The effect of existing and novel walker boot designs on offloading and gait mechanics.

BACKGROUND: Orthopedic walker boots are often used to treat foot ulcers and other wounds with the goal of offloading plantar pressure. However, poor ulcer healing outcomes and high recurrence rates show a need for additional solutions in the growing diabetes epidemic. We compared a novel spring-loaded walker boot to a traditional rigid ankle boot and a hinged ankle boot as well as a control shoe. Our aim was to better understand how boot design affects offloading mechanisms. We hypothesized that all boots would offload force from the foot to the shank, but that the hinged boot would have fewer gait alterations and the spring boot would further reduce pressure in early and late stance. METHODS: Ten healthy participants tested each of the four conditions in static stance and walking gait. Offloading was quantified by the difference between pressure insole and platform forces, while joint mechanics changes were calculated from instrumented gait analysis and inverse dynamics. RESULTS: Minimal offloading was found in the rigid and hinged boots compared to athletic shoes. In contrast, the spring boot offloaded nearly 50% of total load in static stance, with similarly large reductions in peak pressures during gait, particularly under the hindfoot during early stance. All boots resulted in some ankle joint mechanics compensations, with the rigid and spring boots showing similar restrictions in ankle motion and propulsive work. While the hinged boot resulted in ankle mechanics more like the shoe condition, it increased dorsiflexion and negative work, suggesting energetic inefficiency. CONCLUSIONS: The novel spring boot shows promise for more effective offloading that could lead to improved healing outcomes.

Development, Evaluation, and Implementation of a Pan-African Cancer Research Network: Men of African Descent and Carcinoma of the Prostate.

PURPOSE: Cancer of the prostate (CaP) is the leading cancer among men in sub-Saharan Africa (SSA). A substantial proportion of these men with CaP are diagnosed at late (usually incurable) stages, yet little is known about the etiology of CaP in SSA. METHODS: We established the Men of African Descent and Carcinoma of the Prostate Network, which includes seven SSA centers partnering with five US centers to study the genetics and epidemiology of CaP in SSA. We developed common data elements and instruments, regulatory infrastructure, and biosample collection, processing, and shipping protocols. We tested this infrastructure by collecting epidemiologic, medical record, and genomic data from a total of 311 patients with CaP and 218 matched controls recruited at the seven SSA centers. We extracted genomic DNA from whole blood, buffy coat, or buccal swabs from 265 participants and shipped it to the Center for Inherited Disease Research (Baltimore, MD) and the Centre for Proteomics and Genomics Research (Cape Town, South Africa), where genotypes were generated using the UK Biobank Axiom Array. RESULTS: We used common instruments for data collection and entered data into the shared database. Double-entered data from pilot participants showed a 95% to 98% concordance rate, suggesting that data can be collected, entered, and stored with a high degree of accuracy. Genotypes were obtained from 95% of tested DNA samples (100% from blood-derived DNA samples) with high concordance across laboratories. CONCLUSION: We provide approaches that can produce high-quality epidemiologic and genomic data in multicenter studies of cancer in SSA.

WITHDRAWN: Characterisation of the Intact Sensor Kinase VicK from Enterococcus faecalis: Direct Evidence for YycH as a Potent Modulating Signal in vitro.

This article has been withdrawn consistent with Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The Publisher apologizes for any inconvenience this may cause.