US Assessment Research Articles

Synovitis in rheumatoid arthritis detected by grey scale ultrasound predicts the development of erosions over the next three years.

ObjectivesTo evaluate grey scale US (GSUS) and power Doppler US synovitis (PDUS), separately or in combination (CombUS), to predict joint damage progression in RA.MethodsIn this cohort study nested in the Swiss RA register, all patients with sequential hand radiographs at their first US assessment were included. We analysed the summations of semi-quantitative GSUS, PDUS and CombUS assessments of both wrists and 16 finger joints (maximum 54 points) at their upper limit of normal, their 50th, 75th or 87.5th percentiles for the progression of joint damage (ΔXray). We adjusted for clinical disease activity measures at baseline, the use of biological DMARDs and other confounders.ResultsAfter a median of 35 months, 69 of 250 patients with CombUS (28%), 73 of 259 patients with PDUS (28%) and 75 of 287 patients with available GSUS data (26%) demonstrated joint damage progression. PDUS beyond upper limit of normal (1/54), GSUS and CombUS each at their 50th (9/54 and 10/54) and their 75th percentiles (14/54 and 15/54) were significantly associated with ΔXray in crude and adjusted models. In subgroup analyses, GSUS beyond 14/54 and CombUS higher than 15/54 remained significantly associated with ΔXray in patients on biological DMARDs, while clinical disease activity measures had no significant prognostic power in this subgroup.ConclusionHigher levels of GSUS and CombUS are associated with the development of erosions. GSUS appears to be an essential component of synovitis assessment and an independent predictor of joint damage progression in patients on biological DMARDs.

Sleep problems are associated with academic performance in a national sample of collegiate athletes

Objective Examine associations between a range of sleep problems and academic performance in a national sample of collegiate athletes. Participants: Data were obtained from the National College Health Assessment of US college/university students from 2011–2014 (N = 8,312 collegiate athletes). Methods: Univariate comparisons for all sleep variables and demographics were stratified across GPA, using one-way ANOVA for continuous variables and chi-square for categorical variables. Multinomial logistic regression models, with GPA as outcome (reference = A) and sleep variable as predictor, were examined and adjusted for age, sex, and survey year. Ordinal regression examined a 1-level change in GPA associated with each sleep variable, adjusted for covariates. Results: Sleep difficulty was associated with increased likelihood of B/C averages. Initial-insomnia was associated with increased likelihood of B/C, and D/F averages. Tiredness was associated with increased likelihood of B/C, and D/F averages. Conclusions: Sleep problems are highly prevalent and associated with poorer academic performance in collegiate athletes.

ASSESSMENT OF INFERIOR VENA CAVA DIAMETER MEASURED BY ULTRA-SONOGRAPHY IN CORRELATION WITH CENTRAL VENOUS PRESSURE VALUE IN PATIENTS WITH SEPSIS

Background: Bedside ultrasound is potentially a useful noninvasive adjunct to estimate the intravascular volume status in sepsis. Aim of the work: Evaluating the correlation between inferior vena cava diameter measured non-invasively with ultrasonography versus central venous pressure in assessment of intravascular volume status in patients with sepsis.Patients and methods: The study was conducted on sixty patients with sepsis (30 ventilated and 30 non-ventilated) in the Respiratory Intensive Care Unit at Abbassia Chest Hospital from January 2018 to September 2018. For all included patients demographic data were collected Recording vital sings, mean arterial pressure and Pao2/ Fio2were done. Laboratory investigation including complete blood count, serum lactic acid, arterial blood gas, quantitative C-reactiveprotein were also done. Sequential Organ Failure Assessment score (SOFA), Qsofa and Acute Physiology And Chronic Health Evaluation II score (APACHE II) were recorded. Finally measurement of IVC, CVP and intra-abdominal pressure were done Results: Males represent 75%while female were 25%withmean age of (47.40±14.49) years. The mean CVP was 12.48±3.78 cmH2O with an IVC maximum diameter of 17.95±3.28 mm and collapsibility index of 50.55±11.83 %. There was statistically significant positive correlation between CVP and IVC dmax and statistically significant negativecorrelation between CVP and IVC CI (%)in both ventilated and non ventilated groups. Also, CVP and IVC dmax were significantly correlated with outcome in both ventilated and non ventilated patients. The higher values of CVP and IVC dmax and the lower the value of IVC CI, the higher rates of mortality. Conclusion: US assessment of IVC diameter and caval index are simple and non invasive methods to assess intravascular volume status.

Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis.

To develop and test the reliability of a new semiquantitative scoring system for the assessment of cartilage changes by ultrasound in a web-based exercise as well as a patient exercise of patients with RA. A taskforce of the Outcome Measures in Rheumatology Ultrasound Working Group performed a systematic literature review on the US assessment of cartilage in RA, followed by a Delphi survey on cartilage changes and a new semiquantitative US scoring system, and finally a web-based exercise as well as a patient exercise. For the web-based exercise, taskforce members scored a dataset of anonymized static images of MCP joints in RA patients and healthy controls, which also contained duplicate images. Subsequently, 12 taskforce members used the same US to score cartilage in MCP and proximal interphalangeal joints of six patients with RA in in a patient reliability exercise. Percentage agreement and prevalence of lesions were calculated, as intrareader reliability was assessed by weighted kappa and interreader reliability by Light's kappa. The three-grade semiquantitative scoring system demonstrated excellent intrareader reliability (kappa: 0.87 and 0.83) in the web-based exercise and the patient exercise, respectively. Interreader reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.48) in the patient exercise. Our study demonstrates that ultrasound is a reliable tool for evaluating cartilage changes in the MCP joints of patients with RA and supports further development of a new reliable semiquantitative ultrasound scoring system for evaluating cartilage involvement in RA.

Overcoming long Bayesian run times in integrated fisheries stock assessments

Abstract Bayesian inference is an appealing alternative to maximum likelihood estimation, but estimation can be prohibitively long for integrated fisheries stock assessments. Here, we investigated potential causes of long run times including high dimensionality, complex model structure, and inefficient Bayesian algorithms for four US assessments written in AD Model Builder (ADMB), both custom built and Stock Synthesis models. The biggest culprit for long run times was overparameterization and they were reduced from months to days by adding priors and turning off estimation for poorly-informed parameters (i.e. regularization), especially for selectivity parameters. Thus, regularization is a necessary step in converting assessments from frequentist to Bayesian frameworks. We also tested the usefulness of the no-U-turn sampler (NUTS), a Bayesian algorithm recently added to ADMB, and the R package adnuts that allows for easy implementation of NUTS and parallel computation. These additions further reduced run times and better sampled posterior distributions than existing Bayesian algorithms in ADMB, and for both of these reasons we recommend using NUTS for inference. Between regularization, a faster algorithm, and parallel computation, we expect models to run 50–50 000 times faster for most current stock assessment models, opening the door to routine usage of Bayesian methods for management of fish stocks.

Hand Carried Ultrasound Utilization in Acute Heart Failure Patients, Does It Correlate with Physical Examination?

Purpose Evaluation of intravascular volume is an essential component of clinical management of acute heart failure (HF) patients. Correlation between physical examination and ultrasound measurements has not been well studies and was the focus of this investigation. Methods We prospectively studied patients admitted to the medical floor with acute heart failure exacerbation between January 2017 to October 2018. Assessment of volume status by physical examination (PE) was performed by heart failure team, and classified patient's volume status into (0- euvolemic, 1- Mildly overloaded, 2- Moderately overloaded, 3- Severely overloaded), then central venous pressure (CVP) was measured using hand carried US (assessment of inferior vena cava size and respiratory variation, right and left jugular veins size, respiratory variation and compressibility). Spearman's correlation was used to correlate between PE findings and US-estimated CVP. Finally, the distribution of CVP for each PE category was provided (Figure). Results A total of 186 (Age 64±15,42% females) patients were included during study duration. (34%) patients had HF with preserved ejection fraction (HFpEF), and 104 (66%) patients had HF with reduced ejection fraction (HFrEF). The correlation between PE and US-estimated CVP was moderate at best (rho=0.41, p Conclusion Physical exam is moderately correlated with US-estimated CVP and is unreliable in directing therapy for acute HF exacerbation. Further investigations are needed to integrate hand carried US in the daily management of heart failure patients.

