Australian evidence-based guidelines for the prevention and management of diabetes-related foot disease: a guideline summary

INTRODUCTION: Diabetes-related foot disease (DFD) - foot ulcers, infection, ischaemia - is a leading cause of hospitalisation, disability, and health care costs in Australia. The previous 2011 Australian guideline for DFD was outdated. We developed new Australian evidence-based guidelines for DFD by systematically adapting suitable international guidelines to the Australian context using the ADAPTE and GRADE approaches recommended by the NHMRC. MAIN RECOMMENDATIONS: This article summarises the most relevant of the 98 recommendations made across six new guidelines for the general medical audience, including: prevention - screening, education, self-care, footwear, and treatments to prevent DFD; classification - classifications systems for ulcers, infection, ischaemia and auditing; peripheral artery disease (PAD) - examinations and imaging for diagnosis, severity classification, and treatments; infection - examinations, cultures, imaging and inflammatory markers for diagnosis, severity classification, and treatments; offloading - pressure offloading treatments for different ulcer types and locations; and wound healing - debridement, wound dressing selection principles and wound treatments for non-healing ulcers. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINE: For people without DFD, key changes include using a new risk stratification system for screening, categorising risk and managing people at increased risk of DFD. For those categorised at increased risk of DFD, more specific self-monitoring, footwear prescription, surgical treatments, and activity management practices to prevent DFD have been recommended. For people with DFD, key changes include using new ulcer, infection and PAD classification systems for assessing, documenting and communicating DFD severity. These systems also inform more specific PAD, infection, pressure offloading, and wound healing management recommendations to resolve DFD.Peter A Lazzarini, Anita Raspovic, Jenny Prentice, Robert J Commons, Robert A Fitridge, James Charles, Jane Cheney, Nytasha Purcell, Stephen M Twig

Design, Fabrication, and Testing of 10 MJ Composite Flywheel Energy Storage Rotors

Flywheel energy storage systems employing high-speed composite flywheels and advanced electric motor/generators are being evaluated by the Department of Defense (DoD), NASA, and firms to replace electrochemical battery banks in satellites and manned space applications. Flywheel energy storage systems can provide extended operating life and significant reduction in weight and volume compared to conventional electrochemical systems. In addition, flywheels can provide momentum or reaction wheel functions for attitude control. This paper describes the design, fabrication, and spin testing of two 10 MJ composite flywheel energy storage rotors. To achieve the demonstrated energy density of greater than 310 kJ/kg in a volume of less than 0.05 m?, the rotors utilize flexible composite arbors to connect a composite rim to a metallic shaft, resulting in compact, lightweight, high energy density structures. The paper also describes the finite element stress and rotordynamics analyses, along with a description of the fabrication and assembly techniques used in the construction of the rotor. A description of the experimental setup and a discussion of spin testing of the rotors up to 45,000 rpm (965 m/s tip speed) are also presented. Accurate measurements of rotor centrifugal growth made with laser triangulation sensors confirmed predicted strains of greater than 1.2% in the composite rim. Due to the weight penalty associated with flywheel designs requiring containment structures, there is a strong need to develop flywheel systems which operate safely in space, preferably without dedicated containment structures. A future paper will describe results of a 28,600 rpm composite rotor burst test performed in a containment structure as a step towards understanding composite rotor failure modesCenter for Electromechanic

Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis

Aim: To systematically evaluate research investigating the accuracy of the ankle–brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort. Methods: A database search of EBSCO Megafile Premier, Embase and The Cochrane Library was conducted to 28 February 2019. Prospective and retrospective investigations of the diagnostic accuracy of the ABI for PAD in people with diabetes using an imaging reference standard were eligible. Sensitivity and specify of the ABI and bivariate meta-analysis against reference tests, or a standard summary receiver operating curve analysis (SROC) was performed. Results: Thirty-three studies met the inclusion criteria. ABI was compared with angiography in 12 studies and with colour duplex ultrasound (CDUS) in 21 studies. A SROC analysis of studies using angiography as the reference standard found a diagnostic odds ratio (DOR) of 9.06 [95% confidence interval (CI) 3.61 to 22.69], and area under the curve (AUC) of 0.76 (95% CI 0.66 to 0.86). Bivariate analysis of studies using CDUS demonstrated mean sensitivity of 0.60 (95% CI 0.48 to 0.71; P = 0.097) and mean specificity of 0.87 (95% CI 0.78 to 0.92; P < 0.001) with a DOR of 9.76 (95% CI 5.24 to 18.20; P < 0.0001) and AUC 0.72. Conclusions: These results suggest the ABI has a high specificity but lower sensitivity in detecting imaging diagnosed PAD in people with diabetes. The low probability of the testing being able to rule diagnosis in or out suggest that the ABI has limited effectiveness for early detection of PAD in this cohort

Subscale Rotor Spin Testing for Compulsator Component Development

The maturation of pulsed rotating machines has evolved to the stage where a greater degree of basic research is required to further increase the energy and power density of advanced compulsators. The University of Texas at Austin Center for Electromechanics is studying the combined mechanical and electrical aspects of very high speed compulsator rotor designs for the next generation of compact pulsed rotating machines. This paper describes the design, construction and testing of three scaled composite rotors. Performance specifications included hoop stresses of 1.7 GPa (250 ksi) in the outer banding and strain excursions of 0.4% in the field coil region. Results from the three studies are reviewed in detail. Techniques developed at the Center for Electromechanics for determining composite rotor performance are also discussedCenter for Electromechanic

Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: a systematic review and meta-analysis

Aim: To systematically evaluate research investigating the accuracy of the ankle–brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort. Methods: A database search of EBSCO Megafile Premier, Embase and The Cochrane Library was conducted to 28 February 2019. Prospective and retrospective investigations of the diagnostic accuracy of the ABI for PAD in people with diabetes using an imaging reference standard were eligible. Sensitivity and specify of the ABI and bivariate meta-analysis against reference tests, or a standard summary receiver operating curve analysis (SROC) was performed. Results: Thirty-three studies met the inclusion criteria. ABI was compared with angiography in 12 studies and with colour duplex ultrasound (CDUS) in 21 studies. A SROC analysis of studies using angiography as the reference standard found a diagnostic odds ratio (DOR) of 9.06 [95% confidence interval (CI) 3.61 to 22.69], and area under the curve (AUC) of 0.76 (95% CI 0.66 to 0.86). Bivariate analysis of studies using CDUS demonstrated mean sensitivity of 0.60 (95% CI 0.48 to 0.71; P = 0.097) and mean specificity of 0.87 (95% CI 0.78 to 0.92; P < 0.001) with a DOR of 9.76 (95% CI 5.24 to 18.20; P < 0.0001) and AUC 0.72. Conclusions: These results suggest the ABI has a high specificity but lower sensitivity in detecting imaging diagnosed PAD in people with diabetes. The low probability of the testing being able to rule diagnosis in or out suggest that the ABI has limited effectiveness for early detection of PAD in this cohort