An exploration of parental narratives in the context of a child's diagnosis of autism spectrum disorder

Section A presents a critical review of current literature regarding the parental experiences of receiving, and making sense of, a diagnosis of an Autism Spectrum Disorder (ASD) for their child where there is no learning disability present. It begins with an overview of the current debates in the diagnosis of ASD and considers how parents make sense of a diagnosis. The review then evaluates papers pertaining to parents' experiences of receiving a diagnosis for their child, their experience of living with ASD and the efficacy of post-diagnostic psychoeducation interventions. A consideration of the clinical and research implications of these findings concludes the section. Section B provides the findings of a narrative study examining the development of parental narratives following the diagnosis of their child with high functioning autism or Asperger’s syndrome. Seven parents who were participating in a post-diagnostic psychoeducation group were interviewed across two time points. The findings highlight the parents’ development of a new framework enabling the creation of an alternative personal and family narrative. The implications this has on parental well-being are discussed and recommendations are made for future research to build on these initial findings. Section C provides a critical appraisal and reflective account of the study presented in section B. This includes consideration of development of research skills, limitations of the study, clinical implications, and future research ideas

Placenta microstructure and microcirculation imaging with diffusion MRI

PURPOSE: To assess which microstructural models best explain the diffusion-weighted MRI signal in the human placenta. METHODS: The placentas of nine healthy pregnant subjects were scanned with a multishell, multidirectional diffusion protocol at 3T. A range of multicompartment biophysical models were fit to the data, and ranked using the Bayesian information criterion. RESULTS: Anisotropic extensions to the intravoxel incoherent motion model, which consider the effect of coherent orientation in both microvascular structure and tissue microstructure, consistently had the lowest Bayesian information criterion values. Model parameter maps and model selection results were consistent with the physiology of the placenta and surrounding tissue. CONCLUSION: Anisotropic intravoxel incoherent motion models explain the placental diffusion signal better than apparent diffusion coefficient, intravoxel incoherent motion, and diffusion tensor models, in information theoretic terms, when using this protocol. Future work will aim to determine if model-derived parameters are sensitive to placental pathologies associated with disorders, such as fetal growth restriction and early-onset pre-eclampsia

Integrated and Efficient Diffusion-relaxometry Using ZEBRA

The emergence of multiparametric diffusion models combining diffusion and relaxometry measurements provides powerful new ways to explore tissue microstructure, with the potential to provide new insights into tissue structure and function. However, their ability to provide rich analyses and the potential for clinical translation critically depends on the availability of efficient, integrated, multi-dimensional acquisitions. We propose a fully integrated sequence simultaneously sampling the acquisition parameter spaces required for T1 and T2* relaxometry and diffusion MRI. Slice-level interleaved diffusion encoding, multiple spin/gradient echoes and slice-shuffling are combined for higher efficiency, sampling flexibility and enhanced internal consistency. In-vivo data was successfully acquired on healthy adult brains. Obtained parametric maps as well as clustering results demonstrate the potential of the technique to provide eloquent data with an acceleration of roughly 20 compared to conventionally used approaches. The proposed integrated acquisition, which we call ZEBRA, offers significant acceleration and flexibility compared to existing diffusion-relaxometry studies, and thus facilitates wider use of these techniques both for research-driven and clinical applications

Multi-modal functional MRI to explore placental function over gestation

Purpose: To investigate, visualize and quantify the physiology of the human placenta in several dimensions ‐ functional, temporal over gestation, and spatial over the whole organ. Methods: Bespoke MRI techniques, combining a rich diffusion protocol, anatomical data and T2* mapping together with a multi‐modal pipeline including motion correction and extracted quantitative features were developed and employed on pregnant women between 22 and 38 weeks gestational age including two pregnancies diagnosed with pre‐eclampsia. Results: A multi‐faceted assessment was demonstrated showing trends of increasing lacunarity, and decreasing T2* and diffusivity over gestation. Conclusions: The obtained multi‐modal acquisition and quantification shows promising opportunities for studying evolution, adaptation and compensation processes

Placenta Imaging Workshop 2018 report:Multiscale and multimodal approaches

The Centre for Medical Image Computing (CMIC) at University College London (UCL) hosted a two-day workshop on placenta imaging on April 12th and 13th 2018. The workshop consisted of 10 invited talks, 3 contributed talks, a poster session, a public interaction session and a panel discussion about the future direction of placental imaging. With approximately 50 placental researchers in attendance, the workshop was a platform for engineers, clinicians and medical experts in the field to network and exchange ideas. Attendees had the chance to explore over 20 posters with subjects ranging from the movement of blood within the placenta to the efficient segmentation of fetal MRI using deep learning tools. UCL public engagement specialists also presented a poster, encouraging attendees to learn more about how to engage patients and the public with their research, creating spaces for mutual learning and dialogue

Social use of language in children with reactive attachment disorder and autism spectrum disorders

