Charcot foot: Skin temperature as a good clinical parameter for predicting disease outcome

Twenty-eight diabetics presenting with acute Charcot foot were immobilized and the temperature difference between limbs measured at each month. All patients had monthly follow-up visits for a year and the relapse rate was zero. We found that skin temperature is a good parameter to ensure safe immobilization withdrawal. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

How do Australian podiatrists manage patients with diabetes The Australian diabetic foot management survey

Background Diabetic foot complications are the leading cause of lower extremity amputation and diabetes-related hospitalisation in Australia. Studies demonstrate significant reductions in amputations and hospitalisation when health professionals implement best practice management. Whilst other nations have surveyed health professionals on specific diabetic foot management, to the best of the authors’ knowledge this appears not to have occurred in Australia. The primary aim of this study was to examine Australian podiatrists’ diabetic foot management compared with best practice recommendations by the Australian National Health Medical Research Council. Methods A 36-item Australian Diabetic Foot Management survey, employing seven-point Likert scales (0 = Never; 7 = Always) to measure multiple aspects of best practice diabetic foot management was developed. The survey was briefly tested for face and content validity. The survey was electronically distributed to Australian podiatrists via professional associations. Demographics including sex, years treating patients with diabetes, employment-sector and patient numbers were also collected. Chi-squared and Mann Whitney U tests were used to test differences between sub-groups. Results Three hundred and eleven podiatrists responded; 222 (71%) were female, 158 (51%) from the public sector and 11–15 years median experience. Participants reported treating a median of 21–30 diabetes patients each week, including 1–5 with foot ulcers. Overall, participants registered median scores of at least “very often” (>6) in their use of most items covering best practice diabetic foot management. Notable exceptions were: “never” (1 (1 – 3)) using total contact casting, “sometimes” (4 (2 – 5)) performing an ankle brachial index, “sometimes” (4 (1 – 6)) using University of Texas Wound Classification System, and “sometimes” (4 (3 – 6) referring to specialist multi-disciplinary foot teams. Public sector podiatrists reported higher use or access on all those items compared to private sector podiatrists (p < 0.01). Conclusions This study provides the first baseline information on Australian podiatrists’ adherence to best practice diabetic foot guidelines. It appears podiatrists manage large caseloads of people with diabetes and are generally implementing best practice guidelines recommendations with some notable exceptions. Further studies are required to identify barriers to implementing these recommendations to ensure all Australians with diabetes have access to best practice care to prevent amputations.

Constructal dendritic configuration for the radiation heating of a solid stream

Here we show that the configuration of a slender enclosure can be optimized such that the radiation heating of a stream of solid is performed with minimal fuel consumption at the global level. The solid moves longitudinally at constant rate through the enclosure. The enclosure is heated by gas burners distributed arbitrarily, in a manner that is to be determined. The total contact area for heat transfer between the hot enclosure and the cold solid is fixed. We find that minimal global fuel consumption is achieved when the longitudinal distribution of heaters is nonuniform, with more heaters near the exit than the entrance. The reduction in fuel consumption relative to when the heaters are distributed uniformly is of order 10%. Tapering the plan view (the floor) of the heating area yields an additional reduction in overall fuel consumption. The best shape is when the floor area is a slender triangle on which the cold solid enters by crossing the base. These architectural features recommend the proposal to organize the flow of the solid as a dendritic design, which enters as several branches, and exits as a single hot stream of prescribed temperature. The thermodynamics of heating is presented in modern terms in the Sec. (exergy destruction, entropy generation). The contribution is that to optimize "thermodynamically" is the same as reducing the consumption of fuel. © 2010 American Institute of Physics.

Ultra-precision face grinding with constant pressure, lapping kinematics, and SiC grinding wheels dressed with overlap factor

Several machining processes have been created and improved in order to achieve the best results ever accomplished in hard and difficult to machine materials. Some of these abrasive manufacturing processes emerging on the science frontier can be defined as ultra-precision grinding. For finishing flat surfaces, researchers have been putting together the main advantages of traditional abrasive processes such as face grinding with constant pressure, fixed abrasives for two-body removal mechanism, total contact of the part with the tool, and lapping kinematics as well as some specific operations to keep grinding wheel sharpness and form. In the present work, both U d-lap grinding process and its machine tool were studied aiming nanometric finishing on flat metallic surfaces. Such hypothesis was investigated on AISI 420 stainless steel workpieces U d-lap ground with different values of overlap factor on dressing (Ud=1, 3, and 5) and grit sizes of conventional grinding wheels (silicon carbide (SiC)=#800, #600, and #300) applying a new machine tool especially designed and built for such finishing. The best results, obtained after 10 min of machining, were average surface roughness (Ra) of 1.92 nm, 1.19-μm flatness deviation of 25.4-mm-diameter workpieces, and mirrored surface finishing. Given the surface quality achieved, the U d-lap grinding process can be included among the ultra-precision abrasive processes and, depending on the application, the chaining steps of grinding, lapping, and polishing can be replaced by the proposed abrasive process.

Schulterprothetik und Sport

In the last years life duration of shoulder prostheses could be prolonged through improvement of prosthesis quality, instrumentation and surgical techniques. After shoulder total arthroplasty, the patients show signifi cant reduction of pain and good functional mid and long term results. Indication to shoulder arthroplasty can be made by even younger and sportive active patients. Many sport activities remain possible after implantation of a shoulder prosthesis. A systematic rehabilitation is mandatory to yield optimal functional results. Intensity of sports activities should remain in relation with the preoperative status. Activities with total contact and high impaction strength should be avoided to extend the duration of life of the prosthesis.

Anesthesia Resident Grad Group, June 21, 1997

(3 scans total: "contact" sheet of all 3, then one of each negative at end of strip)

Total internal reflection Raman spectroscopy of poly(alpha-olefin) oils in a lubricated contact

The rheology of a poly(alpha-olefin) base oil (PAO) in a sliding point contact has been investigated by total internal reflection (TIR) Raman spectroscopy. TIR Raman has the sensitivity to analyse nanometer-thick lubricant films in a tribological contact. The Raman signal generated from the sliding contact was used to determine the lubricant film thickness. The experimentally obtained film thicknesses were compared with theoretical calculations and a transition from Newtonian to non-Newtonian behaviour was observed at high shear rates. The Raman spectra showed no significant changes in the conformation of the PAO chains under the applied conditions of pressure and shear, but the polarisation dependence of the spectra revealed a preferred orientation of the hydrocarbon side chains in the shear-thinned region. Monolayers formed by a boundary lubricant, arachidic acid, dissolved in the PAO could be detected on the surfaces in the elastohydrodynamic regime.