Diagnostic values for skin temperature assessment to detect diabetes-related foot complications

Background Skin temperature assessment is a promising modality for early detection of diabetic foot problems, but its diagnostic value has not been studied. Our aims were to investigate the diagnostic value of different cutoff skin temperature values for detecting diabetes-related foot complications such as ulceration, infection, and Charcot foot and to determine urgency of treatment in case of diagnosed infection or a red-hot swollen foot. Materials and Methods The plantar foot surfaces of 54 patients with diabetes visiting the outpatient foot clinic were imaged with an infrared camera. Nine patients had complications requiring immediate treatment, 25 patients had complications requiring non-immediate treatment, and 20 patients had no complications requiring treatment. Average pixel temperature was calculated for six predefined spots and for the whole foot. We calculated the area under the receiver operating characteristic curve for different cutoff skin temperature values using clinical assessment as reference and defined the sensitivity and specificity for the most optimal cutoff temperature value. Mean temperature difference between feet was analyzed using the Kruskal–Wallis tests. Results The most optimal cutoff skin temperature value for detection of diabetes-related foot complications was a 2.2°C difference between contralateral spots (sensitivity, 76%; specificity, 40%). The most optimal cutoff skin temperature value for determining urgency of treatment was a 1.35°C difference between the mean temperature of the left and right foot (sensitivity, 89%; specificity, 78%). Conclusions Detection of diabetes-related foot complications based on local skin temperature assessment is hindered by low diagnostic values. Mean temperature difference between two feet may be an adequate marker for determining urgency of treatment.

Too ill to will? deathbed wills: assessing testamentary capacity near the end of life

Assessing testamentary capacity in the terminal phase of an illness or at a person's deathbed is fraught with challenges for both doctors and lawyers. Numerous issues need to be considered when assessing capacity for a will. These issues are exacerbated when such an assessment needs to be undertaken at the bedside of a dying patient. The nature and severity of the illness, effects on cognition of the terminal illness, effects of medication, urgency, psychological and emotional factors, interactions with carers, family and lawyers, and a range of other issues confound and complicate the assessment of capacity. What is the doctor's role in properly assessing capacity in this context and how does this role intersect with the legal issues? Doctors will play an increasing role in assessing testamentary capacity in this setting. The ageing of society, more effective treatment of acute illness and, often, the prolongation of dying are only some of the factors leading to this increasing need. However, despite its importance and increasing prevalence, the literature addressing this challenging practical area is scarce and offers limited guidance. This paper examines these challenges and discusses some practical approaches.

Governance of enterprise Information and Technology: A new core competency for boards of directors

With the level of digital disruption that is affecting businesses around the globe, you might expect high levels of Governance of Enterprise Information and Technology (GEIT) capability within boards. Boards and their senior executives know technology is important. More than 90% of boards and senior executives currently identify technology as essential to their current businesses, and to their organization’s future. But as few as 16% have sufficient GEIT capability. Global Centre for Digital Business Transformation’s recent research contains strong indicators of the need for change. Despite board awareness of both the likelihood and impact of digital disruption, things digital are still not viewed as a board-level matter in 45% of companies. And, it’s not just the board. The lack of board attention to technology can be mirrored at senior executive level as well. When asked about their organization’s attitude towards digital disruption, 43% of executives said their business either did not recognise it as a priority or was not responding appropriately. A further 32% were taking a “follower” approach, a potentially risky move as we will explain. Given all the evidence that boards know information and technology (I&T***) is vital, that they understand the inevitably, impact and speed of digital change and disruption, why are so many boards dragging their heels? Ignoring I&T disruption and refusing to build capability at board level is nothing short of negligence. Too many boards risk flying blind without GEIT capability [2]. To help build decision quality and I&T governance capability, this research: • Confirms a pressing need to build individual competency and cumulative, across-board capability in governing I&T • Identifies six factors that have rapidly increased the need, risk and urgency • Finds that boards may risk not meeting their duty of care responsibilities when it comes to I&T oversight • Highlights barriers to building capability details three GEIT competencies that boards and executives can use for evaluation, selection, recruitment and professional development.

