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

Simple Neurite Tracer: open source software for reconstruction, visualization and analysis of neuronal processes

Motivation: Advances in techniques to sparsely label neurons unlock the potential to reconstruct connectivity from 3D image stacks acquired by light microscopy. We present an application for semi-automated tracing of neurons to quickly annotate noisy datasets and construct complex neuronal topologies, which we call the Simple Neurite Tracer. Availability: Simple Neurite Tracer is open source software, licensed under the GNU General Public Licence (GPL) and based on the public domain image processing software ImageJ. The software and further documentation are available via http://fiji.sc/Simple_Neurite_Tracer as part of the package Fiji, and can be used on Windows, Mac OS and Linux. Documentation and introductory screencasts are available at the same URL. Contact: [email protected]; [email protected]

The impact of superphosphate and surface-applied lime on the profitability and sustainability of wool production on the tablelands of NSW

Soil acidification is one of the major forms of soil degradation in higher rainfall areas of the tablelands of NSW. A grazing experiment was conducted near Sutton, NSW, to assess the effect of various rates of superphosphate, lime, sewage ash and stocking rates on wool production and sustainability between 1999 and 2008. The results from the discounted cash flow analysis show that the net present value of the treatment without lime, the lower rate of superphosphate and the lowest stocking rate returned the highest net present value of $266.30/ha. Raising the application of superphosphate from 125kg/ha every two to three years to 250kg/ha every year on un-limed and limed soil reduced the net present value by$278.70/ha and $249.30/ha, respectively. The addition of lime at the rate of 4t/ha on un-limed soil at the low superphosphate level reduced the net present value by about$234.60/ha. The net present value fell by $205.24/ha when the level of superphosphate rate increased to 250kg/ha every year. The net present value decreased as the level of stocking rate increased. We conclude that wool producers will be unlikely to use lime to ameliorate acid soil, even though production will not be sustainable, unless there are more favourable input and commodity prices in the market and government intervention.economic, acid soil, lime, superphosphate, sewage ash, stocking rate, policy,

The influence on unaided vision of age, pupil diameter and spherocylindrical refractive error

Background - The aim was to derive equations for the relationship between unaided vision and age, pupil diameter, iris colour and sphero-cylindrical refractive error. Methods - Data were collected from 663 healthy right eyes of white subjects aged 20 to 70 years. Subjective sphero-cylindrical refractive errors ranged from -6.8 to +9.4 D (mean spherical equivalent), -1.5 to +1.9 D (orthogonal component, J0) and -0.8 to 1.0 D (oblique component, J45). Cylinder axis orientation was orthogonal in 46 per cent of the eyes and oblique in 18 per cent. Unaided vision (-0.3 to +1.3 logMAR), pupil diameter (2.3 to 7.5 mm) and iris colour (67 per cent light/blue irides) was recorded. The sample included mostly females (60 per cent) and many contact lens wearers (42 per cent) and so the influences of these parameters were also investigated. Results - Decision tree analysis showed that sex, iris colour, contact lens wear and cylinder axis orientation did not influence the relationship between unaided vision and refractive error. New equations for the dependence of the minimum angle of resolution on age and pupil diameter arose from step backwards multiple linear regressions carried out separately on the myopes (2.91.scalar vector +0.51.pupil diameter -3.14 ) and hyperopes (1.55.scalar vector + 0.06.age – 3.45 ). Conclusion - The new equations may be useful in simulators designed for teaching purposes as they accounted for 81 per cent (for myopes) and 53 per cent (for hyperopes) of the variance in measured data. In comparison, previously published equations accounted for not more than 76 per cent (for myopes) and 24 per cent (for hyperopes) of the variance depending on whether they included pupil size. The new equations are, as far as is known to the authors, the first to include age. The age-related decline in accommodation is reflected in the equation for hyperopes

