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Ultrasound Tools, Atlas Developed for Healthcare in Space Also Works on Earth

By MedImaging International staff writers
Posted on 21 Jul 2011

The remoteness and resource limitations of spaceflight pose a serious challenge to astronaut healthcare. More...

One solution to this problem is ultrasound technology.

Scientists with the US National Space Biomedical Research Institute (NSBRI; Houston, TX, USA) have developed tools that expand the use of ultrasound during spaceflight and on Earth, particularly in rural and underserved locations. These tools include techniques that streamline training and help remote experts guide nonphysician astronauts to perform ultrasound exams. Ultrasound can be used to evaluate many conditions--fractured bones, collapsed lungs, kidney stones, organ damage, and other ailments--in space and on Earth. With an NSBRI grant, they also created a catalog, or atlas, of “space-normal” imagery of the human body, setting the stage for astronauts to provide care without consulting a physician on Earth. This atlas was given to the US National Aeronautics and Space Administration (NASA; Washington DC, USA) earlier in 2011.

Dr. Scott A. Dulchavsky, the Roy D. McClure chairman of surgery and surgeon-in-chief at the Henry Ford Hospital (Detroit, MI, USA) is the lead investigator of these projects and is a member of the NSBRI smart medical systems and technology team. “The ultrasound imagery techniques came from space program constraints of not having a trained radiologist on orbit or having a CT[computed tomography] scan or an MRI [magnetic resonance imaging] available, forcing us to use ultrasound for things in which we would not normally use it,” he said. “Also, time limitations forced us to put some tight brackets around what is absolutely required for training to be able to obtain a high-quality ultrasound image and to make some sense out of the image.”

Dr. Dulchavsky and colleagues from NSBRI, NASA, Henry Ford, and Wyle Integrated Science and Engineering Group (El Segundo, CA, USA) began their first ultrasound experiment--Advanced Diagnostic Ultrasound in Microgravity (ADUM)--by developing exam techniques for use on the International Space Station (ISS). The goal was for ISS crewmembers to collect high-quality ultrasound images to send to the Mission Control Center for analysis. The ADUM research was split into two projects: NSBRI funded the ground portion of the research, while NASA supported the flight portion.

The researchers conducted 80 hours of ultrasound examinations on the ISS and then sifted through approximately 20,000 images and many hours of video collected during ISS Expeditions 8 through 12 to create the “space-normal” atlas. The researchers developed the intuitive ultrasound guide to give astronauts broader use of ultrasound in additional organ systems and medical problems that were not part of the ISS experiment. Dr. Dulchavsky said, “ADUM initially utilized telemedicine and tele-ultrasound operations in which the astronauts were interacting with researchers and flight controllers on the ground during the examinations. The ultrasound intuitive guide allows astronauts to conduct exams when quick communication with an expert is not available due to distance from Earth or other reasons.”

One of the first to be trained and to conduct an ultrasound exam in space was former NASA Astronaut and ISS Expedition 10 Commander Dr. Leroy Chiao. “We demonstrated on the International Space Station that even nonphysicians can produce diagnostic-quality ultrasound images using remote guidance,” said Chiao who is chairman of the NSBRI User Panel and a member of Baylor College of Medicine’s Center for Space Medicine (Houston, TX, USA). “These ultrasound exam techniques and atlas will be increasingly important as we venture farther and longer into space. Telemedicine using ultrasound will be an invaluable medical diagnostic tool.”

The level of skill needed to analyze ultrasound exam results accurately will vary based on the exam’s goal. “To diagnose a broken bone is relatively straight-forward. When we were trialing this at my hospital, we trained the custodial personnel to conduct exams. After about five minutes, they had a diagnostic accuracy in the high 90s,” Dr. Dulchavsky said. “Alternatively, if you are trying to look at subtle changes in how the heart functions in zero-gravity after six months, that takes considerably more expertise, and may take hours or even days of evaluation to do.”

As in space, low costs and reduced-resource consumption make ultrasound an attractive option on Earth, but until recently, the lack of trained personnel has been an issue. Based on their research for NSBRI, Dr. Dulchavsky and his colleagues have spun off the techniques for terrestrial use and published The ICU Ultrasound Pocket Book--a reference guide for conducting examinations.

“The American College of Surgeons, which is charged with continuing education of surgeons in our country, saw the methods we developed for space and has now incorporated these techniques in its ultrasound training courses for all of the surgeons in the United States,” Dr. Dulchavsky said. “Similarly, medical schools are starting to incorporate this training for all medical students, not just surgeons.”

The ultrasound imaging techniques are also being used by athletic trainers for some professional sports teams and the United States Olympic Committee to get point-of-care rapid information about athletes' injuries.

However, it is rural locations, both inside and outside the United States, that stand to gain the most from the diagnostic ultrasound capabilities and telemedicine. Dr. Dulchavsky has been collaborating with the World Interactive Network Focused on Critical UltraSound (WINFOCUS) to train individuals to use ultrasound techniques in under-served regions.

