An investigation of radiographers' and radiologists' perceptions and attitudes in Kuwait towards extending radiographers' role in mammography.

INTRODUCTION: Kuwait has a shortage of radiologists, especially in mammography, resulting in increased workload and longer waiting times for women receiving imaging investigations. This study looked at how radiographers and radiologists perceived radiographers' role extension (RE) in mammography, and whether this could reduce radiologist workload, thereby improving patient service and waiting times. METHODS: A single case study design with 10 radiographers (mammographers) and 10 radiologists was undertaken across multiple sites: hospitals, screening clinics and specialist centres in Kuwait. Data included individual semi-structured interviews, documentary analysis and field notes. Perceptions were examined under a theoretical framework, Abbotts' System of Professions. RESULTS: Two main themes were identified, firstly in examining the current role of radiographers in mammography and areas of interest for extending role, this highlighted insufficient knowledge of the concept. The second focused on in-depth understanding of drivers and barriers to RE in mammography, both groups opposed radiographers performing extended tasks without radiologist supervision. CONCLUSION: Radiologists and radiographers' attitudes were influenced by concepts of professional identity and professional identity formation. Insufficient professional knowledge negatively affected the radiographers' readiness to undertake RE in mammography. Radiologists are reluctant to blur boundaries, enabling them to maintain and control jurisdiction of their own profession and that of radiographers, thereby, as discussed in Abbott's theory, limiting impact on workload or waiting times. IMPLICATIONS FOR PRACTICE: Whilst RE is limited, to improve workload and patient waiting times, setting up an educational programme for radiographers specialising in mammography would be an important step to extending the radiographers' role. The study highlighted a need to educate radiographers to undertake breast ultrasound and amend policy to introduce training programmes for radiographers. Radiographer rotation across the various radiographic modalities negatively affected radiographers' performance, placing well-trained radiographers permanently within the mammography department should improve experience and overall skills.

Chemometric Analysis of Cannabinoids: Chemotaxonomy and Domestication Syndrome.

Cannabis is an interesting domesticated crop with a long history of cultivation and use. Strains have been selected through informal breeding programs with undisclosed parentage and criteria. The term "strain" refers to minor morphological differences and grower branding rather than distinct cultivated varieties. We hypothesized that strains sold by different licensed producers are chemotaxonomically indistinguishable and that the commercial practice of identifying strains by the ratio of total THC and CBD is insufficient to account for the reported human health outcomes. We used targeted metabolomics to analyze 11 known cannabinoids and an untargeted metabolomics approach to identify 21 unknown cannabinoids. Five clusters of chemotaxonomically indistinguishable strains were identified from the 33 commercial products. Only 3 of the clusters produce CBDA in significant quantities while the other 2 clusters redirect metabolic resources toward the THCA production pathways. Six unknown metabolites were unique to CBD-rich strains and/or correlated to CBDA and 3 unknowns were found only in THC-rich strains. Together, these data indicate the domestication of the cannabis germplasm has resulted in a loss of the CBDA pathway in some strains and reallocation of resources between CBDA and THCA pathways in others. The impact of domestication is a lack of chemical diversity and loss of biodiversity in modern cannabis strains.

A national audit of current cardiac device policies from radiotherapy centres across the UK.

AIMS: The number of patients with cardiac implantable electronic devices (permanent pacemakers and implantable cardioverter defibrillators) undergoing radiotherapy treatment is increasing. The aims of this audit were to establish current UK practice regarding the management of patients with implanted cardiac devices undergoing radiotherapy and to compare this practice with current 'gold standard' evidence-based guidelines. MATERIALS AND METHODS: All UK radiotherapy departments were contacted and asked to provide their current cardiac implantable electronic device policy or to indicate if there was no current policy. A proforma was created to analyse these policies and to compare with current best practice. RESULTS: In total, 47/67 (70%) radiotherapy departments responded and 45 departmental policies were submitted; 31/45 (69%) policies defined the radiotherapy tolerance dose to permanent pacemakers and 14/45 (31%) defined the monitoring procedure for patients in line with current best practice. Only 5/45 (11%) policies defined the radiotherapy tolerance dose to implantable cardioverter defibrillators and 12/45 (27%) defined the monitoring procedure in line with current best practice. CONCLUSION: Most UK cardiac device policies do not reflect current best evidence. Policies are based on research carried out in 1994 by the American Association of Physicists in Medicine. This evidence does not account for advances in cardiac implantable electronic device technology. Further research is urgently needed to establish the effect of radiotherapy on these devices.

