Portable Ultrasound Research Articles

Diagnostic Accuracy and Prognostic Significance of Point-Of-Care Ultrasound (POCUS) for Traumatic Cervical Spine in Emergency care setting: A Comparison of clinical outcomes between POCUS and Computed Tomography on a Cohort of 284 Cases and Review of Literature.

Background:The cervical spine is injured in approximately 3% of major trauma patients, and 10% of patients with serious head injury. Therefore, clearance of the cervical spine in multitrauma patients is a critically important task. This is particularly important, considering that there is a positive correlation between a Glasgow Coma Scale of <14 and cervical spine injury. Radiography is not sensitive enough to rule out cervical spine injury, especially as radiography done in the trauma setting is usually technically unsatisfactory.Objective:The current study aims to assess the diagnostic accuracy and prognostic significance of using bedside point-of-care ultrasound (POCUS) in traumatic cervical spine injuries compared to computed tomography (CT) as the reference standard.Materials and Methods:This comparative study enrolled 284 patients with severe multiple trauma at a tertiary care center between July 2017 and March 2020. The inclusion criteria included an indication of cervical spine CT scan, satisfaction of patients with participation in the study, and the lack of history of injury and severe traumatic events. The exclusion criteria were the history of a previous cervical spinal trauma, spondylosis, scoliosis, spinal tuberculosis, degenerative vertebral changes, and patients who refused to give consent to participate in research or CT scanning. The data were analyzed by SPSS software, and sensitivity, specificity, and positive predictive value (PPV)/negative predictive value (NPV) were determined based on CT findings.Results:The best window for the cervical spine was through the anterior triangle using the linear array probe (6–13 MHz). POCUS had a sensitivity of 78.5%, specificity of 98.4%, PPV of 93.2%, NPV of 92.8%, and accuracy of 93.2% in detecting all types of spinal injuries in comparison with CT scan as the standard modality. POCUS had a sensitivity of 100%, specificity of 92.3%, PPV of 62.3%, NPV of 100%, and accuracy of 91.7% in cases with the movement of injured particles. POCUS had a sensitivity of 32.2%, specificity of 100%, PPV of 100%, NPV of 91.4%, and accuracy of 90.8% in detecting the fracture of transverse process. POCUS had a sensitivity of 36.1%, specificity of 100%, PPV of 100%, NPV of 98.1%, and accuracy of 98.4% in ≤14-year age multitrauma patients. In comparison, the current study achieved a sensitivity of 79.4%, specificity of 95.7%, PPV of 92.1%, NPV of 86.3%, and accuracy of 88.6% in >14-year age multitrauma patients.Conclusion:POCUS for cervical spine is feasible using portable ultrasound machine and by neurosurgeons/radiologists/emergency physicians with basic training. It holds great potential in resource-starved settings and in unstable patients for ruling out unstable cervical spine injuries and injuries associated with the movement of fractured or dislocated particles. POCUS examination of the cervical spine was possible in the emergency setting and even in unstable patients and could be done without moving the neck. Future studies, ideally conducted as randomized control trials, are required to establish training and education standards, and to assess the feasibility and safety of POCUS as an alternative to radiography.

Lightweight Transfer Learning Models for Ultrasound-Guided Classification of COVID-19 Patients

Lightweight deep convolutional neural networks (CNNs) present a good solution to achieve fast and accurate image-guided diagnostic procedures of COVID-19 patients. Recently, advantages of portable Ultrasound (US) imaging such as simplicity and safe procedures have attracted many radiologists for scanning suspected COVID-19 cases. In this paper, a new framework of lightweight deep learning classifiers, namely COVID-LWNet is proposed to identify COVID-19 and pneumonia abnormalities in US images. Compared to traditional deep learning models, lightweight CNNs showed significant performance of real-time vision applications by using mobile devices with limited hardware resources. Four main lightweight deep learning models, namely MobileNets, ShuffleNets, MENet and MnasNet have been proposed to identify the health status of lungs using US images. Public image dataset (POCUS) was used to validate our proposed COVID-LWNet framework successfully. Three classes of infectious COVID-19, bacterial pneumonia, and the healthy lung were investigated in this study. The results showed that the performance of our proposed MnasNet classifier achieved the best accuracy score and shortest training time of 99.0% and 647.0 s, respectively. This paper demonstrates the feasibility of using our proposed COVID-LWNet framework as a new mobile-based radiological tool for clinical diagnosis of COVID-19 and other lung diseases.

