Virtually optimized insoles for offloading the diabetic foot: a randomized crossover study

Integration of objective biomechanical measures of foot function into the design process for insoles has been shown to provide enhanced plantar tissue protection for individuals at-risk of plantar ulceration. The use of virtual simulations utilizing numerical modeling techniques offers a potential approach to further optimize these devices. In a patient population at-risk of foot ulceration, we aimed to compare the pressure offloading performance of insoles that were optimized via numerical simulation techniques against shape-based devices. Twenty participants with diabetes and at-risk feet were enrolled in this study. Three pairs of personalized insoles: one based on shape data and subsequently manufactured via direct milling; and two were based on a design derived from shape, pressure, and ultrasound data which underwent a finite element analysis-based virtual optimization procedure. For the latter set of insole designs, one pair was manufactured via direct milling, and a second pair was manufactured through 3D printing. The offloading performance of the insoles was analyzed for forefoot regions identified as having elevated plantar pressures. In 88% of the regions of interest, the use of virtually optimized insoles resulted in lower peak plantar pressures compared to the shape-based devices. Overall, the virtually optimized insoles significantly reduced peak pressures by a mean of 41.3 kPa (p < 0.001, 95% CI [31.1, 51.5]) for milled and 40.5 kPa (p < 0.001, 95% CI [26.4, 54.5]) for printed devices compared to shape-based insoles. The integration of virtual optimization into the insole design process resulted in improved offloading performance compared to standard, shape-based devices.Full Tex

Effect of temperature and relative humidity on the development times and survival of Synopsyllus fonquerniei and Xenopsylla cheopis, the flea vectors of plague in Madagascar

Acknowledgements We would like to thank Dr Lila Rahalison and Jocelyn Ratovonjato for their advice and help during the experiment. We are grateful to the staff of the Plague Unit and the Medical Entomology Unit at the Institut Pasteur de Madagascar, particularly Dr Nohal Elissa. Without their expertise this study would not have been possible. Sincere thanks to Mr Tojo Ramihangihajason for his technical assistance. We are indebted to the Institut Pasteur de Madagascar for an internal grant which facilitated additional laboratory research. Two Wellcome Trust fellowships supported ST during this work (081705 and 095171).Peer reviewedPublisher PD

Satellite monitoring of sea surface pollution

There are no author-identified significant results in this report

Dynamic plantar loading index detects altered foot function in individuals with rheumatoid arthritis but not changes due to orthotic use

Background Altered foot function is common in individuals with rheumatoid arthritis. Plantar pressure distributions during gait are regularly assessed in this patient group; however, the association between frequently reported magnitude-based pressure variables and clinical outcomes has not been clearly established. Recently, a novel approach to the analysis of plantar pressure distributions throughout stance phase, the dynamic plantar loading index, has been proposed. This study aimed to assess the utility of this index for measuring foot function in individuals with rheumatoid arthritis.Methods Barefoot plantar pressures during gait were measured in 63 patients with rheumatoid arthritis and 51 matched controls. Additionally, 15 individuals with rheumatoid arthritis had in-shoe plantar pressures measured whilst walking in standardized footwear for two conditions: shoes-only; and shoes with prescribed custom foot orthoses. The dynamic plantar loading index was determined for all participants and conditions. Patient and control groups were compared for significant differences as were the shod and orthosis conditions.Findings The patient group was found to have a mean index of 0.19, significantly lower than the control group's index of 0.32 (p > 0.001, 95% CI [0.054, 0.197]). No significant differences were found between the shoe-only and shoe plus orthosis conditions. The loading index was found to correlate with clinical measures of structural deformity.Interpretation The dynamic plantar loading index may be a useful tool for researchers and clinicians looking to objectively assess dynamic foot function in patients with rheumatoid arthritis; however, it may be unresponsive to changes caused by orthotic interventions in this patient group.</p

