Controlling fly strike and louse infections in sheep with tea tree oil

This study aimed to assess the effect of tea tree oil based formulations against two major ectoparasitic diseases in the sheep industry, flystrike and louse infestation, and to provide data to assist the assessment of the commercial feasibility of development of tea tree oil based ectoparasiticides. The results demonstrate insecticidal effects against both sheep lice and blowflies and repellent effects against adult flies and maggots. Dipping sheep in a Tea Tree Oil based formulation appeared to completely eradicate lice and suggests its potential use in sheep dipping formulations. Repellent and insecticidal effects against sheep blowflies, together with previously reported anti-microbial and wound healing properties, suggest significant benefits from the inclusion of tea tree oil in flystrike and wound treatment formulations. These effects occurred at concentrations of Tea Tree Oil that suggest the commercial viability of development of Tea Tree Oil based formulations for sheep parasite control and wound treatment and a potential new market for Tea Tree Oil.

Palladin, a novel microfilament protein

Palladin is a novel actin microfilament associated protein, which together with myotilin and myopalladin forms a novel cytoskeletal IgC2 domain protein family. Whereas the expression of myotilin and myopalladin is limited mainly to striated muscle, palladin is widely expressed in both epithelial and mesenchymal tissues, including heart and the nervous system. Palladin has a complex genetic structure and it is expressed as several different sized and structured splice variants, which also display differences in their expression pattern and interactions. In muscle cells, all the family members localize to the sarcomeric Z-disc, and in non-muscle cells palladin also localizes to the stress-fiber-dense regions, lamellipodia, podosomes and focal adhesions. A common feature of this protein family is the binding to α-actinin, but other interactions are mostly unique to each member. Palladin has been shown to interact with several proteins, including VASP, profilin, Eps8, LASP-1 and LPP. Its domain structure, lack of enzymatic activity and multiple interactions define it as a molecular scaffolding protein, which links together proteins with different functional modalities into large complexes. Palladin has an important role in cytoskeletal regulation, particularly in stress fiber formation and stabilization. This assumption is supported by several experimental results. First, over-expression of palladin in non-muscle cells results in rapid reorganization of the actin cytoskeleton and formation of thick actin bundles. Second, the knock-down of palladin with anti-sense and siRNA techniques or knock-out by genetic methods leads to defective stress fiber formation. Furthermore, palladin is usually up-regulated in situations requiring a highly organized cytoskeleton, such as differentiation of dendritic cells, trophoblasts and myofibroblasts, and activation of astrocytes during glial scar formation. The protein family members have also direct disease linkages; myotilin missense mutations are the cause of LGMD1A and myofibrillar myopathy. Palladin mutations and polymorphisms, on the other hand, have been linked to hereditary pancreatic cancer and myocardial infarction, respectively. In this study we set out to characterize human palladin. We identified several palladin isoforms, studied their tissue distribution and sub-cellular localization. Four novel interaction partners were identified; ezrin, ArgBP2, SPIN90 and Src-kinase.The previously identified interaction between palladin and α-actinin was also characterized in detail. All the identified new binding partners are actin cytoskeleton associated proteins; ezrin links the plasma membrane to the cytoskeleton, ArgBP2 and SPIN90 localize, among other structures, to the lamellipodia and in cardiomyocytes to the Z-disc. Src is a transforming tyrosine kinase, which besides its role in oncogenesis has also important cytoskeletal associations. We also studied palladin in myofibroblasts, which are specialized cells involved in diverse physiological and pathological processes, such as wound healing and tissue fibrosis. We demonstrated that palladin is up-regulated during the differentiation of myofibroblasts in an isoform specific manner, and that this up-regulation is induced by TGF-β via activation of both the SMAD and MAPK signalling cascades. In summary, the results presented here describe the initial characterization of human palladin and offer a basis for further studies.

