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Is plasma beta-glucuronidase a novel human biomarker for monitoring anticholinesterase pesticides exposure? A Malaysian experience

Inayat-Hussain SH, Lubis SH, Sakian NI, Ghazali AR, Ali NS, El Sersi M, et al.

Toxicol Appl Pharmacol, 2007 Mar;219(2-3):210-6.
PMID: 17140616

A cross-sectional study was conducted to investigate the effects of acute and chronic pesticide exposure on the plasma beta-glucuronidase enzyme activity among five patients of acute pesticide poisoning in Tengku Ampuan Rahimah Hospital, Klang, 230 farmers in the MADA area, Kedah and 49 fishermen in Setiu, Terengganu. The duration of pesticide exposure among the patients was unknown, but the plasma samples from patients were collected on day one in the hospital. The duration of pesticide exposure among the farmers was between 1 and 45 years. The beta-glucuronidase activity was compared with plasma cholinesterase activity in the same individual. The plasma cholinesterase activity was measured using Cholinesterase (PTC) Reagent set kit (Teco Diagnostics, UK) based on colorimetric method, while the plasma beta-glucuronidase activity was measured fluorometrically based on beta-glucuronidase assay. The plasma cholinesterase activity was significantly reduced (p<0.05) among the patients (1386.786+/-791.291 U/L/min) but the inhibition in plasma cholinesterase activity among the farmers (7346.5+/-1860.786 U/L/min) was not significant (p>0.05). The plasma beta-glucuronidase activity among the farmers was significantly elevated (p<0.05) (0.737+/-0.425 microM/h) but not significant among the patients (p>0.05). The plasma cholinesterase activity was positively correlated with the plasma beta-glucuronidase activity among the farmers (r=0.205, p<0.01) but not among the patients (r=0.79, p>0.05). Thus, plasma beta-glucuronidase enzyme activity can be measured as a biomarker for the chronic exposure of pesticide. However, further studies need to be performed to confirm whether plasma beta-glucuronidase can be a sensitive biomarker for anticholinesterase pesticide poisoning.
Effects of nicardipine on lipid peroxidation in rabbits given 2% cholesterol diet

Ismail NM, Jaarin K, Vasudevan SK, Hashim S

Pharmacol. Toxicol., 1995 Jul;77(1):10-5.
PMID: 8532606

Nicardipine has been shown to have an anti-atherogenic effect in rabbits given a 2% cholesterol diet. Current evidence suggests that lipid peroxidation plays an important role in atherogenesis. This study examines the effect of nicardipine on lipid peroxidation in rabbits given a 2% cholesterol diet, 8 of these rabbits given nicardipine 0.5 mg/kg twice daily intramuscularly for ten weeks while the remaining untreated 6 were controls. After ten weeks, serum malondialdehyde in the control group was significantly higher compared to their baseline levels (P < 0.05). However, there was no increase in serum malondialdehyde in the nicardipine group after 10 weeks. The area of Sudan IV positive intimal lesions (atherosclerotic plaques) were significantly decreased (P < 0.01) in the treated group compared to the control group. The aortic tissue content of cholesterol and diene conjugates were also decreased in the nicardipine group (P < 0.01). These findings suggest a possible link between nicardipine and lipid peroxidation in mediating its antiatherogenic effects.
Fulltext Patients' perceptions of participation in educational home visits

Jaffar A, Tan CE, Hamzah Z, Mohd Hashim S, Mohd Tohit N

Educ Health (Abingdon), 2016;29(1):63-4.
PMID: 26996805 DOI: 10.4103/1357-6283.178930
Fulltext Entrance Surface Dose Measurement and Lifetime Attribute Risk Analysis from Postero-anterior Chest X-ray Imaging via Direct and Indirect Measurement

Kamal, I., Salehhon, N., Hashim, S., Musa, Y., Abdul Karim, M. K.

