bluuebunny/crossref_metadata_2025 huggingface dataset:
Cassini observations of ionospheric plasma in Saturn's magnetotail lobes
Authors: Felici M. , Arridge C. S. , Coates A. J. , Badman S. V. , Dougherty M. K. , Jackman C. M. , Kurth W. S. , Melin H. , Mitchell D. G. , Reisenfeld D. B. , Sergis N.
Published: December 2015

Studies of Saturn's magnetosphere with the Cassini mission have established the importance of Enceladus as the dominant mass source for Saturn's magnetosphere. It is well known that the ionosphere is an important mass source at Earth during periods of intense geomagnetic activity, but lesser attention has been dedicated to study the ionospheric mass source at Saturn. In this paper we describe a case study of data from Saturn's magnetotail, when Cassini was located at ≃ 2200 h Saturn local time at 36 RS from Saturn. During several entries into the magnetotail lobe, tailward flowing cold electrons and a cold ion beam were observed directly adjacent to the plasma sheet and extending deeper into the lobe. The electrons and ions appear to be dispersed, dropping to lower energies with time. The composition of both the plasma sheet and lobe ions show very low fluxes (sometimes zero within measurement error) of water group ions. The magnetic field has a swept‐forward configuration which is atypical for this region, and the total magnetic field strength is larger than expected at this distance from the planet. Ultraviolet auroral observations show a dawn brightening, and upstream heliospheric models suggest that the magnetosphere is being compressed by a region of high solar wind ram pressure. We interpret this event as the observation of ionospheric outflow in Saturn's magnetotail. We estimate a number flux between (2.95 ± 0.43) × 109 and (1.43 ± 0.21) × 1010 cm−2 s−1, 1 or about 2 orders of magnitude larger than suggested by steady state MHD models, with a mass source between 1.4 ×102 and 1.1 ×103 kg/s. After considering several configurations for the active atmospheric regions, we consider as most probable the main auroral oval, with associated mass source between 49.7 ±13.4 and 239.8 ±64.8 kg/s for an average auroral oval, and 10 ±4 and 49 ±23 kg/s for the specific auroral oval morphology found during this event. It is not clear how much of this mass is trapped within the magnetosphere and how much is lost to the solar wind.
Modeling the MJO in a cloud‐resolving model with parameterized large‐scale dynamics: Vertical structure, radiation, and horizontal advection of dry air
Authors: Wang Shuguang , Sobel Adam H. , Nie Ji
Published: December 2015

Two Madden‐Julian Oscillation (MJO) events, observed during October and November 2011 in the equatorial Indian Ocean during the DYNAMO field campaign, are simulated in a limited‐area cloud‐resolving model using parameterized large‐scale dynamics. Three parameterizations of large‐scale dynamics—the conventional weak temperature gradient (WTG) approximation, vertical mode‐based spectral WTG (SWTG), and damped gravity wave coupling (DGW)—are employed. A number of changes to the implementation of the large‐scale parameterizations, as well as the model itself, are made and lead to improvements in the results. Simulations using all three methods, with imposed time‐dependent radiation and horizontal moisture advection, capture the time variations in precipitation associated with the two MJO events well. The three methods produce significant differences in the large‐scale vertical motion profile, however. WTG produces the most top‐heavy profile, while DGW's is less so, and SWTG produces a profile between the two, and in better agreement with observations. Numerical experiments without horizontal advection of moisture suggest that that process significantly reduces the precipitation and suppresses the top‐heaviness of large‐scale vertical motion during the MJO active phases. Experiments in which a temporally constant radiative heating profile is used indicate that radiative feedbacks significantly amplify the MJO. Experiments in which interactive radiation is used produce agreement with observations that is much better than that achieved in previous work, though not as good as that with imposed time‐varying radiative heating. Our results highlight the importance of both horizontal advection of moisture and radiative feedbacks to the dynamics of the MJO.
Using time scales to characterize phytoplankton assemblages in a deep subalpine lake during the thermal stratification period: Lake Iseo, Italy
Authors: Marti Clelia Luisa , Imberger Jörg , Garibaldi Letizia , Leoni Barbara
Published: December 2015

A combination of field observations and 3‐D hydrodynamic simulations were used to identify the phytoplankton species and to estimate the various time scales of the dominant physical and biological processes in Lake Iseo, a deep subalpine lake located in northern Italy, during a stratified period (July 2010). By ordering the rate processes time scales, we derive a phytoplankton patch categorization and growth interpretation that provides a general framework for the spatial distribution of phytoplankton concentration in Lake Iseo and illuminates the characteristics of their ecological niches. The results show that the diurnal surface layer was well mixed, received strong diurnal radiation, had low phosphorus concentrations and the phytoplankton biomass was sustained by the green alga Sphaerocystis schroeterii. The vertical mixing time scales were much shorter than horizontal mixing time scales causing a depth‐uniform chlorophyll a concentration. The horizontal patch scale was determined by horizontal dispersion balancing the phytoplankton growth time scale, dictating the success of the observed green algae. The strongly stratified nutrient‐rich metalimnion had mild light conditions and Diatoma elongatum and Planktothrix rubescens made up the largest proportions of the total phytoplankton biomass at the intermediate and deeper metalimnetic layers. The vertical transport time scales were much shorter than horizontal transport and vertical dispersion leading to growth niche for the observed phytoplankton. The study showed that time‐scale hierarchy mandates the essential phytoplankton attributes or traits for success in a particular section of the water column and/or water body.
Hierarchical Bayesian method for mapping biogeochemical hot spots using induced polarization imaging
Authors: Wainwright Haruko M. , Flores Orozco Adrian , Bücker Matthias , Dafflon Baptiste , Chen Jinsong , Hubbard Susan S. , Williams Kenneth H.
Published: December 2015

