Functional status, postural stability and falls among older adults with glaucoma

Visual impairment is an important contributing factor in falls among older adults, which is one of the leading causes of injury and injury-related death in this population. Visual impairment is also associated with greater disability among older adults, including poorer health-related quality of life, increased frailty and reduced postural stability. The majority of this evidence, however, is based on measures of central visual function, rather than peripheral visual function. As such, there is comparatively limited research on the associations between peripheral visual function, disability and falls, and even fewer studies involving older adults with specific diseases which affect peripheral visual function, the most common of which is glaucoma. Glaucoma is one of the leading causes of irreversible vision loss among older adults, affecting around 3 per cent of adults aged over 60 years. The condition is characterised by retinal nerve fibre loss, primarily affecting peripheral visual function. Importantly, the number of older adults with glaucomatous visual impairment is projected to increase as the ageing population grows. The first component of the thesis examined the cross-sectional association between glaucomatous visual impairment and health-related quality of life (Study 1a), functional status (Study 1b) and postural stability (Study 1c) among older adults. A cohort of 74 community-dwelling adults with glaucoma (mean age 74.2 ± 5.9 years) was recruited and completed a baseline assessment. A number of visual function measures was assessed, including central visual function (visual acuity and contrast sensitivity), motion sensitivity, retinal nerve fibre analysis and monocular and binocular visual field measures (monocular 24-2 and binocular integrated visual fields (IVF): IVF-60 and IVF-120). The analyses focused on the associations between the outcomes measures and severity and location of visual field loss, as this is the primary visual function affected by glaucoma. In Study 1a, we examined the association between visual field loss and health-related quality of life, measured by the Short Form 36-item Health Survey (SF-36). Greater binocular visual field loss, on both IVF measures, was associated with lower SF-36 physical component scores, adjusted for age and gender (Pearson's r =|0.32| to |0.36|, p<0.001). Furthermore, inferior visual field loss was more strongly associated with the SF-36 physical component than superior field loss. No association was found between visual field loss and SF-36 mental component scores. The association between visual field loss and functional status was examined in Study 1b. Functional status outcomes measures included a physical activity questionnaire (Physical Activity Scale for the Elderly, PASE), performance tests (six-minute walk test, timed up and go test and lower leg strength) and an overall functional status score. Significant, but weak, correlations were found between binocular visual field loss and PASE and overall functional status scores, adjusted for age and gender (Pearson's r =|0.24| to |0.33|, p<0.05). Greater inferior visual field loss, independent of superior visual field loss, was significantly associated with poorer physical performance results and lower overall functional status scores. In Study 1c, we examined the association between visual field loss and postural stability, using a swaymeter device which recorded body movement during four conditions: eyes open and closed, on a firm and foam surface. Greater binocular visual field loss was associated with increased postural sway, both on firm and foam surfaces, independent of age and gender (Pearson’s r =|0.44| to |0.46|, p <0.001). Furthermore, inferior visual field was a stronger contributor to postural stability, more so than the superior visual field, particularly on the foam condition with the eyes open. Greater visual field loss was associated with a reduction in the visual contribution to postural sway, which underlies the observed association with postural sway. The second component of the thesis examined the association between severity and location of visual field loss and falls during a 12-month longitudinal follow-up. The number of falls was assessed prospectively using monthly fall calendars. Of the 71 participants who successfully completed the follow up (mean age 73.9 ± 5.7 years), 44% reported one or more falls, and around 20% reported two or more falls. After adjusting for age and gender, every 10 points missed on the IVF-120 increased the rate of falls by 25% (rate ratio 1.25, 95% confidence interval 1.08 - 1.44) or every 5dB reduction in IVF-60 increased the rate of falls by 47% (rate ratio 1.47, 95% confidence interval 1.16 - 1.87). Inferior visual field loss was a significant predictor of falls, more so than superior field loss, highlighting the importance of the inferior visual field area in safe and efficient navigation. Further analyses indicated that postural stability, more so than functional status, may be a potential mediating factor in the relationship between visual field loss and falls. Future research is required to confirm this causal pathway. In addition, the use of topical beta-blocker medications was not associated with an increased rate of falls in this cohort, compared with the use of other topical anti-glaucoma medications. In summary, greater binocular visual field loss among older adults with glaucoma was associated with poorer health-related quality of life in the physical domain, reduced functional status, greater postural instability and higher rates of falling. When the location of visual field loss was examined, inferior visual field loss was consistently more strongly associated with these outcomes than superior visual field loss. Insights gained from this research improve our understanding of the association between glaucomatous visual field loss and disability, and its link with falls among older adults. The clinical implications of this research include the need to include visual field screening in falls risk assessments among older adults and to raise awareness of these findings to eye care practitioners and adults with glaucoma. The findings also assist in developing further research to examine strategies to reduce disability and prevent falls among older adults with glaucoma to promote healthy ageing and independence for these individuals.

