Prevalence of malnutrition in children under five and school-age children in Milot Valley, Haiti.

OBJECTIVES: This research aims to provide child malnutrition prevalence data from Haiti's Milot Valley to inform the design and implementation of local health interventions. STUDY DESIGN: This cross-sectional study measured underweight, stunting, and wasting/thinness using international growth standards. METHODS: Anthropometric measurements (height/length and weight) were taken on a convenience sample of 358 children aged 0-14 years. Participants were recruited through door-to-door field visits at five recruitment sites in the Milot Valley, including individuals in the waiting area of the Pediatric Outpatient Clinic at Hôpital Sacré Coeur. Caregivers were asked questions about the child's health history, including past and current feeding practices. RESULTS: Combining moderate and severe forms of malnutrition, 14.8% of children under five were stunted, 15.3% were wasted, and 16.1% were underweight. Among children 5-14 years of age, 14.1% were stunted, 7.6% were thin (low body mass index (BMI)-for-age), and 14.5% were underweight. For children under five, 42% of mothers ended exclusive breastfeeding before the recommended six months. CONCLUSION: This study illustrates the local magnitude of childhood malnutrition and can serve as a resource for future child health interventions in the Milot Valley. To fight malnutrition, a multipronged, integrated approach is recommended, combining effective community outreach and monitoring, inpatient and outpatient nutrition therapy, and expanded partnerships with nutrition-related organizations in the region.

Analysis of the CONRAD computational problems expressing only stochastic uncertainties: neutrons and protons.

Within the scope of CONRAD (A Coordinated Action for Radiation Dosimetry) Work Package 4 on Computational Dosimetry jointly collaborated with the other research actions on internal dosimetry, complex mixed radiation fields at workplaces and medical staff dosimetry. Besides these collaborative actions, WP4 promoted an international comparison on eight problems with their associated experimental data. A first set of three problems, the results of which are herewith summarised, dealt only with the expression of the stochastic uncertainties of the results: the analysis of the response function of a proton recoil telescope detector, the study of a Bonner sphere neutron spectrometer and the analysis of the neutron spectrum and dosimetric quantity H(p)(10) in a thermal neutron facility operated by IRSN Cadarache (the SIGMA facility). A second paper will summarise the results of the other five problems which dealt with the full uncertainty budget estimate. A third paper will present the results of a comparison on in vivo measurements of the (241)Am bone-seeker nuclide distributed in the knee. All the detailed papers will be presented in the WP4 Final Workshop Proceedings.

Measurement and simulation of lineal energy distribution at the CERN high energy facility with a tissue equivalent proportional counter.

The response of a tissue equivalent proportional counter (TEPC) in a mixed radiation field with a neutron energy distribution similar to the radiation field at commercial flight altitudes has been studied. The measurements have been done at the CERN-EU High-Energy Reference Field (CERF) facility where a well-characterised radiation field is available for intercomparison. The TEPC instrument used by the ARC Seibersdorf Research is filled with pure propane gas at low pressure and can be used to determine the lineal energy distribution of the energy deposition in a mass of gas equivalent to a 2 microm diameter volume of unit density tissue, of similar size to the nuclei of biological cells. The linearity of the detector response was checked both in term of dose and dose rate. The effect of dead-time has been corrected. The influence of the detector exposure location and orientation in the radiation field on the dose distribution was also studied as a function of the total dose. The microdosimetric distribution of the absorbed dose as a function of the lineal energy has been obtained and compared with the same distribution simulated with the FLUKA Monte Carlo transport code. The dose equivalent was calculated by folding this distribution with the quality factor as a function of linear energy transfer. The comparison between the measured and simulated distributions show that they are in good agreement. As a result of this study the detector is well characterised, thanks also to the numerical simulations the instrument response is well understood, and it's currently being used onboard the aircrafts to evaluate the dose to aircraft crew caused by cosmic radiation.

Measurements and simulations of the radiation exposure to aircraft crew workplaces due to cosmic radiation in the atmosphere.