In floodplain environments, a naturally reduced zone (NRZ) is considered to be a common biogeochemical hot spot, having distinct microbial and geochemical characteristics. Although important for understanding their role in mediating floodplain biogeochemical processes, mapping the subsurface distribution of NRZs over the dimensions of a floodplain is challenging, as conventional wellbore data are typically spatially limited and the distribution of NRZs is heterogeneous. In this study, we present an innovative methodology for the probabilistic mapping of NRZs within a three‐dimensional (3‐D) subsurface domain using induced polarization imaging, which is a noninvasive geophysical technique. Measurements consist of surface geophysical surveys and drilling‐recovered sediments at the U.S. Department of Energy field site near Rifle, CO (USA). Inversion of surface time domain‐induced polarization (TDIP) data yielded 3‐D images of the complex electrical resistivity, in terms of magnitude and phase, which are associated with mineral precipitation and other lithological properties. By extracting the TDIP data values colocated with wellbore lithological logs, we found that the NRZs have a different distribution of resistivity and polarization from the other aquifer sediments. To estimate the spatial distribution of NRZs, we developed a Bayesian hierarchical model to integrate the geophysical and wellbore data. In addition, the resistivity images were used to estimate hydrostratigraphic interfaces under the floodplain. Validation results showed that the integration of electrical imaging and wellbore data using a Bayesian hierarchical model was capable of mapping spatially heterogeneous interfaces and NRZ distributions thereby providing a minimally invasive means to parameterize a hydrobiogeochemical model of the floodplain.
Flow field during eccentric discharge from quasi‐two‐dimensional silos–extension of the kinematic model with validation
Authors: Maiti Ritwik , Meena Sanjay , Das Prasanta Kumar , Das Gargi
Published: December 2015

A comprehensive investigation of granular discharge through the eccentric opening of rectangular silos has been presented. Slip flow of the grains over the vertical wall closer to the orifice was observed experimentally. This has not been emphasized by the earlier researchers. Considering slip flow at the wall, the kinematic model of granular discharge has been extended to simulate the hydrodynamics during drainage through any eccentric opening. The simulation is applicable over the entire range of eccentricity possible and for both the uniform and the triangular velocity profile through the orifice. Results from the experiments using sand grains (300–500 μm) and glass beads (400–600 μm) have been used for validating the model. The excellent agreement not only justifies the application of the kinematic model for eccentric discharge, it also extends the model for irregular and much smaller grain size. Finally, some limitations of the kinematic model have been examined critically. © 2016 American Institute of Chemical Engineers AIChE J, 62: 1439–1453, 2016
Particles mixing induced by bubbles in a gas‐solid fluidized bed
Authors: Amiri Zahra , Movahedirad Salman , Shirvani Mansour
Published: December 2015

The effect of bubble injection characteristics on the mixing behavior of a gas‐solid fluidized bed is investigated using a discrete particle model. The effect of different parameters including gas injection time, velocity, and mode are studied. Simulation results show that injecting gas at a constant gas flow rate in the form of small bubbles results in a better overall particle mixing. It was also found that the injection velocities have limited effect on particle mixing behavior for the same total gas volume injected into the bed. Moreover, the mixing index (MI) of continuous gas jet bubbling regime is compared with the MI obtained in uniform gas injection regime and the results revealed that the MI of continuous jet bubbling regime has a larger value than that of uniform gas injection regime at the fixed total gas flow rate. In both regimes, z‐direction MI is larger than x‐direction index. The differences between two direction indices are more noticeable in continuous jet bubbling in comparison with the uniform gas injection regime. © 2016 American Institute of Chemical Engineers AIChE J, 62: 1430–1438, 2016
The Olfactory Cleft Endoscopy Scale correlates with olfactory metrics in patients with chronic rhinosinusitis
Authors: Soler Zachary M. , Hyer J. Madison , Karnezis Tom T. , Schlosser Rodney J.
Published: December 2015

Background

Olfactory loss affects a majority of patients with chronic rhinosinusitis (CRS). Traditional objective measures of disease severity, including endoscopy scales, focus upon the paranasal sinuses and often have weak correlation to olfaction.

Methods

Adults with CRS were prospectively evaluated by blinded reviewers with a novel Olfactory Cleft Endoscopy Scale (OCES) that evaluated discharge, polyps, edema, crusting, and scarring of the olfactory cleft. Objective olfactory function was assessed using “Sniffin’ Sticks” testing, including composite threshold‐discrimination‐identification (TDI) scores. Olfactory‐specific quality of life was evaluated using the short modified version of the Questionnaire of Olfactory Disorders (QOD‐NS). Interrater and intrarater reliability was assessed among 3 reviewers for OCES grading. Multivariate linear regression was then used to test associations between OCES scores and measures of olfaction, controlling for potential confounding factors.