Supercritical-fluid synthesis of FeF2 and CoF2 Li-ion conversion materials

The synthesis of the Li-ion conversion candidates, FeF2 and CoF2, obtained from the single source organometallic precursors [Fe(tta)3] (tta = C8H4F3O2S), and [Co(hfac)2[middle dot]2H2O] (hfac = C5H1F6O2), respectively, via a novel supercritical fluid (SCF) method is presented. The nature of the synthesis led to highly-crystalline FeF2 and CoF2 powders requiring no additional thermal treatment. The as-obtained powders were investigated for use as potential positive Li-ion conversion electrodes by means of chronopotentiometric measurements. The FeF2 cells displayed high initial capacities following electrochemical conversion (up to [similar]1100 mA h g-1 at a potential of 1.0 V vs. Li/Li+), with appreciable cyclic behaviour over 25 discharge-charge cycles. The deposition of a [similar]5 nm layer of amorphous carbon onto the surface of the active material following SCF treatment, likely facilitated adequate electron transport through an otherwise poorly conducting FeF2 phase. Similarly, CoF2 cells displayed high initial capacities (up to [similar]650 mA h g-1 at a potential of 1.2 V vs. Li/Li+), although significant capacity fading ensued in the subsequent cycles. Ex situ XRD measurements confirmed a poor reversibility in the conversion sequence for CoF2, with a complete loss of CoF2 crystallinity and the sole presence of a crystalline LiF phase following charging

The Clinical Application of Polarization Pattern Perception

Purpose: Determine the repeatability of and optimum stimulus parameters for testing polarization pattern perception in a real-world clinical population, and assess the ability of polarization perception to distinguish normal from abnormal eyes. Methods: Polarization perception was evaluated in staff and patients attending ophthalmology clinics at Warwick Hospital, UK. A series of visual stimuli were presented in pseudorandom order using a liquid-crystal-display–based polarization pattern generator. Stimuli included geometric patterns, gratings, checkerboards, and optotypes. Participants had one or both eyes diagnosed as normal or abnormal following ophthalmic examination, optical coherence tomography, and measures of visual acuity. Measurement scores were assigned to the eye(s) of each participant depending on the total number of stimuli perceived or identified. Results: Stimuli covered the range of spatial scales resolvable within polarization perception by normal and abnormal eyes. Different stimuli had different saliencies. For each stimulus type, polarization perception in the abnormal group was significantly reduced compared with normal eyes (P < 0.001). Relative stimulus salience was broadly similar for normal-eye and abnormal-eye viewing groups, being greatest for radially symmetric patterns and least for optotypes. Checkerboard pattern salience had an inverse logarithmic relationship with check fundamental spatial frequency. A devised metric covering the dynamic range of polarization perception was repeatable, and the score derived from the metric was reduced in the abnormal group compared with the normal group (P < 0.001). Conclusions: Clinically useful metrics of polarization perception distinguish between normal and abnormal eyes. Translational Relevance: Perception of spatial patterns formed of non-uniform polarization fields has potential as a quantitative clinical diagnostic measuremen

Substrate utilization during exercise performed with and without glucose ingestion in female and male endurance trained athletes

