Cs was apparent. A somewhat decreased relative risk of acute lymphatic leukemia appeared in areas with increased exposure. Other neoplasms showed no changes in incidence over time or with regard to exposure. Until now, there is no indication that the Chernobyl accident has affected the incidence of childhood and adolescence neoplasms in Sweden, but it is still too early for any final conclusion about the effect of this event.

Adolescent↗

PubMed2003

Thyroid cancers in France and the Chernobyl accident: risk assessment and recommendations for improving epidemiological knowledge.

From 1975 to 1995, the incidence of thyroid cancer in the French population increased by a factor of 5.2 in men and 2.7 in women, thereby raising public concerns about its association with the nuclear accident at Chernobyl. A study performed at the request of French health authorities sought to quantify the potential risk of thyroid cancer associated with the Chernobyl fallout in France in order to determine if this risk could be observed through an epidemiological approach. The study focused on the most exposed population: those living in eastern France and younger than 15 y at the time of the Chernobyl nuclear power plant accident (26 April 1986). The number of spontaneous thyroid cancers in this population was predicted from French cancer registry data, and the thyroid doses were estimated from all available data about contamination in France. Associated risks were calculated with different risk models, all based on a linear no-threshold dose-effect relationship. Under this hypothesis, from 1.3 to 22 excess thyroid cancer cases were predicted for the 1991-2000 period, compared with the 212 spontaneous cases (0.5 to 10.5%) predicted, and from 11.2 to 55.2 excess cases were predicted for 1991-2015, compared with the 1,342 spontaneous cases (0.8 to 4.1%) predicted. These risk calculations indicate that the Chernobyl fallout cannot explain the entire increase in thyroid cancers in France, and that it is improbable that an epidemiological study could demonstrate such an excess. The surveillance of thyroid cancers in France should be enhanced.

Adolescent↗

PubMed2006

The risk of radiation-induced cerebrovascular disease in Chernobyl emergency workers.

The paper deals with estimating radiation risks of non-cancer diseases of the circulatory system among the Chernobyl emergency workers based on data from the Russian National Medical and Dosimetric Registry. The results for the cohort of 61,017 people observed between 1986 and 2000 are discussed. These are essentially updated results for the similar cohort that was studied by authors earlier in 1986-1996. Newly discovered is the statistically significant dose risk of ischemic heart disease [ERR Gy = 0.41, 95% CI = (0.05; 0.78)]. Confirmation is provided for the existence of significant dose risks for essential hypertension [ERR Gy = 0.36, 95% CI = (0.005; 0.71)] and cerebrovascular diseases [ERR Gy = 0.45, 95% CI = (0.11; 0.80)]. In 1996-2000, the assessed ERR Gy for cerebrovascular diseases was 0.22 with 95% CI = (-0.15; 0.58). Special consideration is given to cerebrovascular diseases in the cohort of 29,003 emergency workers who arrived in the Chernobyl zone during the first year after the accident. The statistically significant heterogeneity of the dose risk of cerebrovascular diseases is shown as a function of the duration of stay in the Chernobyl zone: ERR Gy = 0.89 for durations of less than 6 wk, and ERR Gy = 0.39 on average. The at-risk group with respect to cerebrovascular diseases are those who received external radiation doses greater than 150 mGy in less than 6 wk [RR = 1.18, 95% CI = (1.00; 1.40)]. For doses above 150 mGy, the statistically significant risk of cerebrovascular diseases as a function of averaged dose rate (mean daily dose) was observed: ERR per 100 mGy d = 2.17 with 95% CI = (0.64; 3.69). The duration of stay within the Chernobyl zone itself, regardless of the dose factor, had little influence on cerebrovascular disease morbidity: ERR wk = -0.002, with 95% CI = (-0.004; -0.001). The radiation risks in this large-scale cohort study were not adjusted for recognized risk factors such as excessive weight, hypercholesterolemia, smoking, alcohol consumption, and others.

Cerebrovascular Disorders↗

PubMed1987

Nuclear power after Chernobyl.

The causes and progress of the accident at Chernobyl are described, and a comparison between the Chernobyl accident and the 1979 accident at the Three Mile Island nuclear power station is made. Significant similarities between Chernobyl and Three Mile Island include complacency of operators and industry, deliberate negation of safety systems, and a lack of understanding of their plant on the part of the operators, which shows the critical importance of the human element. The Chernobyl accident has implications for nuclear power in the United States; it will affect the research program of the Nuclear Regulatory Commission, regulation of Department of Energy reactors, new reactor designs, and public attitudes.

