Sammanfattning   Titel: Patienters erfarenheter av diabeteskontroller på hälsocentraler. Bakgrund: Diabetes är en kronisk sjukdom som kan orsaka flera olika komplikationer. För att undvika diabeteskomplikationer erbjuds patienter med diabetes typ 2 regelbundna kontroller. Sjuksköterskan har en viktig roll i behandlingen av dessa patienter, genom dialog och kompetens kan sjuksköterskan stärka patienten i sin diabetes. Med denna studie vill författarna ta tillvara på patienternas erfarenheter för att utveckla de återkommande diabeteskontrollerna på hälsocentralerna. Syfte: Att belysa de erfarenheter som patienter med diabetes typ 2 har av återkommande kontroller på vård-/ hälsocentral. Metod: Studien genomfördes med en kvalitativ ansats. Nio patienter med diabetes som gick på regelbundna diabeteskontroller på vård-/ hälsocentral, intervjuades med semistrukturerade frågor utifrån en intervjuguide. En kvalitativ manifest innehållsanalys användes för att analysera intervjuerna. Resultat: Vid analysen framkom tre huvudkategorier och sju underkategorier. De tre huvudkategorierna var: Vårdrelation, patienterna upplevde att de fick bra bemötande när de var på kontroll för sin diabetes. Vårdpersonalen ingav trygghet och förtroende. Patienterna kände sig delaktiga i sin diabetesbehandling och de kände att de fick det stöd som de önskade från vården. Kontinuitet, att möta samma kompetenta vårdpersonal på sina regelbundna diabeteskontroller var uppskattat av alla patienterna. Egenvård, informationen om egenvård upplevdes som tillräcklig. Slutsats: Med utgångspunkt från resultaten är det viktigt att patienter med diabetes får träffa samma vårdpersonal för att känna trygghet i vårdrelationen. För att frambringa en god vårdrelation förutsätter det att sjuksköterskorna kan möta patienterna i en jämbördig och ömsesidig vårdrelation. Studiens resultatet visar att det är viktigt att bekräfta och se patientens erfarenheter av att leva med diabetes.

Diabetes typ 2 omnämns till viss del som en livsstilssjukdom då orsaker till insjuknande ofta beror på övervikt, höga blodfetter och högt blodtryck. Sjukdomen drabbar vanligtvis personer från 40 år, dock har åldern vid insjuknandet sjunkit på senare år. Diabetes typ 2 påverkar livsvärlden och kan leda till försämrad livskvalitet och en rad fysiologiska komplikationer. För att sjuksköterskan ska kunna hjälpa patienten att leva med och hantera sin sjukdom, samt minska risken för komplikationer, är det viktigt att sjuksköterskan ser varje patient som unik. För att möjliggöra detta är det viktigt att som sjuksköterska få kunskap om hur den unika patienten upplever situationen. Syftet med denna litteraturstudie är därmed att beskriva vuxna, från 19 års ålder, patienters upplevelser av att leva med diabetes typ 2. Nio kvalitativa artiklar har analyserats enligt Axelssons (2012, ss. 203-220) modell. Detta resulterade i tre huvudteman: Stigmatisering med undertemana: Distansering – en följd av skuld och skam och ”Den goda patienten” – rädsla för att bli kritiserad. Behov av kunskap om diabetes typ 2 med undertemana Kunskap skapar delaktighet och Hur hantera diabetes typ 2 i det dagliga livet? Kontakt med vården med undertemana Maktbalans – en förutsättning för gott vårdande och Lärande möten – möjligheter och hinder. I resultatet framkommer det att de flesta patienterna upplever negativa attityder, både från närstående och sjuksköterska vilket kan leda till isolering samt skuld- och skamkänslor. Patienterna upplever att teoretisk och praktisk kunskap och information om sjukdomen är en viktig del i hur patienterna ser på och hanterar sin sjukdom. I diskussionen behandlas vikten av kunskap, vårdkontakt samt sjuksköterskans bemötande.