Impact of intestinal ultrasound with a portable system in the management of Crohn's disease.

BackgroundIntestinal ultrasound (IUS) is a valid cross-sectional imaging technique for the evaluation of Crohn’s disease (CD). With advancements in technology, portable ultrasound systems are becoming widely available, and the inevitable change to their use by non-radiologist clinicians would be a valuable contribution to improving patient care. This study aimed to investigate the diagnostic yield of IUS examination performed by a gastroenterologist with a portable system as an adjunct imaging modality in the routine care of CD patients.MethodsA total of 117 CD patients were assessed by IUS imaging. Pre- and post-IUS clinical-management decisions were recorded. The primary outcome was to evaluate the change in the patients’ clinical-management decision following the IUS examination. The diagnostic accuracy was compared against the reference decision reached via a multidisiplinary meeting after the evaluation of all patient-related data. The endoscopic disease activity was determined using the simple endoscopic score for Crohn's disease (SES-CD).ResultsThe initial clinical-management decision was changed in 47 patients (40.2%) after the IUS examination (P = 0.001). The accuracy of patient-management decisions improved from 63.2% to 90.6% in comparison to reference decisions (P < 0.001). After IUS examination, a further 13 cases (11.1%) were identified for urgent surgical/interventional procedures. The accuracy of colonoscopic (SES-CD ≥3) assessment was shown to be comparable to that of IUS (94% vs 91%). The sensitivity for disease presence was 95% with colonoscopy and 94% with the IUS assessment.ConclusionIUS examination with the use of a portable ultrasonography system significantly improves clinical-management decisions. With further supporting data, this practice would possibly become a requirement for CD management.

Point-of-Care Ultrasound and Modernization of the Bedside Assessment.

Point-of-Care Ultrasound and Modernization of the Bedside Assessment.

English

BACKGROUND Road traffic accidents are the most common cause of thoracic and abdominal trauma. The role of point of care ultrasound especially in developing countries is gaining evidence in management of acutely ill. We wanted to test the reliability of Fast and E-Fast in blunt abdominal and thoracic trauma cases and evaluate their role in the management of RTAs. METHODS A cross sectional study was conducted over a 12-month period among patients presenting at Emergency Medicine Department at Government Medical College, Kannur (then known as Academy of Medical Sciences, Pariyaram). After clinical examination and recording details, fast and E-Fast was done in the emergency department by emergency physicians trained in ATLS using a standard curvilinear probe of 2 - 5 MHz using Sonosite M-Turbo portable ultrasound machine (Fujifilm Sonosite) and compared with the gold standard CT. The CT used was 16 slice Spiral CT scan machine by GE Healthcare (Chicago, Illinois, United States). Results on continuous measurements presented on mean + SD (min-max) and results on categorical measurements were presented in numbers (%). Sensitivity and specificity were computed for analysis. RESULTS The overall sensitivity of Fast is 72.8 % and the specificity is 92 %. The overall sensitivity and specificity of E-Fast are 87 % and 92.3 % respectively. The reliability of point of care ultrasound as a screening tool to triage patients with blunt abdominal and thoracic trauma is 100 %. CONCLUSIONS Fast and E-Fast are quite reliable as screening tools in the management of acutely ill blunt trauma abdomen and chest patients. KEYWORDS Point of Care, Ultrasound, Blunt Trauma, Sensitivity, Fast, E-Fast

Perioperative Point-of-Care Ultrasound in Children.

Anesthesiologists and other acute care physicians perform and interpret portable ultrasonography—point-of-care ultrasound (POCUS)—at a child’s bedside, in the perioperative period. In addition to the established procedural use for central line and nerve block placement, POCUS is being used to guide critical clinical decisions in real-time. Diagnostic point-of-care applications most relevant to the pediatric anesthesiologist include lung ultrasound for assessment of endotracheal tube size and position, pneumothorax, pleural effusion, pneumonia, and atelectasis; cardiac ultrasound for global cardiac function and hydration status, and gastric ultrasound for aspiration risk stratification. This article reviews and discusses select literature regarding the use of various applications of point-of-care ultrasonography in the perioperative period.

Inter-Stage Output Voltage Amplitude Improvement Circuit Integrated with Class-B Transmit Voltage Amplifier for Mobile Ultrasound Machines.

