Defending the sanctity of life principle : a reply to John Keown

This article is a response to Professor Keown’s criticism of my paper “Finding a Way Through the Ethical and Legal Maze: Withdrawal of Medical Treatment and Euthanasia” (2005) 13 (3) Medical Law Review 357. The article takes up and responds to a number of criticisms raised by Keown in an attempt to further the debate concerning the moral and legal status of withdrawing life-sustaining measures, its distinction from euthanasia, and the implications of the lawfulness of withdrawal for the principle of the sanctity of life.

Assessment of corneal dynamics with high-speed swept source optical coherence tomography combined with an air puff system

We present a novel method and instrument for in vivo imaging and measurement of the human corneal dynamics during an air puff. The instrument is based on high-speed swept source optical coherence tomography (ssOCT) combined with a custom adapted air puff chamber from a non-contact tonometer, which uses an air stream to deform the cornea in a non-invasive manner. During the short period of time that the deformation takes place, the ssOCT acquires multiple A-scans in time (M-scan) at the center of the air puff, allowing observation of the dynamics of the anterior and posterior corneal surfaces as well as the anterior lens surface. The dynamics of the measurement are driven by the biomechanical properties of the human eye as well as its intraocular pressure. Thus, the analysis of the M-scan may provide useful information about the biomechanical behavior of the anterior segment during the applanation caused by the air puff. An initial set of controlled clinical experiments are shown to comprehend the performance of the instrument and its potential applicability to further understand the eye biomechanics and intraocular pressure measurements. Limitations and possibilities of the new apparatus are discussed.

A survey of the use of grading scales for contact lens complications in optometric practice

Purpose:  The aim of this study was to investigate the extent and pattern of use of grading scales for contact lens complications (‘grading scales’) in optometric practice. Methods:  An anonymous postal survey was sent to all 756 members of the Queensland Division of Optometrists Association Australia. Information was elicited relating to level of experience, practice type and location, and mode of usage of grading scales. Results:  Survey forms were returned by 237 optometrists, representing a 31 per cent response rate. The majority of respondents (61 per cent) reported using grading scales frequently in practice, while 65 per cent of these preferred to use the Efron Grading Scales for Contact Lens Complications. Seventy-six per cent of optometrists use a method of incremental grading rather than simply grading with whole numbers. Grading scales are more likely to be used by optometrists who have recently graduated (p < 0.001), have a postgraduate certificate in ocular therapeutics (p = 0.018), see more contact lens patients (p = 0.027) and use other forms of grading scales (p < 0.001). The most frequently graded ocular conditions were corneal staining, papillary conjunctivitis and conjunctival redness. The main reasons for not using grading scales included a preference for sketches, photographs or descriptions (87 per cent) and unavailability of scales (29 per cent). Conclusion:  Grading scales for contact lens complications are used extensively in optometric practice for a variety of purposes. This tool can now be considered as an expected norm in contact lens practice. We advocate the incorporation of such grading scales into professional guidelines and standards for good optometric clinical practice.

Laser doppler imaging in a paediatric burns population

Objective Laser Doppler imaging (LDI) was compared to wound outcomes in children's burns, to determine if the technology could be used to predict these outcomes. Methods Forty-eight patients with a total of 85 burns were included in the study. Patient median age was 4 years 10 months and scans were taken 0–186 h post-burn using the fast, low-resolution setting on the Moor LDI2 laser Doppler imager. Wounds were managed by standard practice, without taking into account the scan results. Time until complete re-epithelialisation and whether or not grafting and scar management were required were recorded for each wound. If wounds were treated with Silvazine™ or Acticoat™ prior to the scan, this was also recorded. Results The predominant colour of the scan was found to be significantly related to the re-epithelialisation, grafting and scar management outcomes and could be used to predict those outcomes. The prior use of Acticoat™ did not affect the scan relationship to outcomes, however, the use of Silvazine™ did complicate the relationship for light blue and green scanned partial thickness wounds. Scans taken within the 24-h window after-burn also appeared to be accurate predictors of wound outcome. Conclusion Laser Doppler imaging is accurate and effective in a paediatric population with a low-resolution fast-scan.