Molecular biology and functions of epilysin (MMP-28)

Epilysin (MMP-28) is the most recently identified member of the matrix metalloproteinase (MMP) family of extracellular proteases. Together these enzymes are capable of degrading almost all components of the extracellular matrix (ECM) and are thus involved in important biological processes such as development, wound healing and immune functions, but also in pathological processes such as tumor invasion, metastasis and arthritis. MMPs do not act solely by degrading the ECM. They also regulate cell behavior by releasing growth factors and biologically active peptides from the ECM, by modulating cell surface receptors and adhesion molecules and by regulating the activity of many important mediators in inflammatory pathways. The aim of this study was to define the unique role of epilysin within the MMP-family, to elucidate how and when it is expressed and how its catalytic activity is regulated. To gain information on its essential functions and substrates, the specific aim was to characterize how epilysin affects the phenotype of epithelial cells, where it is biologically expressed. During the course of the study we found that the epilysin promoter contains a well conserved GT-box that is essential for the basic expression of this gene. Transcription factors Sp1 and Sp3 bind this sequence and could hence regulate both the basic and cell type and differentiation stage specific expression of epilysin. We cloned mouse epilysin cDNA and found that epilysin is well conserved between human and mouse genomes and that epilysin is glycosylated and activated by furin. Similarly to in human tissues, epilysin is normally expressed in a number of mouse tissues. The expression pattern differs from most other MMPs, which are expressed only in response to injury or inflammation and in pathological processes like cancer. These findings implicate that epilysin could be involved in tissue homeostasis, perhaps fine-tuning the phenotype of epithelial cells according to signals from the ECM. In view of these results, it was unexpected to find that epilysin can induce a stable epithelial to mesenchymal transition (EMT) when overexpressed in epithelial lung carcinoma cells. Transforming growth factor b (TGF-b) was recognized as a crucial mediator of this process, which was characterized by the loss of E-cadherin mediated cell-cell adhesion, elevated expression of gelatinase B and MT1-MMP and increased cell migration and invasion into collagen I gels. We also observed that epilysin is bound to the surface of epithelial cells and that this interaction is lost upon cell transformation and is susceptible to degradation by membrane type-1-MMP (MT1-MMP). The wide expression of epilysin under physiological conditions implicates that its effects on epithelial cell phenotype in vivo are not as dramatic as seen in our in vitro cell system. Nevertheless, current results indicate a possible interaction between epilysin and TGF-b also under physiological circumstances, where epilysin activity may not induce EMT but, instead, trigger less permanent changes in TGF-b signaling and cell motility. Epilysin may thus play an important role in TGF-b regulated events such as wound healing and inflammation, processes where involvement of epilysin has been indicated.

Cytotoxic Effects and Biocompatibility of Antimicrobial Materials

The rising demand for medical implants for ageing populations and ongoing advancements in medical technology continue to drive the use of implantable devices. Higher implant usage has a consequent increased incidence of implant-related infections, and associated prolonged patient care, pain and loss of limb and other organ function. Numerous antibacterial surfaces have been designed that prevent the onset of biofilm formation, thus reducing or preventing implant-associated infections through inhibiting bacterial adhesion or by killing the organisms that successfully attach to the surface of the implant. Other surfaces have been designed to stimulate a local immune response, promoting the natural clearing of the invading pathogen. The desired antibacterial effects are typically achieved by modulating the surface chemistry and morphology of the implant material, by means of the controlled release of pharmacological agents and bioactive compounds from the surface of the material, or by a combination of both processes. An important issue for any type of antibacterial surface modification lies in balancing the non-fouling, bacteriostatic or bactericidal effects against local and systemic biocompatibility. In this chapter, we will first describe the concept of biocompatibility and its evolution, from devices that do not evoke a negative host response to those that actively drive host regeneration. We will then review the challenges associated with merging the need for an implant material to withstand a bacterial load with those associated with supporting function restoration and tissue healing.

Mechanical testing of internal fixation devices: A theoretical and practical examination of current methods

Successful healing of long bone fractures is dependent on the mechanical environment created within the fracture, which in turn is dependent on the fixation strategy. Recent literature reports have suggested that locked plating devices are too stiff to reliably promote healing. However, in vitro testing of these devices has been inconsistent in both method of constraint and reported outcomes, making comparisons between studies and the assessment of construct stiffness problematic. Each of the methods previously used in the literature were assessed for their effect on the bending of the sample and concordant stiffness. The choice of outcome measures used in in vitro fracture studies was also assessed. Mechanical testing was conducted on seven hole locked plated constructs in each method for comparison. Based on the assessment of each method the use of spherical bearings, ball joints or similar is suggested at both ends of the sample. The use of near and far cortex movement was found to be more comprehensive and more accurate than traditional centrally calculated inter fragmentary movement values; stiffness was found to be highly susceptible to the accuracy of deformation measurements and constraint method, and should only be used as a within study comparison method. The reported stiffness values of locked plate constructs from in vitro mechanical testing is highly susceptible to testing constraints and output measures, with many standard techniques overestimating the stiffness of the construct. This raises the need for further investigation into the actual mechanical behaviour within the fracture gap of these devices.

