Exploring the experiences of parents of Autistic children when attending the diagnostic imaging department for an X-ray examination.

INTRODUCTION: Autism is a neuro-developmental condition which affects the social-emotional skills, behaviour, language, communication skills and flexibility of thoughts of an individual and their sensory processing. This can result in Autistic service users finding it difficult to navigate current healthcare provision and cope with the unpredictable environment. This paper explores the experiences of parents of Autistic children when attending the diagnostic imaging department for an X-ray examination. METHODS: A cross sectional, mixed methods approach was adopted and the initial phase consisting of an online survey for parents to complete is the subject of this paper. The quantitative data was analysed using descriptive statistics and cross comparison between questions was also completed. Thematic analysis was taken to analyse the data from the two open questions at the end of the survey. RESULTS: The online survey results are presented in this paper under four key themes; waiting times and environment, forms of communication, lack of understanding of staff regarding Autism and preparation for the X-ray examination. CONCLUSION: The overall rating of the parents' experience whilst in the X-ray/diagnostic imaging department was positive, however there are several areas which received low scores which need further attention. These were waiting areas, waiting times, staff development and patient preparation. IMPLICATIONS FOR PRACTICE: The development of more inclusive waiting areas is needed, more effective lines of communication between staff to expedite the patient journey where possible, staff development of both radiographers and also support staff and the review of design of more accessible and inclusive patient information.

Autism-friendly MRI: Improving radiography practice in the UK, a survey of radiographer practitioners.

INTRODUCTION: Autistic individuals undergoing magnetic resonance imaging (MRI) examinations may face significant challenges, mainly due to sensory overload and MRI environment-related limitations. This study aimed to explore radiographers' perspectives and experiences regarding MRI scanning of autistic individuals. METHODS: Data collection was achieved using a specifically designed mixed methods questionnaire on Qualtrics. The snowball technique was used. This UK-wide survey was electronically distributed by three main recruitment agencies between December 2020 and February 2021. RESULTS: 130 valid responses were received. A lack of relevant training and knowledge related to autism was noted. Effective communication, optimisation and customisation of the MRI examination, and MRI environment adjustments facilitated the completion of a safe and effective MRI examination. Poor patient-radiographer communication, unavailability of Special Educational Needs (SEN) experts, lack of specialised radiographer training and lack of specific guidelines were identified as the main barriers to successful MRI examinations. CONCLUSION: Although routine MRI safety and patient care rules will apply, MRI scanning of autistic individuals requires customisation and reasonable adjustments in communication, environment, and training of clinical teams. In addition, guidelines should be established to be used as a reference point to improve clinical practice. The adjustments proposed by radiographers were all consistent with the interventions in the wider literature. IMPLICATIONS FOR PRACTICE: MRI practice for personalised care of autistic individuals should be aligned with current evidence, to customise communication and offer workflow and environmental adjustments. Formal training related to autism, integrated within radiography academic curricula and better co-ordination and communication of interdisciplinary teams would provide the necessary skill mix to deliver safe, high quality MRI scans with optimal experience for autistic service users and their carer(s).

Being a newly qualified diagnostic radiographer: Learning to fly in the face of reality.

INTRODUCTION: The phenomenon of role transition has been investigated by a range of differing professions over a range of time and utilising a range of different methodologies. It is acknowledged by all studies that the period of transition from student to practitioner is a challenging and at times a stressful experience, often culminating in the newly qualified practitioners experiencing the reality shock of practice. This paper explores one of the key subthemes 'reality hits' which was identified during a wider PhD study Being and Becoming a Diagnostic Radiographer. METHODS: A longitudinal study was utilised employing an interpretive phenomenological methodology, collating data from nine participants during their first year as a newly qualified diagnostic radiographer. Each participant was interviewed at three months, six months and twelve months. RESULTS: Six main themes were identified. This paper explores the subtheme 'reality hits' which strongly featured in the three and six month interviews. CONCLUSION: Eight of the nine participants found the first three to six months a stressful and emotional time. The experience of the graduates during this time raises issues which need to be used to inform future curriculum development, practice placement models and support strategies.

