Real-time x-ray abnormality alerts for emergency departments using a radiographer comment model - a multisite pilot study.

INTRODUCTION: The timely communication of clinically significant image appearances to Emergency Department (ED) referrers is necessary for optimum patient care. Australian reliance on verbal communication only is time-limited, open to misinterpretation and lacks transparency. A combined radiographer alert and comment model was designed to reliably communicate image abnormalities to ED referrers in real-time. METHODS: A multidisciplinary steering group designed the model for all ED general imaging. Protocols were developed to document radiographer comments (critical, urgent and clinically significant) in patients' medical records. Critical findings were communicated directly to ED. Five NSW hospitals varying in size, complexity and population demographics piloted the model between three to twelve months during 2021-2022. Site auditors compared comments with the radiology report and designated each as True Positive (TP), False Positive (FP), indeterminate and clinically significant. Indeterminate cases were analysed by an external radiologist. Inter-observer consensus was obtained for all classifications via two independent auditors. The Positive Predictive Value (PPV), or precision of the comment, was calculated for each site. RESULTS: Radiographers (n = 69) provided comments for 1102 cases. The pooled average PPV for TP was 0.96; (0.947-0.971; 95% CI). The weighted mean error (FP comments) was 3.9%; (2.9% - 5.3%.; 95% CI). CONCLUSION: The Radiographer Comment model provided consistent levels of commenting precision and reproducibility across a range of sites with a pooled average PPV (0.96). The False Positive rate or weighted mean error (FP) of 3.9% (2.9% - 5.3%.; 95% CI) was low. IMPLICATIONS FOR FUTURE PRACTICE: A strategic, interprofessional approach in the implementation of an image alert combined with a Radiographer Comment can be adapted across a variety of hospital settings for ED and other departments.

A single synthetic lipid antigen for improved serological diagnosis of Buruli ulcer.

SETTING: The diagnosis of Buruli ulcer (BU) is frequently made by experienced health workers in rural regions. This leads to long turnaround times to confirm the diagnosis as it requires specialised laboratory infrastructure to perform confirmatory testing. BACKGROUND: Given the lack of success with protein antigens to detect BU in human sera, the aim of this study was to evaluate a range of single synthetic lipid antigens using an enzyme-linked immunosorbent assay (ELISA). The ELISA system used was initially developed to detect TB using single synthetic lipid antigens. METHODS: Thirty polymerase chain reaction (PCR) positive BU samples and 30 PCR-negative healthy contact samples collected from Asante Akim North and Ahafo Ano North Districts, Ghana, that are endemic for BU between 2013 and 2016 were used to evaluate the synthetic lipid antigen ELISA. A Quantikine ELISA was also conducted on a randomly blinded sub-set of 30 samples. RESULTS: The synthetic lipid ELISA evaluated here outperforms all other ELISA tests using protein antigens to detect BU to date and has shown potential as a fast (2 h) test for BU which may be adapted for use at the point of care. A sensitivity of 63% and specificity of 80% was observed for 30 BU-positive and 30 BU-negative samples, with significantly reduced interleukin-8 (IL-8) levels in a subset of patients with BU. CONCLUSION: A single lipid was shown for the first time to have the ability to distinguish between PCR-positive BU and negative sera using ELISA. The low lipid antibody load detected may be a result of immune suppression caused by the presence of mycolactone in patients with BU, given that levels of IL-8 were significantly reduced in patients with BU compared to the control serum samples.

Measurement of the ν_{e}-Nucleus Charged-Current Double-Differential Cross Section at ⟨E_{ν}⟩=2.4 GeV Using NOvA.

The inclusive electron neutrino charged-current cross section is measured in the NOvA near detector using 8.02×10^{20} protons-on-target in the NuMI beam. The sample of GeV electron neutrino interactions is the largest analyzed to date and is limited by ≃17% systematic rather than the ≃7.4% statistical uncertainties. The double-differential cross section in final-state electron energy and angle is presented for the first time, together with the single-differential dependence on Q^{2} (squared four-momentum transfer) and energy, in the range 1 GeV≤E_{ν}<6 GeV. Detailed comparisons are made to the predictions of the GENIE, GiBUU, NEUT, and NuWro neutrino event generators. The data do not strongly favor a model over the others consistently across all three cross sections measured, though some models have especially good or poor agreement in the single differential cross section vs Q^{2}.

