A stakeholder informed, low-cost, personalised 3D-printed insole for diabetic foot ulcer prevention

Background: Diabetic Foot Ulcer (DFU) incidence will rise in line with the increasing global prevalence of diabetes. Healthcare providers must develop effective interventions that address the needs of patients and clinicians if DFUs are to be prevented. Aim: Engage with stakeholders (patients and clinicians) to inform the development and evaluation criteria of a novel low-cost 3D-printed insole to reduce DFU risk in patients with neuropathy. Method: Data from the transcripts of 15 semi-structured patient interviews and the views of 7 podiatrists were used to develop a consensus statement of insole design specifications. A prototype insole was developed and evaluated against these specifications. Clinical effectiveness was established by comparing reduction in peak plantar pressures and patient perceived comfort of 4 people with diabetic neuropathy whist wearing 1) no insole 2) standard custom insole and 3) 3D-printed insole conditions. The F-scan in-shoe pressure measurement system was used to collect kinetic data. Insoles were presented in a random order with participants blinded to the condition. Results: The 3D-printed insole fulfilled most of the design specifications including being lightweight, easy to clean and walk in. It was more effective at reducing forefoot plantar loads when compared to the standard insole condition, reducing mean peak plantar pressure by 31%, a 4% greater reduction over the standard insole condition. Conclusion: This study provided valuable pilot data for the efficacy, acceptability and future direction of this intervention. The impact of stakeholder involvement on insole design, adherence and ulceration rate need to be evaluated through a clinical trial

The tactical mimicry of social enterprise strategies: acting ‘as if’ in the everyday life of third sector organizations

Using England as a paradigmatic case of the „enterprising up ‟ of the third sector through social enterprise policies and programs, this article sheds light on resistance as enacted through dramaturgical identification with government strategies. Drawing from a longitudinal qualitative research study, which is interpreted via Michel de Certeau‟s theory of the everyday, we present the case study of Teak, a charitable regeneration company, to illustrate how its Chief Executive Liam „acted as ‟ a social entrepreneur in order to gain access to important resources. We establish „tactical mimicry ‟ as a sensitizing concept to suggest that third sector practitioners ‟ identification with the normative premises of „social enterprise ‟ is part of a parasitical prosaics geared toward appropriating public money. While tactical mimicry conforms to strategies only in order to exploit them, its ultimate aim is to increase potentials of collective agency outside the direct influence of power. The contribution we make is threefold: first, we extend the recent debate on productive resistance by highlighting how „playing the game ‟ without changing existing relations of power can nevertheless produce largely favorable outcomes. Second, we suggest that recognition of the productive potential of tactical mimicry requires methodologies which pay attention to the spatial and temporal dynamics of resistance. And third, we argue that explaining „social enterprise‟ without consideration of the non-discursive, mainly financial resources made available to those who identify with it, necessarily risks overlooking a crucial element of the dramaturgical dynamic of discourse

Stroke rate is markedly reduced after carotid endarterectomy by avoidance of protamine

AbstractPurpose: Postoperative neurologic injury remains a significant risk of carotid endarterectomy. Mechanisms include embolization of debris and formation of thrombus on the newly endarterectomized surface. We hypothesized that the risk of postoperative neurologic injury would be lower in those patients who did not receive protamine for reversal of heparin anticoagulation.Methods: We reviewed 348 consecutive primary carotid endarterectomies performed since January 1, 1986, to determine the relationship between surgical outcomes and reversal of heparin anticoagulation. Patients undergoing additional simultaneous cardiovascular procedures were excluded. One hundred ninety-three patients received protamine after completion of the endarterectomy. The remaining 155 patients did not receive any protamine.Results: All patients in both groups survived to discharge. There were no strokes in those patients who did not receive any protamine; however, the stroke rate in the protamine group was 2.6% (5 of 193), p < 0.045. The incidence of hematoma requiring reexploration was 1.0% (2 of 193) and 1.9% (3 of 155) in the protamine and no-protamine groups, respectively (p = NS). Intraoperative shunting was used more frequently in the no-protamine group (84% vs 67%, p < 0.001), and patch angioplasty was performed more frequently in the protamine group (35% vs 15%, p < 0.001). However, neither shunting nor patching significantly influenced stroke rates.Conclusions: We conclude that carotid endarterectomy without reversal of heparin anticoagulation is associated with a reduced postoperative stroke rate without a significant increase in morbidity rates. (J VASC SURG 1995;22:264-70.