As required by the European Directive 96/29/Euratom, radiation exposure due to natural ionizing radiation has to be taken into account at workplaces if the effective dose could become more than 1 mSv per year. An example of workers concerned by this directive is aircraft crew due to cosmic radiation exposure in the atmosphere. Extensive measurement campaigns on board aircrafts have been carried out to assess ambient dose equivalent. A consortium of European dosimetry institutes within EURADOS WG5 summarized experimental data and results of calculations, together with detailed descriptions of the methods for measurements and calculations. The radiation protection quantity of interest is the effective dose, E (ISO). The comparison of results by measurements and calculations is done in terms of the operational quantity ambient dose equivalent, H(10). This paper gives an overview of the EURADOS Aircraft Crew In-Flight Database and it presents a new empirical model describing fitting functions for this data. Furthermore, it describes numerical simulations performed with the Monte Carlo code FLUKA-2005 using an updated version of the cosmic radiation primary spectra. The ratio between ambient dose equivalent and effective dose at commercial flight altitudes, calculated with FLUKA-2005, is discussed. Finally, it presents the aviation dosimetry model AVIDOS based on FLUKA-2005 simulations for routine dose assessment. The code has been developed by Austrian Research Centers (ARC) for the public usage (http://avidos.healthphysics.at).

Uncertainty budget for a whole body counter in the scan geometry and computer simulation of the calibration phantoms.

At the Austrian Research Centers Seibersdorf (ARCS), a whole body counter (WBC) in the scan geometry is used to perform routine measurements for the determination of radioactive intake of workers. The calibration of the WBC is made using bottle phantoms with a homogeneous activity distribution. The same calibration procedures have been simulated using Monte Carlo N-Particle (MCNP) code and FLUKA and the results of the full energy peak efficiencies for eight energies and five phantoms have been compared with the experimental results. The deviation between experiment and simulation results is within 10%. Furthermore, uncertainty budget evaluations have been performed to find out which parameters make substantial contributions to these differences. Therefore, statistical errors of the Monte Carlo simulation, uncertainties in the cross section tables and differences due to geometrical considerations have been taken into account. Comparisons between these results and the one with inhomogeneous distribution, for which the activity is concentrated only in certain parts of the body (such as head, lung, arms and legs), have been performed. The maximum deviation of 43% from the homogeneous case has been found when the activity is concentrated on the arms.

Calibration and background measurements with a tissue equivalent proportional counter.

A tissue-equivalent-proportional counter (TEPC) instrument has been used as the reference instrument for cosmic radiation measurement at flight altitudes by several institutes. For purposes of characterisation the response of the instrument has been investigated under different standard radiation conditions, in terms of radiation particle, energy and angle of incidence. Photon sources and photon beams of energies up to 6.6 MeV and neutron beams up to 200 MeV were used. To have a better understanding of the shielding influence of the instrument assembly, the angle dependence of response was analysed for several radiation conditions. Specific measurement conditions were simulated with the Monte Carlo transport code, FLUKA. The measured instrument response was compared with simulation results. It was demonstrated, that simulations were very helpful to understand the instrument's response. The TEPC instrument used by the Austrian Research Centre Seibersdorf (ARCS) research simulates the energy deposition in a unit density tissue volume of 2 microm diameter, of similar size to a cell nucleus. Pure propane at low pressure is used as measurement gas. To characterise the instrument at low dose rates background measurements were done 800 m below ground and at the ultra low level laboratory in Gran Sasso, 1380 m below ground. These results were compared with measurements on the Earth's surface at different altitudes on mountains up to 3480 m above sea level. The significant increase of the expected dose rate is well reproduced by the experiments at mountain altitudes. As a result of this study a full characterisation and a thorough understanding of the performance and reliability of the detector was achieved.

The results of cosmic radiation in-flight TEPC measurements during the CAATER flight campaign and comparison with simulation.