Past the Precipice? Projected Coral Habitability Under Global Heating.

Coral reefs are rapidly declining due to local environmental degradation and global climate change. In particular, corals are vulnerable to ocean heating. Anomalously hot sea surface temperatures (SSTs) create conditions for severe bleaching or direct thermal death. We use SST observations and CMIP6 model SST to project thermal conditions at reef locations at a resolution of 1 km, a 16-fold improvement over prior studies, under four climate emissions scenarios. We use a novel statistical downscaling method which is significantly more skillful than the standard method, especially at near-coastal pixels where many reefs are found. For each location we present projections of thermal departure (TD, the date after which a location with steadily increasing heat exceeds a given thermal metric) for severe bleaching recurs every 5 years (TD5Y) and every 10 years (TD10Y), accounting for a range of post-bleaching reef recovery/degradation. As of 2021, we find that over 91% and 79% of 1 km2 reefs have exceeded TD10Y and TD5Y, respectively, suggesting that widespread long-term coral degradation is no longer avoidable. We project 99% of 1 km2 reefs to exceed TD5Y by 2034, 2036, and 2040 under SSP5-8.5, SSP3-7.0, and SSP2-4.5 respectively. We project that 2%-5% of reef locations remain below TD5Y at 1.5°C of mean global heating, but 0% remain at 2.0°C. These results demonstrate the importance of further improving ecological projection capacity for climate-vulnerable marine and terrestrial species and ecosystems, including identifying refugia and guiding conservation efforts. Ultimately, saving coral reefs will require rapidly reducing and eliminating greenhouse gas emissions.

Changing the model of radiography practice: Challenges of role advancement and future needs for radiographers working in the UAE.

INTRODUCTION: The radiographers' role in the United Arab Emirates (UAE) is focused on image acquisition with a willingness to accept advanced practice roles after appropriate education and training. Radiographers working in the UAE are highly motivated and ambitious to achieve those internationally identified levels of professional recognition and opportunities for role advancement. This study investigates the radiographers' perspectives, perceptions and hopes for role advancement in the UAE. METHODS: A qualitative research study design using Focus Group Discussions (FGD) was used to elicit the perceptions of radiographers. Participants were radiographers working in the hospitals and clinics supervised by the Ministry of Health and Prevention. Participants were asked about the recognized tasks defined as advancement roles, needs for roles clinically, challenges and requirements to prepare radiographers to participate in extended/developed roles. The discussions were audio recorded and later transcribed by an independent research assistant. Thematic analysis was used for data analysis RESULTS: 29 radiographers participated in the FGDs, and 83% (n = 24) were interested in role advancement. FGD revealed that their current practice showed some informal extended role that may promote career progression. The most significant challenges identified by participants was their knowledge level as provided by the current curriculum and the need for education and licensing body support to accommodate change. CONCLUSION: The study identified a need for education and licensing body support to enable change in roles by radiographers, through improving radiographer knowledge and experience for role advancement. IMPLICATIONS FOR PRACTICE: To sustain role advancement, formal intense training and education are necessary, normally above bachelor's degree level. Furthermore, establishing standards, licensing organizations/professional bodies should be part of the transformation of the profession to enable internationally recognized models to be followed.

Search for Active-Sterile Antineutrino Mixing Using Neutral-Current Interactions with the NOvA Experiment.

This Letter reports results from the first long-baseline search for sterile antineutrinos mixing in an accelerator-based antineutrino-dominated beam. The rate of neutral-current interactions in the two NOvA detectors, at distances of 1 and 810 km from the beam source, is analyzed using an exposure of 12.51×10^{20} protons-on-target from the NuMI beam at Fermilab running in antineutrino mode. A total of 121 of neutral-current candidates are observed at the far detector, compared to a prediction of 122±11(stat.)±15(syst.) assuming mixing only between three active flavors. No evidence for ν[over ¯]_{µ}→ν[over ¯]_{s} oscillation is observed. Interpreting this result within a 3+1 model, constraints are placed on the mixing angles θ_{24}<25° and θ_{34}<32° at the 90% C.L. for 0.05 eV^{2}≤Δm_{41}^{2}≤0.5 eV^{2}, the range of mass splittings that produces no significant oscillations at the near detector. These are the first 3+1 confidence limits set using long-baseline accelerator antineutrinos.

