| 1. |
- Rieth, M., et al.
(author)
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Review on the EFDA programme on tungsten materials technology and science
- 2011
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In: Journal of Nuclear Materials. - : Elsevier BV. - 0022-3115 .- 1873-4820. ; 417:1-3, s. 463-467
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Journal article (peer-reviewed)abstract
- All the recent DEMO design studies for helium cooled divertors utilize tungsten materials and alloys, mainly due to their high temperature strength, good thermal conductivity, low erosion, and comparably low activation under neutron irradiation. The long-term objective of the EFDA fusion materials programme is to develop structural as well as armor materials in combination with the necessary production and fabrication technologies for future divertor concepts. The programmatic roadmap is structured into four engineering research lines which comprise fabrication process development, structural material development, armor material optimization, and irradiation performance testing, which are complemented by a fundamental research programme on "Materials Science and Modeling". This paper presents the current research status of the EFDA experimental and testing investigations, and gives a detailed overview of the latest results on fabrication, joining, high heat flux testing, plasticity, modeling, and validation experiments.
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| 2. |
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| 3. |
- Paton, A., et al.
(author)
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Plant and fungal collections: Current status, future perspectives
- 2020
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In: Plants People Planet. - : Wiley. - 2572-2611. ; 2:5, s. 499-514
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Journal article (peer-reviewed)abstract
- Societal Impact Statement Plant and fungal specimens provide the auditable evidence that a particular organism occurred at a particular place, and at a particular point in time, verifying past occurrence and distribution. They also document the aspects of human exploration and culture. Collectively specimens form a global asset with significant potential for new uses to help address societal and environmental challenges. Collections also serve as a platform to engage and educate a broad range of stakeholders from the academic to the public, strengthening engagement and understanding of plant and fungal diversity-the basis of life on Earth. SummaryWe provide a global review of the current state of plant and fungal collections including herbaria and fungaria, botanic gardens, fungal culture collections, and biobanks. The review focuses on the numbers of collections, major taxonomic group and species level coverage, geographical representation and the extent to which the data from collections are digitally accessible. We identify the major gaps in these collections and in digital data. We also consider what collection types need to be further developed to support research, such as environmental DNA and cryopreservation of desiccation-sensitive seeds. Around 31% of vascular plant species are represented in botanic gardens, and 17% of known fungal species are held in culture collections, both these living collections showing a bias toward northern temperate taxa. Only 21% of preserved collections are available via the Global Biodiversity Information Facility (GBIF) with Asia, central and north Africa and Amazonia being relatively under-represented. Supporting long-term collection facilities in biodiverse areas should be considered by governmental and international aid agencies, in addition to short-term project funding. Institutions should consider how best to speed up digitization of collections and to disseminate all data via aggregators such as GBIF, which will greatly facilitate use, research, and community curation to improve quality. There needs to be greater alignment between biodiversity informatics initiatives and standards to allow more comprehensive analysis of collections data and to facilitate linkage of extended information, facilitating broader use. Much can be achieved with greater coordination through existing initiatives and strengthening relationships with users.
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| 4. |
- Rieth, M., et al.
(author)
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A brief summary of the progress on the EFDA tungsten materials program
- 2013
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In: Journal of Nuclear Materials. - : Elsevier BV. - 0022-3115 .- 1873-4820. ; 442:1-3, s. S173-S180
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Journal article (peer-reviewed)abstract
- The long-term objective of the European Fusion Development Agreement (EFDA) fusion materials programme is to develop structural and armor materials in combination with the necessary production and fabrication technologies for reactor concepts beyond the International Thermonuclear Experimental Reactor. The programmatic roadmap is structured into four engineering research lines which comprise fabrication process development, structural material development, armor material optimization, and irradiation performance testing, which are complemented by a fundamental research programme on "Materials Science and Modeling." This paper presents the current research status of the EFDA experimental and testing investigations, and gives a detailed overview of the latest results on materials research, fabrication, joining, high heat flux testing, plasticity studies, modeling, and validation experiments.
