Radiation shielding assessment for interventional radiology personnel: Geant4 dosimetry of lead-free compositions.

The inherent biological hazards associated with ionizing radiation necessitate the implementation of effective shielding measures, particularly in medical applications. Interventional radiology, in particular, poses a unique challenge as it often exposes medical personnel to prolonged periods of high x-ray doses. Historically, lead and lead-based compounds have been the primary materials employed for shielding against photons. However, the drawbacks of lead, including its substantial weight causing personnel's inflexibility and its toxicity, have raised concerns regarding its long-term impact on both human health and the environment. Barium tantalate has emerged as a promising alternative, due to its unique attenuation properties against low-energy x-rays, specifically targeting the weak absorption area of lead. In the present study, we employ the Geant4 Monte Carlo simulation tool to investigate various formulations of barium tantalate doped with rare earth elements. The aim is to identify the optimal composition for shielding x-rays in the context of interventional radiology. To achieve this, we employ a reference x-ray spectrum typical of interventional radiology procedures, with energies extending up to 90 keV, within a carefully designed simulation setup. Our primary performance indicator is the reduction in air kerma transmission. Furthermore, we assess the absorbed doses to critical organs at risk within a standard human body phantom protected by the shield. Our results demonstrate that specific concentrations of the examined rare earth impurities can enhance the shielding performance of barium tantalate. To mitigate x-ray exposure in interventional radiology, our analysis reveals that the most effective shielding performance is achieved when using barium tantalate compositions containing 15% Erbium or 10% Samarium by weight. These findings suggest the possibility of developing lead-free shielding solutions or apron for interventional radiology personnel, offering a remarkable reduction in weight (exceeding 30%) while maintaining shielding performance at levels comparable to traditional lead-based materials.

An Assessment of the Knowledge, Perception, and Willingness to Use Telepharmacy Services Among the General Public in the Kingdom of Saudi Arabia.

Background and objective At the height of the coronavirus disease 2019 (COVID-19) pandemic, numerous strategies were introduced by the authorities to contain the spread of the virus, which significantly affected people's lives and impeded their mobility. As the general public was unable to leave their dwellings, many digitalized pharmacist-led services were initiated to meet the public's needs for pharmaceutical care. The aim of this study was to ascertain the knowledge, perception, and willingness to utilize telepharmacy services and the determinants associated with these services among the general public in the Kingdom of Saudi Arabia (KSA). Methodology A cross-sectional survey involving participants recruited from the Saudi general public was conducted by using a validated questionnaire. We collected information regarding participants' demographics, as well as knowledge, perception, and willingness toward telepharmacy. The results were analyzed via descriptive statistics. The Mann-Whitney U Test was applied to assess the associations between knowledge, perception, willingness, and demographic variables regarding the utilization of telepharmacy services. Results A total of 273 Saudi citizens participated in the study; 71% (n=193) of them were aware of telepharmacy services. Many respondents showed a positive perception towards telepharmacy services and 83% (n=227) of the total participants showed their willingness to use telepharmacy services in the future. A significant association was identified between education, gender, and the knowledge of the participants regarding telepharmacy services. The demographic characteristics such as age, gender, and education, were not associated with the participants' perception regarding telepharmacy services. However, gender was significantly associated with the willingness to use telepharmacy services in the future. Conclusions Many participants had a fair knowledge and positive perception of telepharmacy services. More than two-thirds of the participants showed their willingness to utilize telepharmacy services in the future. However, further measures should be implemented involving strategies to increase the knowledge about telepharmacy by targeting the less educated among the Saudi population and those with limited access to technology.

Day-case diagnostic and interventional peripheral angiography: 10-year experience in a radiology specialist nurse-led unit.

We describe a prospective evaluation of the safety of peripheral angiography procedures performed on day-case patients in a dedicated radiological nurse-led and administrated unit. Patients referred for peripheral vascular angiography, over a 10-year period, were pre-assessed by a radiology specialist nurse in a nurse-led clinic. Radiologists performed all procedures, whereas radiology specialist nurses were responsible for patient care before, during and after angiography and during the 24 h follow-up. Procedures were divided into diagnostic or interventional; complications were divided into immediate or delayed (24 h follow-up) either requiring hospital admission (major) or day-case unit management (minor). Patient acceptability was assessed using a standard questionnaire. Cost analysis was also performed. 401 day-case peripheral angiography procedures (144 diagnostic and 257 interventional) were performed in 310 patients. 109/401 (27.2%) procedures were performed on patients with diabetes mellitus. In diagnostic studies, 16/144 (11.1%) immediate and 6/144 (4.2%) delayed complications occurred whereas, in interventional studies, 65/257 (25.3%) immediate and 13/257 (5.1%) delayed complications were noted. A major complication occurred in 17/257 (6.6%) of patients in the interventional group and 3/144 (2.1%) in the diagnostic group. Puncture site haematoma was the most common complication. Nurse-led care was acceptable to the patient, with a high level of patient satisfaction seen. In conclusion, day-case diagnostic and interventional peripheral angiography procedures can be performed safely in a specialist nurse-led and administrated unit, with complication rates being within the accepted guidelines.

