Reporting of adenomyosis: a service evaluation

Background: Adenomyosis diagnosis is based on imaging alone[4]. Ultrasound demonstrates high accuracy with expert sonographers[3], however there is little knowledge regarding how well adenomyosis is identified and reported within daily clinical practice. Method: A retrospective service evaluation was undertaken which included (n=79) adult female participants with possible symptoms of adenomyosis who had undergone a transvaginal ultrasound scan during the first quarter of 2023. Patients were identified using the CRIS statistic module according to pre-defined inclusion and exclusion criteria. Data were anonymised and collected in a data collection form to include the patient age, symptoms, scan report and sonographer. The scan report and archived images were evaluated using the sonographic signs identified by the MUSA group[1] then compared to the original report. Statistical analysis for inter-rater agreement was conducted using Cohen’s Kappa[2]. Results: Results indicate that adenomyosis is not being effectively identified and reported upon. 21.5% (n= 17) of patients had signs of adenomyosis on image review. Of these, only 23.5% (n= 4) were reported as such. Conclusion: Most ultrasonic diagnoses of adenomyosis were not identified, which may be due to the lack of sonographer awareness and training, compounded by a lack of internationally agreed criteria for ultrasound diagnosis. Limitations include the small cohort of participants, the author working independently and limitations in reviewing static images

The Republic of Ireland sonographer reporting pilot study

Background: In the Republic of Ireland (ROI) speciality radiographers (sonographers) undertake ultrasound examinations however, outside of obstetrics they are limited to providing a provisional report which a radiologist will verify. Sonographers in ROI are usually educated to the same standard as their independently reporting UK counterparts having attended CASE-accredited post-graduate courses. This report investigates the comparability of sonographer and radiologist reporting throughout ROI. Methodology: The report follows a clinical audit methodology. To ensure full population representation CEOs from all hospitals in the ROI were contacted to take part. Participants were all sonographers, covering 6 of the 7 hospital groups of ROI. Each sent data from 400 randomly chosen non-obstetric examinations over 6 months, provisionally sonographer reported then reviewed by the supporting radiologist. The radiologist allocated an agreement score to the report based on the Riley et al (2010) grading system. Results: 6037 ultrasound examinations were included in the audit. Over 99% of the reports fell into the acceptable range of Grades 1 and 2. 0.35% (21) of reports were classified as Grade 3. Only 2 reports within the Grade 3 classification were changed to upgrade the classification of pathology seen. No reports were classified as Grade 4. Conclusion: This large, multicentre audit demonstrates the accuracy of sonographer reporting in the ROI with an acceptable agreement score of over 99%. Sonographers in ROI can report as accurately as their UK counterparts who report independently. With the increasing demand for non-obstetric ultrasound, the existing workforce needs to be utilised efficiently

Work-related musculoskeletal disorders in ultrasound practice, the contextual concerns of sonographers

Background: Work-related musculoskeletal disorder (WRMSD) are already widespread among sonographers, at least partly due to the additional physical stresses of working in understaffed environments (Harrison & Harris, 2015). While contemporary research has described the broad picture regarding WRMSD in ultrasound (Bolton and Cox, 2015), none has, to date, extensively explored its personal and professional impacts from a qualitative perspective. Method: Extended semi-structured interviews with N=9 experienced sonographers working in the UK were conducted and analysed using Interpretative Phenomenological Analysis (IPA; Miller, Booth and Spacey, 2019). Core thematic areas that emphasised personal and professional impacts of WRMSD were then further examined to highlight how participants specifically made sense of them. Results: Analysis revealed six pertinent themes: (a) Sonographers’ attributions around WRSMD; (b) Resistance to sickness-labelling; (c) Making sense of vulnerability and risk; (d) Sickness, pain and impact on self; (e) Health, fitness and self-preservation. Conclusion: The research built upon and extended existing accounts which have offered broad insights into WRMSD (Gemark Simonsen and Gard, 2017, Bolton and Cox, 2015). By utilising IPA as a foundation for thematic analysis, the research has provided rich contextualised narratives of the experiences of the participants selected

“We’ve got 30 patients, so who’s working Saturday?” Seven ideological dilemmas for sonographers with work-related musculoskeletal disorders

