Association and risk factors of healthcare-associated infection and burden of illness among chemotherapy-induced ulcerative mucositis patients.

OBJECTIVES: To evaluate the association and risk factors of healthcare-associated infection (HAI) and burden of illness among chemotherapy-induced ulcerative mucositis (UM) patients. METHODS: For this research, US National Inpatient Sample database 2017 was utilized to study UM patients. The association of healthcare-associated infection-related burden of illness among UM patients was assessed on the outcome--length of hospital stays (LOS), total charges, in-hospital mortality, and discharge disposition. RESULT: In 2017, there were 11,350 adult (> 18 years of age) UM patients, among them there were 415 (3.5%) HAI. After adjusting for patient and clinical characteristics, UM patients with HAI were most likely to have higher total charges and longer LOS (1.91; 95% CIs: 1.51-2.41; P < 0.001; 1.84; 95% CIs: 1.53-2.21; P < 0.001) than those without HAI. Further, mortality was not significantly different. UM patients with HAI were less likely to have higher burden of illness who were younger, females, those living in non-metropolitan or micropolitan counties, and those with lower co-morbidity score. Additionally, UM patients with HAI were more likely to discharge to skilled nursing facility (SNF), intermediate care facility (ICF), and another type of facility (ATF), (aOR = 2.58 (1.16-5.76), P = 0.02), than they were to discharge to self-care or home care. CONCLUSION: UM patients with HAI were more likely to have higher burden of illness and more likely to discharged to the SNF, ICF, and ATF rather than to home or self-care. Clinical relevance UM patients when associated with HAI have higher burden of illness; a tailored approach to oral care might prevent HAIs and burden of illness among UM.

NE-OBT and TFWT activity concentrations in wild plants in the vicinity of the PHWR nuclear power plant and control regions of the tropical monsoonal climatic region of the Indian subcontinent.

The results of the first detailed study, involving a large number of samples, on water equivalent factor (WEQp), non-exchangeable organically bound tritium (NE-OBT) and tissue free water tritium (TFWT) activity concentrations in predominant plant species of the tropical monsoonal climatic region, are presented. A total of 369 samples from the vicinity of the PHWR nuclear power plant (NPP) at Kaiga, West Coast of India, and 47 samples of the control region (region not affected by local anthropogenic sources) were analysed. The WEQp varied in the range of 0.347-0.666 L kg-1 with an overall mean value of 0.540 ± 0.045 L kg-1. The NE-OBT activity concentration varied in the range of <9.8-60.9 Bq L-1 of combustion water (mean = 24.6 ± 11.5 Bq L-1) and that of TFWT in the range of 9.2-60.5 Bq L-1 (mean = 30.7 ± 10.9 Bq L-1) in the vicinity of the NPP. Rigorous statistical analysis of the data confirmed that (i) the activity concentrations of both forms of tritium decreased with the increase in the distance between the sampling location and NPP, and beyond 10 km, it was similar to that of the control region, (ii) the incorporation of tritium released from the NPP into wild plant leaves is not species-dependent, (iii) the NE-OBT activity concentration in the 5-10 km zone exhibited a dependence on the prevailing wind regime with respect to the NPP, but not in the 2.3-5 km zone which suggests that the transport of tritium, released into the atmosphere as the gaseous effluent, through diffusion is a dominating factor governing its activity concentration in the 2.3-5 km zone. The NE-OBT to TFWT specific activity concentration ratio (R-value) had a mean value of 0.82 ± 0.27 (range: 0.38-1.64) for samples collected from the vicinity of the NPP and 1.93 ± 0.50 (range: 1.35-3.19) for the control region. Recording higher NE-OBT activity concentration and R-value at the control region highlights the necessity of detailed studies to understand the mechanism of NE-OBT partitioning in the terrestrial environment.

Optimisation of a batch thermal combustion method using a tube furnace oxidation system (pyrolyser) and LSC for carbon-14 determination in environmental matrices.

