scholarly journals Performance of a Handheld Ultrasound Device to Assess Articular and Periarticular Pathologies in Patients with Inflammatory Arthritis

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1139
Author(s):  
Giulia Corte ◽  
Sara Bayat ◽  
Koray Tascilar ◽  
Larissa Valor-Mendez ◽  
Louis Schuster ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Structural Damage ◽  
Power Doppler ◽  
Pathological Finding ◽  
Joint Effusion ◽  
Handheld Ultrasound ◽  
And Performance ◽  
Time Required ◽  
Flow Detection ◽  
Blinded Reader

The purpose of this study was to assess the accuracy and performance of a new handheld ultrasound (HHUS) machine in comparison to a conventional cart-based sonographic machine in patients with inflammatory arthritis (IA). IA patients with at least one tender and swollen joint count were enrolled. US was performed on the clinically affected joints using a cart-based sonographic device (Samsung HS40) and a HHUS device (Butterfly iQ). One blinded reader scored all images for the presence of erosions, bony enlargement, synovial hypertrophy, joint effusion, bursitis, tenosynovitis, and enthesitis. Synovitis was graded (B mode and power Doppler (PD)) by the 4-level EULAR-OMERACT scale. To avoid bias by the blinded reader, we included 67 joints of two healthy volunteers in the evaluation. We calculated the overall concordance and the concordance by type of joint and pathological finding. We also measured the time required for the US examination per joint with both devices. Thirty-two patients (20 with RA, 10 with PsA, and one each with gout and SLE-associated arthritis) were included, and 186 joints were examined. The overall raw concordance in B mode was 97% (κappa 0.90, 95% CI (0.89, 0.94)). In B mode, no significant differences were found in relation to type of joint or pathological finding examined. The PD mode of the HHUS device did not detect any PD signal, whereas the cart-based device detected a PD signal in 61 joints (33%). The portable device did not offer any time savings compared to the cart-based device (47.0 versus 46.3 s). The HHUS device was accurate in the assessment of structural damage and inflammation in patients with IA, but only in the B mode. Significant improvements are still needed for HHUS to reliably demonstrate blood flow detection in PD mode.

scholarly journals OMERACT agreement and reliability study of ultrasonographic elementary lesions in osteoarthritis of the foot

RMD Open ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e000795 ◽  
Author(s):  
Alen Zabotti ◽  
Georgios Filippou ◽  
Marco Canzoni ◽  
Antonella Adinolfi ◽  
Valentina Picerno ◽  
...  
Keyword(s):  
Structural Damage ◽  
Interobserver Reliability ◽  
Cartilage Damage ◽  
Power Doppler ◽  
Joint Effusion ◽  
Ordinal Scale ◽  
Web Based ◽  
Inflammatory Lesions ◽  
Structural Abnormalities ◽  
Static Images

ObjectiveTo evaluate the level of agreement on ultrasonographic (US) lesions among highly experienced sonographers as well as the intraobserver and interobserver reliability of inflammatory and structural US lesions in patients with osteoarthritis (OA) of the foot.MethodsAfter a systematic literature review, a Delphi survey was performed to test definitions of US lesions in OA of the foot, including inflammatory lesions (ie, synovial hypertrophy [SH], joint effusion [JE], power Doppler signal [PD]), and structural abnormalities (ie, cartilage damage [CD] and osteophytes). Subsequently, the reliability of US in assessing the aforementioned lesions was tested on static images as well as during a live exercise. Reliability was assessed by kappa analyses and prevalence-adjusted bias-adjusted kappa (PABAK) on a dichotomous and an ordinal scale.ResultsIntraobserver and interobserver reliability for SH and JE evaluated by binary scoring was good for both components, while the intraobserver reliability for semiquantitative scoring of SH ranged from moderate in the web-based exercise (PABAK 0.49) to good (PABAK 0.8) in the live exercise. Reliability for CD and PD assessments were respectively good and excellent in all exercises (ranged from PABAK 0.61 to 0.79 for CD and 0.88 to 0.95 for PD). The interobserver reliability for the semiquantitative scoring of osteophytes was fair in the live exercise (PABAK 0.36) and moderate in the static exercise (PABAK 0.60).ConclusionsConsensual US definitions were found to be reliable for assessing inflammatory lesions in OA of the foot, while the use of US to assess structural damage requires further studies.

