Radiation Doses vs Patient’s Life Styles

Radiation Doses vs Patient’s Life Styles Radiation doses from 131I treated hyperthyroidism patients’ vs life style- A  survey A.S. Shah*, Hameedullah, F. Saeed, K.A.Shah, A. Khan, M. Rauf Khattak ABSTRACT The Radioactive Iodine is widely used for the treatment of various thyroid disorders. The patients  undergoing such treatments are advised to restrict their social and work related activities to limit  radiation exposures to others. The present work describes the results of a structured survey  conducted on patients visiting Institute of Radiotherapy and nuclear Medicine (IRNUM), Peshawar,  for the thyrotoxicosis treatment. The patients were asked about their housing conditions, family set  up, number of kids, travelling mode and time back home from the hospital. The radiation doses to the  other people with whom they might come in contact in their living environment were estimated. The  radiation doses to others at one meter from the patients were calculated as 0.76, 1.53, 2.29, 3.06, 3.82  and 4.58mSv. The results of the survey indicate that the radiation protection advice and other  regulatory requirements need to be reviewed keeping in view individual patientâ⠂¬â„¢s circumstances. INTRODUCTION The radioactive iodine (RAI) is widely used for the treatment of various thyroid disorders  since long. The differentiated thyroid cancer (DTC) is treated by admitting the patients in  hospital where as hyperthyroidism patients are treated on out patient basis in most of the  countries (1-4). The safety issues for the patients, their families, comforters, hospital staff and  the general public arise with either treatment approach. The radiation hazards are more in  case of hyperthyroidism treatment than the DTC treatment due to shorter effective half life  of the 131I in the later application. Therefore at the time of release of the patient from  medical confinement, the retained radioactivity in DTC patients is much lower causing low  risk of radiation exposure to other people. In case of thyrotoxicosis treatment the  administered radioactivity is much lower as compared to DTC treatment but radiation  doses to others are more due to high uptake of RAI by these pa tients (5-8). The patients  undergoing such treatments are advised to restrict their social and work related activities  to reduce radiation exposure to others when they return to their families in community (9-16). This radiation protection advice is usually based on residual activity or radiation exposure level and is not specific to an individual patient circumstances or socioeconomic  condition. These advices are usually formulated by the developed countries and are  adopted as such in most of the developing countries. In actual practice the compliance to the  protection advice depends on socioeconomic conditions and the life style of the patients. Therefore keeping in view this aspect of RAI treatments, an interview based structured  survey was conducted on patients visiting our hospital for the treatment of thyrotoxicosis. The patients were asked about their housing conditions, family/home set up, number of  kids, mode of travelling and travelling time to back home from the hospital. The radiation  doses to the other people with whom they might come in contact in their living  environment MATERIAL AND METHODS The patients were asked about their housing conditions, family set up, number of kids and  travelling periods back home. The total number of patients inducted in the present survey  was 419. The data collected was tabulated and reviewed for completeness. A calibrated  dose of 131I (185-1106MBq) was administered to the patients. The exposure rate from the  patient was measured at a distance of one meter from standing position with a hand-held  pressurized battery operated ÃŽ ² ÃŽ ³ survey meter, Victoreen Model 450P, calibrated from  secondary standard dosemetry laboratory, Islamabad. The dose rate was recorded in units  of ÃŽ ¼Svhr-1. The patients were instructed to sleep alone, drink fluids liberally and avoid prolonged close personal contact with others for the first 2 days. The patients and familymembers were told that they could resume normal activities thereafter (9-12). The estimated  radiation doses to the maximally exposed person were calculated using the form ula given in  equation 2 (14). RESULTS There were 385 (93%) patients residing in joint and 29 (07%) in separate family system  Table 1. It was found that 15.27 % of the patients were male and 84.73% females with age  wise distribution as shown in Table 2. The measured hospital leaving dose rate at one meter from the patients were 5.7, 11.0, 15.7,  18.7, 23.0 and 28.0ÃŽ ¼Svh-1 for administered RAI activity of 5, 10, 15, 20, 25 and 29.9mCi  respectively. The corresponding radiation doses to others from exposure to the patient at  one meter using occupancy factor of 0.25 were calculated as 0.76, 1.53, 2029, 3.06, 3.82 and  4.58mSv Table 3. They survey showed that 4.77, 17.66, 22.91, 24.10, 12.66 and 17.90% patients had  accommodation consisting of one, two, three, four, five and more than five rooms  respectively Table 4. It was observed that 78.04% patients used public transport and 21.96% used private  transport for back home after RAI administration. The radiation doses to others during  travelling were estimated using occupancy factor of 0.1m and 1m distance plotted versus  travelling time of the patient from hospital to back home Figure 1 and Figure 2 respectively.   