A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): A protocol

Background Charcot neuroarthropathy is a complication of peripheral neuropathy associated with diabetes which most frequently affects the lower limb. It can cause fractures and dislocations within the foot, which may progress to deformity and ulceration. Recommended treatment is immobilisation and offloading, with a below knee non-removable cast or boot. Duration of treatment varies from six months to more than one year. Small observational studies suggest that repeated assessment with Magnetic Resonance Imaging improves decision making about when to stop treatment, but this has not been tested in clinical trials. This study aims to explore the feasibility of using serial Magnetic Resonance Imaging without contrast in the monitoring of Charcot neuroarthropathy to reduce duration of immobilisation of the foot. A nested qualitative study aims to explore participants’ lived experience of Charcot neuroarthropathy and of taking part in the feasibility study. Methods We will undertake a two arm, open study, and randomise 60 people with a suspected or confirmed diagnosis of Charcot neuroarthropathy from five NHS, secondary care multidisciplinary Diabetic Foot Clinics across England. Participants will be randomised 1:1 to receive Magnetic Resonance Imaging at baseline and remission up to 12 months, with repeated foot temperature measurements and x-rays (standard care plus), or standard care plus with additional three-monthly Magnetic Resonance Imaging until remission up to 12 months (intervention). Time to confirmed remission of Charcot neuroarthropathy with off-loading treatment (days) and its variance will be used to inform sample size in a full-scale trial. We will look for opportunities to improve the protocols for monitoring techniques and the clinical, patient centred, and health economic measures used in a future study. For the nested qualitative study, we will invite a purposive sample of 10-14 people able to offer maximally varying experiences from the feasibility study to take part in semi-structured interviews to be analysed using thematic analysis. Discussion The study will inform the decision whether to proceed to a full-scale trial. It will also allow deeper understanding of the lived experience of Charcot neuroarthropathy, and factors that contribute to engagement in management and contribute to the development of more effective patient centred strategies. Trial registration ISRCTN, ISRCTN, 74101606. Registered on 6 November 2017, http://www.isrctn.com/ISRCTN74101606?q=CADom&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-searc

Results from 730 kg days of the CRESST-II Dark Matter Search

The CRESST-II cryogenic Dark Matter search, aiming at detection of WIMPs via elastic scattering off nuclei in CaWO$_4$ crystals, completed 730 kg days of data taking in 2011. We present the data collected with eight detector modules, each with a two-channel readout; one for a phonon signal and the other for coincidently produced scintillation light. The former provides a precise measure of the energy deposited by an interaction, and the ratio of scintillation light to deposited energy can be used to discriminate different types of interacting particles and thus to distinguish possible signal events from the dominant backgrounds. Sixty-seven events are found in the acceptance region where a WIMP signal in the form of low energy nuclear recoils would be expected. We estimate background contributions to this observation from four sources: 1) "leakage" from the e/\gamma-band 2) "leakage" from the \alpha-particle band 3) neutrons and 4) Pb-206 recoils from Po-210 decay. Using a maximum likelihood analysis, we find, at a high statistical significance, that these sources alone are not sufficient to explain the data. The addition of a signal due to scattering of relatively light WIMPs could account for this discrepancy, and we determine the associated WIMP parameters.Comment: 17 pages, 13 figure

Status of the CRESST Dark Matter Search

The CRESST experiment aims for a detection of dark matter in the form of WIMPs. These particles are expected to scatter elastically off the nuclei of a target material, thereby depositing energy on the recoiling nucleus. CRESST uses scintillating CaWO4 crystals as such a target. The energy deposited by an interacting particle is primarily converted to phonons which are detected by transition edge sensors. In addition, a small fraction of the interaction energy is emitted from the crystals in the form of scintillation light which is measured in coincidence with the phonon signal by a separate cryogenic light detector for each target crystal. The ratio of light to phonon energy permits the discrimination between the nuclear recoils expected from WIMPs and events from radioactive backgrounds which primarily lead to electron recoils. CRESST has shown the success of this method in a commissioning run in 2007 and, since then, further investigated possibilities for an even better suppression of backgrounds. Here, we report on a new class of background events observed in the course of this work. The consequences of this observation are discussed and we present the current status of the experiment.Comment: Proceedings of the 13th International Workshop on Low Temperature Detectors, 4 pages, 3 figure

The CRESST II Dark Matter Search

Direct Dark Matter detection with cryodetectors is briefly discussed, with particular mention of the possibility of the identification of the recoil nucleus. Preliminary results from the CREEST II Dark Matter search, with 730 kg-days of data, are presented. Major backgrounds and methods of identifying and dealing with them are indicated.Comment: Talk at DSU workshop, ITP Beijing, Oct. 2011. 9 figures, 2 table

Composite CaWO4 Detectors for the CRESST-II Experiment

CRESST-II, standing for Cryogenic Rare Events Search with Superconducting Thermometers phase II, is an experiment searching for Dark Matter. In the LNGS facility in Gran Sasso, Italy, a cryogenic detector setup is operated in order to detect WIMPs by elastic scattering off nuclei, generating phononic lattice excitations and scintillation light. The thermometers used in the experiment consist of a tungsten thin-film structure evaporated onto the CaWO4 absorber crystal. The process of evaporation causes a decrease in the scintillation light output. This, together with the need of a big-scale detector production for the upcoming EURECA experiment lead to investigations for producing thermometers on smaller crystals which are glued onto the absorber crystal. In our Run 31 we tested composite detectors for the first time in the Gran Sasso setup. They seem to produce higher light yields as hoped and could provide an additional time based discrimination mechanism for low light yield clamp events.Comment: Proceedings of the Thirteenth International Workshop on Low Temperature Detectors 4 pages, 9 figure

Motivation and Knowledge Sharing through Social Media within Danish Organizations

Part 3: Creating Value through ApplicationsInternational audienceBased on an empirical quantitative study, this article investigates employee motivation in Danish companies and aims at determining which factors affect employees’ knowledge sharing through social media in a working environment. Our findings pinpoint towards the potential social media have for enhancing internal communication, knowledge sharing and collaboration in organizations, but the adoption is low, at this point, due to mainly organizational and individual factors. Technological factors do not seem to affect employees’ motivation for knowledge sharing as much as previous research has found, but it is the influence from the combination of individual and organizational factors, which affect the adoption of the platforms. A key finding in the study is that knowledge sharing is not a ‘social dilemma’ as previous studies have found. The study shows a positive development in employees’ willingness to share knowledge, because knowledge sharing is considered more beneficial than to hoard it