Piezoelectric transducers are triggered by the output voltage signal of a transmit voltage amplifier (TVA). In mobile ultrasound instruments, the sensitivity of piezoelectric transducers is a critical parameter under limited power supply from portable batteries. Therefore, the enhancement of the output voltage amplitude of the amplifier under limited power supply could increase the sensitivity of the piezoelectric transducer. Several-stage TVAs are used to increase the voltage amplitude. However, inter-stage design issues between each TVA block may reduce the voltage amplitude and bandwidth because the electronic components of the amplifier are nonlinearly operated at the desired frequency ranges. To compensate for this effect, we propose a novel inter-stage output voltage amplitude improvement (OVAI) circuit integrated with a class-B TVA circuit. We performed fundamental A-mode pulse-echo tests using a 15-MHz immersion-type piezoelectric transducer to verify the design. The echo amplitude and bandwidth when using an inter-stage OVAI circuit integrated with a class-B TVA circuit (696 mVPP and 29.91%, respectively) were higher than those obtained when using only the class-B TVA circuit (576 mVPP and 24.21%, respectively). Therefore, the proposed OVAI circuit could be beneficial for increasing the output amplitude of the class-B TVA circuit for mobile ultrasound machines.

Bedside ultrasound assessments of jugular venous compliance to track central venous pressure change during the treatment of decompensated heart failure

Abstract Background Accurate volume status assessment is crucial for the treatment of acute decompensated heart failure (ADHF). Volume status assessment by physical exam is inaccurate, necessitating invasive measurement with right heart catheterization (RHC), which carries safety, pragmatic (scheduling, holding anticoagulants, etc) and financial burdens. Therefore, a reliable, non-invasive, cost-effective alternative is desired. Previously, we developed an ultrasound (US) based technique to measure internal jugular vein (IJV) compliance during RHC which was used for single time point central venous pressure (CVP) predictions. We now aim to apply this technique to track acute changes in CVP during diuresis for ADHF in patients with an in-dwelling pulmonary artery catheter. Purpose The objective of our study was to devise a rapid, portable and reliable alternative to RHC to track acute volume changes during treatment of ADHF. Methods We used an observational, prospective study design and recruited 15 patients from the CCU between 7/19–12/19 being treated for ADHF (systolic or diastolic) with IV diuretics +/−inotropic agents who underwent PA catheter insertion for continuous CVP monitoring. 13 of 15 patients received milrinone infusions. US images of the IJV were obtained at end expiration and during the strain phase of Valsalva at multiple 2–3 hr intervals. Change in IJV cross sectional area (ImageJ) was used as a measure of IJV compliance. Patients unable to perform the Valsalva maneuver and on mechanical circulatory support were excluded. Results Calculated % change in CSA of IJV was plotted against CVP. An inverse relationship was observed between CVP and % change in CSA of IJV. The data was fit with an inverse exponential regression shown in Figure 1 (R2=0.36, root mean square error = 3.19). Fivefold cross validation showed a stable model for predicting CVP based CSA (R2=0.34, root mean square error = 3.26) Conclusion Serial portable US assessment of IJV compliance can act a surrogate measure of CVP and,therefore, can provide reliable information on acute hemodynamic changes in ADHF. Funding Acknowledgement Type of funding source: None

Diagnosing skull fracture in children with closed head injury using point-of-care ultrasound vs. computed tomography scan.

Diagnostic and therapeutic interventions in children for traumatic brain injury, which is known as the most important complication in trauma, require special attention. This study aimed to evaluate the accuracy of point-of-care ultrasound (POCUS) in diagnosing skull fracture in children with closed head injury in comparison with computed tomography (CT) scan. The current prospective cross-sectional study was conducted on children (0–14 years old), who were referred to the emergency department of a general teaching hospital in Shiraz, southern Iran (January–March 2018), with close head injury and were suspected of bone fracture. The participants were selected using a convenience sampling. The results of POCUS performed by emergency medicine (EM) residents were compared with the results of CT scan, which was reported by radiologists and considered a gold standard. Then, diagnostic tests were calculated. A total of 168 children were enrolled, with the mean ± standard deviation age of 6.21 ± 3.99. The most affected areas in the skull were the frontal (34.5%) and occipital areas (33.3%). POCUS had a sensitivity and specificity of 81.8% (95%CI, 48.2–97.7%) and 100% (95%CI, 97.7–100%), respectively. Positive and negative predictive values were 100% and 98.7%, with an accuracy of 98.8% in comparison with CT scan in the diagnosis of skull fracture.Conclusion: The results showed that POCUS with a portable ultrasonography machine, performed by the EM’s physicians, have high diagnostic precision and can be considered a tool in the management of patients with closed head injury.What is Known:• Some studies have investigated the accuracy of ultrasound in diagnosing skull bone fractures in children with closed head injury, but before conducting this survey, no definite evidence recommended POCUS for skull fracture in children with closed head trauma in the ED.What is New:• POCUS with a portable ultrasonography machine, performed by the EM’s physicians, has high diagnostic precision and can be considered a tool in the management of patients with closed head injury.

