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By: Paul Reynolds, PharmD, BCPS
- Critical Care Pharmacy Specialist, University of Colorado Hospital
- Clinical Assistant Professor, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
http://www.ucdenver.edu/academics/colleges/pharmacy/Departments/ClinicalPharmacy/DOCPFaculty/Q-Z/Pages/Paul-Reynolds,-PharmD.aspx
In educating patients about medication it is important to anxiety symptoms 4-6 buy generic atarax 25 mg provide the realistic view that individuals have different risk/benefit profiles on medication anxiety symptoms help buy generic atarax online, ranging from those who cannot to anxiety 5-htp generic atarax 10 mg with visa lerate or benefit from medication at all anxiety symptoms abdominal pain order cheapest atarax, to those who have full remission with no side effects. While our evidence base on medication allows us to provide patients with a great deal of information on medication options, it is also important to remind patients and parents that all individuals are unique and may require doses that are smaller or larger than are usually recommended. It is important to point out that agreeing to a “trial” of medication is not a decision to use it forever. A trial is an experiment that carries minimal if any risks that would extend beyond a very brief period of time, and can be discontinued at any point. Patients who are good stimulant responders, but whose medication is limited by side effects, should be managed by the techniques described below or switched to a different medication regimen that minimizes that particular problem. Patients who are not responding to medication and obtaining little benefit, but do not have major side effects, may require non-medication strategies. If a change in medication is thought necessary, switch medication during long vacations or during the summer to avoid possible side effects that may impair school performance in the short-term. However, sometimes switching medications requires a more immediate intervention due to the urgency of the situation. If a period off medication or on a reduced dose to minimize side effect is required, it should be done during long vacations, the summer, or on long weekends to minimize impact on school performance. Clinically, it is observed that interrupting medication every weekend may in fact increase side effects. These medications should be tapered due to the risk of significant side effects or dangers. If there is no response to treatment, it is important to review the diagnosis, including comorbidities, and the treatment plan in order to ensure compliance to treatment as well as to check if there are new external fac to rs that could complicate the clinical picture. Patients’ responses to medication cannot be predicted based solely on the clinical symp to ms displayed. Specifically, if a patient does not have an adequate response to one class of stimulant, then it would be prudent to switch to the other class of stimulant. Sustained-release medications are preferred as they are taken once daily, thus improving adherence, and are less likely to be abused, misused or diverted than immediate-release products. Also sustained-release preparations maintain privacy, dignity and respect for patients and families in the context of the school setting. Switching from One Type of Medication to Another: Points to consider Generally, it is best to only be medicating with one medication at a time. Thus, it is often best to gradually decrease on the first medication and s to p it before starting on the second. Trying to use two medications at the same time often results in side effects from each medication and prevents the clinician from reaching optimal clinical dosages because of side effects. Situation A: Switching from a psychostimulant to another psychostimulant Choose an opportune time for transition, such as during holidays or at the weekend. If the patient gets better with a combination of both a non-stimulant and a psychostimulant, closely moni to r adverse effects and try to eventually reduce either the psychostimulant or the non-stimulant. An increased dose could be spread out to include q2pm dose with a daily maximum of 60 mg. In Canada, Vyvanse comes in capsules available in five doses (20, 30, 40, 50 and 60 mg). Occasionally it may be necessary to " to p up" the medication in the late afternoon to extend the clinical effect. While multiple doses can be used to create a closer titration (18 mg + 27 mg= 45 mg; 27 mg + 36 mg = 63 mg, etc), the higher cost of the combination of two dosages may be prohibitive. Occasionally it may be necessary to " to p up" the medication in the morning to extend the clinical effect. However, the clinical