Embracing diversity in radiography: The role of service users.

This article outlines the importance of cultural competence for student radiographers. The UK population is becoming more diverse in terms of ethnicity, the population is also made up of a much wider age range, varying genders and people of different sexual orientation, physical abilities and faiths. Radiographers need to be able to communicate with and care for people of all backgrounds. Radiographers need to be able to build relationships with service users based on mutual respect to provide optimum care despite personal differences. In order to prepare for this, service user involvement in the radiography curriculum is key. This article discussed the way in which service users are involved at one university. All of the strategies used enable students to learn about the different people that they will encounter in their professional role and to develop cultural competence. It is vitally important that student radiographers feel comfortable to interact with and care for service users from different backgrounds and cultures and to be able to demonstrate an awareness of and sensitivity to the range of issues and individual needs of every service user they may encounter in their professional role.

The Thompson hemiarthroplasty: a new problem for an old favourite.

The Thompson hemiarthroplasty is a popular hip prosthesis. We present two case reports highlighting a significant alteration in the design of the implant which compromised the success of the operations. In recent years the manufacturing process of this prosthesis has changed, with a resultant increase in the volume of the stem of 10 ml. It is essential that manufacturers inform orthopaedic surgeons of any alteration in the design of the implant and supply compatible instrumentation to minimise surgical errors. Surgeons must remain vigilant when checking the compatibility of the trial and definitive prostheses.

Detection of luteinizing hormone beta messenger ribonucleic acid (RNA) in individual gonadotropes after castration: use of a new in situ hybridization method with a photobiotinylated complementary RNA probe.

Patterns of gonadotropin storage in individual gonadotropes change with alterations in the physiological state. After castration in the male rat, there is a 2.5-fold increase in the percentage of gonadotropes and an increase in the proportion of gonadotropes storing both LH and FSH. In addition, there are 6- to 8-fold increases in the pituitary concentrations of LH beta subunit mRNAs. In order to determine whether these changes are due to increases in the number of gonadotropes containing subunit mRNA, or the amount of mRNA per cell or both, an in situ hybridization technique using a photobiotinylated rat LH beta cRNA probe (bio-LH beta-cRNA) was applied to detect LH beta mRNA in fixed whole rat pituitary cells from intact or castrated rats. After hybridization, the bio-LH beta-cRNA was localized with either avidin-biotin peroxidase complex or the fluorescent streptavidin phycoprobe methods. The cells containing LH beta mRNA were then counted and the amount of mRNA per cell was measured by video microdensitometry. Ten percent of the anterior pituitary cells from intact animals contained LH beta mRNA. After castration (2-4 weeks) this percentage rose to 19-24.5%. Image and microdensitometric analyses showed that castration produced a 1.9-fold increase in the amount of LH beta mRNA per cell, and a 2.2-fold increase in the area of cells containing LH beta mRNA. Hence, castration resulted in an increase in the level of LH beta mRNA per cell as well as the number of LH beta mRNA-containing cells. When in situ hybridization was followed by immunocytochemistry in cells from intact rats, 83% of gonadotropes that stained for LH beta and 80% of gonadotropes that stained for FSH beta contained LH beta mRNA whereas after castration 99% of LH-storing and 93% of FSH-storing cells contained LH beta mRNA. This new in situ hybridization protocol is rapid and allows quantification of mRNA within individual gonadotropes. In addition, since the hybridization protocol does not apparently alter the gonadotropin antigens, the hormone content of the same gonadotrope may be defined by immunocytochemistry.

Differential storage and release of luteinizing hormone and follicle-releasing hormone from individual gonadotropes separated by centrifugal elutriation.