Accident Prevention↗

PubMed1994

Risk of acute childhood leukaemia in Sweden after the Chernobyl reactor accident. Swedish Child Leukaemia Group.

OBJECTIVE: To evaluate the risk of acute childhood leukaemia in areas of Sweden contaminated after the Chernobyl reactor accident in April 1986. DESIGN: Population based study of childhood leukaemia diagnosed during 1980-92. SETTING: Coordinates for places of residence of all 1.6 million children aged 0-15 years; aerial mapped areas of Sweden heavily contaminated after the Chernobyl accident. SUBJECTS: 888 children aged 0-15 years with acute leukaemia diagnosed in Sweden during 1980-92, identified with place of birth and residence at diagnosis. MAIN OUTCOME MEASURES: Risk of leukaemia in areas contaminated after the Chernobyl accident compared with the rest of Sweden and in the same areas before the accident. RESULTS: During six and a half years of follow up after the accident the odds ratio for acute leukaemia was 0.9 (95% confidence interval 0.6 to 1.4) in highly contaminated areas (> or = 10 kBq/m2) compared with the same areas before the accident. For the subgroup acute lymphoblastic leukaemia in children aged under 5 years at diagnosis the odds ratio was 1.5 (0.8 to 2.6). For all cases diagnosed after May 1986 in highly contaminated areas compared with areas of low contamination the odds ratio was 0.9 (0.7 to 1.3). For acute lymphoblastic leukaemia in children aged under 5 years at diagnosis the odds ratio was 1.2 (0.8 to 1.9) in highly contaminated areas compared with areas of low contamination. Dose-response analysis showed no correlation between the degree of contamination and the incidence of childhood leukaemia. CONCLUSION: There has been no significant increase in the incidence of acute childhood leukaemia in areas of Sweden contaminated after the Chernobyl reactor accident.

Accidents↗

PubMedDate not supplied

Breast cancer trends in two oblasts of Belarus and the Chernobyl accident.

The 1986 Chernobyl accident contaminated 23% of Belarus with radioactive iodine and long half-life radionuclides. Radiation causes breast cancer. Population-based breast cancer incidence data from the Belarus National Cancer Registry were used to study secular trends and urban-rural differences, and determine whether an effect of Chernobyl radiation exposure was discernable. Trends in age-standardized incidences in Gomel and Vitebsk oblasts maximally and minimally exposed to Chernobyl radiation, respectively, were compared for 1978-2003 among all women, and women aged 30-49, separately for urban and rural areas. Incidences were higher and increasing more rapidly in urban than rural areas of both oblasts, annually increasing 0.150 +/- 0.008 vs. 0.098 +/- 0.007 new cases per 10,000 persons, p < 0.00005. Levels were similar in urban Gomel and Vitebsk, and slightly higher in rural Vitebsk than rural Gomel. For ages 30-49 trends in urban and rural Gomel and rural Vitebsk were similar to the all-ages rural trend: common urban/rural Gomel slope 0.098 +/- 0.015, rural Vitebsk slope 0.091 +/- 0.022. In urban Vitebsk, significant but erratic nonlinearity suggested stabilizing incidence since the mid-nineties after a sharp rise. However, recent declines in slopes, greater in Vitebsk, are nonsignificant. Secular breast cancer increases in Gomel have been generally consistent for 26 years. Secular increases in Vitebsk have been similar, but could be slowing. However, these data provide no convincing evidence for Chernobyl-induced breast cancer in Belarus.

Adult↗

PubMed1996

Thyroid lesions in children and adolescents after the Chernobyl disaster: implications for the study of radiation tumorigenesis.