Hans Hirschfeld : (1873-1944).

Brochure on occasion of the 1986 exhibition ‘Heilen und Vernichten im Nationalsozialismus’ (Healing and destruction under the Nazis) in Aachen, Germany. It includes a list of Hirschfeld’s publications.

Surviving the effects of barotrauma: assessing treatment options and a ‘natural’ remedy to enhance the release survival of line caught pink snapper (Pagrus auratus)

A new technique to ameliorate the effects of barotrauma was tested based on observations of pink snapper, Pagrus auratus (Forster), inadvertently piercing their everted stomach with their teeth and releasing trapped swim bladder gases. This technique was termed buccal venting and involved piercing the everted stomach protruding into the buccal cavity or out of the mouth with a 16-gauge hypodermic needle (a practice previously not encouraged). Short-term (~3 days) survival of buccal-vented fish was not significantly different from laterally vented fish nor untreated controls. Both buccal and lateral venting techniques were shown to cause no harm and allowed fish to return to depth. The short-term (1–3 days) post-release survival of line caught snapper was 88% with no significant difference in survival across three depth ranges tested (37–50, 51–100 and 101–180 m). Survival of sublegal pink snapper (<35 cm TL) was not significantly different (P > 0.05) from that of legal-sized fish (≥35 cm TL). Healing of the swim bladder was observed in 27% of pink snapper dissected after ≤3 days in captivity, and healing of stomachs was observed in 64% of pink snapper that had been buccal vented. Relatively high post-release survival rates of line caught pink snapper may offer some protection for snapper stocks where high fishing pressure and legal size restrictions result in the majority of the catch having to be released.

Papaya as a Medicinal Plant

Papaya has been used medicinally to treat an extremely broad range of ailments including intestinal worms, dengue fever, diabetes, hypertension, wound repair, and as an abortion agent. Although papaya is most commonly consumed as a ripe fruit, the plant tissues used as curatives are mainly derived from the seeds, young leaves, latex, or green immature fruit. The agents responsible for action have not been conclusively identified for all uses, but there is increasing evidence that activity may be attributable to benzyl isothiocyanate (BITC) in the case of anthelmintic and abortifacient action, and to the protease papain, and possibly chymopapain, in relation to wound repair. The location of these compounds in papaya tissues is likely to explain why different tissues are used for different ailments. Seeds, young leaves, and latex are good sources of BITC and are consequently used as a curative for intestinal worms. Immature green fruit is a good source of protease and is used as a topical application for burn wounds to accelerate tissue repair. The type of papaya tissue used may therefore provide a clue as to the active agent in ailments where papaya extracts have exhibited some activity (diabetes, hypertension, dengue fever). However, the compound(s) responsible for action remains to be identified. Modes of action of papaya extracts vary, but may include lowering blood glucose levels (diabetes), vascular muscle relaxation (hypertension), increasing blood cell count (dengue fever), stimulation of cell proliferation (wound healing), spasmodic contraction of uterine muscles (abortion), and induction of phase 2 enzymes (cancer chemoprevention). Although there has been increased study over the last decade into the physiological mode of action of papaya extracts, further increase in the knowledge of the compounds responsible for curative action will help to transfer the use of papaya from folklore remedies to mainstream medicinal use.

A comparison of welfare outcomes for weaner and mature Bos indicus bulls surgically or tension band castrated with or without analgesia: 2. Responses related to stress, health and productivity

