Radiographer role extension in Oman - Current practice and future opportunities.

INTRODUCTION: Radiographers in Oman are believed to be engaged with varying levels of role extension however the nature and extent of this currently unknown. The aim of this study was to investigate role extension for radiographers in Oman, and to evaluate radiographers and the radiologists' opinions and attitudes toward role extension. METHODS: A cross sectional study of radiographers and radiologists at 13 major hospitals in Oman was used. A total of 189 radiographers and 77 radiologists were invited to complete a questionnaire seeking information on current and possible future role extension activities. RESULTS: The overall response rate was 80.4% for radiographers and 63.6% for radiologists. Approximately half (53.3%) of the radiographer respondents reported they carry out examinations traditionally performed by radiologists (i.e. role extension); this was primarily in gastrointestinal and barium enema studies. Fewer (21%) reported being involved in image interpretation, most commonly in accident and emergency examinations. Forty percent of radiographers reported involvement in intravenous injections, most commonly for CT and intravenous urography procedures. Both radiographers and radiologists supported the involvement of radiographers in a range of examination types however responses vary within and between hospitals. CONCLUSION: This study concluded that radiography role extension activities are widely implemented at hospitals in Oman and that radiographers have sufficient skills and education for participating in these activities. IMPLICATIONS FOR PRACTICE: The involvement of radiographers in role extension activities is believed to be cost and time effective, improve teamwork and has potential for significant service delivery benefits.

Cannabinoid WIN-55,212-2 mesylate inhibits interleukin-1ß induced matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase expression in human chondrocytes.

OBJECTIVE: Interleukin-1ß (IL-1ß) is involved in the up-regulation of matrix metalloproteinases (MMPs) leading to cartilage degradation. Cannabinoids are anti-inflammatory and reduce joint damage in animal models of arthritis. This study aimed to determine a mechanism whereby the synthetic cannabinoid WIN-55,212-2 mesylate (WIN-55) may inhibit cartilage degradation. METHODS: Effects of WIN-55 were studied on IL-1ß stimulated production of MMP-3 and -13 and their inhibitors TIMP-1 and -2 in human chondrocytes. Chondrocytes were obtained from articular cartilage of patients undergoing total knee replacement. Chondrocytes were grown in monolayer and 3D alginate bead cultures. Real-time polymerase chain reaction (PCR) was used to determine the gene expression of MMP-3, -13, TIMP-1 and -2 and Enzyme Linked Immunosorbent Assay (ELISA) to measure the amount of MMP-3 and MMP-13 protein released into media. Immunocytochemistry was used to investigate the expression of cannabinoid receptors in chondrocyte cultures. RESULTS: Treatment with WIN-55 alone or in combination with IL-1ß, decreased or abolished MMP-3, -13, TIMP-1 and -2 gene expression in human chondrocyte monolayer and alginate bead cultures in both a concentration and time dependent manner. WIN-55 treatment alone, and in combination with IL-1ß, reduced MMP-3 and -13 protein production by chondrocytes cultured in alginate beads. Immunocytochemistry demonstrated the expression of cannabinoid receptors in chondrocyte cultures. CONCLUSION: Cannabinoid WIN-55 can reduce both basal and IL-1ß stimulated gene and protein expression of MMP-3 and -13. However WIN-55 also decreased basal levels of TIMP-1 and -2 mRNA. These actions of WIN-55 suggest a mechanism by which cannabinoids may act to prevent cartilage breakdown in arthritis.

A preliminary study of complementary and alternative medicine (CAM) practitioners in Singapore.

OBJECTIVES: To investigate the profile and health attitudes of complementary and alternative medicine (CAM) practitioners in Singapore. DESIGN AND SETTING: A descriptive survey with convenience and snowball sampling were used. An anonymous self-administered survey was sent to 130 practitioners found in publicly accessible online practitioner registers, groups, and directories practicing CAM modalities from April 2010 to October 2010. MAIN OUTCOME MEASURES: Participants' demographics, business structure, and attitudes towards health, CAM and orthodox medicine (OM). RESULTS: Response rate was 32%. The data suggest that the typical CAM practitioner in Singapore is a middle-aged female who specialises in more than one CAM modality. Almost half (45%) of the participants possessed a degree and massage is the most commonly practiced modality. Participants practiced an average of 2-3 therapies and group-practice size ranged from 2 to 15 practitioners. Most participants (69%) experienced a radical change in job type to become a CAM practitioner and their previous employment suggests a slightly middle-class profile. The cost and duration of initial consultation and treatment ranged from SG$20 to SG$345 and 30-120min, respectively. The most common source of CAM information was seminars/lectures/workshops (76%). Communication and referral between CAM and orthodox medicine practitioners are high (>70%). Participants perceived CAM to be more suitable for disease prevention than treatment of serious medical conditions. CONCLUSIONS: This study provides important base-line data that will help future researchers explore further Singaporean CAM practitioners' business aspirations, and attitudes towards regulation and integration with OM.