Rancang Bangun Alat Olahan Minyak Kelapa

2016 ◽  
Vol 10 (1) ◽  
pp. 70-77
Author(s):  
Jantri Sirait ◽  
Sulharman Sulharman
Keyword(s):  
Electric Motor ◽  
Performance Test ◽  
Production Capacity ◽  
Coconut Oil ◽  
Heating Time ◽  
Design Tool ◽  
Coconut Milk ◽  
Heating Process ◽  
And Performance ◽  
Time Required

Has done design tool is a tool of refined coconut oil coconut grater, squeezer coconut milk and coconut oil heating, with the aim to streamline the time of making coconut oil and coconut oil increase production capacity. The research method consists of several stages, among others; image creation tool, procurement of materials research, cutting the material - the material framework of tools and performance test tools. The parameters observed during the performance test tools is time grated coconut, coconut milk bleeder capacity, the capacity of the boiler and the heating time of coconut oil. The design tool consists of three parts, namely a tool shaved coconut, coconut milk wringer and coconut milk heating devices. Materials used for the framework of such tools include iron UNP 6 meters long, 7.5 cm wide, 4 mm thick, while the motor uses an electric motor 0.25 HP 1430 rpm and to dampen the rotation electric motor rotation used gearbox with a ratio of round 1 : 60. the results of the design ie the time required for coconut menyerut average of 297 seconds, coconut milk wringer capacity of 5 kg of processes and using gauze pads to filter coconut pulp, as well as the heating process takes ± 2 hours with a capacity of 80 kg , The benefits of coconut oil refined tools are stripping time or split brief coconut average - average 7 seconds and coconut shell can be used as craft materials, processes extortion coconut milk quickly so the production capacity increased and the stirring process coconut oil mechanically.ABSTRAKTelah dilakukan rancang bangun alat olahan minyak kelapa yaitu alat pemarut kelapa, pemeras santan kelapa dan pemanas minyak kelapa, dengan tujuan untuk mengefisiensikan waktu pembuatan minyak kelapa serta meningkatkan kapasitas produksi minyak kelapa. Metode penelitian terdiri dari beberapa tahapan antara lain; pembuatan gambar alat, pengadaan bahan-bahan penelitian, pemotongan bahan - bahan rangka alat dan uji unjuk kerja alat. Parameter yang diamati pada saat uji unjuk kerja alat adalah waktu parut kelapa, kapasitas pemeras santan kelapa, kapasitas tungku pemanas serta waktu pemanasan minyak kelapa. Rancangan alat terdiri dari tiga bagian yaitu alat penyerut kelapa, alat pemeras santan kelapa dan alat pemanas santan kelapa. Bahan yang dipergunakan untuk rangka alat tersebut  yaitu besi UNP panjang 6 meter, lebar 7,5 cm, tebal 4 mm, sedangkan untuk motor penggerak menggunakan motor listrik 0,25 HP 1430 rpm dan untuk meredam putaran putaran motor listrik dipergunakan gearbox  dengan perbandingan putaran 1 : 60. Hasil dari rancangan tersebut yaitu waktu yang dibutuhkan untuk menyerut kelapa rata-rata 297 detik, kapasitas alat pemeras santan kelapa 5 kg sekali proses dan menggunakan kain kassa untuk menyaring ampas kelapa, serta Proses pemanasan membutuhkan waktu ± 2 jam dengan kapasitas 80 kg. Adapun keunggulan alat olahan minyak kelapa ini adalah waktu pengupasan atau belah kelapa singkat rata – rata 7 detik dan tempurung kelapa dapat digunakan sebagai bahan kerajinan, proses pemerasan santan kelapa cepat sehingga kapasitas produksi meningkat dan proses pengadukan minyak kelapa secara mekanis. Kata kunci : penyerut, pemeras, pemanas,minyak kelapa,olahan minyak kelapa.

scholarly journals POS0677 THE ROLE OF MUSCULOSKELETAL ULTRASOUND IN PREDICTING THE RESPONSE TO JAK INHIBITORS: RESULTS FROM A LARGE MONOCENTRIC COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 583-583
Author(s):  
C. Garufi ◽  
F. Ceccarelli ◽  
F. R. Spinelli ◽  
S. Mancuso ◽  
C. Pirone ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Structural Damage ◽  
Power Doppler ◽  
Response To Treatment ◽  
Jak Inhibitors ◽  
Inflammatory Score ◽  
Inflammatory Status

