Scheimpflug imaging of the post lens tear film during contact lens wear

A new imaging methodology is described to visualise the post lens tear film (PLTF) during contact lens wear. A rotating-Scheimpflug camera in combination with sodium fluorescein allows evaluation of the PLTF for different contact lens modalities, including mini-scleral, rigid gas permeable (RGP) and soft contact lenses. This imaging technique provides an extension of the instrument’s current functionality. The potential advantages and limitations of the technique are discussed.

A model for reflection in the pedagogic field of higher education

This chapter provides an introduction to the use of pedagogical patterns in capturing and sharing educational design experience. In higher education, helping students to learn to engage in productive reflection presents a complex set of challenges. Delicate balances must be found: too little structure and support for students’ reflective work can leave them floundering; too much, and some will remain dependent. Moreover, this is a dynamic teaching problem – scaffolding needs to be adjusted as students develop confidence and capability, which they will do at different rates. The model presented in this chapter embraces the three main elements that teachers can legitimately design, or help set in place, to support their students’ reflective activity: good tasks, the right tools, and appropriate divisions of labour. It delineates a complex, shifting architecture of tasks, tools and people, activities and outcomes associated with reflective learning. It shows how the designable elements of this complex mix can be described in patterns and pattern languages, which then become design resources for teachers’ own action, reflection and professional development.

Developing and evaluating interventions that are applicable and relevant to inpatients and those who care for them; a multiphase, pragmatic action research approach

Background Randomised controlled trials may be of limited use to evaluate the multidisciplinary and multimodal interventions required to effectively treat complex patients in routine clinical practice; pragmatic action research approaches may provide a suitable alternative. Methods A multiphase, pragmatic, action research based approach was developed to identify and overcome barriers to nutritional care in patients admitted to a metropolitan hospital hip-fracture unit. Results Four sequential action research cycles built upon baseline data including 614 acute hip-fracture inpatients and 30 purposefully sampled clinicians. Reports from Phase I identified barriers to nutrition screening and assessment. Phase II reported post-fracture protein-energy intakes and intake barriers. Phase III built on earlier results; an explanatory mixed-methods study expanded and explored additional barriers and facilitators to nutritional care. Subsequent changes to routine clinical practice were developed and implemented by the treating team between Phase III and IV. These were implemented as a new multidisciplinary, multimodal nutritional model of care. A quasi-experimental controlled, ‘before-and-after’ study was then used to compare the new model of care with an individualised nutritional care model. Engagement of the multidisciplinary team in a multiphase, pragmatic action research intervention doubled energy and protein intakes, tripled return home discharge rates, and effected a 75% reduction in nutritional deterioration during admission in a reflective cohort of hip-fracture inpatients. Conclusions This approach allowed research to be conducted as part of routine clinical practice, captured a more representative patient cohort than previously reported studies, and facilitated exploration of barriers and engagement of the multidisciplinary healthcare workers to identify and implement practical solutions. This study demonstrates substantially different findings to those previously reported, and is the first to demonstrate that multidisciplinary, multimodal nutrition care reduces intake barriers, delivers a higher proportional increase in protein and energy intake compared with baseline than other published intervention studies, and improves patient outcomes when compared with individualised nutrition care. The findings are considered highly relevant to clinical practice and have high translation validity. The authors strongly encourage the development of similar study designs to investigate complex health problems in elderly, multi-morbid patient populations as a way to evaluate and change clinical practice.

Moving forwards with the aim of going backwards fast : high performance rowing as a learning environment

