Individual Monitoring Programs Research Articles

КЛИНИЧЕСКИЕ ОСОБЕННОСТИ И ДИНАМИКА АРТЕРИАЛЬНОГО ДАВЛЕНИЯ У ДЕТЕЙ В ВОЗРАСТЕ 6 МЕСЯЦЕВ, РОЖДЕННЫХ В СРОКЕ СВЕРХРАННИХ ПРЕЖДЕВРЕМЕННОГО РОДОВ.

Children born at the time of early preterm labor (SPR) are a group with a high risk of developing cardiovascular diseases, including arterial hypertension, which can occur throughout their lives. Currently, the issues of diagnosis of high blood pressure in this category of children are relevant. Our aim of the study is to identify the clinical features and features of changes in the dynamics of blood pressure in children aged 6 months born at the time of early preterm labor. At 6 months of age, children born at the time of early preterm labor have low indicators of physical development, manifestations of vegetative-vascular dysfunction, cardiac arrhythmias, high blood pressure. High normal blood pressure was registered in 16.7% of subgroup 1 and 29.2% of subgroup 2, 13.6% in children of the comparison group (p1-2=0.001; p1-3=0.001; p2-3=0.004). Arterial hypertension was diagnosed only in the main group: 41.7% of children of subgroup 1, and 29.2% in subgroup 2 (p1-2=0.001; p1-3=0.001; p2-3=0.004). The results of laboratory data showed a statistically significant increase in the level of renin and angiotensin II in venous blood in children of the main group than in children of the comparison group. The highest levels of renin and angiotensin II were found in children weighing 500-750g. Children born in the period of early preterm labor require monthly monitoring of blood pressure levels and the development of individual dynamic monitoring programs.

Decontamination of equipment with oil and gas NORM: the need for internal individual monitoring

In the oil field, Naturally Occurring Radioactive Material - NORM is present in petroleum-forming rocks and this is related to the presence of radioactive decay series of 238U and 232Th, mainly the daughter radionuclides 226Ra and 228Ra. These radionuclides are detected during the process of production and extraction of oil and gas. They migrate from the reservoir rock and flow through the production lines until the operating areas, forming sludge and scale. The presence of 226Ra and 228Ra can be found in many pieces of equipment on the platforms, and NORM concentrations may increase due to different extraction processes. When this accumulation of NORM occurs inside the equipment, it is necessary to decontaminate them. Depending on the decontamination technique, workers can be exposed to radioactive materials contained in sludge and scale, which are released in the form of aerosols. The existing radiological risk during decontamination is based on external irradiation and internal contamination of workers, this is why an individual monitoring program covering both external and internal dosimetry is necessary. External monitoring is widely used during the routine work of decontamination of equipment, but for internal monitoring, the real importance has not been given, despite the probability of being the greatest contribution to radiological risk for workers. This article presents the need for internal individual monitoring for a comprehensive assessment of radiological risk and a general description of how it is being done in several countries to assist in the implementation of a complete individual monitoring program, mainly in Brazil.

[THE EVOLUTION OF PROACTIVE DISPENSARY MONITORING IN THE MOSCOW HEALTHCARE SYSTEM].

Economic and social losses due to epidemics of non-communicable diseases have put prevention and control of them on the first line in the field of sustainable development of the United Nations. The tasks of combating NCDs and risk factors within the framework of the Sustainable Development Goals require targeted actions on the part of States in the field of policy and legislation and provision of health systems with appropriate resources. In the Russian Federation, such work is being implemented within the framework of the national project "Healthcare", federal programs to combat oncological and cardiovascular diseases. Each subject takes into account the peculiarities of economic development, staffing, implementation of informatization processes, etc. The rapid pace of transformation of Moscow healthcare, its unique institutional structure allowed to form the basis for the effective development of a system of proactive dispensary monitoring of patients suffering from chronic diseases. The authors describe the process of formation of preventive work and organization of dynamic dispensary observation in Moscow. The paper presents in detail the organizational, administrative and technological resources used to create a unique system of dynamic dispensary observation. In addition, the article illustrates the personalized subsystem of dynamic dispensary observation in EMIAS and the institute of "physician assistant". The introduction of a proactive dispensary monitoring system will reduce premature mortality and disability among residents of the city. Moscow through an individual monitoring program and motivation for the responsible attitude of metropolitan patients to their health.