Physics and Technology in Medicine, 2020;1(2):20-26.
MyJurnal

The aimed of this study is to estimate the entrance surface dose (ESD) of routine chest X-ray (CXR) examination and to compare the direct and indirect measurement. This study also extended to relate with the patients body thickness and established lifetime attributable risk (LAR) of the examinations. A total of 101 CXR examinations in posteroanterior (PA) projections were selected
as subjects and data, such as patient habitus and scanning acquisition parameters were recorded. The mean ESD value obtained from the TLD-100 and the software calculation was 0.31 mGy and 0.17 mGy, respectively. The percentage deviation obtained ranged from 25.5% to 61.3%. In comparison with the national diagnostic reference level (DRL), the mean values of ESD obtained from this study were lower by a factor of 3. Furthermore, it was observed that the mean absorbed dose of the adrenals, kidneys, lungs, oesophagus, and heart walls were lower as compared to the ESD value. The examinations were only associated with very low risk of cancer incidence and mortality. Hence, the results of this study suggested a need for standardisations of the personnel training to perform X-ray examinations according to ALARA principles.
The effectiveness of bismuth breast shielding with protocol optimization in CT Thorax examination

Karim MKA, Rahim NA, Matsubara K, Hashim S, Mhareb MHA, Musa Y

J Xray Sci Technol, 2019;27(1):139-147.
PMID: 30584178 DOI: 10.3233/XST-180397

BACKGROUND: Numerous techniques had been proposed to reduce radiation exposure in computed tomography (CT) including the use of radiation shielding.
OBJECTIVE: This study aims to evaluate efficacy of using a bismuth breast shield and optimized scanning parameter to reduce breast absorbed doses from CT thorax examination.
METHODS: Five protocols comprising the standard CT thorax clinical protocol (CP1) and four modified protocols (CP2 to CP5) were applied in anthropomorphic phantom scans. The phantom was configured as a female by placing a breast component on the chest. The breast component was divided into four quadrants, where 2 thermoluminescence dosimeters (TLD-100) were inserted into each quadrant to measure the absorbed dose. The bismuth shield was placed over the breast component during CP4 and CP5 scans.
RESULTS: The pattern of absorbed doses in each breast and quadrant were approximately the same for all protocols, where the 4th quadrant > 3rd quadrant > 2nd quadrant > 1st quadrant. The mean absorbed dose value in CP3 was reduced to almost 34% of CP1's mean absorbed dose. It was reduced even lower to 15% of CP1's mean absorbed dose when the breast shield was used in CP5.
CONCLUSION: This study showed that CT radiation exposure on the breast could be reduced by using a bismuth shield and low tube potential protocol without compromising the image quality.
Fulltext Malaysian adolescent students' needs for enhancing thinking skills, counteracting risk factors and demonstrating academic resilience

Kuldas S, Hashim S, Ismail HN

Int J Adolesc Youth, 2015 Jan 2;20(1):32-47.
PMID: 25663734

The adolescence period of life comes along with changes and challenges in terms of physical and cognitive development. In this hectic period, many adolescents may suffer more from various risk factors such as low socioeconomic status, substance abuse, sexual abuse and teenage pregnancy. Findings indicate that such disadvantaged backgrounds of Malaysian adolescent students lead to failure or underachievement in their academic performance. This narrative review scrutinises how some of these students are able to demonstrate academic resilience, which is satisfactory performance in cognitive or academic tasks in spite of their disadvantaged backgrounds. The review stresses the need for developing a caregiving relationship model for at-risk adolescent students in Malaysia. Such a model would allow educators to meet the students' needs for enhancing thinking skills, counteracting risk factors and demonstrating academic resilience.
Fulltext Unconscious learning processes: mental integration of verbal and pictorial instructional materials

Kuldas S, Ismail HN, Hashim S, Bakar ZA

Springerplus, 2013 Dec;2(1):105.
PMID: 23556145 DOI: 10.1186/2193-1801-2-105

This review aims to provide an insight into human learning processes by examining the role of cognitive and emotional unconscious processing in mentally integrating visual and verbal instructional materials. Reviewed literature shows that conscious mental integration does not happen all the time, nor does it necessarily result in optimal learning. Students of all ages and levels of experience cannot always have conscious awareness, control, and the intention to learn or promptly and continually organize perceptual, cognitive, and emotional processes of learning. This review suggests considering the role of unconscious learning processes to enhance the understanding of how students form or activate mental associations between verbal and pictorial information. The understanding would assist in presenting students with spatially-integrated verbal and pictorial instructional materials as a way of facilitating mental integration and improving teaching and learning performance.
Greater Cognitive Effort for Better Learning: Tailoring an Instructional Design for Learners with Different Levels of Knowledge and Motivation