Changing the model of radiography practice in the UAE: A snapshot of a profession in transition.

INTRODUCTION: This study forms part of a needs assessment in relation to the challenges United Arab Emirates (UAE) radiographers face as they move beyond the role of a technician, and their learning needs to facilitate role advancement. It presents a snapshot of the workforce in terms of qualifications, clinical experience, and responsibilities, as it transitions towards an Emirati, led profession. The results will aid the radiography workforce to embrace a broader role within medical imaging and radiographic practice in the UAE. METHODS: An electronically distributed cross-sectional study was conducted among radiographers in the UAE. The questionnaire captured radiographer demographics, qualifications, professional experience, postgraduate training, professional development plans, and their interest in future role developments. RESULTS: 272 radiographers were invited to participate with a response rate of 68% (n = 185). Thirty-four (18%) radiographers were UAE nationals with the remainder educated overseas. BSc qualifications were held by 153 (82.7%) and had 6-20 years of experience. There were 12 masters' qualified and two with doctoral qualifications. Modality vendors were significant providers of professional development. Improved job satisfaction and the development of an Emirati led radiography profession were identified as the main gains for role advancement by 171 (92.4%) respondents. CONCLUSION: Currently, UAE radiographers work within traditional professional boundaries focussing on image acquisition under direct radiologist supervision. At the same time, many respondents revealed they had embraced advanced practice roles after appropriate education and training. IMPLICATIONS FOR PRACTICE: The findings suggest an Emirati led profession requires the creation of a distinct professional body to represent the interests of radiographers, more investment in postgraduate education, and the creation of a career structure that encompasses positive role development.

Experiences of radiographers working alone in remote locations: A Far North Queensland non-participant observational study.

INTRODUCTION: Radiographers employed in remote locations such as Far North Queensland (FNQ) can face unique sets of challenges as they often perform radiographic and sonographic diagnostic imaging without onsite radiologists' services. Additionally, the majority of patients presenting to these sites are Indigenous for whom English may be their third language. This non-participant observational study observed two FNQ radiographers' interactions with patients and interprofessional staff, and the radiographers' ability to fit into the Indigenous community during routine radiographic and sonographic examinations which to date have received little attention. METHODS: Non-participant observations and semi-structured interviews with radiographers were held at two FNQ hospitals. Consecutive radiographer-patient interactions were observed and recorded on checklists. Interviews were audio recorded and transcribed for thematic analysis. RESULTS: Across both remote sites, 24 patients were observed as they underwent diagnostic imaging examinations, with the majority being Aboriginal or Torres Strait Islanders (n = 17/24 (70.8%). In total, eleven general radiography and sixteen ultrasound examinations were observed. Semi-structured interviews highlighted complex issues such as the need for radiographer communication in local dialect, ongoing interprofessional collaborations, overcoming the lack of radiologists' onsite support by providing radiographic reports directly to referring doctors and midwives, and isolation with regard to professional development opportunities. CONCLUSIONS: Radiographers working in remote hospitals need to be culturally competent, navigate local indigenous languages and possess excellent interprofessional skills as well as thorough knowledge of imaging pathology to convey findings to referring doctors and allied health professionals. These findings have implications for the entry to practice curriculum. IMPLICATIONS FOR PRACTICE: This study provides evidence that culturally competent radiographers are capable of undertaking reporting roles to facilitate patient management in the absence of timely radiologists' reports at remote sites.

Computed tomography learning via high-fidelity simulation for undergraduate radiography students.