Effects of a Long-Term Monitored Exercise Program on Aerobic Fitness in a Small Group of Children with Cystic Fibrosis.

Background: The aim of this study was to investigate the effects of a monitored exercise program on aerobic fitness in children with cystic fibrosis (CF). Methods: Six children (2f/4m) with ages ranging from 6 to 14 years (11.3 ± 3.3 years.) and a mean ppFEV1 102.5 ± 13.5% pred. participated in the partially monitored 12-month exercise program. VO2peak and Wpeak were used as parameters of aerobic fitness. Incremental Cardio-Pulmonary Exercise Tests (CPETs) were performed before the program began (T1), after 6 months (T3) of monitoring, and after a further 6 months (T4) without monitoring. Habitual physical activity (HPA) was assessed with accelerometry. Results: The values of VO2peak and Wpeak improved slightly from T1 to T3 (p > 0.05), without a further increase after monitoring was stopped (T4). However, the VO2peak and Wpeak values were higher after monitoring was stopped compared to at T1. The exercise program with and without monitoring (p > 0.05) had no or only a slight effect on the FEV1 values, steps/day, and the intensity of HPA. Conclusions: Monitoring seems to facilitate the achievement of beneficial effects on physical fitness in CF children. For that reason, continuous individual exercise monitoring programs that involve close contact with an exercise therapist should be provided to maintain long-term motivation and participation in physical activities and sport activities during leisure time.

Study on type-testing of a manual TLD-reader for dosimetry programs

In a radiation individual monitoring program, the type testing of measuring devices is a great important part of the quality management system. The IEC-62387 standard applies to dosimetry systems that measure external photon and/or beta radiation within limited ranges of the associated physical parameters. In this work, a type-testing program was conducted for a manual thermoluminescence dosimetry (TLD) reader employing the IEC-62387 radiation and environmental performance criteria. The uncertainty of non-linearity of the response of the dosimetry system in a range of 0.7-850 mSv was obtained between -15% and + 17%, which fulfilled the IEC standard range of -16% to +18%. Furthermore, the total uncertainty of all reader tests was measured to be 12%, which was less than the criteria of 20% in the IEC standard. Thus, it can be concluded that the TLD reader met all requirements of the IEC standard for the reader-tests by an appropriate margin.

ОБОСНОВАНИЕ И ПРИМЕНЕНИЕ КРИТЕРИЯ ДОСТАТОЧНОСТИ ДЛЯ ИЗМЕРЕНИЙ АКТИВНОСТИ РАДИОИЗОТОПОВ УРАНА В БИОЛОГИЧЕСКИХ ПРОБАХ

Purpose: Ensuring the fulfillment of the sufficiency n criterion when measuring the activity of uranium radionuclides in biological samples carried out within the individual monitoring programme by calculation of the uncertainty and characteristics limits for measurements.
 Material and methods: The sufficiency criterion definition is given, which determines the maximum value of the decision threshold for measurements carried out for the individual monitoring of workers at which the fact of non-exceeding of the annual dose limit or permissible level takes place, taking into account the uncertainty of the dose assessment. A model approach is used to calculate the sufficiency criterion and characteristics limits when measuring the radioactive material excrected by individual workers. The model approach consisted in the development of a calculation model based on the functional dependence of measured input values on the process of radiochemical preparation and subsequent spectrometric measurement of the sample.
 Results: A model has been developed for calculating the activity of uranium radionuclides 234U, 235U and 238U in a biological sample based on the description of the procedure for spectrometric measurement, which consisted in the deposition by the electrolytic method on the target after chromatographic extraction of uranium from the urine sample. The reference radioactive solution of the 232U radionuclide added to the sample as a reference point for determining the efficiency of uranium radionuclide separation (chemical yield). Equations are obtained for calculating the values of the decision threshold and the detection limit for the total activity of the above alpha-emitting uranium radionuclides. Using these equations, the dependence of the decision threshold and the detection limit on measurement time is determined for the given input data. This allows planning the measurement time at which the activity of uranium radionuclides in the sample can be determined reliably or at which the sufficiency criterion of the measurement method will be provided (necessary in the case when the activity is not detected, that is, the measurement result is less than the decision threshold). The values of the activity of uranium radionuclides 234U, 235U and 238U and the corresponding characteristics limits for the measurement were calculated on the basis of a real example of spectrometric measurement of the activity of uranium radionuclides in a sample.
 Conclusion: Ensuring the fulfillment of the sufficiency criterion when measuring the activity of uranium radionuclides in biological samples is achieved by the correct determination of the sample measurement time. This is determined by time dependence analysis of the characteristics limits (the decision threshold and the detection limit ) for the measurement of the total activity of the above alpha-emitting uranium radionuclides 234U, 235U and 238U.

