Bakgrund: Diabetes mellitus typ 2 (DMT2) ökar i världen och kan leda till allvarliga fotkomplikationer. Det har påvisats brister i den förbyggande vården för att undvika fotkomplikationer. Sjuksköterskan ansvarar för att stötta personer med DMT2 och målet är att få dem att känna sig självständiga och delaktiga i sin egenvård. Syfte: Syftet med studien var att belysa omvårdnadsåtgärder och egenvård som förebygger fotkomplikationer för personer med DMT2 Metod: En litteraturstudie som utgår ifrån 20 vetenskapliga artiklar med kvantitativ uppbyggnad. Sökningarna av Artiklarna är sökta i databaserna Cinahl och Pubmed. Samtliga artiklar är kvalitetsgranskade. Resultat: Identifiering av risker är en viktig faktor i förebyggandet av fotkomplikationer. Dagliga inspektioner och undersökningar av fötterna är viktiga egenvårdsråd som sjuksköterskan bör tilldela genom individuell undervisning. Sjuksköterskan skall efter bästa förmåga stötta och motivera personer med DMT2 till god egenvård. Slutsats: Sjuksköterskan bör undervisa och ge personer med DMT2 tillräcklig kunskap, för att självständigt kunna utföra förebyggande egenvård. / Background: Diabetes mellitus type 2 (DMT2) increases in the world and can lead to serious foot complications. It has been demonstrated deficiencies in preventive care to avoid foot complications. The nurse is responsible for supporting people with DMT2 and the goal is to get them to feel independent and involved in their self-care. Aim: The aim of the study was to highlight nursing care and self-care to prevent foot complications for people with DMT2 Method: A literature review based on 20 scientific articles by quantitative structure. Articles are searched in the databases Cinahl and Pubmed. All items are quality controlled. Results: Risk identification is a key factor in the prevention of foot complications. Important self-care measures as to inspect and examine their feet daily are substances as the nurse should provide individual instruction in. The nurse shall endeavor to support and motivate people with DMT2 until good self-care. Conclusion: The nurse should teach and give people with DMT2 sufficient knowledge, to independently carry out preventive self-care.

Food safety scares affect consumption behavior, and food safety and animal health issues are increasingly impacting international agricultural trade. Foot-and-mouth disease (FMD) is a highly contagious viral-type disease, and has raised not only the concerns of animal health issue but also food safety issue. Over 58 countries in the world have experienced FMD outbreaks, and pork exports and imports among these countries are largely impacted. This dissertation focuses on how global pork trade is affected by FMD. This dissertation consists of three parts: first, this study specifically focuses on the market of U.S. pork exports. Results show that disease-affected pork importers are potential traders with the U.S., and only importing countries with a vaccination policy are more likely to increase pork imports from the U.S. rather than those importers with a slaughter policy. Second, a further investigation focuses basic hypothesis on import demand of FMD-affected importers by using a gravity model with fixed-effects to show how pork trade is affected by FMD among 186 countries. Results confirm that pork export falls when an exporting country develops FMD. Exporters with a vaccination policy have larger negative impacts than those with a slaughter policy. Further, pork importers that develop FMD and institute a slaughter policy will import more pork, but importers with a vaccination policy import the same level of pork. Third, the findings of part one and two reveal that FMD-free pork exporters face different market opportunities when pork importers have FMD outbreaks. Hence, four major FMD-free pork exporters, such as Canada, U.S., Germany, and Spain, are further investigated. Results confirm that the impacts of foreign FMD have altered pork exporters differently. Germany has gained the most exports during foreign FMD outbreaks in pork importers; the U.S. is second; Spain is third; and Canada is fourth. In sum, this dissertation contributes to the literature of gravity model when endogeneity and heteroskedasticity may coexist, when an extremely large number of zero observations are included, when single commodity for one specific exporter is analyzed, when a spatial econometric approach is compared, and when pork export market has been altered by foreign FMD outbreaks.

