In a device-to-device (D2D) caching system that utilizes a device\'s available storage space as a content cache, a device called a helper can provide content requested by neighboring devices, thereby reducing the burden on the wireless network. To enhance the efficiency of a limited-size cache, one can consider not only macro caching, which is content-based caching based on content popularity, but also micro caching, which is chunk-based sequential prefetching and stores content chunks slightly behind the one that a nearby device is currently viewing. If the content in a cache can be updated intermittently even during peak hours, the helper can improve the hit ratio by performing micro caching, which stores chunks that are expected to be requested by nearby devices in the near future. In this paper, we discuss the performance and effectiveness of micro D2D caching when there are multiple operators, the helpers can communicate with the devices of other operators, and the operators are under a low load independently of each other. We also discuss the ratio of micro caching in the cache area when the cache space is divided into macro and micro cache areas. Good performance can be achieved by using micro D2D caching in conjunction with macro D2D caching when macro caching alone does not provide sufficient performance, when users are likely to continue viewing the content they are currently viewing, when the content update cycle for the cache is short and a sufficient number of chunks can be updated for micro caching, and when there are multiple operators in the region.

Resource optimization, timely data capture, and efficient unmanned aerial vehicle (UAV) operations are of utmost importance for mission success. Latency, bandwidth constraints, and scalability problems are the problems that conventional centralized processing architectures encounter. In addition, optimizing for robust communication between ground stations and UAVs while protecting data privacy and security is a daunting task in and of itself. Employing edge computing infrastructure, artificial intelligence-driven decision-making, and dynamic task offloading mechanisms, this research proposes the dynamic task offloading edge-aware optimization framework (DTOE-AOF) for UAV operations optimization. Edge computing and artificial intelligence (AI) algorithms integrate to decrease latency, increase mission efficiency, and conserve onboard resources. This system dynamically assigns computing duties to edge nodes and UAVs according to proximity, available resources, and the urgency of the tasks. Reduced latency, increased mission efficiency, and onboard resource conservation result from dynamic task offloading edge-aware implementation framework (DTOE-AIF)\'s integration of AI algorithms with edge computing. DTOE-AOF is useful in many fields, such as precision agriculture, emergency management, infrastructure inspection, and monitoring. UAVs powered by AI and outfitted with DTOE-AOF can swiftly survey the damage, find survivors, and launch rescue missions. By comparing DTOE-AOF to conventional centralized methods, thorough simulation research confirms that it improves mission efficiency, response time, and resource utilization.

OBJECTIVE: Charcot neuroosteoarthropathy (CN) is considered a rare complication of diabetic neuropathy. Due to its insidious mode of presentation, CN may be difficult to diagnose timely and a high index of suspicion is required from both, the diabetic patient (especially those with neuropathy) and their physicians for the early diagnosis and treatment to prevent major complications.
METHODS: We planned a narrative review and searched MEDLINE database to identify evidence regarding CN incidence, treatment options, and recent guidelines. As practitioners do not commonly treat CN, a characteristic clinical case is also presented.
RESULTS: The available evidence for diagnosis and treatment remains of low quality. On the one hand, there is an urgent need for action to increase awareness of the disease in both practitioners and people with diabetes. On the other hand, prospective nationwide registries of patients with diabetic neuropathy will help clarify the prognostic factors that may predispose to this complication, and more randomized clinical trials are needed to identify whether medical treatment may improve CN outcomes. For the time being, offloading of the foot to stop the perpetuation of trauma, and inflammation, and importantly to arrest the progression to a deformed nonfunctional foot is the cornerstone of medical therapy of CN. Multidisciplinary assessment between diabetologists and radiologists is fundamental for prompt diagnosis.
CONCLUSIONS: To avoid potentially deleterious delays in diagnosis and treatment, every physician should bear in mind that every patient with diabetic neuropathy presenting with a warm swollen foot should be treated as having CN until proven otherwise.

Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.

