The Advantages of a Rural Resident Rotation in Otolaryngology Training: Comparing Surgical Case Volumes of a Rural Rotation with a University Rotation

Objective: Rural residency rotations have played a significant role in encouraging surgical residents to pursue a career in a rural community. This study reviews the resident caseload of an otolaryngology residency rural rotation in comparison with a traditional primary university-based urban location. Methods: The Accreditation Council for Graduate Medical Education (ACGME) case log system was used to review cases logged by residents during their rural rotations from July 2017 to December 2018. Case log data were compared with a matched resident of similar training experience on the university service during the same time period. Results: Rural residents reported more cases than their urban-based counterparts (1143 vs 690 cases). Junior residents had over double the number of cases in rural practice (400) compared to junior residents on the university service (168). The university service was much stronger on H&N Neck (54 vs. 28 cases), Larynx (39 vs 8) and Endoscopy (92 vs 42). In contrast, the rural rotation provided substantially more Endocrine cases (103 vs 47) and comparable Salivary cases (23 vs 21) compared to the university service. Discussion: This study defines a surgically robust rotation in rural medicine and highlights the possibility of obtaining exposure to a surgical practice unique to a rural setting. By participating in high volume surgical rural residency rotations, trainees may better understand the otolaryngologic needs of a rura

An in situ method for the high resolution mapping of 137Cs and estimation of vertical depth penetration in a highly contaminated environment

The Chernobyl nuclear power plant meltdown has to date been the single largest release of radioactivity into the environment. As a result, radioactive contamination that poses a significant threat to human health still persists across much of Europe with the highest concentrations associated with Belarus, Ukraine, and western Russia. Of the radionuclides still prevalent with these territories 137Cs presents one of the most problematic remediation challenges. Principally, this is due to the localised spatial and vertical heterogeneity of contamination within the soil (~ 10's of meters), thus making it difficult to accurately characterise through conventional measurement techniques such as static in situ gamma-ray spectrometry or soil cores. Here, a practical solution has been explored, which utilises a large number of short-count time spectral measurements made using relatively inexpensive, lightweight, scintillators (sodium iodide and lanthanum bromide). This approach offers the added advantage of being able to estimate activity and burial depth of 137Cs contamination in much higher spatial resolution compared to traditional approaches. During the course of this work, detectors were calibrated using the Monte Carlo Simulations and depth distribution was estimated using the peak-to-valley ratio. Activity and depth estimates were then compared to five reference sites characterised using soil cores. Estimates were in good agreement with the reference sites, differences of ~ 25% and ~ 50% in total inventory were found for the three higher and two lower activity sites, respectively. It was concluded that slightly longer count times would be required for the lower activity (< 1 MBq m− 2) sites. Modelling and reference site results suggest little advantage would be gained through the use of the substantially more expensive lanthanum bromide detector over the sodium iodide detector. Finally, the potential of the approach was demonstrated by mapping one of the sites and its surrounding area in high spatial resolution

Reconstructing the deposition environment and long-term fate of Chernobyl (137)Cs at the floodplain scale through mobile gamma spectrometry

Cs-137 is considered to be the most significant anthropogenic contributor to human dose and presents a particularly difficult remediation challenge after a dispersal following nuclear incident. The Chernobyl Nuclear Power Plant meltdown in April 1986 represents the largest nuclear accident in history and released over 80 PBq of 137Cs into the environment. As a result, much of the land in close proximity to Chernobyl, which includes the Polessie State Radioecology Reserve in Belarus, remains highly contaminated with 137Cs to such an extent they remain uninhabitable. Whilst there is a broad scale understanding of the depositional patterns within and beyond the exclusion zone, detailed mapping of the distribution is often limited. New developments in mobile gamma spectrometry provide the opportunity to map the fallout of 137Cs and begin to reconstruct the depositional environment and the long-term behaviour of 137Cs in the environment. Here, full gamma spectrum analysis using algorithms based on the peak-valley ratio derived from Monte Carlo simulations are used to estimate the total 137Cs deposition and its depth distribution in the soil. The results revealed a pattern of 137Cs distribution consistent with the deposition occurring at a time of flooding, which is validated by review of satellite imagery acquired at similar times of the year. The results were also consistent with systematic burial of the fallout 137Cs by annual flooding events. These results were validated by sediment cores collected along a transect across the flood plain. The true merit of the approach was confirmed by exposing new insights into the spatial distribution and long term fate of 137Cs across the floodplain. Such systematic patterns of behaviour are likely to be fundamental to the understanding of the radioecological behaviour of 137Cs whilst also providing a tracer for quantifying the ecological controls on sediment movement and deposition at a landscape scale

Detection and Localization of Weapons Grade Plutonium with an Array of NaI Detectors