Green fireballs and ball lightning

This paper presents evidence of an apparent connection between ball lightning and a green fireball. On the evening of the 16th May 2006 at least three fireballs were seen by many people in the skies of Queensland, Australia. One of the fireballs was seen passing over the Great Divide about 120 km west of Brisbane, and soon after, a luminous green ball about 30 cm in diameter was seen rolling down the slope of the Great Divide. A detailed description given by a witness indicates that the phenomenon was probably a highly luminous form of ball lightning. An hypothesis presented in this paper is that the passage of the Queensland fireball meteor created an electrically conductive path between the ionosphere and ground, providing energy for the ball lightning phenomenon. A strong similarity is noted between the Queensland fireball and the Pasamonte fireball seen in New Mexico in 1933. Both meteors exhibit a twist in the tail that could be explained by hydrodynamic forces. The possibility that multiple sightings of fireballs across South East Queensland were produced owing to fragments from comet 73P Schwassmann-Wachmann 3 is discussed.

Kindergarten transitions and linkages to primary school-readiness reconceptualised

Young children’s transition into school has been constructed as a time-limited period around initial school entry, a set of teacher or school practices, a process of establishing continuity of experience, a multi-layered, multi-year set of experiences and a dynamic relationship-based process. Although preparedness issues continue to be addressed, there is a trend towards more complex understandings of transition emphasizing continuity, relationships amongst multiple stakeholders, system coherence across extended time periods and enhancement of resilience and transition capital. This article, in the early years of a new century, outlines some conceptualisations of readiness and transition as they relate to diverse children’s pathways through early childhood and early school settings.

Assessing and learning in internships: Reflecting on pedagogy and progress

An elective internship unit as part of a work integrated learning program in a business faculty is presented as a case study. In the unit, students complete a minimum of 120 hours work placement over the course of a 13 week semester. The students are majoring in advertising, marketing, or public relations and are placed in corporations, government agencies, and not for profit organisations. To support and scaffold the students’ learning in the work environment, a range of classroom and online learning activities are part of the unit. Classroom activities include an introductory workshop to prepare students for placement, an industry panel, and interview workshop. These are delivered as three workshops across the semester. Prior to commencing their placement, students complete a suite of online learning modules. The Work Placement Preparation Program assists students in securing obtaining a placement and make a successful transition to the work environment. It provides an opportunity for students to source possible work placement sites, prepare competitive applications, develop and rehearse interview skills, deal with workplace issues, and use a student ePortfolio to reflect on their skills and achievements. Students contribute to a reflective blog throughout their placement, with feedback from academic supervisors throughout the placement. The completion of the online learning modules and contribution to a reflective blog are assessed as part of the unit. Other assessment tools include a internship plan and learning contract between the student, industry supervisor, and academic supervisor; job application including responses to selection criteria; and presentation to peers, academics and industry representatives at a poster session. The paper discusses the development of the internship unit over three years, particularly learning activities and assessment. The reflection and refinement of the unit is informed by a pedagogical framework, and the development of processes to best manage placement for all stakeholders. A model of best practice is proposed, that can be adapted to a variety of discipline areas.

