Researchers have developed a new shoe insole technology that helps reduce the risk of diabetic foot ulcers, which can lead to hospitalisation and leg, foot or toe amputations. They describe the technology in The International Journal of Lower Extremity Wounds.
“The goal of this innovative insole technology is to mitigate the risk of diabetic foot ulcers by addressing one of their most significant causes: skin and soft tissue breakdown due to repetitive stress on the foot during walking,” said Muthu B.J. Wijesundara, principal research scientist at The University of Texas at Arlington Research Institute (UTARI).
Diabetes can damage the small blood vessels that supply blood to the nerves, leading to poor circulation and foot sores, also called ulcers. About one-third of people with diabetes develop foot ulcers during their lifetime. Those who have foot ulcers often die at younger ages than those without ulcers.
“Although many shoe insoles have been created over the years to try to alleviate the problem of foot ulcers, studies have shown that their success in preventing them is marginal,” Wijesundara said. “We took the research a step further by creating a pressure-alternating shoe insole that works by cyclically relieving pressure from different areas of the foot, thereby providing periods of rest to the soft tissues and improving blood flow. This approach aims to maintain the health of the skin and tissues, thereby reducing the risk of diabetic foot ulcers.”
In an article in the peer-reviewed International Journal of Lower Extremity Wounds, Wijesundara and UTA colleagues Veysel Erel, Aida Nasirian and Yixin Gu, along with Larry Lavery of UT Southwestern Medical Center, described their innovative insole technology. After this successful pilot project, the next step for the research team will be refining the technology to make it more accessible for users with varying weights and shoe sizes.
“Considering the impact of foot ulcers, it’s exciting that we may be able to make a real difference in the lives of so many people,” Wijesundara said.
It’s one of the inescapable realities of aging: The older we get, the slower we tend to move – whether we’re walking around the block or just reaching for the remote control. A new study led by CU Boulder engineers helps explain why.
The research is one of the first studies to experimentally tease apart the competing reasons why people over age 65 might not be as quick on their feet as they used to be. The group reported that older adults may move slower, at least in part, because it costs them more energy than younger people – perhaps not too shocking for anyone who’s woken up tired the morning after an active day.
The findings could one day give doctors new tools for diagnosing a range of illnesses, including Parkinson’s disease, multiple sclerosis and even depression and schizophrenia, said study co-author Alaa Ahmed.
“Why we move the way we do, from eye movements to reaching, walking and talking, is a window into aging and Parkinson’s,” said Ahmed, professor in the Paul M. Rady Department of Mechanical Engineering. “We’re trying to understand the neural basis of that.”
She and her colleagues published their findings this month in the journal JNeurosci.
For the study, the group asked subjects age 18 to 35 and 66 to 87 to complete a deceptively simple task: to reach for a target on a screen, akin to playing a video game on a Nintendo Wii. By analysing patterns of these reaches, the researchers discovered that older adults seemed to modify their motions under certain circumstances to conserve their more limited supplies of energy.
“All of us, whether young or old, are inherently driven to get the most reward out of our environment while minimising the amount of effort to do so,” said Erik Summerside, a co-lead author of the new study who earned his doctorate in integrative physiology from CU Boulder in 2018.
Using engineering to understand the brain
Ahmed added that researchers have long known that older adults tend to be slower because their movements are less stable and accurate. But other factors could also play a role in this fundamental part of growing up.
According to one hypothesis, the muscles in older adults may work less efficiently, meaning that they burn more calories while completing the same tasks as younger adults – like running a marathon or getting up to grab a soda from the refrigerator.
Alternatively, aging might also alter the reward circuitry in the human brain. Ahmed explained that as people age, their bodies produce less dopamine, a brain chemical responsible for giving you a sense of satisfaction after a job well done. If you don’t feel that reward as strongly, the thinking goes, you may be less likely to move to get it. People with Parkinson’s disease experience an even sharper decline in dopamine production.
In the study, the researchers asked more than 80 people to sit down and grab the handle of a robotic arm, which, in turn, operated the cursor on a computer screen. The subjects reached forward, moving the cursor toward a target. If they succeeded, they received a reward – not a big one, but still enough to make their brains happy.
“Sometimes, the targets exploded, and they would get point rewards,” Ahmed said. “It would also make a ‘bing bing’ sound.”
Moving slower but smarter
That’s when a contrast between the two groups of people began to emerge.
Both the 18 to 35-year-olds and 66 to 87-year-olds arrived at their targets sooner when they knew they would hear that ‘bing bing’ – roughly 4% to 5% sooner over trials without the reward. But they also achieved that goal in different ways.