profile of this new delivery system formulation has not been field tested. Monograph information is derived from the Concerta Monograph; only the bioequivalence data has been researched. The tablets look like Concerta but can be more easily crushed; this could affect its abuse potential as the time to maximum concentration (Tmax) is earlier with the generic medication. Meanwhile, the decision to switch to a generic formulation is an individual-based decision and we strongly advocate that the patient/family be advised of the switch, to ld to check for clinical changes in efficacy or to lerability and report any changes to their pharmacist and doc to r. However, the compound has a wax matrix which at times results in inconsistent release of medication and thus inconsistent effects. The onset of action is slower than stimulants as it acts differently on neurotransmitters and the maximum treatment effect may not be reached for six to eight weeks. The dose is calibrated to the weight of the patient (see relevant tables for initiation, titration and maximum doses in Supporting Document 7A). The American Academy of Child and Adolescent Psychiatry has stated that the doses could go as high as 2. The medication’s safety profile has been established, including risk fac to rs related to cardiovascular conduction irregularity similar to those of stimulant drugs. There have been rare reports of increase in suicidal ideation; one suicide attempt (overdose) was identified; no completed suicides occurred212, 213. Clinicians need to carefully moni to r suicidal ideation, especially in the early phases of treatment, not unlike with many antidepressant medications. The clinical efficacy was the same as stimulants in patients who were treatment naive214. Strattera can be given as a morning and evening split dose which is sometimes optimal to reduce side effects (but this strategy increases costs). Strattera capsules should not be opened because the contents are an ocular irritant. If the contents get in the eye, there should be immediate eye-flushing and seek medical attention if needed. The onset of action is slower than stimulants as it acts differently on neurotransmitters and the maximum treatment effect may not be reached for several weeks. It would not be suitable in cases where there is an urgency to obtain a rapid onset of action. Dose is calibrated slowly (see relevant tables for initiation, titration and maximum doses in Supporting Document 7A). The tablets should not be crushed, chewed or broken down before swallowing as this will alter the rate of guanfacine release. The risk fac to rs related to cardiovascular side effects differ from those associated with stimulant drugs and a to moxetine. Somnolence, sedation and a lowering of pulse and blood pressure may occur, particularly at the initiation, after dose adjustments and following discontinuation. To help maintain adequate blood pressure, patients should be advised to avoid dehydration. In addition, stimulant medication may increase the difficulty of falling asleep218, 219. Patients often complain that "they cannot turn their thoughts off" and resist going to bed since they do not feel sleepy. Most sleep problems can be diagnosed clinically and treated effectively with significant improvement in quality of life11. Stimulants may induce insomnia: Administer medication as early as possible in the morning. Try to assure that the patient is not in rebound at the time that they are trying to fall back asleep by either lowering the dose late in the day or shaping a slow offset of action. Strategies to Improve Sleep Sleep Hygiene Optimize sleep hygiene: maintain a quiet and comfortable sleep environment. If the patient is allowed to sleep late in the day this will phase delay the circadian rhythm. Exposure to passive stimulation activities such as watching television, playing computer games or going on chat lines will disrupt the initiation of sleep, despite beliefs that these activities promote fatigue. It is better that the individual do active stimulation such as reading as a means to make themselves mentally fatigued. It is helpful if the individual is physically active through the day (though not within two hours of bedtime) to aid in physical exhaustion. Limit the use of the bed to sleep and sex only as this will create a positive association.
Syndromes
- Benign positional vertigo, a spinning feeling that occurs when you move your head
- Chest x-ray
- Children: 7 to 20
- Sour taste in the mouth
- Itching, most commonly at night
- FDA-approved color additives
- An eye injury or other problem with your eyes or eyelids (like a drooping eyelid or bulging eyes)
- Biliary atresia
- For a cerebrospinal fluid sample, see CSF collection.
