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Telerobotic Approach Provides Virtual Ultrasound Evaluations for Physicians, Hospitals, and Communities

By MedImaging International staff writers
Posted on 26 Aug 2014

ge: Graphic of the way trans-Atlantic robot-assisted ultrasound is performed (Photo courtesy of Mount Sinai).

Image: Graphic of where the new tele-robotic ultrasound used to perform a carotid artery exam is placed (Photo courtesy of Mount Sinai).

An American physician, while in Germany, used a computer to perform a robot-assisted transatlantic ultrasound exam on a person in Boston (MA, USA). In another study, a Swedish doctor, working in collaboration with another physician, showed how a cardiologist’s video e-consultation, combined with a remote robot-assisted echocardiogram test, can drastically lessen the waiting time for a diagnosis faced by heart failure patients who live in a rural communities far from the hospital from nearly four months to less than one month.

These research studies were published in the August 2014 issue of the Journal of the American College of Cardiology-Imaging. “The two studies give us a glimpse of what to expect in the near future, a patient-friendly imaging technology at your doorstep,” said Jagat Narula, MD, PhD, senior author of both research studies who serves as the director of the Mount Sinai Cardiovascular Imaging Center and associate dean of global research at Icahn School of Medicine at Mount Sinai (New York, NY, USA).

“These studies lift the robotic imaging and telemedicine to the next level,” remarked Sherif F. Nagueh, MD, medical director of the echocardiography laboratory at the Methodist DeBakey Heart and Vascular Center (Houston, TX, USA), who authored the accompanying editorial about the two studies in JACC-Imaging.

“Our first-in-man experiment shows long-distance, telerobotic ultrasound examinations over standard internet are possible,” said Partho P. Sengupta, MD, who is director of cardiac ultrasound research at Icahn School of Medicine at Mount Sinai, and chair of the new technology Task Force at the American Society of Echocardiography. “Our successful experiment opens up a new frontier for the use of remote, robotic ultrasound imaging that could potentially be more efficient and cost-effective overall for healthcare access and delivery.”

In the first study, lead investigator Dr. Sengupta and researchers assessed the use of a small, lightweight robotic-arm with built-in ultrasound technology located in Boston and connected to a personal computer (PC) with a low-bandwidth Internet connection in Munich, Germany. The robotic ultrasound exam of an individual’s carotid artery in their neck was completed in just four minutes.

“This feasibility and time-efficiency of long-distance, telerobotic ultrasound may help expand the role of imagers to care for patients online virtually lending a true ‘helping hand’ remotely and providing a patient’s care team expert guidance,” said Mount Sinai’s Dr. Sengupta. Significantly, in the study experiments, both advanced specialists and early trainees on robotic ultrasound were able to operate the telerobotic technology.

In the second study, Kurt Boman, MD, of Umea University (Umea, Sweden) and colleagues randomized half their study patients to remote consultation and the other half to standard of care referral to the hospital. Remote consultation and the robotic echocardiogram exam were conducted on the same day of a patient’s visit to their local Primary healthcare center located more than 100 miles away from the hospital. Study results show, the total diagnostic process time was greatly decreased from 114 to 27 days in those patients receiving remote consultation. Furthermore, the patient’s wait time until obtaining a specialist consultation was reduced from 86 to 12 days, with 95% of remote consult patients claiming remote consult to be a superior strategy.

“As a result of our pilot study, we were able to establish a safe and efficient e-health solution to improve the comprehensive, convenient examination of suspected heart failure patients in a rural community of northern Sweden and improve their physician care team's communication,” stated Dr. Narula of Mount Sinai. “This pilot study may serve as a future model for use of e-consults and robotic imaging in similar rural communities to improve access to specialists and the latest diagnostic technology globally.”

“In clinical medicine, the use of more portable low-cost, safe, non-radiation using ultrasound imaging technology is growing for diagnosis, patient monitoring, and procedural, and surgical planning,” commented Valentin Fuster, MD, PhD, director of Mount Sinai Heart at Icahn School of Medicine at Mount Sinai and the new editor-in-chief of the Journal of the American College of Cardiology (JACC). “The technology may be key to accelerating greater local and global healthcare access more efficiently and cost-effectively for patients, doctors, communities, and hospitals in need.”

According to researchers, on-demand, virtual robotic ultrasound could be used in a wide variety of clinical setting collaborations ranging from in-hospital or emergency room patient imaging studies, community screenings, or even within hazardous sites such as war zones.

Related Links:
Icahn School of Medicine at Mount Sinai
Umea University

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59 (125.16975402832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

60 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

61 (!!!!! 5215.8832550049): 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

62 (478.98292541504): SELECT fid FROM jos_deeppockets WHERE id=294754178 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754178 AND published='1' LIMIT 1

63 (257.96890258789): 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`

64 (66.995620727539): select jos_twitters.link from jos_twitters where cat=10

65 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

66 (29.087066650391): select jos_google_plus.link from jos_google_plus where cat=10

67 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

68 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE id=294754178 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754178 AND published='1' LIMIT 1

69 (30.994415283203): 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`

70 (164.03198242188): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754178 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (138.0443572998): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754178 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (44.107437133789): 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`

73 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (31.232833862305): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (45.7763671875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754178 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (33.855438232422): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754178 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (41.007995605469): 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`

90 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (23.841857910156): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.226043701172): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (58.174133300781): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 3779.8881530762): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

105 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

106 (97.990036010742): 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=294754178 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (51.975250244141): 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=294754178 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

109 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

110 (61.988830566406): 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=294754178 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (442.0280456543): 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=294754178 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (601.05323791504): 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

113 (371.21772766113): 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 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

115 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

116 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

117 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

118 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

119 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

120 (306.12945556641): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 35655.02166748): 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

122 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

123 (47.206878662109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

124 (!!!!! 3223.8960266113): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754178 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754178 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 567584.99145508): ( 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

126 (165.93933105469): ( 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 (141.14379882812): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (189.06593322754): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (139.95170593262): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (130.89179992676): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (118.01719665527): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (127.79235839844): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (!!!!! 2779.0069580078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (323.05717468262): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (224.11346435547): SELECT name FROM jos_deeppockets WHERE id=214

136 (50.067901611328): SELECT name FROM jos_deeppockets WHERE id=214

137 (575.06561279297): 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

138 (379.80079650879): 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

139 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

140 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

141 (!!!!! 8708.0001831055): TRUNCATE TABLE jos_trademed_module

142 (828.02772521973): 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=294754178 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (!!!!! 1380.2051544189): 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=294754178 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (376.93977355957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (261.06834411621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (427.9613494873): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

147 (119.92454528809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

148 (!!!!! 1467.9431915283): 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

149 (151.8726348877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

150 (464.91622924805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

151 (137.8059387207): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754178 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754178 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (219.10667419434): 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)

153 (82.015991210938): 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)

154 (78.916549682617): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (201.94053649902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

156 (269.17457580566): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754178 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754178 AND published='1' LIMIT 1

157 (35.04753112793): select jos_twitters.link from jos_twitters where cat=10

158 (27.894973754883): select jos_facebook.link from jos_facebook where cat=10

159 (27.894973754883): select jos_google_plus.link from jos_google_plus where cat=10

160 (27.179718017578): select jos_linkedin.link from jos_linkedin where cat=10

161 (303.03001403809): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1070.9762573242): insert into jos_banners_delta values (14615,'2025-05-02 02:45:42','3.14.12.254','view'),(14202,'2025-05-02 02:45:42','3.14.12.254','view'),(14203,'2025-05-02 02:45:42','3.14.12.254','view')

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