Naturopaths and Western herbalists' attitudes to evidence, regulation, information sources and knowledge about popular complementary medicines.

BACKGROUND: The practice of naturopathy and Western herbal medicine (WHM) was built on traditional evidence but may be undergoing change with the advent of scientific evidence. The aims of this research were to provide a better understanding of practitioners' attitudes towards evidence, information sources, professional regulation and their knowledge about the evidence of commonly used complementary medicines (CMs). METHOD: Naturopaths and WHM practitioners were invited to participate in an anonymous, self-administered, on-line survey. Participants were recruited using the mailing lists and websites of CM manufacturers and professional associations. RESULTS: Four hundred and seventy nine practitioners participated; 95% currently in practice. The majority (99%) thought well documented traditional evidence was essential or important, 97% patient reports and feedback, 97% personal experience, 94% controlled randomised trials and 89% published case reports. Significantly more recent graduates (less than 5 years) rated randomised trials as essential compared to others. Most (82%) respondents want information sources containing both traditional and scientific evidence. They currently use several resources; 74% CM textbooks, 67% conferences/seminars, 57% CM journals, 48% databases and 40% manufacturers' information. The mean knowledge score was 61.5% with no significant differences between respondents with diploma or degree level education or by graduating year. Eighty-five percent of practitioners strongly agreed or agreed that practitioners should be formally registered to safeguard the public, 8% were unsure and 8% disagreed or strongly disagreed. CONCLUSION: Naturopaths and WHM practitioners accept the importance of scientific evidence whilst maintaining the importance and use of traditional evidence. The majority are in favour of professional registration.

The effect of Leptospermum petersonii essential oil on Candida albicans and Aspergillus fumigatus.

A variety of assays were utilized to determine the effects of Leptospermum petersonii essential oil on both Candida albicans and Aspergillus fumigatus. Hyphal morphology, susceptibility of spheroplasts and uptake of propidium iodide following exposure to the oil suggest that the mode of action of L. petersonii essential oil is through direct disturbance of the fungal cell membrane. Data also confirms that the volatile component of the oil is highly antifungal, independent of direct contact between the liquid oil and the fungal membrane. The degree of inhibition was greater when fungi were directly exposed to oil volatiles compared to pre-inoculation exposure of oil volatiles into the agar. It is likely that the essential oil volatiles are acting both directly and indirectly on the fungi to produce growth inhibition.

Mitigating climate change: the role of domestic livestock.

Livestock contribute directly (i.e. as methane and nitrous oxide (N2O)) to about 9% of global anthropogenic greenhouse gas (GHG) emissions and around 3% of UK emissions. If all parts of the livestock production lifecycle are included (fossil fuels used to produce mineral fertilizers used in feed production and N2O emissions from fertilizer use; methane release from the breakdown of fertilizers and from animal manure; land-use changes for feed production and for grazing; land degradation; fossil fuel use during feed and animal production; fossil fuel use in production and transport of processed and refrigerated animal products), livestock are estimated to account for 18% of global anthropogenic emissions, but less than 8% in the UK. In terms of GHG emissions per unit of livestock product, monogastric livestock are more efficient than ruminants; thus in the UK, while sheep and cattle accounted for 32% of meat production in 2006, they accounted for 48% of GHG emissions associated with meat production. More efficient management of grazing lands and of manure can have a direct impact in decreasing emissions. Improving efficiency of livestock production through better breeding, health interventions or improving fertility can also decrease GHG emissions through decreasing the number of livestock required per unit product. Increasing the energy density of the diet has a dual effect, decreasing both direct emissions and the numbers of livestock per unit product, but, as the demands for food increase in response to increasing human population and a better diet in some developing countries, there is increasing competition for land for food v. energy-dense feed crops. Recalculating efficiencies of energy and protein production on the basis of human-edible food produced per unit of human-edible feed consumed gave higher efficiencies for ruminants than for monogastric animals. The policy community thus have difficult decisions to make in balancing the negative contribution of livestock to the environment against the positive benefit in terms of food security. The animal science community have a responsibility to provide an evidence base which is objective and holistic with respect to these two competing challenges.

Antifungal activity of Leptospermum petersonii oil volatiles against Aspergillus spp. in vitro and in vivo.