- Acute kidney failure
Humans are not designed to anxiety symptoms list 25 mg atarax mastercard be awake at night and asleep during the day and this causes a conflict with the circadian rhythm anxiety symptoms vs heart attack symptoms buy generic atarax online. Page 22 | Sleep: A Basic Introduction Figure 5: Phase Delays and Phase Advances – Jet Lag Phase Delay: Flying from West to pain anxiety symptoms scale 20 buy atarax 10mg without a prescription East Phase Advance: Flying from East to status anxiety purchase discount atarax on line West creates a ‘phase delay’ as the body creates a ‘phase advance’ where the body clock shifts backwards and we go to clock shifts forwards and we are forced to bed earlier. Jet lag occurs because mela to nin production remains on the same day-night pattern of the home country for several days resulting in a conflict between the internal body clock and the external stimuli telling you to stay awake or go to sleep. The sleep-wake cycle is set on where you left (telling you one time), but the light cues are trying to tell us it is a different time of day. A sleep disorder – technically known as a ‘somnipathy’ or ‘dyssomnia’ – is any medical disorder which negatively affects a person’s healthy sleep patterns. There are at least 80 different sleep disorders that have been identified, the most common and well known being insomnia. Sleep problems can be broken down in to two distinct types – ‘Parasomnias’ and ‘Sleep Disorders’ – and we will explore some of the most Insomnia is the most common sleep disorder common ones in this part of the booklet. Typically, sufferers may complain of difficulty getting to sleep, difficulty staying asleep, intermittent wakefulness during the night, early morning awakening, or combinations of any or all of these. Insomnia, sleep apnea and sleepwalking are just a few of the conditions which contribute to sleep deprivation and lead to an individual not feeling refreshed and res to red when they wake up. As we now know, inadequate sleep can result in fatigue, depression; concentration problems, illness and injury. Six hours of quality sleep could be enough to have a person feeling rested the next day, but having eight to ten hours of restless sleep may leave you feeling exhausted after you awaken and for the rest of the day. There are a plethora of medical and counselling websites and self-help books which deal with sleep disorders in great detail. Fac to rs that can cause sleep problems include: fi Physical disturbances such as pain. Short-term or acute insomnia can be caused by life stresses such as job loss or change, death of a loved one, or moving home, illness, or environmental fac to rs, such as light, noise, or extreme temperatures. Long-term or chronic insomnia (insomnia that occurs at least three nights a week for a month or longer) can be caused by fac to rs such as depression, chronic stress, and pain or discomfort at night. Their activities run contrary to their biological clocks and disrupt sleep routines. Some people turn to alcohol to help them sleep, however, alcohol is a sedative and so suppresses certain stages of the sleeping process meaning sleep doesn’t achieve its physiological functions. In fact, an underlying condition is identified in only about 1% of children who routinely wet the bed. Sleepwalking mostly happens in childhood, typically between the ages of 4 and 8, but adults can do it to o. When someone sleepwalks, they might quietly walk around their room or they might run or attempt to "escape. Page 27 | Sleep: A Basic Introduction Brief episodes of sleepwalking are often caused by stress or a disturbance in your usual sleep pattern. Nightmares and Night Terrors While it’s true that nightmares are more common among children, one out of every two adults has nightmares on occasion and between 2% and 8% of the adult population is plagued by nightmares. For example, a lot of adults have nightmares about not being able to run fast enough to escape danger or about falling from a great height. They are experienced as feelings, not dreams, so people do not recall why they are terrified upon awakening. Some people have nightmares after having a late-night snack, which can increase metabolism and signal the brain to be more active. Night terrors may be caused by stressful and/or traumatic life events, fever, sleep deprivation and medications that affect the brain but are usually influenced by frightening experiences that have occurred during the day. A typical night terror episode usually begins approximately 90 minutes after falling asleep. During an episode, a person may hear, feel, or see things that are not there, which often results in Page 28 | Sleep: A Basic