RESUMO
BACKGROUND: Point-of-care-ultrasound (POCUS) improves diagnostic accuracy and expedites lifesaving procedures. Remote areas disproportionately underuse ultrasound (US) due to a dearth of US trained professionals, imaging tools, and lack of quality assurance. Handheld US probes have been approved for diagnostic imaging but there have been limited studies examining their tele-guidance features. This study investigates whether physician tele-guidance improved ultrasound image acquisition by untrained scanners. METHODS: To determine the effectiveness of tele-guidance for ultrasound image acquisition, 30 participants (15 in each study arm: experimental and control) with no ultrasound or medical experience gathered images of the heart, right kidney, and gallbladder of a standardized patient using a handheld ultrasound probe (Butterfly iQ +). All participants watched a standardized ultrasound tutorial video and were randomized into the control or experimental group. A physician assisted the experimental group using ultrasound probe's tele-guidance feature while the control group received no assistance. Time to image acquisition was recorded for both groups, and the images were graded by 3 blinded radiologists using the RACE tool to determine image and diagnostic quality. RESULTS: There was evidence that mean imaging time was greater in the control group for the heart, right kidney, and gallbladder (p < 0.0001, all; Cohen's DL: 2.0, 1.7, 3.0, respectively). Similarly, there was evidence that the predicted mean image quality for the heart, right kidney, and gallbladder was higher for the experimental group compared to the control group (3.46 versus 1.86, 4.49 versus 1.58, and 3.93 versus 1.5, respectively; p < 0.0001, all). There was also evidence that the diagnostic quality of images had a statistically higher predicted probability of meaningful interpretation for the experimental group for pericardial fluid, intraperitoneal fluid, and acute cholecystitis (p = 0.003, p < 0.0001, p < 0.0001, respectively). CONCLUSIONS: Tele-guidance improves time to image acquisition and clinical applicability of ultrasound images obtained by untrained scanners.
RESUMO
Wastewater treatment systems are nowadays evolving into systems where energy and resources are recovered from wastewater. This work presents the long term operation of a demo-scale pilot plant (7.8 m3) with a novel configuration named as mainstream SCEPPHAR (ShortCut Enhanced Phosphorus and polyhydroxyalkanoate (PHA) Recovery) and based on two sequencing batch reactors (R1-HET and R2-AUT). This is the first report of an implementation at demo scale and under relevant operational conditions of the simultaneous integration of shortcut nitrification, P recovery and production of sludge with a higher PHA content than conventional activated sludge. An operating period under full nitrification mode achieved successful removal efficiencies for total N, P and CODT (86 ± 12%, 93 ± 9% and 79 ± 6%). In the following period, nitrite shortcut (with undetectable activity of nitrite oxidising bacteria) was achieved by implementing automatic control of the aerobic phase length in R2-AUT using ammonium measurement and operating at a lower sludge retention time. Similar N, P and CODT removal efficiencies to the full nitrification period were obtained. P-recovery from the anaerobic supernatant of R1-HET was achieved in a separate precipitator by increasing pH and dosing MgCl2, recovering an average value of 45% of the P in the influent as struvite precipitate, with a peak up to 63%. These values are much higher than the typical values of sidestream P-recovery (12%). Regarding PHA, a percentage in the biomass in the range 6.9-9.2% (gPHA·g-1TSS) was obtained.