Plantar threshold sensitivity assessment using an automated tool-Clinical assessment comparison between a control population without type 2 diabetes mellitus, and populations with type 2 diabetes mellitus, with and without neuropathy symptoms.

Diabetic peripheral neuropathy is often classified as a loss of sensation in the extremities, particularly in elderly populations. The most common diagnosis technique is with the use of the hand-applied Semmes-Weinstein monofilament. This study's first aim was to quantify and compare sensation on the plantar surface in healthy and type 2 diabetes mellitus populations with the standard Semmes-Weinstein hand-applied methodology and a tool that automates this approach. The second was to evaluate correlations between sensation and the subjects' medical characteristics. Sensation was quantified by both tools, at thirteen locations per foot, in three populations: Group 1-control subjects without type 2 diabetes, Group 2-subjects with type 2 diabetes and with neuropathy symptoms, and Group 3-subjects with type 2 diabetes without neuropathy symptoms. The percentage of locations sensitive to the hand-applied monofilament, yet insensitive to the automated tool was calculated. Linear regression analyses between sensation and the subject's age, body mass index, ankle brachial index, and hyperglycemia metrics were performed per group. ANOVAs determined differences between populations. Approximately 22.5% of locations assessed were sensitive to the hand-applied monofilament, yet insensitive to the automated tool. Age and sensation were only significantly correlated in Group 1 (R2 = 0.3422, P = 0.004). Sensation was not significantly correlated with the other medical characteristics per group. Differences in sensation between the groups were not significant (P = 0.063). Caution is recommended when using hand-applied monofilaments. Group 1's sensation was correlated to age. The other medical characteristics failed to corelate with sensation, despite group.

Victorian public healthcare Chief Executive Officers' views on renewable energy supply.

Objective Identify the views of healthcare leaders towards public healthcare's carbon footprint; the importance or not of healthcare energy supply and sources and; the perceived key barriers for Victorian health care to show leadership on renewable energy sources and supply. Methods Self-administered questionnaire (10 Likert scale, two open-ended questions) among 24 Victorian Health Chief Executive Officers (CEOs). Responses were anonymous. Descriptive analysis was conducted. Results Overall, 13/24 (54%) of CEOs responded. A majority (11/13) agreed that climate change is causing real and accelerating harm to health and the environment, with impacts on patients, staff and services a current issue. One hundred percent (13/13) saw leadership by the public healthcare sector on environmental sustainability as an important responsibility (strongly agreed, 9/13 (69%); agreed, 4/13 (31%)), with most CEOs supporting their institution increasing the amount of renewable electricity supply over-and-above grid levels (strongly agreed, 3/13 (23%); agreed, 9/13 (69%)). However, support for renewable electricity was, for the most part, aspirational and not perceived as a current priority. The key perceived barriers to increasing renewable electricity supply were Health Purchasing Victoria contract and financial constraints. Conclusions Health care itself has a carbon footprint. Public healthcare CEOs are supportive of their institutions increasing use of renewable electricity supply, yet perceived barriers regarding inflexible and poorly transparent purchasing contracts and financial cost exist. What is known about the topic? Australian health care contributes ~7 percent to Australia's total carbon emissions, with hospital energy consumption (coal-generated electricity and natural/fossil gas) a large majority. An executive level champion is a consistent factor across health services that are taking the lead on environmental sustainability. What does this paper add? Our research is original in understanding the views of Victorian public healthcare CEOs on climate change, renewable energy supply and key barriers to increasing uptake. A majority of public healthcare CEOs see energy choices as an important issue for their patients, staff and institution, and that greater leadership should be shown by health care in light of the urgency required to address greenhouse gas emissions. However, support for renewable electricity was, for the most part, aspirational, with specific barriers identified across the healthcare network. What are the implications for practitioners? This research provides information that can inform a pathway to healthcare decarbonisation via sector-wide action.