“The use of ultrasound truly enhances people’s opportunities to access and provide accurate, immediate, cost-effective healthcare,” said Dr. Luca Neri, director of the WINFOCUS Global Ultrasound Program, and scientific chair of the Point-of-care Lombardia UltraSound project at Niguarda Ca' Granda Hospital and AREU EMS Public Regional Company in Milan, Italy. “Particularly, within the resource-scarce communities and healthcare systems, we are successfully building upon the innovative ultrasound and telecommunication technologies developed by Dr. Dulchavsky for NSBRI and NASA and integrating their capabilities into the national health and education systems. “By empowering local personnel to offer affordable, immediate, accurate, portable imaging, we facilitate earlier and more effective diagnosis, treatment, and follow-up of patients on a broader basis and in a more sustainable manner.”

Some of the countries in which the ultrasound techniques are being implemented to foster sustainable primary health-care development are Mozambique, Lesotho, Madagascar, India, Brazil, and Nicaragua, with programs planned in Honduras, Congo, and Malaysia. Tele-ultrasound has also been performed by Dr. Dulchavsky’s team on Mount Everest and in the high Arctic Circle.

In addition to Dr. Dulchavsky’s work, the NSBRI smart medical systems and technology team portfolio contains projects developing other innovative ultrasound technologies. One project is developing an ultrasound system to measure bone density and quality and accelerate fracture healing. Another project is developing a system for bloodless tumor removal, internal bleeding treatment, and kidney stone reduction.

Related Links:
[US] National Space Biomedical Research
[US] National Aeronautics and Space Administration
Henry Ford Hospital

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45 (!!!!! 1144.8860168457): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

46 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

47 (394.10591125488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

48 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

49 (868.08204650879): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

50 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

51 (710.96420288086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

52 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

53 (344.03800964355): SELECT name FROM jos_deeppockets WHERE id=294736212 LIMIT 1

54 (349.04479980469): SELECT name FROM jos_deeppockets_archive WHERE id=294736212 LIMIT 1

55 (82.969665527344): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

56 (95.129013061523): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294736212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (671.8635559082): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294736212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1641.0350799561): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

59 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

60 (185.96649169922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

61 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

62 (133.03756713867): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

63 (797.98698425293): SELECT fid FROM jos_deeppockets WHERE id=294736212 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736212 AND published='1' LIMIT 1

64 (72.002410888672): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

65 (71.048736572266): select jos_twitters.link from jos_twitters where cat=10

66 (45.061111450195): select jos_facebook.link from jos_facebook where cat=10

67 (90.122222900391): select jos_google_plus.link from jos_google_plus where cat=10

68 (51.975250244141): select jos_linkedin.link from jos_linkedin where cat=10

69 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE id=294736212 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736212 AND published='1' LIMIT 1

70 (47.206878662109): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

71 (488.0428314209): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (372.88665771484): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (59.127807617188): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

74 (76.055526733398): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (66.995620727539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (40.054321289062): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (42.915344238281): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

91 (65.088272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

106 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

107 (85.830688476562): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294736212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (77.009201049805): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294736212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (134.22966003418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

110 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

111 (72.002410888672): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294736212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (704.05006408691): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294736212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (608.20579528809): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (422.95455932617): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

116 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

117 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

118 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

119 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

120 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

121 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

122 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

123 (332.83233642578): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 23771.047592163): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

125 (721.93145751953): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736212 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736212 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 11034.01184082): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (92.983245849609): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

128 (57.93571472168): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

130 (66.041946411133): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (44.107437133789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

132 (425.81558227539): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (59.127807617188): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

134 (45.061111450195): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

136 (569.82040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (515.93780517578): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (61.988830566406): SELECT name FROM jos_deeppockets WHERE id=214

139 (46.014785766602): SELECT name FROM jos_deeppockets WHERE id=214

140 (819.20623779297): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (730.03768920898): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

143 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

144 (!!!!! 10811.09046936): TRUNCATE TABLE jos_trademed_module

145 (82.015991210938): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294736212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (72.002410888672): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294736212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (546.93222045898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

150 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

151 (!!!!! 1120.0904846191): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

152 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

153 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

154 (45.061111450195): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736212 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736212 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (36.001205444336): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

156 (33.140182495117): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

157 (65.803527832031): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (177.14500427246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

159 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736212 AND published='1' LIMIT 1

160 (46.014785766602): select jos_twitters.link from jos_twitters where cat=10

161 (36.001205444336): select jos_facebook.link from jos_facebook where cat=10

162 (36.001205444336): select jos_google_plus.link from jos_google_plus where cat=10

163 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

164 (324.96452331543): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

165 (!!!!! 1155.1380157471): insert into jos_banners_delta values (14202,'2025-08-12 18:33:40','216.73.216.186','view'),(14203,'2025-08-12 18:33:40','216.73.216.186','view')

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