Nature and extent of outpatient podiatry service utilisation in people with diabetes undergoing minor foot amputations : a retrospective clinical audit

Background: People with diabetes are at high risk of foot complications that can lead to lower extremity amputations. National standards suggest that early assessment and management by a podiatry led multidisciplinary high-risk foot clinic (HRFC) helps to reduce complications. This review is a retrospective audit of the Central Coast Local Health District (CCLHD) podiatry department service utilisation in people with diabetes who had undergone a minor foot amputation. Methods: All people with diabetes who had minor foot amputations in the calendar year 2017 in the CCLHD in New South Wales were identified. Podiatry occasions of service from all podiatry service clinics (e.g. general, orthoses, wound, HRFC) and hospital stays for 12 months prior to, and 12 months, post the minor foot amputation were extracted. Results: Data on 74 people with diabetes who underwent 85 minor foot amputations were collected. In the 12-month period leading up to their minor foot amputation less than half, 42% (n=31), of the patients had attended any of the available podiatry service clinics within the CCLHD system. Post-amputation and discharge from hospital there was an overall rise of 26% in numbers attending all CCLHD podiatry- led clinics bringing the total to 68% (51). However, attendance at the HRFC rose by only 2% from 16% (n=12) to 18% n= (13). Conclusion: This study shows that there was underutilisation of Podiatry Services in the CCLHD in 2017 with some participants not meeting national treatment guidelines for foot health services. Revision of current referral pathways both prior to, during and following hospitalisation and expanding the multidisciplinary HRFC to accommodate the population by providing more accessible locations has since been undertaken to increase service access. Further provision of education to those highlighted to be at high risk has also been implemented

A Model for Patchy Reconnection in Three Dimensions

We show, theoretically and via MHD simulations, how a short burst of reconnection localized in three dimensions on a one-dimensional current sheet creates a pair of reconnected flux tubes. We focus on the post-reconnection evolution of these flux tubes, studying their velocities and shapes. We find that slow-mode shocks propagate along these reconnected flux tubes, releasing magnetic energy as in steady-state Petschek reconnection. The geometry of these three-dimensional shocks, however, differs dramatically from the classical two-dimensional geometry. They propagate along the flux tube legs in four isolated fronts, whereas in the two-dimensional Petschek model, they form a continuous, stationary pair of V-shaped fronts. We find that the cross sections of these reconnected flux tubes appear as teardrop shaped bundles of flux propagating away from the reconnection site. Based on this, we argue that the descending coronal voids seen by Yohkoh SXT, LASCO, and TRACE are reconnected flux tubes descending from a flare site in the high corona, for example after a coronal mass ejection. In this model, these flux tubes would then settle into equilibrium in the low corona, forming an arcade of post-flare coronal loops.Comment: 27 pages plus 16 figure

Do toe blood pressures predict healing after minor lower limb amputation in people with diabetes? : a systematic review and meta-analysis

Purpose of study: To investigate toe systolic blood pressure and/or toe-brachial pressure index in predicting healing post minor diabetic foot amputations. Key methods: A systematic search of EMBASE and PubMed (including Medline and The Cochrane Library) was conducted from database inception to 9 March 2020. Two authors independently reviewed and selected relevant studies. Quality was assessed with a modified Critical Appraisal Skill Programme checklist. Main results: Ten studies met the inclusion criteria. Nine studies investigating toe systolic blood pressure reported healing occurred at mean toe systolic blood pressure values ⩾30 mmHg, ranging between 30 and 83.6 mmHg. The meta-analysis (four studies) found toe systolic blood pressure 0.2, with one study reporting a higher value of 0.8. Main conclusions: Successful post-amputation healing outcomes were reported at mean toe systolic blood pressure ⩾30 mmHg, and the results varied considerably between the studies. Further research should identify whether variables, including amputation level, method of wound closure and length of post-operative follow-up periods, affect the values of toe systolic blood pressure and toe-brachial pressure index observed in this review

Patchy Reconnection in a Y-Type Current Sheet

We study the evolution of the magnetic field in a Y-type current sheet subject to a brief, localized magnetic reconnection event. The reconnection produces up- and down-flowing reconnected flux tubes which rapidly decelerate when they hit the Y-lines and underlying magnetic arcade loops at the ends of the current sheet. This localized reconnection outflow followed by a rapid deceleration reproduces the observed behavior of post-CME downflowing coronal voids. These simulations support the hypothesis that these observed coronal downflows are the retraction of magnetic fields reconnected in localized patches in the high corona.Comment: 4 pages, 3 figure

Experiences of living with chronic back pain: The physical disabilities

Purpose. Back-related functional limitations are largely assessed using lists of activities, each scored on a yes/no basis and the scores then summed. This provides little information about how chronic back pain (CBP) patients live with their condition. This study describes the consequences of living day-to-day with CBP and documents the 'insider' accounts of its impact on daily life. Method. Unstructured interviews, using the 'Framework' approach with topic guide, were recorded and transcribed verbatim. Subjects were sampled for age, sex, ethnicity and occupation from new referrals with back pain to a rheumatology outpatient clinic. Eleven subjects (5 male, 6 female) were interviewed either in English (n = 9) or their preferred language (n = 2). Interviews were read in-depth twice to identify the topics. Data were extracted in phrases and sentences using thematic content analysis. Results. Four themes emerged: sleep/rest, mobility, independence and leisure. All subjects reported issues about sleep and rest, nine about mobility, seven about independence and six on leisure. Most descriptions concerned loss and limitation in daily life. Strategies for coping with sleep disruption and physical limitations were described. Conclusions. Subjects provided graphic 'in-depth' descriptions of experiences living with CBP every day; expressed regret at the loss of capabilities and distress at the functional consequences of those losses. Facilitating 'adjustment' to 'loss' may be more helpful than inferring the potential for a life free of pain as a result of therapeutic endeavours

Field techniques for rearing and marking mountain pine beetle for use in dispersal studies

Mountain pine beetles, Dendroctonus ponderosae, were marked with fluorescent (DayGlo) powders in vacuum chambers and on powder-covered brood trees in the field for use in release-recapture studies of dispersal behaviour. A large wall tent was used as a field insectary to accelerate late stages of development of large numbers of beetles in naturally infested bolts of lodgepole pine. Up to 28% of the marked beetles which flew were recovered from lethal trap trees. Beetles self-marked on powdered brood trees were captured in barrier traps in predicted proportions

A Nationwide Study of Campylobacter jejuni and Campylobacter coli Bacteremia in Finland Over a 10-Year Period, 1998–2007, With Special Reference to Clinical Characteristics and Antimicrobial Susceptibility

Campylobacter jejuni and Campylobacter coli bacteremia patients were mainly young and without severe underlying diseases. The bacterial isolates were typically susceptible to antimicrobial agents. The outcome was usually good, regardless of appropriate or inappropriate antimicrobial treatment given at the hospital

Bandgaps in the propagation and scattering of surface water waves over cylindrical steps

Here we investigate the propagation and scattering of surface water waves by arrays of bottom-mounted cylindrical steps. Both periodic and random arrangements of the steps are considered. The wave transmission through the arrays is computed using the multiple scattering method based upon a recently derived formulation. For the periodic case, the results are compared to the band structure calculation. We demonstrate that complete band gaps can be obtained in such a system. Furthermore, we show that the randomization of the location of the steps can significantly reduce the transmission of water waves. Comparison with other systems is also discussed.Comment: 4 pages, 3 figure