Diabetes Mellitus typ 2 förutspås vara fördubblad fram till år 2030 (WHO 2015). För att minska riskfaktorer och framtida diabetes relaterade komplikationer är det viktigt att egenvårdsbehandlingen är optimal för att förbättra individens livskvalité samt främja dennes hälsa. Syfte: Att belysa och identifiera vad som hindrar patienter med diabetes mellitus typ 2 att följa de råd om egenvård som sjuksköterskan ger. Metod: Studien är en litteraturstudie som följt Polit och Beck (2010) flödesschema, nio steg. Databaser som användes var CINAHL samt PubMed där åtta artiklar valdes ut. Två artiklar tillkom från manuell sökning i Google Scholar. Till analysen markerades text som svarade på studiens syfte och som sedan klassificerades i teman. Resultat: Åtta kategorier identifierades, okunskap, känslor, brist på självdisciplin, brist på socialt stöd, brist på tilltro, andra sjukdomar, tidsbrist samt begränsad ekonomi. Slutsats: Flera hinder till hanteringen av egenvården var förknippad med negativa känslor, bristande kunskap och fallerad tilltro till sjukvården. Upplevelser av att inte bli respekterad, bli bedömd och inte bli hörd av sjukvårdspersonal framkom. Begränsad ekonomi samt tidsbrist påverkade negativt då arbete och familj upptog större delen av individernas liv.

Fibroblast growth factor-2 (FGF-2) is expressed as high molecular weight (> 20 kDa, Hi-FGF-2), or low molecular weight, (18 kDa, Lo-FGF-2) isoforms with distinct functions in the heart and other tissues. Studies to-date have focused on Lo-FGF-2, while the biology of Hi-FGF-2 is less well understood. This work investigated potential autocrine and paracrine effects of rat and human Hi-FGF-2 on cardiac myocytes and non-myocytes (myofibroblasts). Using rat ventricular myofibroblast cultures stimulated with angiotensin II (Ang II), in the absence or presence of YVAD, a peptide inhibitor of caspase-1, it was shown that caspase-1 activity was required for the Ang II-stimulated Hi-FGF-2 secretion. Secreted rat Hi-FGF-2 was shown to be biologically active and capable of stimulating neonatal as well as adult cardiomyocyte hypertrophy in vitro. The effect of extracellular-acting Hi- versus Lo-FGF-2 on the secretome profile of rat cardiac myofibroblasts was compared. Conditioned media collected after stimulation with rat Hi- or Lo-FGF-2 were analyzed by mass spectroscopy (LC-MS/MS). Secretome profiles suggested that Hi-FGF-2 was more potent than Lo-FGF-2 in upregulating several matricellular and fibrosis-associated proteins, most prominently periostin, follistatin-like protein 1, plasminogen activator inhibitor-1, and tenascin. Human heart (atrial) tissue, pericardial fluid, and human heart-derived myofibroblasts were shown to accumulate predominantly Hi-FGF-2. Ang II up-regulated Hi-FGF-2 in human cells, via activation of: type 1 or type 2 Ang II receptors (AT-1R, AT-2R); the ERK pathway; and matrix metalloprotease-2. Neutralizing antibodies specific for Hi-FGF-2 (neu-AbHi-FGF-2) reduced expression of proteins associated with fibroblast-to-myofibroblast conversion and fibrosis. Blocking the autocrine action of Hi-FGF-2 on human cells with neu-AbHi-FGF-2 resulted in down-regulation of periostin, as well as α-smooth muscle actin, pro-collagen, embryonic smooth muscle myosin, and extra domain A fibronectin, consistent with a reversal from activated myofibroblast to fibroblast phenotype. Stimulation of human myofibroblasts with human Hi-FGF-2 was significantly more potent than Lo-FGF-2 in upregulating pro-interleukin-1β and plasminogen activator inhibitor-1, considered to be pro-inflammatory proteins. It is concluded that exported, extracellular-acting Hi-FGF-2 has pro-fibrotic, pro-inflammatory, and pro-hypertrophic properties, contributes to the ‘activated fibroblast’ phenotype, and represents a therapeutic target for prevention of maladaptive cardiac remodeling in humans.

The purpose of this study was to create two multimedia projects using computer software that combined a soundtrack with an interpretive visualization of music written for two pianos, and to document the technical procedures involved in the creation of the multimedia projects.This study was a collaborative undertaking between the author and the other member of PALENAI Piano Duo, Adrienne Shannon. A companion to the current dissertation has been submitted by Ms. Shannon, titled Black and White in Color: The Creative Aspects Involved in the Production of Two Computer Multimedia Projects Based on Music for Two Pianos.The goal of the multimedia projects was to produce visualizations of the musical elements and compositional devices found in the selected compositions. The two pieces selected for these visualizations were "Le Cygne", from Le Carnaval des Animaux by Camille Saint-Satins, and the Prologue from the Sonata for Two Pianos by Francis Poulenc. The SWAN project is visualized by means of realistic photography and the PROLOGUE project makes use of abstract imagery.This study examines the technical procedures in all stages of the projects, including the creation of the source photographs and the scanning procedures, the image editing and manipulation stage that was carried out in Adobe Photoshop, the composition of the project using Adobe Premiere, and the output to a computer-based presentation by compiling the project into a QuickTime movie.The projects in this study are intended to express the music by visual means as a creative endeavour, as an educational tool, and as a demonstration of the capabilities of two Adobe software programs within a Macintosh environment. / School of Music