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| 5. |
- Rieth, M., et al.
(author)
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Recent progress in research on tungsten materials for nuclear fusion applications in Europe
- 2013
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In: Journal of Nuclear Materials. - : Elsevier BV. - 0022-3115 .- 1873-4820. ; 432:1-3, s. 482-500
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Research review (peer-reviewed)abstract
- The current magnetic confinement nuclear fusion power reactor concepts going beyond ITER are based on assumptions about the availability of materials with extreme mechanical, heat, and neutron load capacity. In Europe, the development of such structural and armour materials together with the necessary production, machining, and fabrication technologies is pursued within the EFDA long-term fusion materials programme. This paper reviews the progress of work within the programme in the area of tungsten and tungsten alloys. Results, conclusions, and future projections are summarized for each of the programme's main subtopics, which are: (1) fabrication, (2) structural W materials, (3) W armour materials, and (4) materials science and modelling. It gives a detailed overview of the latest results on materials research, fabrication processes, joining options, high heat flux testing, plasticity studies, modelling, and validation experiments.
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| 6. |
- Keppler, M., et al.
(author)
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Discovery of a planetary-mass companion within the gap of the transition disk around PDS 70
- 2018
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In: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 617
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Journal article (peer-reviewed)abstract
- Context. Young circumstellar disks are the birthplaces of planets. Their study is of prime interest to understand the physical and chemical conditions under which planet formation takes place. Only very few detections of planet candidates within these disks exist, and most of them are currently suspected to be disk features.Aims. In this context, the transition disk around the young star PDS 70 is of particular interest, due to its large gap identified in previous observations, indicative of ongoing planet formation. We aim to search for the presence of an embedded young planet and search for disk structures that may be the result of disk-planet interactions and other evolutionary processes.Methods. We analyse new and archival near-infrared images of the transition disk PDS 70 obtained with the VLT/SPHERE, VLT/NaCo, and Gemini/NICI instruments in polarimetric differential imaging and angular differential imaging modes.Results. We detect a point source within the gap of the disk at about 195 mas (similar to 22 au) projected separation. The detection is confirmed at five different epochs, in three filter bands and using different instruments. The astrometry results in an object of bound nature, with high significance. The comparison of the measured magnitudes and colours to evolutionary tracks suggests that the detection is a companion of planetary mass. The luminosity of the detected object is consistent with that of an L-type dwarf, but its IR colours are redder, possibly indicating the presence of warm surrounding material. Further, we confirm the detection of a large gap of similar to 54 au in size within the disk in our scattered light images, and detect a signal from an inner disk component. We find that its spatial extent is very likely smaller than similar to 17 au in radius, and its position angle is consistent with that of the outer disk. The images of the outer disk show evidence of a complex azimuthal brightness distribution which is different at different wavelengths and may in part be explained by Rayleigh scattering from very small grains.Conclusions. The detection of a young protoplanet within the gap of the transition disk around PDS 70 opens the door to a so far observationally unexplored parameter space of planetary formation and evolution. Future observations of this system at different wavelengths and continuing astrometry will allow us to test theoretical predictions regarding planet-disk interactions, planetary atmospheres, and evolutionary models.
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| 7. |
- Olofsson, J., et al.
