Oral Health Assessment Form Section 1: Child'S Information (Filled: Fill & Download for Free

Short answer, anemia in Indian girls is predicated by both biology and socio-economic factors, i.e., unique confluence of biology, culture (diet, marriage age), and great variations in relative affluence and education.Early marriage ---> early initiation of sexual activity ---> repeated early child bearing ---> recurrent iron loss. This emerges as a major reason for anemia among Indian girls.Thus, large part of anemia in Indian girls ensues from exacerbation of their inherently greater risk of iron loss attendant to their biology, i.e., pregnancy, child birth and breast feeding. Such exacerbation is cultural, i.e., tendency for early marriages and child births, as well as dietary, i.e., inadequate iron intake and inefficient absorption.There are also substantial, surprising and inexplicable regional differences.While there are several types of anemia, I'll restrict my answer to nutritional anemia, specifically to Iron-Deficiency Anemia (IDA), the most common form of anemia in India (1, 2).Anemia is assessed by measuring circulating blood hemoglobin levels. Typically, there are 3 levels, Mild (10 to 11.9g/dl), Moderate (7 to 9.9g/dl) and Severe (<7g/dl). Typically, in India, severe anemia prevalence tends to be <3%, moderate ranges from 5 to 20%, and mild from 25 to 44%. So the silver lining is that severe anemia levels are low.Biological factors that contribute to anemia in Indian girlsThe most important biological reason for IDA is inadequate dietary intake of bioavailable iron (3; see figure below).There are unique factors associated with Indian diets that may predispose to IDA.Being heavily plant-based, it relies on the less bioavailable non-haem form of iron.Higher levels of Polyphenol and phytates (Phytic acid).Lower ascorbic acid (Vitamin C) to iron ratio which impedes iron absorption.Possible average gastric acidity levels that are sub-optimal for iron absorption.Inadequate dietary iron intakeDietary iron is available in two forms, haem or non-haem.Haem form of dietary iron is commonly available in meat with the non-haem form in plant foods.Haem iron is much better absorbed so already we arrive at a partial answer to the question.90 to 95% of total daily dietary iron in Indian diets is non-haem iron (4).Vegetarian diet iron bioavailability is 10% compared to 18% in omnivorous diets.This means Indian diets are richer in the less efficiently absorbed non-haem iron.To compensate for this lower efficiency, nutritionists recommend increasing dietary iron intake by 80% (5).Adding another wrinkle, adequate dietary iron levels does not in and of itself explain India's anemia prevalence since Gujarat with ~23mg/day iron intake still has 55% anemia prevalence compared to Kerala's much lower 33% with just 11mg/day iron intake (4).Thus, inadequate iron intake explains Indian girls' anemia partly, not wholly.Defective iron absorptionMore acidic the stomach, better the iron absorption.With the caveat that the same studies didn't compare gastric acidity in India to other countries, an old study found that Indian gastric acidity averages ~3.4, much higher than the average of ~2.5 in other countries (6).Vitamin C (ascorbic acid) is a strong iron absorption enhancer of plant non-haem iron (7). Indian Vitamin C intake tends to be sub-par.In a small (n = 54) 1985 study, vegetarian Indian children with IDA and low vitamin C intake given 100mg Vitamin C during lunch and dinner for 60 days had dramatic improvement, even full recovery from anemia (8).Indian diets tend to have rather low levels of Vitamin C (4, 9).A 2007 study of 214 men and 108 women found sub-optimal Vitamin C intake (recommended 0.4mg/dl) among both (7).Young, married girls in urban Indian slums? Again, sub-optimal Vitamin C intake (10).Indian diets have several dietary components that bind to bioavailable iron preventing its absorption. These includePolyphenols. Tea, herb teas, cocoa, coffee, cinnamon, red wine are polyphenol-rich (11).Calcium (12), phosphorus, manganese, zinc.Higher intake of Calcium and Phosphorus correlated with anemia in pregnant women (13).Indians' tendency to drink tea/coffee with meals reduces bioavailability of dietary iron (5).These are all general reasons for IDA in India. Now let's examine the specific reasons for IDA in Indian girls.Here the most pertinent factors are blood loss during menstruation and pregnancies, and loss through breast feeding.Blood loss is perhaps the most important one since iron isn't excreted out through urine or feces but only through loss of cells, skin or blood cells for example.Age of highest prevalence of IDA in Indian girls, i.e., 12 to 13 years old, coincides with menarche (first menstruation). Two inter-related problems reveal themselves here.One, substantial numbers of Indian girls have menstrual abnormalities but don't seek medical help (14).Two, menstrual blood loss increases daily total iron requirement, consumption of which is sub-optimal for many Indian girls anyway for reasons we've already covered, namely inadequate daily intake and inefficient absorption due to peculiarities associated with Indian diets. Thus, menstruation in Indian girls exacerbates their pre-existing tendency for anemia.Socio-economic factors that contribute to anemia in Indian girlsThe National Family Health Surveys (NFHS) are periodic Indian Government health surveys conducted since 1992-1993.It shows that currently ~27% of Indian girls aged 15 to 19 years are married. This tracks closely with UNICEF data (15). It's also currently one of the highest rates of early marriage in the world.Studies show that married adolescent Indian girls tend to consume diets high in phytates, low in Vitamin C and iron, and