The purpose of this study was to create two multimedia projects using computer software that combined a soundtrack with an interpretive visualization of music written for two pianos, and to document the creative factors involved in the creation of the multimedia projects.This study was a collaborative undertaking between the present writer and the other member of PALENAI Piano Duo, Joy Innis. A companion to the current dissertation has been submitted by Ms. Innis, titled Black and White in Color: The Technical Procedures Involved n the Production of Two Computer Multimedia Projects Based on Music for Two Pianos.The goal of the multimedia projects was to produce visualizations of the musical elements and compositional devices found in the selected compositions. The two pieces selected for these visualizations were "Le Cygne", from Le Carnaval des Animaux by Camille Saint-Satins, and the Prologue from the Sonate pour deux pianos by Francis Poulenc.The study begins with a traditional analysis of the works followed by a description of the images that were selected from the image pool for the visualizations (the image pool is described in detail in the companion dissertation); an explanation of the criteria for image enhancement and manipulations that were carried out in the Adobe Photoshop program; and a detailed outline of the composition stage of the projects using the Adobe Premiere program.The projects in this study are intended to express the music by visual means as a creative endeavour, as an educational tool, and as a demonstration of the capabilities of two Adobe software programs within a Macintosh environment. / School of Music

Type 2 diabetes (T2DM) is a chronic disease characterized by cellular insulin resistance and consequent disturbances in glucose metabolism. Long-term consumption of buckwheat has been previously shown to improve glycemia in individuals with T2DM; however, the underlying mechanisms as well as the contribution of improved acute glycemic responses have not been fully characterized. The current study used cell culture and clinical studies to investigate the mechanisms and effectiveness of common buckwheat for acute modulation of glucose metabolism and glycemia. Glucose uptake was inhibited in H4IIE cells treated with a buckwheat extract (BWE), an effect attributed to the actions of an unknown compound(s). Reduced glucose uptake and transepithelial glucose transport was also present in Caco2 colorectal adenocarcinoma cells and monolayers. The mechanism behind inhibited glucose uptake did not involve modulation of several signaling pathways regulating glucose metabolism, including p38 MAPK, p42/44 ERK, PI3Kγ, PKC, PKA, mTOR and AMPK. Interestingly, BWE treatment was associated with other effects on glucose metabolism, including elevated glucose production and levels of gluconeogenic enzymes. However, these effects were not mediated through the classical pathway of CREB activation involving cyclic AMP and PKA. In a blinded, reference product-controlled study, consumption of a cracker product made from whole grain common buckwheat flour containing 50 grams of available carbohydrate was not associated with changes in post-prandial glucose or insulin concentrations in both healthy individuals and those with diet-controlled T2DM. However, consumption of buckwheat crackers was associated with changes in selected gastrointestinal satiety hormones. Interestingly, several significant correlations observed between fasting concentrations and the overall post-prandial response of these hormones were affected by T2DM. In conclusion, glucose-lowering effects of common buckwheat are not due to the actions of known bioactive compounds, and may involve direct inhibition of facilitative transporters by a novel compound. Although a buckwheat food product did not reduce post-prandial glycemia, identifying the compound responsible for inhibited glucose uptake will allow development of food products enriched with this compound, and may represent a more effective dietary approach to managing glycemia.

Introduktion: diabetes mellitus typ 2 är en progressiv hormonell sjukdom. Livsstilsförändringar i form av kostreglering och regelbunden fysisk aktivitet är väsentliga i behandlingen. Syftet med litteraturstudien var att beskriva motionens effekter på hälsorelaterad livskvalitet hos individer med diabetes mellitus typ 2. Metoden var en litteraturstudie som följde Polit och Becks  nio steg. Sökningen gjordes i databaserna Cinahl och PubMed. Artiklarna kritiskt granskades och de som svarade på studiens syfte och uppfyllde kvalitetsgranskningens krav inkluderades i litteraturstudien. Under databearbetningen identifierades tre kategorier. Resultatet baseras på sju vetenskapliga artiklar och presenteras i kategorierna förbättrad fysisk hälsa, förbättrad psykisk hälsa och förbättrat generellt välbefinnande. Motion hade positiva effekter i alla tre kategorierna men förbättringen berodde på motionens intensitet och varaktighet, samt vilka instrument användes för att mäta livskvalitet. Slutsats: regelbunden motion hade effekt på diabetes mellitus typ 2. Den förbättrade inte bara den fysiska funktionen och aktiviteten utan minskade även symtom på depression och ångest samt bidrog till ett generellt välbefinnande.

