International Reference Research Articles

A Review: Assessment of Hba1c as A Diagnostic Tool in Diabetes Mellitus

Background: Hemoglobin A1C (HbA1c) measures the average plasma glucose level over the two to three months before by expressing the ratio of total to glycated hemoglobin. It has emerged as the most significant indicator of long-term hyperglycemia and is highly associated with late complications from diabetes. Now that the analysis has been standardized, it may be linked to international reference sources and reference techniques. The major method for identifying diabetes was made possible by the standardization of HbA1c analyses. The addition of HbA1c as a diagnostic tool will simplify the diagnosis of diabetes compared to the glucose criteria, and should increase the avoidance of late consequences of diabetes, despite some limitations in which HbA1c is not reflective of average glucose concentration.

Food Insecurity and Social Policy: A Comparative Analysis of Welfare State Regimes in 19 Countries.

We sought to determine whether a country's social policy configuration-its welfare state regime-is associated with food insecurity risk. We conducted a cross-sectional study of 2017 U.N. Food and Agriculture Organization individual-level food insecurity survey data from 19 countries (the most recent data available prior to COVID-19). Countries were categorized into three welfare state regimes: liberal (e.g., the United States), corporatist (e.g., Germany), or social democratic (e.g., Norway). Food insecurity probability, calibrated to an international reference standard, was calculated using a Rasch model. We used linear regression to compare food insecurity probability across regime types, adjusting for per-capita gross domestic product, age, gender, education, and household composition. There were 19,008 participants. The mean food insecurity probability was 0.067 (SD: 0.217). In adjusted analyses and compared with liberal regimes, food insecurity probability was lower in corporatist (risk difference: -0.039, 95% CI -0.066 to -0.011, p = .006) and social democratic regimes (risk difference: -0.037, 95% CI -0.062 to -0.012, p = .004). Social policy configuration is strongly associated with food insecurity risk. Social policy changes may help lower food insecurity risk in countries with high risk.

Modeling Total Electron Content and Critical Frequency at F1 and E Layer Boundary

This work investigates the variation of the total electron content TEC and the critical frequency fo in the boundary zone of the F1 and E layers at the low-latitude in the ionosphere. This study takes place at the Ouagadougou station (12.4°N and 358.5°E), in West Africa during the quiet geomagnetic activity of solar cycle 23. Ionosphere is the upper layer of the Earth's atmosphere ionized mainly by solar X- and UV-rays, extending from around 80km altitude up to 1000km [1] [2]. Ultraviolet light from the sun ionizes the atoms and molecules in the Earth's upper atmosphere [3]. For this study we use the 2016 version of International Reference Ionosphere (IRI) model. The quiet periods of maximum and minimum phase of solar cycle 23 are considered [4] [5]. From this study, it emerges that at the E and F1 layer boundary zone, TEC and fo increase during the day as solar irradiance increases and decrease as solar irradiance decreases.

Изучение прогресса повышения точности прогноза параметров вращения Земли в российском и международном центрах определения ПВЗ за последние 16 лет

The paper analyzes the real predictions of the Earth's rotation parameters (ERP) made in the Russian State Service of the Earth's Rotation (the Center for processing and analyzing data on the parameters of the Earth's rotation of the Main Metrological Center of the State Service of Time, Frequency and Determination of the Parameters of the Earth's Rotation, SSTF) and the International Earth Rotation and Reference Systems Service (IERS) in 2007--2023. Daily predictions of the Earth's Pole coordinates and Universal Time were considered. In total, 6021 SSTF predictions and 5684 IERS predictions were processed. The change in median and maximum errors over time for prediction lengths of 1, 3, 7, 15 and 30 days was studied. As a result, it turned out that over the past 16 years there has not been a general steady trend towards a decrease in the error of ERP predictions in both centers, although such a decrease is clearly noticeable for certain types and lengths of the prediction. Moreover, in some cases, there is a tendency to worsen the accuracy of the prediction, especially for the maximum error of short-term predictions of Universal Time.

