Foot ulcers associated with external trauma among people with diabetes: An integrative review of the origin of trauma and outcomes

Background Foot ulcers are common among people with diabetes. These ulcers are caused by a number of factors including trauma. To date, research findings on the origin of external trauma and the outcome of foot ulcers resulting from an external trauma have not been summarised. Objective To examine the origin of external trauma that contribute to the development of foot ulcers among people with diabetes and the outcome of such ulcers. Design An integrative review. Settings Hospital/community. Participants Patients with diabetes and foot ulcer. Method The Joanna Briggs framework was used to underpin this integrative review. Six different databases (CINAHL +, Medline, SCOPUS, Embase, ProQuest and Web of Science databases) were searched systematically to find research publications reporting traumas that contributed to foot ulcers sustained by people with diabetes. The search was limited to articles published in English. The search revealed 3193 articles that were filtered to 78 articles to be assessed at the full-text level and 45 articles were subsequently included. Quality appraisal was conducted independently by two reviewers, using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Data were extracted into a form developed for the purpose of this review. Narrative synthesis was used to manage the extracted verbatim details on the origin of external trauma contributing to foot ulcers and the outcomes. Results The origins of external trauma were summarised into two domains and further specified into 16 categories. The identified traumas were mainly minor and originated within the home environment. The most commonly reported origins of external trauma were puncture wounds, ill-fitting shoes and self-care practices that caused foot ulcers. Twenty-seven studies reported outcomes following the development of an ulcer. Twenty-two studies reported amputation as an outcome and mortality was reported in 10 studies. It was not clear whether these outcomes were directly related to the foot ulcer or related to other diabetes-related complications. Conclusions The majority of ulcers occurred in the home environment and were preventable in nature. The assessment of an individual\u27s local context, particularly the home and actions to reduce risk is a priority. The extent of the risks related to external trauma need to be more widely communicated through clinical guidelines and training opportunities for frontline staff. Tweetable abstract The main origins of external foot trauma among people with diabetes were puncture wounds, ill-fitting footwear and self-care practices

The reported external traumas among people with diabetes-related foot ulcers and their outcomes: A systematic review of case reports

The objective of this systematic review was to collate evidence published in case reports on the reported origins of external traumas that contribute to the development of diabetic foot ulcers and their outcomes. The review also aimed to suggest reporting criteria for external traumas contributing to the development of diabetic foot ulcers. The search strategy led to the identification of 1224 articles across six electronic databases. Additional articles were also sourced from other electronic platforms (Google scholar) and the reference lists of the included case reports. Ninety-four articles met the inclusion criteria and were published between 1989 and 2020. The included case reports were independently assessed for methodological quality using a Joanna Briggs Institute (JBI) checklist. Following the verbatim extraction of data, the JBI three steps approach to “meta-aggregation” for managing qualitative data was used to synthesise the data on external traumas that contributed to the development of foot ulcers along with the reported outcome. Information on the included case report characteristics was also extracted. The case reports included 155 patients. Average age was 57.2 years with a range from 17 to 86 years. External traumas were mainly experienced in the domestic setting and were categorised into two main categories, mechanical trauma (n = 87, 60%) or burns (n = 58, 40%). The most frequently reported origins of external trauma were contact with a hot surface, animal bites, friction, and puncture wounds. Although healing was the most frequent outcome, a prolonged time was recorded for the ulcers to heal highlighting the importance of prevention. Prevention might not eradicate origins of external trauma 100%, showing the importance of patient and/or family role in monitoring domestic risks, early detection of ulcer and seeking immediate professional care. Foot ulcers need to be reported against standardised criteria considering local characteristics of the ulcer and the individual\u27s general profile

Some mixed Hodge structure on l^2-cohomology of covering of K\"ahler manifolds

We give methods to compute l^2-cohomology groups of a covering manifolds obtained by removing pullback of a (normal crossing) divisor to a covering of a compact K\"ahler manifold. We prove that in suitable quotient categories, these groups admit natural mixed Hodge structure whose graded pieces are given by expected Gysin maps.Comment: 40 pages. This revised version will be published in Mathematische Annale

Use of spherical particles to understand conidial attachment to surfaces using atomic force microscopy

Binding of particles and spores to surfaces is a natural phenomenon which is a prerequisite for biofilm formation. Perpendicular force measurements were carried out using atomic force microscopy cantilevers modified with a polystyrene or glass sphere. The attachment of the spheres was tested against glass, PVAc, p(g-MPSco-MMA), p(g-MPS-co-LMA), PMMAsc, and silicon surfaces. The polystyrene spheres demonstrated less varied force and strength of attachment measurement to the surfaces than the glass spheres. The force of attachment of the polystyrene spheres was also influenced by mobility of the co-polymer surfaces. Surface wettability did not affect the force of polystyrene or glass sphere attachment. The force measurements of the non-biological spheres were similar to those seen in biological systems with fungal conidia, and this was due to their size, shape, and binding energies. The use of non-biological systems may present an insight into understanding the fundamentals of more complex biological processes

Breaking Borders: How Barriers to Global Mobility Hinder International Partnerships in Academic Medicine

