Preliminary definitions for the sonographic features of synovitis in children

Objectives Musculoskeletal ultrasonography (US) has the potential to be an important tool in the assessment of disease activity in childhood arthritides. To assess pathology, clear definitions for synovitis need to be developed first. The aim of this study was to develop and validate these definitions through an international consensus process. Methods The decision on which US techniques to use, the components to be included in the definitions as well as the final wording were developed by 31 ultrasound experts in a consensus process. A Likert scale of 1-5 with 1 indicating complete disagreement and 5 complete agreement was used. A minimum of 80% of the experts scoring 4 or 5 was required for final approval. The definitions were then validated on 120 standardized US images of the wrist, MCP and tibiotalar joints displaying various degrees of synovitis at various ages. Results B-Mode and Doppler should be used for assessing synovitis in children. A US definition of the various components (i.e. synovial hypertrophy, effusion and Doppler signal within the synovium) was developed. The definition was validated on still images with a median of 89% (range 80-100) of participants scoring it as 4 or 5 on a Likert scale. Conclusions US definitions of synovitis and its elementary components covering the entire pediatric age range were successfully developed through a Delphi process and validated in a web-based still images exercise. These results provide the basis for the standardized US assessment of synovitis in clinical practice and research

SAT0636 Ultrasonography definitions for synovitis grading in children: the omeract pediatric ultrasound task force

n/

Scales and structure of frontal adjustment and freshwater export in a region of freshwater influence

Sea surface temperature satellite imagery and a regional hydrodynamic model are used to investigate the variability and structure of the Liverpool Bay thermohaline front. A statistically based water mass classification technique is used to locate the front in both data sets. The front moves between 5 and 35 km in response to spring-neap changes in tidal mixing, an adjustment that is much greater than at other shelf-sea fronts. Superimposed on top of this fortnightly cycle are semi-diurnal movements of 5-10 km driven by flood and ebb tidal currents. Seasonal variability in the freshwater discharge and the density difference between buoyant inflow and more saline Irish Sea water give rise to two different dynamical regimes. During winter, when cold inflow reduces the buoyancy of the plume, a bottom-advected front develops. Over the summer, when warm river water provides additional buoyancy, a surface-advected plume detaches from the bottom and propagates much larger distances across the bay. Decoupled from near-bed processes, the position of the surface front is more variable. Fortnightly stratification and re-mixing over large areas of Liverpool Bay is a potentially important mechanism by which freshwater, and its nutrient and pollutant loads, are exported from the coastal plume system. Based on length scales estimated from model and satellite data, the erosion of post-neap stratification is estimated to be responsible for exporting approximately 19% of the fresh estuarine discharge annually entering the system. Although the baroclinic residual circulation makes a more significant contribution to freshwater fluxes, the episodic nature of the spring-neap cycle may have important implications for biogeochemical cycles within the ba