Kuldas S, Satyen L, Ismail HN, Hashim S

Psychol Belg, 2014 Aug 08;54(4):350-373.
PMID: 30479408 DOI: 10.5334/pb.aw

The capacity limitation of working memory is a widely recognised determinant of human learning. A cognitive load exceeding the capacity hampers learning. Cognitive load can be controlled by tailoring an instructional design to levels of learner prior knowledge. However, such as design does not necessarily motivate to use the available capacity for better learning. The present review examines literatures on the effects of instructional design, motivation, emotional state, and expertise level on cognitive load and cognitive effort, which ultimately affect working memory performance and learning. This examination suggests further studies on the effects of motivation and negative emotional states on the use of working memory. Prospective findings would help better explain and predict individual differences in the use of working memory for cognitive learning and task performance.
Thermoluminescence response of dysprosium doped strontium tetraborate glasses subjected to electron irradiations

Lim TY, Wagiran H, Hussin R, Hashim S

Appl Radiat Isot, 2015 Aug;102:10-4.
PMID: 25933405 DOI: 10.1016/j.apradiso.2015.04.005

The paper presents the thermoluminescence (TL) response of strontium tetraborate glass subjected to electron irradiations at various Dy2O3 concentrations ranging from 0.00 to 1.00mol%. All glass samples exhibited single broad peak with maximum peak temperature positioned at 170-215°C. The optimum TL response was found at Dy2O3 concentration 0.75mol%. This glass showed good linearity and higher sensitivity for 7MeV compared to 6MeV electrons. Analysis of kinetic parameters showed that the glasses demonstrate second order kinetic.
A review of the burden of disease due to otitis media in the Asia-Pacific

Mahadevan M, Navarro-Locsin G, Tan HK, Yamanaka N, Sonsuwan N, Wang PC, et al.

Int J Pediatr Otorhinolaryngol, 2012 May;76(5):623-35.
PMID: 22404948 DOI: 10.1016/j.ijporl.2012.02.031

The burden of disease due to otitis media (OM) in Asia Pacific countries was reviewed to increase awareness and raise understanding within the region.
Utilizing hybrid functional fuzzy wavelet neural networks with a teaching learning-based optimization algorithm for medical disease diagnosis

Majeed Alneamy JS, A Hameed Alnaish Z, Mohd Hashim SZ, Hamed Alnaish RA

Comput Biol Med, 2019 09;112:103348.
PMID: 31356992 DOI: 10.1016/j.compbiomed.2019.103348

Accurate medical disease diagnosis is considered to be an important classification problem. The main goal of the classification process is to determine the class to which a certain pattern belongs. In this article, a new classification technique based on a combination of The Teaching Learning-Based Optimization (TLBO) algorithm and Fuzzy Wavelet Neural Network (FWNN) with Functional Link Neural Network (FLNN) is proposed. In addition, the TLBO algorithm is utilized for training the new hybrid Functional Fuzzy Wavelet Neural Network (FFWNN) and optimizing the learning parameters, which are weights, dilation and translation. To evaluate the performance of the proposed method, five standard medical datasets were used: Breast Cancer, Heart Disease, Hepatitis, Pima-Indian diabetes and Appendicitis. The efficiency of the proposed method is evaluated using 5-fold cross-validation and 10-fold cross-validation in terms of mean square error (MSE), classification accuracy, running time, sensitivity, specificity and kappa. The experimental results show that the efficiency of the proposed method for the medical classification problems is 98.309%, 91.1%, 91.39%, 88.67% and 93.51% for the Breast Cancer, Heart Disease, Hepatitis, Pima-Indian diabetes and Appendicitis datasets, respectively, in terms of accuracy after 30 runs for each dataset with low computational complexity. In addition, it has been observed that the proposed method has efficient performance compared with the performance of other methods found in the related previous studies.
Fulltext Isolation, Characterization, Crystal Structure Elucidation, and Anticancer Study of Dimethyl Cardamonin, Isolated from Syzygium campanulatum Korth

Memon AH, Ismail Z, Aisha AF, Al-Suede FS, Hamil MS, Hashim S, et al.