Opioid prescription patterns among urologists as compiled from within Medicare.

We aimed to evaluate opioid prescribing patterns of urologists across the United States (U.S.) and the District of Columbia (D.C.) using publicly available data from Medicare Part D. Our secondary analysis was to identify any loco-regional trends that may exist within the U.S. We queried publicly reported information from the Part D prescriber database, which is compiled from beneficiaries enrolled within the Medicare Part D prescription drug program. Only providers with the specialty description of urologist were included in this study. Between 2013 and 2017, a five-year average of 452 901 opioid claims by 9640 urologists - amounting to $5 357 114 USD and comprising 3.78% of all claims made - were identified. The state of Maine featured the highest percentage of opioid claims in relation to all claims (5.81%). West Virginia had the greatest average total opioid claims per provider (90), while Michigan featured the highest average proportion of opioid claims per provider (10.63%). The fewest opioid claims were processed within the Mid-Atlantic and New England regions. A multitude of factors likely contributes to variability between states. Urologists should be increasingly aware of their individual prescription tendencies and use available drug monitoring programs to reduce unnecessary prescriptions, all while providing more targeted and appropriate pain management.

Internal dosimetry of uranium workers exposed during the nuclear fuel fabrication process in Spain

Workers in the Juzbado plant of ENUSA in Spain are exposed to intakes of low enriched uranium during the fabrication of nuclear fuel elements for Nuclear Power Plants. CIEMAT started in 2014 an individual monitoring program for ENUSA workers consisting in routine bioassay measurements of uranium in urine by alpha spectrometry and a methodology of dose assessment based on ICRP Publications 78/68, ISO 27048 standard and IDEAS Guidelines V2. The individual monitoring program is complemented with workplace monitoring using Static Air Samplers (SAS) at the Juzbado facility. Results of routine monitoring data of 24 h-urine samples of Juzbado workforce confirmed low level of chronic intakes of uranium oxides in the plant, combined with acute intakes associated to incidents. IMBA software allows the dose assessments in complex intake regimes of occupational inhalation of Type S uranium compounds. Uncertainties of monitoring data were evaluated using the Scattering Factor approach (ISO 27048) for the intake calculation in the defined internal exposure scenario. A total of 200 workers at risk of internal exposures in the Juzbado facility were included in routine, special, confirmatory or task-related monitoring programs established by CIEMAT in agreement with ENUSA. Annual chronic intakes were assessed for 106 workers with monitoring results above the Minimum Detectable Activity (MDA = 0.50 mBq.sample−1 of 234U, 238U and 235U). Committed Effective Doses E(50) > 1 mSv/year were initially detected in 50% of these cases. Maximum annual intakes correspond to few cases of long term exposed workers with E(50) around 5 mSv/year. The preliminary study of the impact on the dose assessment using the new uranium model according to ICRP Publication 137 is presented here, showing a reduction of E(50) around a factor of 4 for workers exposed to uranium oxides re-defined as Type M/S materials (more soluble compounds, higher urinary excretion, lower dose coefficients than Type S uranium materials defined by ICRP Publications 78/68).

Hand monitoring in nuclear medicine departments in Croatia - first results

Individual hand monitoring for workers who manipulate unsealed radioactive sources in nuclear medicine is a necessity and the results can serve as the base for optimization processes. We performed an analysis of individual hand doses for medical staff preparing and applying radiopharmaceuticals (99mTc, 123I, 201Tl, 131I, or 125I) in three Croatian clinical hospitals, for a period of one year since extremity monitoring became legally mandatory in Croatia. The majority of annual hand doses for workers were below or slightly above 150 mSv per year with only a few workers exceeding the annual dose limit of 500 mSv. The analysis confirmed that the radiation protection expert's role in an individual monitoring programme and personal dosimetry is crucial in order to achieve the optimal radiation protection of workers.