Tension banding castration of cattle is gaining favour because it is relatively simple to perform and is promoted by retailers of the banders as a humane castration method. Two experiments were conducted, under tropical conditions using Bos indicus bulls comparing tension banding (Band) and surgical (Surgical) castration of weaner (7–10 months old) and mature (22–25 months old) bulls with and without pain management (NSAID (ketoprofen) or saline injected intramuscularly immediately prior to castration). Welfare outcomes were assessed using a range of measures; this paper reports on some physiological, morbidity and productivity-related responses to augment the behavioural responses reported in an accompanying paper. Blood samples were taken on the day of castration (day 0) at the time of restraint (0 min) and 30 min (weaners) or 40 min (mature bulls), 2 h, and 7 h; and days 1, 2, 3, 7, 14, 21 and 28 post-castration. Plasmas from day 0 were assayed for cortisol, creatine kinase, total protein and packed cell volume. Plasmas from the other samples were assayed for cortisol and haptoglobin (plus the 0 min sample). Liveweights were recorded approximately weekly to 6 weeks and at 2 and 3 months post-castration. Castration sites were checked at these same times to 2 months post-castration to score the extent of healing and presence of sepsis. Cortisol concentrations (mean ± s.e. nmol/L) were significantly (P < 0.05) higher in the Band (67 ± 4.5) compared with Surgical weaners (42 ± 4.5) at 2 h post-castration, but at 24 h post-castration were greater in the Surgical (43 ± 3.2) compared with the Band weaners (30 ± 3.2). The main effect of ketoprofen was on the cortisol concentrations of the mature Surgical bulls; concentrations were significantly reduced at 40 min (47 ± 7.2 vs. 71 ± 7.2 nmol/L for saline) and 2 h post-castration (24 ± 7.2, vs. 87 ± 7.2 nmol/L for saline). Ketoprofen, however, had no effect on the Band mature bulls, with their cortisol concentrations averaging 54 ± 5.1 nmol/L at 40 min and 92 ± 5.1 nmol/L at 2 h. Cortisol concentrations were also significantly elevated in the Band (83 ± 3.0 nmol/L) compared with Surgical mature bulls (57 ± 3.0 nmol/L) at weeks 2–4 post-castration. The timing of this elevation coincided with significantly elevated haptoglobin concentrations (mg/mL) in the Band bulls (2.97 ± 0.102 for mature bulls and 1.71 ± 0.025 for weaners, vs. 2.10 ± 0.102 and 1.45 ± 0.025 respectively for the Surgical treatment) and evidence of slow wound healing and sepsis in both the weaner (0.81 ± 0.089 not healed at week 4 for Band, 0.13 ± 0.078 for Surgical) and mature bulls (0.81 ± 0.090 at week 4 for Band, 0.38 ± 0.104 for Surgical). Overall, liveweight gains of both age groups were not affected by castration method. The findings of acute pain, chronic inflammation and possibly chronic pain in the mature bulls at least, together with poor wound healing in the Band bulls support behavioural findings reported in the accompanying paper and demonstrate that tension banding produces inferior welfare outcomes for weaner and mature bulls compared with surgical castration.

Welfare outcomes for 3- and 6-month-old beef calves in a tropical environment castrated surgically or by applying rubber rings

Castration of cattle using rubber rings is becoming increasingly popular due to the perceived ease of the procedure and greater operator safety when compared with surgical castration. Few comparative studies have investigated the effects of different castration methods and calf age on welfare outcomes, particularly in a tropical environment. Thirty Belmont Red (a tropically adapted breed), 3-month-old (liveweight 71–119 kg) and 30, 6-month-old (liveweight 141–189 kg) calves were assigned to a two age × three castration (surgical, ring and sham) treatment factorial study (Surg3, Surg6, Ring3, Ring6, Sham3 and Sham6, n = 10 for each treatment group). Welfare outcomes were assessed post-castration using: behaviour for 2 weeks; blood parameters (cortisol and haptoglobin concentrations) to 4 weeks; wound healing to 5 weeks; and liveweights to 6 weeks. More Surg calves struggled during castration compared with Sham and Ring (P < 0.05, 90 ± 7% vs. 20 ± 9% and 24 ± 10%) and performed more struggles (1.9 ± 0.2, 1.1 ± 0.3 and 1.1 ± 0.3 for Surg, Sham and Ring, respectively), suggesting that surgical castration caused most pain during performance of the procedure. A significant (P < 0.05) time × castration method × age interaction for plasma cortisol revealed that concentrations decreased most rapidly in Sham; the Ring6 calves failed to show reduced cortisol concentrations at 2 h post-castration, unlike other treatment groups. By 7 h post-castration, all treatment groups had similar concentrations. A significant (P < 0.01) interaction between time and castration method showed that haptoglobin concentrations increased slightly to 0.89 and 0.84 mg/mL for Surg and Ring, respectively over the first 3 days post-castration. Concentrations for Surg then decreased to levels similar to Sham by day 21 and, although concentrations for Ring decreased on day 7 to 0.76 mg/mL, they increased significantly on day 14 to 0.97 mg/mL before reducing to concentrations similar to the other groups (0.66 mg/mL) by day 21. Significantly (P < 0.05) more of the wounds of the 3-month compared with the 6-month calves scored as ‘healed’ at day 7 (74% vs. 39%), while more (P = 0.062) of the Surg than Ring scored as ‘healed’ at day 21 (60% vs. 29%). At day 14 there were significantly (P < 0.05) fewer healed wounds in Ring6 compared with other treatment groups (13% vs. 40–60%). Liveweight gain was significantly (P < 0.05) greater in 3-month (0.53 kg/day) than in 6-month calves (0.44 kg/day) and in Sham calves (P < 0.001, 0.54 kg/day), than in Ring (0.44 kg/day) and Surg (0.48 kg/day) calves. Overall, welfare outcomes were slightly better for Surg than Ring calves due to reduced inflammation and faster wound healing, with little difference between age groups.