Patents, Ethics and Stem Cell Research : The Case of hESC Innovation in Australia, Europe and the United States

Embryonic stem cells offer potentially a ground-breaking insight into health and diseases and are said to offer hope in discovering cures for many ailments unimaginable few years ago. Human embryonic stem cells are undifferentiated, immature cells that possess an amazing ability to develop into almost any body cell such as heart muscle, bone, nerve and blood cells and possibly even organs in due course. This remarkable feature, enabling embryonic stem cells to proliferate indefinitely in vitro (in a test tube), has branded them as a so-called miracle cure . Their potential use in clinical applications provides hope to many sufferers of debilitating and fatal medical conditions. However, the emergence of stem cell research has resulted in intense debates about its promises and dangers. On the one hand, advocates hail its potential, ranging from alleviating and even curing fatal and debilitating diseases such as Parkinson s, diabetes, heart ailments and so forth. On the other hand, opponents decry its dangers, drawing attention to the inherent risks of human embryo destruction, cloning for research purposes and reproductive cloning eventually. Lately, however, the policy battles surrounding human embryonic stem cell innovation have shifted from being a controversial research to scuffles within intellectual property rights. In fact, the ability to obtain patents represents a pivotal factor in the economic success or failure of this new biotechnology. Although, stem cell patents tend to more or less satisfy the standard patentability requirements, they also raise serious ethical and moral questions about the meaning of the exclusions on ethical or moral grounds as found in European and to an extent American and Australian patent laws. At present there is a sort of a calamity over human embryonic stem cell patents in Europe and to an extent in Australia and the United States. This in turn has created a sense of urgency to engage all relevant parties in the discourse on how best to approach patenting of this new form of scientific innovation. In essence, this should become a highly favoured patenting priority. To the contrary, stem cell innovation and its reliance on patent protection risk turmoil, uncertainty, confusion and even a halt on not only stem cell research but also further emerging biotechnology research and development. The patent system is premised upon the fundamental principle of balance which ought to ensure that the temporary monopoly awarded to the inventor equals that of the social benefit provided by the disclosure of the invention. Ensuring and maintaining this balance within the patent system when patenting human embryonic stem cells is of crucial contemporary relevance. Yet, the patenting of human embryonic stem cells raises some fundamental moral, social and legal questions. Overall, the present approach of patenting human embryonic stem cell related inventions is unsatisfactory and ineffective. This draws attention to a specific question which provides for a conceptual framework for this work. That question is the following: how can the investigated patent offices successfully deal with patentability of human embryonic stem cells? This in turn points at the thorny issue of application of the morality clause in this field. In particular, the interpretation of the exclusions on ethical or moral grounds as found in Australian, American and European legislative and judicial precedents. The Thesis seeks to compare laws and legal practices surrounding patentability of human embryonic stem cells in Australia and the United States with that of Europe. By using Europe as the primary case study for lessons and guidance, the central goal of the Thesis then becomes the determination of the type of solutions available to Europe with prospects to apply such to Australia and the United States. The Dissertation purports to define the ethical implications that arise with patenting human embryonic stem cells and intends to offer resolutions to the key ethical dilemmas surrounding patentability of human embryonic stem cells and other morally controversial biotechnology inventions. In particular, the Thesis goal is to propose a functional framework that may be used as a benchmark for an informed discussion on the solution to resolving ethical and legal tensions that come with patentability of human embryonic stem cells in Australian, American and European patent worlds. Key research questions that arise from these objectives and which continuously thread throughout the monograph are: 1. How do common law countries such as Australia and the United States approach and deal with patentability of human embryonic stem cells in their jurisdictions? These practices are then compared to the situation in Europe as represented by the United Kingdom (first two chapters), the Court of Justice of the European Union and the European Patent Office decisions (Chapter 3 onwards) in order to obtain a full picture of the present patenting procedures on the European soil. 2. How are ethical and moral considerations taken into account at patent offices investigated when assessing patentability of human embryonic stem cell related inventions? In order to assess this part, the Thesis evaluates how ethical issues that arise with patent applications are dealt with by: a) Legislative history of the modern patent system from its inception in 15th Century England to present day patent laws. b) Australian, American and European patent offices presently and in the past, including other relevant legal precedents on the subject matter. c) Normative ethical theories. d) The notion of human dignity used as the lowest common denominator for the interpretation of the European morality clause. 3. Given the existence of the morality clause in form of Article 6(1) of the Directive 98/44/EC of the European Parliament and of the Council of 6 July 1998 on the legal protection of biotechnological inventions which corresponds to Article 53(a) European Patent Convention, a special emphasis is put on Europe as a guiding principle for Australia and the United States. Any room for improvement of the European morality clause and Europe s current manner of evaluating ethical tensions surrounding human embryonic stem cell inventions is examined. 4. A summary of options (as represented by Australia, the United States and Europe) available as a basis for the optimal examination procedure of human embryonic stem cell inventions is depicted, whereas the best of such alternatives is deduced in order to create a benchmark framework. This framework is then utilised on and promoted as a tool to assist Europe (as represented by the European Patent Office) in examining human embryonic stem cell patent applications. This method suggests a possibility of implementing an institution solution. 5. Ultimately, a question of whether such reformed European patent system can be used as a founding stone for a potential patent reform in Australia and the United States when examining human embryonic stem cells or other morally controversial inventions is surveyed. The author wishes to emphasise that the guiding thought while carrying out this work is to convey the significance of identifying, analysing and clarifying the ethical tensions surrounding patenting human embryonic stem cells and ultimately present a solution that adequately assesses patentability of human embryonic stem cell inventions and related biotechnologies. In answering the key questions above, the Thesis strives to contribute to the broader stem cell debate about how and to which extent ethical and social positions should be integrated into the patenting procedure in pluralistic and morally divided democracies of Europe and subsequently Australia and the United States.

