Search

Introduction While there has been strong emphasis on enhancing interprofessional education and interprofessional care in the published literature, there is relatively little literature focused on advancing interprofessional research. In extrapolating from the current frameworks of interprofessional collaboration (IPC), it becomes clear that the core competencies of IPC are transferable to research teams. The aim of this paper is to present our experience of an international research team framed within core competencies for IPC. Methods A simplified narrative inquiry approach was used to share the experience of an international research team framed within six core competencies of IPC. Results and discussion By way of our international research collaboration, we demonstrate the translation of key core competencies for IPC. We share key learnings and mitigation strategies for the successful outcomes of the research team. Conclusion To embark on a successful international research collaboration requires integrating IPC core competencies across the entire research continuum. In addition to the core competencies of collaboration, enablers to success also include digital collaborative forums, existing professional relationships and research projects that offer global meaning and value.

Purpose The purpose of the study was to evaluate student exchange experiences to gain insight into what students perceived as benefits, challenges, and overall areas for improvement that might inform and enhance future exchange projects. Methods A general program evaluation survey, adapted to address the project objectives, was conducted. Eight students from Norway, Canada, and South Africa participating in an international exchange project completed an online survey. The responses were coded and organized in themes such as pre-exchange preparation, home/host country support, challenges, and new learning. Results & Conclusions Despite the challenges the students experienced, students indicated advantages such as new learning, personal development, and expanded professional knowledge. Students gained an international perspective and deeper understanding of their profession and insight into the similarities and differences in clinical practice emphasizing the importance of creating global citizens through internationalization in radiography education. These student experiences confirmed their agency in disposition, motivation, self-efficacy, and position.

Introduction The focus on paediatric radiation dose reduction supports reevaluation of paediatric imaging protocols. This is particularly important in the neonates where chest radiographs are frequently requested to assess respiratory illness and line placement. This study aims to assess the impact of neonatal chest radiographic protocols on patient dose in four hospitals in different countries. Methods Exposure parameters, collimation, focus to skin distance (FSD) and radiation dose from 200 neonatal chest radiographs were registered prospectively. Inclusion criteria consisted of both premature and full-term neonates weighing between 1000 and 5000 g. Only data from the examinations meeting diagnostic criteria and approved for the clinical use were included. Radiation dose was assessed using dose area product (DAP). Results The lowest DAP value (4.58 mGy cm2) was recorded in the Norwegian hospital, employing a high kVp, low mAs protocol using a DR system. The Canadian hospital recorded the highest DAP (9.48), using lower kVp and higher mAs with a CR system, including the addition of a lateral projection. The difference in the mean DAP, weight, field of view (FOV) and kVp between the hospitals is statistically significant (p Conclusion Use of non-standardised imaging protocols in neonatal chest radiography results in differences in patient dose across hospitals included in the study. Using higher kVp, lower mAs and reducing the number of lateral projections to clinically relevant indications result in a lower DAP measured in the infant sample studied. Further studies to examine image quality based on exposure factors and added filtration are recommended. Implications for practice Reevaluation of paediatric imaging protocols presents an opportunity to reduce patient dose in a population with increased sensitivity to ionising radiation.

Background Computed tomography (CT) contributes to 60% of the collective dose in medical imaging. Literature has demonstrated that patient dose varies across regions and countries. Establishing diagnostic reference levels (DRLs) contributes to the optimization of clinical practices and radiation protection. Purpose To survey the dose indices (CTDIvol and dose-length product) for frequently performed CT examinations from the chosen hospitals in Norway and Canada and to determine local DRLs (LDRLs) based on the collected data. Material and Methods The survey included eight scanners from two Norwegian hospitals and four scanners from four Canadian hospitals. Dosimetry data were collected for the following routine CT examinations: head, contrast-enhanced thorax, and abdomen and pelvis. Overall 480 adult average-sized patients from Norway and 360 from Canada were included in the survey. The LDRLs were determined as the 75th percentile of distributions of median values of dose indicators from different CT scanners. The differences in dose between scanners were determined using single-factor ANOVA. Results The LDRLs determined in Norway were higher overall than in Canada. The obtained values were compared to the national DRLs. The dose from several scanners in Norway exceeded national Norwegian DRLs, while Canadian LDRLs were below the Canadian reference levels. The differences between the means of the dose distributions from each scanner were statistically significant ( p < 0.05) for all examinations with exception of identical scanners located in the same hospital and using the same protocols. Conclusion Observed dose variations even in the same hospital, or from the same scanner model confirmed the need for CT protocol optimization.

Aim: To compare the absorption ability of two lead-free aprons with a lead apron. \ud Method: Measure and compare the absorption ability of 3 aprons; OpaqFu bilayer apron containing bismuth and antimony, NoLead one layer apron containing antimony, and a lead apron. The measurements were repeated with and without each of the aprons present in both primary and scattered beams. The selected tube voltages were between 60 and 113 kVp with constant mAs, a fixed field size and fixed source to object distance. \ud Results: No significant difference in absorption ability of the two lead-free aprons compared to the lead apron were observed when the dose was measured in the primary beam. When measurements were performed in the scatter radiation field, the absorption ability of the OpaqFu apron was 1.3 times higher than NoLead apron and nearly equal to the absorption ability of the lead apron. An increase in the difference between the OpaqFu and NoLead aprons was observed for the tube energies higher than 100 kVp in favor of OpaqFu apron.\ud Conclusion: It is safe to use the lead free aprons that were tested in this study in a clinical environment for the tube energy range of 60-113 kVp.

