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.

Medium term results of per-operative knee arthroscopy in confirming suitability for unicompartmental arthroplasty.

INTRODUCTION: The status of the lateral compartment of the knee is a determining factor in the long-term outcome of medial unicompartmental arthroplasty (UKA). Various methods of assessing the lateral compartment have been used including stress radiography, radioisotope bone scanning, magnetic resonance imaging and visualisation at the time of surgery. Arthroscopy is another means of directly assessing the integrity of the articular cartilage and the meniscus in the lateral compartment. PURPOSE: This study aims to show that per-operative arthroscopy is a safe and effective means of deciding whether to proceed with UKA or convert to total knee arthroplasty (TKA). METHOD: We have used arthroscopy of the lateral compartment to assess suitability for UKA in 151 knees over 8 years. RESULTS: At time of arthroscopy 34 knees underwent a change of surgical plan from UKA to TKA (22.5%). There has been one revision to TKA and 2 bearing exchanges for dislocation. CONCLUSION: Immediate per-operative arthroscopy is a reliable method for assessing the suitability of a knee for UKA, in particular the lateral compartment.

What is the role of minimally invasive surgery in a fast track hip and knee replacement pathway?

INTRODUCTION: Minimally invasive hip and knee replacement surgery (MIS) continues to receive coverage in both the popular press and scientific literature. The cited benefits include a smaller scar, less soft tissue trauma, faster recovery, reduced hospital stay, decreased blood loss and reduced post-operative pain. These outcomes are highly desirable and consistent with the aims of fast track hip and knee pathways. This paper evaluates the literature and discusses whether performing MIS over conventional surgical techniques offers advantages in a fast track hip and knee pathway. METHODS: An English language literature search was performed using the MEDLINE and PubMed databases. Case series, randomised controlled trials and systematic reviews were included in the review. RESULTS: The reported improvements in recovery brought about by MIS must be considered multifactorial. In combination with improved clinical pathways, MIS can be associated with quicker recovery and shorter length of hospital stay. CONCLUSIONS: There is insufficient evidence to indicate that surgical technique alone makes a significant difference to recovery or reduces soft tissue trauma. No consensus on whether to use MIS techniques in fast track hip and knee replacement pathways can therefore be drawn. This is especially important given that the complication rates of MIS in the low to medium volume surgeon appear unacceptably high compared with standard approaches. It is also too early to assess the long-term effects of MIS on implant survival.

Proximal humerus fracture with a pink, pulseless arm in a teenage boy and literature review.

Proximal humeral fractures associated with vascular compromise are extremely rare in children. We describe the presentation, diagnosis and management of one such injury in a child.

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.

The practice of out-lying patients is dangerous: a multicentre comparison study of nursing care provided for trauma patients.

Pressure for acute hospital beds is a national problem with many acute trauma patients being admitted to non-trauma wards. This prospective multicentre questionnaire study of 220 qualified trauma and non-trauma nurses aims to compare the quality of nursing care that trauma patients receive when admitted to trauma wards and non-trauma wards. The questions included the nursing management of common fractures and post-operative conditions. The completed questionnaires were scored and the results analysed. Hundred percent of the questionnaires were completed and returned. The trauma nurses conveyed the importance of ice (85%) and elevation (97%) in the initial management of limb fractures. This compares with ice (10%) and elevation (50%) on the outlying wards. Trauma nurses correctly monitor for potentially devastating post-operative complications and compartment syndrome 87% of the time compared with 42% on outlying wards. Spinal injuries are managed appropriately 88% of the time on trauma wards compared with 36% on outlying wards. Trauma patients receive better nursing care when admitted to a trauma ward and are nursed by trauma nurses. Many of the out-lying wards provide sub-optimal trauma nursing care and a few are positively dangerous. We suggest that trauma patients should not be nursed on outlying wards.

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.

The "languid child" and the eighteenth-century man-midwife.