Accelerator mass spectrometry and benzene synthesis coupled with liquid scintillation spectrometry are often used for accurate measurements of 14C activity in the environmental matrices. Thermal oxidation is one of the methods employed for 14C determination in environmental matrices. In this method, the sample is oxidised at high temperature (600-900 °C) to convert carbon species to CO2 and trapped in an amine-based absorber for determining the activity in a liquid scintillation counting (LSC) system. In this study, the performance of a commercially available tube furnace system (pyrolyser), for batch combustion of samples, was evaluated for the determination of 14C specific activity in terrestrial biota samples. Significant improvements over the manufacturer specified method, which is primarily designed for analysis of samples with activity well above the environmental background level, was implemented to achieve accurate determination of 14C specific activity at ambient background level. In the improved method, the CO2 produced from the combustion of the sample was isolated from the combustion products through cryogenic trapping and then absorbed in the absorber (Carbo-Sorb E) through a simple off-line transfer process. This allowed (i) optimisation of CO2 absorption by the absorber (2.2477 g of CO2/10 mL), (ii) achieving good accuracy and precision in the measurements, and a minimum detectable activity value of 13 Bq kg-1C for a counting time of 300 min (7 Bq kg-1C for 1000 min), (iii) avoiding uncertainty associated with the determination of recovery of 14C in the combustion and trapping process, and (iv) elimination of the need for an independent determination of carbon content (%) for expressing the results in terms of 14C specific activity. The method is capable of yielding accurate results with a deviation of <2.4% from the target value for IAEA C3 quality assurance reference material (with a relative standard deviation of 1.40%, and relative error of 0.34%). The combined uncertainty (1σ) associated with the measurements was computed to be 3.4%. Upon optimisation, the suitability of the method for the determination of 14C specific activity in typical terrestrial biota samples of clean air region (region not affected by local anthropogenic sources) and for the quantification of a small increase in the 14C activity above ambient levels in the vicinity of a nuclear power plant is demonstrated.

Experimental database on water equivalent factor (WEQp) and organically bound tritium activity for tropical monsoonal climate region of South West Coast of India.

Tritium in the form of tritiated water is easily incorporated into terrestrial biota as tissue free water tritium (TFWT). A part of TFWT is converted into organically bound tritium (OBT) through metabolic processes. For the computation of NE-OBT activity (expressed as Bq L-1 of combustion water) in terrestrial plants, knowledge on 'water equivalent factor (WEQp)', defined as the volume of water produced from the combustion of 1 kg of the dry sample, is essential. On a global scenario, experimental data are not available on this parameter. This paper presents (i) a method for determination of WEQp by combustion method using a tube furnace system, (ii) a large database (N = 294) on WEQp parameter for samples of tropical monsoonal climate region of the Indian subcontinent, and (iii) NE-OBT activity in terrestrial biota samples (N = 186) collected from the vicinity of a PHWR nuclear power plant of India. The data generated in this study on WEQp serves for the validation of the data compiled in IAEA (2009 and 2010), which are estimated based on the hydrogen content of protein, fat and carbohydrates, and the fractions of protein, fat and carbohydrates. The WEQp varied in the ranges of 0.492-0.678 L kg-1 (GM = 0.569 Bq L-1, GSD = 1.06), 0.520-0.630 L kg-1 (GM = 0.557 Bq L-1, GSD = 1.02) 0.473-0.633 L kg-1 (GM = 0.562 Bq L-1, GSD = 1.02) for non-leafy vegetables, leafy vegetables, and fruits, respectively. A comparison between the experimental WEQp data with those compiled in the IAEA report revealed that the maximum deviation between the two data sets is <10%. The NE-OBT activity in the food samples collected from 2.3 to 20 km zone around NPP had a geometric mean (GM) value of 25.4 Bq L-1 (GSD = 1.6, N = 186). Variations in NE-OBT activity with different seasons of the year are discussed.

A WALK-IN TYPE CALIBRATION CHAMBER FACILITY FOR 222Rn MEASURING DEVICES AND INTER-COMPARISON EXERCISES.

A walk-in type 222Rn calibration chamber of volume 22.7 m3, which has traceability to international standards, is established at the Centre for Advanced Research in Environmental Radioactivity, Mangalore University, India. It has a human-machine interface communication system, a programmable logic controller and sensor feedback circuit for controlling and data acquisition of relative humidity (RH) and temperature (T). An innovative method for the generation of desired 222Rn concentration (a few hundred Bq m-3 up to about 36 kBq m-3) using soil gas as a source was adopted. Leak rates of 222Rn from the chamber for the mixing fan ON and OFF conditions were determined to be 0.0011 and 0.00018 h-1 respectively. With the exhaust system fully turned on, the maximum clearance rate of the chamber was 0.58 ± 0.07 h-1. Excellent spatial uniformity in 222Rn concentration in the chamber was confirmed (with a mean value of relative standard deviation < 12%) through measurements at 23 locations using CR-39 film-based passive devices. Demonstration of calibration applications was performed using charcoal canister and PicoRad vials as the 222Rn adsorption devices. The study shows that gamma spectrometry is a convenient alternative approach to liquid scintillation analysis of PicoRad vials for 222Rn measurement.

GAMMA DOSE RATES IN THE HIGH BACKGROUND RADIATION AREA OF MANGALORE REGION, INDIA.

Elevated levels of natural background radiation due to scattered patches of monazite sand around the beaches of Mangalore, India, have been reported earlier. A comparative study of gamma dose rates was performed in both normal background and high natural background radiation areas around Mangalore using different types of portable gamma dosimeters. In addition to this, gamma-ray energy spectra were acquired, in situ, using a NaI(Tl) based portable gamma spectrometer. Soil and sand samples were collected for laboratory analysis with HPGe detectors. Measurements were carried out during the years 2016-18 revealed that in majority of the locations the gamma dose rates were similar to the normal background regions, whereas, in certain locations the dose rates were higher with values up to 530 nSv/h.