Introduction fear. Sleep researchers conclude that, in most cases, sleep paralysis is simply a sign that your body is not moving smoothly through the stages of sleep. This common condition is often first noticed in the teen years but men and women of any age can have it. Sleep talking can involve complicated dialogues or monologues, complete gibberish or mumbling. Anyone can experience sleep talking, but the condition is more common in males and children. Sleep-talkers are not typically aware of their behaviours or speech; therefore their voices and the type of language they use may sound different from their wakeful speech. Little is known about the content of the sleep talking: some talking makes no sense at all and some of it may relate to past events, experiences, and relationships that no longer have current relevance or emotional impact. Although not physically harmful, sleep talking can cause embarrassment and can annoy a bed partner, roommate, or be disruptive in group-sleeping situations. Occasional teeth grinding, medically called bruxism, does not usually cause harm, but when teeth grinding occurs on a regular basis, the teeth can be damaged and other complications can arise, such as jaw muscle discomfort or pain. Stress reduction and other lifestyle modifications, including the avoidance of alcohol and caffeine, may also be helpful. Sleep disorders, including snoring, sleep apnea, insomnia, sleep deprivation, and restless legs syndrome, are common. Whether they are caused by a health problem or by to o much stress, sleep disorders are becoming increasingly common. However, when these issues begin to occur on a regular basis and interfere with daily life, they may indicate a sleeping disorder. Depending on the type of sleep disorder, people may have a difficult time falling asleep and may feel extremely tired throughout the day. The lack of sleep can have a negative impact on energy, mood, concentration, and overall health. Insomnia Insomnia is the most common type of sleep disorder where the person has poor quality sleep, not enough sleep and wakes up for long periods during the night. It is the inability to fall or remain asleep over a period of several nights and may be due to stress, anxiety, hormonal changes, lifestyle, environmental fac to rs, physical ailments, or psychiatric illness. People with insomnia have one or more of the following symp to ms: fi Difficulty falling asleep fi Waking up often during the night and having trouble going back to sleep fi Waking up to o early in the morning fi Feeling tired upon waking There are also two types of insomnia: fi Primary insomnia: this is where the person is having sleep problems that are not directly associated with any other health condition or problem. Page 30 | Sleep: A Basic Introduction It has been suggested one in ten people suffer from some form of insomnia with the most common causes being stress, medication and other stimulants, pain, anxiety and depression. The most likely groups of sufferers are older people with ill health and shift workers, due to the constant changing of the sleep patterns. Importantly though, sleeping pills and other prescribed medication are only temporary cures and their effectiveness will decrease over time. This condition usually begins between the ages of 35 and 60 and leads to their death a few months later. Sleep apnea can be a very dangerous condition which has been linked to heart disease, high blood pressure and strokes. It is characterised by pauses in breathing or instances of shallow or infrequent breathing during sleep, commonly caused by snoring. Billy Connolly, the Scottish comedian and ac to r, is a high-profile sufferer of sleep apnea and tells some very funny s to ries about trying to cure the problem, but for people unaware they are suffering this chronic condition, the results can be tragic. It is also more prevalent in people who are either obese or overweight and smoking and alcohol consumption increase the risk of developing the condition. The person may snore very loudly and sometimes s to p breathing for short periods throughout the night. The sleeper wears a special mask over nose and mouth during sleep whilst a Page 31 | Sleep: A Basic Introduction breathing machine pumps a constant stream of air to keep the airway open. For some people, symp to ms may cause severe nightly sleep disruption that can significantly impair their quality of life. Research suggests that having extra magnesium, vitamin B, vitamin E and iron may help and eating foods such as wholegrain, nuts, seeds and pulses. Narcolepsy Narcolepsy is a chronic neurological disorder that is caused by the brain’s inability to regulate sleep wake cycles normally.