OBJECTIVES: This study investigates the volatile (vapour) component of an essential oil derived from the Australian native Leptospermum petersonii as a potential treatment for aspergillosis. METHODS: The in vitro antifungal effects of the volatiles were assayed by a variety of methods. In vitro mammalian cell toxicity of the oil and the oil volatiles was also determined prior to animal testing. Efficacy of the volatiles in vivo was assessed using a murine model. RESULTS: L. petersonii oil volatiles were found to be potent inhibitors of fungal growth in vitro, with fungicidal activity displayed following short exposure times (< or =1 h). No significant mammalian cell toxicity was found to be associated with the volatiles. In the absence of treatment, Aspergillus fumigatus infection of animals resulted in an increase in inflammatory cell counts and high fungal burden within the lung tissue. Chitin levels in treated animals were significantly reduced compared with control animals. No viable fungi could be recovered from animals that had completed the treatment regimen. CONCLUSIONS: The significant reduction in fungal burden in the lungs of infected animals by the volatiles of L. petersonii oil was larger than that reported for conventional antifungal drugs of choice.

The antioxidant activity of Clitoria ternatea flower petal extracts and eye gel.

Extracts of Clitoria ternatea (butterfly pea) flowers are used in Thailand as a component of cosmetics and the chemical composition of the flowers suggest that they may have antioxidant activity. In this study the potential antioxidant activity of C. ternatea extracts and an extract containing eye gel formulation was investigated. Aqueous extracts were shown to have stronger antioxidant activity (as measured by DPPH scavenging activity) than ethanol extracts (IC(50) values were 1 mg/mL and 4 mg/mL, respectively). Aqueous extracts incorporated in to an eye gel formulation were also shown to retain this activity, however, it was significantly less than a commercial antiwrinkle cream included for comparison. The total phenolic content was 1.9 mg/g extract as gallic acid equivalents. The data from this study support the use of C. ternatea extracts as antioxidant inclusions in cosmetic products.

Effect of essential oil concentration on the pH of nutrient and Iso-sensitest broth.

The role of pH on the antimicrobial activity of essential oils has not been well studied. The effect of four essential oils: Backhousia citriodora, Melaleuca alternifolia, Lavandula angustifolia and Santalum spicatum (0.1% to 10%) on the pH of two commonly used media, nutrient broth and Iso-sensitest broth, was therefore undertaken. Small (less than 0.5 pH units) but statistically significant differences between the pH of the two media followed the addition of M. alternifolia, L. angustifolia and S. spicatum essential oil. In general the effect on pH was greatest at higher concentrations and the fall in pH was greatest in the nutrient broth. The addition of B. citriodora essential oil to nutrient broth resulted in a fall in pH from 7.29 +/- 0.02 (no oil) to 5.2 +/- 0.03 (10% oil). This effect was not observed in the Iso-sensitest broth.

Honey: a potent agent for wound healing?

Although honey has been used as a traditional remedy for burns and wounds, the potential for its inclusion in mainstream medical care is not well recognized. Many studies have demonstrated that honey has antibacterial activity in vitro, and a small number of clinical case studies have shown that application of honey to severely infected cutaneous wounds is capable of clearing infection from the wound and improving tissue healing. The physicochemical properties (eg, osmotic effects and pH) of honey also aid in its antibacterial actions. Research has also indicated that honey may possess antiinflammatory activity and stimulate immune responses within a wound. The overall effect is to reduce infection and to enhance wound healing in burns, ulcers, and other cutaneous wounds. It is also known that honeys derived from particular floral sources in Australia and New Zealand (Leptospermum spp) have enhanced antibacterial activity, and these honeys have been approved for marketing as therapeutic honeys (Medihoney and Active Manuka honey). This review outlines what is known about the medical properties of honey and indicates the potential for honey to be incorporated into the management of a large number of wound types.

Personal and professional use of complementary therapies by nurses in NSW, Australia.

In this study, we investigate the personal and professional use of complementary therapies by nurses in NSW, Australia. We found that the therapies and products used by respondents were similar to those used by the general population. Seventy-four percent of respondents had used a complementary therapy in the last year and 38% had used them with a patient. In addition, 67% indicated that they would refer to a complementary practitioner. Respondents were also found to have favourable views of complementary therapies with 85% believing they improve quality of life and only 0.8% indicating they serve no purpose. No major differences were seen between respondents residing in the city vs those in regional areas. The data from this study support the view that nurses are high users of complementary therapies and that they may be the health profession most open to the use of complementary therapies as an integral part of normal health care.

Biological activities of lavender essential oil.