Mid-urethral slings for treatment of stress urinary incontinence : long- and mid-term follow-up

Urinary incontinence is a common problem, affecting one third of the women at least at some time during their lives. The prevalence of urinary incontinence increases with advancing age, and the everyday impact of incontinence on women and on health services is enormous. Urinary incontinence is usually divided into three different subtypes, of which stress urinary incontinence (SUI) is the most common. Surgical treatment is often needed to cure SUI, and modern mid-urethral sling procedures give the possibility to cure this condition with a low risk of adverse events, a problem often associated with the so-called traditional incontinence operations. Life expectancy among women in Western countries has grown beyond 80 years of age. Long-term efficacy of treatment options for urinary incontinence therefore becomes an important issue in a world with limited eco-nomic resources. The purpose of the present study was to prospectively evaluate the long-term efficacy and safety of the first minimally invasive mid-urethral tape procedure, the Tension-free Vaginal Tape (TVT) procedure. The long-term (5-year) follow-up results of the TVT procedure as a repeat operation af-ter an unsuccessful mid-urethral tape operation were studied and the reasons for failure of the first operation were analyzed. Another purpose was to compare the original TVT procedure with a newer modification, the Tension-free Vaginal Tape Obturator (TVT-O) procedure within a multi-centre, randomized context in order to find out possible differences between these procedures re-garding efficacy and complications and the effects on symptoms of urgency. The first study of the present thesis is a prospective, Nordic, three-centre follow-up study of 90 women suffering from SUI, who were treated by means of the TVT procedure. The mean follow-up time was more than eleven years, and the study is the first to be published in connection with more than ten years of follow-up. The second study is a retrospective analysis of 26 women who were treated with a repeat TVT procedure after an unsuccessful primary mid-urethral tape procedure. The third and fourth studies concern 273 women in seven centres in Finland who were ran-domly assigned to the TVT and TVT-O procedures, the 3-year follow-up results of which are pre-sented in this thesis. After eleven years of follow-up, 90% of the women had a negative cough stress test result and a negative 24-h pad test result. The subjective cure rate measured as the women s global impression of cure was 77%, the rate of improvement 20%, and only 3% thought that the treatment had failed. No late-onset adverse effects were found. The repeat TVT procedure was successful in 75% of the cases when women who were cured and women who were significantly improved were included. The reasons for failure of the first operation could be separated into four different groups: tape material-related, operation technique-related, concomitant illness-related and a group with no identifiable reason. There were no intra-operative complications during the repeat operation. In the randomized trial comparing the TVT with the TVT-O procedure a cough stress test results were negative in 94.6% and 89.5% of the women in the two groups, respectively, after a 3-year follow-up period. There were no statistical differences in the cure rate or the rate of complications be-tween the two procedures. Symptoms of urgency were analyzed more closely and the main finding was that the prevalence of urgency symptoms decreased significantly after both mid-urethral sling procedures. The TVT operation was found to be an effective and safe procedure even after eleven years of follow-up. Long-term follow-up after a repeat TVT procedure revealed that the TVT procedure can well be considered after an unsuccessful mid-urethra tape procedure, because 75% of the patients showed significantly improvement of their incontinence. The TVT and TVT-O procedures showed no statistically significant differences in efficacy and rate of complications after three years of follow-up. In most cases these procedures alleviate preoperative symptoms of urgency and the risk of developing de novo urgency is low.