Welfare outcomes for 3- and 6-month-old beef calves in a tropical environment castrated surgically or by applying rubber rings

Castration of cattle using rubber rings is becoming increasingly popular due to the perceived ease of the procedure and greater operator safety when compared with surgical castration. Few comparative studies have investigated the effects of different castration methods and calf age on welfare outcomes, particularly in a tropical environment. Thirty Belmont Red (a tropically adapted breed), 3-month-old (liveweight 71–119 kg) and 30, 6-month-old (liveweight 141–189 kg) calves were assigned to a two age × three castration (surgical, ring and sham) treatment factorial study (Surg3, Surg6, Ring3, Ring6, Sham3 and Sham6, n = 10 for each treatment group). Welfare outcomes were assessed post-castration using: behaviour for 2 weeks; blood parameters (cortisol and haptoglobin concentrations) to 4 weeks; wound healing to 5 weeks; and liveweights to 6 weeks. More Surg calves struggled during castration compared with Sham and Ring (P < 0.05, 90 ± 7% vs. 20 ± 9% and 24 ± 10%) and performed more struggles (1.9 ± 0.2, 1.1 ± 0.3 and 1.1 ± 0.3 for Surg, Sham and Ring, respectively), suggesting that surgical castration caused most pain during performance of the procedure. A significant (P < 0.05) time × castration method × age interaction for plasma cortisol revealed that concentrations decreased most rapidly in Sham; the Ring6 calves failed to show reduced cortisol concentrations at 2 h post-castration, unlike other treatment groups. By 7 h post-castration, all treatment groups had similar concentrations. A significant (P < 0.01) interaction between time and castration method showed that haptoglobin concentrations increased slightly to 0.89 and 0.84 mg/mL for Surg and Ring, respectively over the first 3 days post-castration. Concentrations for Surg then decreased to levels similar to Sham by day 21 and, although concentrations for Ring decreased on day 7 to 0.76 mg/mL, they increased significantly on day 14 to 0.97 mg/mL before reducing to concentrations similar to the other groups (0.66 mg/mL) by day 21. Significantly (P < 0.05) more of the wounds of the 3-month compared with the 6-month calves scored as ‘healed’ at day 7 (74% vs. 39%), while more (P = 0.062) of the Surg than Ring scored as ‘healed’ at day 21 (60% vs. 29%). At day 14 there were significantly (P < 0.05) fewer healed wounds in Ring6 compared with other treatment groups (13% vs. 40–60%). Liveweight gain was significantly (P < 0.05) greater in 3-month (0.53 kg/day) than in 6-month calves (0.44 kg/day) and in Sham calves (P < 0.001, 0.54 kg/day), than in Ring (0.44 kg/day) and Surg (0.48 kg/day) calves. Overall, welfare outcomes were slightly better for Surg than Ring calves due to reduced inflammation and faster wound healing, with little difference between age groups.

Psychiatric design : Using a salutogenic model for the development and management of mental health facilities

The prevailing model of psychiatric facility design does not fulfil its potential in supporting the healing process. A salutogenic approach can improve coherence and foster meaning, will actually improve mental health outcomes, not only manage patient behaviour.

Rakkauden välittäjä vai moraalinvartija : Narratiivinen tutkimus Suomen evankelis-luterilaisen kirkon papeista perhe- ja seksuaalikysymysten äärellä