unsurpisingly, have high prevalence of IDA (10, 16).In a 2008 study on 118 young, pregnant, poorly educated, low-income Indian girls from North Indian villages, folic acid intakes also tended to be very low (9).On average, Indian women have 297mg of iron loss (blood loss during delivery, iron transfer to newborn, iron content of umbilical cord) versus 150mg of iron conservation (no menstruation) during pregnancy (17). In other words, pregnancy leads to net iron loss. This can only be offset by higher iron intake and absorption.Lactating women obviously have higher daily iron intake requirements, not just to meet infant iron requirement through breast milk but also to make up for loss during pregnancy and delivery.Since daily iron intake requirements are already sub-par in India, deficiency is only exacerbated for pregnant and lactating women.Thus, early marriage ---> early initiation of sexual activity ---> repeated early child bearing ---> recurrent iron loss. This emerges as a major reason for anemia among Indian girls.In other words, large part of anemia in Indian girls ensues from exacerbation of their inherently greater risk of iron loss attendant to their biology, i.e., pregnancy, child birth and breast feeding. Such exacerbation is cultural, i.e., tendency for early marriages and child births, as well as dietary, i.e., inadequate iron intake and inefficient absorption.Several groups have analyzed the Indian Government's NFHS anemia data.Careful data mining of the NFHS and other epidemiological data shows that anemia tends to be higher among women who are illiterate, reside in rural areas, work in agriculture, are Hindu, Scheduled Caste (SC) or Scheduled Tribe (ST) (18, 19, 20).Poorest urban women are also more likely to be anemic compared to everyone else including their rural counterparts (21, 22). Why? Key factors includeLower income, lower access to income and resources.Higher rates of infection due to poor sanitation.Factors found to be protective against anemiaBelonging to middle/upper class.Educated up to high school or higher.Consuming alcohol or pulses.Higher BMI (Body Mass Index).Being Muslim.Alcohol consumption protects against anemia, especially among poorer rural women, particularly ST women (21).Surprising? Yes and the underlying biology is still a mystery.A robust literature links alcohol consumption to higher iron levels and absorption (23, 24, 25).Alcohol may increase the fermentation process/gastric acid secretion or promote iron solubility/absorption/ferric ion reduction or could itself be an iron source.Pulses have high iron content and are also a surrogate for higher income.Muslim versus Hindu could be attributed to differences between iron-replete, i.e., non-vegetarian, versus iron-deficient, i.e., vegetarian, diets.On the whole, protective factors clearly suggest that higher income ---> better education ---> better diets ---> lower anemia.In fact, wealth tracks better with iron sufficiency than even education or caste (26).Education comes second (27).One of the most interesting trends is a regional bias in anemia.Anemia prevalence is highest among women in the Eastern states of India (4, 19, 22).Assam, Bihar, Jharkhand, Odisha, West Bengal tend to have the highest women anemia prevalence rates (see figures below from 4 and 19). Why? No clear answer.Anemia in general and IDA in particular is multi-factorial.Likely answer is some combination of biology and culture, i.e., dietary iron and micronutrient deficiencies, and cultural practices such as early marriages, tendency of less educated women, lower incomes.While there's substantial literature on high anemia prevalence in Indian women, there are fewer such studies in men.In one study on 544 older rural Indian men aged 60 to 84, majority were anemic (28).In fact, Indian men weren't even included in the 1st two NFHS, only being included in the 3rd one (2005-2006) (29).Anemia rates in Indian women are the highest in the world (3). What could be done to reverse this trend?Centralized approaches would be to co-ordinate and encourage manufacture of fortified foods.This is something that the FAO (Food and Agriculture Organization) also recommends (30).The Micronutrient Initiative began in 2004.Through it, the Tamil Nadu Salt Corporation (TNSC) manufactures double- and triple-fortified salts, Vita-Shakti, fortified with iron and folic acid, and Anuka, fortified with iron, Vitamins A and C (31, 32).As we explored earlier, certain peculiarities of Indian diets easily lead to IDA.Cultural norms are extremely difficult to overcome.Dietary habits are part of such norms.However, there is a silver lining to this conundrum in that several foods that are already part of Indian diets, namely, egg, green vegetables, jaggery, whole wheat, onion stalks, pulses, are iron-rich.Food-based approach is also safer than oral iron supplements which have side-effects such as gastro-intestinal upset (31).Better education of Indian girls will go a long way in alleviating their prevailing anemia levels.Would better ensure their conscious and conscientious consumption of iron-rich foods that are already part of Indian diets. So no need to re-invent the wheel in terms of dietary habits.Would encourage their becoming better aware of their basic health parameters such as height, weight, blood type and hemoglobin levels.Would help delay their marriage age.Would help them make better, more empowered decisions regarding childbirth age, spacing between children, and increasing iron, Vitamins A, B12, C, folic acid and riboflavin intake during pregnancy.BibliographyRaman, L., A. B. Pawashe, and B. A. Ramalakshmi. "Iron nutritional status of preschool children." The Indian Journal of Pediatrics 59.2 (1992): 209-212.Yip, Ray. "Iron deficiency: contemporary scientific