Two subtypes of pituitary gonadotropes are known to exist: monohormonal and multihormonal. When separated by centrifugal elutriation monohormonal cells are found in the small fractions whereas multihormonal cells predominate in the large gonadotrope-enriched fractions. Since GnRH is known to shift the proportion of subtypes to cells that are mainly multihormonal, we tested its effect on the small monohormonal gonadotropes. Dispersed cells from cycling female rats were plated on glass coverslips overnight. Storage was evaluated by application of dual immunocytochemical stains with anti-LH beta and anti-FSH beta to cells stimulated with 0.5 nM [D-Lys6]GnRH. Secretion was detected by the reverse hemolytic plaque assay for LH and a newly developed RHPA for FSH. After 4 h of GnRH stimulation, the percentage of total gonadotropes was increased only in fraction (Fr.) 3 [13.9 +/- 0.4% (+/- SE) to 25.2 +/- 2%]. However, cells in Fr. 2 responded with an increase in multihormonal cells from 18.2 +/- 7% to 46.2 +/- 5%, a proportion not different from that in gonadotrope-enriched fractions. GnRH had less striking effects on changing the size or number of LH and FSH plaques. It seems, therefore, that these small gonadotropes are multipotential and respond initially to stimulation by synthesizing and storing the other gonadotropin. In contrast, the large gonadotropes (Frs. 6 and 7) showed no significant changes in storage patterns. Gonadotropes in both fractions were predominantly multihormonal. The LH and FSH reverse hemolytic plaque assays run with cells from Fr. 7 showed striking increases in both the number of plaque-forming cells and the area of the plaques in response to GnRH. However, in the multihormonal cells in Fr. 6, which were 53.5 +/- 9% of the total cell population, a heterogeneous secretory pattern was observed. In the basal state, there were 36.6 +/- 9% LH and only 2.7 +/- 2% FSH plaques, whereas after GnRH stimulation there were 43.1 +/- 10% LH and 10.5 +/- 4% FSH plaques. This finding is the first direct evidence for nonparallel release of gonadotropins from cells known to store both hormones. These studies show that gonadotrope subpopulations exhibit differences in their storage and secretory responses to GnRH. It is suggested that other factors may be required for the release of FSH from unresponsive gonadotropes in Fr. 6.

Age-related changes in proopiomelanocortin (POMC) gene expression in the periarcuate region of ovariectomized rats.

Aging of the female reproductive system results in a decline in estrous cyclicity which is due, in part, to alterations in hypothalamic function. Opioid peptides, especially the proopiomelanocortin (POMC)-derived neuropeptide, beta-endorphin, are thought to play a role in maintaining normal patterns of LH secretion. Previous studies have shown that the level of hypothalamic beta-endorphin and POMC messenger RNA (mRNA) decreases in old animals; however, it is unknown whether opioid peptides are involved in age-related reproductive decline. To determine whether POMC gene expression changes with age and is related to reproductive status, we assessed POMC mRNA levels by in situ hybridization histochemistry in the periarcuate region of young (3-4 months), middle-aged (10-12 months), and old (17-19 months) ovariectomized rats. Two methods of quantitation were used: 1) slides were apposed to x-ray film and POMC mRNA levels were quantitated over the entire periarcuate region, and 2) the same slides were dipped in emulsion and the level of POMC was quantitated in individual cells. POMC mRNA levels decreased 20-30% by the time animals were middle-aged, and no further decline was noted in the old animal groups. The decrease in POMC mRNA levels in the middle-aged and old animals occurred regardless of their reproductive status prior to ovariectomy. In addition, there was a 30-40% decline in the number of cells expressing POMC mRNA in middle-aged and old animals, suggesting an overall age-related decline in POMC gene expression in middle-aged and old animals independent of reproductive status.

Decline in immediate early gene expression in gonadotropin-releasing hormone neurons during proestrus in regularly cycling, middle-aged rats.

