SECONDARY NEUTRON DOSES IN A PROTON THERAPY CENTRE

The formation of secondary high-energy neutrons in proton therapy can be a concern for radiation protection of staff. In this joint intercomparative study (CERN, SCK•CEN and IBA/IRISIB/ULB), secondary neutron doses were assessed with different detectors in several positions in the Proton Therapy Centre, Essen (Germany). The ambient dose equivalent H(*)(10) was assessed with Berthold LB 6411, WENDI-2, tissue-equivalent proportional counter (TEPC) and Bonner spheres (BS). The personal dose equivalent Hp(10) was measured with two types of active detectors and with bubble detectors. Using spectral and basic angular information, the reference Hp(10) was estimated. Results concerning staff exposure show H(*)(10) doses between 0.5 and 1 nSv/monitoring unit in a technical room. The LB 6411 showed an underestimation of H(*)(10), while WENDI-2 and TEPC showed good agreement with the BS data. A large overestimation for Hp(10) was observed for the active personal dosemeters, while the bubble detectors showed only a slight overestimation.

A new version of the LUPIN detector: improvements and latest experimental verification

LUPIN-II is an upgraded version of LUPIN, a novel rem counter first developed in 2010 specifically conceived to work in pulsed neutron fields (PNFs). The new version introduces some modifications that improve the performance of the detector, in particular extending its upper detection limit in PNFs. This paper discusses the characteristics and the performance of the instrument. Measurements have been carried out in radiation fields characterized by very different conditions: the detector has first been exposed in PNFs with intensity up to 5 μSv per burst, where it could keep the H*(10) underestimation below 20% up to 500 nSv per burst. It has then been tested in operational conditions around particle accelerators, where it has shown performances similar to that of ionization chambers. Its proper functioning has also been verified in high energy mixed fields, where the experimental results matched the Monte Carlo predictions. Its neutron/photon discrimination capability has been tested in a steady-state photon field where, via an innovative technique based on a threshold set on the derivative of the current signal, it was capable of rejecting a photon H*(10) rate of about 25 mSv/h, and in a mixed neutron/photon field, where a time-based discrimination method was employed.

Training health professionals: a multidisciplinary team approach in a university-based weight-loss program

In a university-based weight-loss program for preadolescent girls, a multidisciplinary team delivered the intervention. The team included a nurse/health educator, an exercise physiologist, a psychologist, five dietitians, and 17 dietetics, nursing, and medical students, The six-month program provided 12 educational sessions in nutrition, stress management, behavior modification, and exercise. Concurrent sessions for parents addressed comparable educational topics and parenting skills. Dietitians and student research assistants (n = 19) were surveyed regarding their participation on a multidisciplinary team and their acquisition of new knowledge/skills. The survey included both open-ended questions and Likert-type statements. Results indicate that participation enhanced knowledge of nutrition counseling/education (chi = 1.6) as well as appreciation for research (chi = 1.8) and for the multidisciplinary team approach (chi = 1.7). Qualitative data reinforce the benefits of the multidisciplinary experience and multiskill training. Exercise, stress management, parenting skills, and psychological techniques were perceived as important skills to develop for professional careers.

Enhancing didactic education through participation in a clinical research project

The purpose of this study was to assess self-evaluation of knowledge and skills (e.g., counseling, education, interviewing, and assessment skills) of students participating as research assistants. Fifteen students enrolled in the Dietetics Program (n = 10) or the Graduate Program in Nutrition (n = 5) were recruited as research assistants via flyers and announcements in nutrition courses. These students assisted faculty researchers with their clinical study called "Weight Loss Effects on Bone Mass in Adolescent Females." The clinical study included a comprehensive 6-month weight-loss program. Surveys asking students to evaluate their experience as research assistants were mailed with a self-addressed, stamped envelope to all 15 student research assistants, followed by a reminder telephone call. Thirteen surveys (87%) were returned. On a Likert scale (1 = poor, 5 = excellent) student research assistants scored 63% of the knowledge-based and skill-based requirements of their research participation as "good" (mean score > or = 4.0) and 27% as "adequate" (4.0 > or = mean > or = 3.5). Open-ended questions reported the research experience to be beneficial in developing knowledge and skills and in identifying knowledge deficits (e.g., behavior modification). According to our findings, it seems that participation in clinical research enhances students' knowledge and skills and, thus, is valuable in preparing dietetics students for future practice.