Research bioethics training in Bangladesh.

The Bangladesh Medical Research Council is implementing a training program on research bioethics under International Bioethics Education and Career Development Award of Fogarty International Center of National Institutes of Health (NIH), USA. The ultimate goal of the program is to improve ethical practice in implementation of health research through capacity strengthening of the professionals involved in health research in Bangladesh. The duration of the program is 4 years and it has started from the year 2002. The first year (2002-2003) was assigned for curriculum development. Several workshops, focus group discussions and consultative meetings were organized during 2002-2003 and curriculum was developed. Under this training program every year 2 Certificate Courses on Research Bioethics (CCRB) with a duration of 10 weeks will be conducted for 40 participants (20 participants in each batch). Each year one Advance Course on Research Bioethics (ACRB) will be organized for 10 participants with a duration of 6 days. The courses are to be conducted during 2nd, 3rd and 4th year. The Certificate Course on Research Bioethics is intended for multidisciplinary participants having previous experience in research methodology while the Advance Course on Research Bioethics will target for training the members of Ethics Review Committees of the country. Through this program one hundred fifty Bangladeshi professionals will get adequate training on research bioethics. The training program will be implemented by national experts with technical assistance from distinguished international scientists in the field.

Assessment of renal insufficiency in gestational proteinuric hypertension in third trimester pregnancy.

This prospective study on assessment of renal insufficiency in pregnancy induced proteinuric hypertension was carried out on 104 cases, in Bangabandhu Sheikh Mujib Medical University (former IPGM&R), Dhaka during period of August 1997 to September 1998. The objective of this study, to find out the impairment of renal function in mild (<110 mmHg) and severe (>110 mmHg) hypertension. The frequency of mild hypertension was 96.29% and severe hypertension was 3.71% in third trimester of pregnancy. In this study mean age of the patient was 26.53+/-3.9 years, mean gestional age was 36.46+/-1.93 weeks and mean diastolic BP was 99.07 mmHg. The prevalence of hypertension was more in primigravida which was (72.23%) than multigravida (27.77%). Proteinuria was diagnosed as quantitative measurement of 24 hour urinary protein in photometric colorometer. The mean value of total urinary protein was 335+/-74.14 mg/24 hour (range 280-800 mg/24) hour). 1+Oedema was present in 48.14%, 2+ was 12.96% and 3+ was 14.81% of cases. There is a correlation of proteinuric hypertension with renal function which was done on the basis of laboratory investigations. Findings of parameters of renal function found to declined: Serum creatinine mean value 1.0+/-0.14 (P<0.001) (normal range 0.6-0.8 mg/dl.), Urinary creatinine mean 57.69+/-12 mg/dl., Creatinine clearance mean 53.72+/-11.63 ml/min, Total urinary protein mean 335.52+/-74.14 mg/24 hour. Total urinary volume mean 2985+/-49 ml/24 hr. All the patients and their babies were followed up till discharge from hospital. Cesarean section was done in 76% of cases and vaginal delivery was done in 24% cases. Mean hospital stay was prolonged in proteinuric hypertension 7+/-1 days than non proteinuric normotensive goup 3+/-1 days. All of those were average socio-economic status. Extreme low birth weight was 14.81% in 50% of IUGR cases.

Energy intake and expenditure of obese and non-obese urban Bangladeshi children.