Ultrasound Role in Diagnosis of Carpal Tunnel Syndrome and Postoperative Evaluation in Endoscopic Carpal Tunnel Release

Carpal tunnel syndrome (CTS) represents about 90% of all entrapment neuropathies and is caused by entrapment of the median nerve while passing in the carpal tunnel. US has revealed equal effectiveness as magnetic resonance imaging (MRI) in diagnosis of CTS; however further attention should be given in case of equivocal results from nerve conduction studies (NCS) and/or before endoscopic surgical intervention. This study was conducted to evaluate the role of US in diagnosis and treatment of CTS which was done by endoscopic release. This is a prospective study including patients having CTS who were treated by endoscopic release between December 2017 and December 2018. All cases were evaluated by electrophysiological studies and US at the preoperative period. US was used to measure the cross sectional area (CSA) of the median nerve. Patients underwent endoscopic carpal tunnel release and were called for follow up after 1, 3, and 6 months for clinical and US assessment of the median nerve. Forty cases were included with mean age of 27.85 years. Numbness was the predominant symptom (92.5%) followed by wrist pain (85%). The mean diameter of median nerve showed a significant decrease at different time points (P < 0.001). The sensitivity of US in diagnosis of CTS was 87.5% in the preoperative assessment as compared to electrophysiological study. The sensitivity of US in detecting the improvement of CTS as compared to clinical examination increased from 28% at 1 month postoperative, 53.4% at 3 months to 92.1% at 6 months. Ultrasonography is a sensitive non-invasive diagnostic tool in diagnosis of CTS preoperative and diagnosis of improvement of the patients postoperatively especially at 6 months.

Overlooked Trends in Observed Global Annual Precipitation Reveal Underestimated Risks

Numerous human and environmental systems are sensitive to the spatial and temporal distribution of precipitation, including agriculture, water supply, and ecosystems. Trends in observed precipitation form an important line of evidence to understand how changes may increase system vulnerabilities. Linear trends reported in US and global climate assessments reflect changes in mean annual precipitation. Mean trends may not reflect changes across other quantiles in the precipitation probability distribution, including the tails (very high and low precipitation levels), leading to systematic mischaracterization of climate risk. Here we reanalyze global annual precipitation using quantile regression to reveal overlooked trends. We find trends in the tails inconsistent with the mean in 44.4% of land area and 40.7% of rainfed agricultural regions. Previously undetected trends offer a more accurate view of the changing climate. This work enables reappraisals of risk aggregated over thresholds in human and environmental systems, enabling revaluation of threats and identification of appropriate adaptation strategies.

Identification of a distinct imaging phenotype may improve the management of palindromic rheumatism

ObjectivesTo use high-resolution imaging to characterise palindromic rheumatism (PR) and to compare the imaging pattern observed to that seen in new-onset rheumatoid arthritis (NORA).MethodsUltrasound (US) assessment of synovitis, tenosynovitis and...

Greater magnitude of entheseal microdamage and repair in psoriatic arthritis compared with ankylosing spondylitis on ultrasound.

