Wednesday, March 4, 2015

SALSA's Armstrong Joins Amputee Coalition's Limb Loss Task Force in Developing National "Model System" For Care and Prevention

David G Armstrong, Professor of Surgery and Chair of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona joined 10 other leading researchers and policymakers from around the country at a special limb loss task force in Boston this past week.  "I'm grateful to the Amputee Coalition for putting this program together." noted Dr. Armstrong, "It is our collective hope that the end result of this great group of top clinicians and scientists will be development of and federal funding for a 'model system' to care not only for those with amputations-- but also those at risk for their first or re-amputation." Armstrong went on to say that "There now exists a good amount of data that putting teams together to not only prevent problems but to rapidly rehabilitate people after amputation can lead not only to a higher quantity of years-- but a higher quality of life. I think we owe it to our patients to do our level best to see that happens, nationwide."
Members of the Amputee Coalition Limb Loss Task Force (Front L-R): Jason Highsmith, David G. Armstrong, Robert Gailey, Diane J. Atkins, David M. Crandell (Rear L-R): Paul E. Prusakowski, Jack Richmond, Terrence P. Sheehan, Stephen T. Wegener, Alan T. Hirsch, Jeff Kalish, Brian S. Armour, Alberto Esquenazi


Tuesday, February 24, 2015

Can you say...Inflammation (and LTB4)? Study Finds Root Cause of #Diabetes

UCSD Study Finds Root Cause of Type 2 Diabetes | NBC 7 San Diego:



Bringing SALSA from @uofa to Peshawar: Saving Limbs and Lives

Faisal Shah Jehan and Numan Khan see the world a bit differently. Their home, Peshawar, Pakistan, has been on the front lines of trauma and tragedy for many years. One month before their arrival in the United States, more than 140 people, mostly children, were killed in a bomb blast at a local school. However, both of them are here for a more quiet problem-- diabetes. "In fact, more people are losing their legs from diabetes than from all of the bombs combined" noted Faisal, who is completing his medical training alongside his colleague, Numan Khan, who finished Faisal's thought "So we must bring the very best methods of treatment in limb and life salvage back home." The two have set up a medical "grand tour" taking them to many units, the final one being The University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA), led by David G. Armstrong and Joseph Mills. "We are honored to have people from around the world at SALSA, every day, noted Dr. Armstrong, but it is particularly true in this instance with Numan and Faisal. They're at the front lines of injury and wounds every day-- but there is a silent, sinister problem happening underneath the surface-- and that is diabetes-- which is quietly affecting more people than the loudest bomb blast." People with diabetes often lose sensation and develop vascular disease, both of which can lead to wounds, gangrene, and loss of limb or death. "What these young men are doing may never get the attention it deserves," said Dr. Mills, "but that doesn't mean it isn't noble. Quite the opposite."

From Left: Dr. Armstrong with Faisal Shah Jehan and Numan Khan of Peshawar

From SALSA-iCAMP: Wearables and Visual-Feedback to Improve Stability in #Diabetes: A Randomised Controlled Trial @kargerpublisher

Sensor-Based Interactive Balance Training with Visual Joint Movement Feedback for Improving Postural Stability in Diabetics with Peripheral Neuropathy: A Randomized Controlled Trial

Grewal G.S.a, b · Schwenk M.a, b · Lee-Eng J.a, b · Parvaneh S.a, b · Bharara M.b · Menzies R.A.c ·Talal T.K.c · Armstrong D.G.b · Najafi B.a, b 
aInterdisciplinary Consortium on Advanced Motion Performance (iCAMP), and bSouthern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine, University of Arizona, Tucson, Ariz., USA; cHamad Medical Co., Doha, Qatar




Background: Individuals with diabetic peripheral neuropathy (DPN) have deficits in sensory and motor skills leading to inadequate proprioceptive feedback, impaired postural balance and higher fall risk. Objective: This study investigated the effect of sensor-based interactive balance training on postural stability and daily physical activity in older adults with diabetes. Methods: Thirty-nine older adults with DPN were enrolled (age 63.7 ± 8.2 years, BMI 30.6 ± 6, 54% females) and randomized to either an intervention (IG) or a control (CG) group. The IG received sensor-based interactive exercise training tailored for people with diabetes (twice a week for 4 weeks). The exercises focused on shifting weight and crossing virtual obstacles. Body-worn sensors were implemented to acquire kinematic data and provide real-time joint visual feedback during the training. Outcome measurements included changes in center of mass (CoM) sway, ankle and hip joint sway measured during a balance test while the eyes were open and closed at baseline and after the intervention. Daily physical activities were also measured during a 48-hour period at baseline and at follow-up. Analysis of covariance was performed for the post-training outcome comparison. Results: Compared with the CG, the patients in the IG showed a significantly reduced CoM sway (58.31%; p = 0.009), ankle sway (62.7%; p = 0.008) and hip joint sway (72.4%; p = 0.017) during the balance test with open eyes. The ankle sway was also significantly reduced in the IG group (58.8%; p = 0.037) during measurements while the eyes were closed. The number of steps walked showed a substantial but nonsignificant increase (+27.68%; p = 0.064) in the IG following training. Conclusion: The results of this randomized controlled trial demonstrate that people with DPN can significantly improve their postural balance with diabetes-specific, tailored, sensor-based exercise training. The results promote the use of wearable technology in exercise training; however, future studies comparing this technology with commercially available systems are required to evaluate the benefit of interactive visual joint movement feedback.

Sunday, February 15, 2015

Wearable Robots? That's a thing now at SALSA-iCAMP thanks to the geektastic folks at Sugar Lab. See more at #DFCon15

Healthy skin in #diabetes should be more like a tortilla and less like a cracker, right?