Retinopathy of prematurity in infants < 32 weeks' gestation at birth in New South Wales in 1993 and 1994

OBJECTIVE

To study the incidence and severity of retinopathy of prematurity (ROP) in infants < 32 weeks' gestation.

DESIGN

Review of the records maintained in the New South Wales Neonatal Intensive Care Unit Study (NICUS) database on infants admitted to the neonatal intensive care units (NICU) in NSW from 1 January 1993 to 31 December 1994.

RESULTS

In the more premature infants, 23-26 weeks' gestation, 65% developed ROP (102 of 157 examined for ROP). Forty-four infants (28%) developed severe ROP (Stage >/= 3 ROP), 19 infants (12.1%) required cryo/laser therapy and one infant (0.6%) in this group had a retinal detachment. One hundred and fifty-seven of 159 surviving infants (98.7%) were examined for ROP. In the infants 27-28 weeks' gestation, 38.3% developed ROP (103 of 269 examined for ROP). Fifteen infants (5.6%) developed severe ROP, seven infants (2. 6%) required cryo/laser therapy for threshold ROP and three infants (1.1%) in this group had a retinal detachment. Two hundred and sixty-nine of 299 surviving infants (90%) were examined for ROP. In the infants 29-31 weeks' gestation, 10.8% developed ROP (48 of 443 examined for ROP). Six infants (1.4%) developed severe ROP, one infant (0.2%) required cryo/laser therapy for threshold ROP and no infant in this group had a retinal detachment. However, only 443 of 681 surviving infants (65.1%) in this group were examined for ROP. Of the four infants with detached retinas, one was a 25 week gestation infant weighing 840 g, two were 27 weeks' gestation weighing 960 and 980 g and one infant was a 28 week gestation infant weighing 620 g. No infant developed Stage 5 ROP.

CONCLUSION

In the more mature infants 29-31 weeks' gestation, the rate of ROP is low, although severe ROP still occurs. However, only 65.1% of these infants were examined for ROP and we should be diligent in screening for ROP in the sicker infants in this group. The incidence of severe ROP as well as the rate of cryo/laser therapy in premature infants 23-26 weeks' in NSW has not changed since the increases seen in the early 1990s. Retinal detachment also occurs in the infants 27-28 weeks' gestation and it is important that all these infants are screened for ROP.

Retinopathy of prematurity in infants < 32 weeks' gestation at birth in New South Wales in 1993 and 1994

OBJECTIVE

To study the incidence and severity of retinopathy of prematurity (ROP) in infants < 32 weeks' gestation.

DESIGN

Review of the records maintained in the New South Wales Neonatal Intensive Care Unit Study (NICUS) database on infants admitted to the neonatal intensive care units (NICU) in NSW from 1 January 1993 to 31 December 1994.

RESULTS

In the more premature infants, 23-26 weeks' gestation, 65% developed ROP (102 of 157 examined for ROP). Forty-four infants (28%) developed severe ROP (Stage ≥ 3 ROP), 19 infants (12.1%) required cryo/laser therapy and one infant (0.6%) in this group had a retinal detachment. One hundred and fifty-seven of 159 surviving infants (98.7%) were examined for ROP. In the infants 27-28 weeks' gestation, 38.3% developed ROP (103 of 269 examined for ROP). Fifteen infants (5.6%) developed severe ROP, seven infants (2.6%) required cryo/laser therapy for threshold ROP and three infants (1.1%) in this group had a retinal detachment. Two hundred and sixty-nine of 299 surviving infants (90%) were examined for ROP. In the infants 29-31 weeks' gestation, 10.8% developed ROP (48 of 443 examined for ROP). Six infants (1.4%) developed severe ROP, one infant (0.2%) required cryo/laser therapy for threshold ROP and no infant in this group had a retinal detachment. However, only 443 of 681 surviving infants (65.1%) in this group were examined for ROP. Of the four infants with detached retinas, one was a 25 week gestation infant weighing 840 g, two were 27 weeks' gestation weighing 960 and 980 g and one infant was a 28 week gestation infant weighing 620 g. No infant developed Stage 5 ROP.