Identify community resources or support groups and visiting May need additional assistance with self-moni to anxiety symptoms belching order atarax 10 mg without a prescription ring and home home health nurse anxiety panic attack symptoms buy discount atarax, as indicated anxiety reduction buy discount atarax 10mg line. The presumption is that sudden cardiac death is produced by a lethal cardiac arrhythmia anxiety quotes images atarax 25mg lowest price, as well as struc tural and functional changes in the heart (Tomaselli, 2004). If client chooses to refuse life-support measures, an alterna tive contact person (rather than 911) needs to be desig nated, should cardiac arrest occur. Pain may or symp to ms compatible with myocardial ischemia and includes may not radiate to jaw, neck, back, or arm. Women often present with atypical symp to ms, such as 2012) “indigestion,” palpitations, nausea, fatigue, numbness in a. The disorder is characterized by a narrowing of coronary ar the hands, and discomfort (not necessarily pain) and not teries due to atheroscleroscloritc plaque, damaging the in necessarily in the chest (Pilote, 2007). There can be plaque rupture or clot forma (15 minutes), not generally relieved with rest or tion causing a sudden reduction of blood flow and a partial medications. The imbalance between oxygen supply and demand is angina, approximately 9 million. Etiology (Go et al, 2012; Mayo Clinic, 2010) disease in 2008; accounts for approximately 33% of to tal a. Cost: Inpatient cardiovascular procedures and operations in off, creating emboli, and coronary artery obstruction. Usually be elevated in skeletal muscle injury, liver disease, or kidney due to an occlusive thrombus. Troponins ies supplying the muscles of the heart, resulting in injury or are the preferred tests for a suspected heart attack because necrosis of the heart muscle (heart attack). X-ray imaging is used to guide the the actual rupture of a plaque in a coronary artery resulting catheter threading. At the blockage, the balloon is inflated to in clot formation, with impairment of free blood flow to tis open the artery, allowing blood to flow. The imminent risk of a complete myocardial infarction at the site of blockage to permanently open the artery. It may show changes during symp to ms and in response to ischemia present, or any damage to myocardial tissue from treatment; confirm a cardiac basis for symp to ms. It also may the past demonstrate preexisting structural or ischemic heart disease (left ventricular hypertrophy, Q waves). An echocardiogram can also help in defining the extent of an infarction when muscle damage occurs. Client with intractable angina (despite shape, and evaluates ventricular contractility medication) should immediately undergo cardiac catheteriza tion (Coven, 2013). Differentiation is generally based on three sets of tests measured at 6 to 8-hour intervals after the client’s presentation to the emergency depertment. Prevent or minimize development of myocardial compli baseline, and self-care needs met with minimal or no pain. Demonstrate relief of pain as evidenced by stable vital signs and absence of muscle tension and restlessness. This potent vasoconstric to r causes coronary artery spasm, which can precipitate, compli cate, and prolong an anginal attack. Assess and document client response and effects of Provides information about disease progression. Evaluate reports of pain in jaw, neck, shoulder, arm, or hand Cardiac pain may radiate; for example, pain is often referred to (typically on left side). Tachycardia also develops in response to sympathetic stimulation and may be sustained as a compensa to ry response if cardiac output falls. Clients with unstable angina have an increased risk of acute life-threatening dysrhythmias, which occur in response to ischemic changes and stress hormones. Observe for associated symp to ms, such as dyspnea, nausea, Decreased cardiac output, which may occur during ischemic vomiting, dizziness, palpitations, and desire to urinate. Anxiety releases catecholamines, which increase myocardial workload and can escalate or prolong ischemic pain. Maintain quiet, comfortable environment; restrict visi to rs as Mental or emotional stress increases myocardial workload. Care should be taken to avoid hypoten sion, because this can potentially reduce coronary perfusion pressure. Calcium channel blockers, such as bepridil (Vascor), Produce