Compared to males, females oxidize proportionately more fat and less carbohydrate during endurance exercise performed in the fasted state. This study was designed to test the hypothesis that there may also be gender differences in exogenous carbohydrate (CHOexo) oxidation during exercise. Healthy, young males (n = 7) and females (n = 7) each completed 2 exercise trials (90 min cycle ergometry at 60% VO[sub2peak]), 1 week apart. Females were eumenorrheic and were tested in the midfollicular phase of their menstrual cycle. Subjects drank intermittently either 8% CHOexo (1 g glucose &sdot; kg &sdot; h[sup-1]) enriched with U-13C glucose or an artificially sweetened placebo during the trial. Whole-body substrate oxidation was determined from PER, urinary urea excretion, and the ratio of 13C:12C in expired gas during the final 60 min of exercise. During the placebo trial, fat oxidation was higher in females than in males (0.42 &plusmn; 0.07 vs. 0.32 &plusmn; 0.09 g &sdot; min[sup-1] . kg LBM[sup-1] x 10[sup-2]) at 30 min of exercise (p &lt; .05). When averaged over the final 60 min of exercise, the relative proportions of fat, total carbohydrate, and protein were similar between groups. During CHOexo ingestion, both the ratio of 13C: 12C in expired gas (p &lt; .05) and the proportion of energy derived from CHOexo relative to LBM (p &lt; .05) were higher in females compared to males at 75- and 90-min exercise. When averaged over the final 60 min of exercise, the percentage of CHOexo to the total energy contribution tended to be higher in females (14.3 + 1.2%) than in males (11.2 &plusmn; 1.2%; p = .09). The reduction in endogenous CHO oxidation with CHOexo intake was also greater in females (12.9 &plusmn; 3.1%) than in males (5.1 &plusmn; 2.0%; p = .05). Compared to males, females may oxidize a greater relative proportion of CHOexo during endurance exercise which, in turn, may spare more endogenous fuel. Based on these observations, ingested carbohydrate may be a particularly beneficial source of fuel during endurance exercise for females.<br /

Multi-component physical activity interventions in the UK must consider determinants of activity to increase effectiveness

Interventions to increase physical activity in children have adopted broad approaches and achieved varying success. There is a need to adopt approaches underpinned with a theoretical basis. Accordingly, the aim here was to implement and evaluate a 12-week intervention designed using the concepts of the COM-B model to determine the effect this has on physical activity levels. One hundred and forty-seven school-age children (mean age 8.9 ± 1.3 years) took part in a 12-week program delivered in a school setting. Topics included physical activity, healthy eating, sleep quality and reducing screen time/sedentary activities when not in school. A sample of participants wore a wrist-worn accelerometer for seven days pre-and post-intervention (N = 11). The physical activity frequency was unchanged (2.9 ± 1.0 AU) when compared with post-intervention values (3.1 ± 0.8 AU, mean increase 6.8 ± 3.7%, p > 0.05). Changes were observed in the daily consumption of fruit and vegetables (pre-intervention 44.6% vs. post-intervention 60.2%, p p > 0.05). There is a need to adopt a broader approach that incorporates a theoretical basis and considers the complex ways by which physical activity behaviours are influenced

Atypical Teratoid/Rhabdoid Tumors in Adults: A Case Report and Treatment-Focused Review

Atypical teratoid/rhabdoid tumor is predominantly a childhood tumor and has only been rarely reported in adults; therefore, treatment regimens are often extrapolated from the pediatric experience. Typically, children are treated with craniospinal radiation therapy which is often followed by systemic chemotherapy. Employing pediatric regimens to treat this tumor in adult patients poses a particular risk for myelosuppression, as the prescribed doses in pediatric protocols exceed those tolerated by adults, and conventional craniospinal radiation can be associated with prolonged myelotoxicity and a depletion of the bone marrow reserve in vertebrae of adults. Here we present a case of a woman with a pineal region atypical teratoid/rhabdoid tumor, an unusual adult cancer presenting in an atypical location. This is followed by a review of the disease in adult patients with an emphasis on treatment and suggestions to minimize myelotoxicity

Exploring views on satisfaction with life in young children with chronic illness: an innovative approach to the collection of self-report data from children under 11

The objective of this study was to explore young children’s views on the impact of chronic illness on their life in order to inform future development of a patient-based self-report health outcome measure. We describe an approach to facilitating self-report views from young children with chronic illness. A board game was designed in order to obtain qualitative data from 39 children with a range of chronic illness conditions and 38 healthy controls ranging in age from 3 to 11 years. The format was effective in engaging young children in a self-report process of determining satisfaction with life and identified nine domains. The board game enabled children aged 5–11 years with chronic illness to describe the effects of living with illness on home, family, friends, school and life in general. It generated direct, non-interpreted material from children who, because of their age, may have been considered unable or limited their ability to discuss and describe how they feel. Obtaining this information for children aged 4 and under continues to be a challenge