IntroductionWe assessed the impact of a diabetic foot ulcer prevention program incorporating once-daily foot temperature monitoring on hospitalizations, emergency department and outpatient visits, and rates of diabetic foot ulcer recurrence and lower extremity amputations for patients with recently healed foot ulcers.Research design and methodsIn this retrospective analysis of real-world data, we enrolled 80 participants with a healed diabetic foot ulcer in a year-long foot ulcer recurrence prevention program. Four outpatient centers within a large integrated healthcare system in the USA contributed to enrollment. We evaluated diabetic foot-related outcomes and associated resource utilization for participants during three periods: the 2 years before the program, the year during the program, and after the program ended. We reported unadjusted resource utilization rates during the program and the periods before and after it. We then adjusted rates of outcomes in each phase using an interrupted time series approach, explicitly controlling for overall trends in resource utilization and recurrence during the three periods.ResultsOur unadjusted data showed high initial rates of resource utilization and recurrence before enrollment in the program, followed by lower rates during the program, and higher rates of resource utilization and similar rates of recurrence in the period following the end of the program. The adjusted data showed lower rates of hospitalizations (relative risk reduction (RRR)=0.52; number needed to treat (NNT)=3.4), lower extremity amputations (RRR=0.71; NNT=6.4), and outpatient visits (RRR=0.26; absolute risk reduction (ARR)=3.5) during the program. We also found lower rates of foot ulcer recurrence during the program in the adjusted data, particularly for wounds with infection or greater than superficial depth (RRR=0.91; NNT=4.4).ConclusionsWe observed lower rates of healthcare resource utilization for high-risk participants during enrollment in a diabetic foot prevention program incorporating once-daily foot temperature monitoring.Trial registration numberNCT04345016.

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In this work we consider atmospheric refractive bending and its effects on long-range imaging along a horizontal path. Refraction can impact the ability of a remote sensing or image system to accurately locate objects and determine their apparent proportions. We use a low-cost commercial camera operating in a time-lapse mode for refraction studies and have been recording images of a building that is 15.3 km west of the camera. Based on the paraxial ray equation, a solution for ray height and angle is obtained for a refractive index profile with curvature. A curved index profile can produce the effects of towering (stretching) and stooping (compression). The curvature parameter for the average atmospheric index profile between the camera and target can be derived from an analysis of the images collected by the camera system. We show example images where the building (33 m height) appears to stretch by 5.1 m and calculate a refractive index curvature parameter of 6.0x10 -5 m -2 .

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