Improved image quality for x-ray CT imaging of gel dosimeters

Purpose: This study provides a simple method for improving precision of x-ray computed tomography (CT) scans of irradiated polymer gel dosimetry. The noise affecting CT scans of irradiated gels has been an impediment to the use of clinical CT scanners for gel dosimetry studies. Method: In this study, it is shown that multiple scans of a single PAGAT gel dosimeter can be used to extrapolate a ‘zero-scan’ image which displays a similar level of precision to an image obtained by averaging multiple CT images, without the compromised dose measurement resulting from the exposure of the gel to radiation from the CT scanner. Results: When extrapolating the zero-scan image, it is shown that exponential and simple linear fits to the relationship between Hounsfield unit and scan number, for each pixel in the image, provides an accurate indication of gel density. Conclusions: It is expected that this work will be utilised in the analysis of three-dimensional gel volumes irradiated using complex radiotherapy treatments.

(Re)focusing the Lens to Make Diversity and Difference Visible : Teaching for Quality and Equity

Despite the evidence that Australia’s children are learning literacy, there is also significant evidence that the poorest and most disadvantaged children are being left behind. To date our understanding of the place of transitions in this has been limited, although there has been work on the fourth grade slump (Gee, 2000, 2008), the transition from primary years to secondary years (e.g. Bahr & Pendergast, 2007; Pendergast & Bahr, 2005, 2010), and transitions when changing schools (Henderson, 2008). In this chapter, we consider the notion of transitioning, as we unpack issues related to recognising and valuing student diversity and difference. We want to highlight ways of providing high quality and high equity literacy pedagogy and literacy outcomes for middle years students. We will also discuss the importance of recognising that students transit to schools and school learning from other significant contexts, each with their own combinations of literacy practices, rituals and values.

Linear models for endocytic transformations from live cell imaging

Endocytosis is the process by which cells internalise molecules including nutrient proteins from the extracellular media. In one form, macropinocytosis, the membrane at the cell surface ruffles and folds over to give rise to an internalised vesicle. Negatively charged phospholipids within the membrane called phosphoinositides then undergo a series of transformations that are critical for the correct trafficking of the vesicle within the cell, and which are often pirated by pathogens such as Salmonella. Advanced fluorescent video microscopy imaging now allows the detailed observation and quantification of these events in live cells over time. Here we use these observations as a basis for building differential equation models of the transformations. An initial investigation of these interactions was modelled with reaction rates proportional to the sum of the concentrations of the individual constituents. A first order linear system for the concentrations results. The structure of the system enables analytical expressions to be obtained and the problem becomes one of determining the reaction rates which generate the observed data plots. We present results with reaction rates which capture the general behaviour of the reactions so that we now have a complete mathematical model of phosphoinositide transformations that fits the experimental observations. Some excellent fits are obtained with modulated exponential functions; however, these are not solutions of the linear system. The question arises as to how the model may be modified to obtain a system whose solution provides a more accurate fit.

Predictive factors of contact lens case contamination

PURPOSE: To examine the relationship between contact lens (CL) case contamination and various potential predictive factors. METHODS: 74 subjects were fitted with lotrafilcon B (CIBA Vision) CLs on a daily wear basis for 1 month. Subjects were randomly assigned one of two polyhexamethylene biguanide (PHMB) preserved disinfecting solutions with the corresponding regular lens case. Clinical evaluations were conducted at lens delivery and after 1 month, when cases were collected for microbial culture. A CL care non-compliance score was determined through administration of a questionnaire and the volume of solution used was calculated for each subject. Data was examined using backward stepwise binary logistic regression. RESULTS: 68% of cases were contaminated. 35% were moderately or heavily contaminated and 36% contained gram-negative bacteria. Case contamination was significantly associated with subjective dryness symptoms (OR 4.22, CI 1.37–13.01) (P<0.05). There was no association between contamination and subject age, ethnicity, gender, average wearing time, amount of solution used, non-compliance score, CL power and subjective redness (P>0.05). The effect of lens care system on case contamination approached significance (P=0.07). Failure to rinse the case with disinfecting solution following CL insertion (OR 2.51, CI 0.52–12.09) and not air drying the case (OR 2.31, CI 0.39–13.35) were positively correlated with contamination; however, did not reach statistical significance. CONCLUSIONS: Our results suggest that case contamination may influence subjective comfort. It is difficult to predict the development of case contamination from a variety of clinical factors. The efficacy of CL solutions, bacterial resistance to disinfection and biofilm formation are likely to play a role. Further evaluation of these factors will improve our understanding of the development of case contamination and its clinical impact.