Evid Based Complement Alternat Med, 2014;2014:470179.
PMID: 25530783 DOI: 10.1155/2014/470179

Syzygium campanulatum Korth is an equatorial, evergreen, aboriginal shrub of Malaysia. Conventionally it has been used as a stomachic. However, in the currently conducted study dimethyl cardamonin or 2',4'-dihydroxy-6'-methoxy-3',5'-dimethylchalcone (DMC) was isolated from S. campanulatum Korth, leaf extract. The structural characterization of DMC was carried out by making use of various techniques including UV, IR, NMR spectral followed by LC-MS, and X-ray crystallographic techniques. For determining the purity of compound, highly effective techniques including TLC, HPLC, and melting point were used. The cytotoxicity of DMC and three different extracts of S. campanulatum was evaluated against human colon cancer cell line (HT-29) by three different assays. DMC and ethanolic extract revealed potent and dose-dependent cytotoxic activity on the cancer cell line with IC50 12.6 and 90.1 µg/mL, respectively. Quite astonishingly to our knowledge, this is the very first report on S. campanulatum as being a rich source (3.5%) of DMC, X-ray crystallography, and anticancer activity on human colon cancer cells.
Thermoluminescence properties of lithium magnesium borate glasses system doped with dysprosium oxide

Mhareb MH, Hashim S, Ghoshal SK, Alajerami YS, Saleh MA, Razak NA, et al.

Luminescence, 2015 Dec;30(8):1330-5.
PMID: 25828828 DOI: 10.1002/bio.2902

We report the impact of dysprosium (Dy(3+)) dopant and magnesium oxide (MgO) modifier on the thermoluminescent properties of lithium borate (LB) glass via two procedures. The thermoluminescence (TL) glow curves reveal a single prominent peak at 190 °C for 0.5 mol% of Dy(3+). An increase in MgO contents by 10 mol% enhances the TL intensity by a factor of 1.5 times without causing any shift in the maximum temperature. This enhancement is attributed to the occurrence of extra electron traps created via magnesium and the energy transfer to trivalent Dy(3+) ions. Good linearity in the range of 0.01-4 Gy with a linear correlation coefficient of 0.998, fading as low as 21% over a period of 3 months, excellent reproducibility without oven annealing and tissue equivalent effective atomic numbers ~8.71 are achieved. The trap parameters, including geometric factor (μg), activation energy (E) and frequency factor (s) associated with LMB:Dy are also determined. These favorable TL characteristics of prepared glasses may contribute towards the development of Li2O-MgO-B2O3 radiation dosimeters.
Dosimetric features and kinetic parameters of a glass system dosimeter

Mhareb MHA, Alajerami YSM, Alqahtani M, Alshahri F, Saleh N, Alonizan N, et al.

Luminescence, 2020 Jun;35(4):525-533.
PMID: 31883298 DOI: 10.1002/bio.3761

Lithium borate (LB) glasses doped with dysprosium oxide (Dy2 O3 ) have been prepared by utilizing the conventional melt-quench technique. The prepared glass samples were exposed to 60 Co to check their dosimetric features and kinetic parameters. These features involve glow curves, annealing, fading, reproducibility, minimum detectable dose (MDD), and effective atomic number (Zeff ). Kinetic parameters including the frequency factors and activation energy were also determined using three methods (glow curve analysis, initial rise, and peak shape method) and were thoroughly interpreted. In addition, the incorporation of Dy impurities into LB enhanced the thermoluminescence sensitivity ~170 times. The glow from LB:Dy appeared as a single prominent peak at 190°C. The best annealing proceeding was obtained at 300°C for 30 min. Signal stability was reported for a period of 1 and 3 months with a reduction of 26% and 31%, respectively. The proposed glass samples showed promising dosimeter properties that can be recommended for personal radiation monitoring.
Fulltext Spontaneous Haemothorax in a Patient with COVID-19

Mohan SA, Fadzaily ZS, Abdullah Hashim SH

Case Rep Med, 2022;2022:8275326.
PMID: 35898334 DOI: 10.1155/2022/8275326

The global pandemic of COVID-19 is caused by SARS-CoV-2 virus. We continue to discover the wide spectrum of complications associated with COVID-19. Some well-known complications include pneumonia, acute respiratory distress syndrome, pneumothorax, disseminated intravascular coagulation (DIC), chronic fatigue, multiorgan dysfunction, and long COVID-19 syndrome. We report a rare case of a 51-year-old man with severe COVID-19 pneumonia who developed haemorrhagic shock secondary to spontaneous haemothorax after 17 days of hospitalisation. Clinicians should be aware of such occurrence, and hence, high clinical suspicion, prompt recognition of signs and symptoms of shock, and adequate resuscitation will improve the outcomes of patients.
Fulltext Knowledge of colorectal cancer among patients presenting with rectal bleeding and its association with delay in seeking medical advice