Essential oils distilled from members of the genus Lavandula have been used both cosmetically and therapeutically for centuries with the most commonly used species being L. angustifolia, L. latifolia, L. stoechas and L. x intermedia. Although there is considerable anecdotal information about the biological activity of these oils much of this has not been substantiated by scientific or clinical evidence. Among the claims made for lavender oil are that is it antibacterial, antifungal, carminative (smooth muscle relaxing), sedative, antidepressive and effective for burns and insect bites. In this review we detail the current state of knowledge about the effect of lavender oils on psychological and physiological parameters and its use as an antimicrobial agent. Although the data are still inconclusive and often controversial, there does seem to be both scientific and clinical data that support the traditional uses of lavender. However, methodological and oil identification problems have severely hampered the evaluation of the therapeutic significance of much of the research on Lavandula spp. These issues need to be resolved before we have a true picture of the biological activities of lavender essential oil.

High use of complementary therapies in a New South Wales rural community.

In this study a postal questionnaire was used to investigate the use of complementary therapies (CT) in a rural region of New South Wales (NSW). A total of 70.3% of respondents reported using one or more therapies with 62.7% having visited a complementary practitioner. Vitamin/mineral therapy (68.7%), chiropractic (26.1%) and massage therapy (25.1%) were the most frequently used therapies, with the most commonly visited practitioners being chiropractors (55.3%) and those trained in vitamin/mineral therapy (47.9%). Of the vitamins, vitamin C and multivitamins were used most often, with garlic and Echinacea being the most used herbal products. The main source of information were friends (64.5%) with most people indicating that CT could improve quality of life and provide relief of symptoms. Results suggest that CT use in rural communities is high and that, in light of these findings, there is a need for training in CT to be included in the undergraduate and continuing education of health professionals. Furthermore, these professionals should be alert to the potential for increased numbers of herb-drug interactions in rural communities.

Antibacterial activity of raspberry cordial in vitro.

Raspberry juice cordial has a long anecdotal use in Australia for the prophylaxis and treatment of gastroenteritis in livestock, cage birds and humans. The antimicrobial properties of raspberry juice cordial, raspberry juice, raspberry leaf extract and a commercial brand of raspberry leaf tea were investigated against five human pathogenic bacteria and two fungi. Raspberry cordial and juice were found to significantly reduce the growth of several species of bacteria, including Salmonella, Shigella and E. coli, but demonstrated no antifungal activity. No antimicrobial activity was detected in the leaf extract or tea.

Complementary therapy use by nursing, pharmacy and biomedical science students.

Attitudes towards the use of complementary therapies by students of undergraduate Bachelor of Nursing, Pharmacy and Biomedical Sciences were determined using a self-administered questionnaire. Overall, 78% of students had used a complementary therapy in the past year and 56% had visited a complementary therapy practitioner. The therapies most used were those involving vitamins, mineral and other supplements. Practitioners specializing in this area were the most visited, followed by chiropractors. Commonly used products included vitamin C, multivitamins, B group vitamins, garlic, iron and echinacea. Most students thought complementary therapies improved quality of life, with friends and family providing the main sources of information. There were few differences attributable to course or gender. The results suggest that these students have favorable attitudes towards complementary therapies and that many choose to use them as part of normal health care.

Effect of ginger tea on the fetal development of Sprague-Dawley rats.

This study investigated the effect of ginger, a common morning sickness remedy, on fetal development. Pregnant Sprague-Dawley rats were administered, from gestation day 6 to 15, 20 g/liter or 50 g/liter ginger tea via their drinking water and then sacrificed at day 20. No maternal toxicity was observed, however embryonic loss in the treatment groups was double that of the controls (P<0.05). No gross morphologic malformations were seen in the treated fetuses. Fetuses exposed to ginger tea were found to be significantly heavier than controls, an effect that was greater in female fetuses and was not correlated with increased placental size. Treated fetuses also had more advanced skeletal development as determined by measurement of sternal and metacarpal ossification centers. The results of this study suggest that in utero exposure to ginger tea results in increased early embryo loss with increased growth in surviving fetuses.

What do we know about herbal morning sickness treatments? A literature survey.

OBJECTIVE: A literature survey investigating the use of herbs to treat morning sickness, with particular reference to what is known about their safety. DESIGN: All major English language medical, nursing and scientific databases as well as 300 World Wide Web sites, Internet newsgroups, books and magazines were searched for information about the use and safety of herbs in pregnancy. FINDINGS: A search of medical databases failed to locate any articles which specifically reported investigations of the safety of herbs used during pregnancy. Of 300 non-medical sources studied 75 cited the use of herbs in pregnancy. The most commonly cited herbs for morning sickness were ginger, chamomile, peppermint and raspberry leaf (55, 37, 44 and 63% cited respectively). There was no consensus in the popular literature about whether or not each of these herbs was safe for use in pregnancy. Seven sources (6%) cited chamomile and peppermint as unsafe, while 16 (12%) cited the use of ginger and 11 (15%) the use of raspberry leaf as unsafe during pregnancy. CONCLUSIONS: Herbal remedies are often seen as safe, 'drug-free' treatments for morning sickness. However, the contradictory information and dearth of original research related to their safety indicates that these compounds should be used with caution.