issues and international programmatic approaches." The Journal of nutrition 124.8 Suppl (1994): 1479S-1490S. Page on nutrition.orgBalarajan, Yarlini, et al. "Anaemia in low-income and middle-income countries." The Lancet 378.9809 (2012): 2123-2135. Page on indiaenvironmentportal.org.inNair, K. Madhavan, and Vasuprada Iyengar. "Iron content, bioavailability & factors affecting iron status of Indians." Indian J Med Res 130.5 (2009): 634-45. Page on icmr.nic.inRammohan, Anu, Niyi Awofeso, and Marie-Claire Robitaille. "Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?." ISRN Public Health 2012 (2011). Page on hindawi.comGoyal, R. K., P. S. Gupta, and K. H. Chuttani. "Gastric acid secretion in Indians with particular reference to the ratio of basal to maximal acid output." Gut 7.6 (1966): 619-623. Page on bmj.comChiplonkar, S. A., et al. "Are lifestyle factors good predictors of retinol and vitamin C deficiency in apparently healthy adults?." European journal of clinical nutrition 56.2 (2002): 96-104. Page on nature.comSeshadri, S., A. Shah, and S. Bhade. "Haematologic response of anaemic preschool children to ascorbic acid supplementation." Human nutrition. Applied nutrition 39.2 (1985): 151-154.Gautam, Virender P., et al. "Dietary aspects of pregnant women in rural areas of Northern India." Maternal & child nutrition 4.2 (2008): 86-94.Tupe, Rama, > Shashi A. Chiplonkar, and Nandita Kapadia-Kundu. "Influence of dietary and socio-demographic factors on the iron status of married adolescent girls from Indian urban slums." International journal of food sciences and nutrition 60.1 (2009): 51-59.Hurrell, Richard F., Manju Reddy, and James D. Cook. "Inhibition of non-haem iron absorption in man by polyphenolic-containing beverages." British Journal of Nutrition 81.04 (1999): 289-295. Page on iastate.eduHallberg, Leif. "Does calcium interfere with iron absorption?." American Journal of Clinical Nutrition 68.1 (1998): 3-4. Page on nutrition.orgSamuel, Tinu Mary, et al. "Correlates of anaemia in pregnant urban South Indian women: a possible role of dietary intake of nutrients that inhibit iron absorption." Public health nutrition 16.02 (2013): 316-324. Page on cambridge.orgKulkarni, Meenal V., and P. M. Durge. "Reproductive health morbidities among adolescent girls: Breaking the silence." Ethno Med 5.3 (2011): 165-168. Page on krepublishers.comPage on unicef.orgSharma, Vridhee, et al. "NUTRITIONAL ANAEMIA AMONG CURRENTLY MARRIED FEMALES IN THE REPRODUCTIVE AGE GROUP IN RURAL JAMMU." Page on jemds.comApte, S. V., and P. S. Venkatachalam. "IRON LOSSES IN INDIAN WOMEN." The Indian journal of medical research 51 (1963): 958.Bharati, Premananda, et al. "Prevalence of anemia and its determinants among nonpregnant and pregnant women in India." Asia-Pacific Journal of Public Health 20.4 (2008): 347-359. Page on isical.ac.inBharati, Susmita, et al. "Temporal trend of anemia among reproductive-aged Women in India." Asia-Pacific Journal of Public Health 27.2 (2015): NP1193-NP1207.Agarwal, K. N., et al. "Prevalence of anaemia in pregnant & lactating women in India." Indian journal of medical research 124.2 (2006): 173. Page on icmr.nic.inBentley, M. E., and P. L. Griffiths. "The burden of anemia among women in India." European journal of clinical nutrition 57.1 (2003): 52-60. Page on nature.comGhosh, Saswata. "Exploring socioeconomic vulnerability of anaemia among women in eastern Indian States." Journal of biosocial science 41.06 (2009): 763-787.Turnbull, A. Iron Absorption. pp369-403. In Jacobs, Allan, and Mark Worwood. Iron in biochemistry and medicine. Academic Press Inc.(London) Ltd., 1974.Milman, N., and M. Kirchhoff. "Relationship between serum ferritin, alcohol intake, and social status in 2235 Danish men and women." Annals of hematology 72.3 (1996): 145-151.Hallberg, Leif, and Lena Hulthén. "Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron." The American Journal of Clinical Nutrition 71.5 (2000): 1147-1160.an algorithm for calculating absorption and bioavailability of dietary ironBalarajan, Yarlini S., Wafaie W. Fawzi, and S. V. Subramanian. "Changing patterns of social inequalities in anaemia among women in India: cross-sectional study using nationally representative data." BMJ open 3.3 (2013): e002233. cross-sectional study using nationally representative dataLee, Jinkook, et al. "Education, gender, and state-level disparities in the health of older Indians: Evidence from biomarker data." Economics & Human Biology 19 (2015): 145-156. Education, gender, and state-level disparities in the health of older Indians: Evidence from biomarker dataMaiti, S., et al. "Prevalence of anaemia among the male population aged 60 years and above in rural area of Paschim Medinipur, West Bengal, India." Health Renaissance 11.1 (2013): 23-26. Page on www.nepjol.infoRajan, S. Irudaya, and K. S. James. "Third national family health survey in india: issues, problems and prospects." Economic and Political Weekly (2008): 33-38. Page on environmentportal.inThompson, Brian. "Food-based approaches for combating iron deficiency." Nutritional Anemia. Sight and Life Press, Switzerland (2007). ftp://ftp.fao.org/ag/agn/nutrition/Kapitel_21_210207.pdfUpadhyay, Ravi Prakash, C. Palanivel, and Vaman Kulkarni. "Unrelenting burden of anaemia in India: highlighting possible prevention strategies." International Journal of Medicine and Public Health 2.4 (2012): 1-6. Page on researchgate.netAnand, Tanu, et al. "Issues in prevention of iron deficiency anemia in India." Nutrition 30.7 (2014): 764-770.Thanks for the A2A, Kritika Gupta.