Female reproductive decline is characterized by a gradual loss of estrous cyclicity due in part to age-related changes in several hypothalamic neurotransmitter systems known to regulate reproductive function. Previously, we have demonstrated that in middle-aged rats that exhibited no changes in the regularity of their estrous cycles, the proestrous LH surge is markedly attenuated. To determine whether these age-related deficits involve alterations in GnRH neuronal activation, we examined expression of the immediate early gene products, c-fos and Jun, in GnRH neurons of young and middle-aged proestrous animals. Regularly cycling young (3- to 4-month-old) and middle-aged (10- to 12-month-old) animals were perfused transcardially at 2300 h on diestrus or at 0230, 0530, 0900, 1400, 1630, 1930, or 2300 h on proestrus, and the brains were processed for dual immunocytochemistry of c-fos or Jun and GnRH. In agreement with earlier studies in young rats, 34 +/- 4% of the GnRH neurons expressed c-fos and 40 +/- 3% expressed Jun during the proestrous LH surge (1630 and 1930 h). However, in the middle-aged animals, there was a dramatic decline in the number of GnRH neurons that expressed c-fos (9 +/- 1%) and Jun (14 +/- 1%) during the LH surge. There were no changes in the number of GnRH neurons between the two age groups. Furthermore, the strong correlation that existed between c-fos expression and serum LH in young animals was lost by the time the animals reached middle age. These data demonstrate that by the time animals reach middle age, there is a significant decline in the number of activated GnRH neurons, which may account for the decrease in the amplitude of the LH surge that precedes the onset of irregular estrous cycles. This could be due to either age-related changes in the GnRH neuron itself or in the neuronal circuitry involved in activation of these neurons.

Cytological factors that support nonparallel secretion of luteinizing hormone and follicle-stimulating hormone during the estrous cycle.

Gonadotropes from cycling female rats were studied to investigate possible mechanisms for the nonparallel release of LH and FSH. The percentages of total gonadotropes increased from 14% during estrus (E) to 18% by diestrous day 2. More of these cells became multihormonal on the morning of proestrus (P; from 46% during diestrus to 69%). Since LH-containing cells increased from 7% at E to 13.3% during early proestrus, this suggests that monohormonal FSH cells may have contributed by synthesizing LH. Gonadotrope cell areas were greatest just before the LH surge (P 1600 h). Microdensitometric measurements demonstrated that the amount and density of immunoperoxidase stain for either gonadotropin subunit were highest during the midafternoon of P. Interestingly, the amount of stain for LH continued to increase during the LH surge, suggesting that the stain had detected newly synthesized LH beta. At the same time, the average density of the LH beta stain decreased. In contrast, the amount, concentration, and density of stain for FSH beta increased during the afternoon of P and decreased during late P and early E. The percentages of granules that contained immunogold stains for only LH or FSH (monohormonal granules) at P 1600-P 1700 h were 3-4 times higher than those in diestrous rats. The percentages of monohormonal LH granules declined during the proestrous surge, whereas percentages of monohormonal FSH granules declined during the first rise (P 1900 h) and after the second rise in serum FSH (E 0800 h). Finally, the average number of gold particles per micron 2 granule area rose over the value in diestrous rats during P 1600-P 1700 h. These studies suggest that multihormonal gonadotropes support nonparallel gonadotropin release by changing the rate of subunit packaging and transit in the Golgi complex.

Enrichment of corticotropes by counterflow centrifugation.

