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).

Population, agriculture, and the environment in Africa.

PIP: An overview is provided of the World Bank study about the interaction between rapid population growth, poor agricultural performance, and environmental degradation. The links between these 3 phenomena are identified as traditional methods of crop and livestock production, land tenure systems, women's responsibilities, and methods of forest use. When land was abundant and capital limited, pastoralism, shifting cultivation, and setting aside fallow land was possible. Mobility and allowances for natural regeneration of vegetation could not continue with rapid population growth. Permanent settlements developed but cultivation methods remained the same; the result was deterioration of soil fertility, low yields, and erosion of soil as occurred in Rwanda, Burkina Faso, and parts of Nigeria. Technological innovation has been slow and poor roads have interfered with a market oriented economy. Inappropriate pricing, exchange rates, and fiscal policies also prevent productivity gains. A heavy demand is placed on women's time. Demand for children is high and is stimulated by environmental degradation, food insecurity, land tenure systems, and cultural traditions. Child labor is needed. The demand for contraception is 30-50% in North Africa, 36-55% in Asia, and 40-60% in South America. Land ownership problems have arisen under community ownership and between herders and settlers. Solutions have ranged from land nationalization and arbitrary designation of individual ownership. Open access situations have developed and lent themselves to exploitation. Fuelwood needs have exacerbated the destruction of forests. Commercial logging accounted for 10-20% of the forest loss. New approaches are needed to link cross-sectionally population, the environment, an agriculture. Emphasis should be on resource conservation, family planning, and environmentally benign intensive farming. Agricultural production needs to grow at 4%/year, fertility lowered by 50% over 30 years, and deforestation slowed. Women's time constraints should b alleviated and productivity improved. Open access and state ownership should be stopped.^ieng