Time to branch out? Application of hierarchical survival models in plant phenology

The sensitivity of phenology to environmental drivers can vary across geography and species. As such, models developed to predict phenology are typically site- or taxon-specific. Generation of site- and taxon-specific models is limited by the intensive in-situ phenological monitoring effort required to generate sufficient data to parameterize each model. Where in-situ phenological observations exist, the data are often subject to analytical issues due to the limited duration of any individual monitoring program, spotty site- and species- level coverage, lack of standardized methodology, and infrequent or variable census intervals. Together, these characteristics constrain our ability to make phenological inferences outside of select sites and taxa where long-duration, intensive monitoring has occurred. In this study, we leveraged two national, standardized phenology datasets to develop a multi-species and multi-site state-space survival model of the onset of deciduous tree and shrub spring (leaf out) and fall (leaf-color) events across temperate ecoregions of the United States. We used data from two national-scale phenological databases, a 9-year, broadly distributed dataset from the USA National Phenology Network and a 4-year dataset from the National Ecological Observatory Network, to quantify regional and interspecific variation in sensitivity to environmental drivers for both spring and fall leaf phenophases. Spring leaf out was generally promoted by longer days, spring growing degree day accumulation, overwinter chilling, and was suppressed by frost events, whereas fall leaf color was promoted by shorter days and cold accumulation. The sensitivity to most environmental drivers tended to be more variable among species than among the regions as defined here (EPA ecoregions of North America, excluding desert and tropical areas). The results of this study lay the groundwork for incorporating the growing collection of phenological observations into a generalized framework for predicting the transition states for any species, in any location.

Bioassay and alpha spectrometry in indirect monitoring of Spanish workers exposed to enriched uranium.

Workers at risk of exposure to uranium compounds should be monitored and their internal exposure quantified in terms of committed effective dose E(50) in mSv. In vitro bioassay methods can quantify uranium in urine and faeces at low activity levels. Alpha spectrometry (AS) is the most common method used for monitoring alpha-emitting radionuclides in internal dosimetry services. It provides isotopic information and low minimum detectable activity (MDA) values (≤0.50 mBq per sample). This study reports the results of a five-year monitoring of workers exposed to uranium at a Spanish Juzbado facility, which produces nuclear fuel elements enriched with up to 5 % of 235U. Monitoring included about 100 workers per year, most of whom had worked at the facility for more than 10 years before the individual monitoring programme was established. We analysed nearly 550 samples of more than 200 workers over five years. The obtained results indicate that workers were adequately protected from uranium exposure through inhalation and had an acceptably low chronic intake at the facility.

Disentangling data discrepancies with integrated population models.

A common challenge for studying wildlife populations occurs when different survey methods provide inconsistent or incomplete inference on the trend, dynamics, or viability of a population. A potential solution to the challenge of conflicting or piecemeal data relies on the integration of multiple data types into a unified modeling framework, such as integrated population models (IPMs). IPMs are a powerful approach for species that inhabit spatially and seasonally complex environments. We provide guidance on exploiting the capabilities of IPMs to address inferential discrepancies that stem from spatiotemporal data mismatches. We illustrate this issue with analysis of a migratory species, the American Woodcock (Scolopax minor), in which individual monitoring programs suggest differing population trends. To address this discrepancy, we synthesized several long-term data sets (1963-2015) within an IPM to estimate continental-scale population trends, and link dynamic drivers across the full annual cycle and complete extent of the woodcock's geographic range in eastern North America. Our analysis reveals the limiting portions of the life cycle by identifying time periods and regions where vital rates are lowest and most variable, as well as which demographic parameters constitute the main drivers of population change. We conclude by providing recommendations for resolving conflicting population estimates within an integrated modeling approach, and discuss how strategies (e.g., data thinning, expert opinion elicitation) from other disciplines could be incorporated into ecological analyses when attempting to combine multiple, incongruent data types.