Stability Analysis of Satellite Navigation and Positioning Reference Stations Considering Linear Motion

The coordinate frame is not only the foundation for depicting the shape and changes of the Earth and expressing geospatial information but also the crucial geospatial information infrastructure for expanding human activities and promoting social development. Research on satellite navigation and positioning reference stations considering linear motion will be of great significance for navigation and positioning. Therefore, this paper first deduces the transformation formula between different international terrestrial reference frames (ITRF) and the transformation relationship between different reference epochs. Second, a comparison experiment is conducted to analyze the influence of coordinates under different reference frames and epochs on the accuracy of the international GNSS service (IGS) baseline solution results. Finally, stability analysis is performed considering the effect of linear motion on the urban frame points. The results show that using the coordinates under the reference frame and epochs that best fit the measurement time for the baseline solution gives the most reliable results.

Topside Electron Density Modeling Using Neural Network and Empirical Model Predictions

AbstractWe model the electron density in the topside of the ionosphere with an improved machine learning (ML) model and compare it to existing empirical models, specifically the International Reference Ionosphere (IRI) and the Empirical‐Canadian High Arctic Ionospheric Model (E‐CHAIM). In prior work, an artificial neural network (NN) was developed and trained on two solar cycles worth of Defense Meteorological Satellite Program data (113 satellite‐years), along with global drivers and indices to predict topside electron density. In this paper, we highlight improvements made to this NN, and present a detailed comparison of the new model to E‐CHAIM and IRI as a function of location, geomagnetic condition, time of year, and solar local time. We discuss precision and accuracy metrics to better understand model strengths and weaknesses. The updated neural network shows improved mid‐latitude performance with absolute errors lower than the IRI by 2.5 × 109 to 2.5 × 1010 e−/m3, modestly improved performance in disturbed geomagnetic conditions with absolute errors reduced by about 2.5 × 109 e−/m3 at high Kp compared to the IRI, and high Kp percentage errors reduced by >50% when compared to E‐CHAIM.

Ion Density Climatology Based on FPMU Measurements on Board the International Space Station

AbstractWe performed, for the first time, a season‐dependent geomagnetically quiet‐time climatology of mid‐ and low‐latitude ion densities during low and moderate solar flux conditions using Floating Potential Measurement Unit (FPMU) observations aboard the International Space Station (ISS) from 2008 to 2019. Our daytime observations indicate that the main characteristics of the equatorial ionization anomaly (EIA) at ∼400 km are consistent with those from other in situ and remote sensing probes. The FPMU daytime densities are also generally in good agreement with the corresponding results from the International Reference Ionosphere (IRI). However, the IRI does not reproduce the mid‐solar flux evening low‐latitude measured densities. In this period, the EIA exhibits strong longitude‐dependent crest‐to‐trough ratios and asymmetries due to the pre‐reversal enhancement (PRE) of the zonal electric field and thermospheric neutral winds. Our data also show strong structuring of the daytime and nighttime plasma densities. This includes a bulge, discussed for the first time here, in the EIA southern crest in the South Atlantic sector during the December solstice and equinox data, which we suggest being generated by the transport of plasma from the Weddell Sea anomaly (WSA). We also highlight and show the evolution of a midlatitude summer nighttime anomaly (MSNA) during the June solstice data in the North Atlantic sector. Our results give new insights into these two anomalies, where we show that they are stronger with increasing solar flux levels and that they last until the early morning. These latter results are not consistent with those from previous studies.

PT48 International Reference Pricing Analysis of Medicines in Turkiye By 2022

PT48 International Reference Pricing Analysis of Medicines in Turkiye By 2022

Validation of global ionospheric models using long-term observations of pulsar Faraday rotation with the LOFAR radio telescope