Eight years after the Chernobyl nuclear accident, the most obvious effect is manifested by an increase in the prevalence of thyroid gland diseases in the exposed children and adolescents. In this study, we describe a comparative analysis of epidemiological, clinical, and morphological features of 92 malignant and 59 benign thyroid lesions from patients 5-18 yr of age exposed to radiation in Belarus as a result of the Chernobyl disaster. All of them were operated at the same institution during the period from September 1991 through December 1992. The highest number of patients that subsequently developed thyroid carcinomas was in the group that was less that 1 yr of age at the time of Chernobyl, and this number decreased progressively through age 12 yr. Conversely, none of the patients with benign lesions only was less than 2 yr old at the time of the accident, and an exposure age of 5-6 yr was a threshold separating significant prevalence of malignant tumors in younger children from the more frequent benign lesions in older patients (P < 0.001). Fifty-two percent of children with carcinomas and only 24% with benign lesions (P < 0.005) were residents of the Gomel region, which is the most contaminated in Belarus. The morphology of thyroid tissue adjacent to carcinomas showed a high prevalence of multinodular and diffuse changes, but not of adenomas or solitary adenomatoid nodules. There was a high prevalence of focal micropapillary hyperplasia with graded degrees of severity, which we hypothesize may correspond to precursors for papillary thyroid carcinoma in post-Chernobyl radiation-associated tumors.

Adolescent↗

PubMed1999

High prevalence of RET/PTC rearrangements in Ukrainian and Belarussian post-Chernobyl thyroid papillary carcinomas: a strong correlation between RET/PTC3 and the solid-follicular variant.

A sharp increase in the incidence of pediatric thyroid papillary cancer was documented after the Chernobyl power plant explosion. An increased prevalence of rearrangements of the RET protooncogene (RET/PTC rearrangements) has been reported in Belarussian post-Chernobyl papillary carcinomas arising between 1990 and 1995. We analyzed 67 post-Chernobyl pediatric papillary carcinomas arising in 1995-1997 for RET/PTC activation: 28 were from Ukraine and 39 were from Belarus. The study, conducted by a combined immunohistochemistry and RT-PCR approach, demonstrated a high frequency (60.7% of the Ukrainian and 51.3% of the Belarussian cases) of RET/PTC activation. A strong correlation was observed between the solid-follicular subtype of papillary carcinoma and the RET/PTC3 isoform: 19 of the 24 RET/PTC-positive solid-follicular carcinomas harbored a RET/PTC3 rearrangement, whereas only 5 had a RET/PTC1 rearrangement. Taken together these results support the concept that RET/PTC activation plays a central role in the pathogenesis of thyroid papillary carcinomas in both Ukraine and Belarus after the Chernobyl accident.

Adolescent↗

PubMed1987

The Chernobyl reactor accident: the impact on the United Kingdom.

I had originally thought that by this time, nearly 1 year after the Chernobyl reactor accident, I would be in a position to describe fully its impact on the UK in terms of radiation doses, economics and future emergency planning. However, only one of these is reasonably clear-the radiological impact. We shall continue our measurements, particularly those of activity in persons, and doubtless we shall refine our estimates of collective dose, but they are unlikely to change significantly. We can therefore be certain that the radiological impact on the UK was small and that the health effects will not be detectable. Predictions of the consequences of accidental releases of radionuclides have in the past, perforce, relied upon models of environmental transfer. Data on which the models are based were obtained from investigations of weapons fallout and of routine releases from nuclear facilities. The Chernobyl accident provided a situation of activity deposition that was well characterised in time and in geographical distribution, and measurements along environmental pathways will allow us to validate or refine our models. This accidental deposition reinforced the importance of some effects that we knew about-such as the importance of wet deposition-and will cause us to consider the need to take account of specific situations that we had not considered previously in adequate detail-in particular, the behaviour of radionuclides in upland ecosystems. The overall economic impact is not yet clear and, unfortunately, is unlikely to become so until all restrictions on the movement and slaughter of sheep are removed and the farmers have received compensation. The effect on international trade may never be quantified. Some international agencies are evaluating the consequences of Chernobyl and their reports will become available during 1987. International agreements on intervention levels are also still under discussion and it would be premature to speculate about the need for any fundamental revisions to Emergency Reference Levels and derived quantities. Similarly, we are aware of the need for revision of the national emergency plan, but we are awaiting the government decision on this. One effect of the Chernobyl accident, however, is clear: the public's awareness of radiation issues has reached a new height. Members of the public demand information and advice, and better means of communicating these must be provided. Advice to take some action may provoke unnecessary alarm, but advice that no action is required may be distrusted. We cautiously assume that any dose, no matter how small, has some deleterious effect and yet, in situations of accidental releases, we may tell the public that no actions are required to reduced doses that they may consider appreciable and avoidable. We clearly need to promote a better understanding of the nature and acceptability of the risk of radiation doses in such circumstances and we intend to do so.

Accidents↗