INTRODUCTION: Universities offering accredited medical imaging degrees must ensure their graduates can deliver radiographic services including computed tomography (CT). On-campus high-fidelity simulation can potentially facilitate this learning outside the clinical environment yet there is a paucity of research validating its benefits in relation to diagnostic CT. METHODS: A pragmatic multiple methods approach tested for differences in knowledge acquired from two high-fidelity CT simulation environments and explored student perceptions of the learning activities. Third year radiography students (n = 62) were randomly assigned to two groups prior to undertaking a CT placement. Group 1 completed learning activities on a remote-access CT scanner (RA) with peer-assisted learning (PAL). Group 2 completed identical tasks on a local-access CT scanner (LA) facilitated by a CT radiographer. RA students were offered additional scan time if so inclined. Students' CT knowledge was assessed pre- and post-clinical placement. Students were surveyed about their learning experiences. Assessment data was analysed via an ANOVA and survey data via descriptive statistics, t-test and thematic analysis. RESULTS: Assessment results demonstrated no significant difference in CT knowledge between the groups (F(1,60) = 0.3, p = 0.6). There was significant improvement in assessment scores between the pre- and post-clinical period for both groups (F(1,60) = 37.4, p < 0.001). Four themes emerged: remote versus local-access capabilities, facilitation versus PAL, use of a real scanner, and preparedness for the learning activity. CONCLUSION: CT knowledge acquisition via RA with PAL is comparable to LA with facilitation. Students reported increased satisfaction and confidence in CT skills via facilitated LA compared to RA students with PAL. IMPLICATIONS FOR PRACTICE: Opportunity for CT knowledge acquisition is now available outside of the clinical centre via remote-access. PAL requires in-depth training of the peers in technologically rich learning environments.

First measurement of neutrino oscillation parameters using neutrinos and antineutrinos by NOvA.

The NOvA experiment has seen a 4.4σ signal of ν[over ¯]_{e} appearance in a 2 GeV ν[over ¯]_{µ} beam at a distance of 810 km. Using 12.33×10^{20} protons on target delivered to the Fermilab NuMI neutrino beamline, the experiment recorded 27 ν[over ¯]_{µ}→ν[over ¯]_{e} candidates with a background of 10.3 and 102 ν[over ¯]_{µ}→ν[over ¯]_{µ} candidates. This new antineutrino data are combined with neutrino data to measure the parameters |Δm_{32}^{2}|=2.48_{-0.06}^{+0.11}×10^{-3} eV^{2}/c^{4} and sin^{2}θ_{23} in the ranges from (0.53-0.60) and (0.45-0.48) in the normal neutrino mass hierarchy. The data exclude most values near δ_{CP}=π/2 for the inverted mass hierarchy by more than 3σ and favor the normal neutrino mass hierarchy by 1.9σ and θ_{23} values in the upper octant by 1.6σ.

Simulated fate of catchment-derived sediment on the Great Barrier Reef shelf.

Numerical experiments using a 3D model of fine sediment transport in the Great Barrier Reef region indicate deposition of the bulk mass of catchment sediments from river plumes within a few tens of kilometres from river mouths. A very fine fraction of easily resuspended catchment sediment has a capacity to propagate over much greater distances reaching out into the mid-shelf and outer-shelf regions. The model suggests such particles, instrumental to the development of low density flocs in the marine environment, can play a critical role in altering optical properties of water masses over the shelf during wet years. The mid-term (4 year) impact of Great Barrier Reef catchments on the probability of suspended sediment concentration exceeding the ecologically significant trigger value of 2 mg/L is confined to inshore regions adjacent to river mouth locations.

Microparticles produced by human papillomavirus type 16 E7-expressing cells impair antigen presenting cell function and the cytotoxic T cell response.

High-risk, cancer-causing human papillomaviruses (HPV) cause infections of the epidermis that may progress to cancer, including cervical cancer. Viral persistence, contributed to by viral evasion of the host immune response, is associated with the likelihood of cancer developing. Langerhans cells (LCs) are the only professional antigen presenting cells located in the epidermis, therefore may influence the antiviral immune response. Microparticles, or microvesicles, are small membrane particles shed by cells that can exert effects on other cells at both a local and systemic level. We found increased numbers of microparticles were shed from human or mouse keratinocytes expressing the HPV16 E7 oncoprotein, compared with control keratinocytes. Co-culture of LCs with microparticles from E7-expressing cells suppressed the cytotoxic T cell response. We attributed this, at least in part, to the reduction in surface of CD40 and intracellular pro-inflammatory cytokine IL-12 p40 subunit that we measured in the LCs. The evidence provided here shows that co-culture of E7-microparticles with LCs inhibits antigen-specific cytotoxicity. This is an important finding, suggesting that microparticles from HPV-infected cells could suppress the T cell response by regulating LCs, potentially contributing to persistence of HPV infection and cancer.