Undesirable landing area (e. g. , a hole, a fragment of glass, a water puddle, etc) creates the necessity for an alternate foot placement planning and execution. Previous study has proposed that three determinants are used by the central nervous system (CNS) for planning an alternate foot placement: minimum foot displacement, stability and maintenance of forward progression. However, validation of these determinants is lacking. Therefore, the general purpose of the series of studies presented here is to validate and test the generality of the decision algorithm of alternate foot placement selection developed previously. The first study was designed to validate the use of a virtual planar obstacle paradigm and the economy assumption behind minimum foot displacement determinant. Participants performed two blocks of trials. In one block, they were instructed to avoid stepping in a virtual planar obstacle projected in the screen of a LCD monitor embedded in the ground. In another block, they were instructed to avoid stepping in a real hole present in walkway. Behavioral response was unaffected by the presence of a real hole. In addition, it was suggested that minimum foot displacement results in minimum changes in EMG activity which validates the economy determinant. The second study was proposed to validate the stability determinant. Participants performed an avoidance task under two conditions: free and forced. In the free condition participants freely chose where to land in order to avoid stepping in a virtual obstacle. In the forced condition, a green arrow was projected over the obstacle indicating the direction of the alternate foot placement. The data from the free condition was used to determine the preferred alternate foot placement whereas the data from the forced condition was used to assess whole body stability. It was found that long and lateral foot placements are preferred because they result in a more stable behavior. The third study was designed to validate the alternate foot placement model in a more complex terrain. Participants were required to avoid stepping in two virtual planar obstacles placed in sequence. It was found that participants used the strategy of planning the avoidance movement globally and additional determinants were used. One of the additional determinants was implementation feasibility. In the third study, gaze behavior was also monitored and two behaviors emerged from this data. One sub-group of participants fixated on the area stepped during adaptive step, whereas another sub-group anchor their gaze in a spot ahead of the area-to-be avoided and used peripheral vision for controlling foot landing. In summary, this thesis validates the three determinants for the alternate foot placement planning model and extends the previous model to more complex terrains.

Background: Previous literature showed contradictory evidence on the subject of predictors of chemotherapy-induced Palmar Plantar Erythrodysesthesia (PPE). While there is evidence to suggest that dose and schedule of the drugs play a large role, the fact that many still go on to develop severe PPE following dose reduction would indicate that there are other factors involved. Since the incidence of PPE is more prevalent during the first three cycles of treatment this would also indicate that there are factors other than a cumulative effect. The contradictory evidence in the literature relates to biographical factors, performance status, co-morbidities and renal function. There is a lack of empirical evidence to support the theory that PPE is caused by damage to the microcapillaries due to everyday activities that cause friction or pressure to the hands or feet. Purpose: The aim of this exploratory study was to identify pre-treatment risk factors for the development of PPE prior to cycle four. Patients and methods: The study was made up of two phases, a retrospective phase and a prospective phase, using mixed strategies to collect data. Thus providing two independent samples to compare and validate or refute results. Phase I: A retrospective notes review of patients who had received Infusional 5FU or capecitabine containing regimes over a 1 year period (n=392). Phase II Prospective data collection from participants receiving capecitabine monotherapy (n = 125). Data was collected during semi-structured interviews, from participant's diaries, physical examination of the hands and feet and notes review. Data relating to activities that cause friction, pressure or heat were collected during this phase. Data from both samples were analysed independently using bivariate (chi-square and t-test) tests where each independent variable was analysed against PPE. The variables which achieved statistical significance were entered into a multivariate (binary logistic regression) model. The multivariate analysis employed a specific modelling algorithm using a relaxed alpha value applied to various entry methods to produce multiple models. The outcomes from these models were entered into a ROC curve test to establish which model was the best predictor of PPE. Results: Phase I The bivariate analysis demonstrated that those at most risk of developing PPE prior to cycle 4 of capecitabine monotherapy were males with non-metastatic colorectal cancer, who had either developed PPE with previous chemotherapy regimes or not had previous chemotherapy and who started their treatment during the winter months. When variables were combined in a multivariate logistic regression model, those that were associated with an increased risk of PPE were male, no metastatic spread, no inflammatory condition as co morbidity, smoked, did not drink, had weight loss prior to treatment, a low/normal pre treatment ALP level and started their treatment during the winter. Phase II: The bivariate analysis demonstrated that those at most risk of developing PPE prior to cycle 4 of capecitabine monotherapy were those with no metastatic disease, had an inflammatory condition as co morbidity, were receiving capecitabine as adjuvant treatment, had a good performance status (0-1) and had a tendency to have warm hands. When variables were combined in a multivariate logistic regression model, those that were associated with an increased risk of PPE were younger (< 65) had no metastatic disease, an inflammatory condition as co morbidity, drank alcohol regularly, had a good performance status, had not received previous radiotherapy, were overweight or obese, had a pre treatment creatinine clearance of 30-50mls/min and had a tendency to have warm hands. Conclusions: Similarly to the literature, contradictory findings were seen between the two samples within this study. There was only one variable that was associated with the development of PPE prior to cycle 4, which was the absence of metastatic disease. Limitations of retrospective data may explain variation in some variables which may have been underreported; however it is likely that it is not possible to identify specific factors that increase the risk of PPE. This is the first study to have collected and analysed data related to friction, pressure and heat causing activities. These activities have been suggested as increasing the risk of developing PPE and form the basis of patient education to avoid these activities. Data from this study indicates that only a tendency to have warm hands is associated with an increased risk of PPE. Whilst this finding would need validating in larger studies, it is a unique contribution to the body of knowledge of PPE. This finding indicates that avoidance of activities that cause friction and pressure has no evidence base. Patients may therefore be avoiding activities that add to their enjoyment which at this stressful time in their lives may add to any psychological distress. Despite limitations of this study, the importance of the findings presented here lie in its usefulness in shaping future research to investigate identified variables, where before no direction was available.