Broad band pulsar radiation can be effectively used to monitor the properties of the magneto-ionic media through which it propagates. Faraday rotation calculated from polarised pulsar observations provides an integrated product of electron densities and the line-of-sight component of the magnetic field in the intervening plasma. In particular, a time-variable effect mainly associated with the rapidly changing column density of the Earth’s ionosphere and plasmasphere heavily dominates the observed Faraday rotation of pulsar radiation. In this work, we aim to carry out a performance test of three GNSS-based models of the ionosphere using observations of PSR J0332+5434 taken with the LOw Frequency ARray (LOFAR). As it was shown in Porayko et al. (Month Not Roy Astron Soc 483(3):4100–4113, 2019. https://doi.org/10.1093/mnras/sty3324. arXiv:1812.01463), the conventional single layer model (SLM), which assumes that the ionosphere is a thin slab at a fixed effective height, is not capable of fully accounting for the ionospheric Faraday rotation in pulsar data. The simplified physics of the SLM is upgraded within IRI-Plas (International Reference Ionosphere and Plasmasphere) extended SLM and the dual-layer voxel TOmographic Model of the Ionosphere (TOMION), both of which partially account for the thickness and vertical dynamics of the terrestrial plasma. Although the last two improve the reconstruction of the ionospheric Faraday rotation, none of the considered models completely purge the observed residual variations. With this study, we show that the long term LOFAR observations of Faraday rotation of pulsars provide an excellent tool to test and improve models of the magneto-ionic content of the Earth’s atmosphere.

CLIMF2: A climatological model of the ionospheric F2 layer. Part 1: Model methodology

The ionospheric F2 layer is of key importance to systems dependent on the propagation of radio waves through the ionosphere, including over-the-horizon (OTH) radar, high frequency (HF) communications, global navigation satellite systems (GNSS), and low-frequency radio astronomy. The currently accepted F2 layer model, the International Reference Ionosphere (IRI), does not provide the variance in the parameters used to describe the layer and furthermore, was developed from a limited dataset. The newly developed model, CLIMF2, can be used in conjunction with IRI to overcome these limitations, and thereby improve applications such as the climatological modelling of OTH radar performance. CLIMF2 is an empirical climatological model of the F2 layer parameters derived from a global network of vertical incidence sounder (VIS) observations, consisting of 267 sites with data from the 1950s to 2021. CLIMF2 has the added functionality of providing the variance in the foF2 and hmF2 parameters.

P7 International Reference Pricing and Joint Clinical Assessments—How Will European-Level HTA Evaluations Impact International Reference Pricing and Launch Sequencing?

P7 International Reference Pricing and Joint Clinical Assessments—How Will European-Level HTA Evaluations Impact International Reference Pricing and Launch Sequencing?

Prices, availability and affordability of selected essential medicines for chronic diseases in Türkiye.

Fair access to essential medicines is a significant parameter in fulfilling the right to basic health. We investigated the availability, prices and affordability of essential medicines for chronic diseases in Ankara, Türkiye. We used the procedures outlined in the WHO and Health Action International guidelines for measuring prices, availability, affordability, and price components of medicines. The sample consisted of 334 (14%) of the 2354 pharmacies in Ankara, and 24 essential medicines for cardiovascular diseases, diabetes, chronic respiratory diseases, and palliative care, adopted from the WHO Model List of Essential Medicines (2021). We collected the data in 2021 using a questionnaire administered through face-to-face survey and analysed the data using SPSS version 22. The findings showed that 15 medicines (62.5% of the selected medicines) met the 80% availability target set by WHO, while 9 did not. The original medicines were more readily available than the generic ones. Among the original medicines, furosemide (10.11) and acetylsalicylic acid (9.26) had the highest median price ratios. The generic medicines seemed to be more affordable than original medicines. Glibenclamide, budesonide, gliclazide, and diazepam had low availability and were sold at higher prices than their international reference prices. This research highlights priority areas of action to improve access to affordable medicines for chronic diseases in Ankara, Türkiye.

Status of the revision of ISO 1996-1 standard on the assessment of environmental noise

The international standard on "Description, measurement and assessment of environmental noise - basic quantities and assessment procedures" ISO 1996 Part 1 is a major international reference document that both inspires and is inspired by regional and national standards on noise assessment. It is supplemented by a number of standards including ISO 1996 Part 2 which deals with the determination of sound pressure levels, Part 1 defines the basic quantities to be used for the description of noise in community environments and describes basic assessment procedures. It specifies methods to assess environmental noise and gives guidance on predicting the potential annoyance response of a community to long-term exposure from various types of environmental noises. The current edition from 2016 is under revision, as an ISO "preliminary work item." This paper will explain why it was decided to revise the standard, what comments were submitted during the standard's systematic review, and the topics under discussion in the working group assigned by ISO to revise it. In addition, it will describe the process of revision within the ISO structure including the current development framework, the status of the revision and the planned next steps.