Argument: Hypertension is a main contributing risk factor to many cardiovascular diseases and may be the cause or the result of cardiovascular dysfunction. Black Africans, especially, suffer from hypertension because of lifestyle changes that occur during westernisation, which may lead to sympatho-adrenal hyperactivity. Vascular endothelial growth factor-A (VEGF-A) and angiopoietin-2 (Ang-2) are regulators of angiogenesis and are significantly up regulated during states of vascular dysfunction. Levels of angiogenic factors are unknown for African people and may not be the same as levels thus far reported for Caucasians. Aims: The aim of this study is firstly, to determine whether differences exist regarding the levels of VEGF-A and Ang-2 in urbanised compared to rural black Africans and secondly, to determine whether increased levels of VEGF-A and Ang-2 factors are related to hypertension in black Africans. Methodology: This is a sub study that is based upon the Prospective Urban and Rural Epidemiological (PURE) study. Apparently healthy, fasting African men and women (N=272, aged 35 to 50 years) from the North-West province of South Africa were selected by a medical doctor to participate in this study. Groups were stratified according to gender and urbanisation status based upon information derived from sociodemographic questionnaires. Cardiovascular parameters (Omron HEM-757), pulse wave velocity (PWV) (Compiler SP), plasma angiogenic factor levels (ELISA) and anthropometric measures were determined. An independent t-test and Pearson Chi-square test were used to compare urban and rural data, followed by an analysis of covariance (ANCOVA) while correcting for confounders (age, body mass index, physical activity and tobacco usage). ANCOVAs (corrected for confounders) were applied where hypertensive and normotensive groups were compared within the whole group and urbanised groups. Correlations, correcting for confounders, between cardiovascular variables and angiogenic factors were determined within the whole group and urbanised groups. Results and conclusion: Plasma VEGF-A values for all black Africans were very low while the ANG-2 levels were elevated compared to control values for Caucasians (normotensive and hypertensive) in literature. Urbanised men were more overweight and indicated a higher incidence of hypertension (42.47%) and elevated VEGF-A levels, but lower Ang-2 levels compared to rural men. Urbanised women were generally overweight, physically less active and smoked less, but indicated higher diastolic blood pressure (BP), VEGF-A levels and lower PWV compared with their rural counterparts. Ang-2 levels indicate a negative relationship to diastolic BP data in rural women. No relationships between hypertensive individuals and high angiogenic factor levels were uncovered. Conclusive evidence suggested that angiogenic factor levels were affected more by urbanisation than by the state of hypertension. If low levels of VEGF-2 occur, ANG-2 stimulation and properties may be altered, thereby switching ANG-2 from an anti-angiogenic to a pro-angiogenic molecule, inferring blood vessel destabilisation and vascular dysfunction, such as is observed in hypertensive urbanised men. Higher ANG-2 levels may result in Tie-2 receptor down regulation, hence causing VEGF-A levels to be lower. Further study is needed to ascertain this mechanism since Tie-2 receptor activity was not determined in this study. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2009.

El presente trabajo estudia la recepción de la Biblia por parte de Jorge Luis Borges a partir del análisis de su obra completa. Se compone de tres partes. En la primera, contextual, después de perfilar la fortuna literaria del imaginario bíblico, cuestión bien estudiada en el ámbito anglosajón desde la década de 1980, se atiende brevemente al modo en que tres autores importantes para Borges Dante, Milton y Blake usaron la Escritura en su obra. En la segunda, a partir de ciertos datos biográficos, declaraciones y escritos de Borges, se trata de precisar la importancia que tuvo para él la literatura bíblica y de qué modo ésta influyó en su propia poética. En la tercera se analiza el uso literario de ciertos personajes de la Escritura por parte de Borges; el análisis revela que esos personajes encarnan de un modo paradigmático algunos de los temas centrales de su obra, como el conocimiento, la muerte, el tiempo o la identidad. / The present work studies the reception of the Bible by Jorge Luis Borges by means of the analysis of his complete work. It consists of three parts. The first one, merely contextual, outlines the literary fortune of the biblical imagery, a question that has occupied to the Anglo-Saxon criticism from the decade of 1980, and concisely attends to the way in which three important authors for Borges Dante, Milton and Blake used the Scriptures in their work. The second one attempts to specify, from the basis of certain biographical information, declarations and writings of Borges, the importance that the Biblical literature had for him and the way it influenced his own poetics. The third one analyzes the literary use of certain characters of the Scriptures by Borges; the analysis reveals that these characters personify in a paradigmatic way some of the central topics of his work, as knowledge, death, time or identity.