Precarious Pregnancies : Alcohol, drugs and the regulation of risks

Since the 1970s alcohol and drug use by pregnant women has become a target of political, professional and personal concern. The present study focuses on prenatal substance use and the regulation of risks by examining different kinds of societal responses to prenatal alcohol and drug use. The study analyses face-to-face encounters between professionals and service users at a specialised maternity clinic for pregnant women with substance abuse problems, medical and political discourses on the compulsory treatment of pregnant women as a means of FAS prevention and official recommendations on alcohol intake during pregnancy. Moreover, the study addresses the women s perspective by asking how women who have used illicit drugs during pregnancy perceive and rank the dangers linked to drug use. The study consists of five empirical sub-studies and a summary article. Sub-study I was written in collaboration with Dorte Hecksher and Sub-study IV with Riikka Perälä. Theoretically the study builds on the one hand, on the socio-cultural approach to the selection and perception of risks and on the other on governmentality studies which focus on the use of power in contemporary Western societies. The study is based on an ethnographic approach and makes use of the principles of multi-sited ethnography. The empirical sub-studies are based on three different types of qualitative data: ethnographic field notes from a maternity clinic from a period of 7 months, documentary material (medical journals, political documents, health education materials, government reports) and 3) interviews from maternity clinics with clients and members of staff. The study demonstrates that the logic of the regulation of prenatal alcohol use in Finland is characterised by the rise of the foetus , a process in which the urgency of protecting the foetus has gradually gained a more prominent role in the discourses on alcohol-related foetal damage. An increasing unwillingness to accept any kinds of risks when foetal health is at stake is manifested in the public debate on the compulsory treatment of pregnant women with alcohol problems and in the health authorities decision to advise pregnant women to refrain from alcohol use during pregnancy (Sub-studies I and II). Secondly, the study suggests that maternity care professionals have an ambivalent role in their mundane encounters with their pregnant clients: on the one hand professionals focus on the well-being of the foetus, but on the other, they need to take into account the women s needs and agency. The professionals daily encounters with their clients are thus characterised by hybridisation: the simultaneous use of technologies of domination and technologies of agency (Sub-studies III and IV). Finally, the study draws attention to the women s understanding of the risks of illicit drug during pregnancy, and shows that the women s understanding of risk differs from the bio-medical view. The study suggests that when drug-using pregnant women seek professional help they can feel that their moral worth is threatened by professionals negative attitudes which can make service-use challenging.

Spatial Analysis and Characterisation of Lentic Ecosystems: A Case Study of Varthur Lake, Bangalore

Lentic ecosystems vital functions such as recycling of nutrients, purification of water, recharge of groundwater,augmenting and maintenance of stream flow and habitat provision for a wide variety of flora and fauna along with their recreation values necessitates their sustainable management through appropriate conservation mechanisms. Failure to restore these ecosystems will result in extinction of species or ecosystem types and cause permanent ecological damage. In Bangalore, lentic ecosystems (for example lakes) have played a prominent role serving the needs of agriculture and drinking water. But the burgeoning population accompanied by unplanned developmental activities has led to the drastic reduction in their numbers (from 262 in 1976 to 81). The existing water bodies are contaminated by residential, agricultural, commercial and industrial wastes/effluents. In order to restore the ecosystem, assessment of the level of contamination is crucial. This paper focuses on characterisation and restoration aspects of Varthur lake based on hydrological, morphometric, physical-chemical and socio-economic investigations for a period of six months covering post monsoon seasons. The results of the water quality analysis show that the lake is eutrophic with high concentrations of phosphorous and organic matter. The morphometric analysis indicates that the lake is shallow in relation to its surface area. Socio-economic analyses show dependence of local residents for irrigation, fodder, etc. These analyses highlight the need and urgency to restore the physical, chemical and biological integrity through viable restoration and sustainable watershed management strategies, which include pollution abatement, catchment treatment, desilting of the lake and educating all stakeholders on the conservation and restoration of lake ecosystems.