During 2007 the UK experienced outbreaks of three notifiable exotic livestock diseases; Foot and Mouth Disease (FMD), Highly Pathogenic Avian Influenza (HPAI) and bluetongue. Large epidemics of any of these diseases would have a serious impact on animal welfare, farming, food production and the economy. In light of this, understanding holdings which are most likely to acquire and spread infection and being able to identify areas at higher risk of an epidemic is valuable when preparing for and managing an epidemic. This thesis uses a spatial epidemiological framework and the detailed disease and demographic data from the 2001 Great Britain (GB) FMD epidemic to develop static models of the risk of FMD susceptibility and transmission. These models are used to develop maps of FMD risk. These methods are then applied to the outbreak of FMD in 2007. The inputs for this analysis comprised a set of data relating to the farms diagnosed with FMD and farms culled as part of the disease control measures. The cleaning of these data is described and data which were estimated relating to dates of infection and putative sources of infection are evaluated. The distribution of farm holdings and animals is taken from the June 2000 GB agricultural census, off-fields of farms in the agricultural census are recorded in other datasets and these have been identified and linked to census holdings. A model of holding level susceptibility is developed using both farm level variables and measures of animal numbers in the locality of the holding as well as the distance to the nearest farm infected before the ban on animal movements (seeds). The overall fit of the model was very good with an area under the Receiver Operator Characteristic (ROC) curve of 0.91. A further model was developed to describe the risk of FMD transmission. However, due to incompleteness of transmission data, this was a model of the risk of finding a subsequent Infected Premises (IP) within 3km of an IP. Risk factors were a combination of holding level variables and locality measures as well as data relevant to the infection, such as infectious period and the species initially infected. The area under the ROC curve for this model was 0.71, which is regarded as an acceptable fit. Geographical barriers to FMD transmission were investigated using a case-control methodology, linear barriers comprising rivers and railways had a significant protective effect with respect to disease transmission (odds ratio = 0.54, 95% CIs = 0.30,0.96, p=0.038). Modelled values for the transmission and susceptibility models were transformed to a raster surface in ESRI ArcMap for both the disease as it was seeded in the 2001 epidemic and a non-specific background risk surface independent of the distribution of seeds. A risk map generated for the outbreak of FMD in Surrey in August 2007 suggested that there was little risk of a large outbreak in Surrey. Potential disease introductions through livestock movements from Surrey into Scotland were identified and these suggested that if the disease were introduced into Scotland there was great danger of substantial local spread. These methods described in this thesis have been used to map risk of FMD and subsequently applied to inform the risk presented by a different outbreak of FMD. The study underlines the value of detailed data both disease and demographic, for epidemic management. Similar methods could and should be applied to other infectious diseases threats of livestock such as HPAI and bluetongue.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiv, 99 leaves / Plantar Fasciitis (PF), also called ‘the painful heel syndrome’, is a common cause of heel pain (Barrett and O’Malley, 1999:2200), accounting for between 7% and 10% of all running injuries (Batt and Tanji, 1995:77; Chandler and Kibler, 1993:345). Primarily an overuse injury, resulting from tensile overload, it involves inflammation and micro-tears of the plantar fascia at its insertion on the calcaneus (Lillegard and Rucker, 1993:168; Barrett and O’Malley, 1999:2200). The body’s attempt to heal these micro-tears leads to chronic inflammation and the formation of adhesions (Ambrosius and Kondracki, 1992:30). Transverse friction massage has been found to be beneficial in the treatment of PF (Hyde and Gengenbach, 1997:478,481; Hertling and Kessler, 1996:137). Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. Graston Technique Instrument-assisted Soft Tissue Mobilisation (GISTM), based on the principles of frictions, aims to break down adhesions, realign collagen fibres and aid in the completion of the inflammatory process (Carey-Loghmani, 2003:31, 51-62; Hammer, 2001). Enabling us to see changes on ultrasonography, which has been found to be an objective, non-invasive way of evaluating PF (Wall and Harkness, 1993:468; Tsai et al, 2000:259; Cardinal et al, 1996:258). These changes include decreased thickness of the fascia. The aim of the study was to see the effect of GISTM on PF in runners, in terms of ultrasonography, and identify any correlation between these findings and other objective and subjective findings. / M