Results

The OCES score was evaluated in 38 patients and had a high overall reliability (intraclass correlation coefficient [ICC] = 0.92; 95% confidence interval [CI], 0.91 to 0.96). The OCES significantly correlated with objective olfaction as measured by TDI score (p < 0.001), with TDI score falling by 1.13 points for every 1‐point increase in OCES score. Similar significant associations were found for threshold, discrimination, and identification scores (p < 0.003 for all) after controlling for age, gender, race, and reviewer/review. The OCES was also highly associated with patient‐reported QOD‐NS scores (p = 0.009).

Conclusion

A novel olfactory cleft endoscopy scale, OCES, shows high reliability and correlates with both objective and patient‐reported olfaction in patients with CRS. Further studies to determine prognostic value and responsiveness to change are warranted.
Comparison of percutaneous coronary intervention for chronic total occlusion outcome according to operator experience from the Japanese retrograde summit registry
Authors: Habara Maoto , Tsuchikane Etsuo , Muramatsu Toshiya , Kashima Yoshifumi , Okamura Atsunori , Mutoh Makoto , Yamane Masahisa , Oida Akitsugu , Oikawa Yuji , Hasegawa Katsuyuki ,   for the Retrograde Summit Investigators
Published: December 2015

Objectives

This study was performed to evaluate the acute outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) based on operator experience.

Background

Despite developments in both technology and techniques, PCI procedures for CTO's remain challenging.

Methods

A total of 3,229 eligible subjects who underwent CTO‐PCI were enrolled from 56 centers by a retrograde summit using a web registry system. To compare the acute outcomes of the CTO data, 18 centers were classified as higher volume centers (HC) and 38 centers as lower volume centers (LC) depending on the CTO‐PCI experience of the operator.

Results

The mean procedural success rate of all centers was 88.4%. The overall procedural success rate was significantly higher in HC than LC (90.6% vs. 85.6%, respectively; P < 0.0001). In addition, overall antegrade success rate was also higher in HC than LC (91.0% vs. 83.9%, respectively; P < 0.0001). Although the overall retrograde approach success rate was significantly higher in HC than LC (85.0% vs. 77.6%, respectively; P < 0.0001), there was no significant difference in that of the retrograde alone (89.0% vs. 93.7%, respectively; P = 0.051). Major in‐hospital adverse events were observed in 0.53% of cases, and the rates were similar between the two groups (0.45% vs. 0.62%, respectively; P = 0.25).

Conclusions

Although CTO‐PCI was safe in both groups, the procedural success rate was significantly higher in HC than LC, even in this new era of CTO‐PCI. This difference was attributed to the difference in the antegrade procedural success rate. © 2015 Wiley Periodicals, Inc.
Nonsteroidal Anti‐inflammatory Drugs and Risk of Incident Heart Failure: A Systematic Review and Meta‐analysis of Observational Studies
Authors: Ungprasert Patompong , Srivali Narat , Thongprayoon Charat
Published: December 2015

Background

The association between the development of heart failure (HF) and use of nonsteroidal anti‐inflammatory drugs (NSAIDs) is not well established.

Hypothesis

Use of NSAIDs may increase the risk of incident HF.

Methods

We conducted a systematic review and meta‐analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of incident HF in NSAID users vs nonusers. Pooled risk ratios (RR) and 95% confidence intervals (CI) for all NSAIDs and both subclasses (conventional NSAIDs and highly selective cyclooxygenase‐2 inhibitors [COXIBs]) were calculated using a random‐effect, generic inverse variance method.

Results

Seven studies with 7 543 805 participants were identified and included in our data analysis. Use of NSAIDs was associated with a significantly higher risk of developing HF, with a pooled RR of 1.17 (95% CI: 1.01‐1.36). Subgroup analysis showed a significantly elevated risk among users of conventional NSAIDs (RR: 1.35, 95% CI: 1.15‐1.57) but not users of COXIBs (RR: 1.03, 95% CI: 0.92‐1.16).

Conclusions

A significantly elevated risk of incident HF was observed among users of NSAIDs.
Effects of Antimicrobial Air Filters on the Viability and Culturability of Airborne Bacteria
Authors: Hwang Gi Byoung , Kwon Bo Mi , Lee Seung Jae , Lee Byung Uk , Sim Kyoung Mi , Bae Gwi‐Nam , Jung Jae Hee
Published: December 2015