 2014 Jul-Aug;28(4):488-93. doi: 10.1016/j.jdiacomp.2014.03.011. Epub 2014 Mar 22.

The relationship between the mechanical properties of heel-pad and common clinical measures associated with foot ulcers in patients with diabetes.

Abstract

AIM:

The present study aims at investigating the correlation between the mechanical properties of the heel-pad of people with type-2 diabetes and the clinical parameters used to monitor their health and ulceration risk.

METHODS:

A new device for the in-vivo testing of plantar soft tissues was built and pilot-tested. This device consists of an ultrasound probe connected in series with a dynamometer. Loading is applied manually using a ball-screw actuator. A total of 35 volunteers with type-2 diabetes were recruited and the thickness, stiffness of their heel-pads as well as the energy absorbed during loading were assessed. The participants with diabetes also underwent blood tests and measurements of Ankle Brachial Index and Vibration Perception Threshold.

RESULTS:

Pearson correlation analysis revealed strong correlations between triglycerides and heel-pad stiffness (r=0.675, N=27, p<0.001) and between triglycerides and energy (r=-0.598, N=27, p=0.002). A correlation of medium strength was found between Fasting Blood Sugar (FBS) and stiffness (r=0.408, N=29, p=0.043).

CONCLUSIONS:

People with type-2 diabetes and high levels of triglycerides and FBS are more likely to have stiffer heel-pads. Increased stiffness could limit the tissues' ability to evenly distribute loads making them more vulnerable to trauma and ulceration.
Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

Diabetic foot; FBS; Hypertriglyceridemia; In-vivo tissue stiffness; Ulceration risk; Ultrasound indentation

SALSA's Armstrong Keynotes 13th Japanese Society for Footcare @bio5 @apmatweets

David G. Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona College of Medicine served as keynote lecturer at the 13th Japanese Society for Footcare in Tokyo Japan. "This has been amongst the most interdisciplinary meetings I've attended in a long time", noted Armstrong from the podium, as he surveyed the meeting's delegates from around Japan "From plastic surgery to nephrology to diabetology to nursing, I think you have every organ system covered." In addition to surgical outcomes data from his team, Armstrong described recent validation studies from SALSA and other centers using the Society for Vascular Surgery's Wound / Ischemia / Foot Infection (aka WIFI) scoring system pioneered by his partner, vascular surgeon Joseph Mills. "This is a wonderful time to be working in this area, as we are beginning to stop speaking in tongues and learning a common language of healing."
David G. Armstrong, DPM, MD, PhD, Delivering Keynote in Tokyo

Saturday, February 14, 2015

Toe, Flow and Blow(fly): Lecture with Larvae for Japanese Footcare Society

For those of you attending the Japanese Footcare Society (and others just hanging outside the stadium tailgating), you're so very welcome to this lecture or any others from the SALSA bowl. Enjoy.


Tuesday, February 10, 2015

Here's to our SALSAmigo, DaveK: #Blackberry Hires New Security Chief (and more) #IOT



DaveK Takes over as CSO at #Blackberry, to spearhead Internet of Things



The Wall Street Journal
BlackBerry Hires New Security Chief
By Ben Dummett
February 10, 2015
TORONTO— BlackBerry Ltd. Tuesday said it hired a new chief security officer, strengthening the smartphone-maker’s focus on developing mobile security technology.
David Kleidermacher will oversee development of security features for BlackBerry devices, mobile device security software and other products, as well as spearhead research and development aimed at preventing security breaches at a time when enterprise employees increasingly access and transmit data over their smartphones.
Mr. Kleidermacher joins the Waterloo, Ontario-based company from Green Hills Software, where he was chief technology officer. Green Hills, a closely held developer of embedded software based in Santa Barbara, Calif., targets many of the same security-conscious customers as BlackBerry, including the military, medical, industrial and automotive sectors.
“We have to be able to raise the level of assurance so that...we can actually prevent attacks instead of just always responding or reacting to them,” Mr. Kleidermacher said in a phone interview.
His hiring comes after BlackBerry’s senior vice president for security, Scott Totzke, left the company last summer. Mr. Totzke is now senior vice president, device and enterprise security, at Huawei Technologies Co., a rival smartphone maker.
It is also BlackBerry’s second high-profile hire since October. That is when Travis Angle joined from Apple Inc. to head development of companion products.
After a failed comeback attempt in the consumer market in 2013, BlackBerry is betting on its traditional strength developing secure mobile security software and devices that emphasize worker productivity to woo back its traditional enterprise customers. In November, BlackBerry launched a new security software that companies use to oversee employee devices on their corporate networks. It has also introduced two smartphones over the last five months aimed at professionals and other government and corporate users, and next month it is expected to outline its device plans for 2015.
A big part of Mr. Kleidermacher’s job will be to focus on helping BlackBerry take advantage of the expected growth in companies using secure mobile technology for data collection, record maintenance and smartphone-device management to cut costs and operate more efficiently.
BlackBerry’s “Internet of Things” strategy centers on its QNX operating system, which is used by many of the world’s major automobile makers to power their in-car infotainment systems, and the company’s secure network and device-management software. BlackBerry aims to extend the reach of this technology to the medical industry to capture and transmit medical data between doctors and patients.
Similarly, BlackBerry expects the shipping industry to use its Internet of Things technology to track cargo shipments, while betting the automotive industry will use the technology to allow drivers to remotely control Internet-enabled electronic devices in their homes.
Mr. Kleidermacher’s “knowledge of securing the Internet of Things and embedded systems will be invaluable as we execute on our strategy,” BlackBerry Chief Executive John Chen said in a statement.
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Barbara Tate
Manager, Corporate Communications
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