Using Dynamic Portable Ultrasonography for the Diagnosis of Lateral Ankle Instability

Category:Sports; AnkleIntroduction/Purpose:Destabilizing injuries to the lateral ligament have relied on physical examination and radiographic stress test for diagnosis, with a focus on anterior translation and tilting of the talus relative to the tibial bone. Portable ultrasonography (PUS) has increasingly been used in the clinical setting, allowing dynamic and non-invasive evaluation. The primary aim of this study was to assess the anterior translation and tilting of the talus with PUS in various stages of lateral ankle ligamentous injury.Secondary, we compared the instability values measured with PUS with those measured on fluoroscopy. Third, we aimed to determine the optimal cutoff values of the PUS that distinguish stable from unstable state.Methods:8 fresh-frozen cadaveric specimens underwent PUS and fluoroscopic evaluation for lateral ankle stability. The assessment was done with all ligaments intact and later with sequential transection of the anterior-talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior-talofibular ligament (PTFL). In all scenarios, 2 loading conditions were considered; 1) Performing the anterior drawer test under 50N and 80N of force, anterior translation was measured with PUS and fluoroscopy; 2) Performing the talar tilt test under 1.7Nm of torque, the lateral clear space (the distance between the fibular tip and lateral process of the talus) was measured with PUS, and the talar tilt angle was measured with fluoroscopy (Figure1).Pearson’s and Spearman’s rank correlation was used to determine the correlation. Youden’s J statistic was used to determine the optimal cutoff values for the PUS to distinguish intact or ATFL injury versus ATFL-CFL or ATFL-CFL-PTFL injuries under various loading conditions.Results:Strong positive correlations were found between PUS and fluoroscopic measurements (Pearson correlation:r=0.78- 0.85). PUS and fluoroscopic measurements during anterior translation and talar tilt test increased as additional ligaments were transected (Spearman’s rank correlation: anterior translation; r=0.74, p < 0.001: talar tilt; r=0.81, p<0.001). Inter-rater and intra- rater reliability for PUS and fluoroscopic measurements were all excellent (ICCs >=0.8). The optimal PUS cutoff values for distinguishing intact or ATFL injury from ATFL-CFL or ATFL-CFL-PTFL injuries were >=3.40mm (sensitivity 87.5%, specificity 81.25%) and >=4.78mm (sensitivity 87.5%, specificity 81.25%) of anterior talar translation under 50N and 80N of force respectively, as well as >=3.09mm (sensitivity 75%, specificity 93.75%) of the lateral clear space under 1.7Nm of torque.Conclusion:Portable ultrasonography for the diagnosis of lateral ankle instability was strongly correlated with fluoroscopic findings, and thus, can be a valuable diagnostic tool at the point of care. We recommend future in vivo research to investigate the accuracy of this new ultrasound application in a clinical setting.

Using Portable Ultrasound to Measure the Effect of Lateral Ankle Ligament Injury on Syndesmotic Stability: A Cadaveric Study