This article describes the authors' personal experiences of collaborating across international borders in academic research. International collaboration in academic medicine is one of the most important ways by which research and innovation develop globally. However, the intersections among colonialism, academic medicine, and global health research have created a neocolonial narrative that perpetuates inequalities in global health partnerships. The authors critically examine the visa process as an example of a racist practice to show how the challenges of blocked mobility increase inequality and thwart research endeavors. Visas are used to limit mobility across certain borders, and this limitation hinders international collaborations in academic medicine. The authors discuss the concept of social closure and how limits to global mobility for scholars from low- and middle-income countries perpetuate a cycle of dependence on scholars who have virtually barrier-free global mobility-these scholars being mainly from high-income countries. Given the current sociopolitical milieu of increasing border controls and fears of illegal immigration, the authors' experiences expose what is at stake for academic medicine when the political sphere, focused on tightening border security, and the medical realm, striving to build international research collaborations, intersect. Creating more equitable global partnerships in research requires a shift from the current paradigm that dominates most international partnerships and causes injury to African scholars

Meningococcal genetic variation mechanisms viewed through comparative analysis of Serogroup C strain FAM18

Copyright @ 2007 Public Library of ScienceThe bacterium Neisseria meningitidis is commonly found harmlessly colonising the mucosal surfaces of the human nasopharynx. Occasionally strains can invade host tissues causing septicaemia and meningitis, making the bacterium a major cause of morbidity and mortality in both the developed and developing world. The species is known to be diverse in many ways, as a product of its natural transformability and of a range of recombination and mutation-based systems. Previous work on pathogenic Neisseria has identified several mechanisms for the generation of diversity of surface structures, including phase variation based on slippage-like mechanisms and sequence conversion of expressed genes using information from silent loci. Comparison of the genome sequences of two N. meningitidis strains, serogroup B MC58 and serogroup A Z2491, suggested further mechanisms of variation, including C-terminal exchange in specific genes and enhanced localised recombination and variation related to repeat arrays. We have sequenced the genome of N. meningitidis strain FAM18, a representative of the ST-11/ET-37 complex, providing the first genome sequence for the disease-causing serogroup C meningococci; it has 1,976 predicted genes, of which 60 do not have orthologues in the previously sequenced serogroup A or B strains. Through genome comparison with Z2491 and MC58 we have further characterised specific mechanisms of genetic variation in N. meningitidis, describing specialised loci for generation of cell surface protein variants and measuring the association between noncoding repeat arrays and sequence variation in flanking genes. Here we provide a detailed view of novel genetic diversification mechanisms in N. meningitidis. Our analysis provides evidence for the hypothesis that the noncoding repeat arrays in neisserial genomes (neisserial intergenic mosaic elements) provide a crucial mechanism for the generation of surface antigen variants. Such variation will have an impact on the interaction with the host tissues, and understanding these mechanisms is important to aid our understanding of the intimate and complex relationship between the human nasopharynx and the meningococcus.This work was supported by the Wellcome Trust through the Beowulf Genomics Initiative

The liquid carbon challenge: evolving views on transportation fuels and climate

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109834/1/wene133.pd

Non-Thermal Plasma Activation of Gold-Based Catalysts for Low-Temperature Water-Gas Shift Catalysis

Acknowledgements The UK Catalysis Hub is kindly thanked for resources and support provided via our membership of the UK Catalysis Hub Consortium and funded by EPSRC (Portfolio Grants EP/K014706/2, EP/K014668/1, EP/K014854/1, EP/K014714/1, and EP/I019693/1). Open access data can be found via the University of Manchester research portal. We are grateful to Helen Daly (Queen's University Belfast) for discussion, to Fabio de Rosa (Queen's University Belfast) for the thermodynamic equilibrium calculations (obtained using the Convergence tool of Aspen Plus 8.0) and to Emma Gibson (Harwell Research Complex) for the BET measurements. JJ Delgado is grateful to Ramon y Cajal program and the Ce-NanoSurPhases project grant from MINECO.Peer reviewedPostprintPostprintPublisher PD

Evidence for distinct coastal and offshore communities of bottlenose dolphins in the north east Atlantic.

Bottlenose dolphin stock structure in the northeast Atlantic remains poorly understood. However, fine scale photo-id data have shown that populations can comprise multiple overlapping social communities. These social communities form structural elements of bottlenose dolphin (Tursiops truncatus) [corrected] populations, reflecting specific ecological and behavioural adaptations to local habitats. We investigated the social structure of bottlenose dolphins in the waters of northwest Ireland and present evidence for distinct inshore and offshore social communities. Individuals of the inshore community had a coastal distribution restricted to waters within 3 km from shore. These animals exhibited a cohesive, fission-fusion social organisation, with repeated resightings within the research area, within a larger coastal home range. The offshore community comprised one or more distinct groups, found significantly further offshore (>4 km) than the inshore animals. In addition, dorsal fin scarring patterns differed significantly between inshore and offshore communities with individuals of the offshore community having more distinctly marked dorsal fins. Specifically, almost half of the individuals in the offshore community (48%) had characteristic stereotyped damage to the tip of the dorsal fin, rarely recorded in the inshore community (7%). We propose that this characteristic is likely due to interactions with pelagic fisheries. Social segregation and scarring differences found here indicate that the distinct communities are likely to be spatially and behaviourally segregated. Together with recent genetic evidence of distinct offshore and coastal population structures, this provides evidence for bottlenose dolphin inshore/offshore community differentiation in the northeast Atlantic. We recommend that social communities should be considered as fundamental units for the management and conservation of bottlenose dolphins and their habitat specialisations