Professional practice influences : a sequential qualitative investigation on MSK assessment of the diabetic foot and podiatry practice

Within the UK public sector, the present healthcare landscape is a result of changing priorities over the last few decades with health care policies requiring healthcare professionals to adapt to new ways of working. These policies reflect the need to sustain a health service which can cope with the shifting demographic of an ageing population and an increase in conditions such as diabetes. These factors have an impact for the profession of podiatry, meaning potential changes influencing the profession, the shape of services delivered and the nature of everyday podiatry practice.This thesis aimed to get a clearer understanding of the influencing factors on practice for podiatrists. It achieved this by using an interpretative phenomenological analysis approach to gain insight into the experiential practice of podiatrists in both specialist and non specialist practice. Specialist podiatry care is needed for foot related complications in diabetes and international guidance IWGDF (2019) has indicated LJM is a contributory risk factor in the development of diabetic foot ulcerations (DFU). However, the characteristics of foot related LJM are not well understood, therefore, at it’s outset, this thesis aimed to develop a clearer understanding from experiential practice. This revealed LJM is currently “off the radar” in podiatry practice, partly due to lack of recommendation to assess in UK clinical guidelines and because priority is being given to other assessments.As the thesis shifted focus to professional practice, the superordinate themes, safe in our silos, stretching and sensemaking, steering or sailing, revealed the challenges faced by podiatrists in specialist and non-specialist roles. It is difficult to quantify the impact of health policy and changing organisational needs on professional practice, however the podiatrists in this study were employing a range of strategies to cope with the increasing demands. Some of these demands impact on the internal dynamics within the profession. Therefore, it is vital to encourage leading voices within the profession to help podiatrists with transformational change, and to encourage the next generation of podiatrists to embrace digital health technology, and public health roles in order to grow and develop the profession

On polynomially integrable domains in Euclidean spaces

Let $D$ be a bounded domain in $\mathbb R^n,$ with smooth boundary. Denote $V_D(\omega,t), \ \omega \in S^{n-1}, t \in \mathbb R,$ the Radon transform of the characteristic function $\chi_{D}$ of the domain $D,$ i.e., the $(n-1)-$ dimensional volume of the intersection $D$ with the hyperplane $\{x \in \mathbb R^n: =t \}.$ If the domain $D$ is an ellipsoid, then the function $V_D$ is algebraic and if, in addition, the dimension $n$ is odd, then $V(\omega,t)$ is a polynomial with respect to $t.$ Whether odd-dimensional ellipsoids are the only bounded smooth domains with such a property? The article is devoted to partial verification and discussion of this question

Comparison of limb kinematics between collected and lengthened (medium/extended) trot in two groups of dressage horses on two different surfaces

Background: Dressage horses are often asked to work in lengthened paces during training and competition, but to date there is limited information about the biomechanics of dressage-specific paces. Preliminary work has shown increased fetlock extension in extended compared with collected paces, but further investigation of the kinematic differences between collected, medium and extended trot in dressage horses is warranted. Objectives: Investigation of the effect of collected versus medium/extended trot on limb kinematics of dressage horses. Study design: Prospective kinematic evaluation. Methods: Twenty clinically sound horses in active dressage training were used: Group 1) ten young horses (≤ 6 years) were assessed at collected and medium trot; Group 2) ten mature horses (≥9 years) were assessed at collected and extended trot. All horses were evaluated on two different surfaces. High-speed motion-capture (240Hz) was used to determine kinematic variables. Forelimb and hindlimb angles were measured at midstance. Descriptive statistics and mixed-effect multilevel-regression analyses were performed. Results: Speed and stride length were reduced and stride duration increased at collected compared with medium/extended trot. Lengthened trot (medium/extended trot) was associated with increased fetlock extension in both the forelimbs and hindlimbs in both groups of horses. Changes were greater in Group 2 compared with Group 1. Shoulder and carpus angles were associated with forelimb fetlock angle. Hock angle was not significantly influenced by pace. Surface had no effect on fetlock or hock angles. Main limitations: Only 2D motion analysis was carried out. Results may have been different in horses with more extreme gait characteristics. Conclusions: Medium/extended trot increases extension of the forelimb and the hindlimb fetlock joints compared with collected trot in both young and mature dressage horses, respectively

The biopsychosocial-digital continuum of foot orthosis practice and research : the VALUATOR model