If your school is in California, and if you appear to be in a mental health crisis, your school could call the police who are allowed to evaluate the situation. They will be allowed to take you to a mental hospital for a 72 hour hold where you will be assessed to see if you need further treatment or if you can be released. The nickname for this is “5150,” after the section in the Code, which is shown below.Law sectionWELFARE AND INSTITUTIONS CODE - WICDIVISION 5. COMMUNITY MENTAL HEALTH SERVICES [5000 - 5952]( Division 5 repealed and added by Stats. 1967, Ch. 1667. )PART 1. THE LANTERMAN-PETRIS-SHORT ACT [5000 - 5556]( Heading of Part 1 amended by Stats. 1968, Ch. 1374. )CHAPTER 2. Involuntary Treatment [5150 - 5349.5]( Chapter 2 added by Stats. 1967, Ch. 1667. )ARTICLE 1. Detention of Mentally Disordered Persons for Evaluation and Treatment [5150 - 5155]( Heading of Article 1 amended by Stats. 1969, Ch. 1472. )5150.(a) When a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, a peace officer, professional person in charge of a facility designated by the county for evaluation and treatment, member of the attending staff, as defined by regulation, of a facility designated by the county for evaluation and treatment, designated members of a mobile crisis team, or professional person designated by the county may, upon probable cause, take, or cause to be taken, the person into custody for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a facility designated by the county for evaluation and treatment and approved by the State Department of Health Care Services. At a minimum, assessment, as defined in Section 5150.4, and evaluation, as defined in subdivision (a) of Section 5008, shall be conducted and provided on an ongoing basis. Crisis intervention, as defined in subdivision (e) of Section 5008, may be provided concurrently with assessment, evaluation, or any other service.(b) When determining if a person should be taken into custody pursuant to subdivision (a), the individual making that determination shall apply the provisions of Section 5150.05, and shall not be limited to consideration of the danger of imminent harm.(c) The professional person in charge of a facility designated by the county for evaluation and treatment, member of the attending staff, or professional person designated by the county shall assess the person to determine whether he or she can be properly served without being detained. If, in the judgment of the professional person in charge of the facility designated by the county for evaluation and treatment, member of the attending staff, or professional person designated by the county, the person can be properly served without being detained, he or she shall be provided evaluation, crisis intervention, or other inpatient or outpatient services on a voluntary basis. Nothing in this subdivision shall be interpreted to prevent a peace officer from delivering individuals to a designated facility for assessment under this section. Furthermore, the assessment requirement of this subdivision shall not be interpreted to require peace officers to perform any additional duties other than those specified in Sections 5150.1 and 5150.2.(d) Whenever a person is evaluated by a professional person in charge of a facility designated by the county for evaluation or treatment, member of the attending staff, or professional person designated by the county and is found to be in need of mental health services, but is not admitted to the facility, all available alternative services provided pursuant to subdivision (c) shall be offered as determined by the county mental health director.(e) If, in the judgment of the professional person in charge of the facility designated by the county for evaluation and treatment, member of the attending staff, or the professional person designated by the county, the person cannot be properly served without being detained, the admitting facility shall require an application in writing stating the circumstances under which the person’s condition was called to the attention of the peace officer, professional person in charge of the facility designated by the county for evaluation and treatment, member of the attending staff, or professional person designated by the county, and stating that the peace officer, professional person in charge of the facility designated by the county for evaluation and treatment, member of the attending staff, or professional person designated by the county has probable cause to believe that the person is, as a result of a mental health disorder, a danger to others, or to himself or herself, or gravely disabled. The application shall also record whether the historical course of the person’s mental disorder was considered in the determination, pursuant to Section 5150.05. If the probable cause is based on the statement of a person other than the peace officer, professional person in charge of the facility designated by the county for evaluation and treatment, member of the attending staff, or professional person designated by the county, the person shall be liable in a civil action for intentionally giving a statement that he or she knows to be false. A copy of the application shall be treated as the original.(f) At the time a person is taken into custody for evaluation, or within a reasonable time thereafter, unless a responsible relative or the guardian or conservator of the person is in possession of the person’s personal property, the person taking him or her into custody shall take reasonable precautions to preserve and safeguard the personal property in the possession of or on the premises occupied by the person. The person taking him or her into custody shall then furnish to the court a report generally describing the person’s property so preserved and safeguarded and its disposition, in substantially the form set forth in Section 5211, except that if a responsible relative or the guardian or conservator of the person is in possession of the person’s property, the report shall include only the name of the relative or guardian or conservator and the location of the property, whereupon responsibility of the person taking him or her into custody for that property shall terminate. As used in this section, “responsible relative” includes the spouse, parent, adult child, domestic partner, grandparent, grandchild, or adult brother or sister of the person.