Background:In the management of chronic arthritis, such as Rheumatoid Arthritis (RA), Ultrasound (US) assessment can provide relevant information about the joint inflammatory status in the diagnostic phase and even more in the monitoring of disease activity and structural damage1,2.Objectives:In this longitudinal study, we aimed to assesse the role of US in predicting the efficacy of JAK-inhibitors (JAKi) in RA patients.Methods:We enrolled RA patients starting baricitinib or tofacitinib. All patients were evaluated at baseline and after 4, 12, 24, 48 weeks. Disease activity was calculated by DAS28CRP. US examination in 22 joints (I–V MCPs and PIPs, wrists) aimed at evaluating inflammatory features (synovial effusion and hypertrophy, power Doppler-PD), through a semi-quantitative scale (0-3). The total US (0-198) and PD (0-66) scores were calculated. We scanned bilateral flexor (I–V fingers of hands) and extensor compartments (1-6) tendons: tenosynovitis was scored as absent/present (0/1), resulting in a total score (0-22).Results:We studied 102 patients (M/F 15/87; median age 59.2 years, IQR 17.75; median disease duration 144 months, IQR 126), 61 treated with baricitinib and 41 with tofacitinib. At baseline, the median total US score was 18 (IQR 19) and the median PD score 2 (4). We observed a significant reduction in both total and PD US scores at all time-points (p<0.0001) (Figure 1). At baseline, 75.4% of patients showed tenosynovitis involving at least one tendon, with a median score of 2 (IQR 3.5) significantly decreasing after 24 weeks (p=0.02). Multivariate analysis, adjusted for baseline DAS28CRP and other concomitant treatments (including glucocorticoids and methotrexate treatment), confirmed the independent association between baseline US (PD and tenosynovitis) scores and the reduction of disease activity at follow-up evaluations.Conclusion:The present study confirmed the early efficacy of JAKi in RA patients by using US evaluation. Furthermore, power doppler and tenosynovitis scores could play a predictive role in response to treatment.References:[1]MUELLER RB, HASLER C, POPP F, et al. Effectiveness, Tolerability, and Safety of Tofacitinib in Rheumatoid Arthritis: A Retrospective Analysis of Real-World Data from the St. Gallen and Aarau Cohorts. J Clin Med. 2019;8(10):1548.[2]COLEBATCH AN, EDWARDS CJ, ØSTERGAARD M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72(6):804-14.Figure 1.Ultrasound inflammatory score (a) and Ultrasound Power Doppler (PD) score (b) at baseline and follow-up.Table 1.Baseline characteristics of 414 RA patients.WEEKS04122448US inflammatory score18 (19)11 (15.5)9.5 (11.7)7.5 (8)6 (11)US PD score2 (4)0 (2)0 (1)0 (1)0 (0.7)Disclosure of Interests:Cristina Garufi: None declared, Fulvia Ceccarelli: None declared, Francesca Romana Spinelli Speakers bureau: Abbvie, Eli Lilly, Consultant of: Gilead/Galapagos, Eli Lilly, Grant/research support from: Pfizer, Silvia Mancuso: None declared, Carmelo Pirone: None declared, Fabrizio Conti Speakers bureau: Abbvie, Eli Lilly, Sanofi, Pfizer, Consultant of: Gilead/Galapagos

First-Attempt Success Rate of Ultrasound-Guided Peripheral IV Access using a Handheld Ultrasound Machine in a Simulation Model

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S30-S34
Keyword(s):  
Simulation Model ◽  
Success Rate ◽  
Training Session ◽  
Confidence Score ◽  
Ultrasound Guided ◽  
Emergency Nurses ◽  
Handheld Ultrasound ◽  
Kolmogorov Smirnov ◽  
Application Data ◽  
Time Required