The younger adults, by and large, moved their arms faster toward the reward. The older adults, in contrast, mainly improved their reaction times, beginning their reaches about 17 milliseconds sooner on average.
When the team added an 8-pound (3.6kg) weight to the robotic arm for the younger subjects, those differences vanished.
“The brain seems to be able to detect very small changes in how much energy the body is using and adjusts our movements accordingly,” said Robert Courter, a co-lead author of the study who earned his doctorate in integrative physiology from CU Boulder in 2023. “Even when moving with just a few extra pounds, reacting quicker became the energetically cheaper option to get to the reward, so the young adults imitated the older adults and did just that.”
The research seems to paint a clear picture, Ahmed said. Both the younger and older adults didn’t seem to have trouble perceiving rewards, even small ones. But their brains slowed down their movements under tiring circumstances.
“Putting it all together, our results suggest that the effort costs of reaching seem to be determining what’s slowing the movement of older adults,” Ahmed said.
The experiment can’t completely rule out the brain’s reward centres as a culprit behind why we slow down when we age. But, Ahmed noted, if scientists can tease out where and how these changes emerge from the body, they may be able to develop treatments to reduce the toll of aging and disease.
Researchers from Aston University have found that people following healthy eating accounts on social media for as little as two weeks ate more fruit and vegetables and less junk food.
Previous research has shown that positive social norms about fruit and vegetables increases individuals’ consumption. The research team sought to investigate whether positive representation of healthier food on social media would have the same effect. The research was led by Dr Lily Hawkins, whose PhD study it was, supervised by Dr Jason Thomas and Professor Claire Farrow in the School of Psychology.
The researchers recruited 52 volunteers, all social media users, with a mean age of 22, and split them into two groups. Volunteers in the first group, known as the intervention group, were asked to follow healthy eating Instagram accounts in addition to their usual accounts. Volunteers in the second group, known as the control group, were asked to follow interior design accounts. The experiment lasted two weeks, and the volunteers recorded what they ate and drank during the time period.
Overall, participants following the healthy eating accounts ate an extra 1.4 portions of fruit and vegetables per day and 0.8 fewer energy dense items, such as high-calorie snacks and sugar-sweetened drinks, per day. This is a substantial improvement compared to previous educational and social media-based interventions attempting to improve diets.
Dr Thomas and the team believe affiliation is a key component of the change in eating behaviour. For example, the effect was more pronounced amongst participants who felt affiliated with other Instagram users.
The 2018 NHS Health Survey for England study showed that only 28% of the UK population consumed the recommended five portions of fruit and vegetables per day. Low consumption of such food is linked to heart disease, cancer and stroke, so identifying ways to encourage higher consumption is vital. Exposing people to positive social norms, using posters in canteens encouraging vegetable consumption, or in bars to discourage dangerous levels of drinking, have been shown to work. Social media is so prevalent now that the researchers believe it could be an ideal way to spread positive social norms around high fruit and vegetable consumption, particularly amongst younger people.
Dr Hawkins, who is now at the University of Exeter, said: “Our previous research has demonstrated that social norms on social media may nudge food consumption, but this pilot demonstrates that this translates to the real world. Of course, we would like to now understand whether this can be replicated in a larger, community sample.”
If a patient is successfully resuscitated after a cardiac arrest and circulation resumes, they are not out of the woods yet. A number of factors can influence whether and how they survive the trauma in the subsequent phase. But a multicentre study of 571 patients has shown that the administration of the anaesthetic midazolam has a positive effect.
In cases where the patient required anaesthesia after successful resuscitation, midazolam improved the chances of optimal oxygen saturation and CO2 levels in the blood. The risk of a renewed drop in blood pressure or a renewed circulatory arrest didn’t increase. “This specific group of patients who have been successfully resuscitated should definitely be included in the guidelines for pre-hospital anaesthesia. Midazolam has proven to have a particularly positive effect in this group,” concludes Dr Gerrit Jansen, lead author of the study, which was published in the journal Deutsches Ärzteblatt International.
In the event of a cardiac arrest, rapid intervention is essential: If first aiders carry out resuscitation measures in good time, the patient’s circulation can be restarted in the best-case scenario. “However, it’s often the case that the patient hasn’t yet regained consciousness,” explains Gerrit Jansen. In this phase, there are various factors that can affect the chances of survival and subsequent permanent limitations due to the circulatory arrest.