Could musculo-skeletal radiograph interpretation by radiographers be a source of support to Australian medical interns: A quantitative evaluation.

INTRODUCTION: Public expectations regarding access to the emergency department (ED) challenges providers and policy makers with finite resources being stretched beyond capacity. To enable education of a greater numbers of doctors the format of the medical internship in Australia has changed and assumes that sufficient supervision is provided to interns to enable image interpretation skills development. Furthermore this assumes that appropriate foundational skills are established during undergraduate education. METHODS: A mixed methods approach using a convenience, self selecting sample population of radiographers and final year medical students was adopted. The study measured the interpretive ability of final year medical students and radiographers in musculo-skeletal trauma (MSK) plain radiographic images. An image test bank based upon radiologist consensual agreement was corrected for prevalence and bias. Performance across a range of measurements was completed and compared for statistical significance using Mann-Whitney U. RESULTS: Results were divided to enable analysis across age ranges and types of skeletal presentation. Radiographer performance was better numerically and demonstrated statistically significant difference in several areas. CONCLUSION: Radiographers have the knowledge base to assist junior doctors to clinically interpret the musculo-skeletal radiographic image. To meet the requirements of AMC and the Medical Board of Australia (MBA), a tailored clinically based educational system could be developed and provided by an accredited radiographer. Australian radiographers could also be employed to provide a safety net to avoid misinterpretation, such as seen in the UK commenting system, operating as an interprofessional team.

Occupational burnout among radiation therapists in Australia: Findings from a mixed methods study.

INTRODUCTION: Evidence demonstrates that health care professionals in the palliative care context are more burned out than other health professionals. The aims of this study were to examine: (1) occupational burnout levels among radiation therapists in Australia, (2) association between demographic factors on burnout and (3) radiation therapists' perceptions of burnout. METHODS: A cross-sectional online survey including the Maslach Burnout Inventory was administered to Radiation Therapists in Australia. Data were analysed using SPSS Ver 20 and open ended comments were analysed thematically using Nvivo 10. RESULTS: A total of 200 radiation therapists participated in the survey. RTs had a high mean (±SD) burnout score for emotional exhaustion (38.5 ± 8.2), depersonalisation (17.5 ± 4.7) and personal achievement (30.5.3 ± 4.3) compared to RTs and health workers in other studies. High levels of emotional exhaustion, depersonalisation and low levels of personal achievement were present in 93% (186/200), 87% (174/200) and 61% (122/200) of participants respectively. RTs identified high workload and staff shortages, interpersonal conflict and technology as key sources of stress in the RT work environment. CONCLUSION: Australian RTs' level of burnout on all three stages of burnout exceed previously reported burnout levels for similar cohorts both locally and internationally. It is important that future interventions aimed at minimising or preventing stressors are identified and implemented in the radiation therapy work environment.

Constraints on Oscillation Parameters from ν_{e} Appearance and ν_{µ} Disappearance in NOvA.

Results are reported from an improved measurement of ν_{µ}→ν_{e} transitions by the NOvA experiment. Using an exposure equivalent to 6.05×10^{20} protons on target, 33 ν_{e} candidates are observed with a background of 8.2±0.8 (syst.). Combined with the latest NOvA ν_{µ} disappearance data and external constraints from reactor experiments on sin^{2}2θ_{13}, the hypothesis of inverted mass hierarchy with θ_{23} in the lower octant is disfavored at greater than 93% C.L. for all values of δ_{CP}.

Measurement of the Neutrino Mixing Angle θ_{23} in NOvA.

This Letter reports new results on muon neutrino disappearance from NOvA, using a 14 kton detector equivalent exposure of 6.05×10^{20} protons on target from the NuMI beam at the Fermi National Accelerator Laboratory. The measurement probes the muon-tau symmetry hypothesis that requires maximal θ_{23} mixing (θ_{23}=π/4). Assuming the normal mass hierarchy, we find Δm_{32}^{2}=(2.67±0.11)×10^{-3} eV^{2} and sin^{2}θ_{23} at the two statistically degenerate values 0.404_{-0.022}^{+0.030} and 0.624_{-0.030}^{+0.022}, both at the 68% confidence level. Our data disfavor the maximal mixing scenario with 2.6σ significance.