Background: Although peripheral Intravenous (IV) cannulation is a routine procedure performed by nurses, IV access can be difficult to achieve, particularly in emergency patients who have critical illnesses. Ultrasound is used in this procedure to increase the success rate in novice practitioners. Objective: We aimed to determine the first-attempt success rate of ultrasound-guided peripheral IV (USGPIV) performed by emergency nurses in simulation model after having undergone training in the procedure. Materials and Methods: This was prospective descriptive study. The participants consisted of 61 emergency nurses at Srinagarind Hospital Emergency Department from January to April 2020. USGPIV cannulation training was provided by an emergency physician who is also a specialist in emergency ultrasound. After training, we calculated the number of attempts and time required to successfully complete USGPIV in a simulation model. Following this, participants responded to a questionnaire to evaluate their confidence in performing the procedure, as well as its feasibility and practical application. Data were analyzed using a Kolmogorov-Smirnov test, and p<0.05 was considered to be significant. Results: Sixty-one emergency nurses were included. The first-attempt success rate of USGPIV was 85.25% (95% CI 0.761, 0.944), and the mean time required was 47.33+4.89 sec. (95% CI 37.547, 57.103). Fifty-nine participants (96.72%) completed the questionnaire. All items had a mean score of greater than 3 points, with confidence score being the highest. Conclusion: Emergency nurses with no previous experience with USGPIV were able to perform a simulated version of the procedure with a high first-attempt success rate after a short training session. Further studies should be conducted to evaluate nurses’ USGPIV competency in real patients. Keywords: Ultrasound, Peripheral IV cannulation, Emergency medicine, Emergency nurse

scholarly journals Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an OMERACT Reliability Exercise Using Consensual Definitions

2018 ◽  
Vol 46 (4) ◽  
pp. 351-359 ◽  
Author(s):  
George A.W. Bruyn ◽  
Heidi J. Siddle ◽  
Petra Hanova ◽  
Félicie Costantino ◽  
Annamaria Iagnocco ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Subtalar Joint ◽  
Interobserver Reliability ◽  
Power Doppler ◽  
Delphi Process ◽  
Joint Effusion ◽  
Synovial Hypertrophy ◽  
Reliable Tool

Objective.To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA).Methods.Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen’s and Light’s κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal.Results.Mean weighted Cohen’s κ for SH, PD, and JE were 0.80 (95% CI 0.62–0.98), 0.61 (95% CI 0.48–0.73), and 0.52 (95% CI 0.36–0.67), respectively. Weighted Cohen’s κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were −0.04 to 0.79, 0.42–0.95, and 0.28–0.77; 0.31–1, −0.05 to 0.65, and −0.2 to 0.69; 0.66–1, 0.52–1, and 0.42–0.88, respectively. Weighted Light’s κ for SH was 0.67 (95% CI 0.58–0.74), 0.46 (95% CI 0.35–0.59) for PD, and 0.16 (95% CI 0.08–0.27) for JE. Weighted Light’s κ for SH, PD, and JE were 0.63 (95% CI 0.45–0.82), 0.33 (95% CI 0.19–0.42), and 0.09 (95% CI −0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27–0.64), 0.35 (95% CI 0.27–0.4), and 0.04 (95% CI −0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75–0.89), 0.66 (95% CI 0.56–0.8), and 0.18 (95% CI 0.04–0.34) for posterolateral STJ, respectively.Conclusion.Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.

scholarly journals Sustaining open innovation through a “Center of Excellence”

2019 ◽  
Vol 47 (3) ◽  
pp. 19-26 ◽  
Author(s):  
Elizabeth E. Richard ◽  
Jeffrey R. Davis ◽  
Jin H. Paik ◽  
Karim R. Lakhani
Keyword(s):  
Open Innovation ◽  
Business Strategy ◽  
Pilot Scale ◽  
Lessons Learned ◽  
Cultural Issues ◽  
Content Type ◽  
Center Of Excellence ◽  
And Performance ◽  
Time Required ◽  
The Right

Purpose This paper presents NASA’s experience using a Center of Excellence (CoE) to scale and sustain an open innovation program as an effective problem-solving tool and includes strategic management recommendations for other organizations based on lessons learned. Design/methodology/approach This paper defines four phases of implementing an open innovation program: Learn, Pilot, Scale and Sustain. It provides guidance on the time required for each phase and recommendations for how to utilize a CoE to succeed. Recommendations are based upon the experience of NASA’s Human Health and Performance Directorate, and experience at the Laboratory for Innovation Science at Harvard running hundreds of challenges with research and development organizations. Findings Lessons learned include the importance of grounding innovation initiatives in the business strategy, assessing the portfolio of work to select problems most amenable to solving via crowdsourcing methodology, framing problems that external parties can solve, thinking strategically about early wins, selecting the right platforms, developing criteria for evaluation, and advancing a culture of innovation. Establishing a CoE provides an effective infrastructure to address both technical and cultural issues. Originality/value The NASA experience spanned more than seven years from initial learnings about open innovation concepts to the successful scaling and sustaining of an open innovation program; this paper provides recommendations on how to decrease this timeline to three years.

Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)

2018 ◽  
Vol 77 (10) ◽  
pp. 1426-1431 ◽  
Author(s):  
Orazio De Lucia ◽  
Viviana Ravagnani ◽  
Francesca Pregnolato ◽  
Arvena Hila ◽  
Irene Pontikaki ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Rheumatoid Factor ◽  
Strong Predictor ◽  
Power Doppler ◽  
Joint Effusion ◽  
Synovial Hyperplasia ◽  
Individual Patient Level ◽  
Grey Scale ◽  
Therapy Modification

ObjectivesTo define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.Methods88 consecutive patients with JIA—46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months—underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.ResultsUS was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18).ConclusionsUS abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.

Biological control of Eutypa armeniacae. 4. Design and performance of an applicator for metered delivery of protective aerosols during pruning

1978 ◽  
Vol 18 (91) ◽  
pp. 287 ◽  
Author(s):  
MV Carter ◽  
LF Mullett
Keyword(s):  
Biological Control ◽  
Laboratory Tests ◽  
Field Tests ◽  
Piston Pump ◽  
Light Weight ◽  
Biological Matter ◽  
And Performance ◽  
Time Required ◽  
Aerosol Form ◽  
Three Components

The paper describes the development of a prototype applicator for delivery of protective mixtures, in aerosol form, to the wounded sapwood surfaces exposed during pruning. The equipment has three components : a 2 litre day-service tank, a light weight belt-mounted piston pump, and a modification of a standard pneumatic-powered pruning handgun. Laboratory tests of the applicator have proved its ability to deliver, repeatedly, a uniform dose of aerosol containing sufficient particulate chemical and/or biological matter to protect apricot sapwood from invasion by Eutypa armeniacae. Field tests of the equipment in two orchards demonstrated that from 90-100 per cent of wounds can be treated for the addition of less than 20 per cent to the time required to prune a tree. Over a period of three weeks' use no mechanical defects developed. Estimated volume of protective fluid required per day, treating up to 90 per cent of wounds, is less than two litres.

Joint pain

2018 ◽  
Author(s):  
Pippa Watson
Keyword(s):  
Differential Diagnosis ◽  
Soft Tissue ◽  
Joint Pain ◽  
Inflammatory Arthritis ◽  
Morning Stiffness ◽  
Early Morning ◽  
Joint Line ◽  
Joint Effusion ◽  
Joint Tenderness ◽  
Soft Tissue Swelling

When a patient complains of pain confined to a joint or joints, they are said to have arthralgia. If, in addition, there is swelling of the joint, tenderness of the joint line to palpation, and limitation of movement, the patient is said to have an arthritis. It is important to establish if an arthritis is inflammatory or non-inflammatory, as this affects the differential diagnosis. Soft tissue swelling of the joint, the presence of a joint effusion, increased temperature of the joint, erythema of overlying skin, and early morning stiffness of at least 30 minutes duration are signs of an inflammatory arthritis.

scholarly journals COST SIMULATION AND PERFORMANCE OPTIMIZATION OF WEB-BASED APPLICATIONS ON MOBILE CHANNELS

2006 ◽  
Vol 16 (05) ◽  
pp. 655-676
Author(s):  
MATTHIAS BOOK ◽  
VOLKER GRUHN ◽  
MALTE HÜLDER ◽  
ANDRÉ KÖHLER ◽  
ANDREAS KRIEGEL
Keyword(s):  
Performance Optimization ◽  
Response Times ◽  
Mobile Network ◽  
Time Data ◽  
Web Based ◽  
Log Files ◽  
Mobile Channel ◽  
And Performance ◽  
Time Required ◽  
The Cost

When considering the addition of a mobile presentation channel to an existing web-based application, a key question that has to be answered even before development begins is how the mobile channel's characteristics will impact the user experience and the cost of using the application. If either of these factors is outside acceptable limits, economical considerations may forbid adding the channels, even if it would be feasible from a purely technical perspective. Both of these factors depend considerably on two metrics: The time required to transmit data over the mobile network, and the volume transmitted. The PETTICOAT method presented in this paper uses the dialog flow model and web server log files of an existing application to identify typical interaction sequences and to compile volume statistics, which are then run through a tool that simulates the volume and time that would be incurred by executing the interaction sequences on a mobile channel. From the simulated volume and time data, we can then calculate the cost of accessing the application on a mobile channel, and derive suitable approaches for optimizing cost and response times.

Sign in / Sign up

Export Citation Format

Share Document