It was also observed that 1.67% of the patients had no sanitary arrangements at home and  they used open space in the fields as toilet. The patients residing in localities where there is  comparatively better sanitation arrangements had one (31.74%), two (36.04%), three  (17.42%) and more than three (13.13%) toilets available Table 5. In addition 11.93% of the patients had no kids where 10.74% lived in joint family system  and 1.19% as separate. The survey showed that 88.7% of the patients had kids and 82.33%  of these lived in joint family system where as 5.73% lived separate. The number of kids and  the family status showed that 17.18%, 31.50% and 33.65% patients had 1-3, 4-6 and more  than 6 kids respectively lived in joint family system while 2.86%, 1.91% and 0.95% patients  had 1-3, 4-6 and more than 6 kids respectively and they used to live in separate family  system Table 6. DISCUSSION The patients treated for thyrotoxicosis with RAI (131I) are advised certain restrictions on  behavior in order to ensure the radiation safety of all other individuals with whom they may  come into contact. Generally it is assumed that the patients are unlikely to create a hazard  to other persons. A dose limit of 5mSv and 1mSv had been recommended for these peoples  depending upon the nature and type of their interaction with the patient (17). The  compliance to the safety instructions depend upon patient’s literacy level, decision making  capacity, health education, grasping and understanding disclosure of treatment in general  and patient’s socioeconomic conditions and life styles in particular(18,19). The over all literacy level of the survey region is 37.26 % (20). Literacy level reflects the  ability of the patients to comprehend that they emit detectable levels of radiation for  specified period of time after their treatment which are hazardous for other peoples. It was  observed that 93% of the patients inducted in the survey used to reside in joint family  system and 07% lived in separate system Table 1. This aspect coupled with the low literacy  level puts emphasis on the patients receiving treatments to comply with the instructions  strictly to limit radiation exposure to others. The restriction on mode of travelling back to home is important factor in RAI treatment  especially when 78.96% of the patients used public transport to back home from hospital. It  is practically difficult to measure radiation doses to other passengers traveling in the same  vehicle. The measured hospital leaving dose rate at one meter from the patients suggest  that the time restrictions to travel by private transport (at 1m distance) are not required,  although they should not sit immediately adjacent to another passenger, accompanying  person or driver Table 3. Similarly restrictions would not be required for public transport (0.1m distance) for one  hour journey. It was observed that radiation doses to others at 1m and 0.1m with  administered 131I radioactivity of 185, 555 and 1106MBq increases linearly with the travelling time Figure 1 2. The patients needing greater travelling time back home should  use private transport after RAI administration. Therefore regulatory authorities need to  reassess the situation with respect to private or public mode of travelling while  recommending discharge limits for RAI treatments. The radiation doses from the exposure  to the patient to total decay (t=∞) at one meter using occupancy factor of 0.25 for RAI  administered were well within recommended dose limit of 5mSv for adult comforters Table  3. However for patients residing in single room accommodation, with kids and joint family  system, the dose limit of 1mSv is unlikely to be adhered. This aspect becomes more  important where a very large percentage of the patients (88.07%) had kids and 82.33% of  those used to live in joint family system as observed in the present survey Table 6. The  sanitary conditions of the patients at home are important to protect family members from  radioactive contamination and associated external radiation exposure. It was observed that  patients having better sanitation arrangements would not pose radiation related problems. However patients having no proper sanitation (1.67%) are source of concern for the  communities where they reside Table 5. The trends observed indicate that the patients with single room accommodation, having  kids and joint family system need strict compliance to radiation protection advice to restrict  radiation doses to the immediate family members. Therefore RAI treatments need to be  carried out keeping in view patient’s living conditions and life styles. CONCLUSION The radiation protection advice and regulatory requirements need to be formulated  keeping in view patient’s socioeconomic, life style and living conditions. It needs to be  reviewed depending upon individual patient’s circumstances. Table 1 Family Status (N=419) Status No of patients (%) Joint Family 390 (93) Separate Family 29(07) Table 2 Age and Sex Distribution of Patients Age No. of Patients (%) 17 to 28 36(8.59) 29 to 40 161 (38.42) 41 to 50 119 (28.4) 51 TO 60 67 (15.9) >60 33 (7.8) *15.27 % of patients are males ** 84.73 % of patients are females Table 3 131I administered Vs Average Radiation Doses S.No 131I activity (mCi) No. of patients (%) Average leaving dose rate at 1 meter (ÃŽ ¼Sv/hr) Average Dose* to others at 1 meter (mSv) 1 05 12 (2.88) 5.7 0.76 2 10 18 (4.3) 11 1.53 3 15 99 (23.62) 15.7 2.29 4 20 233 (55.6) 18.7 3.06 5 25 47 (11.21) 23 3.82 6 29.9 10 (2.3) 28 4.58 * Average doses to total decay (t=∞) to other individual exposed to the patient at one meter using  occupancy factor of 0.25. Table 4 Status of Patients in Relation to No. of Rooms in Joint/ Separate System No. of rooms in home No. of Patients (%) Patients living in Joint Family System Patients living in Separately 1 20(4.77) 18 2 2 74(17.66) 69 7 3 96(22.91) 90 7 4 101(24.10) 96 4 5 53(12.66) 46 4 More than 5 75(17.90) 71 5 Table 5 Sanitary Status of Patients No. of Toilets in home of Patients No. of Patients (%) Open without flush 07(1.67) With one flush 133(31.74) With two flush 151(36.04) With three flush 73(17.42) More than three flush 55(13.13) Table 6 Kids Status Vs Family System Figure 1 Radiation Doses (mSv) at 0.1m Vs Travelling Time (Hrs) Kids Status Joint Families (%) Separate Families (%) Without Kids 50(11.93) 45(10.74) 05(1.19) With Kids 369(88.07) 345(82.33) 24(5.73) Up to 3 Kids 4 to 6 Kids 7 and above 72(17.18) 132(31.50) 141(33.65) 12(2.86) 08(1.91) 04(0.95) Figure 2 Radiation Doses (mSv) at 1m Vs Travelling Time (Hrs)