CONCLUSION

In the more mature infants 29-31 weeks' gestation, the rate of ROP is low, although severe ROP still occurs. However, only 65.1% of these infants were examined for ROP and we should be diligent in screening for ROP in the sicker infants in this group. The incidence of severe ROP as well as the rate of cryo/laser therapy in premature infants 23-26 weeks' in NSW has not changed since the increases seen in the early 1990s. Retinal detachment also occurs in the infants 27-28 weeks' gestation and it is important that all these infants are screened for ROP.

Sexual behavior among U.S. high school students, 1990-1995

CONTEXT

High rates of unintended pregnancy and sexually transmitted diseases (STDs), including HIV infection, among adolescents are major public health concerns that have created interest in trends in teenage sexual activity.

METHODS

Nationally representative data from Youth Risk Behavior Surveys conducted in 1990, 1991, 1993 and 1995 are used to examine levels of sexual experience, age at first intercourse, current sexual activity and condom use at last intercourse among students in grades 9-12.

RESULTS

The proportion of students who reported being sexually experienced remained at 53-54% from 1990 through 1995, while the percentage of sexually active students who used condoms at last intercourse rose from 46% to 54% between 1991 and 1995. Black students were more likely than white students to report being sexually experienced, being currently sexually active and having had four or more lifetime sexual partners; black students also reported a significantly younger age at first intercourse. Gender differences in sexual behavior were found more frequently among black students than among white or Hispanic students.

CONCLUSIONS

Although levels of sexual experience for high school students in the United States have not risen during the 1990s, a very high percentage of students continue to be at risk for unintended pregnancy and STDs, including HIV infection.

Retinopathy of prematurity in infants <29 weeks' gestation at birth in New South Wales from 1986-92

OBJECTIVE

To study the effect of increased survival of infants <29 weeks' gestation on the incidence and severity of retinopathy of prematurity (ROP).

METHODOLOGY

Review of prospective records from 1986 to 1992 kept in the New South Wales (NSW) NICUS database on infants admitted to the neonatal intensive care units (NICU) in NSW. The survival rate and the incidence and severity of ROP on all infants <29 weeks' gestation admitted to the NICUs in NSW from 1 July 1986 to 31 December 1987 were compared to a similar group of infants admitted from 1 January 1992 to 31 December 1992.

RESULTS

There was a significant difference in the survival rate of infants admitted between the two periods (235 of 376, 62.5% survival vs 255 of 336, 75.9% survival, respectively, P<0.0001). The odds ratio for survival adjusted for gestational age in the second period was 1.76 [1.24, 2.48 (95% confidence interval), P<0.002]. There was a slight increase in ROP in the second period (79 of 172 examined, 45.9% ROP vs 133 of 238 examined, 55.8% ROP, respectively). There was a rise in the number of infants with Stage 3 ROP in the second time period (14 of 172 examined, 8.1% ROP vs 41 of 238 examined, 17.2% ROP, respectively). However, fewer infants had detached retinas or > or = Stage 4 ROP in the second group [7 of 172, (4.1 %) vs 3 of 238, (1.3%), respectively]. This may be a reflection of the increase in the use of cryo- or laser therapy for Stage 3 ROP with 'plus' disease [2 of 172 examined, (1.2%) vs 18 of 238 examined, (7.6%), respectively].

CONCLUSIONS

With the increase in survival of the very preterm infant in recent years, there has been an increase in severe ROP (> or = Stage 3) in NSW. Despite the increased survival of the highest at-risk group (24- to 26-week gestation infants), there have been fewer cases of retinal detachment. There was also a rise in the number of infants receiving cryo- or laser therapy intervention.

Bone mineral density in elite 7- to 9-yr-old female gymnasts and swimmers

It is has been suggested that physical activity may increase bone mineral density (BMD) in children, thereby preventing development of osteoporosis later in life. We studied 14 gymnasts, 14 swimmers, and 17 controls to investigate whether participation in different types of sports among girls 7-9 yr of age is associated with higher total body BMD. Gymnasts were lighter than both swimmers and controls (P = 0.001), and a larger percent of gymnasts compared with swimmers and controls were below the 25th percentile for height and weight. Fat mass, percent body fat, and lean mass were less in gymnasts compared with swimmers and controls (all P < or = 0.05). The relationship between total body BMD and body weight differed among the three groups (interaction term of weight and sport, P < 0.001); the increase in BMD per unit increase in body weight was more among gymnasts than among swimmers and controls. These results indicate that high impact bone loading activities may lead to increased bone density among young girls.