Monitoring of pH and temperature of neuropathic diabetic and nondiabetic foot ulcers for 12 weeks: An observational study.

Wound bed assessment is largely reliant on subjective interpretation without recourse to objective tools or biomarkers. The identification of a point of care, reliable biomarker would enhance assessment and ultimately clinical decision making. Two potentially emerging wound biomarkers exist: surface pH and surface temperature. To date, knowledge of their use has been predominantly in wound prevention, in vitro studies and single time measurements. Our objective was to determine surface pH, size, and surface temperature in noninfected, neuropathic foot ulcers at baseline and at 12 weeks. 50 patients (68% [n = 34] had diabetes) participated. Mean baseline pH of wounds was 6.95 (SD 1.01); temperature 30.91 °C (SD 3.00); and size 0.82 cm2 (SD 0.61). After 12 weeks, 26% (n = 13) were lost to follow-up, 50% (n = 25) had healed. Of the remaining patients, mean pH was 6.72 (SD 0.54); temperature 30.88 °C (SD 2.97), and size 0.13 cm2 (SD 0.13). We have provided baseline values for pH and temperature of noninfected, neuropathic diabetic, and nondiabetic foot ulceration. Further studies in a larger cohort are warranted to determine if temperature and or pH are indicative of a healing or nonhealing state.

Fungal burden exposure assessment in podiatry clinics from Ireland.

Fungi are amongst the bioaerosols of most importance, as indicated by the growing interest in this field of research. The aim was to characterize the exposure to fungal burden in podiatry clinics using culture-based and molecular methods. METHODS: Airborne fungi were collected using an impaction air sampler and surface samples were also performed. Fourteen air samples were collected for direct detection of fungal DNA from filamentous fungi and dermatophytes. Overall, 63.6 % of the evening samples and 46 % of the morning samples surpassed the threshold values (150 CFU/m3). Molecular detection, by real time PCR, of the target fungal species/strains (Aspergillus and Stachybotrys species) was negative for all samples collected. Trichophyton rubrum was detected by PCR analysis in one DNA sample collected on day six. Results suggest the use of both culture-based and molecular methodologies are desirable for a complete evaluation of fungal burden in this particular health care setting.

The Impact of Equine Therapy and an Audio-Visual Approach Emphasizing Rhythm and Beat Perception in Children with Developmental Coordination Disorder.

Objectives: This study aims to investigate the impact of a therapeutic horse riding (HR) intervention and an audiovisual (AV) intervention comprising exposure to equine rhythm and motion on developmental parameters of children with Developmental Coordination Disorder (DCD). Design: The study design was a pretest/post-test. Settings/Location: The study took place in three locations across Ireland-St. Michael's Boys School in Mervue, Co Galway, The Hunt Museum in Limerick City, Co. Limerick, and Fettercairn Youth Horse Project in Tallaght, Co. Dublin. Subjects: Eighty-three children (6-14 years) with a primary diagnosis of DCD. Interventions: Children meeting the inclusion criteria were divided into three groups: HR, AV, and a control (C) group. Those in the intervention groups participated in eight 30 min HR lessons or AV screening sessions. Outcome measures: A Childhood Depression Inventory (CDI) measured signs of depression. A Childhood Behavior CheckList (CBCL) determined any behavioral and emotional problems, while a Social Responsiveness Scale (SRS) assessed the presence and extent of any social impairment. A GAITRite system provided an overall Functional Ambulation Performance (FAP) score (an automatic accumulated score of gait parameters, including gait speed, symmetry, distance, cadence, tension, support, and velocity), which was used to evaluate gait improvements. Results: Repeated measures analysis of variance revealed a main effect of time on all variables. Bonferroni post hoc tests revealed that these effects were due to significant improvements in both HR and AV groups for CDI, CBCL, and SRS, and significant improvements in the HR group only for FAP. Conclusions: This study provides initial evidence to support the value of an equine AV perception intervention at improving developmental parameters in children with DCD and provides additional support for the benefits of therapeutic HR on social, emotional, behavioral, and gait variables in these children.

Enhanced thermal imaging of wound tissue for better clinical decision making.

Infrared cameras are increasingly applied in clinical applications as they allow fast, inexpensive and non-contact temperature measurements. As abnormal heat distribution can indicate illness, infrared cameras have been applied in the prediction, diagnosis and monitoring of medical conditions. Current practices, however, often overlook the importance of emissivity when taking thermal measurements. The consensus is that human skin has an emissivity of 0.98 but this value varies between individuals, areas examined, and if the skin is damaged. In particular, further research should be conducted on the emissivity variations of wounds. OBJECTIVE: This research investigated the emissivity variation of chronic wounds and its effect on thermal measurements. Eleven patients with non-infected foot ulcers were recruited. Three non-diabetic wounds were also investigated in a clinical setting. APPROACH: A reflectance based method was used which involved alternating shades at different temperatures over the region of interest. Based on the change in the thermal images, emissivity was calculated at each pixel. MAIN RESULTS: Overall, it was found that the emissivity of wounds was similar or slightly higher to intact skin (range 0.01-0.03 higher with an average value of 0.97 ± 0.03), with lower values at wound edges (on average 0.02 lower than intact skin). Correcting for emissivity resulted in an average temperature difference of 0.83% in the thermal images. SIGNIFICANCE: Despite the similarity in emissivity, the difference between the original thermal image and the emissivity corrected thermal image in some cases was substantial. These differences could prove significant in clinical evaluations, indicating the need to incorporate emissivity measurement into standard protocol to ensure utmost accuracy.

Therapeutic horse riding improves cognition, mood arousal, and ambulation in children with dyspraxia.

OBJECTIVES: The objectives of this study were to evaluate the effects of the physical motion of a horse (riding therapy) combined with the audiovisual perception of this motion on a group of children with dyspraxia in terms of cognition, mood arousal, and gait variability. DESIGN: The study design was a pretest/post-test. SETTINGS/LOCATION: The study was conducted at the Fettercairn Youth Horse Project, Fettercairn, Tallaght, Dublin. SUBJECTS: Forty (40) children ranging from 6 to 15 years of age with a primary diagnosis of dyspraxia were the study subjects. INTERVENTIONS: Children meeting inclusion criteria participated in six 30-minute horse-riding sessions and two 30-minute audiovisual screening sessions. OUTCOME MEASURES: A Standard Progressive Matrices test (also known as the Ravens test) was used to measure aspects of general intelligence. A Childhood Depression Inventory (CDI) questionnaire was used to assess cognitive, affective, and behavioral signs of depression. A GAITRite Pressure Mapping System analyzed foot function and gait variability by measuring single and double support, cycle time, cadence, toe in/out, and stride length. RESULTS: Significant improvements were evident on the Ravens test and the CDI by the end of the study period. The amount of both single and double support required while completing the walking task also was significantly reduced. Improvements were visible on toe in/out values, cycle time, and cadence. Changes in stride length did not reach statistical significance. CONCLUSIONS: These findings support the theory that riding therapy and/or the perception of beat-based rhythms, as experienced by the rider on the horse, stimulates cognition, mood, and gait parameters. In addition, the data also pointed to the potential value of an audiovisual approach to equine therapy.