Cultural industries Essay

A conception referring to the creation, production and distribution of goods and services that are cultural in nature Examples include the music industry, film production, craft and design, architecture, sports, advertising and cultural tourism. Cultural policy Guiding principles that affect unswervingly the cultural uniqueness of a society Are formed by decision makers, managers and promoters Have the primary functions of aiding in the production, distribution, management, preservation and consumption of culture in the society May be international, national or regional in structure, formulation, adoption and implementation The key priorities of cultural most national cultural policies include; †¢ Conservation, restoration and reconstruction of cultural heritage †¢ Creation of cultural legislation †¢ Creation of cultural administration systems †¢ Protection of the media from state interference †¢ Promoting Cultural Education Introduction of cultural industries to cultural policy Introduced by Greater London Council (GLC) in 1983 GLC justified the inclusion based on the notion that cultural practices and tastes of a society are exhibited and shaped by the commercial forms of culture hence the need for policies to foster and protect cultural industries Advocated for the allocation of more resources to the broadcasting industry in order to disseminate information to capture the interest of the people and the need to use investment in cultural industries as a tool to economic revitalization Creative policy Creativity adopted in cultural industries policies to protect creative industries such as the television and software development industries. Creative policies protect cultural industries thereby ensuring originality, innovativeness and competitiveness in cultural development. Notable ones are creative cities and creative clusters The creative industries cultural policies purposely serve to support cultural development, reward creativity and originality in individuals and groups, and to apply creativity to economic development Copyright laws Helps in the regulation and protection of cultural industries Significant changes in Copyright brought about by the WTO and the EU Primarily takes the form of patents; which would help in the protection of new ideas, trademarks which serves to offer uniqueness to cultural products and copyrights to help in the protection of literary or artistic works Recommendations Proper policy and regulation should be embraced for people to explore behold the discriminatory wastefulness of art subsidy at the expense of other industries Resourceful use of the available financial backing to foster and preserve cultural industries Development and adoption of realistic policies by policy makers Integration of the cultural sector to the education sector in order to produce creative and more innovative workers The government should also avail funds to policy makers to aid in the development of regenerative possibilities of cultural industries’ development. Development of cultural polices compatible with the political cultural and technological advancement of the economy Discussion Questions 1. From the presentation above, justify the inclusion of cultural industries to cultural policy 2. Discuss forms of creative policy adopted to protect creative industries References Hesmondhalgh, D & Pratt, C. A (2005). Cultural Industries and Cultural Policy. International Journal of Cultural Policy Vol 11, no. 1 2005. Retrieved from the Internet on 17/07/2008 from; Cliche, D. (2001) Culture, Governance & Regulatio. Recognizing Culture A series of briefing papers on culture and development. Retrieved from the internet on 19/08/2008 from;