Foot orthoses have been used for decades despite uncertainty surrounding their therapeutic efficacy. Orthoses have been used exclusively to affect neuro-biomechanical input and outcome variables, however, there is emerging evidence that therapeutic efficacy may be affected by a psychological stimulus. Critical appraisal of the literature highlights that there is no holistic model upon which foot orthosis practice is taught, practised nor investigated. This paper introduces a conceptual model of foot orthosis practice (Value Based Foot Orthosis Practice (VALUATOR) model) that embraces a broader range of factors that are pertinent to orthosis practice, incorporating contemporary health service behaviours and values into orthosis practice for the first time. Within the VALUATOR model, foot orthosis design and clinical value is considered along a bio-psycho-social-digital continuum that reflects the reality of foot orthosis practice. The model contextualises the variable outcomes that are observed in research and practice within 6 key areas: 1) value, 2) person-centered approach, 3) zone of optimal bio-psycho-social stress, 4) bio-psycho-social assessment, 5) monitoring, 6) primary and secondary clinical strategies. The VALUATOR model is targeted at students, lecturers, scientists and practitioners and includes carefully chosen terminology to support a robust basis for educational and scientific discussion. It is believed that it provides a contemporary viewpoint and a structured conceptual metaphor that builds on existing evidence from a wide range of sources, invites constructive intellectual debate, and is anchored in the experiences of practitioners too. Stress testing the VALUATOR model will help determine its model and support further developments and evolution of orthotic practice in a evidence based way

A conceptual framework for contemporary professional foot care practice : ''The value based digital foot care framework''

Background: A small minority of countries around the globe have podiatry as a recognized profession, hence, there are considerable differences among these countries when it comes to the curricula, the duration of training and legislation regulating the profession. The growth in research led evidence based practice, and the emerging digital landscape of health care practice, occur alongside trends in disease and health behaviours that strongly impact on foot health. As such, the changing complex role of the podiatrist requires critical reflection on current frameworks of practice and whether they are fit for purpose. This commentary presents a conceptual framework which sets the scene for further development of concepts in a podiatry context, reflecting contemporary health care beliefs and the changing expectations of health care and society. The proposed conceptual framework for podiatry practice utilizes the metaphor of an electronic circuit to reflect the vast and complex interconnections between factors that affect practice and professional behaviours. The framework helps in portraying and defining drivers of practice, actual practice as well potential barriers for current and future practice. The circuit emphasis the interconnectedness/interaction of three clusters: 1) internal factors, 2) interaction factors, 3) external factors. Conclusion: Whatever promise this new framework holds, it will only be realised through conscious development of community consensus, respectful dialogue, constructive critical appraisal, and maintaining passion and focus on improving the health of people with foot related problems

Inverse spin-s portrait and representation of qudit states by single probability vectors

Using the tomographic probability representation of qudit states and the inverse spin-portrait method, we suggest a bijective map of the qudit density operator onto a single probability distribution. Within the framework of the approach proposed, any quantum spin-j state is associated with the (2j+1)(4j+1)-dimensional probability vector whose components are labeled by spin projections and points on the sphere. Such a vector has a clear physical meaning and can be relatively easily measured. Quantum states form a convex subset of the 2j(4j+3) simplex, with the boundary being illustrated for qubits (j=1/2) and qutrits (j=1). A relation to the (2j+1)^2- and (2j+1)(2j+2)-dimensional probability vectors is established in terms of spin-s portraits. We also address an auxiliary problem of the optimum reconstruction of qudit states, where the optimality implies a minimum relative error of the density matrix due to the errors in measured probabilities.Comment: 23 pages, 4 figures, PDF LaTeX, submitted to the Journal of Russian Laser Researc

Ovarian Activity and Oestrous Signs among Group-Housed, Lactating Sows: Influence of Behaviour, Environment and Production

Animal welfare concerns require the development of housing systems that allow the animals to express their natural behaviour. One example of this is the group-housing system for lactating sows. The present study aimed at exploring ovarian activity in such a system. Thirty-eight sows farrowing individually outdoors during spring and summer, and indoors during autumn and winter, and group-housed in groups of four during weeks 3–7 of the lactation period, were monitored regarding reproductive functions, behaviour and production during their first to fourth lactation period. Average ovulation frequency during lactation was 47%. Only 50% of these ovulating cases were accompanied by a standing oestrus. Lactational ovulation frequency was higher in later parities (p < 0.001). Ovulation frequency was higher (p < 0.05) during winter (74%) and spring (69%), than during summer (10%) and autumn (23%). Occurrence of lactational ovulation was associated with some aspects of suckling behaviour and also with litter weight gain (p < 0.05). Forty-nine per cent of the lactational ovulations occurred during the seventh week of lactation. Timing of ovulation seemed positively (p = 0.08) associated with weight loss during lactation. Compared with the sows that were anoestrus during lactation, oestradiol-17β values were higher (p < 0.05) only in the week before occurrence of lactational ovulation. Weaning-to-oestrous interval was prolonged (p < 0.05) among the sows that ovulated during lactation. The present study identifies several factors influencing ovarian activity among group-housed sows, thereby providing tools for the control of lactational ovulation in group-housing systems