Anterior pituitary corticotropes represent only 9-10% of the mixed pituitary cell population. However, their small size precludes their enrichment because they cannot be separated from the more abundant PRL and GH cells. They can be induced to enlarge by adrenalectomy, and this report describes the separation of larger CRH-responsive corticotropes from a subpopulation of small pituitary cells. The separation was done by counterflow centrifugation in an elutriator containing the Sanderson chamber which was designed to separate small cells under 15 micron in diameter. The corticotropes were initially eluted at flow rates under 30 ml/min along with other cells less than 12.5 micron in diameter. They were then stimulated for 2-4 h with 0.5 nM CRH and reeluted with the use of higher flow rates to separate the enlarged corticotropes from the unstimulated cells. Reelutriation of the entire pool of small cells produced an enrichment to 60% corticotropes in five separate experiments. However, when the pool was divided into smaller cells (eluted at 20 ml/min) and medium-sized cells (eluted at 30 ml/min), and the two pools were reeluted separately, the enrichment increased to over 90% corticotropes in eight separate experiments. These corticotrope populations remained enriched for up to 14 days in culture. They also secreted in a reverse hemolytic plaque assay that recognizes ACTH-(25-39). The dual labels for ACTH and beta-endorphin showed that 60% of the corticotropes stored both peptides, whereas 30% stored only ACTH, and 10% stored only beta-endorphin. No differences in storage patterns were seen when small and medium-sized corticotropes were compared. Thus, these studies present the first report of the production of an enriched fraction of CRH-responsive corticotropes by counterflow centrifugation and the first report of heterogeneous storage of ACTH and beta-endorphin. The use of enriched fractions facilitated the analysis of these heterogeneous storage patterns in over 8000 corticotropes.

Origin of Plasmodium falciparum malaria is traced by mitochondrial DNA.

The origin and geographical spread of Plasmodium falciparum is here determined by analysis of mitochondrial DNA sequence polymorphism and divergence from its most closely related species P. reichenowi (a rare parasite of chimpanzees). The complete 6 kb mitochondrial genome was sequenced from the single known isolate of P. reichenowi and from four different cultured isolates of P. falciparum, and aligned with the two previously derived P. falciparum sequences. The extremely low synonymous nucleotide polymorphism in P. falciparum (pi=0.0004) contrasts with the divergence at such sites between the two species (kappa=0.1201), and supports a hypothesis that P. falciparum has recently emerged from a single ancestral population. To survey the geographical distribution of mitochondrial haplotypes in P. falciparum, 104 isolates from several endemic areas were typed for each of the identified single nucleotide polymorphisms. The haplotypes show a radiation out of Africa, with unique types in Southeast Asia and South America being related to African types by single nucleotide changes. This indicates that P. falciparum originated in Africa and colonised Southeast Asia and South America separately.

Dipeptidase 1: a candidate tumor-specific molecular marker in colorectal carcinoma.

The aim of this study was to identify tumor-specific markers for the detection of rare disseminated colorectal tumor cells in peripheral venous blood and in intra-peritoneal saline lavage samples collected before and after resection of colorectal tumors. Using cDNA micro-array screening, we found dipeptidase 1 (DPEP1) to be highly expressed in colon tumors compared to matched normal mucosa. Relative reverse transcriptase (RT)-PCR showed that DPEP1 was over-expressed by >/=2 fold in colon tumor compared to normal colonic mucosal tissue in 56/68 (82%) patients. Using immunobead RT-PCR, a technique that first enriches for epithelial cells, we found DPEP1 positive cells in intra-peritoneal lavage and venous blood samples from 15/38 (39%) colorectal cancer cases. This is the first report of DPEP1 as a marker for disseminated colon tumor cells.

Demonstration of an epitope of the transferrin receptor in human cervical epithelium--a potentially useful cell marker.

The distribution of an epitope of the transferrin receptor in the human uterine cervical epithelium has been investigated. Immunohistochemical staining, both immunofluorescent and immunoperoxidase, was performed on biopsy specimens and cytological samples from normal, dysplastic, and neoplastic cervical epithelia using the monoclonal OKT9 antibody. The results of staining 145 cervical biopsy specimens with OKT9 showed widespread staining in all malignant epithelia and most severely dysplastic epithelia. No such staining was seen in either normal epithelia or in mildly dysplastic epithelia apart from the staining of the basal cell layer in some normal epithelia. The incidence of staining in the 50 cervical cytocentrifuge preparations was not as high as that in the 145 tissue sections. The potential role of the OKT9 antibody in both the screening of cervical cytocentrifuge preparations and the prediction of malignancy is discussed. The antibody is considered to be of more value in the examination of biopsy material than of cytocentrifuge preparations.