The effects of antimicrobial filters on the viability and culturability of Escherichia coli and Bacillus subtilis in terms of antimicrobial nanoparticle concentrations and bacterial residence time on filters were investigated. The Sophora flavescens nanoparticles were used to prepare antimicrobial filters. Although the loss of bacterial viability and culturability increased with increasing antimicrobial nanoparticle concentrations on the filter, the intensity of the antimicrobial reactions differed: The culturability loss was more than twice the viability loss under all conditions, and a maximum of 45 ± 12% to 57% ± 12% of bacteria entered the viable but nonculturable (VBNC) state. Testing filters at various bacterial residence times, 87 ± 4% to 92 ± 0.1% of bacteria lost culturability after 60 min due to natural decay, whereas only 10 ± 4 to 13 ± 6% lost viability. Additionally, the number of VBNC bacteria increased with increasing residence time. On antimicrobial filters, the culturability reduction trends of both bacterial species were similar; however, their viability reduction trends differed: The E. coli viability decreased gradually from 77 ± 10% to 64 ± 7% over 60 min, whereas that of B. subtilis decreased dramatically from 70 ± 13% to 22 ± 0.1% over the same period. As residence time increased, the proportion of E. coli and B. subtilis cells that entered the VBNC state decreased due to the increased antimicrobial effect on bacterial viability.
Ultrasound of the eye
Authors: Southern Simon
Published: December 2015

Ultrasound of the eye is not an examination that most sonographers are commonly asked to perform, however it may be requested from time to time, particularly in regional or rural areas. This paper hopes to assist the sonographer to gain an understanding of the anatomical and sonographic anatomy of the eye in order to diagnose several common pathologies.
Reversed internal jugular vein flow as a sign of brachiocephalic vein obstruction
Authors: Yan Warren , Seow Stewart
Published: December 2015

The value of colour Doppler sonography is well known in the assessment of venous disease, including obstruction/occlusion from thrombosis. Central venous disease, however, can be more difficult to directly assess than disease in peripheral veins. Accordingly, there is significant value not only in the direct signs of venous disease, but also in the indirect signs. We report a case of reversed internal jugular vein flow in a patient with left arm swelling as a sign of brachiocephalic vein obstruction.
Sonography for the investigation of a child with a limp
Authors: Crow A , Cheung A , Lam A , Ho E
Published: December 2015

Hip pain is a common paediatric presentation and is potentially serious. While hip pain can be attributed to primary hip pathology, the hip area is also a common site for referred pain. This often poses a diagnostic challenge particularly in the young child who may not verbalise the point of pain and may not report an injury.

Differential diagnoses for paediatric hip joint pain range from fracture, transient synovitis, septic arthritis with or without osteomyelitis, juvenile idiopathic arthritis (JIA, previously juvenile rheumatoid arthritis JRA), Legg‐Calve‐Perthes' disease (LCP), slipped capital femoral epiphysis (SCFE) to haemarthrosis in patient with a clotting disorder. Referred pain from abdominal pathology, for example; appendicitis, psoas abscess or haematoma should also be considered.

The evaluation and management of hip pain requires a thorough history and physical examination. A radiograph is usually indicated to rule out any bony injury. Septic arthritis is a medical emergency requiring urgent surgical as well as medical treatment. Ultrasound of the hip joint plays a role in helping to differentiate which hips require early intervention and to guide a needle aspiration of joint fluid if indicated.

In this article, we aim to review the anatomy of the hip, techniques in ultrasonographic examination and some common pathologies in the paediatric hip.
Ultrasound of ovarian dermoids – sonographic findings of a dermoid cyst in a 41‐year‐old woman with an elevated serum hCG
Authors: Kite Lauren , Uppal Talat
Published: December 2015

Ovarian dermoid cysts are made up of solid, cystic and fat tissue. These components give rise to characteristic sonographic features such as a fat‐fluid level, dermoid mesh and tip of the iceberg sign. The presence of two or more of these typical features can be used to confidently diagnose a dermoid cyst on ultrasound. This 41‐year‐old woman with a known cystic lesion on her right ovary which, on ultrasound, demonstrated two of these features, had the diagnosis of a dermoid cyst later confirmed on histopathology. She concurrently had an elevated serum human chorionic gonadotrophin (hCG), an unusual, but not unknown, finding in the presence of a dermoid cyst. The hCG resolved after removal of the ovarian cyst.
Buerger's disease (thromboangiitis obliterans): clinical features and assessment by colour duplex ultrasound
Authors: Busch Kathryn
Published: December 2015

Buerger's disease is a progressive, nonatherosclerotic, segmental inflammatory vasoocclusive disease of unknown aetiology1–9, affecting the small and medium sized arteries, veins and nerves and is often bilateral5–7. The normal structure of the vessel wall is usually preserved, including the internal elastic lamina and media.

Buerger's disease predominantly affects male cigarette smokers1–3,8 with 11%–23% of disease distribution in females6–7.