Standardization of natural mycolic acid antigen composition and production for use in biomarker antibody detection to diagnose active tuberculosis.

Mycobacterium tuberculosis, the causative agent of tuberculosis, is characterized by the abundance of species specific, antigenic cell wall lipids called mycolic acids. These wax-like molecules all share an identical, amphiphilic mycolic motif, but have different functional groups in a long hydrophobic hydrocarbon mero-chain that divide them into three main classes: alpha-, keto- and methoxy-mycolic acids. Whereas alpha-mycolic acids constitutively maintain an abundance of around 50%, the ratio of methoxy- to keto-mycolic acid types may vary depending on, among other things, the growth stage of M. tuberculosis. In human patients, antibodies to mycolic acids have shown potential as diagnostic serum biomarkers for active TB. Variations in mycolic acid composition affect the antigenic properties and can potentially compromise the precision of detection of anti-mycolic acids antibodies in patient sera to natural mixtures. We demonstrate this here with combinations of synthetic mycolic acid antigens, tested against TB patient and control sera. Combinations of methoxy- and α-mycolic acids are more antigenic than combinations of keto- and α-mycolic acids, showing the former to give a more sensitive test for TB biomarker antibodies. Natural mixtures of mycolic acids isolated from mature cultures of M. tuberculosis H37Rv give the same sensitivity as that with synthetic methoxy- and α-mycolic acids in combination, in a surface plasmon resonance inhibition biosensor test. To ensure that the antigenic activity of isolates of natural mycolic acids is reproducible, we cultured M. tuberculosis H37Rv on Middlebrook 7H10 solid agar plates to stationary growth phase in a standardized, optimal way. The proportions of mycolic acid classes in various batches of the isolates prepared from these cultures were compared to a commercially available natural mycolic acid isolate. LC-MS/MS and NMR data for quantitation of mycolic acids class compositions show that the variation in batches is small, suggesting that the quality of the results for anti-mycolic acid antibody detection in the TB patients should not be affected by different batches of natural mycolic acid antigens if prepared in a standard way.

First Measurement of Electron Neutrino Appearance in NOvA.

We report results from the first search for ν_{µ}→ν_{e} transitions by the NOvA experiment. In an exposure equivalent to 2.74×10^{20} protons on target in the upgraded NuMI beam at Fermilab, we observe 6 events in the Far Detector, compared to a background expectation of 0.99±0.11(syst) events based on the Near Detector measurement. A secondary analysis observes 11 events with a background of 1.07±0.14(syst). The 3.3σ excess of events observed in the primary analysis disfavors 0.1π<δ_{CP}<0.5π in the inverted mass hierarchy at the 90% C.L.

The Δ133p53 isoform and its mouse analogue Δ122p53 promote invasion and metastasis involving pro-inflammatory molecules interleukin-6 and CCL2.

A number of naturally occurring isoforms of the tumour suppressor protein p53 have been discovered, which appear to have differing roles in tumour prevention or promotion. We are investigating the tumour-promoting activities of the Δ133p53 isoform using our mouse model of Δ133p53 (Δ122p53). Here, we report that tumours from Δ122p53 homozygous mice show evidence of invasion and metastasis and that Δ122p53 promotes migration though a 3-dimensional collagen matrix. We also show that Δ122p53 and Δ133p53 promote cell migration in scratch wound and Transwell assays, similar to the 'gain-of-function' phenotypes seen with mutant p53. Using the well-defined B16 mouse melanoma metastatic model, we show that Δ122p53 leads to faster generation of lung metastases. The increased migratory phenotypes are dependent on secreted factors, including the cytokine interleukin-6 and the chemokine CCL2. We propose that Δ122p53 (and Δ133p53) acts in a similar manner to 'gain-of-function' mutant p53 proteins to promote migration, invasion and metastasis, which may contribute to poor survival in patients with Δ133p53-expressing tumours.