Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer.

BackgroundIn 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this with the best available data as they currently exist. Since that time, more reports have emerged both on cancer mortality and mortality associated with diabetic foot ulcer (DFU), Charcot arthropathy, and diabetes-associated lower extremity amputation.MethodsWe collected data reporting 5-year mortality from studies published following 2007 and calculated a pooled mean. We evaluated data from DFU, Charcot arthropathy and lower extremity amputation. We dichotomized high and low amputation as proximal and distal to the ankle, respectively. This was compared with cancer mortality as reported by the American Cancer Society and the National Cancer Institute.ResultsFive year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6%, respectively. This is compared to 9.0% for breast cancer and 80.0% for lung cancer. 5 year pooled mortality for all reported cancer was 31.0%. Direct costs of care for diabetes in general was $237 billion in 2017. This is compared to$80 billion for cancer in 2015. As up to one-third of the direct costs of care for diabetes may be attributed to the lower extremity, these are also readily comparable.ConclusionDiabetic lower extremity complications remain enormously burdensome. Most notably, DFU and LEA appear to be more than just a marker of poor health. They are independent risk factors associated with premature death. While advances continue to improve outcomes of care for people with DFU and amputation, efforts should be directed at primary prevention as well as those for patients in diabetic foot ulcer remission to maximize ulcer-free, hospital-free and activity-rich days

A Kingdom of Priests and Gods: Angelic and Participatory Deification in John\u27s Apocalypse

Ancient Jewish and Christian apocalyptic literature contains soteriological narratives of human transformation that qualify as examples of deification in antiquity. One widely exemplified type of deification in ancient Jewish apocalypses and apocalyptic literature focuses first on the analogy between priests and angels, and then the gradual assimilation of the former to the identity of the latter. In much apocalyptic thought, God resides in a celestial sanctuary in heaven where angels serve a heavenly liturgy of worship and praise, and it is this reality which the earthly priesthood, temple, and cult mimic and extend into the human world, which led to speculation that human priests would become angels either at death or in the eschaton. This narrative of transformation also accords with what Martha Himmelfarb calls a “democratization” of the priesthood to include righteous individuals who otherwise would not enjoy such privileges. The Book of Revelation, as an apocalypse written by a Christian Jew, makes use of this traditional Jewish soteriology in a uniquely Christian framework, by appropriating its imagery and logic in the context of an early Christian participatory model of deification, the communicatio idiomatum, or “exchange of attributions.” Through participation in the angelomorphic, priestly Christ, the priestly saints are also guaranteed a share in angelic, divine glory. The study adds Revelation to an ongoing scholarly conversation about the trajectory of early Christian soteriological development

Ethnic Banking: Turkish Immigrants in Berlin

This work is a preliminary study into the significance of the ethnic banking market in Berlin, Germany, featuring a case study on the Turkish immigrant population. Past literature has shown a positive correlation between integration, ethnic closeness, and immigrants\u27 bank usage. Emphasis is placed on how select banks in two Berlin sub-communities, Kreuzberg and Neukolln, are managing their relationship with the Turkish immigrant customer. The factors of integration, which influence the Turkish immigrants\u27 use of financial institutions in Berlin, are analyzed. Key interviews were conducted to further understand the integration process and bank usage. I contribute to the academic discussion by recognizing a strong relationship between stages of reciprocal integration by ethnic Turkish immigrant customers and banks in Berlin. The findings of this study may prove significant for other saturated European and international banking markets

Contraction of the geographic range of distribution of snow crab (Chionoecetes opilio) in the eastern Bering Sea: An environmental ratchet?

Over the last three decades the geographic range of distribution of snow crab (Chionoecetes opilio) from the eastern Bering Sea (EBS) has contracted dramatically to the north. An increase in near-bottom temperature (NBT) during 1975–1979 was accompanied by a northward contraction of the cold pool (bound by the 2°C NBT isotherm) that extends over the Middle Domain during the summer. Warming was tracked with a 6-year lag by a contraction to the north of the mature female's range. Snow crab settle and grow to maturity in the Middle Domain. Successful recruitment during cold regimes may result from the occurrence of spring blooms and the stenothermy of early benthic instars. However, recruitment to the mature female population did not expand back to the southern shelf after the mid-1990s, despite some years when NBT was low. Cross-correlation of year-to-year shifts in geographic distribution of cod (Gadus macrocephalus) and immature snow crab during the 1990s suggests that the northward expansions of cod controlled the southern boundary of snow crab’s distribution range. Reestablishment of crab populations in the south may be hindered by cod predation. Also, because spawning females are now located “up-current,” advection of larvae to the south is unlikely. Contraction to the north may not be followed by an expansion back to the south after a change in regime. We refer to this suggested asymmetry as the environmental ratchet hypothesis and discuss it in the context of other conceptual models of the EBS ecosystem.Fil: Orensanz, Jose Maria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ernest, Billy. Universidad de Concepción; ChileFil: Armstrong, David A.. University of Washington; Estados UnidosFil: Stabeno, Phyllis. Pacific Marine Environmental Laboratory; Estados UnidosFil: Livingston, Pat. National Ocean And Atmospheric Administration. Alaska Fisheries Science Center; Estados Unido