Buerger's disease remains largely a clinicopathologic entity highlighting the importance of the sonographer's role to obtain a comprehensive clinical history and clinical examination. The combination of clinical assessment and the distinctive appearance of vessels affected by Bueger's disease on colour duplex ultrasound provide a useful tool for correct diagnosis.
Sonovaginography: redefining the concept of a “normal pelvis” on transvaginal ultrasound pre‐laparoscopic intervention for suspected endometriosis
Authors: Reid Shannon , Winder Simon , Condous George
Published: December 2015

Office sonovaginography (SVG) challenges the concept of the “normal” pelvic ultrasound in women with chronic pelvic pain and suspected endometriosis. When positive for posterior compartment deep infiltrating endometriosis, with or without Pouch of Douglas obliteration, office SVG allows for triaging of women to the appropriately trained advanced laparoscopic gynaecological and colorectal surgical team. We advocate that all women with suspected endometriosis undergo office SVG prior to laparoscopy to ensure an accurate pre‐operative mapping of endometriosis disease location and extension.
The role of ultrasound in the management of breast disease
Authors: Bennett Ian C , Biggar Magdalena A
Published: December 2015

Surgeon‐performed ultrasound has also been increasingly utilised by breast surgeons in particular, who find ultrasound an invaluable tool in the office to assist in the management of breast patients, and also in the operating room where it can be used to directly guide excision of impalpable breast lesions without the use of hookwires2,3. In the future, the role of ultrasound will continue to grow, particularly with the advent of 3‐D ultrasound, and in the evolving area of breast lesion ablation techniques using modalities such as radiofrequency ablation or laser therapy. Ultrasound is a very important tool in the assessment and management of breast disease and it has dramatically changed the way breast cancer patients are managed.
Pregnancy after uterine arteriovenous malformation–case series and literature review
Authors: Eling Rebeka , Kent Alison , Robertson Meiri
Published: December 2015

Purpose: To perform a retrospective audit of cases of uterine arteriovenous malformations (UAVM) at The Canberra Hospital and review of recent literature reporting pregnancies occurring after the diagnosis of UAVM aiming to devise a diagnostic and treatment protocol to optimise pregnancy post UAVM.

Methods: A retrospective audit of cases of UAVM at the Canberra Hospital from a prospectively managed patient database was performed. A search of the electronic database PubMed, for articles between 2000–2011 relating to pregnancy post UAVM. Individual case studies were analysed separately to case series.

Results: The study included 28 individual studies and five case series (61 women). Average age was 29.5 ± 6.7 (range 18–42). Most women (24, 85.7%, 100% in case series) presented with abnormal vaginal bleeding; 11 (41%) individuals presented post interruption of pregnancy. All women had had a previous pregnancy (mean gravidity 3.1 ± 3.1, range 1–15 for case studies) and only four women (14.2 %) had no history of uterine trauma. Only one woman (3.6 %) did not have any ultrasound and most women underwent colour Doppler ultrasonography (20, 71.4% in case studies; 61, 83.6% in case series). Of the women, 72 (53.6 % of case studies, 78.1 % of case series) were treated with uterine artery embolisation, seven (25%) were treated expectantly. A total of 63 pregnancies occurred post treatment, seven (13.9%) ending in miscarriage. Average time to conceive post diagnosis was 19 months ± 16.3 (range 2–72). A total of 54 healthy infants were born to mothers post AVM diagnosis.

Conclusion: UAVM are likely to exist on a continuum with other pregnancy related pathologies, such as sub involution of the placental bed, making a single best diagnostic and treatment plan difficult. However, this study shows that successful uncomplicated pregnancy is achievable for women after the diagnosis of UAVM.
The development, structure and blood flow within the umbilical cord with particular reference to the venous system
Authors: Spurway Jacqueline , Logan Patricia , Pak Sokcheon
Published: December 2015

The umbilical cord is a helical and tubular blood conduit connecting the foetus to the placenta. The umbilical cord achieves its final form by the 12th week of gestation and normally contains two arteries and a single vein, all embedded in Wharton's jelly. The structure of the umbilical cord receives only a cursory glance during many obstetric ultrasound examinations: with imaging limited to documenting the number of vessels within the cord and the insertion sites at the foetus and placenta. Extensive research into blood flow characteristics of the umbilical cord arteries has been undertaken and is now widely applied in contemporary ultrasound practice. In contrast, investigation of umbilical vein blood flow is only instigated in instances of foetal compromise when the spectral waveform of the ductus venosus and pulsations in the vein are scrutinised. The current level of ultrasound imaging of the umbilical vein demonstrates a lack of appreciation and knowledge about a structure that is crucial to sustaining foetal life.

The goal of this review is to increase awareness of the importance of the umbilical cord. In addition, this review will provide an information platform for undertaking and critically analysing research into the umbilical cord by providing a summary of cord embryology, structure, foetal venous circulation and mechanisms of blood flow within the umbilical cord vein.
Bedside emergency department ultrasound in assessment of a gunshot wound
Authors: Burns Brian
Published: December 2015

This case report presents the bedside use of ultrasound in the emergency department in assessment of a gunshot wound, finding its flexibility and portability to be a premium.
Advanced echocardiographic techniques
Authors: Perry Rebecca , Joseph Majo
Published: December 2015

Echocardiography has advanced significantly since its first clinical use. The move towards more accurate imaging and quantification has driven this advancement. In this review, we will briefly focus on three distinct but important recent advances, three‐dimensional (3D) echocardiography, contrast echocardiography and myocardial tissue imaging. The basic principles of these techniques will be discussed as well as current and future clinical applications.
The role of ultrasound in percutaneous dilatational tracheostomy
Authors: Rudas Máté
Published: December 2015

Background: The use of ultrasound to evaluate cervical anatomy and to guide tracheal puncture in real‐time has been advocated to improve safety and efficacy of percutaneous dilatational tracheostomy (PDT) in intensive care.