BASELINE STUDIES ON RADIONUCLIDE CONCENTRATION IN FOOD MATERIALS AND ESTIMATION OF THE COMMITTED RADIATION DOSE AROUND THE PHOSPHATE INDUSTRIAL AREA OF SOUTH TUNISIA.

The activity concentration of natural and anthropogenic radionuclides was determined in different vegetable samples, and foods derived from animal origin, from different locations in the four cities of Southern Tunisia, where large-scale phosphate industries are operating. The aim of the studies was to establish a baseline database on radionuclide concentration in food materials and to evaluate the radiation dose to the general population due to its ingestion through the food chain. The activity concentrations of 40K, 210Pb, 226Ra, 228Ra and 137Cs was determined by gamma spectrometry using a HPGe detector, and from the measured activity concentrations, the doses were estimated using the dose coefficients given by the ICRP. The dose due to intake of radionuclides through mineral water was also determined. The total annual effective doses were found to be 2.2, 1.4, and 0.7 mSv y-1 for 1 y, 5-15 y and adult (>17 y) age groups, respectively. Among the radionuclides studied, 210Po was the highest contributor to the total dose, followed by 210Pb.

A study of temporal variations of 7Be and 210Pb concentrations and their correlations with rainfall and other parameters in the South West Coast of India.

As a part of establishing a regional database on natural radioactivity, the atmospheric concentrations of 210Pb and 7Be were measured over a three and half year period (2014-2017) in Mangalore and Kaiga in the South West Coast of India. A total of 99 air samples, collected in the different months of the year, were analysed in this study. The mean activity concentrations of 7Be and 210Pb were found to be 5.5 ±â€¯3.1 mBq m-3 and 1.1 ±â€¯0.73 mBq m-3, respectively. Both the radionuclides exhibited strong seasonal variations, with maximum concentration of 7Be occurring in the summer and that of 210Pb in the winter season. The concentration of both the radionuclides was minimum in the rainy season. Higher 210Pb concentration during winter was attributed to the ingression of continental air masses due to the wind regime from the North East. The sunspot number index of the solar activity also plays an important role in the increase and decrease of 7Be concentration in the air. A clear trend of increased and lowered concentration of 7Be with lower and higher solar activity (low and high sunspot number), respectively, in accordance with the 11-year solar cycle, was observed in this study. The temporal variation of PM10 concentration was also studied and it showed maximum value in the winter and minimum in the rainy season with an average of 56.9 µg m-3. Statistically significant positive correlation was observed between the PM10 and 210Pb activity concentration, whereas a weak correlation was observed between PM10 and 7Be. This is due to the fact that 7Be is largely associated with sub-micrometer size particles, whereas PM10 is contributed by larger sizes. The dependence of the activity concentrations of 7Be and 210Pb with meteorological parameters such as rainfall, temperature, and humidity was studied through linear regression analysis. A significant correlation was observed between 7Be and 210Pb concentrations with rainfall intensity (with identical correlation coefficients), which suggested that the removal mechanisms of these two radionuclides were similar. 7Be showed a strong correlation with temperature, whereas 210Pb with humidity. A comparison of the data obtained in the present study for the South West Coast of India with the global literature values of 7Be and 210Pb in aerosols showed that the values did not reflect the well-known latitudinal dependence of the 7Be tropospheric fluxes. Overall, the study provides an improved understanding of the correlation and variability of 210Pb and 7Be concentrations in the atmosphere in the South West Coast of India.

Estimation of air-to-grass mass interception factors for iodine.

Air-to-grass mass interception factors for radionuclide are important basic input parameter for the estimation of radiation dose to the public around a nuclear power plant. In this paper, we present the determination of air-to- grass mass interception factors for iodine using a 2 m × 2 m × 2 m (l × b × h) size environmental chamber. The temperature, humidity, and rainfall inside the environmental chamber was controlled to required values to simulate different environmental conditions. Grass (Pennisetum purpureum, Schum), grown in pots, was kept inside the environmental chamber and stable iodine in elemental form was sublimed quickly inside the chamber to simulate an accidental release of iodine to the environment. The concentration of iodine in the air was measured periodically by drawing air through a bubbling setup, containing 1% sodium carbonate solution. The mass interception factor for dry deposition varied in the range of 0.25-7.7 m2 kg-1 with mean value of 2.2 m2 kg-1 with respect to fresh weight of grass, and that due to wet deposition varied in the range of 0.6-4.8 m2 kg-1 with mean value of 2.3 m2 kg-1. The mass interception factor was inversely correlated with the total iodine deposited through dry deposition as well as with the rainfall.

Multiple autoimmune syndrome.

We report a case in which the presence of dermatological autoimmune conditions, vitiligo and alopecia areata, led to the diagnosis of a systemic autoimmune disease, ulcerative colitis.