(author)
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Resolving faint structures in the debris disk around TWA 7 Tentative detections of an outer belt, a spiral arm, and a dusty cloud
- 2018
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In: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 617
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Journal article (peer-reviewed)abstract
- Context. Debris disks are the intrinsic by-products of the star and planet formation processes. Most likely due to instrumental limitations and their natural faintness, little is known about debris disks around low mass stars, especially when it comes to spatially resolved observations. Aims. We present new VLT/SPHERE IRDIS dual-polarization imaging (DPI) observations in which we detect the dust ring around the M2 spectral type star TWA 7. Combined with additional angular differential imaging observations we aim at a fine characterization of the debris disk and setting constraints on the presence of low-mass planets. Methods. We modeled the SPHERE DPI observations and constrain the location of the small dust grains, as well as the spectral energy distribution of the debris disk, using the results inferred from the observations, and performed simple N-body simulations. Results. We find that the dust density distribution peaks at similar to 0.72 '' (25 au), with a very shallow outer power-law slope, and that the disk has an inclination of similar to 13 degrees with a position angle of similar to 91 degrees east of north. We also report low signal-to-noise ratio detections of an outer belt at a distance of similar to 1.5 '' (similar to 52 au) from the star, of a spiral arm in the southern side of the star, and of a possible dusty clump at 0.11 ''. These findings seem to persist over timescales of at least a year. Using the intensity images, we do not detect any planets in the close vicinity of the star, but the sensitivity reaches Jovian planet mass upper limits. We find that the SED is best reproduced with an inner disk at similar to 0.2 '' (similar to 7 au) and another belt at 0.72 '' (25 au). Conclusions. We report the detections of several unexpected features in the disk around TWA 7. A yet undetected 100 M-circle plus planet with a semi-major axis at 20-30 au could possibly explain the outer belt as well as the spiral arm. We conclude that stellar winds are unlikely to be responsible for the spiral arm.
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| 8. |
- Due, P., et al.
(author)
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Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries
- 2009
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In: International Journal of Obesity. - : Springer Science and Business Media LLC. - 1476-5497 .- 0307-0565. ; 33:10, s. 1084-1093
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Journal article (peer-reviewed)abstract
- Objective: It is important to understand levels and social inequalities in childhood overweight within and between countries. This study examined prevalence and social inequality in adolescent overweight in 35 countries, and associations with macroeconomic factors. Design: International cross-sectional survey in national samples of schools. Subjects: A total of 11-, 13- and 15-year-olds from 35 countries in Europe and North America in 2001-2002 (N = 162 305). Measurements: The main outcome measure was overweight based on self-reported height and weight ( body mass index cut-points corresponding to body mass index of 25 kg/m(2) at the age of 18 years). Measures included family and school affluence (within countries), and average country income and economic inequality (between countries). Results: There were large variations in adolescent overweight, from 3.5% in Lithuanian girls to 31.7% in boys from Malta. Prevalence of overweight was higher among children from less affluent families in 21 of 24 Western and 5 of 10 Central European countries. However, children from more affluent families were at higher risk of overweight in Croatia, Estonia and Latvia. In Poland, Lithuania, Macedonia and Finland, girls from less affluent families were more overweight whereas the opposite was found for boys. Average country income was associated with prevalence and inequality in overweight when considering all countries together. However, economic inequality as measured by the Gini coefficient was differentially associated with prevalence and socioeconomic inequality in overweight among the 23-high income and 10-middle income countries, with a positive relationship among the high income countries and a negative association among the middle income countries. Conclusion: The direction and magnitude of social inequality in adolescent overweight shows large international variation, with negative social gradients in most countries, but positive social gradients, especially for boys, in some Central European countries. Macroeconomic factors are associated with the heterogeneity in prevalence and social inequality of adolescent overweight. International Journal of Obesity (2009) 33, 1084-1093; doi:10.1038/ijo.2009.128; published online 21 July 2009
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| 9. |
- Engler, N., et al.