Individual external dose monitoring of all citizens of Date City by passive dosimeter 5 to 51 months after the Fukushima NPP accident (series): 1. Comparison of individual dose with ambient dose rate monitored by aircraft surveys

Date (da’te) City in Fukushima Prefecture has conducted a population-wide individual dose monitoring program after the Fukushima Daiichi Nuclear Power Plant Accident, which provides a unique and comprehensive data set of the individual doses of citizens. The purpose of this paper, the first in the series, is to establish a method for estimating effective doses based on the available ambient dose rate survey data. We thus examined the relationship between the individual external doses and the corresponding ambient doses assessed from airborne surveys. The results show that the individual doses were about 0.15 times the ambient doses, the coefficient of 0.15 being a factor of 4 smaller than the value employed by the Japanese government, throughout the period of the airborne surveys used. The method obtained in this study could aid in the prediction of individual doses in the early phase of future radiological accidents involving large-scale contamination.

NUMERICAL ASSESSMENT OF 131I DEPOSITED IN THYROID FOR NON-STANDARD SITUATIONS.

At the CIEMAT whole-body counter, a low-energy germanium detector is used for the in vivo assessment of (131)I activity in thyroid, mainly for the individual monitoring programmes of workers. The detector is calibrated with a cylindrical neck phantom made of polymethyl methacrylate that mimics the neck of an adult, containing a vial with a radioactive solution. For an accurate activity assessment, it is necessary to perform the calibration of the detector with phantoms that closely reproduce the anatomy of a real person. Nevertheless, it is not affordable to count on a variety of physical phantoms covering the different anatomical characteristics that could be found over the whole population, including children. An alternative approach to face this situation is offered by the numerical calibration procedure based on Monte Carlo calculations in conjunction with realistic voxel phantoms. A series of computational voxel phantoms of different ages and dimensions have been used in this work to simulate an internal contamination of the thyroid and to estimate the response of the detector for measurements involving individuals whose anatomical characteristics differ from the reference adult man.

Reflections on a Vision for Integrated Research and Monitoring After 15 Years

In May of 1998, Owen Bricker and his co-author Michael Ruggiero introduced a conceptual design for integrating the Nation’s environmental research and monitoring programs. The Framework for Integrated Monitoring and Related Research was an organizing strategy for relating data collected by various programs, at multiple spatial and temporal scales, and by multiple science disciplines to solve complex ecological issues that individual research or monitoring programs were not designed to address. The concept nested existing intensive monitoring and research stations within national and regional surveys, remotely sensed data, and inventories to produce a collaborative program for multi-scale, multi-network integrated environmental monitoring and research. Analyses of gaps in data needed for specific issues would drive decisions on network improvements or enhancements. Data contributions to the Framework from existing networks would help indicate critical research and monitoring programs to protect during budget reductions. Significant progress has been made since 1998 on refining the Framework strategy. Methods and models for projecting scientific information across spatial and temporal scales have been improved, and a few regional pilots of multi-scale data-integration concepts have been attempted. The links between science and decision-making are also slowly improving and being incorporated into science practice. Experiments with the Framework strategy since 1998 have revealed the foundational elements essential to its successful implementation, such as defining core measurements, establishing standards of data collection and management, integrating research and long-term monitoring, and describing baseline ecological conditions. They have also shown us the remaining challenges to establishing the Framework concept: protecting and enhancing critical long-term monitoring, filling gaps in measurement methods, improving science for decision support, and integrating the disparate integrated science efforts now underway. In the 15 years since the Bricker and Ruggiero (Ecol Appl 8(2):326–329, 1998) paper challenged us with a new paradigm for bringing sound and comprehensive science to environmental decisions, the scientific community can take pride in the progress that has been made, while also taking stock of the challenges ahead for completing the Framework vision.