Foot-and-mouth disease virus (FMDV) is an economically devastating and highly contagious livestock pathogen. It exists as seven serotypes, comprising numerous antigenically distinct subtypes. The large amount of antigenic heterogeneity has confounded attempts at developing broadly reactive vaccines. In order to overcome this issue the fundamentals of the interactions between the virus and the host humoral immune response must first be understood. Previous work in this area using monoclonal antibody (mAb) escape mutants has identified five antigenic sites for the O serotype and efforts have been made to quantify their relative importance. However, this does not represent a complete picture of serotype O antigenicity. The work conducted in this thesis demonstrates the role of a limited number of dominant substitutions in mediating the antigenic diversity of serotype O Foot-and-Mouth disease virus. Two alternative but complementary methods for identifying epitopes were developed. The first used a mathematical model to analyse newly generated serological and sequence data from 105 viruses, cultured for this purpose (and cross-reacted to 5 reference antisera), in the context of an existing crystallographic structure to identify and quantify the antigenic importance of sites on the surface of the virus. The second approach was purely structural, using existing B cell epitope prediction tools to develop a method for predicting FMDV epitopes using existing crystallographic structures of FMDV. These techniques were validated by the use of reverse genetics, which confirmed the impact on cross reactivity of two predicted novel serotype O antigenic residues, with a further four novel residues identified by looking in depth at the interactions between two genetically close, but antigenically distant viruses. This increased knowledge of the antigenic composition of serotype O FMDV contributes to our understanding of the nature of vaccine efficacy and the breadth of protection, which, in the longer term, will aid in the goal of developing vaccines to better protect livestock from such a highly antigenically variable disease.

Mini-dissertation submitted in partial compliance with the requirements of the Master's Degree in Technology: Homoeopathy, Durban Institute of Technology, 2006. / Tinea pedis, more commonly known as “Athlete’s foot”, is a common acute infection that occurs in warm, humid climates (Fitzpatrick, et al. 1992:98). Warmth, humidity, trauma and occlusion such as non-breathable footwear increase the susceptibility to infection (Prescott, et al. 1999:814). The infection can become chronic in people who are more susceptible such as patients who are immuno-suppressed or those who have Diabetes mellitus (al Hassan, et al. 2004: 1). The aim of this placebo-controlled double-blind study was to evaluate the effectiveness of a topical naturopathic complex comprising of Allium sativum mother tincture (Ø), Hydrastis canadensis (Ø), Apis mellifica (D3) and Urtica urens (D3) (in an aqueous cream base) in the treatment of Tinea pedis. The complex utilized in this study is regarded as naturopathic because the remedies comprising the complex were selected for the following reasons: •Allium sativum and Hydrastis canadensis, each utilized in mother tincture, were selected for their antifungal properties. •Apis mellifica and Urtica urens, each utilized in D3 potency were selected because their skin symptomotology most accurately matched the symptoms associated with “Athlete’s foot”. / M

The purpose of this study was to evaluate the functional effectiveness of a selection of women's walking shoes with particular attention being directed towards an assessment of specific shoe modifications which were included in a prototype model to theoretically reduce the undesirable characteristics associated with flexible shoes. Nine female subjects performed three trials for each of five shoe conditions. The prototype model decreased the encountered pressures and pressure integrals in the region of the second metatarsal-phalangeal joint. The use of the prototype shoe did not appear to unduly affect the gait of the subject.

Computational modeling of joints and their function, a developing field, is becoming a significant health and wellness tool of our modern age. Due to familiarity of prior research focused on the lower extremity, a foot and ankle 3D computational model was created to explore the potential for these computational methods. The method of isolating CT scanned tissue and rendering a patient specific anatomy in the digital domain was accomplished by the use of MIMICS™ , SolidWorks™, and COSMOSMotion™ – all available in the commercial domain. The kinematics of the joints are driven solely by anatomically modeled soft tissue applied to articulating joint geometry. Soft tissues are based on highly realistic measurements of anatomical dimension and behavior. By restricting all model constraints to true to life anatomical approximations and recreating their behavior, this model uses inverse kinematics to predict the motion of the foot under various loading conditions. Extensive validation of the function of the model was performed. This includes stability of the arch (due to ligament deficiency) and joint behavior (due to disease and repair). These simulations were compared to a multitude of studies, which confirmed the accuracy of soft tissue strain, joint alignment, joint contact force and plantar load distribution. This demonstrated the capability of the simulation technique to both qualitatively recreate trends seen experimentally and clinically, as well as quantitatively predict a variety of tissue and joint measures. The modeling technique has further strength by combining measurements that are typically done separate (experimental vs. clinical) to build a more holistic model of foot behavior. This has the potential to allow additional conclusions to be drawn about complications associated with repair techniques. This model was built with the intent to provide an example of how patient specific bony geometry can be used as either a research or surgical tool when considering a disease state or repair technique. The technique also allows for the repeated use of anatomy, which is not possible experimentally or clinically. These qualities, along with the accuracy demonstrated in validation, prove the integrity of the technique along with demonstrating its strengths.