(author)
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The high-albedo, low polarization disk around HD 114082 that harbors a Jupiter-sized transiting planet Constraints from VLT/SPHERE completed with TESS, Gaia, and radial velocities
- 2023
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In: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 672
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Journal article (peer-reviewed)abstract
- Aims. We present new optical and near-infrared images of the debris disk around the F-type star HD 114082 in the Scorpius-Centaurus OB association. We obtained direct imaging observations and analyzed the TESS photometric time series data of this target with the goal of searching for planetary companions to HD 114082 and characterizing the morphology of the debris disk and the scattering properties of dust particles. Methods. HD 114082 was observed with the VLT/SPHERE instrument in different modes - the IRDIS camera in the K band (2.0-2.3 mu m) together with the IFS in the Y, J, and H bands (0.95-1.66 mu m) using the angular differential imaging technique as well as IRDIS in the H band (1.5-1.8 mu m) and ZIMPOL in the I_PRIME band (0.71-0.87 mu m) using the polarimetric differential imaging technique. To constrain the basic geometrical parameters of the disk and the scattering properties of dust grains, scattered light images were fitted with a 3D model for single scattering in an optically thin dust disk using a Markov chain Monte Carlo approach. We performed aperture photometry to derive the scattering and polarized phase functions, the polarization fraction, and the spectral scattering albedo for the dust particles in the disk. This method was also used to obtain the reflectance spectrum of the disk and, in turn, to retrieve the disk color and study the dust reflectivity in comparison to the debris disk HD 117214. We also performed the modeling of the HD 114082 light curve measured by TESS using models for planet transit and stellar activity to put constraints on the radius of the detected planet and its orbit. Last, we searched for additional planets in the system by combining archival radial velocity data, astrometry, and direct imaging. Results. The debris disk HD 114082 appears as an axisymmetric debris belt with a radius of similar to 0.37 '' (35 au), an inclination of similar to 83 degrees, and a wide inner cavity. Dust particles in HD 114082 have a maximum polarization fraction of similar to 17% and a higher reflectivity when compared to the debris disk HD 117214. This high reflectivity results in a spectral scattering albedo of similar to 0.65 for the HD 114082 disk at near-infrared wavelengths. The disk reflectance spectrum exhibits a red color at the position of the planetesimal belt and shows no obvious features, whereas that of HD 117214 might indicate the presence of CO2 ice. The analysis of TESS photometric data reveals a transiting planetary companion to HD 114082 with a radius of similar to 1 R-Jup on an orbit with a semimajor axis of 0.7 +/- 0.4 au. No additional planet was detected in the system when we combined the SPHERE images with constraints from astrometry and radial velocity. We reach deep sensitivity limits down to similar to 5 M-Jup at 50 au and similar to 10 M-Jup at 30 au from the central star.
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| 10. |
- Merlone, Andrea, et al.
(author)
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A new challenge for meteorological measurements : The meteoMet project-Metrology for meteorology
- 2013
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In: AIP Conference Proceedings. - : AIP. - 0094-243X .- 1551-7616. - 9780735411784 ; , s. 1030-1035
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Conference paper (peer-reviewed)abstract
- Climate change and its consequences require immediate actions in order to safeguard the environment and economy in Europe and in the rest of world. Aiming to enhance data reliability and reduce uncertainties in climate observations, a joint research project called MeteoMet-Metrology for Meteorology started in October 2011 coordinated by the Italian Istituto Nazionale di Ricerca Metrologica (INRiM). The project is focused on the traceability of measurements involved in climate change: surface and upper air measurements of temperature, pressure, humidity, wind speed and direction, solar irradiance and reciprocal influences between measurands. This project will provide the first definition at the European level of validated climate parameters with associated uncertainty budgets and novel criteria for interpretation of historical data series. The big challenge is the propagation of a metrological measurement perspective to meteorological observations. When such an approach will be adopted the requirement of reliable data and robust datasets over wide scales and long terms could be better met.
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| 11. |
- Pickwell, K., et al.
(author)
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Minor amputation does not negatively affect health-related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer : An observational study
- 2017
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In: Diabetes/Metabolism Research and Reviews. - : Wiley. - 1520-7552. ; 33:3
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Journal article (peer-reviewed)abstract
- Background: Health-related quality of life (HRQoL) is poor in patients with persistent diabetic foot ulcers and poor HRQoL predicts worse outcomes in these patients. Amputation is often considered a treatment failure, which is why conservative treatment is generally preferred over amputation. However, it is unclear whether minor amputation negatively affects HRQoL compared with conservative treatment in patients with diabetic foot ulcers. Methods: In the cohort of the multicenter, prospective, observational Eurodiale study, we determined difference in change of HRQoL measured by EQ-5D between patients with a diabetic foot ulcers that healed after conservative treatment (n = 676) and after minor amputation (n = 145). Propensity score was used to adjust for known confounders, attempting to overcome lack of randomization. Results: Baseline HRQoL was not significantly different between patients treated conservatively and undergoing minor amputation. In addition, there was no difference in the change of HRQoL between these groups. In patients who healed 6 to 12 months after the first visit, HRQoL on the anxiety/depression subscale even appeared to improve more in those who underwent minor amputation. Conclusions: Minor amputation was not associated with a negative impact on HRQoL in patients with a diabetic foot ulcers. It may therefore not be considered treatment failure in terms of HRQoL but rather a viable treatment option. A randomized controlled trial is warranted to further examine the influence of minor amputations on health-related quality of life.