Diisopropylamide and TMP turbo-grignard reagents : a structural rationale for their contrasting reactivities

A neutral dimeric molecule in crystal form, the diisopropylamido turbo-Grignard reagent "(iPr2N)MgCl⋅LiCl" (see structure; blue N, red O, green Mg, yellow Cl, black C) separates into several charged ate species in dynamic exchange with each other in THF solution as determined by a combination of EXSY and DOSY NMR studies

Late Neogene exhumation patterns in Taranaki Basin (New Zealand): evidence from offset porosity-depth trends

Journal ArticleTaranaki Basin, New Zealand, is located adjacent to the Australian-Pacific Plate boundary where the tectonic regime changes from dominantly subduction-related to the north to transpression-related along the Alpine Fault to the south. During the Neogene, burial and exhumation varied extensively, in both time and space, in response to subsidence and uplift along this evolving plate boundary zone

Exhumation of the central Wasatch Mountains, Utah: 1, Patterns and timing of exhumation deduced from low-temperature thermochronology data

Journal ArticleThe Wasatch Mountains are often cited as an example of normal fault growth and footwall flexure. They represent a tilted footwall at the edge of the Basin and Range extensional province, a major rift basin. Thus understanding the detailed spatial and elevation changes in coupled thermochronometer data, and how these changes can be interpreted, may aid in the analysis of thermochronometer data from other extensional regions around the world

Economic Impact of Wildlife-Associated Recreation Expenditures in the Southeast United States: A General Equilibrium Analysis

The economic impact of wildlife-associated recreation in the Southeast United States was evaluated using a general equilibrium model. Exogenous demand shocks to the regional economy were based on estimates of expenditures by wildlife recreationists on hunting, fishing, and wildlife watching activities. Counterfactual simulations were carried out, making alternative assumptions about labor and capital mobility and their supply. Without wildlife-associated recreation expenditures, regional employment would have been smaller by up to 783 thousand jobs, and value added would have been $22 to$48 billion less. These findings underscore the significance of regional factor market conditions in economic impact and general equilibrium analysis.general equilibrium modeling, input-output analysis, regional economic impact, wildlife-associated recreation activities, Resource /Energy Economics and Policy, R13, R15, Q26,

Transit shapes and self organising maps as a tool for ranking planetary candidates : application to Kepler and K2

A crucial step in planet hunting surveys is to select the best candidates for follow up observations, given limited telescope resources. This is often performed by human ‘eyeballing’, a time consuming and statistically awkward process. Here we present a new, fast machine learning technique to separate true planet signals from astrophysical false positives. We use Self Organising Maps (SOMs) to study the transit shapes of Kepler and K2 known and candidate planets. We find that SOMs are capable of distinguishing known planets from known false positives with a success rate of 87.0%, using the transit shape alone. Furthermore, they do not require any candidates to be dispositioned prior to use, meaning that they can be used early in a mission’s lifetime. A method for classifying candidates using a SOM is developed, and applied to previously unclassified members of the Kepler KOI list as well as candidates from the K2 mission. The method is extremely fast, taking minutes to run the entire KOI list on a typical laptop. We make Python code for performing classifications publicly available, using either new SOMs or those created in this work. The SOM technique represents a novel method for ranking planetary candidate lists, and can be used both alone or as part of a larger autovetting code

Self-aware SGD: reliable incremental adaptation framework for clinical AI models

Healthcare is dynamic as demographics, diseases, and therapeutics constantly evolve. This dynamic nature induces inevitable distribution shifts in populations targeted by clinical AI models, often rendering them ineffective. Incremental learning provides an effective method of adapting deployed clinical models to accommodate these contemporary distribution shifts. However, since incremental learning involves modifying a deployed or in-use model, it can be considered unreliable as any adverse modification due to maliciously compromised or incorrectly labelled data can make the model unsuitable for the targeted application. This paper introduces self-aware stochastic gradient descent (SGD) , an incremental deep learning algorithm that utilises a contextual bandit-like sanity check to only allow reliable modifications to a model. The contextual bandit analyses incremental gradient updates to isolate and filter unreliable gradients. This behaviour allows self-aware SGD to balance incremental training and integrity of a deployed model. Experimental evaluations on the Oxford University Hospital datasets highlight that self-aware SGD can provide reliable incremental updates for overcoming distribution shifts in challenging conditions induced by label noise