This article addresses the methods used to preserve the life of a sickly neonate--that is, a child described as "languid" in the immediate period after birth. By looking at the work of some seventeenth-century midwifery authors, we can see how a fragile baby was handled in the period before formal training in midwifery and in the appropriate use of forceps. The article assesses the recognized causes of neonatal risk at the time of William Smellie. Examples from the manuscript midwifery case histories of William Hey, F.R.S. (1736-1819), reveal how a provincial man-midwife handled at-risk babies in domiciliary deliveries. The article also places William Hey within the wider group of eighteenth-century men-midwives and those whose work was leading them toward neonatal and infant care. Respect for life, parental love and grief, and the status of men-midwives in the last half of the eighteenth century are discussed.

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.

Transplantation of fetal suprachiasmatic nuclei into middle-aged rats restores diurnal Fos expression in host.

In young animals, the suprachiasmatic nuclei (SCN) of the hypothalamus, which are critical circadian pacemakers, exhibit a light-induced diurnal rhythm in Fos expression. The expression of this immediate-early gene has been used as an index of the activity of the SCN and their ability to respond to external cues that entrain them, such as light. In the present study, we show that by the time rats reach middle age baseline Fos expression increases prematurely during the dark and that light-induced Fos expression is blunted and delayed. We also demonstrate that transplantation of fetal tissue containing the SCN into the third cerebral ventricle of middle-aged rats enables aged hosts to regain the ability to exhibit diurnal patterns of Fos expression that are strikingly similar to those observed in young animals. Our findings lead to the following conclusions: 1) the diurnal pattern of activity of SCN cells is blunted in middle-aged rats, and 2) SCN transplants provide unique signals that enable the cellular systems of the host to regain rhythmic functional capabilities. These results provide new insights into the critical active role that the host plays in restoration of function evoked by the presence of a transplant.

Aging of the female reproductive system: a window into brain aging.

The menopause marks the permanent end of fertility in women. It was once thought that the exhaustion of ovarian follicles was the single, most important explanation for the transition to the menopause. Over the past decade, this perception has gradually changed with the realization that there are multiple pacemakers of reproductive senescence. We will present evidence that lends credence to the hypothesis that the central nervous system is a critical pacemaker of reproductive aging and that changes at this level contribute to the timing of the menopause. Studies demonstrate that an increasing de-synchronization of the temporal order of neuroendocrine signals may contribute to the accelerated rate of follicular loss that occurs during middle age. We suggest that the dampening and destabilization of the precisely orchestrated ultradian, circadian, and infradian neural signals lead to miscommunication between the brain and the pituitary-ovarian axis. This constellation of hypothalamic-pituitary-ovarian events leads to the inexorable decline of regular cyclicity and heralds menopausal transition.

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.

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.

Age-Related Changes in Opiate Receptor Densities in Discrete Hypothalamic Nuclei of Ovariectomized (OVX) and Estradiol (E2)-Treated Rats.

Hypothalamic opioid peptides influence a variety of diverse functions. During the aging process many aspects of hypothalamic opioid activity appear to change. Previously, we reported in young rats that steroid-induced changes in the density of naloxone binding sites parallel altered responsiveness to opiates. To determine whether age-related changes in opiate function are associated with alterations in the density of opiate receptors, we measured the density of naloxone binding sites at various times of day in young, middle-aged, and old ovariectomized or ovariectomized, estradiol-treated rats. In the medial preoptic nucleus, there is no age-related decline in the density of naloxone binding sites in ovariectomized animals. In the arcuate and ventromedial nuclei, the density of naloxone binding sites declines by middle-age and is suppressed further in the old animals. In the median eminence, there is a similar progressive age-related decline in naloxone receptor densities. In young animals estradiol treatment suppresses naloxone binding sites in all four nuclei. The ability to respond to steroid treatment persists in middle-aged and old animals except in the median eminence. These data demonstrate that the density of naloxone binding sites and the ability of estradiol to induce changes in these binding sites changes with age. The rate of these progressive changes is different in each brain region and correlates with age-related changes in opiate-mediated functions.