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| 12. |
- Prompers, L, et al.
(author)
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Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study
- 2008
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In: Diabetic Medicine. - : Wiley. - 1464-5491 .- 0742-3071. ; 25:6, s. 700-707
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Journal article (peer-reviewed)abstract
- Aims To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease. Methods The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization. Results Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6-55%). At study entry, 77% of the patients had no or inadequate offloading. During follow-up, casting was used in 35% (0-68%) of the plantar fore- or midfoot ulcers. Predictors of use of casting were male gender, large ulcer size and being employed. Vascular imaging was performed in 56% (14-86%) of patients with severe limb ischaemia; revascularization was performed in 43%. Predictors of use of vascular imaging were the presence of infection and ischaemic rest pain. Conclusion Treatment of many patients is not in line with current guidelines and there are large differences between countries and centres. Our data suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot disease.
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| 13. |
- Prompers, L., et al.
(author)
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High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study
- 2007
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In: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 50:1, s. 18-25
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Journal article (peer-reviewed)abstract
- Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries. The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1 September 2003 and 1 October 2004. Standardised data on patient characteristics, as well as foot and ulcer characteristics, were obtained. Foot disease was categorised into four stages according to the presence or absence of peripheral arterial disease (PAD) and infection: A: PAD -, infection -; B: PAD -, infection +; C: PAD +, infection -; D: PAD +, infection +. PAD was diagnosed in 49% of the subjects, infection in 58%. The majority of ulcers (52%) were located on the non-plantar surface of the foot. With regard to severity, 24% had stage A, 27% had stage B, 18% had stage C and 31% had stage D foot disease. Patients in the latter group had a distinct profile: they were older, had more non-plantar ulcers, greater tissue loss and more serious comorbidity. According to our results in this European cohort, the severity of diabetic foot ulcers at presentation is greater than previously reported, as one-third had both PAD and infection. Non-plantar foot ulcers were more common than plantar ulcers, especially in patients with severe disease, and serious comorbidity increased significantly with increasing severity of foot disease. Further research is needed to obtain insight into the clinical outcome of these patients.
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| 14. |
- Prompers, L., et al.
(author)
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Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study
- 2008
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In: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 51:5, s. 747-755
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Journal article (peer-reviewed)abstract
- Aims/hypothesis Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD. Methods Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer). Results After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only. Conclusions/Interpretation Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation.
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| 15. |
- Prompers, L., et al.
(author)
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Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study
- 2008
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In: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 51:10, s. 1826-1834
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Journal article (peer-reviewed)abstract
- Aims/hypothesis The aim of the present study was to investigate resource utilisation and associated costs in patients with diabetic foot ulcers and to analyse differences in resource utilisation between individuals with or without peripheral arterial disease (PAD) and/or infection. Methods Data on resource utilisation were collected prospectively in a European multicentre study. Data on 1,088 patients were available for the analysis of resource use, and data on 821 patients were included in the costing analysis. Costs were calculated for each patient by multiplying the country-specific direct and indirect unit costs by the number of resources used from inclusion into the study up to a defined endpoint. Country-specific costs were converted into purchasing power standards. Results Resource use and costs varied between outcome groups and between disease severity groups. The highest costs per patient were for hospitalisation, antibiotics, amputations and other surgery. All types of resource utilisation and costs increased with the severity of disease. The total cost per patient was more than four times higher for patients with infection and PAD at inclusion than for patients in the least severe group, who had neither. Conclusions/interpretation Important differences in resource use and costs were found between different patient groups. The costs are highest for individuals with both peripheral arterial disease and infection, and these are mainly related to substantial costs for hospitalisation. In view of the magnitude of the costs associated with in-hospital stay, reducing the number and duration of hospital admissions seems an attractive option to decrease costs in diabetic foot disease.