BACKGROUND: It is known that heel offloading devices are widely used in clinical practice for the prevention of heel pressure ulcers, even though there is a lack of robust, good quality evidence to inform their use.
OBJECTIVE: To explore how and why heel offloading devices are used (or not used) and reasoning behind their use in population at high risk of developing heel pressure ulcers.
METHODS: An ethnographic study was conducted as part of a realist evaluation in three orthopaedic wards in a large English hospital. Twelve observations took place, with 49 h and 35 min of patient care observed. A total of 32 patients were observed and 19 members of the nursing team were interviewed and in-depth interviews with the three ward managers were conducted.
RESULTS: Although the focus of the study was on offloading devices, constant low pressure heel specific devices were also observed in use for pressure ulcer prevention, whilst offloading devices were perceived to be for higher risk patients or those already with a heel pressure ulcer. Nursing staff viewed leadership from the ward manager and the influence of the Tissue Viability Nurse Specialists as key mechanisms for the proactive use of devices.
CONCLUSIONS: This study informs trial design as it has identified that a controlled clinical trial of both types of heel specific devices is required to inform evidence-based practice. Involving the ward managers and Tissue Viability Nurse Specialists during set up phase for clinical equipoise could improve recruitment. Tweetable abstract How, for whom, and in what circumstances do devices work to prevent heel pressure ulcers? Observations of clinical practice.

BACKGROUND: ACL reconstruction (ACLR) patients commonly adopt poor movement patterns that potentially place them at an increased risk for reinjury if untreated. Limb loading characteristics during functional tasks can highlight movement compensations.
OBJECTIVE: Examine loading symmetry during a bilateral bodyweight squatting task between sexes, compare loading metrics between limbs and sexes, and describe the relationship between loading metrics and patient reported outcomes (PROs) following ACLR.
METHODS: Cross-Sectional Study.
METHODS: Laboratory.
METHODS: 142 patients (71M/71F, 24.4±11.10yrs) with a primary, unilateral, uncomplicated ACLR completed a squatting assessment and PROs at approximately 5.2 months post-ACLR.
METHODS: Normalized limb loading peak force (N/kg) and unilateral cumulative load (%) were collected bilaterally during the squatting task. Limb symmetry index (%) was calculated for normalized peak force. Our first objective compared limb loading symmetry (%) between sexes using independent samples t-test. Our second objective assessed differences in limb loading metrics between limbs and sexes were analyzed via an analysis of covariance. Our third objective was assessed using Spearman Rho correlations to determine the relationship between limb loading metrics and PROs.
RESULTS: The majority of individuals (91/142, 64.1%) offloaded their ACLR limb (ACLR: 6.6±1.56 N/kg; contralateral: 7.3±1.61 N/kg, p<0.001). Females significantly offloaded their ACLR limb (ACLR: 6.3±1.38 N/kg; contralateral: 7.2±1.62 N/kg, p<0.001) where males did not significantly offload their ACLR limb (ACLR 6.98±1.65 N/kg; contralateral: 7.4±1.60, p=0.07). Weak relationships were observed (ρ-value range: -0.23 to 0.19) across limb loading metrics and PROs.
CONCLUSIONS: Individuals approximately five months following ACLR, on average, offloaded their ACLR limb compared to the contralateral limb. Patients\' tendency to offload their weight during a squat was influenced by sex. Relationships between limb loading metrics and PROs indicate patients who load their limbs disproportionately have a lower perception in their capability to complete activities of daily living and lower subjective knee function.

Background: If unrecognized, Charcot neuro-osteoarthropathy (CNO) can be a devastating complication of diabetes. Methods: The aim of this retrospective study was to evaluate the outcomes in a cohort of diabetic patients diagnosed with active CNO managed in a tertiary level diabetic foot clinic (DFC). We included consecutive patients with active CNO, stage 0-1, according to the Eichenholtz-Shibata classification, who were referred from 1 January 2019 to 27 September 2022. Diagnosis of CNO was based on clinical signs and imaging (X-rays and magnetic resonance). All patients were completely offloaded by a total-contact cast (TCC) or removable knee-high device. Each patient was closely monitored monthly until CNO remission or another outcome. At 12 months of follow-up, the following outcomes were analyzed: remission, time to remission, major amputations (any above the ankle), and surgical indication. Results: Forty-three patients were included. The mean age was 57.6 ± 10.8 years; 65% were males and 88.4% had type 2 diabetes, with a mean duration of 20.6 ± 9.9 years. At baseline, 32.6% was affected by peripheral artery disease. Complete remission was recorded in 40/43 patients (93%), with a mean time to remission of 5.6 ± 1.5 months; major amputation and surgical indication occurred, respectively in 1/43 patients (2.3%) and 3/43 patients (7%). Conclusions: Early treatment of active Stage 0/1 CNO leads to high rates of remission and limb salvage.

