scholarly journals Telerobotic ultrasound to provide obstetrical ultrasound services remotely during the COVID-19 pandemic

2020 ◽  
pp. 1357633X2096542
Author(s):  
Scott J Adams ◽  
Brent Burbridge ◽  
Leslie Chatterson ◽  
Veronica McKinney ◽  
Paul Babyn ◽  
...  
Keyword(s):  
Second Trimester ◽  
Rural And Remote ◽  
Third Trimester ◽  
Remote Communities ◽  
Remote Community ◽  
System A ◽  
Patient Travel ◽  
Ultrasound System ◽  
Clinical Questions ◽  
Obstetrical Ultrasound

Introduction Obstetrical ultrasound imaging is critical in identifying at-risk pregnancies and informing clinical management. The coronavirus disease 2019 (COVID-19) pandemic has exacerbated challenges in accessing obstetrical ultrasound for patients in underserved rural and remote communities where this service is not available. This prospective descriptive study describes our experience of providing obstetrical ultrasound services remotely using a telerobotic ultrasound system in a northern Canadian community isolated due to a COVID-19 outbreak. Methods A telerobotic ultrasound system was used to perform obstetrical ultrasound exams remotely in La Loche, Canada, a remote community without regular access to obstetrical ultrasound. Using a telerobotic ultrasound system, a sonographer 605 km away remotely controlled an ultrasound probe and ultrasound settings. Twenty-one exams were performed in a five-week period during a COVID-19 outbreak in the community, including limited first-, second- and third-trimester exams ( n = 11) and complete second-trimester exams ( n = 10). Participants were invited to complete a survey at the end of the telerobotic ultrasound exam describing their experiences with telerobotic ultrasound. Radiologists subsequently interpreted all exams and determined the adequacy of the images for diagnosis. Results Of 11 limited obstetrical exams, radiologists indicated images were adequate in nine (81%) cases, adequate with some reservations in one (9%) case and inadequate in one (9%) case. Of 10 second-trimester complete obstetrical exams, radiologists indicated images were adequate in two (20%) cases, adequate with some reservations in three (30%) cases and inadequate in five (50%) cases. Second-trimester complete obstetrical exams were limited due to a combination of body habitus, foetal lie and telerobotic technology. Discussion A telerobotic ultrasound system may be used to answer focused clinical questions such as foetal viability, dating and foetal presentation in a timely manner while minimising patient travel to larger centres and potential exposure to severe acute respiratory virus coronavirus 2 during the COVID-19 pandemic.

scholarly journals Optimizing the Environmental and Economic Sustainability of Remote Community Infrastructure

2020 ◽  
Vol 12 (6) ◽  
pp. 2208 ◽  
Author(s):  
Jamie E. Filer ◽  
Justin D. Delorit ◽  
Andrew J. Hoisington ◽  
Steven J. Schuldt
Keyword(s):  
Environmental Impacts ◽  
Sustainability Assessment ◽  
Model Performance ◽  
Assessment Model ◽  
Remote Communities ◽  
Remote Community ◽  
Rural Villages ◽  
Sustainable Technologies ◽  
Study Results

Remote communities such as rural villages, post-disaster housing camps, and military forward operating bases are often located in remote and hostile areas with limited or no access to established infrastructure grids. Operating these communities with conventional assets requires constant resupply, which yields a significant logistical burden, creates negative environmental impacts, and increases costs. For example, a 2000-member isolated village in northern Canada relying on diesel generators required 8.6 million USD of fuel per year and emitted 8500 tons of carbon dioxide. Remote community planners can mitigate these negative impacts by selecting sustainable technologies that minimize resource consumption and emissions. However, the alternatives often come at a higher procurement cost and mobilization requirement. To assist planners with this challenging task, this paper presents the development of a novel infrastructure sustainability assessment model capable of generating optimal tradeoffs between minimizing environmental impacts and minimizing life-cycle costs over the community’s anticipated lifespan. Model performance was evaluated using a case study of a hypothetical 500-person remote military base with 864 feasible infrastructure portfolios and 48 procedural portfolios. The case study results demonstrated the model’s novel capability to assist planners in identifying optimal combinations of infrastructure alternatives that minimize negative sustainability impacts, leading to remote communities that are more self-sufficient with reduced emissions and costs.

scholarly journals Development and assessment of a telesonography system for musculoskeletal imaging