“Some patients display protective reflexes after resuscitation, such as coughing or defensive movements, which make the emergency responders’ work more difficult. They often have to perform extended airway management, for example by intubating the patient in the same way as during surgery. This frequently requires sedation or anaesthesia,” explains Jansen. Until now, there has been concern that anaesthetic drugs could have a negative impact on the circulatory system, which has only just been restored. According to the study, however, this is not the case.
Of the 571 people included in the study who survived a cardiac arrest and were admitted to hospital, 395 were sedated, 249 of them with midazolam. The chance that their blood oxygen saturation levels were in the optimal range following a cardiac arrest increased twofold when midazolam was administered. The chance that carbon dioxide was effectively exhaled increased by a factor of 1.6 with the drug. “Our statistical methods confirmed a correlation between these results and the administration of midazolam, without any indication of negative circulatory effects,” says Gerrit Jansen.
“The European guidelines of the European Resuscitation Council don’t yet set out any specific recommendations for possible anesthetic drugs,” explains Jansen. “The German guideline for pre-hospital anaesthesia for patients with cardiovascular risk doesn’t mention patients in cardiac arrest. We’ve therefore carried out pioneering research in this field, the results of which should be incorporated into the recommendations for the benefit of the patients.”
With technology developed at UC Riverside, scientists can, for the first time, make high resolution images of the human spinal cord during surgery. The advancement could help bring real relief to millions suffering chronic back pain.
The technology, known as fUSI or functional ultrasound imaging, not only enables clinicians to see the spinal cord, but also enables them to map the cord’s response to various treatments in real time. A paper published today in the journal Neuron details how fUSI worked for six people undergoing electrical stimulation for chronic back pain treatment.
“The fUSI scanner is freely mobile across various settings and eliminates the requirement for the extensive infrastructure associated with classical neuroimaging techniques, such as functional magnetic resonance imaging (fMRI),” said Vasileios Christopoulos, assistant professor of bioengineering at UCR who helped develop the technology. “Additionally, it offers ten times the sensitivity for detecting neuroactivation compared to fMRI.”
Until now, it has been difficult to evaluate whether a back pain treatment is working since patients are under general anaesthesia, unable provide verbal feedback on their pain levels during treatment. “With ultrasound, we can monitor blood flow changes in the spinal cord induced by the electrical stimulation. This can be an indication that the treatment is working,” Christopoulos said.
The spinal cord is an “unfriendly area” for traditional imaging techniques due to significant motion artifacts, such as heart pulsation and breathing. “These movements introduce unwanted noise into the signal, making the spinal cord an unfavorable target for traditional neuroimaging techniques,” Christopoulos said.
By contrast, fUSI is less sensitive to motion artifacts, using echoes from red blood cells in the area of interest to generate a clear image. “It’s like submarine sonar, which uses sound to navigate and detect objects underwater,” Christopoulos said. “Based on the strength and speed of the echo, they can learn a lot about the objects nearby.”
Christopoulos partnered with the USC Neurorestoration Center at Keck Hospital to test the technology on six patients with chronic low back pain. These patients were already scheduled for the last-ditch pain surgery, as no other treatments, including drugs, had helped to ease their suffering. For this surgery, clinicians stimulated the spinal cord with electrodes, in the hopes that the voltage would alleviate the patient’s discomfort and improve their quality of life.
“If you bump your hand, instinctively, you rub it. Rubbing increases blood flow, stimulates sensory nerves, and sends a signal to your brain that masks the pain,” Christopoulos said. “We believe spinal cord stimulation may work the same way, but we needed a way to view the activation of the spinal cord induced by the stimulation.”
The Neuron paper details how fUSI can detect blood flow changes at unprecedented levels of less than 1mm/s. For comparison, fMRI is only able to detect changes of 2cm/s.
“We have big arteries and smaller branches, the capillaries. They are extremely thin, penetrating your brain and spinal cord, and bringing oxygen places so they can survive,” Christopoulos said. “With fUSI, we can measure these tiny but critical changes in blood flow.”
Generally, this type of surgery has a 50% success rate, which Christopoulos hopes will be dramatically increased with improved monitoring of the blood flow changes. “We needed to know how fast the blood is flowing, how strong, and how long it takes for blood flow to get back to baseline after spinal stimulation. Now, we will have these answers,” Christopoulos said.
Moving forward, the researchers are also hoping to show that fUSI can help optimise treatments for patients who have lost bladder control due to spinal cord injury or age. “We may be able to modulate the spinal cord neurons to improve bladder control,” Christopoulos said.
“With less risk of damage than older methods, fUSI will enable more effective pain treatments that are optimised for individual patients,” Christopoulos said. “It is a very exciting development.”
