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

Heterobranch sea slugs (Mollusca: Gastropoda) from Ascension Island, South Atlantic Ocean

The small volcanic island of Ascension is situated in the middle of the South Atlantic Ocean, more than 1500 km from the coast of Africa, its nearest continental area. To date, eight 'opisthobranch' species were reported from the island. As a result of a recent survey, 10 species were found. Seven species are new records from Ascension: Platydoris angustipes (Morch, 1863), Diaulula sp., Dolabrifera dolabrifera (Rang, 1828), Aplysia parvula Guilding in Morch, 1863 and Caliphylla mediterranea A. Costa, 1867, and two new species: Phidiana mimica sp. nov.; and Felimida atlantica sp. nov. Half of the species found have a wide geographical distribution, being not restricted to the Atlantic Ocean. However, traditional taxonomy based on few characters is probably masking complexes of species.Darwin Initiative (EIDCF012); CNPq-Brazil; DAAD-Germany; DFG [SCHR667/9,13]info:eu-repo/semantics/publishedVersio

Forces Generated by High Velocity Impact of Ice on a Rigid Structure

Tests were conducted to measure the impact forces generated by cylindrical ice projectiles striking a relatively rigid target. Two types of ice projectiles were used, solid clear ice and lower density fabricated ice. Three forms of solid clear ice were tested: single crystal, poly-crystal, and "rejected" poly-crystal (poly-crystal ice in which defects were detected during inspection.) The solid ice had a density of approximately 56 lb/cu ft (0.9 gm/cu cm). A second set of test specimens, termed "low density ice" was manufactured by molding shaved ice into a cylindrical die to produce ice with a density of approximately 40 lb/cu ft (0.65 gm/cu cm). Both the static mechanical characteristics and the crystalline structure of the ice were found to have little effect on the observed transient response. The impact forces generated by low density ice projectiles, which had very low mechanical strength, were comparable to those of full density solid ice. This supports the hypothesis that at a velocity significantly greater than that required to produce fracture in the ice, the mechanical properties become relatively insignificant, and the impact forces are governed by the shape and mass of the projectile

Design of Quiet Rotorcraft Approach Trajectories

A optimization procedure for identifying quiet rotorcraft approach trajectories is proposed and demonstrated. The procedure employs a multi-objective genetic algorithm in order to reduce noise and create approach paths that will be acceptable to pilots and passengers. The concept is demonstrated by application to two different helicopters. The optimized paths are compared with one another and to a standard 6-deg approach path. The two demonstration cases validate the optimization procedure but highlight the need for improved noise prediction techniques and for additional rotorcraft acoustic data sets

Development of standards for education and training in family and community medidcine - contributions by WONCA IberoAmerica (CIMF)

The WONCA Education Working Party (WEP) is developing a set of standards for medical student education, postgraduate training in family medicine / general practice and continuing professional development for family doctors. At this point the contributions by WONCA world regions are very important, and for this reason the main objective of this report is to present the standards developed by the Iberoamerican WONCA Region (CIMF). To be comprehensive and effective, standards should reflect regional realities and so the contributions from CIMF may reinforce and strengthen the key initiative of WEP and the implementation of the standards throughout the world. (C) 2010 Elsevier Espana, S.L. All rights reserved.Universidade Federal de São Paulo, São Paulo, BrazilUniv Puerto Rico, San Juan, PR 00936 USAUniv Prov Rio de Janeiro UERJ, Rio de Janeiro, BrazilFlinders Univ S Australia, Adelaide, SA, AustraliaUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Status and promise of particle interferometry in heavy-ion collisions

After five years of running at RHIC, and on the eve of the LHC heavy-ion program, we highlight the status of femtoscopic measurements. We emphasize the role interferometry plays in addressing fundamental questions about the state of matter created in such collisions, and present an enumerated list of measurements, analyses and calculations that are needed to advance the field in the coming years

Properties and Potential of Two (ni,pt)ti Alloys for Use as High-temperature Actuator Materials