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Mohammed Obaid ◽  
Qianwei Zhang ◽  
Scott J. Adams ◽  
Reza Fotouhi ◽  
Haron Obaid
Keyword(s):  
Degrees Of Freedom ◽  
Ultrasound Images ◽  
Ultrasound Probe ◽  
Rural And Remote ◽  
Significant Delay ◽  
Remote Communities ◽  
Internet Connection ◽  
Good For ◽  
4 Degrees Of Freedom

Abstract Background Telesonography systems have been developed to overcome barriers to accessing diagnostic ultrasound for patients in rural and remote communities. However, most previous telesonography systems have been designed for performing only abdominal and obstetrical exams. In this paper, we describe the development and assessment of a musculoskeletal (MSK) telesonography system. Methods We developed a 4-degrees-of-freedom (DOF) robot to manipulate an ultrasound probe. The robot was remotely controlled by a radiologist operating a joystick at the master site. The telesonography system was used to scan participants’ forearms, and all participants were conventionally scanned for comparison. Participants and radiologists were surveyed regarding their experience. Images from both scanning methods were independently assessed by an MSK radiologist. Results All ten ultrasound exams were successfully performed using our developed MSK telesonography system, with no significant delay in movement. The duration (mean ± standard deviation) of telerobotic and conventional exams was 4.6 ± 0.9 and 1.4 ± 0.5 min, respectively (p = 0.039). An MSK radiologist rated quality of real-time ultrasound images transmitted over an internet connection as “very good” for all telesonography exams, and participants rated communication with the radiologist as “very good” or “good” for all exams. Visualisation of anatomic structures was similar between telerobotic and conventional methods, with no statistically significant differences. Conclusions The MSK telesonography system developed in this study is feasible for performing soft tissue ultrasound exams. The advancement of this system may allow MSK ultrasound exams to be performed over long distances, increasing access to ultrasound for patients in rural and remote communities.

scholarly journals Serum cystatin is not a marker of glomerular filtration rate in pregnancy

2009 ◽  
Vol 2 (3) ◽  
pp. 121-122 ◽  
Author(s):  
Kate Bramham ◽  
David Makanjuola ◽  
Wael Hussein ◽  
Debra Cafful ◽  
Hassan Shehata
Keyword(s):  
Glomerular Filtration Rate ◽  
Observational Study ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Prospective Observational Study ◽  
Second Trimester ◽  
Third Trimester ◽  
Serum Cystatin ◽  
In Pregnancy

The role of cystatin C (Cys-C) as a marker of glomerular filtration rate (GFR) in pregnancy is undetermined. Measurements of Cys-C and creatinine (Cr) were taken at 14–17+6, 18–23+6, 27–31+6 weeks' gestation, at delivery and 2–6 weeks postpartum in a prospective observational study of 27 women. There was no difference between Cys-C levels in early and late second trimester, but they were significantly higher in early third trimester ( P < 0.001) than second trimester, despite no concurrent increase in Cr. Cys-C was also significantly higher at delivery than at all other times in pregnancy ( P < 0.001) and fell to postpartum values higher than second trimester measurements ( P < 0.01), but lower than delivery ( P<0.001). In conclusion, changes in Cys-C may be influenced by pregnancy-related changes in glomerular filtration and therefore we would advise against their use as a marker of GFR in pregnancy.

Trends in Heart Rate and Heart Rate Variability during Pregnancy and Three Months Postpartum: Continuous Monitoring in a Free-Living Context (Preprint)

2021 ◽  
Author(s):  
Fatemeh Sarhaddi ◽  
Iman Azimi ◽  
Anna Axelin ◽  
Hannakaisa Niela-Vilen ◽  
Pasi Liljeberg ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Pregnant Women ◽  
Time Domain ◽  
Second Trimester ◽  
Third Trimester ◽  
Non Invasive ◽  
The Third ◽  
Invasive Method ◽  
Frequency Power