(g) (1) Each person, at the time he or she is first taken into custody under this section, shall be provided, by the person who takes him or her into custody, the following information orally in a language or modality accessible to the person. If the person cannot understand an oral advisement, the information shall be provided in writing. The information shall be in substantially the following form:My name is .I am a _____ (peace officer/mental health professional) _____ .with _____ (name of agency) _____ .You are not under criminal arrest, but I am taking you for an examination by mental health professionals at ._____ (name of facility) _____You will be told your rights by the mental health staff.(2) If taken into custody at his or her own residence, the person shall also be provided the following information:You may bring a few personal items with you, which I will have to approve. Please inform me if you need assistance turning off any appliance or water. You may make a phone call and leave a note to tell your friends or family where you have been taken.(h) The designated facility shall keep, for each patient evaluated, a record of the advisement given pursuant to subdivision (g) which shall include all of the following:(1) The name of the person detained for evaluation.(2) The name and position of the peace officer or mental health professional taking the person into custody.(3) The date the advisement was completed.(4) Whether the advisement was completed.(5) The language or modality used to give the advisement.(6) If the advisement was not completed, a statement of good cause, as defined by regulations of the State Department of Health Care Services.(i) (1) Each person admitted to a facility designated by the county for evaluation and treatment shall be given the following information by admission staff of the facility. The information shall be given orally and in writing and in a language or modality accessible to the person. The written information shall be available to the person in English and in the language that is the person’s primary means of communication. Accommodations for other disabilities that may affect communication shall also be provided. The information shall be in substantially the following form:My name is  .My position here is  .You are being placed into this psychiatric facility because it is our professional opinion that, as a result of a mental health disorder, you are likely to (check applicable):◻ Harm yourself.◻ Harm someone else.◻ Be unable to take care of your own food, clothing, and housing needs.We believe this is true because(list of the facts upon which the allegation of dangerousor gravely disabled due to mental health disorder is based, including pertinentfacts arising from the admission interview).You will be held for a period up to 72 hours. During the 72 hours you may also be transferred to another facility. You may request to be evaluated or treated at a facility of your choice. You may request to be evaluated or treated by a mental health professional of your choice. We cannot guarantee the facility or mental health professional you choose will be available, but we will honor your choice if we can.During these 72 hours you will be evaluated by the facility staff, and you may be given treatment, including medications. It is possible for you to be released before the end of the 72 hours. But if the staff decides that you need continued treatment you can be held for a longer period of time. If you are held longer than 72 hours, you have the right to a lawyer and a qualified interpreter and a hearing before a judge. If you are unable to pay for the lawyer, then one will be provided to you free of charge.If you have questions about your legal rights, you may contact the county Patients’ Rights Advocate at _____ (phone number for the county Patients’ Rights Advocacy office) _____ .Your 72-hour period began _____ (date/time) _____ .(2) If the notice is given in a county where weekends and holidays are excluded from the 72-hour period, the patient shall be informed of this fact.(j) For each patient admitted for evaluation and treatment, the facility shall keep with the patient’s medical record a record of the advisement given pursuant to subdivision (i), which shall include all of the following:(1) The name of the person performing the advisement.(2) The date of the advisement.(3) Whether the advisement was completed.(4) The language or modality used to communicate the advisement.(5) If the advisement was not completed, a statement of good cause.(Amended by Stats. 2018, Ch. 258, Sec. 1. (AB 2099) Effective January 1, 2019.)

