Home monitoring of foot skin temperatures to prevent ulceration

OBJECTIVE - To evaluate the effectiveness of at-home infrared temperature monitoring as a preventative tool in individuals at high risk for diabetes-related lower-extremity ulceration and amputation. RESEARCH DESIGN AND METHODS - Eighty-five patients who fit diabetic foot risk category 2 or 3 (neuropathy and foot deformity or previous history of ulceration or partial foot amputation) were randomized into a standard therapy group (n = 41) or an enhanced therapy group (n = 44). Standard therapy consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. Enhanced therapy included the addition of a handheld infrared skin thermometer to measure temperatures on the sole of the foot in the morning and evening. Elevated temperatures (>4°F compared with the opposite foot) were considered to be "at risk" of ulceration due to inflammation at the site of measurement. When foot temperatures were elevated, subjects were instructed to reduce their activity and contact the study nurse. Study subjects were followed for 6 months. RESULTS - The enhanced therapy group had significantly fewer diabetic foot complications (enhanced therapy group 2% vs. standard therapy group 20%, P = 0.01, odds ratio 10.3, 95% CI 1.2-85.3). There were seven ulcers and two Charcot fractures among standard therapy patients and one ulcer in the enhanced therapy group. CONCLUSIONS - These results suggest that at-home patient self-monitoring with daily foot temperatures may be an effective adjunctive tool to prevent foot complications in individuals at high risk for lower-extremity ulceration and amputation

Robust interferometer for the routing of light beams carrying orbital angular momentum

We have developed an interferometer requiring only minimal angular alignment for the routing of beams carrying orbital angular momentum. The Mach–Zehnder interferometer contains a Dove prism in each arm where each has a mirror plane around which the transverse phase profile is inverted. One consequence of the inversions is that the interferometer needs no alignment. Instead the interferometer defines a unique axis about which the input beam must be coupled. Experimental results are presented for the fringe contrast, reaching a maximum value of 93±1%

Efficient sorting of Bessel beams

We demonstrate the efficient sorter of Bessel beams separating both the azimuthal and radial components. This is based upon the recently reported transformation of angular to transverse momentum states. We separately identify over forty azimuthal and radial components, with a radial spacing of 1588 m<sup>−1</sup>, and outline how the device could be used to identify the two spatial dimensions simultaneously

Student leadership in the middle years: A matter of concern

Traditionally, student leadership has been seen as the prerogative of senior students. Very little research has been conducted on how schools nurture and develop leadership skills in students in the middle years of schooling. This article provides an overview of student leadership in six secondary schools with a particular focus on student leadership opportunities in the middle years. These schools were drawn from the Government, Catholic and Independent sectors in Western Australia. Specifically, the opinions and experiences of either principals or their delegates were sought in order to develop a sense of the importance placed on student leadership in the middle years and the types of leadership opportunities available to students. Initially, the literature is reviewed on student leadership per se and student leadership in the middle years. This review is followed by an outline of the purpose, research question and significance of the research. The research methodology is then explained, providing a summary of participants, the school contexts and methods of data collection and analysis. The subsequent section on results and discussion highlights three themes: the role of teacher leaders, student leadership structures in middle years and the holistic development of middle year students. The article concludes by providing a number of recommendations, in particular, the need to gain a ‘student voice’ in any understanding of student leadership at the middle school

A novel N-terminal extension in mitochondrial TRAP1 serves as a thermal regulator of chaperone activity.

Hsp90 is a conserved chaperone that facilitates protein homeostasis. Our crystal structure of the mitochondrial Hsp90, TRAP1, revealed an extension of the N-terminal β-strand previously shown to cross between protomers in the closed state. In this study, we address the regulatory function of this extension or 'strap' and demonstrate its responsibility for an unusual temperature dependence in ATPase rates. This dependence is a consequence of a thermally sensitive kinetic barrier between the apo 'open' and ATP-bound 'closed' conformations. The strap stabilizes the closed state through trans-protomer interactions. Displacement of cis-protomer contacts from the apo state is rate-limiting for closure and ATP hydrolysis. Strap release is coupled to rotation of the N-terminal domain and dynamics of the nucleotide binding pocket lid. The strap is conserved in higher eukaryotes but absent from yeast and prokaryotes suggesting its role as a thermal and kinetic regulator, adapting Hsp90s to the demands of unique cellular and organismal environments

Lean Six Sigma analysis of shipboard audit readiness on a U.S. Navy destroyer

MBA Professional ReportOver the last six years, the Department of the Defense (DOD) and Department of the Navy (DON) have ramped up efforts toward achieving financial audit readiness by dedicating additional resources and implementing new process changes in support of the DOD Financial Improvement Audit Readiness (FIAR) program. Despite increased emphasis on ensuring key supporting documentation availability during an audit, the DON still has issues regarding poor quality document submissions from lower-level units, which can ultimately lead to poor audit results. This project attempts to identify and improve upon root causes of quality defects in audit-related key supporting documentation onboard U.S. ships in the Pacific Surface Fleet using a Lean Six Sigma analysis. The recommendations provided in this study augment improvement processes currently in progress, and are sequenced to build momentum before addressing higher-risk priorities. The objective of this research is to develop a case study for use by DON FIAR that examines audit-related areas of improvement and the implementation of additional process changes at the unit level. The case study is meant to spur discussion on how the DON can benefit from Lean Six Sigma analysis to improve quality and mitigate the risk of audit failure.http://archive.org/details/lesixsigmanalysi1094551565Lieutenant Commander, United States NavyLieutenant Commander, United States NavyApproved for public release; distribution is unlimited

A space division multiplexed free-space-optical communication system that can auto-locate and fully self align with a remote transceiver

Free-Space Optical (FSO) systems offer the ability to distribute high speed digital links into remote and rural communities where terrain, installation cost or infrastructure security pose critical hurdles to deployment. A challenge in any point-to-point FSO system is initiating and maintaining optical alignment from the sender to the receiver. In this paper we propose and demonstrate a low-complexity self-aligning FSO prototype that can completely self-align with no requirement for initial manual positioning and could therefore form the opto-mechanical basis for a mesh network of optical transceivers. The prototype utilises off-the-shelf consumer electrical components and a bespoke alignment algorithm. We demonstrate an eight fibre spatially multiplexed link with a loss of 15 dB over 210 m