The association of HLA-DR3 with Graves' disease in Caucasoids is well established but its significance is unclear and its clinical value as a predictive parameter for relapse after a course of antithyroid drug therapy is controversial. We have further investigated the predictive value at the genomic level in 51 patients with Graves' disease who were treated with a 6-month course of carbimazole and followed up for 2 years. Using DNA-restriction fragment length polymorphism (DNA-RFLP) allogenotyping, (i) complete concordance of HLA-DR assignment was observed between serological and DNA-RFLP analysis of all but one of 51 patients with Graves' disease; (ii) the DR beta 17(1)-DQ alpha 2-DQ beta 2a (a DNA-RFLP allogenotype of the classical Northern European haplotype of HLA-B8 DR3) was significantly (corrected P = Pcorr less than 0.02) associated with Graves' disease particularly in patients who relapsed (Pcorr less than 0.005); (iii) HLA-DR3 was highly associated with DQA2 U allele (chi 2 = 18.53, d.f.2, P less than 0.0005); (iv) a strong correlation between the DQA2 U allele and the outcome of the disease was observed. Relapse occurred in 91% (10/11) of the patients who were homozygous for the DQA2 U allele whilst only 65% (15/23) and 41% (7/17) of patients who were hetero or homo-zygous for the DQA2 L allele (DQA2 U/L and DQA2 L/L) relapsed within the same period of follow-up (chi 2 = 7.18, d.f.2, P less than 0.05). Though the relapse rate in patients with the DQA2 U/U genotype was not significantly higher than the relapse rate in patients with the DQA2 U/L genotype, it was significantly higher than the relapse rate in patients with DQA2 L/L genotype (P less than 0.0001) with a relative risk of 14.3.

Two recent studies have reported that antithyroid drugs inhibit killer (K) and natural killer (NK) cell function in vitro, which could be relevant to the changes in these cell populations during treatment of Graves' disease. In contrast to these reports we have found no in vitro effect of pharmacologically relevant concentrations of methimazole (MMI) (100 mumol/l) on (i) NK cell function using K562 cells or MOLT-4 cells as targets, (ii) K cell function using antibody-dependent cytotoxicity assays with L929 cells or thyroid-antigen-coated chick red cells, or (iii) monocyte-dependent cytotoxin-mediated killing of L929 cells. Enhanced cytotoxicity was found with 1 mmol/l MMI in some of these assays but this was not consistent since it occurred only in certain individual cultures. Since we have shown previously that 100 mumol/l MMI inhibits oxygen radical generation, the present results add to the evidence that these radicals are not directly involved in cell-mediated cytotoxicity and do not support the concept that antithyroid drugs have a significant effect on antibody-dependent cell-mediated cytotoxicity in Graves' disease.

The effects of hyperthyroidism on experimental autoimmune thyroiditis were investigated in the rat. Rats were given T4 twice daily by sc injection in amounts sufficient to raise circulating hormone levels 10-fold 4 h after administration. Thyroiditis was induced by immunization with rat thyroglobulin (Tg) in complete Freund's adjuvant, and the severity of the disease was assessed by comparison with saline-treated controls. Thymic and splenic hypertrophy were found in T4-treated animals, whereas lymph node wt decreased. The levels of Tg antibodies did not differ between animals given saline and those given T4, but the expected sustained rise in control animals was not seen in those treated with T4; in addition, there was a significant decrease in the amount of Tg antibody produced by in vitro culture of lymph node lymphocytes from T4-treated rats. Continuous T4 administration lowered the number of T cells in the circulation, but the number of phenotypically identified helper cells remained the same. The most striking effects of T4 were to ameliorate the intensity of histologically defined thyroiditis and lower the response of lymph node T cells to the nonspecific mitogen, phytohemagglutinin. These results show that excessive T4 does not, as previously suggested, enhance the immune response in autoimmune thyroid disease: on the contrary, suppression is found with the dose and model we have used. In view of the magnitude of this effect, it is now important to identify the site of T4 action and investigate how this effect contributes to the autoimmune response in Graves' disease.

The aetiology of Graves’ disease is multifactorial (Table 1). Environmental influences, immunological aberration and perhaps subtle targetorgan alterations (for which there is currently no evidence) all interacting upon or as a result of a genetic predisposition and occurring particularly in females are responsible for a disease in which hyperthyroidism results from the generation of antibodies to the TSH receptor. The familial predisposition to such a course of events and the major histocompatibility (HLA) association have until now been the most easily accessible means to examining the genetic linkage of Graves1disease. The familial predisposition does not allow clear discrimination of the pattern of inheritance (which in a disease upon which the environment has such an impact is not surprising) and the HLA association is weak. There is no evidence for a disease susceptibility gene nor does such a gene seem likely. Rather it would make more sense if Graves’ were to be a polygenic disease representing the conjunction of several independent genetic traits. In this context a greater understanding of the interactions between the immunologic and genetic systems, coupled with the recent availability of reagents and new technology offers the opportunity to examine further the impact which genetic factors may have in Graves1disease.

We have used an automatic cell harvester and micro culture techniques to examine the accumulation of [35S]methimazole by monocytes, macrophages and lymphocytes. Significant temperature-dependent accumulation of the drug was found in resting monocytes and macrophages; this was increased up to 4-fold by phagocytosis. Lymphocytes accumulated little or no drug and myeloma and leukaemic cell lines accumulated none. These results show that two interrelated cells with endogenous peroxidatic activity take up the antithyroid drug methimazole providing further support for the concept that immunosuppression by this drug in Graves' disease is mediated via an action on antigen-presenting cells.

IT was recently pointed out1 that of the two available values, namely, 400 and 498, for the molecular depression of freezing point (K) of camphor, the larger figure seemed the more correct, because it had been subjected to an a posteriori verification by its discoverer Jouniaux,2,3 and, secondly, because the smaller value had been drawn from a fusion point diagram4 of doubtful accuracy.5