Category:Ankle; Sports; TraumaIntroduction/Purpose:About one-fifth of all patients diagnosed with an ankle sprain also suffer a ligamentous injury of the ankle syndesmosis. Despite the common concomitant injuries, it is still unclear whether there is a direct contribution of the lateral ligaments towards stabilizing the syndesmosis. Portable ultrasonography (PUS) has increasingly been used in the clinical setting, allowing dynamic and non-invasive evaluation at the point of care. The primary aim of this study was to assess to what extent lateral ankle ligaments contribute to syndesmotic stability in the sagittal and rotational plane using PUS. Secondary, we determine if PUS is a reliable tool for the assessment of syndesmotic instability. Our primary hypothesis was that lateral ankle ligaments contribute significantly to the stability of the ankle syndesmosis.Methods:16 fresh-frozen cadaveric specimens were equally divided into 2 groups that underwent PUS evaluation for syndesmotic stability. The assessment was done at the intact state and later with sequential ligament transection. In group 1, the anterior talofibular ligament (ATFL) was transected, followed by the calcaneofibular ligament (CFL), the posterior talofibular ligament (PTFL), the anteroinferior tibiofibular ligament (AITFL), the interosseous ligament (IOL), and the posteroinferior tibiofibular ligament (PITFL). In group 2, the transection started with the AITFL then followed by the ATFL, the CFL, the IOL, the PTFL, and the PITFL. PUS measurements were performed during anterior to posterior (AP), posterior to anterior (PA), and external rotated loading condition (Figure 1). One-way ANOVA and post hoc Dunnett test were used to compare the findings of each state to the intact. Besides, we assessed the inter-rater and intra-rater reliability using the intraclass correlation coefficient (ICC) through a two-way mixed-effects model.Results:In group 1, showed that compared to the intact stage, fibular translation in the sagittal plane and the anterior tibiofibular clear space (TFCS) distance did not increase after transection of all three lateral ankle ligaments. However, the syndesmotic PUS measurements did increase after subsequent transection of the AITFL and IOL (p-values ranging from 0.047 to <0.001). In group 2, the AP translation of the fibula in sagittal plane, as well as the anterior TFCS distance, only increased significantly after transection of at least two syndesmotic ligaments (AITFL, IOL) together with two lateral ligaments (ATFL and CFL) (p-values ranging from 0.047 to <0.001). The ICCs Inter-rater and intra-rater reliability for syndesmotic PUS measurements ranged from 0.84-0.95, indicating excellent agreement.Conclusion:PUS is a reliable tool for the assessment of syndesmotic instability. Using PUS we found that lateral ankle ligaments contribute marginally to the stability of the ankle syndesmosis. Syndesmotic sagittal and rotational plane instability occurred after injury to all three syndesmotic ligaments or after partial syndesmotic injury (AITFL+IOL) with concomitant two or more lateral ankle ligament injury. The intraclass correlation coefficient for the sagittal and rotational plane assessment of syndesmosis using PUS indicated excellent inter- and intraobserver agreement, and thus, can be a valuable diagnostic tool at the point of care.

Portable Dynamic Ultrasonography Versus Fluoroscopy for the Evaluation of Syndesmotic Instability: A Cadaveric Study

Category:Ankle; TraumaIntroduction/Purpose:Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The purpose of this study was to determine the association between tibiofibular clear space (TFCS) values measured with 1) a portable ultrasound (US) device and 2) fluoroscopy during applied external roation stress for the evaluation of syndesmotic instability.Methods:Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used in this study. Portable US device (Butterfly iQ, Butterfly Network Inc) images and fluoroscopic images taken by a mini C-arm were used to evaluate the ankle syndesmosis in the intact stage, and after sequentially sectioning of the anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL) at 7.5Nm torque. A Pearson’s correlation was performed to investigate the correlation between the TFCS among the two modalities. A paired t-test was used to compare TFCS values measured with US or fluoroscopy. Three cadavers were measured by two independent observers to assess reliability of the measurements for each diagnostic modality and analyzed using intraclass correlation coefficients (ICC). P-values of < 0.05 were considered significant.Results:The mean TFCS (+- SD mm) values measured with the US and fluoroscopy are presented in Table 1. TFCS values obtained with the US and fluoroscopy correlated (rho 0.60). Between the imaging modalities similar TFCS values were found in the intact state (difference 0.81+-1.0, p-value 0.061). Compared with fluoroscopy, the TFCS values measured using US increased significantly after sequential transection of the AITFL (0.039), IOL (p=0.004) and PITFL (p<0.001). The ICC for measuring the TFCS with US was 0.86 and 0.84 with fluoroscopy indicating excellent agreement.Conclusion:During application of an external rotation force to the ankle, US and fluoroscopic TFCS measurements among different stages of syndesmotic ligamentous injury correlate. However, compared with fluoroscopy, a portable US ultrasound device seems to be a more sensitive diagnostic technique to evaluate subtle syndesmotic instability.