Objective: To review the potential role, attributed theoretical benefits and supporting literature for ultrasound during PDT.

Results: A significant number of mostly observational studies and case series support this modality. Real‐time guidance enables clear visualisation of anatomical landmarks and results in a consistently high success and low complication rate, with appropriate positioning of the tracheal puncture. Recognition of unconventional vascular anatomy enables selection of an appropriate alternative puncture site or an elective open surgical approach.

Conclusion: Current literature supports that using ultrasound for percutaneous tracheostomy is quick, safe, reliable and offers a plausible advantage over the traditional landmark guided procedure, especially in select patient groups, such as those who are morbidly obese or have difficult to palpate cervical anatomy.
Preoperative ultrasound diagnosis of deep endometriosis: importance of the examiner's expertise and lesion size
Authors: Savelli Luca , Fabbri Federica , Zannoni Letizia , De Meis Lucia , Di Donato Nadine , Mollo Francesco , Seracchioli Renato
Published: December 2015

Objectives: To evaluate the accuracy of transvaginal sonography (TVS) in the diagnosis of deep infiltrating endometriosis (DIE) of the posterior compartment (rectovaginal septum, uterosacral ligaments, rectosigmoid colon, vagina) when undertaken by physicians of varying experience and to investigate if size of the nodule is relevant in influencing diagnostic accuracy. Methods: 381 patients who were operated on between January 2007 and December 2010 for suspected pelvic endometriosis were prospectively recruited. Clinical, surgical and histopathologic data were collected and a preoperative TVS was carried out. Comparison was made between the diagnostic accuracy of TVS performed by two groups of physicians of different expertise. Results: One hundred and thirty‐six patients underwent removal of deep endometriotic lesions of the posterior compartment. Sensitivity, specificity, positive and negative predictive value and the overall diagnostic accuracy of the expert operators were 77%, 95%, 90%, 87% and 88% respectively. Corresponding values for first‐level operators were: 45%, 98%, 92%, 79% and 81%. In patients with positive findings at TVS, the mean diameter of the endometriotic nodule was of 4.7 ± 3.4 cm while, in cases with negative findings, the average diameter was 2.6 ± 1.1 cm (P < 0.05). Conclusions: TVS is accurate in detecting the presence of DIE. Accuracy is dependent on the experience of the physician and the size of the nodule.
The short term fetal cardiovascular effects of corticosteroids used in obstetrics
Authors: Henry Amanda , Shand Antonia , Welsh Alec
Published: December 2015

Background: Corticosteroids are widely used in obstetrics due to their striking effect on perinatal morbidity and mortality of premature neonates. Despite this, relatively few studies have explored short term fetal effects of corticosteroids as measured by ultrasound.

Objectives: 1) To present a literature review of short term fetal cardiovascular effects of corticosteroids 2) To describe the protocol of a current observational study (SUPER‐A*STEROID) of cardiovascular effects of dexamethasone and betamethasone in the first week after their administration. This trial is nested within the A*STEROID blinded multicentre randomised controlled trial of the two steroid preparations.

Findings: Existing data suggest corticosteroids have little effect on the major measured fetal blood vessels when the baseline ultrasound is normal. In the compromised fetus, where the umbilical artery end‐diastolic flow is abnormal prior to maternal corticosteroids, flow is temporarily restored in approximately 50% of cases. Whether such changes are beneficial is uncertain. Very little data exist that directly compare the short‐term effects of betamethasone and dexamethasone. The SUPER‐ A*STEROID study described will help provide this information.
The effect of preliminary training on quantitative evaluation of sonographer performance in the fetal morphology ultrasound examination
Authors: Lam Penny , Samson Armie , Magotti Robert , Benzie Ronald
Published: December 2015

Introduction: The aim of this study is to provide a quantitative scoring system to assess sonographer performance by reviewing images from the fetal morphology examination.

Methods: Ten ultrasound images from patients at 18–22 weeks gestation were assessed and scored for quality according to predefined criteria. One hundred normal cases were randomly selected and 10 images from each case were analysed by four experienced reviewers. The preliminary training incorporated the first 25 cases and involved a training period for reviewers; the remaining 75 cases were allocated to post training. The scores acquired by each reviewer were statistically analysed using Pearson's and intra‐class correlations to determine the reproducibility of the results.

Results: The preliminary training results were calculated separately and compared to the post training study. The preliminary intra‐class correlation coefficient was 0.12. In the post training study the intra‐class correlation coefficient was doubled at 0.24. The greatest correlation was observed between reviewers 1 and 4 with a coefficient of 0.71. Reviewers 3 and 4 demonstrated the lowest correlation coefficient of 0.30.

Discussion: A significant increase in the intra‐class correlation coefficient indicated that training reviewers achieves more reproducible results. Suggested improvements to the study include recording fetal position, maternal BMI and assessing individual reviewer variability. An instruction manual defining each criterion might also yield better results.