A case control study was conducted in Dhaka city to measure the energy intake and expenditure among 220 obese children of 4-10 years age group and 220 randomly selected age and sex matched controls. A 24 hour dietary recall was used to assess the energy intake. Data on energy expenditure was obtained by 24 hour physical activity recall. The mean energy intake of obese children (2056 +/- 751 kcal/d) was found to be significantly higher (P<0.001) compared to the non obese (1508 +/- 529 kcal/d). No sex difference was found in both obese and non obese groups. Mean energy expenditure of the obese children (1868 +/- 313 kcal/d vs 1495 +/- 200 kcal/d) was significantly higher than the non-obese (P<0.001). Of the obese, boys expended more energy than the girls (P=0.01). Furthermore, physical activity level (1.40 +/- 0.09 vs 1.35 +/- 0.14) was significantly higher among the non obese than their obese counterpart (P<0.001). However, energy balance was significantly higher among the obese (P<0.001). Dose response of energy balance shows the estimated relative risk of obesity increases with higher level of energy balance (P<0.001). The findings of this study revealed that energy balance as a result of higher energy intake and lower energy expenditure was one of the important risk factors for the development of obesity among the children of Dhaka city. Thus, appropriate interventions like behavioural change regarding food habits and physical activities are recommended.

Public/private partners. Key factors in creating a strategic alliance for community health.

BACKGROUND: The rapidly evolving American health system creates economic and societal incentives for public and private health organizations to collaborate. Despite the apparent benefits of collaboration, there is a paucity of information available to help local agencies develop partnerships. This study, itself a collaboration between a school of public health (SPH) and a Georgia health district, was undertaken to identify critical factors necessary to successfully initiate and sustain a public/private community health collaboration. METHODS: Professional staff at the SPH conducted 26 standardized interviews involving participants from Cobb and Douglas counties Boards of Health; Promina Northwest (now known as Wellstar), a not-for-profit health system; and community stakeholders. Content analysis of each interview question was performed and comparisons were made both within each group and across groups. RESULTS: Trends were identified in the following key areas: vision of health care for Cobb and Douglas counties, forces driving collaboration, strengths of each organization, critical negotiating issues, and potential community gain resulting from the partnership. CONCLUSION: A shared vision between potential collaborators facilitates communication regarding strategies to achieve common goals. A previous history of working together in limited capacities allowed the partners to develop trust and respect for one another prior to entering negotiations. These factors, when taken in conjunction with each organization's strong leadership and knowledge of the community, build a strong foundation for a successful partnership.

The present state and future prospects of occupational health in Bangladesh.

Bangladesh is a relatively young and developing country. At the present time, like in most developing countries, a clear demarcation between occupational health care and general medical care is difficult to be recognized in Bangladesh. Occupational health is a fairly new field, as the country is undergoing industrialization and occupational health activities are operated by several ministries, such as Labour, Health, Industry and Transport. Legal foundations of the occupational health-care system based on British India and Pakistani era, were adopted and amended by the Government of Bangladesh after the liberation of the country in 1971. Most of the Labour laws have been rectified by the Government of Bangladesh according to the ILO Conventions. Reconsideration of the occupational health service system avoiding duplication for the 'occupational health' component in several ministries might be helpful to achieve the successful provision of an occupational health service in the developing Bangladesh.

"Zero-field" dose data for 60Co and other high-energy photon beams in water.

A procedure of separating the primary- and scatter-dose components in therapeutic photon beams is examined. It is based on the observation that the scatter-dose component is proportional to the variable z = rd/(r+d), where r and d are beam radius and depth in phantom, respectively. It is, therefore, possible to express an absorbed dose in the form of a linear equation D(r) = P+Nz, where at a fixed depth d, both primary dose P and coefficient N are constant. A method of linear extrapolation of an absorbed dose D(r) to "zero-field" size, i.e., r = 0, is utilized. Since Monte Carlo technique is capable of scoring separately the primary- and scatter-dose components, it is used to evaluate the accuracy of the linear extrapolation method within the range of 60Co-15-MV nominal photon energies. The results demonstrate that this method is sufficiently accurate to obtain the primary dose component in photon beams. For 60Co gamma radiation in water, tabulated sets of measured depth-dose data are analyzed by the linear extrapolation method to review "zero-field" dose values [percentage depth dose (PDD) and tissue-air ratio (TAR) tables of the British Journal of Radiology, Suppl. 17]. The "zero-field" PDD data are found to be accurate within limits of experimental uncertainties. Inconsistencies in the TAR table are illustrated and discussed. 60Co tables of relative doses, D(r,d)/P(dmax), including "zero-field" values for both fixed SSD and isocentric geometries, are generated. Dose calculation in irregular fields is considered. The linear extrapolation method is recommended as a standard procedure for separating primary dose from depth-dose data in high-energy photon beams.