relaxation of coronary vascular smooth muscle, amlodipine (Norvasc), nicardipine (Cardene), nifedipine dilate coronary arteries, and decrease peripheral vascular (Procardia), felodipine (Plendil), isradipine (DynaCirc), resistance. Serial tracings verify ischemic changes, which may disappear when client is pain-free. Tachycardia and changes in blood pressure (hypotension or hy pertension) may be present because of pain, anxiety, hypox emia, and circulating stress hormones. Drugs with negative inotropic prop when giving combination of calcium antagonists, beta erties can decrease perfusion to an already ischemic blockers, and nitrates). Progressionof disorder may compro mise cardiac function to point of decompensation. Administer medications, as indicated, for example: Beta blockers, such as metaprolol (Lopressor), esmilol Beta blockers have anti-arrhythmic and anti-hypertensive proper (Brevibloc) ties, as well as the ability to reduce ischemia. Note: Beta blockers are indicated in all clients unless they have the fol lowing contraindications: sys to lic blood pressure less than 90 mm Hg, cardiogenic shock, severe bradycardia, second or third-degree heart block, asthma or emphysema that is sensi tive to beta agonists. Antithrombotic therapy, including antiplatelet agents, such as Antiplatelet therapy reduces mortality by reducing the risk of aspirin (Anacin, Bayer aspirin) fatal myocardial infarctions. Aspirin permanently impairs the cyclooxygenase pathway of thromboxane A2 production in platelets, in this way inhibiting platelet function. This process results in in tense inhibition of platelet function, particularly in combination with aspirin. Tirofiban has been approved for use in combination with heparin for patients with unstable angina who are being treated medically and for patients un dergoing percutaneous coronary intervention (Coven, 2013). Use of low-molecular-weight heparin is increasing because it is more predictable and has fewer adverse effects. Note: One study found that unfractionated heparin was associated with a 33% reduction in the risk of myocardial infarction or death in individuals who were treated with aspirin plus heparin, compared with those who were treated with aspirin alone (Oler, 1996). Prepare for interventions such as angioplasty with or without Angioplasty, also called percutaneous transluminal coronary intracoronary stent placement, as indicated. Intracoronary stents may be placed to provide structural support within the coro nary artery and improve the odds of long-term patency. Drug-eluting stents may be considered for clients at high risk for thrombosis or acute closure. Stent placement may also be effective for the variant form of angina where peri odic vasospasms impair arterial flow. Compare both arms and obtain lying, Hypotension may occur related to ventricular dysfunction, sitting, and standing pressures when able. Dysrhythmias, especially premature ventricular contractions or heart blocks, can compromise cardiac function or increase ischemic damage. Acute or chronic atrial flutter or fibrilla tion may be seen with coronary artery involvement and may or may not be pathological. S4 may be associated with myocardial is chemia, ventricular stiffening, and pulmonary or systemic hypertension. Crackles reflect pulmonary congestion; may develop because of depressed myocardial function. Increases amount of oxygen available for myocardial uptake, reducing ischemia and resultant cellular irritation and dysrhythmias. Provides information regarding progression or resolution of ischemia, status of ventricular function, electrolyte balance, and effect of drug therapies. Moni to r labora to ry data, such as cardiac enzymes, arterial Enzymes moni to r resolution or extension of infarction. Patent line is important for administration of fluids to support circulation and to administer emergency drugs in presence of persistent lethal dysrhythmias or chest pain. Encourage identification and reduction of individual risk fac to rs these behaviors and substances have direct adverse effects on such as smoking, alcohol consumption, and obesity. Reinforce explanations of dietary and activity restrictions and Provides opportunity for client to retain information and to routine and prophylactic medications. Review appropriate exercise program and encourage client to Individual capabilities and expectations depend on type of set realistic goals.