Variation of Electron Density in the D-Region Using Kunming MF Radar under Low Solar Activity

So far, the least is known about the D-region ionosphere out of the entire ionosphere due to the lack of a conventional detecting method and continuous data accumulation. Medium frequency (MF) radar is an important conventional tool for understanding the D-region ionosphere by measuring the electron density (Ne) within the height range of 60–90 km. To investigate the statistical variation of the D-region, especially at the mid-low latitude area, this study presents the statistical variations in the D-region Ne with the solar zenith angle (SZA), season, and altitude observed by Kunming MF radar (25.6° N, 103.8° E) under low solar activity (2008–2009). The diurnal variation of Ne behaves like typical diurnal changes, which are closely consistent with the SZA. The outstanding feature, the diurnal asymmetry phenomenon, significantly appears in different seasons and at different altitudes. The Ne has obvious semi-annual characteristics, and is larger in summer and fall and the smallest in winter. Compared to other seasons, the variation in the Ne with altitude is the most stable in summer. Due to the impacts of the highest SZA, the value of Ne in winter is the smallest, with a maximum value of less than 300 electrons/cm3, and the largest in summer and fall, with a maximum of 472 electrons/cm3. Particularly, the peaks of Ne above 76 km do not always appear at the time when the SZA is the smallest (at noon). Both the simulations by the International Reference Ionosphere (IRI2016) and observations using MF radar present a strong positive correlation with solar radiation. Meanwhile, it cannot be ignored that there were still large differences between the simulations and observations. To quantitatively analyze the differences between the observations and simulations, the observed value was subtracted from the simulated value. The results show that the maximum value between them was up to 350 electrons/cm3, and the minimum difference appeared at around 72 km, with a value less than 100 electrons/cm3. However, below 66 km, the observations were larger than the simulations, which were, on the contrary, above 76 km.

Intertextuality in Pre-service Teachers’ Argumentative Essay in Raising AI: Practices and Beliefs

English as Foreign Language (EFL) pre-service teachers arguably face more challenges regarding rhetorical moves in argumentative essays, and one of them is intertextuality because EFL pre-service teachers' arguments require sufficient and high-quality support and evidence from other scholars. Intertextuality was mainly studied, grounding in texts without external tools, for instance, Artificial Intelligence (AI). In raising the AI era, the objective of this study is to investigate Indonesian EFL pre-service teachers' intertextuality in argumentative essays assisted by AI. Ten EFL pre-service teachers who attended sixteen courses in Academic Writing with neither teaching nor writing experience were recruited as participants. We employed a case study design to portray the nature of the phenomena, and the data were collected through documents (academic essays) to portray the practices, and interviews to represent teachers' beliefs on explicit and implicit intertextuality beyond their argumentative essays in facing AI. We employed content analysis from academic essays and interviews. The findings shows that that 1) EFL pre-service teachers mostly used reporting phrases and iconic references, but it was oriented to local references that targeted local audiences, so international references should be more practiced; and 2) EFL pre-service teachers' beliefs that assisted AI while writing argumentative essay was limited to writing accuracy, but it helped them to focus on intertextuality. Although they were enough to give sufficient intertextuality references in practice, they could not present their voices to tailor their arguments. Moreover, the intertextuality praxis and policy implications will be discussed in EFL pre-service teachers' argumentative essays assisted by AI.