Statistical Considerations for Improved Signal Identification from Repeated Measurements at Low Signal-to-background Ratios

Continuously repeated or frequent periodic measurements of the radiation environment in the absence of an identified source of ionizing radiation provide large data sets on the ambient background. Statistical evaluation of these data allows for the identification and quantification of the relevant background distribution parameters paramount to establishing a well characterized background distribution. Given this distribution, the determination of characteristic limits, such as the decision threshold, follows standard procedures. However, the data used to establish these characteristic limits contain additional information on the probabilities for future individual measurement results, which can be employed to improve the detection system capabilities for signal identification at low signal-to-background ratios. In particular, a statistical evaluation of the time history of individual, independent measurements allows for the establishment of new decision thresholds with the same prescribed probability of error of the first kind but with a lower value than the decision threshold obtained from standardized procedures. A rigorous mathematical and statistical treatment of multiple data from a well characterized background distribution is presented, together with an analysis of the relevant operational restrictions and statistical conditions for which an improved lower decision threshold can be obtained. A set of initial projections toward the application of appropriate statistical algorithms is intended to provide a basis for further investigation of these statistical considerations for their implementation in continuous scanning or screening operations or in individual or environmental monitoring programs.

Individual monitoring for internal contamination with plutonium compounds at JAEA-NCL

This paper provides an outline of an individual monitoring programme for internal contamination with Pu compounds and some of the knowledge obtained from experience of inhalation incidents that occurred over the past few decades at the Japan Atomic Energy Agency, Nuclear Fuel Cycle Engineering Laboratories (JAEA-NCL). Most of the incidents resulted in minor exposure doses, being an average of 0.1 mSv at a mixed oxide plant and 1.5 mSv at a reprocessing plant. Only two incidents involving three workers resulted in exposure over the regulatory dose limits of that time. The maximum exposure dose, an effective dose equivalent of 90 mSv, was assessed for a worker involved in the incident that took place at the reprocessing plant in 1993. Only faecal measurements have been used in final dose assessments because alternative monitoring data have rarely been available. Further investigations on the physicochemical properties specific to Pu compounds in workplaces have therefore been needed to improve not only the accuracy of internal dose assessments but also the nasal swab method useful in deciding medical intervention.

Educational and training activities in personal dosimetry in Greece

An individual monitoring programme is one of the main components of any radiation protection programme since it constitutes the mean for assessing and thus optimising the doses of occupationally exposed workers. The Greek Atomic Energy Commission (GAEC) is the competent authority for radiation protection and nuclear safety in Greece. GAEC's educational and training activities in the field of occupational radiation protection at the national and regional (Eastern Europe) level are presented, along with the relevant activities of the University of Ioannina in the region of North-West Greece, as an example of a local education and training programme. The curricula of two postgraduate courses addressed to qualified experts and medical physics experts and mainly the modules dedicated to individual monitoring are discussed as well.

Minimum detectable annual dose calculation for routine individual monitoring programme in case of plutonium and uranium contamination of the workplace

An example of a numerical method application for minimum detectable annual dose calculation that can be guaranteed by the operating monitoring programmes for plutonium and uranium is presented. The method analyses the frequency distribution for a total number of counts obtained in n measurements performed during n monitoring intervals that are inside the calendar year. Urine sample radiometric measurement technique for plutonium and uranium operating monitoring programmes is investigated, showing dependences of the detection limits on the frequency of measurements, on number of calendar years under observation and on the activity median aerodynamic diameter (AMAD). Only a probability density function (PDF), for the background number of counts, stochastic variability of urine excretion and uncertainty of the intake pattern were taken into account as the main variables influencing the calculated detection limits. But there is no limitation for the proposed method to include the variability of other influencing model parameters in the calculation procedure.

Social-demographic profile and dose evaluation of the radiopharmaceutical facility workers

The main aims of this work are to identify the social-demographic profile of the workers based on stratification variables such as gender, age, and tasks performed by the workers, and to evaluate the annual collective doses of workers with potential risk of ionising radiation exposure at the workplace during the years 2004?2008. In this context, the knowledge of the workforce composition in the facility responsible for the radioisotope production and its distribution was used. The individual monitoring programme has been carried out by individual dosimeters, TLDs, and internal contamination monitoring (in vivo method). The reported doses, in the period studied, suggest that the external exposure was the main source of occupational exposure in radioisotope production and distribution areas. The internal exposure was not included in the doses estimated, because it was negligible. This study has an important exploratory character, in order to analyse possible correlations related to adverse health effects, aiming to provide directions for occupational epidemiology research.