The research goal was to clarify how ministers in the Evangelical Lutheran Church of Finland construct their identities when they confront family and sexual issues, particularly as seen in their narrations about their work and the factors that influence their ways of working. The approach was a narrative one placing the emphases was on the internal story. The research material consisted of interviews of 19 ministers and the written biographies of 3 ministers who had also been interviewed. The data was analysed narratively (analysis of the narrations and a narrative analysis). The life stories were classified on the basis of the logic in each, and five different internal story types were created: the persons on the road to recovery, those within safe boundaries, those who had learnt to be critical, those with an obligation to help, and those who had grown to be open. In all of the story types was evidented a conflict between the ministry of the Church and the way it was adapted to the lives of individuals experiencing family and sexual issues. On one hand, this was a source of stress at work, but on the other, it offered a chance to create new images of ministers struggling with family and sexual issues. Life experience was found to be important when the study subjects interpreted and dealt with family and sexual issues. Those on the road to recovery felt that becoming a Christian and the personal recovery that faith had made possible had a significant impact on their personal lives. This healing effect of faith was also a strengthening factor for them when they dealt with family and sexual issues. Typically, they approached work situations by taking into account their faith and the type of psychological knowledge that was acceptable within the boundaries set by it. Those within safe boundaries worked within the limits prescribed by the revivalist movement that they had grown up in, from their childhood onwards, and their experiences in adulthood had even strengthened their commitment to the movement. Typically, they were keen to proclaim the views of the movement in public, but they were also prone to stay silent if and when felt those views would cause an uproar. Those who had learnt to be critical had previously been holistically committed to the views expressed by the Church in family and sexual matters. It was their experiences in life that had led them into conflict with the teachings of the Church. Their approach to work was one of ambivalence resulting from a conflict between their current and previous views, which was further exacerbated by their irresolution concerning how a minister should act in these situations. Those with an obligation to help questioned the church teachings marriage as the only family ideal. When they met various kinds of families and sexual identities, and also when they adopted the identity of a helper, the foundation of their ministerial identity was the Two Commandments of Love. Their work was burdened, however, by a fear of how the Church and the parishioners would take their teaching. Those who had grown to be open were more sure of themselves than the other groups. Years in the ministry as well as life-long experience had made them into persons who were following paths of their own. Openly critical of the views on family and sexual issues proclaimed by the Church, they were keen to present their personal convictions and were able to defend these publicly when necessary. Search words: Narrative research, internal story, minister, church, family, sexuality.

A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable

Diabetic foot ulceration poses a heavy burden on the patient and the healthcare system, but prevention thereof receives little attention. For every euro spent on ulcer prevention, ten are spent on ulcer healing, and for every randomized controlled trial conducted on prevention, ten are conducted on healing. In this article, we argue that a shift in priorities is needed. For the prevention of a first foot ulcer, we need more insight into the effect of interventions and practices already applied globally in many settings. This requires systematic recording of interventions and outcomes, and well-designed randomized controlled trials that include analysis of cost-effectiveness. After healing of a foot ulcer, the risk of recurrence is high. For the prevention of a recurrent foot ulcer, home monitoring of foot temperature, pressure-relieving therapeutic footwear, and certain surgical interventions prove to be effective. The median effect size found in a total of 23 studies on these interventions is large, over 60%, and further increases when patients are adherent to treatment. These interventions should be investigated for efficacy as a state-of-the-art integrated foot care approach, where attempts are made to assure treatment adherence. Effect sizes of 75-80% may be expected. If such state-of-the-art integrated foot care is implemented, the majority of problems with foot ulcer recurrence in diabetes can be resolved. It is therefore time to act and to set a new target in diabetic foot care. This target is to reduce foot ulcer incidence with at least 75%.

The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: Development of an evidence-based global consensus

Foot problems complicating diabetes are a source of major patient suffering and societal costs. Investing in evidence-based, internationally appropriate diabetic foot care guidance is likely among the most cost-effective forms of healthcare expenditure, provided it is goal-focused and properly implemented. The International Working Group on the Diabetic Foot (IWGDF) has been publishing and updating international Practical Guidelines since 1999. The 2015 updates are based on systematic reviews of the literature, and recommendations are formulated using the Grading of Recommendations Assessment Development and Evaluation system. As such, we changed the name from 'Practical Guidelines' to 'Guidance'. In this article we describe the development of the 2015 IWGDF Guidance documents on prevention and management of foot problems in diabetes. This Guidance consists of five documents, prepared by five working groups of international experts. These documents provide guidance related to foot complications in persons with diabetes on: prevention; footwear and offloading; peripheral artery disease; infections; and, wound healing interventions. Based on these five documents, the IWGDF Editorial Board produced a summary guidance for daily practice. The resultant of this process, after reviewed by the Editorial Board and by international IWGDF members of all documents, is an evidence-based global consensus on prevention and management of foot problems in diabetes. Plans are already under way to implement this Guidance. We believe that following the recommendations of the 2015 IWGDF Guidance will almost certainly result in improved management of foot problems in persons with diabetes and a subsequent worldwide reduction in the tragedies caused by these foot problems.