Background: In the course of their work, clinicians across all spheres of healthcare are routinely faced with contradictions that should, in theory at least, prove to be intractable obstacles to ‘getting things done’. In practice, however, such ‘ideological dilemmas’ (Billig et al., 1988) seldom transpire to be insurmountable and, moreover, can be essential - and highly constructive - features in individuals’ everyday reasoning about self, (professional) identity and (working) environment. This paper qualitatively investigates a set of such ideological dilemmas that emerge from experienced sonographers’ accounts of experience with work and work-related musculoskeletal disorders (WRMSD). Method: Detailed semi-structured interviews were conducted with N=9 sonographers, all working in the UK. An Interpretative Phenomenological Analysis (Miller, Booth and Spacey, 2019) indicated points of pragmatic ideological contradiction and participants’ sense-making around them. Results: Analysis revealed seven common dilemmas: (a) Practical necessities versus WRMSD prevention techniques; (b) Being ill versus not being ill; (c) Increasing workload versus job pressure; (d) Self-care versus care of the group; (e) Needing to change versus needing to persevere; (f) Practical versus ethical judgement, and; (g) Self-preservation versus professional pride. In navigating these, participants were often able to find and reinforce their own sense of a committed, professional and agential self. Conclusions: The findings have import for sonographers and other clinicians faced with contradictory voices and difficult choices around work and injury/illness, not least by highlighting the enabling elements of what might otherwise be viewed as a set of straightforward everyday barriers to both practice and wellbeing

UK sonographers’ perspectives on the cultural, professional and environmental contexts of living with work-related musculoskeletal disorders

Background: Work-related musculoskeletal disorder (WRMSD), already widespread among sonographers, is increasingly prevalent due, at least in part, to the physical stresses of working in understaffed environments (Miller et al., 2019). More than 80% of UK sonographers report suffering from WRMSD at some point, and it is estimated 20% will experience a career-ending injury (Sommerich et al., 2019). While sonographers typically understand that their own working practices can contribute to higher risk of WRMSD, many continue to scan even when directly affected condition. In order to help shape a stronger understanding of the circumstances above, this paper qualitatively reports sonographers’ own perspectives on the cultural, professional and environmental contexts of living and working with WRMSD. Methods: Using Interpretive Phenomenological Analysis (Mawson et al., 2022), N=9 semi-structured interviews with experienced sonographers (>5 years) were analysed. Findings: Five major themes emerged from the data: (a) ‘It’s just what we do’ - sonographer culture as rationale; (b) ‘They just don’t care about us’ - exasperation, faceless attribution and anxiety; (c) ‘We just do what we can with what we’ve got’ – finding practical workarounds; (d) ‘The pressure is just ridiculous’ - WRMSD, workload and stress; (e) ‘Ergonomic instructions? What ergonomic instructions?’ – physical environment and equipment. Conclusion: It is contended that the findings above help provide depth and dimension in an understanding of why sonographers with WRSMD might pursue superficially self-defeating courses of action at work. In turn, this could help inform more practitioner-sensitive interventions around WRMSD in ultrasound and analogous AHP domains

Hollow silicon microneedle fabrication using advanced plasma etch technologies for applications in transdermal drug delivery

A novel production process flow is presented here for the manufacture of hollow silicon microneedles using deep reactive-ion etching (DRIE) technology. The patent-pending three-step process flow has been developed to produce multiple arrays of sharp-tipped, hollow microneedles, which facilitate easy insertion and controlled fluid injection into excised skin samples. A bevelled tip and vertical sidewalls for the microneedle have been achieved with good uniformity, despite >45% open etch area. Processing steps and etch challenges are discussed, and preliminary skin testing results are presented, showing effective needle insertion and delivery of fluorescent dye into ex vivo skin from human breast tissue

Loss of a globally unique kelp forest from Oman

Kelp forests are declining in many regions globally with climatic perturbations causing shifts to alternate communities and significant ecological and economic loss. Range edge populations are often at most risk and are often only sustained through localised areas of upwelling or on deeper reefs. Here we document the loss of kelp forests (Ecklonia radiata) from the Sultanate of Oman, the only confirmed northern hemisphere population of this species. Contemporary surveys failed to find any kelp in its only known historical northern hemisphere location, Sadah on the Dhofar coast. Genetic analyses of historical herbarium specimens from Oman confirmed the species to be E. radiata and revealed the lost population contained a common CO1 haplotype found across South Africa, Australia and New Zealand suggesting it once established through rapid colonisation throughout its range. However, the Omani population also contained a haplotype that is found nowhere else in the extant southern hemisphere distribution of E. radiata. The loss of the Oman population could be due to significant increases in the Arabian Sea temperature over the past 40 years punctuated by suppression of coastal upwelling. Climate-mediated warming is threatening the persistence of temperate species and precipitating loss of unique genetic diversity at lower latitudes.info:eu-repo/semantics/publishedVersio