Mother Tongue Essay

Society often influences the identity of an individual through different factors, one of which is language. â€Å"The power of language can evoke an emotion, a visual image, a complex idea, or a simple truth† (FYR: 84). Language is used daily in our lives, and therefore plays a significant role in shaping our identity. The narrative â€Å"Mother Tongue† depicts the variations of the English language, and the nature of talk. Amy Tan also shares the story of her mother’s â€Å"broken† English and how this limited her perception of hers mother’s communication with others. Language can be developed both through environment, and one’s personal experiences. The power of language is essential in the way we express and communicate with one another. We all grow up surrounded by different forms of English speaking, which is due to the atmosphere we are raised in. As denoted in the narrative Amy Tan says â€Å"But I do think that the language spoken in family, especially in immigrant families which is more insular, plays a large role in shaping the language of the child†. (FYR: 87) Coming from an immigrant family myself I can concur with the opinion of Amy Tan. My mother like that of Amy Tan speaks â€Å"broken† English and I too am so accustomed to it, I have no trouble understanding her. However, all do not understand my mother’s language since it’s not the â€Å"proper† fluent English many people are familiar with. My mother is at disadvantage to obtain equal opportunities and services due to the language barrier society impose. My relationship with my mother at home perhaps adds to the difficulty she has when speaking English. Instead of helping my mother improve her English I become impatient and tell her â€Å" mom forget it, you’re not pronouncing it right† and begin speaking to her in Spanish. Holding back from speaking English with my mother will not help her progress from her â€Å"broken† English and it is selfish of me to do so. I want my mother to be able to progress so she can be able to defend herself from all the assumptions that surround being a middle class Hispanic woman. My mother has come a long way breaking down several barriers and I am sure language will be no exception. Perhaps, my mothers English will not be impeccable, but I admire her everything else she has excelled in. Therefore, I am not ashamed of my mother English because she embraces it in a way that is suitable and convenient to her. It is very difficult to speak only one form of English when your audience varies from time to time. We have different ways when approaching family, friends, and professors, which depicts our commitment to diversity. If we all spoke the same way toward everyone it would take away from our identity. As Amy Tan share â€Å"I happen to be rebellious in nature and enjoy the challenge of disproving assumptions made about me†(FYR: 88). Her motivation allows us believe that breaking away from the norms soc to envision ourselves breaking away from the norms society This was a very motivating quote for me because it allows me see that breaking from the norms society has for you is achievable. Our identity is shaped around qualities that make us feel accepted in society. Language is a daily tool used differently amongst one another in order to communicate. Our nature of talk characters the way we see, express, and make sense of the world. Language should not be an obstacle between one another’s communication; instead it should be an opportunity to learn about the diverse tongues in this world. Although all tongues are distinct from one another, it ultimately helps us embrace our true identities or as Amy Tans will refer to it our â€Å"mother tongue†.

Triumph Of The Right George Wallace, Richard Nixon, And...

Many critics classify the 1960’s as the decade of urban uprising and political shifts in the United States. Controversy surrounded these changes whether they were good or bad for the nation and leaving many Americans questioning the power of urban and political movements. In the excerpt â€Å"Triumph of the Left: Sixties Revolution and The Revolution in Manners† Kenneth Cmiel from the University of Iowa shows how the era of the sixties altered and affected the morals of many Americans when they encountered discrimination, hatred, and inequality. Along with that, Dan T. Carter carefully analyzes the political outcomes of the Presidential campaign of the 1960’s and it’s victory in the excerpt â€Å"Triumph of the Right: George Wallace, Richard Nixon, and the Critique of Federal Activism.† While many still argue that both of the tumultuous decade’s social movements harmed the way the United Sates functions today, it also evidently shows to be victorious due to its liberal changes that alters the ways Americans live and perform then and now. Both Cmiel and Carter support their positions with evidence that demonstrates that both urban uprising and political shifts successfully depart the nation from falling into conservative circumstances. Not only do both triumphs succeed, but they also open up doors for economic and political opportunities in the United States. While many African Americans faced racial inequality, their circumstances was not an obstacle as it permitted them to rebelShow MoreRelatedProject Managment Case Studies214937 Words   |  860 PagesMANAGEMENT CASE STUDIES, SECOND EDITION - PROJECT MANAGEMENT CASE STUDIES, SECOND EDITION HAROLD KERZNER, Ph.D. Division of Business Administration Baldwin-Wallace College Berea, Ohio John Wiley Sons, Inc. This book is printed on acid-free paper. @ Copyright O 2006 by John Wiley Sons, Inc. All rights reserved. Published by John Wiley Sons, Inc., Hoboken, New Jersey Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrievalRead MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 PagesCredits and acknowledgments borrowed from other sources and reproduced, with permission, in this textbook appear on the appropriate page within text. Copyright  © 2013, 2011, 2009, 2007, 2005 by Pearson Education, Inc., publishing as Prentice Hall. All rights reserved. Manufactured in the United States of America. This publication is protected by Copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form