Development of vaccines against tuberculosis

Development of an effective vaccine against tuberculosis (TB) hinges on an improved understanding of the human immune responses to Mycobacterium tuberculosis. A successful vaccination strategy should be able to stimulate the appropriate arm of the immune system with concomitant generation of the memory cells. In the absence of a perfect strategy, while long term efforts of TB researchers continue to resolve the nature of protective immunity against TB and other related issues, the current approach, dictated by the urgency of a TB vaccine, employs available knowledge and technology to develop new TB vaccines and channel the promising ones to clinical trials. While Indian scientists have contributed in several areas towards the development of a TB vaccine, this review is an attempt to summarize their contributions mainly pertaining to the discovery of new antigens, immune responses elicited by antigens against TB and development of new vaccines and their evaluation in animal models. (C) 2011 Elsevier Ltd. All rights reserved.

Material And Informational Synergy For Sustainable Prosperity

The quest for prosperity has been a central motive in the life of man from the moment of his entrance into the worldly scence. And certain, it is that the issue of prosperity at the very cost of his very existence has mounted in intensity and urgency with the unforeseen evolution of industrialization. The traditional paradigm of prosperity has been resting on the classical theory of production economics.With increasing empiricism it is obvious that the rational model fail to grapple with the complexity of the concept. The paper addresses the prosperity as an goal state resting on the conviction of harmony between present generation and generation of humans to come. Sustainable prosperity involves more than growth in services/goods. It requires a change in the content of the growth, to make it less material-and energy-intensive and more equitable in its impact. The process of economic prosperity must be more soundly based upon the realities of the stock of capital that sustains it.

La misión como paradigma de la renovación eclesial

Resumen: El papa Francisco ha propuesto la misión como paradigma de la renovación de la Iglesia. El autor toma como punto de partida esta invitación y propone reflexionar sobre la incidencia de la cuestión en algunas cuestiones teológicas. La urgencia de la misión debe modificar no sólo la acción pastoral sino también el lenguaje teológico, porque el decir y el hacer están fuertemente vinculados. Dios, Jesucristo, el hombre, la cultura y las consecuencias éticas de la transformación misionera son los temas abordadas en este artículo. Si, como afirma Francisco, la misión no puede dejar las cosas como están, la teología debe ser interpelada por la acción evangelizadora y la evangelización debe nutrirse en una teología que hable bien de Dios y del hombre.

Medida provisória na Constituição de 1988 e a necessidade de sua limitação

As medidas provisórias passaram a integrar o processo legislativo brasileiro com o advento da Constituição de 1988. A previsão inicial das medidas provisórias no art. 62 da Constituição Federal foi se tornando insatisfatória por deficiências oriundas dos pressupostos de relevância e urgência, em razão dos mesmos terem sido aferidos como muito genéricos ou subjetivos, o que acarretou sua demasiada edição. Com o intuito de restringir o poder do chefe do Executivo, foi aprovada, a Emenda Constitucional n. 32/2002, regulamentada pela Resolução 01/2002 do Congresso Nacional. Há consenso geral sobre a afronta estabelecida ao processo legislativo em função da perda de competência do Congresso derivada da excessiva edição de medidas provisórias, sendo necessário limitar essa prejudicial atuação executiva que tem estabelecido o trancamento de pauta constante nas votações no Parlamento.

Presencia equilibrada entre mujeres y hombres en consejos de administración: identificación de los Stakeholders

[ES] En España, la reciente normativa ha convertido la presencia equilibrada de mujeres y hombres en los Consejos de Administración en un elemento a incorporar en la gestión empresarial. El objetivo de este trabajo es identificar los grupos de interés (stakeholders) que demandan a las empresas esta presencia equilibrada utilizando la metodología de Mitchell et al. (1997) y Agle et al. (1999).