I really enjoyed the HBO miniseries on the Chernobyl Disaster, and overall, I felt that it was fairly historically and technically accurate - again, fairly. However, the writers, the director, and all of the staff working on the project created an excellent piece of art in the form of this docudrama. I am also not the only one who feels this way (perhaps an Emmy award is in the works). It is not too often that Hollywood tackles a story like this and invests this large a budget. You can really tell that they took great care and put forth a great effort to ensure that all the sets, equipment, clothing etc was true to the Soviet era, in order to truly immerse you in the experience. In addition, I felt that the telling of the Chernobyl story as a vehicle to critique the Soviet system of government, human fallibility, and the importance of speaking truth to power was an interesting and fitting way to do it, and it was very well done. It also presented a very important aspect of the Chernobyl disaster, which is often lost in the cold calculus of post disaster analysis – the human element. With all of that said, the show presented a number of historical and technical mistakes that I found a bit troubling and in one case very shocking. I realize that Hollywood sometimes likes to “spice up” a story to make it more engaging and to have a greater impact but as a scientist I feel I need to, at least in a little way, attempt to set the record straight. Especially given the gravity of the topic (a nuclear reactor blowing itself apart is pretty big thing) and the fact that one overriding theme throughout the show is how the suppression or the denial of the truth always leads to terrible outcomes.There is a lot which can be critiqued and I don’t want to get too deep in the weeds so I would like to talk about a handful of technical problems I saw with the show. The more historical aspects I would like to leave out because there is still controversy over some of it, records are dicey, and even with publicly available information there is always the threat that mixed in with it are fabricated or altered records from the KGB. A proper historian would be best suited to critique those aspects of the show. Regardless, here are three of the biggest technical problems I saw from the miniseries.Radiation, Contamination and health effectsFor the most part the show did a good job at presenting the radiation hazards that were present during the accident but there were a few big follies. There is a lot I can write about here but I would like to mention some of the bigger issues I saw.In the show, right after the explosion, it shows a spotlight like beam of blue light being emitted from the reactor, racing up to the sky. There has been recorded accounts that this indeed happened but it should be stressed that this would not have persisted for days on end (the initial radiation level would have been reduced dramatically by then), nor would it have been as intense or as dramatic as it was depicted in the show. Furthermore, the biggest error made during this depiction was the source of the light. It was stated that the blue spotlight like beam of light was caused by Chernkov radiation (I realize that during the show this was, at first, meant as a bit of a cover up explanation but it still doesn’t make any sense). It is virtually impossible to produce Chernkov radiation in air. Even if we assume that the air has 99.9% humidity, any Chernkov radiation produced would be very little, hard to observe, and would probably not propagate too far away from the reactor. It is generally understood in the popular scientific literature on the Chernobyl accident that this blue light was caused by the ionization of the air produced by the ultra intense radiation released immediately after the explosion - to the shows credit this was mentioned later on. Regardless, it did not and would not have made such a dramatic light show. By all accounts it appeared to be a blue haze like glow around the top of the reactor.A blue light was observed coming from Chernobyl but it was not this intense, did not reach this far up into the sky and was not caused by the Chernkov effect.The show also emphasized, repeatedly, how large areas around Chernobyl will be “uninhabitable for 20,000 years” etc. This is an over dramatization. The spent fuel from the reactor will most certainly be radioactive for that period of time but the town of Pripyat and much of the area around the reactor is certainly much safer these days, and in fact, is now flourishing with vegetation and wildlife. Immediately after the initial explosion the whole area was unsafe but over the last 30 years most of the shorter half-life isotopes have decayed away and even much of the longer-lived contamination has been reduced. I don’t have access to recent radiation surveys of Pripyat or Chernobyl but a survey from 2009 found that a day long visit to Chernobyl would give a visitor the equivalent of 1/300 the dose of radiation you would get from a whole body X-ray. This is also similar to the amount of radiation you would absorb on a transatlantic flight. For those of you who don’t believe that the radiation around Chernobyl could have been reduced that much over time, just look at how the radiation level at ground zero of a nuclear weapons explosion changes over a 48 hour period.For Chernobyl, accurate radiation surveys taken immediately after the reactor exploded are not available (and most data from that time is suspect) regardless this is not a totally unfair comparison. In the above plot, you can see how the initial radiation level is very high but over the course of 48 hours the radiation level has decreased by 100 times. This is not to say that the area isn't radioactive but is much less radioactive than before. The point here is that, while the initial radiation level released by Chernobyl was nightmarishly high it did rapidly decrease in the days, weeks, and months afterwards. Over the course of years and decades the ambient radiation level continued with this decay.It is also worth noting that in present day Pripyat, work crews can live in the city but must rotate on a 3 weeks on and 3 weeks off basis, where they must spend the alternating 3 weeks away from Pripyat. It’s not that Chernobyl and Pripyat are so dangerous that you cannot live and work there under any circumstances it’s just that living there might increase your risk to various cancers. However, it should be kept in mind that there are plenty of