Ultrasound assessment of hands and feet for synovitis at time of first clinical visit markedly reduces time to diagnosis in routine care.

OBJECTIVES: The role of musculoskeletal US (MSUS) in routine care for diagnosing arthritis is not fully elucidated, but US is more sensitive than clinical joint examination for detecting synovitis. Therefore, the use of US may facilitate diagnosis of arthritis. The aim of the study was to assess whether MSUS examination of hands and feet in relation to the first clinical visit had an impact on the time to reach a final diagnosis and the number of clinical follow-up visits needed after first consultation. METHODS: Two cohorts referred to the outpatient arthritis clinic with suspected arthritis were compared with each other, (i) MSUS (October 2017 to June 2018) of hands and feet performed prior to the first clinical visit and (ii) MSUS (November 2016 to June 2017) was performed ad hoc, for the following aspects: time to clinical diagnosis, number of clinical visits needed, and number of US examinations. RESULTS: In total, 163 and 109 patients were included in the MSUS and comparative cohorts, respectively. Adding MSUS to the first clinical visit reduced the time to diagnosis from mean 31 (32.2) days to 12 (17.3) days (P < 0.01). The number of clinical visits needed was reduced from mean 2.8 (1.1) to 2.1 (1.3) (P < 0.01), corresponding to a reduction of 114 visits in the MSUS cohort. A final diagnosis with inflammatory arthritis was found in 76 (47%) of patients in the MSUS cohort vs 29 (27%) in the comparative cohort (P < 0.01). CONCLUSION: In patients referred for suspected arthritis, routine MSUS in relation to the first clinical visit significantly reduces time to diagnosis and number of clinical visits needed to reach a final diagnosis.

Coastal infrastructure operativity against flooding - A methodology.

The operativity of the transport infrastructures and urban developments protected by coastal structures is conditioned by flooding events and the resulting wave overtopping. This work presents a methodology to assess the operational conditions of infrastructures located in coastal areas based on the combination of advanced statistical techniques, laboratory experiments and state-of-the-art numerical models properly validated. It is applied to a case study in the SW coast of England, the railway seawall at Dawlish, which was subjected to recurrent wave overtopping until its dramatic collapse in February 2014. To quantify the increase in overtopping discharges with wave height and water level, we define an ad hoc variable, the effective overtopping forcing, which explains 98% of the variability of the overtopping discharge. The return periods associated to the operational thresholds for coastal structures protecting people and railways are also obtained. The proposed methodology enables the assessment of the overtopping discharge induced by a given sea state and, thus, check if a coastal infrastructure will be or not operational under any expected marine condition. This innovative methodology can also be used to analyse the flooding event consequences on urban areas protected by coastal infrastructures.