Mohd Hashim S, Tong SF, Omar K, Abdul Rashid MR, Shah SA, Sagap I

Asian Pac J Cancer Prev, 2011;12(8):2007-11.
PMID: 22292642

BACKGROUND: Knowledge is believed to be a driving factor for patients' early presentation for healthcare. This study was conducted to assess knowledge of colorectal cancer among subjects presenting with rectal bleeding and to determine its association with late presentation.

METHODS: A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The research instruments used in this study was a self-administered questionnaire including data on duration of rectal bleeding, first medical consultation and knowledge of colorectal cancer.

RESULTS: Sixty percent of subjects with rectal bleeding delayed seeking medical advice. Subjects were more aware of symptoms of non-colorectal cancers compared to symptoms of colorectal cancer. The majority of subjects (63.8%) correctly identified rectal bleeding as a symptom but were not aware of the best screening method to detect colorectal cancer. Half of the subjects knew increasing age and genetic background to be risk factors for colorectal carcinoma. However, knowledge of colorectal cancer was not found to be significantly associated with delay in seeking help.

CONCLUSION: Findings indicate poor awareness of colorectal cancer among the subjects. Although public education of colorectal cancer is important for early presentation on rectal bleeding, further studies are advocated to evaluate other factors influencing patients' help seeking behavior other than knowledge.
Fulltext Simple and efficient estimation of photovoltaic cells and modules parameters using approximation and correction technique

Muhammad FF, Karim Sangawi AW, Hashim S, Ghoshal SK, Abdullah IK, Hameed SS

PLoS One, 2019;14(5):e0216201.
PMID: 31048867 DOI: 10.1371/journal.pone.0216201

The behavior of solar cells and modules under various operational conditions can be determined effectively when their intrinsic parameters are accurately estimated and used to simulate the current-voltage (I-V) characteristics. This work proposed a new computational approach based on approximation and correction technique (ACT) for simple and efficient extraction of solar cells and modules parameters from the single-diode model. In this technique, an approximated value of series resistance (Rs) was first derived and used to determine the initial value of parallel resistance (Rp). Later, the final corrected values of Rs and Rp were obtained by resubstituting their approximated values in a five-loop iteration using the manipulated equations. For rapid evaluation and validation of the proposed technique, a software application was also created using MATLAB program. The correctness and robustness of the proposed technique was validated on five types of solar cells and modules operated at varied temperatures and irradiances. The lowest RMSE value was achieved for RTC France (7.78937E-4) and PVM 752 GaAs (2.10497E-4) solar cell. The legitimacy of ACT extracted parameters was established using a simple yet competitive implementation approach wherein the performance of the developed technique was compared with several state-of-the-art methods recently reported in the literature.
Fulltext Diets and Cellular-Derived Microparticles: Weighing a Plausible Link With Cerebral Small Vessel Disease

Nassir CMNCM, Ghazali MM, Hashim S, Idris NS, Yuen LS, Hui WJ, et al.

Front Cardiovasc Med, 2021;8:632131.
PMID: 33718454 DOI: 10.3389/fcvm.2021.632131