AS and PsA share clinical and immunological features centred on enthesitis. However, a strong association between PsA and preceding injury has been recognized. The aim of this study was to test the hypothesis that the entheseal damage seen by US is commoner in PsA patients than in AS patients. Seventy-nine AS and 85 PsA patients had US scans of 1640 entheses to calculate entheseal inflammation (hypoechogenicity, thickening and Doppler) and damage scores (calcifications, enthesophytes and erosions). Regression modelling was done to evaluate the effect of diagnoses on outcomes, controlling for age, gender, BMI, clinical enthesitis, HLA-B27, and anti-TNF use. Both inflammation and damage scores on US were correlated with BMI (r = 0.392; r = 0.320) and age (r = 0.308; r = 0.538) (P < 0.001), and men had higher inflammation scores than women [12.3 (7.5) vs 8.9 (7.3), P = 0.001]. In multivariate analysis, despite similar (anti-TNF-treated patients) or slightly less inflammation (anti-TNF-naïve patients) in the PsA group, they had 4.22 times more US damage than their counterparts with AS. The difference was even higher in the anti-TNF-naïve patients (5.6 times). On US assessment, PsA patients have greater entheseal insertion damage scores compared with AS, suggesting potential differences in tissue repair, immunobiology or response to injury at insertions.

Shear wave velocity measurements of the brachial artery in a population with end-stage renal disease

Introduction: Arterial elasticity measurements have been suggested as a possible biomarker for arterio-venous fistula failure. Elasticity can be non-invasively measured through ultrasonic induction of a shear-wave in tissue. The velocity of this wave is proportional to the square root of Young’s Modulus. This pilot study sought to assess an imaging protocol to measure elasticity in the brachial artery via shear wave elastography (SWE) and determine if differences in shear wave velocity could be observed between a healthy group, and a group with end-stage renal disease (ESRD). Methods: 40 healthy volunteers were recruited into this study. All participants underwent US assessment of brachial artery elasticity via SWE. Brachial artery SWE images of 47 patients with ESRD were retrospectively analysed for comparison. Results: Brachial artery shear wave velocity was measured from each image. The imaging protocol was possible in all volunteers. The mean shear wave velocity was significantly lower in the patient group (3.2 ± 0.5 m/s in patients; 3.4 ± 0.4 m/s in volunteers, P < 0.05). Conclusion: The results from this pilot study suggest SWE measurements of brachial artery mechanics are feasible and can quantify arterial alterations possibly associated with ESRD. SWE may find use in the pre-operative assessment for patients awaiting arterio-venous fistula creation.

Entheseal involvement in patients with systemic lupus erythematosus: an ultrasound study.

The main objective of this study is to explore the prevalence and distribution of entheseal US changes in a cohort of SLE patients, taking as controls a group including both PsA patients and healthy subjects. The secondary objective is to investigate the correlation between the US findings and the clinical and serological data in SLE patients. Clinical and US assessment of quadriceps, patellar and Achilles tendons, and plantar fascia entheses were performed by independent rheumatologists on 65 patients with SLE, 50 patients with PsA and 50 healthy subjects. US findings were identified according to the OMERACT definitions. In SLE patients, the correlation between the US changes and the clinical and laboratory findings was evaluated. US revealed one or more abnormalities in at least one enthesis in 44 out of 65 SLE patients (67.7%), 47 out of 50 PsA patients (94.0%) and 22 out of 50 healthy subjects (44.0%). In SLE patients, US findings indicating active inflammation were significantly more frequently detected than in healthy subjects (P < 0.001). The distal enthesis of the patellar tendon was the most commonly involved. The presence of power Doppler signal at the enthesis was an independent predictor of SLE disease activity (SLEDAI-2k P < 0.001, β = 0.52; musculoskeletal-BILAG P < 0.001, β = 0.56). The burden of entheseal sonographic changes was significantly higher in SLE patients than in healthy subjects, especially as regards active inflammation. The presence of power Doppler signal at the enthesis may represent a potential biomarker of SLE disease activity.

Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease.