Labour supply and skills demands in fashion retailing

If, as Adam Smith once famously suggested, Britain was a nation of shopkeepers then it is now a nation of shopworkers. Retail is now a significant part of the UK economy, accounting for £256 billion in sales and one-third of all consumer spending (Skillsmart, 2007). It is the largest private sector employer in the UK, employing 3m workers, or 1 in 10 of the working population. For future job creation in the UK economy retail is also similarly prominent and the sector is expected to create a further 250,000 jobs to 2014 (Skillsmart, 2007). The centrality of retail to economic success and job creation is apparent in other advanced economies. For example, within the US, retail sales is the occupation with the largest projected job growth in the period 2004-2014 (Gatta et al., 2009) and in Australia retail accounts for 1 in 6 workers (Buchanan et al., 2003). Within the UK these workers are employed in approximately 290,000 businesses, encompassing large and small organizations and also a number of sub-sectors. This variance suggests that retail should not be regarded as homogenous in its labour demands. Hart et al. (2007) note how skill requirements and the types of workers employed may differ across the sector. This chapter further opens up this point, providing an analysis of the labour supply and skills demands for the sub-sectors of clothing, footwear and leather goods, which are described by Skillsmart (2007: 48) as being 'significant categories in UK retailing'

Response to novel objects and foraging tasks by common marmoset (Callithrix Jacchus) female Pairs

Many studies have shown that environmental enrichment can significantly improve the psychological well-being of captive primates, increasing the occurrence of explorative behavior and thus reducing boredom. The response of primates to enrichment devices may be affected by many factors such as species, sex, age, personality and social context. Environmental enrichment is particularly important for social primates living in unnatural social groupings (i.e. same-sex pairs or singly housed animals), who have very few, or no, benefits from the presence of social companions in addition to all the problems related to captivity (e.g. increased inactivity). This study analyses the effects of enrichment devices (i.e. novel objects and foraging tasks) on the behavior of common marmoset (Callithrix jacchus) female pairs, a species that usually lives in family groups. It aims to determine which aspects of an enrichment device are more likely to elicit explorative behaviors, and how aggressive and stress-related behaviors are affected by its presence. Overall, the marmosets explored foraging tasks significantly longer than novel objects. The type of object, which varied in size, shape and aural responsiveness (i.e. they made a noise when the monkey touched them), did not affect the response of the monkeys, but they explored objects that were placed higher in the enclosure more than those placed lower down.Younger monkeys were more attracted to the enrichment devices than the older ones. Finally, stress-related behavior (i.e. scratching) significantly decreased when the monkeys were presented with the objects; aggressive behavior as unaffected. This study supports the importance of environmental enrichment for captive primates and shows that in marmosets its effectiveness strongly depends upon the height of the device in the enclosure and the presence of hidden food. The findings can be explained ifone considers the foraging behavior of wild common marmosets. Broader applications for the research findings are suggested in relation to enrichment

Public Health and the Built Environment: Historical, Empirical, and Theoretical Foundations for an Expanded Role

In 2000, the Center for Disease Control and Prevention\u27s National Center for Environmental Health issued a report that explored some of the ways in which sprawl impacts public health. The report has generated great interest, and state health officials are beginning to discuss the relationship between land use and public health. The CDC report has also produced a backlash. For example, the Southern California Building Industry Association labeled the report a ludicrous sham and argued that the CDC should stick to fighting physical diseases, not defending political ones. In this environment, it is understandable if the CDC looks to such critiques as simply the latest partisan recruit to a political debate. But critics of the CDC\u27s efforts in this area may substantially overstate their case in the other direction. There is now and has long been a demonstrated connection between health, including physical disease, and the built environment. Moreover, government has intervened in the past in response to this connection and it continues to do so. While neither past practice nor current evidence make government intervention inevitable, this paper argues that such intervention is appropriate and supported by theory as well as history and empirical evidence

Geochemistry and oxygen isotope composition of main-group pallasites and olivine-rich clasts in mesosiderites: Implications for the "Great Dunite Shortage" and HED-mesosiderite connection