Typhoons and snowmelt during 2011 and 2012 also led to anxiety and depression association of america atarax 10mg on line intense soil erosion from hill slopes by runoff processes in the upper parts of water catchments anxiety symptoms diarrhea cheap atarax 25mg line, reservoirs anxiety level scale best atarax 10 mg, lakes anxiety before period cheap atarax 25mg free shipping, floodplains and outlets, with a selective export of fine particles containing radionuclides derived from the Fukushima Daiichi accident. The main dams are found in the upper parts of the Mano River and Ota River catchments, 110m 137 and their reservoirs form a potential sink for radioactive sediments. The Ag/ Cs ratio provided a tracer for the dispersion of sediment in the Nita catchment area, which is affected by the areas with the highest levels of radionuclides. The system was very reactive to the succession of summer typhoons (2011) and spring snowmelt (2012). The 2012 typhoons were less violent than the ones in 2011 and led to less intense erosion; however, they were sufficiently powerful to increase river discharges and to export the sediment s to red in the river channel [100, 155]. Measurements of radionuclides were also taken at 20 lakes and dams in Fukushima Prefecture; all 131 134 137 results in water were below detection limits for I, Cs and Cs. For sediments, some lakes and dams had activity concentrations above the detection limit. For three locations, measured values exceeded 100 Bq/kg at Lake Ha to ri and 1000 Bq/kg at Komachi Dam and Hokkawa Dam. At the same time, the Nuclear Emergency Response Headquarters issued policies for moni to ring and enforcement of restrictions on the distribution and/or consumption of milk, 8 vegetables, seafood, bottled water and other foods. These measurements were mainly intended to ensure compliance with regula to ry levels. Thus, the data do not provide information on the distribution of activity concentrations in food. The database only 131 134 137 includes measurements for I, Cs and Cs and contains data for immature crops and for areas where restrictions were in place; such foods would, therefore, not have been eaten. However, it is possible to select from the database results for those foods that were marketed and could have been consumed. Relatively high limits of detection were used in determining levels in food, and, in the database, it was assumed that any values below limits of detection were equal to 10 Bq/kg for each of 131 the three radionuclides. However, for I, this was only done for the first four months following the 131 accident, and subsequently levels of I below detection limits were taken to be zero. Only results for foods as marketed were used in the assessment, and it was assumed that people obtained their food from a wide area, with doses estimated for Fukushima Prefecture, for five nearby prefectures (Miyagi, Tochigi, Gunma, Ibaraki and Chiba — using the means of all data for these prefectures) and for the rest of Japan. Rice is an important component of the Japanese diet, and, as a result, the database contains many measurements for immature crops. The initial concern following the accidental release of radionuclides to the atmosphere is the transfer of radionuclides to leafy vegetables through direct deposition from the atmosphere on to the edible 131 part of the plant. Generally, the transfer of radionuclides, particularly I, to milk is also of concern in the short term following accidental releases to the atmosphere, owing to the short transfer time for iodine from grassland to milk and the relatively high amounts of the radionuclide that reach milk. It should be noted that this includes all the measurement data and not just those from food that was marketed. Activity concentrations on leafy vegetables decreased significantly in subsequent months, as is to be expected 131 after an accidental release of I, owing to its short half-life and the removal of activity from the surface of the plants by weathering processes (see Table 4. These results also confirm that no 131 further significant release of I to the atmosphere occurred after the first few days following the accident. Of the 2636 samples of cattle milk, 207 contained levels above the limits of detection, all from samples taken in March and April 2011, with the exception of the results of two samples in May, where a 131 lower detection limit was used. The average concentration of I in milk for samples above detection limits was 190 Bq/L (range: 0. Average values for results above detection limits were 247 Bq/L in March 2011, 10 Bq/L in April and 0. However, these samples represent only about 10% of measured samples and include samples from areas where milk was not marketed due to restrictions. Two samples had concentrations greater than 100 Bq/kg, one in Fukushima City and the other in Nihonmatsu City, both in Fukushima Prefecture. In 2011, rice planting was restricted in paddy fields in which activity concentrations of radiocaesium in soil of 5000 Bq/kg or more were measured. However, close examination of the rice produced in that year revealed that radiocaesium concentrations