Impact of chemotherapy regimen and rituximab in adult Burkitt lymphoma: a retrospective population-based study from the Nordic Lymphoma Group.

BACKGROUND: Standard treatment of adult Burkitt lymphoma is not defined due to the lack of randomised trials. In this situation, population-based data may represent a useful contribution in order to identify an optimal treatment strategy. PATIENTS AND METHODS: The aims of this study were to investigate the outcome for adult HIV-negative BL with different chemotherapy regimens, and to assess possible improvement within the time frame of the study. The study population was identified through the Swedish and Danish lymphoma registries 2000-2009. RESULTS: A total of 258 patients were identified. Since 2000, overall survival (OS) improved significantly only for younger patients (<65 years). Intensive regimens such as the Berlin-Frankfurt-Münster, hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) and cyclophosphamide, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide, and cytarabine (CODOX-M/IVAC) were associated with a favourable 2-year OS of 82%, 83%, and 69%, respectively. The low-intensive CHOP/CHOEP regimens achieved a 2-year OS of 38.8%, confirming their inadequacy for the treatment of BL. In a multivariate analysis, rituximab was not significantly associated with improved OS. CONCLUSIONS: In this population-based retrospective series of adult BL, intensive chemotherapy regimens were associated with favourable outcome. The impact of the addition of rituximab remains uncertain and warrants further investigation.

Torcetrapib-induced blood pressure elevation is independent of CETP inhibition and is accompanied by increased circulating levels of aldosterone.

BACKGROUND AND PURPOSE: Inhibition of cholesteryl ester transfer protein (CETP) with torcetrapib in humans increases plasma high density lipoprotein (HDL) cholesterol levels but is associated with increased blood pressure. In a phase 3 clinical study, evaluating the effects of torcetrapib in atherosclerosis, there was an excess of deaths and adverse cardiovascular events in patients taking torcetrapib. The studies reported herein sought to evaluate off-target effects of torcetrapib. EXPERIMENTAL APPROACH: Cardiovascular effects of the CETP inhibitors torcetrapib and anacetrapib were evaluated in animal models. KEY RESULTS: Torcetrapib evoked an acute increase in blood pressure in all species evaluated whereas no increase was observed with anacetrapib. The pressor effect of torcetrapib was not diminished in the presence of adrenoceptor, angiotensin II or endothelin receptor antagonists. Torcetrapib did not have a contractile effect on vascular smooth muscle suggesting its effects in vivo are via the release of a secondary mediator. Treatment with torcetrapib was associated with an increase in plasma levels of aldosterone and corticosterone and, in vitro, was shown to release aldosterone from adrenocortical cells. Increased adrenal steroid levels were not observed with anacetrapib. Inhibition of adrenal steroid synthesis did not inhibit the pressor response to torcetrapib whereas adrenalectomy prevented the ability of torcetrapib to increase blood pressure in rats. CONCLUSIONS AND IMPLICATIONS: Torcetrapib evoked an acute increase in blood pressure and an acute increase in plasma adrenal steroids. The acute pressor response to torcetrapib was not mediated by adrenal steroids but was dependent on intact adrenal glands.

Mass spectral analysis of PC-SPES confirms the presence of diethylstilbestrol.