Children with a diagnosis of reactive attachment disorder (RAD) appear to show difficulties in social understanding. We aimed to compare the pragmatic language functioning of children with (RAD) and autism spectrum disorder (ASD). Assessments were made in three groups of children aged 5–8 years, with verbal IQ estimates in the normal range: 35 with a RAD diagnosis, 52 with an ASD diagnosis and 39 with typical development. The Children’s Communication Checklist (CCC) was used to compare their pragmatic language skills, and ADI-R algorithms were used to compare autistic symptomatology, according to parent report. According to the CCC, the RAD group demonstrated significant problems in their use of context, rapport and social relationships with a degree of severity equivalent to children in the ASD comparison group. More than 60% of the group with RAD met ADI-R clinical criteria on the Use of Language and Other Social Communication Skills subscale, 46% on the Reciprocal Social Interaction subscale, and 20% had significant repetitive and stereotyped behaviours. Children with RAD appear to be at least as impaired as children with ASD in certain domains of social relatedness, particularly in their pragmatic language skills

Lip symmetry following rotation advancement cleft lip repair in 5-year-old children treated by Ralph Millard and Ron Pigott

OBJECTIVE: To compare the symmetry of the lip following Rotation-Advancement cleft lip repair by Millard and Pigott and to investigate the effect on the symmetry of cleft side and gender by using different surgical protocols. Symmetry following cleft surgery was compared to that of non-cleft children. DESIGN: Retrospective study of photographs of children aged 5 years. SETTING: Three decades of post-operative photographs of children treated by Millard and Pigott. PATIENTS: Eighty-nine children treated by Millard, 87 by Pigott and 91 non-cleft children. INTERVENTIONS: Photographs were assessed using the Symnose Computer program, a rapid semi-objective quantitative assessment of lip symmetry. MAIN OUTCOME MEASURES: Asymmetry score for each surgeon, and non-cleft children. RESULTS: There was no significant difference in the median lip % mismatch score of Millard, 36.65% and Pigott, 38.52%. Right-sided clefts showed better symmetry than left-sided clefts for Millard (p<.001). This was reversed for Pigott (P=.0121). There was a difference (P<.001) between the symmetry of the two cleft cohorts and the non-cleft children (asymmetry 19.9%), and between Millard's outcomes following different lip surgical protocols (P < .0001), but no difference between Pigott's outcomes using different palate surgical protocols (P = 0.59). CONCLUSIONS: Cleft lip repair by Millard and Pigott resulted in similar lip asymmetry (37% and 39% symmetry mismatch, respectively). Lip surgical protocol and cleft side may affect lip asymmetry. Palate surgery did not affect lip asymmetry. Following cleft surgery, children were more asymmetric than non-cleft children.The article is available via Open Access. Click on the 'Additional link' above to access the full-text.Unknow

InSpect: INtegrated SPECTral Component Estimation and Mapping for Multi-Contrast Microstructural MRI

We introduce a novel algorithm for deriving meaningful maps from multi-contrast MRI experiments. Such experiments enable the estimation of multidimensional correlation spectra, in domains such as T1- diffusivity, T2-diffusivity, or T1-T2. These spectra combine information from complementary MR properties, and therefore have the potential for improved quantification of distinct tissue types compared to singlecontrast analyses. However, spectral estimation is an ill-conditioned problem which is highly sensitive to noise and requires significant regularisation. We propose an Expectation-Maximisation based method - which we term InSpect - for unified analysis of multi-contrast MR images. The algorithm simultaneously estimates canonical spectra associated with distinct tissue types within an image, and produces maps quantifying the spatial distribution of these spectra. We test the algorithm’s capabilities on simulated data, then apply to placental diffusion-relaxometry data. On placental data we identified significant within-organ and acrosssubject variation in T2*-ADC spectra - showing the potential of InSpect for detailed separation and quantification of distinct microstructural environments

Placental magnetic resonance imaging in chronic hypertension: A case-control study

INTRODUCTION: We aimed to explore the use of magnetic resonance imaging (MRI) in vivo as a tool to elucidate the placental phenotype in women with chronic hypertension. METHODS: In case-control study, women with chronic hypertension and those with uncomplicated pregnancies were imaged using either a 3T Achieva or 1.5T Ingenia scanner. T2-weighted images, diffusion weighted and T1/T2* relaxometry data was acquired. Placental T2*, T1 and apparent diffusion coefficient (ADC) maps were calculated. RESULTS: 129 women (43 with chronic hypertension and 86 uncomplicated pregnancies) were imaged at a median of 27.7 weeks’ gestation (interquartile range (IQR) 23.9-32.1) and 28.9 (IQR 26.1-32.9) respectively. Visual analysis of T2-weighted imaging demonstrated placentae to be either appropriate for gestation or to have advanced lobulation in women with chronic hypertension, resulting in a greater range of placental mean T2* values for a given gestation, compared to gestation-matched controls. Both skew and kurtosis (derived from histograms of T2* values across the whole placenta) increased with advancing gestational age at imaging in healthy pregnancies; women with chronic hypertension had values overlapping those in the control group range. Upon visual assessment, the mean ADC declined in the third trimester, with a corresponding decline in placental mean T2* values and showed an overlap of values between women with chronic hypertension and the control group. DISCUSSION: A combined placental MR examination including T2 weighted imaging, T2*, T1 mapping and diffusion imaging demonstrates varying placental phenotypes in a cohort of women with chronic hypertension, showing overlap with the control group