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| 16. |
- Siersma, V., et al.
(author)
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Importance of factors determining the low health-related quality of life in people presenting with a diabetic foot ulcer: the Eurodialestudy
- 2013
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In: Diabetic Medicine. - : Wiley. - 1464-5491 .- 0742-3071. ; 30:11, s. 1382-1387
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Journal article (peer-reviewed)abstract
- AimTo identify the factors responsible for the low health-related quality of life associated with foot ulcers and the relative importance of these factors. MethodsA total of 1232 patients with a new foot ulcer, who presented at one of the 14 centres in 10 European countries participating in the Eurodiale study, were included in this cross-sectional study. Patient and ulcer characteristics were obtained as well as results from the Euro-Qol-5D questionnaire, a health-related quality of life instrument with five domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). To analyse the relative importance of comorbidities and ulcer- and patient-related factors for health-related quality of life, linear regression models were used to calculate the relative contributions of each factor to the fit (R-2) of the model. ResultsPatients reported poor overall health-related quality of life, with problems primarily in the mobility and pain/discomfort domains. Among the comorbidities, the inability to stand or walk without help was the most important determinant of decreased health-related quality of life in all five domains. Among ulcer-related factors, ulcer size, limb-threatening ischaemia and elevated C-reactive protein concentration also had high importance in all domains. The clinical diagnosis of infection, peripheral arterial disease and polyneuropathy were only important in the pain/discomfort domain. ConclusionsThe factors that determine health-related quality of life are diverse and to an extent not disease-specific. To improve health-related quality of life, treatment should not only be focused on ulcer healing but a multifactorial approach by a specialized multidisciplinary team is also important. What's new? The inability to stand or walk without help is the most important determinant of poor health-related quality of life. Other factors with high importance are ulcer size, elevated C-reactive protein concentration and limb-threatening ischaemia. To improve health-related quality of life, treatment should not only be focused on ulcer healing but a multifactorial approach by a specialized multidisciplinary team is also important.
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| 17. |
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| 18. |
- van Battum, P., et al.
(author)
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Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation
- 2011
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In: Diabetic Medicine. - : Wiley. - 1464-5491 .- 0742-3071. ; 28:2, s. 199-205
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Journal article (peer-reviewed)abstract
- P>Objectives The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres. Methods In the Eurodiale study, a prospective cohort study of 1232 patients (1088 followed until end-point) with a new diabetic foot ulcer were followed on a monthly basis until healing, death, major amputation or up to a maximum of 1 year. Ulcers were treated according to international guidelines. Baseline characteristics independently associated with minor amputation were examined using multiple logistic regression modelling. Based on the results of the multivariable analysis, a disease severity score was calculated for each patient. Results One hundred and ninety-four (18%) patients underwent a minor amputation. Predictors of minor amputation were depth of the ulcer (odds ratio 6.08, confidence interval 4.10-9.03), peripheral arterial disease (odds ratio 1.84, confidence interval 1.30-2.60), infection (odds ratio 1.56, confidence interval 1.05-2.30) and male sex (odds ratio 1.42, confidence interval 0.99-2.04). Minor amputation rate varied between 2.4 and 34% in the centres. Minor amputation rate in centres correlated strongly with disease severity score at the moment of presentation to the foot clinic (r = 0.75). Conclusions Minor amputation is performed frequently in diabetic foot centres throughout Europe and is determined by depth of the ulcer, peripheral arterial disease, infection and male sex. There are important differences in amputation rate between the European centres, which can be explained in part by severity of disease at presentation. This may suggest that early referral to foot clinics can prevent minor amputations.
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