INTRODUCTION/OBJECTIVES: PC-SPES is an herbal mixture available over the counter for the treatment of prostate cancer. It was re-called in January 2002 due to alleged contamination with warfarin. Other laboratories, including our own, claim that the potent synthetic estrogen, diethylstilbestrol (DES) which has been used for many years to treat hormone dependent prostate cancer, could be detected in the herbal mixture. Recent clinical studies report objective responses in men with hormone dependent and naïve prostate cancer, and also describe isolated cases of estrogenic side effects. A lack of effective conventional treatments for advanced hormone refractory prostate cancer has led to a widespread use of PC-SPES by patients across the North America continent. The presence of DES in PC-SPES might explain both clinical response and observed side effects in men taking 6-9 capsules per day. METHODS: We tested five batches of commercially available PC-SPES using gas chromatography (GC) and high performance liquid chromatography (HPLC) upon methanolic extraction. Duplicate aliquots were tested for each batch and the results compared to standard curves generated using DES (99% purity). RESULTS AND CONCLUSIONS: We detected significant levels of DES in three out of five tested batches. The presence of a synthetic steroid in PC-SPES is not likely to have occurred as a result of its extraction from a herbal source. The implications of this finding highlight the necessity of regulated quality control and standardization of natural health products.

Synthesis of galactofuranosyl-containing oligosaccharides corresponding to the glycosylinositolphospholipid of Trypanosoma cruzi.

The oligosaccharide beta-D-Galf-(1-->3)-alpha-D-Manp-(1-->2)-[beta-D-Galf- (1-->3)]-alpha-D-Manp-(1-->2)-alpha-D-Manp corresponds to the terminal end of the glycosylinositolphospholipid oligosaccharide of the protozoan Trypanosoma cruzi, the causative agent of Chagas' disease. Syntheses of methyl or ethylthio glycosides of the terminal disaccharide, trisaccharide, tetrasaccharide, and pentasaccharide corresponding to this structure are described. These syntheses employ the selective activation of a phenyl 1-selenogalactofuranoside or a phenyl 1-selenomannopyranoside donor over ethyl 1-thioglycoside acceptors with NIS-TfOH.

Comparison of N-octyl-cyanoacrylate vs suture in the stabilization of cartilage grafts.

OBJECTIVE: To compare N-octyl-cyanoacrylate and suture control to determine the efficacy of this tissue glue preparation in securing grafted cartilage with an acceptable inflammatory reaction. DESIGN: Four 5-mm circular auricular cartilage grafts were harvested, and 2 of these grafts were either glued together with N-octyl-cyanoacrylate or sewn together with nylon suture. These sandwich grafts were then glued or sewn to the periosteum of the calvaria. Histologic analysis for inflammation, necrosis, fibrosis, and foreign-body giant cell reaction was performed 2 and 6 weeks after implantation. We also measured cartilage graft migration from the original site of surgical implantation. SUBJECTS: Sixteen New Zealand white rabbits. The 2-week study group consisted of 7 rabbits (1 died of dehydration), and the 6-week group totaled 8. INTERVENTION: Each rabbit underwent auricular cartilage harvest and cartilage graft implantation to the parietal skull periosteum. RESULTS: We found no histological differences between the glue specimens and the suture controls. Similarly, our examination of graft migration yielded no differences between groups. CONCLUSIONS: N-octyl-cyanoacrylate was superior to standard suture technique by virtue of its speed, ease, and accuracy of application. No adverse inflammation was observed. Further studies, including clinical trials, are needed to assess the safety of N-octyl-cyanoacrylate in humans.

Anaesthesia for children and infants undergoing magnetic resonance imaging: a prospective study.

A prospective study of a method of anaesthetizing children for magnetic resonance imaging was carried out. The end-tidal carbon dioxide, respiratory rate and oxygen saturation of 23 children undergoing magnetic resonance imaging were monitored. The children underwent halothane anaesthesia breathing spontaneously via an endotracheal tube and a modified Bain breathing system. The children were divided into two age groups. In all groups the end-tidal carbon dioxide and oxygen saturation values remained at or near normal for the duration of the scan. All children were recovered within 10 min and there were no post-anaesthetic problems. We suggest, that in the absence of respiratory problems or a rise in intracranial pressure, this is a safe and appropriate technique for magnetic resonance scanning in the child.

Differential effects on sensory nerve processes and behavioral alterations in the rat after treatment with antibodies to nerve growth factor.