Intertextuality in Pre-service Teachers’ Argumentative Essay in Raising AI: Practices and Beliefs

English as Foreign Language (EFL) pre-service teachers arguably face more challenges regarding rhetorical moves in argumentative essays, and one of them is intertextuality because EFL pre-service teachers' arguments require sufficient and high-quality support and evidence from other scholars. Intertextuality was mainly studied, grounding in texts without external tools, for instance, Artificial Intelligence (AI). In raising the AI era, the objective of this study is to investigate Indonesian EFL pre-service teachers' intertextuality in argumentative essays assisted by AI. Ten EFL pre-service teachers who attended sixteen courses in Academic Writing with neither teaching nor writing experience were recruited as participants. We employed a case study design to portray the nature of the phenomena, and the data were collected through documents (academic essays) to portray the practices, and interviews to represent teachers' beliefs on explicit and implicit intertextuality beyond their argumentative essays in facing AI. We employed content analysis from academic essays and interviews. The findings shows that that 1) EFL pre-service teachers mostly used reporting phrases and iconic references, but it was oriented to local references that targeted local audiences, so international references should be more practiced; and 2) EFL pre-service teachers' beliefs that assisted AI while writing argumentative essay was limited to writing accuracy, but it helped them to focus on intertextuality. Although they were enough to give sufficient intertextuality references in practice, they could not present their voices to tailor their arguments. Moreover, the intertextuality praxis and policy implications will be discussed in EFL pre-service teachers' argumentative essays assisted by AI.

Highly Sensitive Chip-Based Digital PCR Platform for Quantitative Detection of BCR::ABL1 Transcripts throughout CML Treatment

Introduction: With various BCR::ABL1 tyrosine kinase inhibitors (TKIs), chronic myeloid leukemia (CML) has become a manageable disease and current therapeutic goal is treatment-free remission (TFR). To achieve a successful TFR in more patients, a precise assessment of minimal residual disease (MRD) is one of the prerequisite requirements. Since undetectable BCR::ABL1 fusion transcripts by conventional Taqman™-based quantitative polymerase chain reaction (qPCR) is not an indicator for complete eradication of the CML clone, it requires the development of more sensitive technologies. Currently, to overcome some limitations of conventional qPCR, such as rigorous standardization process and variations in sensitivity between laboratories, digital quantitative-PCR (dqPCR) methods have been developed for accurate and precise detection and its use in the routine clinical practice is gradually expanding. However, current dqPCR methods require the inclusion of one or more negative partitions to calculate the concentration using Poisson distribution. Consequently, this leads to a more than a 10-fold decrease in the maximum detectable concentration in a single test compared to conventional qPCR. Therefore, we have developed a novel technology, High Dynamic Range Digital Real-time PCR (so called HDR-drPCR) to achieve wider dynamic range, which allows more stable, accurate and sensitive monitoring of BCR::ABL1 in a timely manner. Methods: For linearity assessment, we used BCR::ABL1 positive (e14a2) K562 cell line diluted to 7 points by 10-fold serial dilutions from 25 to 2.5x10 -5 %IS with BCR::ABL1 negative HL60 cells. In HDR-drPCR, the GUSB gene was employed as a control gene to determine %IS values. For this purpose, the 1 st WHO international genetic reference panel was utilized to calculate the correction factor (CF). With the results from cell lines, we also evaluated equivalence between conventional qPCR and HDR-drPCR using 219 clinical specimens. Among them, 100 samples were determined as DMR (<0.01%IS) based on the qPCR test results In detail, conventional qPCR was performed using Transcriptor First Strand cDNA Synthesis Kit (Roche, USA) for cDNA synthesis and Real-Q BCR-ABL Quantification Kit (Biosewoom, South Korea) for qPCR. For HDR-drPCR (1-step reverse transcriptase PCR), 10 6 to 10 7 copies per reaction of GUSB gene were applied to disposable cartridges of Genotizer™ HDR BCR::ABL1 Major IS detection kit (Optolane Technologies, South Korea) with LOAA platform (Optolane Technologies, Korea). Based on the results, correlation analysis between qPCR and HDR-drPCR was performed using correlation graphs and Blend-Altman plots. Results: Linearity was assessed by the dilution of RNA of K562 with RNA of HL60 using 10-fold serial dilution of up to - 7 log. The result showed accurate linearity (R 2 = 0.9972) at the range of BCR::ABL1/GUSB ratio of 10 1 to 10 -5(%). Notably, HDR-drPCR technology allowed to detect the level of BCR::ABL1 transcript of MR 6.34 (0.00005 %IS) (Figure 1A). The correlation analysis for 209 clinical samples showed that measured values from both qPCR and HDR-drPCR were closely correlated with the R 2 of 0.973 1 (Figure 1B) . The Bland-Altman plot showed a mean bias of 0.159, and the limit of agreement at the 95% confidence interval (LOA95) was calculated as -0.387 to 0.705. Furthermore, the concordance rate between the two methods was 96.17%, as measured by the proportion of samples in which the difference between the two methods was within a factor of 5. This indicates a strong concordance between the two methods. HDR-drPCR reliably detected BCR::ABL1 transcripts in all 90 clinical specimens measured below 0.01%IS (DMR) using qPCR. Additionally, HDR-drPCR detected trace amounts of BCR::ABL1 transcripts in 6 out of 10 specimens that were not detected by qPCR, showcasing its improved sensitivity compared to the conventional qPCR method. Conclusion: Taken together, we believe our high dynamic range real-time digital PCR(HDR-drPCR) may minimize false positive results and maximize the analytical sensitivity of detecting BCR::ABL1 fusion transcripts and thus, would be useful for accurately assessing treatment in routine clinical practice and facilitating the application of treatment-free remission (TFR). We will include these results in further intensive studies focusing on DMR clinical specimens Study support: Funded by Korea Research Foundation