Prospective, non-randomized phase 2 clinical trial of carboplatin plus paclitaxel with sequential radical pelvic radiotherapy for uterine papillary serous carcinoma

Objective Uterine Papillary Serous Carcinoma (UPSC) is uncommon and accounts for less than 5% of all uterine cancers. Therefore the majority of evidence about the benefits of adjuvant treatment comes from retrospective case series. We conducted a prospective multi-centre non-randomized phase 2 clinical trial using four cycles of adjuvant paclitaxel plus carboplatin chemotherapy followed by pelvic radiotherapy, in order to evaluate the tolerability and safety of this approach. Methods This trial enrolled patients with newly diagnosed, previously untreated patients with stage 1b-4 (FIGO-1988) UPSC with a papillary serous component of at least 30%. Paclitaxel (175 mg/m2) and carboplatin (AUC 6) were administered on day 1 of each 3-week cycle for 4 cycles. Chemotherapy was followed by external beam radiotherapy to the whole pelvis (50.4 Gy over 5.5 weeks). Completion and toxicity of treatment (Common Toxicity Criteria, CTC) and quality of life measures were the primary outcome indicators. Results Twenty-nine of 31 patients completed treatment as planned. Dose reduction was needed in 9 patients (29%), treatment delay in 7 (23%), and treatment cessation in 2 patients (6.5%). Hematologic toxicity, grade 3 or 4 occurred in 19% (6/31) of patients. Patients' self-reported quality of life remained stable throughout treatment. Thirteen of the 29 patients with stages 1–3 disease (44.8%) recurred (average follow up 28.1 months, range 8–60 months). Conclusion This multimodal treatment is feasible, safe and tolerated reasonably well and would be suitable for use in multi-institutional prospective randomized clinical trials incorporating novel therapies in patients with UPSC.

Ecological sustainable development: a study of the obstacles in Australia's construction industry

Ecological sustainable development (ESD), defined as that which meets the needs of the present without compromising the ability of future generations to meet their own needs, has much to offer in enhancing the quality of life of people and maintaining the environment for future generations by reducing the pollution of water, air and land, minimizing the destruction of irreplaceable ecosystems and cutting down the amount of toxic materials released. However, there is still much to do to achieve full implementation world-wide. This paper reports on three factors-design, attitudes and financial constraints - that are likely barriers to the implementation of ESD within the built environment in Australian industry. A postal questionnaire survey is described aimed at soliciting views on detailed aspects of the factors. This shows that ESD in the Australian built environment has also not been successfully implemented. The main reason is found to be due to the perceived costs involved - the cost of using environmental materials being a predominant factor. The design of ESD, being more sophisticated, also is perceived as involving stakeholders in more expense. There also appears to be a lack of knowledge and a lack of specialised and interdisciplinary design teams available in the Australian context.

Cultivating Innovation through Social Relationships: A Qualitative Study of Outstanding Australian Innovators in Science, Technology and the Creative Industries

In this chapter, we describe and explore social relationship patterns associated with outstanding innovation. In doing so, we draw upon the findings of 16 in-depth interviews with award-winning Australian innovators from science & technology and the creative industries. The interviews covered topics relating to various influences on individual innovation capacity and career development. We found that for all of the participants, innovation was a highly social process. Although each had been recognised individually for their innovative success, none worked in isolation. The ability to generate innovative outcomes was grounded in certain types of interaction and collaboration. We outline the distinctive features of the social relationships which seem to be important to innovation, and ask which ‘social network capabilities’ might underlie the ability to create an optimal pattern of interpersonal relationships. We discuss the implications of these findings for universities, which we argue play a key role in the development of nascent innovators.