Understanding the phenomenon of IS success in China through the lens of the IS-Impact model

This study is conducted within the IS-Impact Research Track at Queensland University of Technology (QUT). The goal of the IS-Impact Track is, “to develop the most widely employed model for benchmarking information systems in organizations for the joint benefit of both research and practice” (Gable et al, 2006). IS-Impact is defined as “a measure at a point in time, of the stream of net benefits from the IS, to date and anticipated, as perceived by all key-user-groups” (Gable Sedera and Chan, 2008). Track efforts have yielded the bicameral IS-Impact measurement model; the “impact” half includes Organizational-Impact and Individual-Impact dimensions; the “quality” half includes System-Quality and Information-Quality dimensions. The IS-Impact model, by design, is intended to be robust, simple and generalizable, to yield results that are comparable across time, stakeholders, different systems and system contexts. The model and measurement approach employ perceptual measures and an instrument that is relevant to key stakeholder groups, thereby enabling the combination or comparison of stakeholder perspectives. Such a validated and widely accepted IS-Impact measurement model has both academic and practical value. It facilitates systematic operationalization of a main dependent variable in research (IS-Impact), which can also serve as an important independent variable. For IS management practice it provides a means to benchmark and track the performance of information systems in use. The objective of this study is to develop a Mandarin version IS-Impact model, encompassing a list of China-specific IS-Impact measures, aiding in a better understanding of the IS-Impact phenomenon in a Chinese organizational context. The IS-Impact model provides a much needed theoretical guidance for this investigation of ES and ES impacts in a Chinese context. The appropriateness and soundness of employing the IS-Impact model as a theoretical foundation are evident: the model originated from a sound theory of IS Success (1992), developed through rigorous validation, and also derived in the context of Enterprise Systems. Based on the IS-Impact model, this study investigates a number of research questions (RQs). Firstly, the research investigated what essential impacts have been derived from ES by Chinese users and organizations [RQ1]. Secondly, we investigate which salient quality features of ES are perceived by Chinese users [RQ2]. Thirdly, we seek to answer whether the quality and impacts measures are sufficient to assess ES-success in general [RQ3]. Lastly, the study attempts to address whether the IS-Impact measurement model is appropriate for Chinese organizations in terms of evaluating their ES [RQ4]. An open-ended, qualitative identification survey was employed in the study. A large body of short text data was gathered from 144 Chinese users and 633 valid IS-Impact statements were generated from the data set. A generally inductive approach was applied in the qualitative data analysis. Rigorous qualitative data coding resulted in 50 first-order categories with 6 second-order categories that were grounded from the context of Chinese organization. The six second-order categories are: 1) System Quality; 2) Information Quality; 3) Individual Impacts;4) Organizational Impacts; 5) User Quality and 6) IS Support Quality. The final research finding of the study is the contextualized Mandarin version IS-Impact measurement model that includes 38 measures organized into 4 dimensions: System Quality, information Quality, Individual Impacts and Organizational Impacts. The study also proposed two conceptual models to harmonize the IS-Impact model and the two emergent constructs – User Quality and IS Support Quality by drawing on previous IS effectiveness literatures and the Work System theory proposed by Alter (1999) respectively. The study is significant as it is the first effort that empirically and comprehensively investigates IS-Impact in China. Specifically, the research contributions can be classified into theoretical contributions and practical contributions. From the theoretical perspective, through qualitative evidence, the study test and consolidate IS-Impact measurement model in terms of the quality of robustness, completeness and generalizability. The unconventional research design exhibits creativity of the study. The theoretical model does not work as a top-down a priori seeking for evidence demonstrating its credibility; rather, the study allows a competitive model to emerge from the bottom-up and open-coding analysis. Besides, the study is an example extending and localizing pre-existing theory developed in Western context when the theory is introduced to a different context. On the other hand, from the practical perspective, It is first time to introduce prominent research findings in field of IS Success to Chinese academia and practitioner. This study provides a guideline for Chinese organizations to assess their Enterprise System, and leveraging IT investment in the future. As a research effort in ITPS track, this study contributes the research team with an alternative operationalization of the dependent variable. The future research can take on the contextualized Mandarin version IS-Impact framework as a theoretical a priori model, further quantitative and empirical testing its validity.