Highly Ionized Collimated Outflow from HE 0238 - 1904

We present a detailed analysis of a highly ionized, multiphased and collimated outflowing gas detected through O V, O VI, Ne VIII and Mg X absorption associated with the QSO HE 0238 - 1904 (z_em ~ 0.629). Based on the similarities in the absorption line profiles and estimated covering fractions, we find that the O VI and Ne VIII absorption trace the same phase of the absorbing gas. Simple photoionization models can reproduce the observed N(Ne VIII), N(O VI) and N(Mg X) from a single phase whereas the low ionization species (e.g. N III, N IV, O IV) originate from a different phase. The measured N(Ne VIII)/N(O VI) ratio is found to be remarkably similar (within a factor of ~ 2) in several individual absorption components kinematically spread over ~ 1800 km/s. Under photoionization this requires a fine tuning between hydrogen density (nH) and the distance of the absorbing gas from the QSO. Alternatively this can also be explained by collisional ionization in hot gas with T > 10^{5.7} K. Long-term stability favors the absorbing gas being located outside the broad line region (BLR). We speculate that the collimated flow of such a hot gas could possibly be triggered by the radio jet interaction.Comment: Minor revision (accepted for publication in MNRAS letter

Knee joint kinetics in response to multiple three-dimensional printed, customised foot orthoses for the treatment of medial compartment knee osteoarthritis

The knee adduction moment is consistently used as a surrogate measure of medial compartment loading. Foot orthoses are designed to reduce knee adduction moment via lateral wedging. The 'dose' of wedging required to optimally unload the affected compartment is unknown and variable between individuals. This study explores a personalised approach via three-dimensional printed foot orthotics to assess the biomechanical response when two design variables are altered: orthotic length and lateral wedging. Foot orthoses were created for 10 individuals with symptomatic medial knee osteoarthritis and 10 controls. Computer-aided design software was used to design four full and four three-quarter-length foot orthoses per participant each with lateral posting of 0° 'neutral', 5° rearfoot, 10° rearfoot and 5° forefoot/10° rearfoot. Three-dimensional printers were used to manufacture all foot orthoses. Three-dimensional gait analyses were performed and selected knee kinetics were analysed: first peak knee adduction moment, second peak knee adduction moment, first knee flexion moment and knee adduction moment impulse. Full-length foot orthoses provided greater reductions in first peak knee adduction moment (p = 0.038), second peak knee adduction moment (p = 0.018) and knee adduction moment impulse (p = 0.022) compared to three-quarter-length foot orthoses. Dose effect of lateral wedging was found for first peak knee adduction moment (p < 0.001), second peak knee adduction moment (p < 0.001) and knee adduction moment impulse (p < 0.001) indicating greater unloading for higher wedging angles. Significant interaction effects were found for foot orthosis length and participant group in second peak knee adduction moment (p = 0.028) and knee adduction moment impulse (p = 0.036). Significant interaction effects were found between orthotic length and wedging condition for second peak knee adduction moment (p = 0.002). No significant changes in first knee flexion moment were found. Individual heterogeneous responses to foot orthosis conditions were observed for first peak knee adduction moment, second peak knee adduction moment and knee adduction moment impulse. Biomechanical response is highly variable with personalised foot orthoses. Findings indicate that the tailoring of a personalised intervention could provide an additional benefit over standard interventions and that a three-dimensional printing approach to foot orthosis manufacturing is a viable alternative to the standard methods.Full Tex

Visual comparison of two data sets: do people use the means and the variability?

In our everyday lives, we are required to make decisions based upon our statistical intuitions. Often, these involve the comparison of two groups, such as luxury versus family cars and their suitability. Research has shown that the mean difference affects judgements where two sets of data are compared, but the variability of the data has only a minor influence, if any at all. However, prior research has tended to present raw data as simple lists of values. Here, we investigated whether displaying data visually, in the form of parallel dot plots, would lead viewers to incorporate variability information. In Experiment 1, we asked a large sample of people to compare two fictional groups (children who drank ‘Brain Juice’ versus water) in a one-shot design, where only a single comparison was made. Our results confirmed that only the mean difference between the groups predicted subsequent judgements of how much they differed, in line with previous work using lists of numbers. In Experiment 2, we asked each participant to make multiple comparisons, with both the mean difference and the pooled standard deviation varying across data sets they were shown. Here, we found that both sources of information were correctly incorporated when making responses. Taken together, we suggest that increasing the salience of variability information, through manipulating this factor across items seen, encourages viewers to consider this in their judgements. Such findings may have useful applications for best practices when teaching difficult concepts like sampling variation