BACKGROUND Heart rate variability (HRV) is a non-invasive method reflecting autonomic nervous system (ANS) regulations. Altered HRV is associated with adverse mental or physical health complications. ANS also has a central role in physiological adaption during pregnancy causing normal changes in HRV. OBJECTIVE Assessing trends in heart rate (HR) and HRV parameters as a non-invasive method for remote maternal health monitoring during pregnancy and three months postpartum. METHODS Fifty-eight pregnant women were monitored using an Internet-of-Things (IoT)-based remote monitoring system during pregnancy and 3-months postpartum. Pregnant women were asked to continuously wear Gear sport smartwatch to monitor their HR and HRV. In addition, a cross-platform mobile application was utilized for collecting pregnancy-related information. The trends of HR and HRV parameters were extracted using reliable data. We also analyzed the trends of normalized HRV parameters based on HR to remove the effect of HR changes on HRV trends. Finally, we exploited hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters. RESULTS HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P<.01). Time-domain HRV parameters, average normal interbeat intervals (AVNN), standard deviation of normal interbeat intervals (SDNN), root mean square of the successive difference of normal interbeat intervals (RMSSD), normalized SDNN (nSDNN), and normalized RMSSD (nRMSSD) decreased significantly during the second trimester (P<.001) then increased significantly during the third trimester (P<.01). Some of the frequency domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF (nHF) decreased significantly during the second trimester (P<.01), and HF increased significantly during the third trimester (P<.01). In the postpartum period, nRMSSD decreased (P<.05), and the LF to HF ratio (LF/HF) increased significantly (P<.01). CONCLUSIONS Our study showed that HR increased and HRV parameters decreased as the pregnancy proceeded, and the values returned to normal after the delivery. Moreover, our results show that HR started to decrease while time-domain HRV parameters and HF started to increase during the third trimester. Our results also demonstrate the possibility of continuous HRV monitoring in everyday life settings.

scholarly journals Infliximab clearance decreases in the second and third trimesters of pregnancy in inflammatory bowel disease

2020 ◽  
pp. 205064062096461
Author(s):  
Ana-Marija Grišić ◽  
Maria Dorn-Rasmussen ◽  
Bella Ungar ◽  
Jørn Brynskov ◽  
Johan F K F Ilvemark ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
First Trimester ◽  
Interquartile Range ◽  
Therapeutic Drug ◽  
Population Pharmacokinetic ◽  
Second Trimester ◽  
Third Trimester ◽  
The Third ◽  
Inflammatory Bowel

Background Infliximab therapy during pregnancy in inflammatory bowel disease is challenged by a dilemma between maintaining adequate maternal disease control while minimizing fetal infliximab exposure. We investigated the effects of pregnancy on infliximab pharmacokinetics. Methods The study population comprised 23 retrospectively identified pregnancies. Patients with inflammatory bowel disease were generally in clinical remission at pregnancy conception (74%) and received steady infliximab maintenance therapy (5 mg/kg q8w n = 17; q6w n = 4; q10w n = 1; 10 mg/kg q8w n = 1). Trough blood samples had been obtained in the same patients prior to pregnancy ( n = 119), the first trimester ( n = 16), second trimester ( n = 18), third trimester ( n = 7), and post-pregnancy ( n = 12). Data were analyzed using nonlinear mixed-effects population pharmacokinetic modelling. Results Dose-normalized infliximab concentrations were significantly higher during the second trimester (median 15 µg/mL/kg, interquartile range 10–21) compared to pre-pregnancy (7, 2–12; p = 0.003), the first trimester (9, 1–12; p = 0.04), or post-pregnancy (6, interquartile range 3–11; p > 0.05) in patients with inflammatory bowel disease. Similar trends were observed in the third trimester (13, 7–36; p > 0.05). A one-compartment model with linear elimination described the pharmacokinetics of infliximab (volume of distribution = 18.2 L; clearance 0.61 L/day). Maternal infliximab exposure was influenced by the second and third trimester of pregnancy and anti-infliximab antibodies, and not by pregnancy-imposed physiological changes in, for example, body weight or albumin. Infliximab clearance decreased significantly during the second and third trimesters by up to 15% as compared to pre- and post-pregnancy and the first trimester. The increased maternal infliximab exposure was weakly associated with lowered clinical disease activity. Pharmacokinetic model simulations of virtual patients indicated the increased maternal infliximab trough concentrations imposed by pregnancy will not completely counteract the decrease in infliximab concentration if therapy is paused in the third trimester. Conclusion Infliximab clearance decreases significantly in the second and third trimesters, leading to increasing maternal infliximab concentrations in any given regimen. Maternal infliximab levels may thus be maintained as constant in a de-intensified regimen by therapeutic drug monitoring guidance in inflammatory bowel disease.

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