OBJECTIVE: This manuscript aims to provide a review and synthesis of contemporary advancements in footwear, sensor technology for remote monitoring, and digital health, with a focus on improving offloading and measuring and enhancing adherence to offloading in diabetic foot care.
METHODS: A narrative literature review was conducted by sourcing peer-reviewed articles, clinical studies, and technological innovations. This paper includes a review of various strategies, from specifically designed footwear, smart insoles and boots to using digital health interventions, which aim to offload plantar pressure and help prevent and manage wounds more effectively by improving the adherence to such offloading.
RESULTS: In-house specially made footwear, sensor technologies remotely measuring pressure and weight-bearing activity, exemplified for example, through applications like smart insoles and SmartBoot, and other digital health technologies, show promise in improving offloading and changing patient behaviour towards improving adherence to offloading and facilitating personalised care. This paper introduces the concept of gamification and emotive visual indicators as novel methods to enhance patient engagement. It further discusses the transformative role of digital health technologies in the modern era.
CONCLUSIONS: The integration of technology with footwear and offloading devices offers unparallelled opportunities for improving diabetic foot disease management not only through better offloading but also through improved adherence to offloading. These advancements allow healthcare providers to personalise treatment plans more effectively, thereby promising a major improvement in patient outcomes in diabetic foot ulcer healing and prevention.

In this podcast the lead authors of the 2023 International Working Group on the Diabetic Foot (IWGDF) guideline on offloading treatments for diabetes-related foot ulcers briefly discuss why we need offloading treatments for people with diabetes-related foot ulcers, what the new international offloading guideline recommends, and where offloading treatment might go into the future.A podcast audio is available with this article.

OBJECTIVE: To compare the effectiveness of commonly used offloading devices for the treatment of neuropathic foot ulcers in patients with diabetes mellitus. This meta-analysis (MA) has been performed for giving an answer to clinical questions on this topic of the Italian guideline on diabetic foot syndrome.
METHODS: The present MA includes randomized controlled studies (duration > 12 weeks) comparing, in patients with diabetes mellitus and non-infected neuropathic foot ulcer: any offloading device vs either no offloading device or conventional footwear; removable versus non-removable offloading devices; surgical procedure vs other offloading approaches. The primary endpoint was ulcer healing.
RESULTS: A total of 184 studies were identified, and 18 were considered eligible for the analysis. We found that: any plantar off-loading, when compared to the absence of plantar offloading device, is associated with a higher ulcer healing (MH-OR: 3.13 [1.08, 9.11], p = 0.04, I2 = 0%); total contact cast or nonremovable knee-high walker, compared to other offloading devices, had a higher ulcer healing rate (MH-OR: 2.64 [1.43, 4.89], p = 0.002, I2 = 51%); surgical offloading for active ulcers in combination with post-surgery offloading achieves higher ulcer healing rate when compared to offloading devices alone (MH-OR: 6.77 [1.64, 27.93], p = 0.008, I2 = 0%).
CONCLUSIONS: Any plantar offloading, compared to the absence of plantar offloading device, is associated with a higher ulcer healing rate. Total contact cast or nonremovable knee-high walker, compared to other offloading devices, is preferable. Surgical offloading for active ulcers, in combination with post-surgery offloading devices, achieves a higher ulcer healing rate when compared to other offloading devices alone. Further studies with a larger cohort of patients with diabetic neuropathic foot ulcers and extended follow-up periods are necessary.