Conclusion: The quantitative method used in this study assessed ultrasound images by placing a numerical value on image quality. Analysis of the preliminary training period demonstrates improved reproducibility of the results. Further investigation into the criteria is necessary to refine the quantitative method.
Ultrasound and saline infused sonography as valuable tool to assess uterine integrity
Authors: Robertson Meiri , Tan Woo Syong
Published: December 2015

Introduction: Ultrasound is under utilised in assessing surgical complications such as uterine perforation resulting from surgical termination of pregnancy.

Method: We found one report in literature using the following search words: pregnancy termination, uterus, perforation and ultrasound.1 The risk of perforation is considered low but the true incidence is unknown. The reported incidence is largely based on self‐reporting and many perforations are not recognised.

Conclusion: A South Australian study reported the perforation risk following a surgical termination as 0.05% in the first trimester and 0.32% in the second trimester (13–20 weeks).
Detection of intraperitoneal free gas by ultrasound
Authors: Goudie Adrian
Published: December 2015

Introduction: Patients with acute abdominal pain may have unsuspected pneumoperitoneum, and be investigated with ultrasound. Although not the primary imaging modality for this condition, ultrasound will usually demonstrate signs of free intraperitoneal or extra‐luminal gas.

Methods: Sonographic signs of pneumoperitoneum are described, along with the limitations and pitfalls of the technique. The reported accuracy of these signs is described.

Conclusion: The different signs that may be seen are described, and it is suggested that all who ultrasound patients for abdominal pain should be aware of these.
Amniotic fluid as a vital sign for fetal wellbeing
Authors: Dubil Elizabeth A , Magann Everett F
Published: December 2015

Introduction: Amniotic fluid, once thought to merely provide protection and room for necessary movement and growth for the fetus, is now understood to be a highly complex and dynamic system that is studied as a data point to interpret fetal wellbeing.

Methods: Assessment of amniotic fluid volume is now routine when performing a sonographic evaluation of fetal status and is an important consideration in the assessment and management of perinatal morbidity and mortality.1,2 In this review, we will cover the dynamics that affect amniotic fluid volume, review methods for measurement and quantification of volume, review definitions for normative data as related to neonatal outcomes, and provide evidence based guidance on the workup and management options for oligoydramnios and polyhydramnios in singleton and twin pregnancies. Conclusions: When abnormalities of fluid exist, appropriate workup to uncover the underlying etiology should be initiated as adverse fetal outcomes are sometimes associated with these variations from normalcy.
The cardiac sonography workforce in New Zealand
Authors: Buckley Belinda , White Steve , Poppe Katrina , Whalley Gillian
Published: December 2015

Introduction: The aim of this paper is to investigate the cardiac sonography workforce characteristics and registration requirements in New Zealand (NZ), with a comparison to similar workforces internationally.

Methods: The Survey of Clinical Echocardiography in New Zealand 2 (SCANZ2) audit was performed in December 2010. All of NZ's public‐funded District Health Board (DHB) centers providing echocardiography services responded to questions relating to staff, equipment, procedure types and patient statistics. The Medical Radiation Technologists Board (MRTB), Clinical Physiologists Registration Board (CPRB) and Australian Sonographers Association Registry (ASAR) websites were reviewed in March 2012 for registered sonographers with a cardiac scope of practice. The cardiac sonography workforces in Australia, the UK, the USA and Canada were investigated for comparison.

Results: There are 84 cardiac sonographers (60.3 full‐time equivalent) working in DHBs: 71% from a cardiac technical background; 40% have post‐graduate qualifications; a further 17% are undertaking post‐graduate qualifications; and 59 cardiac sonographers have registration with professional bodies in NZ and/or Australia. Cardiac sonographers in NZ do not undergo compulsory registration, but other sonographers in NZ have compulsory registration with the MRTB. Sonographers are predominantly not licensed internationally.

Discussion: Disparity exists between registration of cardiac and non‐cardiac sonographers in NZ. Many cardiac sonographers have voluntary registration but few are registered with the MRTB. Reasons for this include professional alignment, educational qualifications and representation. International trends show increased pressure from governments and professional bodies to regulate sonographers. Conclusion: This study provides a snapshot of the cardiac sonography workforce in NZ for the first time.
Limited lung ultrasound protocol in elderly patients with breathlessness; agreement between bedside interpretation and stored images as acquired by experienced and inexperienced sonologists
Authors: Baker Kylie , Mitchell Geoffrey , Stieler Geoffrey
Published: December 2015

Introduction: Bedside lung ultrasound is increasingly performed in the Emergency Department to assess dyspnoeic patients. Quantifying the number of B‐lines (a vertical short path reverberation artefact caused by the presence of interstitial fluid) can help clinicians differentiate ‘wet lung’ – pulmonary oedema, from ‘dry lung’ – not pulmonary oedema.

The aim of this study was to determine inter‐rater agreement for this simple bedside investigation, comparing relative ultrasound novices with more experienced personnel. After completing an introductory ultrasound course the novices had only had four hours of specific lung ultrasound education, followed by 10 proctored scans.

Method: A prospective convenience sample of 217 patients over the age of 60 and presenting with dyspnoea were recruited. Patients were either scanned by an experienced emergency physician sonologist or by relative ultrasound novices. The scans were saved and still images then interpreted by a blinded radiology registrar with sonography training, and agreement calculated using weighted kappa scores.