Automated Cytomorphological Analysis of Bone Marrow Samples: A Proof-of-Principle Study for AI-Based Classification on a Real-Life Data Set of 979 Unselected Cases

BACKGROUND: Cytomorphological analysis of bone marrow (BM) samples is a cornerstone of hematological diagnostics. It requires microscopical cell counting by a human specialist, resulting in a differential cell count and a morphological description/diagnosis. The process is susceptible to interobserver variability and may be limited by the areas examined. AIM: Clinical implementation of AI-based recognition of pathological patterns in BM smears to support cytomorphological diagnostics. METHODS: We evaluated unselected BM samples over a three-week period (n= 979), including cases with various hematological diseases. We analyzed both shipped unstained slides (n=522, 53%) and smears prepared in-house from BM aspirates (n=457, 47%) with variable shipping time (0-10d, median = 1d), reflecting diagnostic reality in an international reference laboratory. After conventional cytomorphological assessment, each sample was further analyzed by immunophenotyping, cytogenetics, FISH or molecular genetics, according to diagnostic guidelines. BM slides were then scanned using a Metasystems Metafer System (Altlussheim, GER), yielding up to 52 fields of view (FOVs) (2048x1496px each). Cells were automatically identified, segmented, and imaged resulting in 2636 cells per case on average (range = 0 - 10,072, SD = 2164), which were classified into 24 distinct cell classes using an AI-classifier based on the ResNext-architecture. After eliminating 107 samples (10.9%) due to insufficient scanning/sample quality or low cell counts (<100), 872 samples were further analyzed. We defined 7 relevant pathological patterns extractable from human differential counts which served as ground truth for comparison with AI-based classifications: elevated blast fraction (three-tiered, ≥5%, ≥10%, ≥20%), eosinophilia (≥ 20%), plasmacytosis (≥10%), lymphocytosis (≥20%) and monocytosis (≥5%). For each case, we calculated the median prediction probability (MPP) for each pathological pattern, based on the sum of single cell predictions for pattern-specific cell type and cell fraction (Figure 1). RESULTS: Out of 872 analyzed cases, 341 cases showed one pathological pattern (39.1%), 85 cases showed two patterns (9.7%), and 8 showed three patterns (0.9%) as ground truth. MPP for the pathological patterns were: 0.60 for blasts ≥20% (indicating acute leukemia), 0.52 for blasts ≥10% (e.g. suggesting MDS-IB2), 0.61 for blasts ≥5% (e.g. suggesting MDS-IB1), 0.90 for Eosinophilia (suggesting ML-Eo, HES), 0.87 for plasmacytosis (suggesting plasma cell myeloma), 0.87 for lymphocytosis (suggesting lymphoma) and 0.79 for monocytosis (suggesting MDS or CMML). In cases presenting a blast fraction ≥20% (ground truth) and an MPP for blasts below the median of 0.61, MPP for lymphocytosis and monocytosis was substantially higher (0.81 and 0.71 respectively). This points to the known challenge of differentiating these 3 cell types in AI-supported as well as in human cell classification. Of note, pathological patterns of high clinical relevance (i.e. elevated blast fractions) had consistently low MPP in true negative cases (0.03 for blasts ≥20%, 0.07 for blasts ≥10%, 0.15 for blasts ≥5%). CONCLUSION: We successfully implemented automated scanning and AI-based recognition of pathological patterns in a high-throughput routine workflow on unselected BM smears with variable pathologies, preanalytical parameters and quality. AI detected 7 relevant pathological patterns extracted from human differentials at acceptable prediction probability, even if present concurrently. Confusion of mononuclear cells was noted and requires further optimization of image acquisition and AI-based quality control (e.g., upstream binary classifiers or pre-selection of FOVs) to enhance robustness. This preliminary study proves the technical feasibility of AI-based recognition of pathological BM patterns, to support human investigators in decision making for further diagnostic processes.

