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Background: The mechanism by which the multidisciplinary approach to diabetic foot disease reduces amputation rates is unclear. Ischemia, sepsis, and necrosis represent aspects of severe diabetic foot disease amenable to intervention. In 2006, a vascular unit introduced a rapid access service for severe foot disease, augmenting the established community provision. This study aimed to determine whether concurrent changes in amputation rates were observed, and to identify areas that may have influenced outcomes., Methods: Unit data prospectively collected during 4 years for patients with lower-limb disease were compared with data retrieved over 2 years before the foot service. Outcome measurements were major amputations, foot surgery, vascular interventions, admissions, and length of stay., Results: Major amputation rates associated with diabetes peaked in 2005 at 24.7/10,000 vs. 1.07/10,000 in 2009; (relative risk = 0.043, 95% confidence interval = 0.006-0.322). The proportion of diabetic to nondiabetic amputations decreased; foot surgery rates also dropped (53.7/10,000 in 2006 vs. 7.5/10,000 in 2009). The number of open revascularization procedures decreased, but the rates of endovascular procedures remained generally constant. Hospital admission rates decreased after initially peaking, and the length of stay was unchanged (16 vs. 15.5 days in 2004 and 2009, respectively)., Conclusions: The integration of a vascular unit with community care has been associated with improved outcomes for patients with diabetic foot disease. Improvements were not related to the increased number of vascular procedures or hospitalizations, but did coincide with a greater proportion of patients attending the foot unit. The referral of patients to the unit facilitates the rapid management of severe disease, reducing delays deleterious to outcomes., (Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

We report the pattern of infection of Glossina pallidipes with Trypanosoma vivax and T. congolense at a site in the Coast region of eastern Tanzania, studied between November 1993 and December 1994. Of the 2315 flies dissected 114 (4.9%) were T. congolense positive, 77 (3.3%) were T. vivax positive and 2 (0.1%) were T. brucei positive. Fly age was determined by the pteridine fluorescence method. Prevalence of infection was most strongly affected by month and the linear effect of age with the interaction of month and age having an effect for T. congolense-type infections. Sex and sex by month also have some predictive capacity when data for T. congolense and T. vivax-type infections are combined. In contrast to other similar studies our results suggest that the infection rate is non-linearly related to age of the tsetse fly, with older flies having progressively more chance of infection. The potential biological factors underpinning these interactions are discussed.

Flight initiation in Triatoma infestans is associated with low nutritional status and increases with rising temperature; it appears to be largely independent of bug age and sex. A predictive model for the probability of flight initiation was constructed based on weight:length ratios of the bugs and maximum ambient temperature, both of which can be ascertained in the field. The model accurately predicted the proportion of bugs initiating flight in > 85% of the groups used in our study. The predictive equation was found to give significant fits with two independent data sets. From our results it might be expected that flight would be rare during colder (< 20 degrees C) months but that 5-10% of the normal population of an infested house would fly on any given night during the hotter months when temperatures approach 30 degrees C. If bug nutritional status falls significantly, this proportion could be expected to rise to 30%.