The Very Highly Ionized Broad Absorption Line System of the QSO SBS1542+541

We have analyzed the broad absorption line system of the bright (V=16.5) high-redshift (z=2.361) QSO SBS1542+541 using UV spectra from the HST FOS along with optical data from the MMT and the Steward Observatory 2.3m telescope. These spectra give continuous wavelength coverage from 1200 to 8000 Angstroms, corresponding to 340 to 2480 Angstroms in the QSO rest frame. This object therefore offers a rare opportunity to study broad absorption lines in the rest-frame extreme UV. We find that the absorption system is dominated by very high-ionization species, including O VI, NeVIII, and SiXII. We also identify apparently saturated broad Lyman-series lines of order Ly-gamma and higher. There is strong evidence for partial occultation of the QSO emission source, particularly from the higher-order Lyman lines which indicate a covered fraction less than 0.2. Overall, the data suggest a correlation between a larger covered fraction and a higher state of ionization. We suggest that the different covered fractions can be explained by either a special line of sight through a disk-like geometry or by the existence of density fluctuations of a factor >2 in the BAL gas. Our photoionization models of the system indicate a large column density and high ionization state similar to that found in X-ray ``warm absorbers''.Comment: 31 pages, 13 figures, to be published in Ap

Psychometric Analysis of the Adult Sickle Cell Quality of Life Measurement Information System (ACSQ-Me) in a UK Population

Background: The Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) has been shown to be a reliable and valid questionnaire measuring health-related quality of life (HRQoL) in the US sickle cell disease (SCD) population. The study objective was to test the validity and reliability of the ASCQ-Me for use in the UK. Methods: The US ASCQ-Me, Hospital Anxiety and Depression Scale (HADS), self-reported symptoms, and Medical Outcome Survey Short Form 36 (SF-36) were administered to 173 patients with SCD. Clinical severity was assessed by the number of painful episodes indicated by hospital admissions. Results: The results showed that the item banks of the UK ASCQ-Me had good internal consistency. Anxiety and depression were strongly correlated with the emotional, and social item banks of the UK ASCQ-Me, with moderate correlations between the UK ASCQ-Me item banks and SF-36 components suggesting convergent validity. A confirmatory factor analysis confirmed the conceptual framework of the scale as being the same as the US ASCQ-Me, indicating construct validity. Known groups validity was found, with the ASCQ-Me being able to differentiate by SCD severity groups. Conclusion: The analysis of the sample shows evidence of both validity and reliability of the ACCQ-Me for use in the UK SCD population

Embracing additive manufacture: implications for foot and ankle orthosis design

<p>Abstract</p> <p>Background</p> <p>The design of foot and ankle orthoses is currently limited by the methods used to fabricate the devices, particularly in terms of geometric freedom and potential to include innovative new features. Additive manufacturing (AM) technologies, where objects are constructed via a series of sub-millimetre layers of a substrate material, may present the opportunity to overcome these limitations and allow novel devices to be produced that are highly personalised for the individual, both in terms of fit and functionality.</p> <p>Two novel devices, a foot orthosis (FO) designed to include adjustable elements to relieve pressure at the metatarsal heads, and an ankle foot orthosis (AFO) designed to have adjustable stiffness levels in the sagittal plane, were developed and fabricated using AM. The devices were then tested on a healthy participant to determine if the intended biomechanical modes of action were achieved.</p> <p>Results</p> <p>The adjustable, pressure relieving FO was found to be able to significantly reduce pressure under the targeted metatarsal heads. The AFO was shown to have distinct effects on ankle kinematics which could be varied by adjusting the stiffness level of the device.</p> <p>Conclusions</p> <p>The results presented here demonstrate the potential design freedom made available by AM, and suggest that it may allow novel personalised orthotic devices to be produced which are beyond the current state of the art.</p