Nail psoriasis disease is associated with an increased probability of psoriatic arthritis, and its clinical signs may have different correlates with the pathogenesis of adjacent bone destruction and have different prognostic value. Recent publications about psoriasis and nail psoriatic disease describe different ultrasonographic findings but the relationship between these ungueal alterations measured by ultrasonography and the presence of enthesopathy of the extensor digitorum has yet to be discovered. To describe which ultrasonographic characteristics of nail psoriasis are associated with the presence of subclinical enthesopathy in patients with PsO and asymptomatic PsA. Patients with psoriasis and asymptomatic psoriatic arthritis were included in the prospective study. Demographic, clinical data and PASI and NAPSI indexes were recorded of all the patients in the assessment visit. The US assessment included Achilles tendon, extensor digitorum tendon and US scan of the nail plate, nail matrix, nail bed and adjacent skin over nail matrix of the five nails of each hand. Forty-eight patients were included in the study; 33 of them presented ultrasound evidence of extensor digitorum tendon enthesopathy. Nails of the patients with subclinical enthesopathy had a higher NAPSI and skin thickness than the nails of the patients without subclinical enthesopathy (P = 0.047). Patients with asymptomatic enthesopathy had significantly thicker proximal nail folds (1.44 ± 0.312 vs. 1.23 ± 0.27, P = 0.023). Nail beds and matrices were also thicker but the differences were not statistically significant (1.77 ± 0.27 vs. 1.74 ± 0.21, P = 0.66, and 1.79 ± 0.28 vs. 1.67 ± 0.19, P = 0.10, respectively). No statistically significant differences in the trilaminar structure were found between both groups. Patients with and without asymptomatic enthesopathy of extensor digitorum tendons did not statistically differ as regards ultrasonographic alterations of the Achilles tendons (60.6% vs. 46.4%, P 0.368). Enthesopathy abnormalities can be detected by US in patients with psoriasis without musculoskeletal complaints frequently. There is a close relationship between subclinical enthesopathy of the extensor digitorum tendon and the presence of nail alterations. Further studies are required to research what implications have the presence of these ungual alterations measured by US, and how it affects later development of a PsA.

MRI is it complementary or mandatory to ultrasound in classification of different congenital anomalies of female reproductive tract?

Aim of workTo assess the added value of MRI compared to US in diagnosis of Mullerian duct anomalies and its subtypes thus guiding proper management plans. Patients and methodsFrom October 2014 to March 2015 we prospectively evaluated 50 female patients, ranging in age from 15 to 40 years. They were referred for US and MRI assessment of clinically suspected Mullerian duct anomalies. ResultsFinal diagnosis of patients includes: 8/50 (16%) cases were classified as class I, 10/50 (20%) cases were classified as class II, 22/50 (44%) cases were classified as class III, 5/50 (10%) cases were classified as class IV and 5/50 (10%) cases were not MDA. MRI was superior to US, with reported diagnostic accuracy of 100%. ConclusionThe use of diverse imaging modalities, in conjunction with clinical information, provided important clues to the diagnosis of MDAs. The imaging work-up for MDAs usually begins with ultrasound. Although it might have been suffice to detect the presence of a uterine abnormality, MRI was generally needed to classify the abnormality into a specific MDA category.

Ultrasound-assessed diaphragmatic impairment is a predictor of outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing noninvasive ventilation