The microstructure, transformation temperatures, basic tensile properties, shape memory behavior, and work output for two (Ni,Ti)Pt high-temperature shape memory alloys have been characterized. One was a Ni30Pt20Ti50 alloy (referred to as 20Pt) with transformation temperatures above 230 C and the other was a Ni20Pt30Ti50 alloy (30Pt) with transformation temperatures about 530 C. Both materials displayed shape memory behavior and were capable of 100% (no-load) strain recovery for strain levels up to their fracture limit (3-4%) when deformed at room temperature. For the 20Pt alloy, the tensile strength, modulus, and ductility dramatically increased when the material was tested just about the austenite finish (A(sub f)) temperature. For the 30Pt alloy, a similar change in yield behavior at temperatures above the A(sub f) was not observed. In this case the strength of the austentite phase was at best comparable and generally much weaker than the martensite phase. A ductility minimum was also observed just below the A(sub s) temperature in this alloy. As a result of these differences in tensile behavior, the two alloys performed completely different when thermally cycled under constant load. The 20Pt alloy behaved similar to conventional binary NiTi alloys with work output due to the martensite-to-austenite transformation initially increasing with applied stress. The maximum work output measured in the 20Pt alloy was nearly 9 J/cu cm and was limited by the tensile ductility of the material. In contrast, the martensite-to-austenite transformation in the 30Pt alloy was not capable of performing work against any bias load. The reason for this behavior was traced back to its basic mechanical properties, where the yield strength of the austenite phase was similar to or lower than that of the martensite phase, depending on temperature. Hence, the recovery or transformation strain for the 30Pt alloy under load was essentially zero, resulting in zero work output

Elongation factor Tu is a multifunctional and processed moonlighting protein

Many bacterial moonlighting proteins were originally described in medically, agriculturally, and commercially important members of the low G + C Firmicutes. We show Elongation factor Tu (Ef-Tu) moonlights on the surface of the human pathogens Staphylococcus aureus (SaEf-Tu) and Mycoplasma pneumoniae (MpnEf-Tu), and the porcine pathogen Mycoplasma hyopneumoniae (MhpEf-Tu). Ef-Tu is also a target of multiple processing events on the cell surface and these were characterised using an N-terminomics pipeline. Recombinant MpnEf-Tu bound strongly to a diverse range of host molecules, and when bound to plasminogen, was able to convert plasminogen to plasmin in the presence of plasminogen activators. Fragments of Ef-Tu retain binding capabilities to host proteins. Bioinformatics and structural modelling studies indicate that the accumulation of positively charged amino acids in short linear motifs (SLiMs), and protein processing promote multifunctional behaviour. Codon bias engendered by an A + T rich genome may influence how positively-charged residues accumulate in SLiMs

On the Growth and Welfare Effects of Defense R&D

In the US, defense R&D share of GDP has decreased significantly since 1960. To analyze the implications on growth and welfare, we develop an R&D-based growth model that features the crowding-out and spillover effects of defense R&D on civilian R&D. The model also captures the effects of defense technology on (i) national security resembling consumption-type public goods and (ii) aggregate productivity via the spin-off effect resembling productive public goods. In this framework, economic growth is driven by market-based civilian R&D as in standard R&D-based growth models and government-financed public goods (i.e., defense R&D) as in Barro (1990). We find that defense R&D has an inverted-U effect on growth, and the growth-maximizing level of defense R&D is increasing in the spillover and spin-off effects. As for the welfare-maximizing level of defense R&D, it is increasing in the security-enhancing effect of defense technology, and there exists a critical degree of this security-enhancing effect below (above) which the welfare-maximizing level is below (above) the growth-maximizing level

Utility of echocardiography in predicting mortality in infants with severe bronchopulmonary dysplasia

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Objective: To determine the relationship between interventricular septal position (SP) and right ventricular systolic pressure (RVSP) and mortality in infants with severe BPD (sBPD). Study design: Infants with sBPD in the Children's Hospitals Neonatal Database who had echocardiograms 34-44 weeks' postmenstrual age (PMA) were included. SP and RVSP were categorized normal, abnormal (flattened/bowed SP or RVSP > 40 mmHg) or missing. Results: Of 1157 infants, 115 infants (10%) died. Abnormal SP or RVSP increased mortality (SP 19% vs. 8% normal/missing, RVSP 20% vs. 9% normal/missing, both p < 0.01) in unadjusted and multivariable models, adjusted for significant covariates (SP OR 1.9, 95% CI 1.2-3.0; RVSP OR 2.2, 95% CI 1.1-4.7). Abnormal parameters had high specificity (SP 82%; RVSP 94%), and negative predictive value (SP 94%, NPV 91%) for mortality. Conclusions: Abnormal SP or RVSP is independently associated with mortality in sBPD infants. Negative predictive values distinguish infants most likely to survive