Advanced gastrointestinal malignancy or benign inflammatory disease? An unusual presentation of sclerosing mesenteritis. Report of a case.

The presentation of change of bowel habit, weight loss, muscle wasting, ascites, and the surgical appearance of "omental cake" are almost pathognomonic of advanced gastrointestinal malignancy. In our case, these symptoms represented a unique presentation of the condition sclerosing mesenteritis. Despite its rarity, the clinician should be aware of this "sheep in wolf's clothing," the clinical importance of which lies in the condition's benign and self-limiting course and imparts to the patient a prognosis and treatment that could not be further removed from that of advanced malignancy. Investigations that may be helpful to the surgeon in distinguishing the condition from carcinomatosis and avoiding unnecessary laparotomy include preoperative colonoscopy, barium enema, cytology of any ascites, and intraoperative frozen section biopsy. Treatment of the condition is conservative unless it has caused extrinsic bowel obstruction.

The amino acid sequence of rabbit slow-muscle troponin I.

Troponin I was isolated from six red muscles in the hind leg of the rabbit. Soleus, semi-tendinosus, vastus intermedius and adductor longus muscles contained primarily slow-muscle troponin I, vastus lateralis contained fast-muscle troponin I and quadratus femoris contained a mixture of the two. The complete amino acid sequence of the troponin I from slow muscle was determined. Seven CNBr fragments were isolated and sequenced by using the dansyl-Edman technique after digestion with proteolytic enzymes. The CNBr fragments were ordered by isolation of tryptic peptides containing carboxy[(14)C]methyl-methionine. Direct evidence for the conjunction of residues 8 and 9 has not been obtained, and one of the carboxyl groups between residues 71 and 79 may carry an amide group. Slow-muscle troponin I is a single polypeptide chain of 184 residues with a mol.wt. of 21146. It has a net overall positive charge of 18 at pH7, and an absorption coefficient, A(1%,1cm) (280), of 5.43. The protein was isolated with both a blocked and an unblocked N-terminus, although the nature of the blocking group was not determined. Proline was found to be the N-terminal amino acid. Two forms of the protein could also be distinguished by the presence of an extra two residues at the C-terminus. Comparison of sequences of troponin I from rabbit slow, fast and cardiac muscle shows that homology is most marked in the C-terminal half of the molecules. Towards the N-terminus the homology becomes much less marked. Detailed evidence on which the sequence is based has been deposited as Supplementary Publication SUP 50079 (32 pages) at the British Library (Lending Division), Boston Spa, Wetherby, West Yorkshire LS23 7BQ, U.K., from whom copies may be obtained in the terms given in Biochem. J. (1977), 161, 1.

The amino acid sequence of rabbit cardiac troponin I.

The complete amino acid sequence of troponin I from rabbit cardiac muscle was determined by the isolation of four unique CNBr fragments, together with overlapping tryptic peptides containing radioactive methionine residues. Overlap data for residues 35-36, 93-94 and 140-145 are incomplete, the sequence at these positions being based on homology with the sequence of the fast-skeletal-muscle protein. Cardiac troponin I is a single polypeptide chain of 206 residues with mol.wt. 23550 and an extinction coefficient, E 1%,1cm/280, of 4.37. The protein has a net positive charge of 14 and is thus somewhat more basic than troponin I from fast-skeletal muscle. Comparison of the sequences of troponin I from cardiac and fast skeletal muscle show that the cardiac protein has 26 extra residues at the N-terminus which account for the larger size of the protein. In the remainder of sequence there is a considerable degree of homology, this being greater in the C-terminal two-thirds of the molecule. The region in the cardiac protein corresponding to the peptide with inhibitory activity from the fast-skeletal-muscle protein is very similar and it seems unlikely that this is the cause of the difference in inhibitory activity between the two proteins. The region responsible for binding troponin C, however, possesses a lower degree of homology. Detailed evidence on which the sequence is based has been deposited as Supplementary Publication SUP 50072 (20 pages), at the British Library Lending Division, Boston Spa, Wetherby, West Yorkshire LS23 7QB, U.K., from whom copies may be obtained on the terms given in Biochem. J. (1976) 153, 5.