Cerebral small vessel disease (CSVD) represents a spectrum of pathological processes of various etiologies affecting the brain microcirculation that can trigger neuroinflammation and the subsequent neurodegenerative cascade. Prevalent with aging, CSVD is a recognized risk factor for stroke, vascular dementia, Alzheimer disease, and Parkinson disease. Despite being the most common neurodegenerative condition with cerebrocardiovascular axis, understanding about it remains poor. Interestingly, modifiable risk factors such as unhealthy diet including high intake of processed food, high-fat foods, and animal by-products are known to influence the non-neural peripheral events, such as in the gastrointestinal tract and cardiovascular stress through cellular inflammation and oxidation. One key outcome from such events, among others, includes the cellular activations that lead to elevated levels of endogenous cellular-derived circulating microparticles (MPs). MPs can be produced from various cellular origins including leukocytes, platelets, endothelial cells, microbiota, and microglia. MPs could act as microthrombogenic procoagulant that served as a plausible culprit for the vulnerable end-artery microcirculation in the brain as the end-organ leading to CSVD manifestations. However, little attention has been paid on the potential role of MPs in the onset and progression of CSVD spectrum. Corroboratively, the formation of MPs is known to be influenced by diet-induced cellular stress. Thus, this review aims to appraise the body of evidence on the dietary-related impacts on circulating MPs from non-neural peripheral origins that could serve as a plausible microthrombosis in CSVD manifestation as a precursor of neurodegeneration. Here, we elaborate on the pathomechanical features of MPs in health and disease states; relevance of dietary patterns on MP release; preclinical studies pertaining to diet-based MPs contribution to disease; MP level as putative surrogates for early disease biomarkers; and lastly, the potential of MPs manipulation with diet-based approach as a novel preventive measure for CSVD in an aging society worldwide.
Fulltext Soil gas radon and soil permeability assessment: Mapping radon risk areas in Perak State, Malaysia

Nuhu H, Hashim S, Aziz Saleh M, Syazwan Mohd Sanusi M, Hussein Alomari A, Jamal MH, et al.

PLoS One, 2021;16(7):e0254099.
PMID: 34320010 DOI: 10.1371/journal.pone.0254099

In this study geogenic radon potential (GRP) mapping was carried out on the bases of field radon in soil gas concentration and soil gas permeability measurements by considering the corresponding geological formations. The spatial pattern of soil gas radon concentration, soil permeability, and GRP and the relationship between geological formations and these parameters was studied by performing detailed spatial analysis. The radon activity concentration in soil gas ranged from 0.11 to 434.5 kBq m-3 with a mean of 18.96 kBq m-3, and a standard deviation was 55.38 kBq m-3. The soil gas permeability ranged from 5.2×10-14 to 5.2×10-12 m2, with a mean of 5.65×10-13 m2. The GRP values were computed from the 222Rn activity concentration and soil gas permeability data. The range of GRP values was from 0.04 to 154.08. Locations on igneous granite rock geology were characterized by higher soil radon gas activity and higher GRP, making them radon-prone areas according to international standards. The other study locations fall between the low to medium risk, except for areas with high soil permeability, which are not internationally classified as radon prone. A GRP map was created displaying radon-prone areas for the study location using Kriging/Cokriging, based on in situ and predicted measured values. The GRP map assists in human health risk assessment and risk reduction since it indicates the potential of the source of radon and can serve as a vital tool for radon combat planning.
Radiological assessment subjected to outdoor radon and thoron concentrations and terrestrial gamma radiation measurements in Perak Malaysia

Nuhu H, Hashim S, Mohd Sanusi MS, Mohammed Saleh MA

Appl Radiat Isot, 2022 Jan;179:109991.
PMID: 34710768 DOI: 10.1016/j.apradiso.2021.109991

The concentrations of radon, thoron and terrestrial gamma radiation were measured to evaluate the outdoor effective dose. The outdoor radon activity concentration ranged from 5.79 to 5110 ± 46.36 Bq m-3, with a mean of 320.03 Bq m-3 which is higher than the EPA level of 14.8 Bq m-3. The range of the thoron activity concentration outdoor was from 0.00 to 4226.7 ± 58.5 Bq m-3, with a mean of 226.1 Bq m-3 which was above the UNSCEAR recommended level of 10 Bq m-3. The terrestrial gamma radiation dose rates range was from 98.31 to 3769.71 nGy h-1 with a mean of 446.27 nGy h-1. The effective dose contribution from radon exposures in the study was estimated to be 3.2 ± 0.5 mSv y-1 is about 84% total annual effective dose received by the population in those areas. The estimated thoron and gamma dose contributions (15%, and 1% respectively) were not significant. The outdoor doses for thoron and gamma were lower than the ICRP (2007) value of 1 mSv. The total annual outdoor effective dose with an occupancy factor of 1825 h (5 h day-1) was estimated to be within the range of 0.30-551.41 ± 0.65 mSv, with a mean of 3.75 mSv which is a little higher than the world average of 2.4 mSv.

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