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

Biological Assessments of Six Selected Fishes, Amphibians, and Mussels in Illinois

ID: 8758; issued November 1, 1996INHS Technical Report prepared for Illinois Department of Natural Resources, Division of Natural Heritag

The impact of disturbed galaxy clusters on the kinematics of active galactic nuclei

© 2020 The Author(s) We produce a kinematic analysis of AGN-hosting cluster galaxies from a sample of 33 galaxy clusters selected using the X-ray Clusters Database (BAX) and populated with galaxies from the Sloan Digital Sky Survey Data Release 8. The 33 galaxy clusters are delimited by their relative intensity of member galaxy substructuring as a proxy to core merging to derive two smaller sub-samples of 8 dynamically active (merging) and 25 dynamically relaxed (non-merging) states. The AGN were selected for each cluster sub-sample by employing the WHAN diagram to the strict criteria of log10([N II]/Hα) ≥ −0.32 and EWHα ≥ 6 Å, providing pools of 70 mergings and 225 non-merging AGN sub-populations. By co-adding the clusters to their respective dynamical states to improve the signal-to-noise ratio of our AGN sub-populations we find that merging galaxy clusters on average host kinematically active AGN between 0-1.5r200 as r200 → 0, where their velocity dispersion profile (VDP) presents a significant deviation from the non-AGN sub-population VDP by ≳3σ. This result is indicative that the AGN-hosting cluster galaxies have recently coalesced on to a common potential. Further analysis of the composite distributions illustrates non-merging AGN-hosting sub-populations have, on average, already been accreted and predominantly lie within backsplash regions of the projected phase-space. This suggests merging cluster dynamical states hold relatively younger AGN sub-populations kinematically compared with those found in non-merging cluster dynamical states

Making the World Safer and Fairer in Pandemics

Global health has long been characterized by injustice, with certain populations marginalized and made vulnerable by social, economic, and health disparities within and among countries. The pandemic only amplified inequalities. In response to it, the World Health Organization and the United Nations have embarked on transformative normative and financial reforms that could reimagine pandemic prevention, preparedness, and response (PPPR). These reforms include a new strategy to sustainably finance the WHO, a UN political declaration on PPPR, a fundamental revision to the International Health Regulations, and negotiation of a new, legally binding pandemic agreement (popularly called the “Pandemic Treaty”). We revisit the cavernous shortcomings of the global Covid-19 response, explain potentially transformative legal reforms and the ethical values that underpin them, and propose actionable solutions to advance both health and justice

Improved methods for simulating nearly extremal binary black holes

Astrophysical black holes could be nearly extremal (that is, rotating nearly as fast as possible); therefore, nearly extremal black holes could be among the binaries that current and future gravitational-wave observatories will detect. Predicting the gravitational waves emitted by merging black holes requires numerical-relativity simulations, but these simulations are especially challenging when one or both holes have mass $m$ and spin $S$ exceeding the Bowen-York limit of $S/m^2=0.93$. We present improved methods that enable us to simulate merging, nearly extremal black holes more robustly and more efficiently. We use these methods to simulate an unequal-mass, precessing binary black hole coalescence, where the larger black hole has $S/m^2=0.99$. We also use these methods to simulate a non-precessing binary black hole coalescence, where both black holes have $S/m^2=0.994$, nearly reaching the Novikov-Thorne upper bound for holes spun up by thin accretion disks. We demonstrate numerical convergence and estimate the numerical errors of the waveforms; we compare numerical waveforms from our simulations with post-Newtonian and effective-one-body waveforms; we compare the evolution of the black-hole masses and spins with analytic predictions; and we explore the effect of increasing spin magnitude on the orbital dynamics (the so-called "orbital hangup" effect).Comment: 18 pages, 18 figure

Financing Reforms to Meet a Pivotal Moment in Global Health

2024 will be the most important moment for global health since the World Health Organization’s founding in 1948, but only if states give major reforms their full political and financial backing. Bold new commitments in disease surveillance, capacity building, and more equitable access to health products cannot be achieved without ample and sustainable funding. In this essay, we discuss major reforms found in the emerging pandemic agreement and reformed International Health Regulations and then explore the significant challenges and opportunities for financing them

Going Global, Acting Local: How an International Pandemic Convention Can Support Regional and Community Response

A WHO pandemic convention could set in place an overarching framework needed for strengthening global health security. As the World Health Assembly (WHA) debated the merits of such an agreement, a critically important regional instrument – the Treaty for the Establishment of the African Medicines Agency (AMA Treaty) – entered into force on 5 November 2021. The new agency will, among other things, ensure there is a “common framework” for addressing “emerging issues and pandemics in the event of a public health emergency on the continent with cross border or regional implications.” An improved worldwide health security strategy is essential but global mechanisms should complement without undermining effective regional, national, and sub-national approaches. Consequently, WHA decision-makers should carefully consider the scope of a potential global convention and make deliberate choices as to the content that requires truly worldwide coordination while incorporating and enhancing fit for purpose regional, national, and local strategies

Methyl tetra-O-acetyl-α-d-glucopyranuronate: crystal structure and influence on the crystallisation of the β anomer

Methyl tetra-O-acetyl-β-d-glucopyranuronate (1) and methyl tetra-O-acetyl-α-d-glucopyranuronate (3) were isolated as crystalline solids and their crystal structures were obtained. That of the β anomer (1) was the same as that reported by Root et al., while anomer (3) was found to crystallise in the orthorhombic space group P212121 with two independent molecules in the asymmetric unit. No other crystal forms were found for either compound upon recrystallisation from a range of solvents. The α anomer (3) was found to be an impurity in initially precipitated batches of β-anomer (1) in quantities <3%; however, it was possible to remove the α impurity either by recrystallisation or by efficient washing, i.e. the α anomer is not incorporated inside the β anomer crystals. The β anomer (1) was found to grow as prisms or needles elongated in the a crystallographic direction in the absence of the α impurity, while the presence of the α anomer (3) enhanced this elongation

The rotational profiles of cluster galaxies

© 2019 The Author(s) We compile two samples of cluster galaxies with complimentary hydrodynamic and N-body analysis using FLASH code to ascertain how their differing populations drive their rotational profiles and to better understand their dynamical histories.We select our main cluster sample from the X-ray Galaxy Clusters Database (BAX), which are populated with Sloan Digital Sky Survey (SDSS) galaxies. The BAX clusters are tested for the presence of substructures, acting as proxies for core mergers, culminating in sub-samples of eight merging and 25 non-merging galaxy clusters. An additional sample of 12 galaxy clusters with known dumbbell components is procured using galaxy data from the NASA/IPAC Extragalactic Database (NED) to compare against more extreme environments. BAX clusters of each sample are stacked on to a common RA-Dec. space to produce rotational profiles within the range of 0.0-2.5 r200. Merging stacks possess stronger core rotation at ≲0.5r200 primarily contributed by a red galaxy sub-population from relaxing core mergers; this is alongside high rotational velocities from blue galaxy sub-populations, until they mix and homogenize with the red sub-populations at ∼r200, indicative of an infalling blue galaxy sub-population with interactive mixing between both sub-populations at ≿ r200. FLASH code is utilized to simulate the merger phase between two originally independent clusters and test the evolution of their rotational profiles. Comparisons with the dumbbell clusters leads to the inference that the peculiar core rotations of some dumbbell clusters are the result of the linear motions of core galaxies relaxing on to the potential during post second infall