Windkessel Model-Based Cuffless Blood Pressure Estimation Using Continuous Wave Doppler Ultrasound System

Blood pressure (BP) measurement plays an essential role in the prevention of cardiovascular diseases. Studies have demonstrated Ultrasound (US) based BP analysis method combining with peripheral components of the circulatory system. In this paper, a cuffless BP measurement technique has been proposed using a portable continuous wave Doppler US system which consumes < 4 Watt of power. The US blood flow signal acquired utilizing 8 MHz pencil transducer probe from the brachial artery is denoised using soft thresholding method. The spectrogram envelope of maximum frequency is obtained by an adaptive signal noise slope intersection (SNSI) method to extract hemodynamic features. In the proposed method, 2-element Windkessel (WK) model consisting of peripheral resistance and arterial compliance is employed for BP estimation. Based on the extracted features, a machine learning algorithm determines the WK model parameters. From the experiments conducted on 85 subjects, it has been observed that both systolic and diastolic BP achieve Grade B and Grade C for British Hypertension Society (BHS) and IEEE Std. 1708 protocols, respectively. Regarding Association for the Advancement of Medical Instrumentation (AAMI) standard, diastolic BP estimation error is within an acceptable limit. The robustness of the approach is examined using pre-exercise and post-exercise performance of 10 subjects. Moreover, the effect on arterial compliance for increased BP and aging is observed to characterize the dynamic property of arterial system. The proposed method is non-invasive, non-occlusive, independent of any additional interfaces, operates with a small dataset and worthy of implementation as a portable system for point-of-care application.

Current role of imaging in COVID-19 infection with recent recommendations of point of care ultrasound in the contagion: a narrative review.

Radiological studies have an important role in the diagnosis and follow up of many infectious diseases. With current pandemic of Coronavirus disease 2019 (COVID-19) though the molecular analysis with reverse transcriptase polymerase chain reaction (RT-PCR) remains the cornerstone of diagnosis, the critical role of chest imaging including CT scan and baseline X-ray became apparent early in the course due to concern for less than optimal sensitivity of PCR testing. Delay in molecular diagnosis due to a shortage of testing kits and laboratory personnel also makes imaging an important modality in early diagnosis for appropriate triage and isolation decisions. CT scan technology is widely available in developed parts of the world but in developing countries, CT scanner is not widely available especially in rural settings. CT imaging usually requires patient movement to the radiology department and the scanner is not easy to disinfect. Point of care ultrasound (POCUS) has been used for many years in the assessment of critically ill patients in emergency departments and intensive care units. It is rapidly gaining popularity across many specialties and part of many general medicine training programs across the United States. It can be learned rapidly and with experienced hands, POCUS can help identify disease patterns in the lung parenchyma, and during the current pandemic has been gaining special attention. In this article, we review the most prominent imaging findings on chest X-ray and CT scan in patients with COVID-19. We also focus on the background and evolution of POCUS with studies showing the promising role of this diagnostic modality in COVID-19 infection. In addition, we describe step by step guidance on the use and disinfection of the portable ultrasound machine.

Performance of portable handheld ultrasound system in fetal therapy.

Performance of portable handheld ultrasound system in fetal therapy.

Use of a portable ultrasound machine to determine pregnancy and uterine litter size for wild Gunnison’s prairie dogs (Cynomys gunnisoni)

Accurate estimates of population dynamics play a major role in formulating conservation strategies for Gunnison’s prairie dogs (Cynomys gunnisoni) and other keystone species. Over 5 years (2014–2018) at Valles Caldera National Preserve in NM, USA, we used a portable ultrasound machine (PUM) to investigate the presence or absence of pregnancy, and to determine uterine litter size for 238 pregnant female Gunnison’s prairie dogs from two colonies. We compared litter size at weaning for 168 of these 238 females and we found no significant difference between uterine litter size and litter size at weaning. For 76 of these 168 females (45%), estimates of uterine litter size and litter size at weaning were identical. We detected no significant variation among years for uterine litter size versus litter size at weaning. To our knowledge, our research is the first to compare uterine litter size to litter size at weaning for the same group of females living under natural conditions.

A Field-based Three-Compartment Model Derived from Ultrasonography and Bioimpedance for Estimating Body Composition Changes.