Background and Purpose: - This paper focuses on the learning culture within the high performance levels of rowing. In doing so, we explore the case of an individual’s learning as he moves across athletic, coaching and administrative functions. This exploration draws on a cultural learning framework and complementary theorisings related to reflexivity. Method - This study makes use of an intellectually, morally and collaboratively challenging approach whereby one member of the research team was also the sole participant of this study. The participant’s careers as a high performance athlete, coach and administrator, coupled with his experience in conducting empirical research presented a rare opportunity to engage in collaborative research (involving degrees of insider and outsider status for each of the research team). We acknowledge that others have looked to combine roles of coach / athlete / administrator with that of researcher however few (if any) have attempted to combine them all in one project. Moreover, coupled with the approach to reflexivity adopted in this study and the authorship contributions we consider this scholarly direction uncommon. Data were comprised of recorded research conversations, a subsequently constructed learning narrative, reflections on the narrative, a stimulated reflective piece from the participant, and a final (re)construction of the participant’s story. Accordingly, data were integrated through an iterative process of thematic analysis. Results - The cultural (i.e., the ways things get done) and structural (e.g., the rules and regulations) properties of high performance rowing were found to shape both the opportunities to be present (e.g., secure a place in the crew) and to learn (e.g., learn the skills required to perform at an Olympic level). However, the individual’s personal properties were brought to bear on re-shaping the constraints such that many limitations could be overcome. In keeping with the theory of learning cultures, the culture of rowing was found to position individuals (a coxswain in this case) differentially. In a similar manner, a range of structural features was found to be important in shaping the cultural and personal elements in performance contexts. For example, the ‘field of play’ was found to be important as a structural feature (i.e., inability of coach to communicate with athletes) in shaping the cultural and personal elements of learning in competition (e.g., positioning the coxswain as an in-boat coach and trusted crewmate). Finally, the cultural and structural elements in rowing appeared to be activated by the participant’s personal elements, most notably his orientation towards quality performance. Conclusion - The participant in this study was found to be driven by the project that he cares about most and at each turn he has bent his understanding of his sport back on itself to see if he can find opportunities to learn and subsequently explore ways to improve performance. The story here emphasises the importance of learner agency, and this is an aspect that has often been missing in recent theorising about learning. In this study, we find an agent using his ‘personal emergent powers to activate the resources in the culture and structure of his sport in an attempt to improve performance. We conclude from this account that this particular high performance rowing culture is one that provided support but nonetheless encouraged those involved, to ‘figure things out’ for themselves – be it as athletes, coaches and/or administrators.

Transmittance properties of contact lens multipurpose solutions and their effects on a hydrogel lens

Purpose The aim was to assess the compatibility of different multipurpose solutions (MPSs) with one type of silicone hydrogel (SiH) contact lens by, assessing the changes in both ultraviolet (UV) and visible light transmissibility of the hydrogel lens caused by the MPSs. Methods The light transmittance from 200-700 nm were measured for the lotrafilcon B blister pack solution (BPS), six MPSs namely, ReNuMultiPlus Multi-Purpose Solution (Bausch and Lomb Inc., Rochester NY, USA.); Complete RevitaLens Multi-Purpose (Abbott Medical Optics Inc., Quarryvale Co. Dublin, Ireland); All In One Light (Sauflon Pharmaceuticals Ltd., Twickenham, England); SOLO-care AQUA™ (Ciba Vision Corporation Duluth, Georgia, USA.); Biomedics All-in-one solution (CooperVision, Hamble, UK); and HippiaMultiPlus All-in-one solution (Interojo Inc., Kyeonggi-do, Korea), and a lotrafilcon B SiH lens (before and after storage), using a spectrophotometer. Results The UV transmitted through the BPS and the MPS were similar (p >.05, for all), except for the HippiaMultiPlus which was lower (p < 0.001) by 19.8%. Mean transparency values were statistically (p<.001) significantly different between the BPS and the MPSs. All MP solution/SiH lens combinations resulted in relatively high UV transmittance values especially in the UVC spectrum, and significantly increased (p <.001) the visible light transmittance values of the SiH lens. Greater changes in transparency were observed in the ReNu/SiH lens (28.5%) and the Complete RevitaLens/SiH lens (24.9%) combinations. Conclusion The six MPSs showed significant variations in the transmitted UV and visible light. Similar to the BPS, all MPSs were equally transparent, but showed very poor UVA & UVB attenuation, except for the Hippia MultiPlus. The MPS/SiH lens combinations did not significantly affect the lens transparency but it significant increased the lens transmittance of UV radiation, after storage. Further in-vivo studies are needed to validate if this effect is constant.