Effects of iodine status on thyroid volume and goiter in children living in an iodine-replete area.

Adequate iodine intake is essential for growing children, and thyroid volume (Tvol) is considered as an indicator of iodine status. We investigated Tvol and goiter using ultrasonography (US) and their association with iodine status in 228 6-year-old children living in Korea. Iodine status was assessed using urine iodine concentration (UIC) and categorized as deficient (<100 μg/L), adequate (100-299 μg/L), mild excess (300-499 μg/L), moderate excess (500-999 μg/L), and severe excess (≥1000 μg/L). Tvol was measured using US, and a goiter on the US (goiter-US) was defined as Tvol greater than 97th percentile value by age- and body surface area (BSA)-specific international references. The median Tvol was 2.4 mL, larger than the international reference value (1.6 mL). The age- and BSA-specific goiter-US rates were 25.9% (n = 59) and 34.6% (n = 79), respectively. The prevalence of excess iodine was 73.7% (n = 168). As iodine status increased from adequate to severe excess, the goiter-US rate significantly increased (P for trend <0.05). The moderate and severe iodine excess groups showed higher risk of goiter-US (adjusted odds ratio (aOR) = 3.1 (95% CI: 1.1-9.2) and aOR = 3.1 (95% CI: 1.2-8.3), respectively; age-specific criteria) than the iodine-adequate group. Excess iodine was prevalent in Korean children, and their Tvol was higher than the international reference values. Goiter rate was associated with iodine excess, which significantly increased in the moderate and severe iodine excess groups. Further studies are warranted to define optimal iodine intake in children.

Evaluation of the Entrance Surface Doses (ESD) for common diagnostic X-ray examinations

ObjectiveThe purpose of this study was to assess the Entrance Skin Dose (ESD) in patients undergoing multiple types of radiographic examinations across three hospitals in Saudi Arabia. MethodsThe patient ESD was estimated directly using optically stimulated luminesces (OSL) and indirectly using a survey meter and calculations for 100 adult patients undergoing common diagnostic X-ray examinations, including a posterior anterior chest, posterior anterior hand, anterior posterior foot, and anterior posterior knee examinations, in three hospitals in Saudi Arabia. Comparative analysis with national and international reference values was conducted. ResultsOur analyses revealed considerable heterogeneity in X-ray exposure parameters among the hospitals. The mean ESD values for the chest examination were 0.28 ± 0.13 mGy for the direct method and 0.19 ± 0.11 mGy for the indirect method. Hand examination using the direct method resulted in a mean ESD of 0.42 ± 0.15 mGy, while the indirect method yielded 0.23 ± 0.06 mGy. Remarkably, the ESD values in most cases exceeded national and international guidelines, with the knee examination ESD using the direct and indirect methods showing an alarming value of 1.54 ± 0.31 mGy and 1.18 ± 0.21 mGy, respectively. The correlation between direct ESD, indirect ESD showed a strong positive correlation exists between direct ESD and Indirect ESD (r = 0.8, p < 0.001). ConclusionThe study highlights the urgent need for standardized protocols and quality control measures across radiographic facilities in Saudi Arabia. The elevated ESD values signify a critical issue that requires immediate attention to minimize patient radiation exposure while maintaining diagnostic image quality. Quality control tests and adjustments in examination parameters are strongly advised.