Immunohistochemical detection of Ca antigen in normal, dysplastic and neoplastic squamous epithelia of the human uterine cervix.

Immunohistochemical staining was performed on biopsies and cytological samples from normal, dysplastic and neoplastic squamous epithelia using the monoclonal Ca 1 antibody. The results of staining 92 biopsies and 20 cytological samples are described and it is reported that positive staining with Ca 1 antibody was detected in normal, dysplastic and neoplastic epithelia. The role of the Ca 1 antibody in the study of cervical cancer is discussed.

Assessment of gene expression and peptide secretion from individual cells.

We have developed an assay that allows one to monitor gene expression in and peptide secretion from individual cells. By combining the reverse hemolytic plaque with in situ hybridization, investigators can quantitate simultaneously the level of gene expression and the level of secretion of a peptide. The method can be used in any system in which an appropriate antibody for the reverse hemolytic plaque assay and probes complementary to the mRNA of interest are available. It can be used to monitor the level of mRNA and secretion of the peptide product, or expression of one gene and the secretion of another peptide. In this paper we will describe the major steps of the method. We have used the pituitary lactotroph as a model to demonstrate the power of this technique. However, we believe that this method may be an important approach to answer many questions regarding the cellular and molecular mechanisms that regulate the coupling of peptide secretion and gene expression at the single cell level.

A new valving system for removal of laser plume during pelvic CO2 laser endoscopic procedures.

The large volumes of laser plume and char created during carbon dioxide laser endoscopy of the pelvis present a common problem to the gynecologic surgeon. Laser plume not only interferes with the view of the surgical field but also reduces the efficiency of emitted laser energy. A valving system has been designed and clinically tested that allows easy removal of laser-created debris while simultaneously maintaining control of the pneumoperitoneum. The system also removes these gas and liquid products without contaminating the operating room environment or hospital vacuum handling systems.

Rapid identification of Haemophilus somnus, Histophilus ovis and Actinobacillus seminis using the API ZYM system.

The API ZYM system, a commercially-available technique that measures bacterial enzyme activity was used to test 43 isolates identified as H. somnus, H. ovis or A. seminis and 19 from related genera. The enzyme patterns resulting from the API ZYM differentiated H. somnus and H. ovis from A. seminis and related genera but not from each other. An identification scheme based on 9 of the enzymes in the API ZYM and a few simple biochemical tests is proposed for the rapid and reliable identification of these bacteria in a diagnostic bacteriology laboratory.

Pressures produced in vitro during intraligamentary anaesthesia.

An in vitro investigation measured the pressures produced by an Astra type aspirating syringe (modified Sterling) and a pressure syringe (Ligmaject) during periodontal ligament injections. A pressure transducer (0-6.9 MPa) was adapted to record the pressures generated within both syringes, with the output of the transducer connected to a microcomputer. Thirty-five clinicians (male: female ratio 3:2) were instructed in the technique of the periodontal ligament injection and the pressures that they produced from both syringes were recorded. Measurements of both the peak and time averaged pressures were obtained from computer print-outs of the recordings. Significantly higher pressures (P less than 0.01) were produced with the pressure syringe than with the aspirating syringe. It was also found that male operators produced significantly (P less than 0.1) higher pressure with the aspirating syringe, although there was no significant sex difference (P greater than 0.1) between the pressures recorded with the pressure syringe. Recordings from the pressure syringe revealed that either a multiple high pressure technique or a steady pressure technique was used, the former producing significantly (P less than 0.01) higher pressures.