BackgroundUltrasound (US) evaluation of diaphragmatic dysfunction (DD) has proved to be a reliable technique in critical care. In this single-center prospective study, we investigated the impact of US-assessed DD on noninvasive ventilation (NIV) failure in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and its correlation with the transdiaphragmatic pressure assessed using the invasive sniff maneuver (Pdi sniff).MethodsA population of 75 consecutive patients with AECOPD with hypercapnic acidosis admitted to our respiratory intensive care unit (RICU) were enrolled. Change in diaphragm thickness (ΔTdi) < 20% during tidal volume was the predefined cutoff for identifying DD+/− status. Correlations between ΔTdi < 20% NIV failure and other clinical outcomes were investigated. Correlation between ΔTdi and Pdi sniff values was analyzed in a subset of ten patients.ResultsDD+ patients had a higher risk for NIV failure than DD− patients (risk ratio, 4.4; p < 0.001), and this finding was significantly associated with higher RICU, in-hospital, and 90-day mortality rates; longer mechanical ventilation duration; higher tracheostomy rate; and longer RICU stay. Huge increases in NIV failure (HR, 6.2; p < 0.0001) and 90-day mortality (HR, 4.7; p = 0.008) in DD+ patients were found by Kaplan-Meier analysis. ΔTdi highly correlated with Pdi sniff (Pearson’s r = 0.81; p = 0.004). ΔTdi < 20% showed better accuracy in predicting NIV failure than baseline pH value and early change in both arterial blood pH and partial pressure of carbon dioxide following NIV start (AUCs 0.84 to DTdi < 20%, 0.51 to pH value at baseline, 0.56 to early change in arterial blood pH following NIV start, and 0.54 to early change in partical pressure of carbon dioxide following NIV start, respectively; p < 0.0001).ConclusionsEarly and noninvasive US assessment of DD during severe AECOPD is reliable and accurate in identifying patients at major risk for NIV failure and worse prognosis.

The role of ultrasound-defined tenosynovitis and synovitis in the prediction of rheumatoid arthritis development.

ObjectivesTenosynovitis (TS) is common in early arthritis. However, the value of US-defined TS in predicting RA development is unclear. We assessed the predictive utility of US-defined TS alongside US-defined synovitis and clinical and serological variables in a prospective cohort of early arthritis patients.MethodsOne hundred and seven patients with clinically apparent synovitis of one or more joint and symptom duration ⩽3 months underwent baseline clinical, laboratory and US assessment of 19 bilateral joint sites and 16 bilateral tendon compartments. Diagnostic outcome was determined after 18 months, applying the 2010 ACR/EULAR classification criteria for RA. The predictive values of US-defined TS for persistent RA were compared with those of US-defined synovitis, clinical and serological variables.ResultsA total of 4066 US joint sites and 3424 US tendon compartments were included in the analysis. Forty-six patients developed persistent RA, 17 patients developed non-RA persistent disease and 44 patients had resolving disease at follow-up. US-defined TS in at least one tendon compartment at baseline was common in all groups (RA 85%, non-RA persistent disease 71% and resolving 70%). On multi-variate analysis, US-defined digit flexor TS provided independent predictive data over and above the presence of ACPA and US-defined joint synovitis.ConclusionUS-defined digit flexor TS provided independent predictive data for persistent RA development in patients with early arthritis. The predictive utility of this tendon site should be further assessed in a larger cohort; investigators designing imaging-based predictive algorithms for RA development should include this tendon component as a candidate variable.

Compliance assessment of US gluten‐free labeled oatmeal produced under a “Purity Protocol” indicates “Serving Level Compliance” not attained

Oats are naturally gluten‐free, but are commonly contaminated with gluten‐containing kernels of wheat, barley, and rye. Gluten compliance (FDA, gluten &lt;20 ppm) when managed at the serving level (40–50 g) is believed to provide the best protection to consumers. In this recent in‐market survey, a third‐party laboratory tested 166 servings of oatmeal manufactured with oats produced under a “Purity Protocol.” Results indicated gluten at noncompliant levels in five servings (spanning 20.4–229 ppm). This equates to a noncompliance rate of 1 in 33 servings. This new finding is comparable to a noncompliant rate of 1 in 57 servings uncovered by our previous in‐market survey, where the gluten‐free (GF) oatmeal was manufactured with oats produced by mechanical/optical cleaning. These new findings, substantiated by the previous ones, show that GF oats not managed for gluten compliance at the serving level may introduce an intermittent bolus of gluten to consumers with celiac disease.