The European-Commission-supported project DOSMAX (Dosimetry of Aircrew Exposure to Radiation During Solar Maximum) was aimed at measuring aircrew exposure to cosmic radiation on-board the aircraft during solar maximum. During a dedicated international comparison mission (Co-ordinated Access to Aircraft for Transnational Environmental Research; CAATER) different measurement techniques have been compared by six European institutes (Results of the CAATER Mission, DOSMAX Meeting, Dublin, June 2004). In this paper, we present the tissue-equivalent proportional counter (TEPC) measurements carried out by ARC Seibersdorf research (ARCS), Austria, and Institut de Radioprotection et de Sûreté Nucléaire (IRSN), France, together with a comparison with simulation results under the same conditions. The whole flight campaign consists of four different in-flight investigations performed at two different geographical positions at 12.2 km (FL 400) and 9.8 km (FL 320). One location was chosen above Rome (42 degrees North, 12 degrees East), Italy, for high cut-off rigidity (6.4 GV) and the second above Aalborg (57 degrees North, 10 degrees East), Denmark, for low cut-off rigidity (1.8 GV). The TEPC measurements are presented in terms of absorbed dose and ambient dose equivalent as well as microdosimetric spectra as a function of lineal energy. For the same conditions of the CAATER flights the response of the TEPC has also been simulated by using the Monte Carlo Transport Code FLUKA (version 2003). The results from simulations are compared with measurements and they show a reasonable agreement.

Determinations of H(10) and its dose components onboard aircraft.

Aircrew is in general receiving a higher average annual dose than other occupationally exposed personnel, and about half of the effective dose is deposited by high-LET neutron secondaries. A recent investigation of the cancer incidence following the atomic bombs at Hiroshima and Nagasaki has put forward the possibility that the relative biological efficiency for neutrons could be underestimated. If so, the effective dose to aircrew from this component would increase and the estimation of this component will become even more important. Different ambient dose equivalent measurement techniques and calculation methods have recently been compared on a dedicated flight. The experimental results are compared with calculations made with the codes EPCARD 3.2 and an updated version of FLUKA and different galactic proton spectra. The aircraft circulated within the target areas at two constant altitudes with a flight route variation of only about 1 degrees in longitude and latitude to reduce the influence from variations in atmospheric and geomagnetic shielding. The instrumentation consisted of tissue-equivalent proportional counters (TEPC) and a silicon diode spectrometer. Measurements were performed for 2 h to reduce the statistical uncertainties in the results. The TEPCs were evaluated either according to single-event analysis techniques or the variance-covariance method. Besides the total ambient dose equivalent, the instruments can be evaluated to reveal the low- and high-LET components. The EPCARD and FLUKA simulations can determine the contribution from each type of particle directly. The ratio between the calculated and the measured average value of the ambient dose equivalent rate was 1.00 +/- 0.08 with all instruments included for EPCARD and 0.97 +/- 0.07 when FLUKA was used. The measured high-LET component and the calculated neutron component are not quite identical, but should be similar. The agreement was always within 20%. The high-LET component contributed with about 57% at N57 E8 and 48% at N42 E12.

Shielding variation effects for 250 MeV protons on tissue targets.

This paper provides results of computer simulation studies with the goal to analyse issues regarding radiation protection for personnel, patients and third persons involved in hadron therapy treatment. The treatment room and the patient are modelled by simple cylindrical geometries at incident proton energies of 250 MeV. Monte Carlo simulations of the energy and angular dependence of proton, neutron and photon radiation fields and resulting ambient dose equivalent distributions outside the shielding walls are performed. In order to investigate systematic uncertainties due to the shielding materials and inherent to the computer models, various concrete compositions, densities and water contents are modelled, and the influence of simulation parameters on the results obtained is determined. Generally, good agreement is found between results provided by MCNPX and FLUKA computer codes. Variations in neutron ambient dose attenuation from -50 to +/-30% are found due to varying concrete composition. Changes in the water content of the concrete in the order of 8% may cause variations up to 20%.

FLUKA simulation of TEPC response to cosmic radiation.

The aircrew exposure to cosmic radiation can be assessed by calculation with codes validated by measurements. However, the relationship between doses in the free atmosphere, as calculated by the codes and from results of measurements performed within the aircraft, is still unclear. The response of a tissue-equivalent proportional counter (TEPC) has already been simulated successfully by the Monte Carlo transport code FLUKA. Absorbed dose rate and ambient dose equivalent rate distributions as functions of lineal energy have been simulated for several reference sources and mixed radiation fields. The agreement between simulation and measurements has been well demonstrated. In order to evaluate the influence of aircraft structures on aircrew exposure assessment, the response of TEPC in the free atmosphere and on-board is now simulated. The calculated results are discussed and compared with other calculations and measurements.