Strategic management practices in the construction industry : a study of Indonesian enterprises

Since the establishment of the first national strategic development plan in the early 1970s, the construction industry has played an important role in terms of the economic, social and cultural development of Indonesia. The industry’s contribution to Indonesia’s gross domestic product (GDP) increased from 3.9% in 1973 to 7.7% in 2007. Business Monitoring International (2009) forecasts that Indonesia is home to one of the fastest-growing construction industries in Asia despite the average construction growth rate being expected to remain under 10% over the period 2006 – 2010. Similarly, Howlett and Powell (2006) place Indonesia as one of the 20 largest construction markets in 2010. Although the prospects for the Indonesian construction industry are now very promising, many local construction firms still face serious difficulties, such as poor performance and low competitiveness. There are two main reasons behind this problem: the environment that they face is not favourable; the other is the lack of strategic direction to improve competitiveness and performance. Furthermore, although strategic management has now become more widely used by many large construction firms in developed countries, practical examples and empirical studies related to the Indonesian construction industry remain scarce. In addition, research endeavours related to these topics in developing countries appear to be limited. This has potentially become one of the factors hampering efforts to guide Indonesian construction enterprises. This research aims to construct a conceptual model to enable Indonesian construction enterprises to develop a sound long-term corporate strategy that generates competitive advantage and superior performance. The conceptual model seeks to address the main prescription of a dynamic capabilities framework (Teece, Pisano & Shuen, 1997; Teece, 2007) within the context of the Indonesian construction industry. It is hypothesised that in a rapidly changing and varied environment, competitive success arises from the continuous development and reconfiguration of firm’s specific assets achieving competitive advantage is not only dependent on the exploitation of specific assets/capabilities, but on the exploitation of all of the assets and capabilities combinations in the dynamic capabilities framework. Thus, the model is refined through sequential statistical regression analyses of survey results with a sample size of 120 valid responses. The results of this study provide empirical evidence in support of the notion that a competitive advantage is achieved via the implementation of a dynamic capability framework as an important way for a construction enterprise to improve its organisational performance. The characteristics of asset-capability combinations were found to be significant determinants of the competitive advantage of the Indonesian construction enterprises, and that such advantage sequentially contributes to organisational performance. If a dynamic capabilities framework can work in the context of Indonesia, it suggests that the framework has potential applicability in other emerging and developing countries. This study also demonstrates the importance of the multi-stage nature of the model which provides a rich understanding of the dynamic process by which asset-capability should be exploited in combination by the construction firms operating in varying levels of hostility. Such findings are believed to be useful to both academics and practitioners, however, as this research represents a dynamic capabilities framework at the enterprise level, future studies should continue to explore and examine the framework in other levels of strategic management in construction as well as in other countries where different cultures or similar conditions prevails.

What aspects of the scoliosis correction are most important to the teenager who has keyhole scoliosis correction surgery? A prospective series of 100 patients

Introduction. Surgical treatment of scoliosis is assessed in the spine clinic by the surgeon making numerous measurements on X-Rays as well as the rib hump. But it is important to understand which of these measures correlate with self-reported improvements in patients’ quality of life following surgery. The objective of this study was to examine the relationship between patient satisfaction after thoracoscopic (keyhole) anterior scoliosis surgery and standard deformity correction measures using the Scoliosis Research Society (SRS) adolescent questionnaire. Methods. A series of 100 consecutive adolescent idiopathic scoliosis patients received a single anterior rod via a keyhole approach at the Mater Children’s Hospital, Brisbane. Patients completed SRS outcomes questionnaires before surgery and again at 24 months after surgery. Multiple regression and t-tests were used to investigate the relationship between SRS scores and deformity correction achieved after surgery. Results. There were 94 females and 6 males with a mean age of 16.1 years. The mean Cobb angle improved from 52º pre-operatively to 21º for the instrumented levels post-operatively (59% correction) and the mean rib hump improved from 16º to 8º (51% correction). The mean total SRS score for the cohort was 99.4/120 which indicated a high level of satisfaction with the results of their scoliosis surgery. None of the deformity related parameters in the multiple regressions were significant. However, the twenty patients with the smallest Cobb angles after surgery reported significantly higher SRS scores than the twenty patients with the largest Cobb angles after surgery, but there was no difference on the basis of rib hump correction. Discussion. Patients undergoing thoracoscopic (keyhole) anterior scoliosis correction report good SRS scores which are comparable to those in previous studies. We suggest that the absence of any statistically significant difference in SRS scores between patients with and without rod or screw complications is because these complications are not associated with any clinically significant loss of correction in our patient group. The Cobb angle after surgery was the only significant predictor of patient satisfaction when comparing subgroups of patients with the largest and smallest Cobb angles after surgery.