Top-Down or Bottom-Up? Uncovering Factors that Influence Pedestrian Safety Programs ( breakout presentation )

Background Pedestrian fatalities have been rising in the US steadily for nearly a decade, now accounting for 18 percent of all road fatalities. This cost is exacerbated in US cities, where 76 percent of all pedestrian fatalities occurred in 2015. Given the prevalence of walking in US cities this imbalance is not surprising. What is surprising is the range of responses US cities have to addressing the problem of pedestrian safety. Cities similar in their size, density, economic health and a host of other factors appear to have remarkably different approaches to improving conditions for walking. What factors influence a city’s response to these alarming safety trends, and what ingredients are needed to mobilize the necessary levels of support to properly address the problem? Description of Program Seth LaJeunesse (Senior Research Associate) will share findings from a comprehensive assessment of US cities’ Vision Zero programs. Mr. LaJeunesse and HSRC colleagues have learned how framing safety in “Vision Zero” terms have tended to create a sense of urgency among diverse stakeholders to take swift and meaningful action to address pedestrian safety. Their findings also reveal the bottom-up and top-down nature of change in how community members both push for better walking conditions (bottom-up), yet are also influenced by city and workplace policies that support walking (top-down). Dan Gelinne (Research Associate) will share the experience of a program funded by the US DOT to support training and technical assistance for the US cities with the highest rates of pedestrian fatalities. An assessment of those cities’ reveals lessons for others seeking to respond to safety problems. Mr. Gelinne will also share the experience of the Walk Friendly Communities program, a national initiative that provides a comprehensive assessment of a city’s pedestrian programs and initiatives. Implications Drawing upon what they have learned throughout these efforts, Mr. LaJeunesse and Mr. Gelinne will share those elements that make up high quality pedestrian programs while inspiring attendees to think critically about how to create communities that serve pedestrians of all ages and abilities.

Politicising intelligence: what went wrong with the UK and US assessments on Iraqi WMD in 2002

ABSTRACTThis essay aims at establishing whether the failure of the intelligence reports that led to the Iraqi War is to blame on flaws in the analysis or on the alleged politicisation. It will do so by examining three possible classes of explanations for the failure. Firstly, it will analyse structural features of the UK and US Intelligence Communities, explaining how the organisation can affect the accuracy of the assessments. Secondly, it will focus on the analytical breakdowns occurred in the 2002 process of assessment. Thirdly, it will address the issue of politicisation, in both its forms of political pressure and political representation of the perceived truth. Finally, it will argue that, although the analysis was undoubtedly flawed, the politicisation played a major role in the failure of the 2002 assessments.

Comparison of ultrasonography and radiography of the wrist for diagnosis of calcium pyrophosphate deposition

ObjectiveUltrasound (US) seems a useful tool for diagnosis of calcium pyrophosphate (CPP) deposition (CPPD). We aimed to compare the performance of US and conventional radiography of the wrist for diagnosis of CPPD. MethodsPatients with CPP crystals identified in synovial fluid (SF) (knee, hip, shoulder, ankle or wrist) were consecutively included and compared to patients without CPP crystals in synovial fluid considered as controls. As recommended, we used the term chondrocalcinosis (CC) to assess imaging features suggesting CPPD. In all patients, US and radiographic assessment of CC of the wrists was performed by two distinct operators blinded each other (one operator by imaging modality). The two operators were blinded to clinical data, SF analysis and US or radiography findings. ResultsWe included 32 CPPD patients and 26 controls. Among CPPD patients, US revealed CC in 30 (93.7%) and radiography in 17 (53.1%) (P<0.001). The sensitivity and specificity of US for the diagnosis of CPPD were 94% and 85%, respectively; the positive likelihood ratio (LR+) was 6.1. The sensitivity and specificity of radiography were 53.1% and 100%, respectively. At joints level independently of SF analysis, US revealed CC in 35 joints without radiographic CC whereas X-rays showed CC in 3 joints without US CC. The κ coefficient between US and radiography for CC was moderate: 0.33 (0.171–0.408). ConclusionOur study suggests that wrist US should be considered as a relevant tool for the diagnosis of CPPD, with higher sensitivity than radiography for detecting CPP deposits.