An array of scintillators is a multipurpose sensitive detection system of photons and neutrons while also providing directional sensitivity. Several simulations were performed with Geant4 software to optimize the design of such an array for neutrons. A crucial design criterion was an excellent detection and localization capability, and the system must be practical for operational field work. A large array, containing four 4 L NaI detectors, can fulfil these criteria. Such an array, clad with 3 - 5 cm of PVC, has a neutron counting efficiency which is of the same order of magnitude as the state-of-the art commercial neutron detectors based on helium tubes or plastic (LiF/ZnS). For a count time of 12 minutes, the array can detect 4 kg of weapons grade plutonium at a distance of 50 m. The detection time can be essentially shortened down to a few minutes by increasing the thickness of the PVC up to 10 cm.This publication is part of the implementation of research funding of the Scientific Advisory Board for Defence (MATINE). (www.defmin.fi/matine) The content is the responsibility of the producers of the information and does not necessarily represent the view of the Defence Ministry

The Benefits of Early Book Sharing (BEBS) for child cognitive and socio-emotional development in South Africa: study protocol for a randomised controlled trial

Background:Children in Low and Middle-Income Countries (LMICs) are at risk for problems in their cognitive, social and behavioural development. Factors such as a lack of cognitive stimulation, harsh parenting practices, and severe and persistent aggression in early childhood are central to the genesis of these problems. Interventions that target the intersection between early childhood development, parenting, and early violence prevention are required in order to meaningfully address these problems. Methods:We are conducting a randomized controlled trial to evaluate a parenting intervention for caregivers of children between 23-27 months, designed to promote child cognitive and socio-emotional development in Khayelitsha, a low income peri-urban township in South Africa. Families are randomly allocated to book sharing or to a wait-list control group. In the intervention, we train caregivers in supportive book-sharing with young children. Training is carried out in small groups over a period of eight weeks. Data are collected at baseline, post-intervention and at six months post-intervention. In addition to targeting child cognitive development, the intervention aims to improve child socio-emotional functioning. Discussion:The Benefits of Early Book Sharing (BEBS) trial aims to evaluate the impact of an early parenting intervention on several key risk factors for the development of violence, including aspects of parenting and child cognition, prosocial behaviour, aggression, and socio-emotional functioning. The study is being carried out in a LMIC where violence constitutes a major social and health burden. Since the intervention is brief and, with modest levels of training, readily deliverable in LMIC contexts, a demonstration that it is of benefit to both child cognitive and socio-emotional development would be of significance

Towards a practical framework for managing the risks of selecting technology to support independent living

Information and communication technology applications can help increase the independence and quality of life of older people, or people with disabilities who live in their own homes. A risk management framework is proposed to assist in selecting applications that match the needs and wishes of particular individuals. Risk comprises two components: the likelihood of the occurrence of harm and the consequences of that harm. In the home, the social and psychological harms are as important as the physical ones. The importance of the harm (e.g., injury) is conditioned by its consequences (e.g., distress, costly medical treatment). We identify six generic types of harm (including dependency, loneliness, fear and debt) and four generic consequences (including distress and loss of confidence in ability to live independently). The resultant client-centred framework offers a systematic basis for selecting and evaluating technology for independent living

Recent Levels of Technetium-99 in Seawater at the West Coast of Svalbard

Seawater from the western coast of Svalbard was sampled in the spring and summer of 2000 to determine levels of technetium-99 (99Tc), a conservative-behaving, manmade radionuclide originating from European nuclear reprocessing plants. This paper deals with the recent levels of this radionuclide in seawater and with the link between an Arctic fjord, Kongsfjorden, and the Western Spitsbergen Current (WSC), investigated using 99Tc results. By means of the WSC, the 99Tc radionuclides ultimately reach the eastern Fram Strait west of Spitsbergen (the largest island of the Svalbard archipelago). Results from oceanographic modelling and sea ice observations indicate a direct coupling between Kongsfjorden and the area west of it. The findings in connection with new radionuclide results presented in this paper concur with these assumptions. Furthermore they indicate that the inner part of Kongsfjorden is also well linked to the WSC. Surface seawater from the central part of the WSC, sampled during a cruise with RV Polarstern in the summer of 2000, shows a higher level of 99Tc than those measured in Kongsfjorden in spring 2000. However, all levels measured in surface water are of the same order of magnitude. Data from sampling of deeper water in the WSC area provide information pertaining to the lateral distribution of 99Tc. The results, along with additional data from spring 2001, indicate that Kongsfjorden is suitable for monitoring the levels of 99Tc arriving in the European Arctic and that the sheltered setting of this fjord does not necessarily provide protection against pollution from the open sea