Genetic Background Can Result in a Marked or Minimal Effect of Gene Knockout (GPR55 and CB2 Receptor) in Experimental Autoimmune Encephalomyelitis Models of Multiple Sclerosis

PMCID: PMC379391

Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors

Background: Limits on the frequency of whole blood donation exist primarily to safeguard donor health. However, there is substantial variation across blood services in the maximum frequency of donations allowed. We compared standard practice in the UK with shorter inter-donation intervals used in other countries. Methods: In this parallel group, pragmatic, randomised trial, we recruited whole blood donors aged 18 years or older from 25 centres across England, UK. By use of a computer-based algorithm, men were randomly assigned (1:1:1) to 12-week (standard) versus 10-week versus 8-week inter-donation intervals, and women were randomly assigned (1:1:1) to 16-week (standard) versus 14-week versus 12-week intervals. Participants were not masked to their allocated intervention group. The primary outcome was the number of donations over 2 years. Secondary outcomes related to safety were quality of life, symptoms potentially related to donation, physical activity, cognitive function, haemoglobin and ferritin concentrations, and deferrals because of low haemoglobin. This trial is registered with ISRCTN, number ISRCTN24760606, and is ongoing but no longer recruiting participants. Findings: 45 263 whole blood donors (22 466 men, 22 797 women) were recruited between June 11, 2012, and June 15, 2014. Data were analysed for 45 042 (99·5%) participants. Men were randomly assigned to the 12-week (n=7452) versus 10-week (n=7449) versus 8-week (n=7456) groups; and women to the 16-week (n=7550) versus 14-week (n=7567) versus 12-week (n=7568) groups. In men, compared with the 12-week group, the mean amount of blood collected per donor over 2 years increased by 1·69 units (95% CI 1·59–1·80; approximately 795 mL) in the 8-week group and by 0·79 units (0·69–0·88; approximately 370 mL) in the 10-week group (p<0·0001 for both). In women, compared with the 16-week group, it increased by 0·84 units (95% CI 0·76–0·91; approximately 395 mL) in the 12-week group and by 0·46 units (0·39–0·53; approximately 215 mL) in the 14-week group (p<0·0001 for both). No significant differences were observed in quality of life, physical activity, or cognitive function across randomised groups. However, more frequent donation resulted in more donation-related symptoms (eg, tiredness, breathlessness, feeling faint, dizziness, and restless legs, especially among men [for all listed symptoms]), lower mean haemoglobin and ferritin concentrations, and more deferrals for low haemoglobin (p<0·0001 for each) than those observed in the standard frequency groups. Interpretation: Over 2 years, more frequent donation than is standard practice in the UK collected substantially more blood without having a major effect on donors' quality of life, physical activity, or cognitive function, but resulted in more donation-related symptoms, deferrals, and iron deficiency. Funding: NHS Blood and Transplant, National Institute for Health Research, UK Medical Research Council, and British Heart Foundation

Solenodon genome reveals convergent evolution of venom in eulipotyphlan mammals

Venom systems are key adaptations that have evolved throughout the tree of life and typically facilitate predation or defense. Despite venoms being model systems for studying a variety of evolutionary and physiological processes, many taxonomic groups remain understudied, including venomous mammals. Within the order Eulipotyphla, multiple shrew species and solenodons have oral venom systems. Despite morphological variation of their delivery systems, it remains unclear whether venom represents the ancestral state in this group or is the result of multiple independent origins. We investigated the origin and evolution of venom in eulipotyphlans by characterizing the venom system of the endangered Hispaniolan solenodon (Solenodon paradoxus). We constructed a genome to underpin proteomic identifications of solenodon venom toxins, before undertaking evolutionary analyses of those constituents, and functional assessments of the secreted venom. Our findings show that solenodon venom consists of multiple paralogous kallikrein 1 (KLK1) serine proteases, which cause hypotensive effects in vivo, and seem likely to have evolved to facilitate vertebrate prey capture. Comparative analyses provide convincing evidence that the oral venom systems of solenodons and shrews have evolved convergently, with the 4 independent origins of venom in eulipotyphlans outnumbering all other venom origins in mammals. We find that KLK1s have been independently coopted into the venom of shrews and solenodons following their divergence during the late Cretaceous, suggesting that evolutionary constraints may be acting on these genes. Consequently, our findings represent a striking example of convergent molecular evolution and demonstrate that distinct structural backgrounds can yield equivalent functions