things you can do which can raise your cancer risk much more than living in Pripyat. For instance, having an unhealthy diet has consistently been shown to shorten your life expectancy, and raise your cancer risk, and of course (the biggest and most certain way to shorten your life), being a regular smoker. There is a reason why health and life insurance providers ask if you are a smoker or not. Dying from acute radiation poisoning is a terrible way to die but dying from lung cancer isn’t all that great either. I did find it ironic that so many of the characters in the show smoked.Finally, when it was shown that Lyudmilla Ignatenko’s child had died soon after birth due to radiation exposure, it was expressed that Lyudmilla had survived because the baby had “absorbed” the radiation, which would have otherwise killed her. I will not argue against the assertion that the child most likely died from damage caused by radiation exposure, during fetal development, but the idea that the mother lived because the child absorbed the radiation, is not scientifically sound. Radiation exposure and radiation poisoning doesn’t work that way and while it makes for a tragic sound bite and a thought provoking anecdote it is not based in reality.In that vein, it is also worth noting that studies which have been conducted since the Chernobyl accident to determine increases or changes to the long-term cancer risks to local populations, have come back largely inconclusive. In the short term, cancer rates did increase measurably and alarmingly but it has still been difficult to determine the long-term impact. One theme from these long-term studies has been that it has been very difficult to distinguish the effects of Chernobyl from other causes which can raise an individuals cancer risk. For instance, the fact that that the smoking rate of many Eastern European countries is very high has skewed results (first and second-hand smoke is really bad for your health). Also, many parts of the former USSR are heavily contaminated from cold war era industrial activities, in the form of heavy metal contamination, petrochemical by-products and other industrially sourced carcinogens. This more conventional contamination has helped to ‘hide’ the effect of the Chernobyl accident on those populations. It also does not help that many of these contaminants also cause the same types of cancer and birth defects caused by radiation exposure.The RBMK-1000 Reactor and Determining the Cause of the ExplosionI need to start this section by mentioning that the Former Soviet Union, and Russia has consistency produced some of the best trained and most talented Nuclear Physicists and Nuclear Engineers in the world - There is no lack of talent in those fields. One plot line of the show was of Dr. Khomyuk’s efforts to determine what caused the reactor to explode. Through her dogged work, she determines that the reactor had a positive void coefficient and that the control rods were tipped with graphite in order to mitigate some mechanical consideration during insertion. Putting it bluntly, a lot of this is complete non-sense.The RBMK-1000 reactor was the pride and joy of the USSR nuclear community and everyone in that community would have known a great deal about the reactor: its design advantages, and design weaknesses. Also, even if Dr. Khomyuk (who never actually existed in real life, she represents a “composite character”) had no knowledge of the RBMK-1000, I’m pretty sure all she would need is a detailed technical drawing of the reactor (which she had during the show), a pen, a piece of paper and a calculator in order to determine that the design suffers from a rather large positive void coefficient. This is a straightforward Nuclear Engineering concept and it is not a secret that certain reactor types and designs suffer from this problem – people have known this since the 1940’s. For those that are not too sure what a positive void coefficient is, it basically means that if the water in the reactor starts to boil the power of the reactor could increase. Not many (and no modern) nuclear reactors suffer from this but the RBMK-1000 did.The other key piece of information which was uncovered over the course of the show, and was found to be suppressed, was that the control rods were tipped with graphite. This is indeed true but it was done as a design modification to the reactor after its initial design lock and construction. It was not a dirty secret from its initial design. It should also be stressed that this is a major modification and affects every operation of the reactor. In particular, the movement of the control rods into the reactor would modulate the neutron flux inside of the reactor and would cause noticeable power fluctuations (increases) during insertion. Also, it is worth mentioning that this modification was not done because of negligence or cost effectiveness but to provide a better neutron configuration for the reactor when the control rod(s) are in the top position (outside of the reactor) – not necessarily a bad idea. None of this would be a secret. The operators, engineers, and scientists all would have had to have known at least a little bit about this major modification, and how it would affect the reactor. Whether they knew how dangerous it was to have all of the control rods outside of the reactor and to then slam them back in is something else altogether but the point is, it would not have been a secret that the control rods were tipped with graphite.Finally, after the reactor exploded scientists and engineers would have taken a number of soil and metal samples from the reactor and analyzed the radiation levels and isotope contents from those samples. From this analysis, they would have realized that the reactor had to have