Getting more than the judgment debtor can give?

Prior to the decision of the High Court in Black v Garnock (2007) 230 CLR 438 it was an established principle in Queensland that a judgment creditor acting under an enforcement warrant could take no interest beyond what the judgment debtor could give. However, the decision of the High Court called this principle into question. This article examines the current position in the context of s 120 of the Land Title Act 1994 (Qld) , Queensland Titles Office practice and standard contractual provisions. This examination is further informed by the recent decision of Martin J in Secure Funding Pty Ltd v Doneley [2010] QSC 91.

The requirement to 'Start a Proceeding' to prevent the lapse of a caveat

Section 126 of the Land Title Act 1994 (Qld) regulates whether, and if so, when a caveat will lapse. While certain caveats will not lapse due to the operation of s 126(1), if a caveator does not wish a caveat to which the section applies to lapse, the caveator must start a proceeding in a court of competent jurisdiction to establish the interest claimed under the caveat within the time limits specified in, and otherwise comply with the obligations imposed by, s 126(4). The requirement, in s 126(4), to “start a proceeding” was the subject of judicial examination by the Court of Appeal (McMurdo P, Holmes JA and MacKenzie J) in Cousins Securities Pty Ltd v CEC Group Ltd [2007] QCA 192.

Land Sales Act 1984: The time limit for an application for exemption

The decision of Wilson J in Wan and Ors v NPD Property Development Pty Ltd [2004] QSC 232 also concerned the operation of the Land Sales Act 1984 (Qld) (‘the Act’). As previously noted, s 8(1) of the Act provides that a proposed allotment of freehold land might be sold only in certain circumstances. An agreement made in contravention of s 8(1) is void. Section 19 allows a purchaser (and others) to apply for an exemption from any of the provisions of Pt 2. By s 19(6), notwithstanding s 8, a person may agree to sell a proposed allotment if the instrument that binds a person to purchase the proposed allotment is conditional upon the grant of an exemption. By s 19(7) an application for exemption must be made ‘within 30 days after the event that marks the entry of a purchaser upon the purchase of the proposed allotment.’

Four models of the creative industries

Les activités et industries culturelles sont aujourd’hui englobées dans une nouvelle approche, celle d’industries créatives. Dans ce contexte, les interrogations sur les contributions de la culture au développement économique peuvent être repensées de manière élargie. La contribution examine les différentes réponses possibles à cette question, et quatre modèles sont ainsi distingués: l’approche du bien être; l’approche concurrentielle; l’approche de la croissance; l’approche de l’innovation. A chacun de ces modèles correspond une interprétation du lien entre activités créatives et économie. Ce sont ces interprétations dont la pertinence est appréciée à l’aide de données statistiques simples.

How do our 'quicks' generate pace? A cross sectional analysis of the Cricket Australia pace pathway

Technique and physical contributions to ball delivery speed in fast bowling have been popular research topics in sports science. However, a common limiting factor of this work is the level of expertise of participants and lack of within bowler investigations (Salter et al., 2007). The relationship between technique, anthropometry and ball speed has not been comprehensively investigated among elite fast bowlers. The purpose of this study was to examine the relationship between technique, anthropometric variables and ball speed using both within- and betweenbowler analyses in a cross section of the Cricket Australia high performance pace pathway.