The purpose of this study was to assess the agreement between a field-based three-compartment (3CFIELD) model and a laboratory-based three-compartment (3CLAB) model for tracking body composition changes over time. Resistance-trained males completed a supervised nutrition and resistance training intervention. Before and after the intervention, assessments were performed via air displacement plethysmography (ADP), bioimpedance spectroscopy (BIS), portable ultrasonography (US), and bioelectrical impedance analysis (BIA). ADP body density and BIS body water were used within the reference 3CLAB model, whereas US-derived body density and BIA body water were used within the 3CFIELD model. Two-compartment model body composition estimates provided by US and BIA were also examined. Changes in fat-free mass and fat mass were analyzed using repeated-measures ANOVA, equivalence testing, Bland-Altman analysis, linear regression, and related validity analyses. Significant increases in fat-free mass (3CLAB, 4.0 ± 4.5 kg; 3CFIELD, 3.9 ± 4.2 kg; US, 3.2 ± 4.3 kg; BIA, 3.9 ± 4.2 kg) and fat mass (3CLAB, 1.3 ± 2.2 kg; 3CFIELD, 1.4 ± 2.2 kg; US, 2.1 ± 2.6 kg; BIA, 1.4 ± 2.9 kg) were detected by all methods. However, only the 3CFIELD model demonstrated equivalence with the 3CLAB model. In addition, the 3CFIELD model exhibited superior performance to US and BIA individually, as indicated by the total error (3CFIELD, 1.0 kg; US, 1.8 kg; BIA, 1.6 kg), 95% limits of agreement (3CFIELD, ±2.1 kg; US, ±3.3 kg; BIA, ±3.1 kg), correlation coefficients (3CFIELD, 0.79-0.82; US, 0.49-0.55; BIA, 0.61-0.72), and additional metrics. The present study demonstrated the potential usefulness of a 3CFIELD model incorporating US and BIA data for tracking body composition changes over time, as well as its superiority to US or BIA individually. As such, this accessible multicompartment model may be suitable for implementation in field or limited-resource settings.

Comparison of the Effectiveness of Portable Ultrasound vs Portable X-Ray as Diagnostic Imaging of Knee Structures in Clinical Medicine

Background: Imaging techniques are providing physicians an opportunity to ensure more accurate diagnostics. While MRI and CT are the gold standard diagnostic tools, they are not utilized as primary diagnostic tools due to their size, immobility, and exposure to radiation. It is not always feasible or practical to wait for a technician in an emergency department to conduct these examinations. As technology continues to advance, diagnostic tools are becoming more portable. X-ray and ultrasound are utilized to diagnose, as well as exclude potential causes of illness. Our objective is to determine which diagnostic tool is more efficient in diagnosing patella/knee injuries.&#x0D; Methods: This systematic review aims to determine which diagnostic tool is more efficient at diagnosing injuries. By collecting and reviewing existing research to compare the limitations of injury detection, the accessibility and portability of both diagnostic machines, the safety in regards to radiation exposure to patient and physician, the reliability of the diagnoses, and the costs of each machine&#x0D; Results: Of the reviewed articles, 58% of the articles focusing on knee injuries indicated that ultrasound imaging is a superior diagnostic instrument due to its efficacy and accessibility. When comparing ultrasound to x-ray directly, it was shown that ultrasound is a more precise diagnostic tool.&#x0D; Conclusion: Ultrasound imaging is a more effective diagnostic tool than x-ray. It is better able to diagnose bone, soft tissue, and vessel injuries. It is a safer tool for both the patient and the physician because it uses sound rather than radiation to produce an image. It is also more accessible as advances in technology have made portable ultrasounds a protocol for quick assessments of injuries.

USNS COMFORT (T-AH 20) Surgical Services Response to the COVID-19 Pandemic in New York City.

USNS COMFORT (T-AH 20) Surgical Services Response to the COVID-19 Pandemic in New York City.

A Portable Ultrasound System for Detecting Food Sweetness Based on Chewing Dynamics: A Preliminary Investigation

Type 1 diabetes (T1D) is an incurable disease that affects 1.25 million Americans. Diabetic patients typically rely on subcutaneous insulin infusions to regulate their glucose levels. A major contributor to their blood glucose levels is the amount of sugar intake, which cannot be easily tracked. While ultrasound imaging has been used to investigate the relationship between food characteristics and tongue movement, the technique utilized a bulky transducer array that cannot be translated into daily monitoring. Capitalizing on advanced electronics and data processing technologies, we developed a portable system that utilizes only a single ceramic disk to quantify the tongue movement in response to various levels of sweetness. After acquiring 32 subject datasets, we found a significant correlation between food sweetness and tongue movement. Our system can potentially be miniaturized into a wearable device for monitoring sugar intake, which will ultimately help T1D patients to better monitor and control their blood glucose levels and balance their diets accordingly.