Dosimetric considerations on TEPC fluka-simulation and measurements.

The response of a tissue equivalent proportional counter (TEPC) has been simulated with the Monte Carlo transport code FLUKA. The absorbed dose distribution of lineal energy y has been determined for several monoenergetic photon and neutron sources. The agreement between the calculated results and the measurements carried out with different well-known sources is well demonstrated. Work is in progress in order to evaluate the response of the instrument in the cosmic ray environment.

Microdosimetric assessment of the radiation quality of a therapeutic proton beam: comparison between numerical simulation and experimental measurements.

Using protons for the treatment of ocular melanoma (especially of posterior pole tumours), the radiation quality of the beam must be precisely assessed to preserve the vision and to minimise the damage to healthy tissue. The radiation quality of a therapeutic proton beam at the Centre Antoine Lacassagne in Nice (France) was measured using microdosimetric techniques, i.e. a miniaturised version of a tissue-equivalent proportional counter. Measurements were performed in a 1-µm site at different depths in a Lucite phantom. Experimental data showed a significant increase in the beam quality at the distal edge of the spread-out Bragg peak (SOBP). In this paper, the numerical simulation of the experimental setup is done with the FLUKA Monte Carlo radiation transport code. The calculated microdosimetric spectra are compared with the measured ones at different depths in tissue for a monoenergetic proton beam (E=62 MeV) and for a modulated SOBP. Numerically and experimentally predicted relative biological effectiveness values are in good agreement. The calculated frequency-averaged and dose-averaged lineal energy mean values are consistent with measured data.

AVIDOS--a software package for European accredited aviation dosimetry.

AVIDOS is a computer code used for the dose assessment of aircraft crew exposed to cosmic radiation. The code employs a multiparameter model built upon simulations of cosmic radiation exposure done using the FLUKA Monte Carlo code. AVIDOS calculates both ambient dose equivalent H*(10) and effective dose E for flight routes over the whole world at typically used altitudes and for the full range of solar activity. The dose assessment procedure using AVIDOS is accredited by the Austrian office for accreditation according to European regulations and is valid in the whole Europe. AVIDOS took part in an international comparison of different codes assessing radiation exposure of aircraft crew where a fully satisfactory agreement between codes has been found. An online version of AVIDOS with user friendly interface is accessible to public under the internet address: http://avidos.healthphysics.at.

Overview of on-board measurements during solar storm periods.

Radiation exposure of aircraft crew caused by cosmic radiation is regulated in Europe by the European Community Council Directive 96/29/EURATOM and implemented into law in almost every country of the European Union. While the galactic cosmic radiation (GCR) leads on average to an exposure of about 3 mSv per year, solar cosmic radiation can lead to 1 mSv per one subsonic flight during solar storm periods. Compared to GCR, solar cosmic radiation shows a much softer proton spectrum but with a larger contribution of several orders of magnitude. This is the reason for the large radiation exposure in high northern and southern geographic latitudes during solar particle events. Here an overview of active radiation in-flight measurements undertaken during solar storms is given. In particular, tissue-equivalent proportional counter on-board measurements are shown and the radiation quality during solar storm periods with that for GCR is compared.

Comparison of codes assessing galactic cosmic radiation exposure of aircraft crew.

The assessment of the exposure to cosmic radiation onboard aircraft is one of the preoccupations of bodies responsible for radiation protection. Cosmic particle flux is significantly higher onboard aircraft than at ground level and its intensity depends on the solar activity. The dose is usually estimated using codes validated by the experimental data. In this paper, a comparison of various codes is presented, some of them are used routinely, to assess the dose received by the aircraft crew caused by the galactic cosmic radiation. Results are provided for periods close to solar maximum and minimum and for selected flights covering major commercial routes in the world. The overall agreement between the codes, particularly for those routinely used for aircraft crew dosimetry, was better than +/-20 % from the median in all but two cases. The agreement within the codes is considered to be fully satisfactory for radiation protection purposes.