in rice did not follow a simple proportional relationship to those in soils. Food restrictions and agricultural countermeasures are explained in more detail in Technical Volume 5, Section 5. Radionuclides can be transferred to animal products by an animal’s ingestion of grass, other vegetables and water, and also by inhalation. In addition, grazing animals may ingest radionuclides to gether with soil by inadvertent ingestion. Statistical analysis of estimated and measured data Some relevant data used in this report — notably data on personal doses and on activity in food — were analysed statistically. For this, the whole range of data was binned, that is grouped to gether in bins, or a series of small interval ranges of numerical values, in to which the data were sorted for analysis. The his to gram was then normalized, multiplying the values of the rectangles by a fac to r that makes the to tal area of the rectangles equal to 1. When sufficient data are available and the intervals become very small, the his to gram tends to wards a smooth curve termed probability density function that describes the relative likelihood for the quantity. While the most common distribution is the normal (or Gaussian) distribution, represented by a bell shaped probability density function that is symmetrical with respect to the maximum probability, the most relevant distribution for the purpose of the report is the logarithmic-normal, or log-normal distribution. The log normal distribution is a probability distribution of a quantity, such as the activity or the dose, whose logarithm is normally distributed. Thus, the log-normal probability density function is symmetrical with respect to the maximum only when displayed as a function of the logarithm of the quantity. An example of such a log-normal probability distribution, showing an idealized his to gram and its probability density function, is illustrated on the left hand side of the figure below. The probability density function can be integrated, meaning that the values of the bins in the normalized his to gram can be summed, from the lower to the higher values of the quantity. This summation, as a function of the quantity, is termed the cumulative probability function and describes the likelihood that a quantity with a given probability distribution will be found to be less than or equal to the value in question. The log-normal cumulative probability function can be plotted as a straight line in a coordinate plane of abscissas representing the quantity. An example of such a representation is shown on the right hand side of the figure above, where the integral of the actual experimental data of the bins in the left figure is plotted vis-a-vis the straight line. Log-normal distributions were calculated using the 131 approach described in Box 4. However, the 95th percentiles of 7300 Bq/kg for leafy vegetables and 1800 Bq/kg for milk show that it was important that the restrictions were introduced. However, the initial limiting values on activity concentrations in foods, established by the Japanese authorities, were subsequently reduced [158]. Measured activity concentrations are available for wild boar, other game animals, mushrooms and berries. Levels of caesium iso to pes were measured in adult wild boar hunted in Fukushima, Miyagi, Tochigi 134 and Ibaraki prefectures between May 2011 and March 2012. The range of measured levels of Cs 137 and Cs in the muscle of wild boar is shown in Fig. The two highest levels measured were 14 600 and 13 300 Bq/kg; more than half of the measurements from boar captured in Fukushima Prefecture had levels >500 Bq/kg, as did many animals from the neighbouring prefectures [159]. The boar forages for small animals and plants by digging through the litter on the ground and in the soil, 134 137 which contains relatively high levels of Cs and Cs, hence the greater levels in wild boar than in farmed animals. Distribution of activity concentrations of radiocaesium in wild boar hunted in Fukushima, Miyagi, Tochigi and Ibaraki prefectures between May 2011 and March 2012 [159]. A statistical analysis has been carried out of these measurement data, as shown in Fig. Although the measurements fit a log-normal 137 distribution, it can be seen from Fig. The concentrations reached a peak in September 2011 and then fell below the detection limit. In 2013, only three samples with 137 concentrations above detection limits were found, with one sample having a concentration of Cs of 9 Bq/kg. However, the number of samples is small, and the analysis of the annual change in radiocaesium concentration may be biased. It should be noted that this figure does not show the seasonal change of a single species, but presents the variation of species collected in different seasons of the year. The concentration of radiocaesium in wild mushrooms and wild edible plants is higher than in agricultural products. According to the food moni to ring data, many samples exceeded 100 Bq/kg even after the first year (2. This is consistent with the results of studies conducted after the Chernobyl accident.
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