Demonstrativo das despesas obrigatórias de caráter continuado : análise e evolução histórica, avaliação e identificação das variáveis que o determinam para proposição de um novo modelo

Analisa os mecanismos referentes ao controle das despesas obrigatórias de caráter continuado: o mecanismo de compensação, que tem suas origens no denominado "pay-as-you-go" implantado com o "Budget Enforcement Act" norte-americano, e o demonstrativo de margem de expansão. A análise da evolução histórica dessa categoria de despesas para a União evidencia que os mecanismos de compensação utilizados não permitiram o controle efetivo do aumento dessas despesas, inviabilizando o direcionamento de recursos para ações que impliquem garantia de desenvolvimento sustentável. A discussão sobre os conceitos de despesas obrigatórias de caráter continuado, dos mecanismos de compensação e dos objetivos da apresentação de um demonstrativo de estimativa de margem de expansão indica a necessidade de uma reavaliação e aprofundamento, baseados nos objetivos originais da Lei de Responsabilidade Fiscal, a fim de se ampliar a eficácia de tais mecanismos. Por fim, o trabalho propõe um novo modelo para a apresentação do demonstrativo de estimativa de margem de expansão de despesas obrigatórias de caráter continuado, que possibilite a utilização de uma terminologia adequada, a identificação de fontes e valores dos parâmetros empregados na previsão de receitas e despesas e a avaliação comparativa entre os valores estimados e aqueles realmente executados nos dois exercícios anteriores.

Building a sustainable community of coastal leaders to deal with sea level rise and inundation

Sea level rise and inundation were stated to be the highest priorities in the community-developed Ocean Research Priorities Plan and Implementation Strategy in 2005. Although they remain stated priorities, very few resources have been allocated towards this challenge. Inundation poses a substantial risk to many coastal communities, and the risk is projected to increase because of continued development, changes in the frequency and intensity of inundation events, and acceleration in the rate of sea-level rise along our vulnerable shorelines. (PDF contains 4 pages) There is an increasing urgency for federal and state governments to focus on the local and regional levels and consistently provide the information, tools, and methods necessary for adaptation. Calls for action at all levels acknowledge that a viable response must engage federal, state and local expertise, perspectives, and resources in a coordinated and collaborative effort. A workshop held in December 2000 on coastal inundation and sea level rise proposes a shared framework that can help guide where investments should be made to enable states and local governments to assess impacts and initiate adaptation strategies over the next decade.

If the tide is rising, who pays for the ark?

Two common goals of this meeting are to arrest the effects of sea level rise and other phenomena caused by Greenhouse Gases from anthropogenic sources ("GHG",) and to mitigate the effects. The fundamental questions are: (1) how to get there and (2) who should shoulder the cost? Given Washington gridlock, states, NGO's and citizens such as the Inupiat of the Village of Kivalina have turned to the courts for solutions. Current actions for public nuisance seek (1) to reduce and eventually eliminate GHG emissions, (2) damages for health effects and property damage—plus hundreds of millions in dollars spent to prepare for the foregoing. The U.S. Court of Appeals just upheld the action against the generators of some 10% of the CO2 emissions from human activities in the U.S., clearing the way for a trial featuring the state of the art scientific linkage between GHG production and the effects of global warming. Climate change impacts on coastal regions manifest most prominently through sea level rise and its impacts: beach erosion, loss of private and public structures, relocation costs, loss of use and accompanying revenues (e.g. tourism), beach replenishment and armoring costs, impacts of flooding during high water events, and loss of tax base. Other effects may include enhanced storm frequency and intensity, increased insurance risks and costs, impacts to water supplies, fires and biological changes through invasions or local extinctions (IPCC AR4, 2007; Okmyung, et al., 2007). There is an increasing urgency for federal and state governments to focus on the local and regional levels and consistently provide the information, tools, and methods necessary for adaptation. Calls for action at all levels acknowledge that a viable response must engage federal, state and local expertise, perspectives, and resources in a coordinated and collaborative effort. A workshop held in December 2000 on coastal inundation and sea level rise proposes a shared framework that can help guide where investments should be made to enable states and local governments to assess impacts and initiate adaptation strategies over the next decade. (PDF contains 5 pages)