Evidence from iron meteorites indicates that a large number of differentiated planetesimals formed early in Solar System history. These bodies should have had well-developed olivine-rich mantles and consequentially such materials ought to be abundant both as asteroids and meteorites, which they are not. To investigate this “Great Dunite Shortage” we have undertaken a geochemical and oxygen isotope study of main-group pallasites and dunitic rocks from mesosiderites. Oxygen isotope analysis of 24 main-group pallasites (103 replicates) yielded a mean Δ17O value of −0.187 ± 0.016‰ (2σ), which is fully resolved from the HED Δ17O value of −0.246 ± 0.014 (2σ) obtained in our earlier study and demonstrates that both groups represent distinct populations and were derived from separate parent bodies. Our results show no evidence for Δ17O bimodality within the main-group pallasites, as suggested by a number of previous studies. Olivine-rich materials from the Vaca Muerta, Mount Padbury and Lamont mesosiderites, and from two related dunites (NWA 2968 and NWA 3329), have Δ17O values within error of the mesosiderite average. This indicates that these olivine-rich materials are co-genetic with other mesosiderite clasts and are not fragments from an isotopically distinct pallasite-like impactor. Despite its extreme lithologic diversity the mesosiderite parent body was essentially homogeneous with respect to Δ17O, a feature best explained by an early phase of large-scale melting (magma ocean), followed by prolonged igneous differentiation. Based on the results of magma ocean modeling studies, we infer that Mg-rich olivines in mesosiderites formed as cumulates in high-level chambers and do not represent samples of the underlying mantle. By analogy, recently documented Mg-rich olivines in howardites may have a similar origin. Although the Dawn mission did not detect mesosiderite-like material on Vesta, evidence linking the mesosiderites and HEDs includes: (i) their nearly identical oxygen isotope compositions; (ii) the presence in both of coarse-grained Mg-rich olivines; (iii) both have synchronous Lu-Hf and Mn-Cr ages; (iv) there are compositional similarities between the metal in both; and (v) mesosiderite-like material has been identified in a howardite breccia. The source of the mesosiderites remains an outstanding question in meteorite science. The underrepresentation of olivine-rich materials amongst both asteroids and meteorites results from a range of factors. However, evidence from pallasites and mesosiderites indicates that the most important reason for this olivine shortage lies in the early, catastrophic destruction of planetesimals in the terrestrial planet-forming region and the subsequent preferential loss of their olivine-rich mantles

Would a student midwife run postnatal clinic make a valuable addition to midwifery education in the UK? - A systematic review

Background – There is growing evidence in the UK that some National Health Service improvements, particularly in the postnatal period, are having an impact on the quality and variety of student midwives’ clinical experiences, making it challenging for them to meet the standards set by the regulatory body for midwives and receive a licence to practice. A possible solution to this may be the introduction of a Student Midwife integrated Learning Environment (SMiLE) focusing upon the delivery of postnatal care (PN) through a student run clinic Objective - To identify the current state of knowledge, regarding the educational outcomes of students who engage with student run clinics (SRC) and the satisfaction of patients who attend them Search strategy - BNI, CINAHL, EMBASE, MEDLINE were searched for articles published until April 2014. Selection criteria - Studies nationally and internationally, that were carried out on healthcare students running their own clinics. Outcome measures were the evaluation of educational outcomes of students and client satisfaction were included Data collection and analysis - Data were extracted, analysed and synthesised to produce a summary of knowledge, regarding the effectiveness of SRC’s Main results - 6 studies were selected for this review Authors conclusions – The findings that SRC can offer advantages in improving educational outcomes of students and provide an effective service to clients is encouraging. However, given the limited number of high-quality studies included in this review, further research is required to investigate the effectiveness of SR

Consensus-based technical recommendations for clinical translation of renal T1 and T2 mapping MRI

To develop technical recommendations on the acquisition and post-processing of renal longitudinal (T1) and transverse (T2) relaxation time mapping. A multidisciplinary panel consisting of 18 experts in the field of renal T1 and T2 mapping participated in a consensus project, which was initiated by the European Cooperation in Science and Technology Action PARENCHIMA CA16103. Consensus recommendations were formulated using a two-step modified Delphi method. The first survey consisted of 56 items on T1 mapping, of which 4 reached the pre-defined consensus threshold of 75% or higher. The second survey was expanded to include both T1 and T2 mapping, and consisted of 54 items of which 32 reached consensus. Recommendations based were formulated on hardware, patient preparation, acquisition, analysis and reporting. Consensus-based technical recommendations for renal T1 and T2 mapping were formulated. However, there was considerable lack of consensus for renal T1 and particularly renal T2 mapping, to some extent surprising considering the long history of relaxometry in MRI, highlighting key knowledge gaps that require further work. This paper should be regarded as a first step in a long-term evidence-based iterative process towards ever increasing harmonization of scan protocols across sites, to ultimately facilitate clinical implementation