In vitro dissolution of tritium-loaded particles from the JET fusion machine.

With the experimental evolution of fusion power the levels of tritium used will increase as will the potential for human exposure. Tritium-loaded carbon particles produced during the experimental operation of the Joint European Torus fusion tokamak have been characterised in terms of size, elemental composition and specific activity of tritium elsewhere. The aim of this study was to characterise the dissolution of tritium from these particles in order to derive dose coefficients for this material and provide guidance on monitoring procedures should it be inhaled accidentally. The dissolution of tritium was measured for 100 d in lung serum simulant from two batches of materials, SG1 and SG2, which were obtained from carbon tiles originating from different positions in the reactor. Retention over this period followed a three-component exponential. About 1-5% dissolved within a minute, and up to a further 20% dissolved over 100 d for the SG1 materials but <1% for the SG2 materials. Dissolution between the SG1 materials varied greatly, whereas the SG2 materials were similar. As a result of this variability, the assessed dose from urinary excretion could be in error by up to two orders of magnitude depending on the material inhaled. It is recommended that (i) the dissolution is measured for a wider range of materials, preferably dusts collected in working areas, and (ii) in vivo studies are performed to characterise fully the urine excretion of tritium from these materials. This information could be used to provide improved guidance on dose assessment after special or routine monitoring, taking account of the likely variation of particle size and biological retention half times.

Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up).

The 2-year results of a randomized, prospective, controlled trial of minimally displaced proximal humeral fractures treated either by immediate physiotherapy (group A) or after 3 weeks of immobilization (group B) are reported. At 1 year shoulder disability, as measured with the Croft shoulder disability questionnaire, was found in 42.8% of patients in group A and 72.5% in group B (P < .01). By 2 years, shoulder disability in group A remained unchanged (43.2%) but had reduced in group B (59.5%). This difference was not statistically significant. Immediate physiotherapy after a minimally displaced proximal humeral fracture results in faster recovery, with maximal functional benefit being achieved at 1 year. Delayed rehabilitation by 3 weeks of shoulder immobilization produces a slower recovery, which continues for at least 2 years after the time of injury.

A review of measurements of radionuclides in members of the public in the UK.

This paper summarises a comprehensive review of radio-analytical data from autopsy, whole or partial body monitoring and the assay of teeth, foetuses and urine for non-occupationally exposed members of the public in the UK between 1957 and 2003. Most attention has been given to measurements of artificial radionuclides formed in the nuclear fuel cycle, uranium and thorium. The review concentrates on measurements on people in the UK who live or have lived in the vicinity of nuclear power sites. When UK data are unavailable, or for the purposes of comparison, information has been included from studies in other countries. Highlights of key findings of the document are listed: The concentrations of strontium-90 in bone and teeth have reflected changes in the amounts present in the environment due to fallout from nuclear testing. There are higher concentration levels of 239+240Pu in samples from West Cumbria compared with the rest of the UK. However, the levels are so low that any increase in risk of induced skeletal tumours (including leukaemia) would be very small compared with those arising from the intake of natural radionuclides. As expected there have been only a few published autopsy studies. Both tissue sample mass and radionuclide concentrations were low, leading to relatively large measurement uncertainties. Whole body measurements of 137Cs in residents in Berkshire and Oxfordshire clearly show the effect of atmospheric testing of nuclear weapons and of the Chernobyl accident. A survey of whole body 137Cs and 134Cs content following the Chernobyl accident showed that residents of Central Scotland, North-West England and North Wales had twice the radiocaesium content of residents in the rest of England and Wales. Measurements of 131I in the thyroid have been reported following the accidents at Windscale and Chernobyl for most regions of the UK. Few excretion studies have been reported although this does not diminish their importance. One study on the urinary excretion rate of 90Sr in adults and children living in the Dounreay area suggested that the results did not support this radionuclide as being the cause of increased childhood leukaemia. Similar conclusions were drawn from another study involving the assay of 239Pu. It is suggested that a national database of measurements made on members of the public should be initiated. The database would provide a means for identifying future trends.

Comparison of predicted with observed biokinetics of inhaled plutonium nitrate and gadolinium oxide in humans.

The absorption kinetics to blood of plutonium and gadolinium after inhalation as nitrate and oxide in humans and animals has been studied. For each material, values describing the time dependence of absorption were derived from the studies in animals and used with the ICRP human respiratory tract model to predict lung retention and cumulative amounts to blood for the volunteers inhaling the same materials. Comparison with the observed behaviour in the volunteers suggests that absorption of plutonium and gadolinium is reasonably species independent, and that data obtained from animal studies can be used to assess their biokinetic behaviour in humans.

Comparison of absorption after inhalation and instillation of uranium octoxide.

Values for the absorption parameters were compared after inhalation or intratracheal instillation of 1.5 microm mass median aerodynamic diameter (MMAD) 233U3O8 particles into the lungs of HMT strain rats. The two sets of parameter values were similar, as were the calculated dose coefficients and predicted biokinetics for workers. Hence the inhalation and instillation techniques can probably both be used to generate values of the absorption parameters for U3O8.

Biokinetics and assessment of intake of thorium dioxide.