Published work on the effects of antibodies to nerve growth factor (ANTI-NGF) treatment on rats has shown an increase in the number of unmyelinated central processes of dorsal root ganglia (DRG) neurons (31). This increase is interpreted to be sprouting of the central projections of the DRG neurons. To test for sprouting of the peripheral DRG projections, we quantitated the number of peripheral DRG processes in the peripheral nerves of ANTI-NGF-treated compared to untreated rats, following selective surgery to eliminate motor and sympathetic nerve fibers. We report the numbers of peripheral DRG processes in an NGF-deprived environment decrease by 48% compared to untreated controls and the decrease is selective for the unmyelinated fiber population. Since the majority of the unmyelinated population is nociceptive, two nociceptive behavioral measures, one reflexive (tail flick) and one nonreflexive (paw or skin pinch), were performed and demonstrated decreased responses in the ANTI-NGF-treated compared to untreated and preimmune-treated rats. These data suggest a directional effect, primarily on the unmyelinated sensory population which results in altered nociceptive behavior, induced by the suppression of one endogenous factor, NGF. Furthermore, it is important to note that the centrally directed sensory processes project to a central nervous system environment and the peripherally directed processes are in a peripheral nervous system environment. Thus, a single molecule may have different effects on directional growth of a neuronal population that may be related to the interactions available in the substrate of the environment.

Risk of nonocular cancer in first-degree relatives of retinoblastoma patients.

The increased risk of nonocular cancer seen consistently in studies of survivors of retinoblastoma may be caused in part by the presence of a retinoblastoma gene that also predisposes to other cancers. It has been claimed that this gene also increases the risk for cancer among unaffected relatives of genetic retinoblastoma probands. We report here a population-based study of the risk of nonocular cancer in parents and siblings of persons notified to the Danish Cancer Registry with retinoblastoma during 1943-84. No excess was observed among first degree relatives of 61 genetic retinoblastoma probands, whereas a slight (10%) excess was seen among the parents of 115 nongenetic probands. The latter was the result of significant excesses of malignant melanoma (4 observed, 0.4 expected), multiple myeloma (2 observed, 0.2 expected) and osteogenic sarcoma (1 observed, 0.03 expected). The observed risk pattern cannot be explained by the presence of the retinoblastoma gene.

Compartmental analysis of cerebrospinal fluid transfer and absorption in simulated hydrocephalus.

A mathematical model of the cerebrospinal fluid (CSF) flow dynamics found in hydrocephalic infants with myelomeningocele lesions was constructed using criteria obtained from analogous clinical situations where 125I-labelled and 131I-labelled ortho-iodobenzoyl-amino-acetic acid (hippuran) had been employed to measure CSF flow dynamics. The quantitative results from this study allowed clinical data to be assessed and the importance of various CSF transfer mechanisms to be discussed. Our mathematical model indicates that the majority of radiopharmaceutical passes from the cerebral reservoir (the ventricles) into the blood. Experimental evidence indicates that the principal mechanism responsible for this movement is the bulk flow of CSF between its sites of production in the choroid plexus and absorption by the arachnoid villi.

A clinical and experimental study of tendon injury, healing and treatment in the horse.

This project was carried out over a five year period (1977 to 1981 inclusive) at the University of Bristol following discussion between the British Veterinary Association and the Royal College of Veterinary Surgeons about the efficacy of, and ethical justification for, the practice of 'firing' (cautery). These discussions had been promoted by parliamentary questions but led to no firm conclusions because previously reported clinical investigations on specific treatments lacked adequate comparisons and controls and thus did not provide scientifically acceptable, statistically valid data. The project was originally conceived as having two main sections, one clinical and the other experimental. The Veterinary Advisory Committee of the Horserace Betting Levy Board felt that primary attention should be given to the clinical investigation and this was done.

An assessment of filamentous carbon fibre for the treatment of tendon injury in the horse.

The results of an assessment of carbon fibre for biological use are given, with particular reference to the clinical use of the material in the treatment of equine tendon injury. Biocompatability of the fibres is assessed using fibroblast cell cultures and replacement of normal tendon with carbon fibre prostheses in experimental animals. The rationale and technique for using this material in clinical cases of tendon injury in the racehorse are described. Results are given from 62 implant operations in a limited series of 40 horses.