experienced an immense power spike and a corresponding neutron flux. This would have determined the source of the power which would have caused the explosion (an uncontrolled power excursion). Considering I have come up with all of this while sitting at my desk in about an hour or so, I really doubt that it would have taken a group of highly trained and experienced Physicists and Engineers months of nuclear detective work to determine what happen.Given all of this, I honestly believe that it would have taken only a matter of hours and at most a few days before scientists and engineers would have figured out a very likely mechanism for the cause the explosion. I understand that this doesn’t make for a very good story, especially if one of the themes you are trying to get across is the toxic compartmentalization and secrecy of the Soviet Union, and the need for openness, freedom of thought and information, and of course, truth, but I digress. However, what was true is that much of this information was suppressed outside of the Soviet Union and it was not until the INSAG-7 report in 1992 did it start to come to light. At least officially.Second Explosion Threat from the CoreIn the second and third episode of the show divers are dispatched on a near suicide mission to drain water from tanks directly below the reactor. This did happen in real life and the heroic actions of those divers did indeed prevent a second explosion but probably not the explosion you are thinking about. When Dr. Legasov and Dr. Khomyuk presented to the Soviet leadership the situation and the need to “sacrifice three men”, she mentioned that if the molten reactor contents impacted the water it would “set off an explosion of approximately 2–4 megatons.” When she said this my jaw dropped. Not because of the scale of the devastation which would be unleashed but because it was completely and totally wrong.There was no risk of an explosion of this size, and it is physically impossible for the reactor contents to explode in this way – it’s the wrong types of materials, in the wrong concentration, in the wrong geometry, in the wrong circumstances. Also, please keep in mind that most nuclear weapons which are in current stockpiles are much less than 1 megaton in explosive power.The show indicated that the hazard caused by the molten core impacting the water on the lower levels of the reactor building would have created an explosion of the scale close to the worlds largest nuclear explosions. In reality it would have been, at most, 1/1000 the explosive power of the explosion which destroyed Hiroshima.To further put this into perspective, what the show is also implying is that all you need to do in order to create one of the biggest explosions in human history is to melt a bunch of low-grade reactor fuel and dump it into a pool of radioactive water. Yeah… If that was the case, everyone has been wasting their time on nuclear weapons development because this is a far simpler and more cost effective solution to building weapons of mass destruction than spending billions of dollars developing complicated and notoriously difficult to produce, weapons. The second explosion risk at Chernobyl was actually caused by the threat of a steam explosion. The threat being, the super heated and molten reactor fuel was going to burn through the remaining floors of the reactor building, reaching the contaminated water in the basement. Once it reached this water it would vaporize it and create a steam explosion. Probably not too dissimilar to the first explosion which blew apart the reactor.This was a big gaff and I am unsure of why the writers and director felt the need to exaggerate the threat so much. The actual threat was already pretty terrible: an additional explosion which would have most certainly killed more people, thrown even more radioactive material into the environment further contaminating possibly thousands more sq kms of land, and possibly caused the precariously positioned reactor lid to fall further, causing even more damage and release of radioactive contamination. Again, there was no need to make up an alarming and unrealistic scenario here. Regardless of the threat this does not and should not take away from the courage of the men who risked their lives by entering the stricken reactor building, which was highly contaminated with deadly radiation, in order to prevent the disaster from becoming even worse.The reception that Chernobyl the miniseries has received has been stunning. When I first heard about the show, I was excited but I must admit I felt that I would probably be only one of a handful of people which would appreciate it. And I am glad that I was wrong about that. The story of Chernobyl has many layers, and many lessons, which we should not forget. It has also set the tone for how the modern day nuclear industry conducts itself and was the motivation behind the genesis of a number of international organizations, which promote safety and excellence in the nuclear industry. Finally, the story of Chernobyl is an inspirational story of the indelible perseverance, and courage of the human spirit. With all of that said, there really wasn’t a need to butter things up by getting some pretty big technical facts incorrect. Regardless, this was a great show and I am sure it will be remembered as a classic. So be it a classic that will always make someone who is knowledgeable about nuclear matters cringe a little – just like Hollywood should.References:INSAG-1 ReportINSAG-7 ReportUNSCEAR 2001 ReportThe Accident and the Safety of RBMK-ReactorsAssessing the Chernobyl ConsequencesLegacy Of ChernobylVoices from Chernobyl: The Oral History of a Nuclear DisasterChernobyl 01:23:40: The Incredible True Story of the World's Worst Nuclear Disaster