The aim of this work was to investigate the biokinetics of thorium dioxide in animals for the purpose of assessing intakes of the compound by workers and the resulting doses. The results imply that measurements of the decay products in the chest or extrapolations from urine analysis data are unlikely to be of value for doses below 20 mSv. Even higher doses should be interpreted with caution as a consequence of uncertainties in particle size distribution and variations in dietary excretion.

Rehabilitation after two-part fractures of the neck of the humerus.

We undertook a prospective, controlled trial which compared two rehabilitation programmes for 86 patients who sustained two-part fractures of the proximal humerus. Patients were randomised either to receive immediate physiotherapy within one week (group A) or delayed physiotherapy after three weeks of immobilisation in a collar and cuff sling (group B). At 16 weeks after the fracture, patients in group A had less pain (p < 0.01) and had greater shoulder function (p < 0.001) than those in group B. At 52 weeks, the differences between the groups had reduced. Although group A still had greater shoulder function and less pain, there was no statistical difference when compared with group B. By analysis of the area under the curve, an overall measure up to the 52-week period, group A experienced less pain as measured by the SF36 general health questionnaire and had improved shoulder function. Our results show that patients with two-part fractures of the proximal humerus who begin immediate physiotherapy, experience less pain. The gains in shoulder function persist at 52 weeks which suggests that patients do not benefit from immobilisation before beginning physiotherapy.

Systemic risk factors for idiopathic macular holes: a case-control study.

PURPOSE/BACKGROUND: The idiopathic full-thickness macular hole (IFTMH) is an important cause of poor vision in the elderly affecting predominantly women over the age of 60 years. While it is accepted that vitreoretinal traction is an important local factor in the development of IFTMH, the underlying cause is not known. The aim of this study was to identify possible systemic risk factors for the development of IFTMH. METHODS: Two hundred and thirty-seven patients with IFTMH (cases) attending the Macular Hole Clinic at Moorfields Eye Hospital were identified. These were compared with 172 patients without macular holes (controls) attending other clinics in the same hospital. Cases and controls were frequency-matched by sex. The prevalence of the following factors in both groups was ascertained by interview: ethnic origin, place of birth, housing tenure, any systemic diseases, current and lifetime consumption of medication, severe dehydrational episodes, menstrual and obstetric history, onset and severity of menopause and use of exogenous oestrogens (in women only), osteoporosis, vegetarianism, use of vitamin supplementation, and smoking and alcohol consumption. Height and weight were measured for all participants. RESULTS: Cases of IFTMH macular holes were predominantly women (67%) and aged 65 years and older (74%). We found very few systemic risk factors that were significantly associated with IFTMH. There was a higher prevalence of diabetes in controls (12% vs 5%). There was no association between the majority of indicators of oestrogen exposure in women and macular holes, but cases had a more difficult menopause as judged by the severity of hot flushes at menopause: odds ratio 2.6 (1.4-4.6). CONCLUSIONS: In common with other studies, we found only a few systemic factors associated with IFTMH. The study did confirm, however, that IFTMH is a strongly gender-related disease. There is some evidence for the role of sudden changes in hormonal balance, as seen by the increased reporting of severity of symptoms around the menopause along with (statistically non-significant) increased risks associated with hysterectomy and oophorectomy. The particular aetiological factor which puts women at increased risk of macular holes requires further studies.

Outcomes of cochlear implants for New Zealand children and their families.

Six children with multichannel cochlear implants and their families were evaluated by means of multiple measures to determine the impact of the cochlear implant on the child's speech perception, language, communication mode, and behavior and on the parents' stress levels. The children showed quite variable improvements in speech perception with the implant. One child showed marked improvements in language 6 months after implantation. Two of the children had behavior problems preimplantation that showed some improvement after implantation. Parenting stress was very high in some families, but on average, stress was lower and social support networks were more extensive than those previously reported in studies of parents of deaf children in the United States.

Invasive Haemophilus influenzae type b disease in the Oxford region (1985-91).

For a seven year period (1985-91) clinical and epidemiological data were prospectively collected on children aged < 10 years with microbiologically confirmed invasive Haemophilus influenzae type b infection in the Oxford region to study the epidemiology of the disease and determine the potential impact of early primary immunisation in infants. Computer records of primary immunisations given to these cases were retrospectively analysed and, where necessary, hospital and general practitioner records were searched to determine the immunisation history. Over the seven year period, 416 cases of invasive H influenzae type b disease were reported. Widescale immunisation against H influenzae type b began in 1991 as part of a regional trial. The estimated annual incidence for invasive disease between 1985 and 1990 was 35.5 cases per 100,000 children aged less than 5 years; for H influenzae type b meningitis it was 25.1 per 100,000 children aged less than 5 years. The cumulative risks for invasive disease and meningitis by the fifth birthday were one in 560 and one in 800 respectively. The majority of disease (71%) occurred in children less than 2 years of age with the peak monthly incidences at 6 and 7 months of age. The overall mortality was 4.3% and 50% of these deaths occurred suddenly. Most (91%) of the children had received at least one primary immunisation against diphtheria, tetanus, and pertussis before H influenzae type b infection and there was only one case of parental refusal of immunisation. None had received H influenzae type b immunisation. Given a vaccine uptake of 90% by 5 months of age it is estimated that at least 82% of the H influenzae type b infections could have been prevented. Extrapolated nationally, 1150 cases of infection and 50 deaths could be prevented each year by routine primary immunisation.