Results: The experienced physician scanned 155 patients, and the 11 novices 62 between them. Agreement between the experienced sonologist and the blinded expert was excellent (kappa = 0.82, 95% CI 0.72 to 0.92); between novice group and sonographer, agreement was good (kappa = 0.70, 95% CI 0.45 to 0.95).

Conclusion: This study demonstrates reasonable inter‐rater agreement firstly between experts, and secondly between novices and experts.
Comparison of a basic lung scanning protocol against formally reported chest x‐ray in the diagnosis of pulmonary oedema
Authors: Baker Kylie , Mitchell Geoffrey , Thompson Angus G , Stieler Geoffrey
Published: December 2015

Introduction: Brief lung scan protocols have been recommended as a useful adjunct to identify pulmonary oedema in the breathless elderly patient. Some papers quote diagnostic accuracies above that of chest x‐ray.

Method: We recruited a prospective convenience sample of patients over sixty years of age reporting any breathlessness on presentation to the emergency department. Those who received both bedside lung scan and chest x‐ray later had their case notes audited by an expert cardiologist for the cause of their breathlessness at presentation. Admission diagnosis was also extracted.

Results: 204 comparative data sets were collected. Compared with cardiologist chart review, delayed expert radiology report had a diagnostic accuracy of 92.2% (95%CI 87.6 to 95.1). Bedside interpretation of lung scan protocol had a diagnostic accuracy of 85.3% (95%CI 79.8 to 89.5). The difference of 6.9% between the two accuracy measures was significant (95%CI 0.69 to 13.1). Admission diagnosis accuracy, which encompasses inexpert x‐ray interpretation was 70.2%(95%CI 62.9 to 76.6), significantly less than either lung scan or expert chest x‐ray report.

Conclusion: For identifying heart failure in breathless patients, urgent chest x‐ray with delayed formal report has not been shown to be redundant. Basic lung scan protocols should not yet replace chest x‐ray, but may be more reliable in the interim than inexpert clinician interpretation of chest x‐rays.
Dicephalus dipus dibrachius: conjoined twins through the ages
Authors: Miceli Frances
Published: December 2015

Conjoined twins are the most rare form of monozygotic twinning occurring when there is incomplete division of the embryonic disc after day 13 post conception. This is associated with a very high risk of perinatal morbidity and mortality. Prognosis is dependent on the site and extent of fusion and the degree of sharing of vital organs. Most conjoined twins die in utero or in the early neonatal period. However less severe cases can be successfully separated.

This is a review of the types of conjoined twinning, an historical perspective and a case of a rare form known as dicephalus dipus dibrachius (two heads and a single body with two arms and two legs).
Ultrasound physical principles in today's technology
Authors: Starkoff Brian
Published: December 2015

Introduction: New technology options are being provided on modern ultrasound machines such as tissue harmonic imaging, panoramic imaging, encoded pulses, mechanical and matrix 4D ultrasound and elastography. The increase in available features requires enhanced knowledge of the clinical benefits associated with each feature and of the additional diagnostic information in the images. However the question arises as to the necessity of understanding how these new technologies work. Also, ultrasound machines have become much more automated in recent years, with designers making it easier for users to produce excellent quality images with minimal technical input.

Discussion: System presets provide adjustments to a variety of basic settings without the user requiring the knowledge of what each setting is doing. The developments in machine design and the increased level of automation pose an interesting question for sonologists and sonographers: Is there a need to know as much about the physical principles of ultrasound today as was required in the past?

Conclusion: To answer this question, this article will look at just one recent advance in ultrasound – Tissue Harmonic Imaging. The various mechanisms of this technology will be discussed with reference to the underlying principles of basic ultrasound physics. The conclusion provided is that a good grounding in the physics of ultrasound remains of vital importance in understanding new technologies and enabling informed decisions to be made on their use.
Sonographically detected thickened small bowel in a case of paediatric Salmonella Typhimurium enteritis
Authors: Whitehall John , Edwards Mathew , Phan David , Thambugala Aruni
Published: December 2015

Introduction: A five‐year‐old year old girl developed fever of 40.3° C, vomiting, mild general abdominal pain, followed by bloody diarrhea.

Description: Ultrasonography revealed a length of symmetrically thickened terminal ileum, more than 20 cm long, with walls greater than 0.5 cm containing a long narrow lumen < 1 mm wide.

Conclusion: Given the difficulty of diagnosing the cause of enteritis in young children, ultrasonography represents a simple, non invasive technique which may demonstrate suggestive mural thickening.
Book review
Authors: White Alison
Published: December 2015

A Sonographer's Guide to the Assessment of Heart Disease Bonita Anderson RRP $169.00 ISBN‐13: 9780992322205 Publisher: MGA Graphics 507 pages
Ultrasound for knee effusion: lipohaemarthrosis and tibial plateau fracture
Authors: Rippey James
Published: December 2015

Knee trauma and effusion are common Emergency Department presentations. This article outlines the clinician's sonographic approach to knee effusion detection and localisation. A case where lipohaemarthrosis was detected with ultrasound is demonstrated, and the characteristic appearance of this pathology discussed. The sonographic detection of the associated tibial fracture is also demonstrated.