Key biological issues in contact lens development

A contact lens is a medical device widely used as an alternative to spectacles in order to correct refractive vision problems. The evolution of polymeric biomaterials has heralded a continuous development in the materials used to produce contact lenses and maximize patient comfort and limit adverse events. Microbial keratitis (MK) is a relatively rare but potentially devastating condition associated with contact lens use, particularly with the extended wear of hydrogel lenses. It is the principal complication related to contact lens wear and the large population at risk make it a public health concern. Bacterial binding to the contact lens material is a precursor to the development of MK and is influenced by properties of the material and the bacteria. In order for bacteria to infiltrate the cornea there must be some degree of corneal damage, usually caused by trauma or hypoxia. The most recent materials available aim to allow the continuous wear of lenses while limiting corneal hypoxia, thus helping to prevent the development of MK. Limitations to the treatment of MK require that novel approaches may be necessary in order to limit bacterial adhesion to contact lens materials.

Using time-to-contact information to assess potential collision modulates both visual and temporal prediction networks

Accurate estimates of the time-to-contact (TTC) of approaching objects are crucial for survival. We used an ecologically valid driving simulation to compare and contrast the neural substrates of egocentric (head-on approach) and allocentric (lateral approach) TTC tasks in a fully factorial, event-related fMRI design. Compared to colour control tasks, both egocentric and allocentric TTC tasks activated left ventral premotor cortex/frontal operculum and inferior parietal cortex, the same areas that have previously been implicated in temporal attentional orienting. Despite differences in visual and cognitive demands, both TTC and temporal orienting paradigms encourage the use of temporally predictive information to guide behaviour, suggesting these areas may form a core network for temporal prediction. We also demonstrated that the temporal derivative of the perceptual index tau (tau-dot) held predictive value for making collision judgements and varied inversely with activity in primary visual cortex (V1). Specifically, V1 activity increased with the increasing likelihood of reporting a collision, suggesting top-down attentional modulation of early visual processing areas as a function of subjective collision. Finally, egocentric viewpoints provoked a response bias for reporting collisions, rather than no-collisions, reflecting increased caution for head-on approaches. Associated increases in SMA activity suggest motor preparation mechanisms were engaged, despite the perceptual nature of the task.

Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards

BACKGROUND: Despite the fact that outreach and early warning systems (EWS) are an integral part of a hospital wide systems approach to improve the early identification and management of deteriorating patients on general hospital wards, the widespread implementation of these interventions in practice is not based on robust research evidence. OBJECTIVES: The primary objective was to determine the impact of critical care outreach services on hospital mortality rates. Secondary objectives included determining the effect of outreach services on intensive care unit (ICU) admission patterns, length of hospital stay and adverse events. SEARCH STRATEGY: The review authors searched the following electronic databases: EPOC Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) and other Cochrane databases (all on The Cochrane Library 2006, Issue 3), MEDLINE (1996-June week 3 2006), EMBASE (1974-week 26 2006), CINAHL (1982-July week 5 2006), First Search (1992-2005) and CAB Health (1990-July 2006); also reference lists of relevant articles, conference abstracts, and made contact with experts and critical care organisations for further information. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series designs (ITS) which measured hospital mortality, unanticipated ICU admissions, ICU readmissions, length of hospital stay and adverse events following implementation of outreach and EWS in a general hospital ward to identify deteriorating adult patients versus general hospital ward setting without outreach and EWS were included in the review. DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data and two review authors assessed the methodological quality of the included studies. Meta-analysis was not possible due to heterogeneity. Summary statistics and descriptive summaries of primary and secondary outcomes are presented for each study. MAIN RESULTS: Two cluster-randomised control trials were included: one randomised at hospital level (23 hospitals in Australia) and one at ward level (16 wards in the UK). The primary outcome in the Australian trial (a composite score comprising incidence of unexpected cardiac arrests, unexpected deaths and unplanned ICU admissions) showed no statistical significant difference between control and medical emergency team (MET) hospitals (adjusted P value 0.640; adjusted odds ratio (OR) 0.98; 95% confidence interval (CI) 0.83 to 1.16). The UK-based trial found that outreach reduced in-hospital mortality (adjusted OR 0.52; 95% CI 0.32 to 0.85) compared with the control group. AUTHORS' CONCLUSIONS: The evidence from this review highlights the diversity and poor methodological quality of most studies investigating outreach. The results of the two included studies showed either no evidence of the effectiveness of outreach or a reduction in overall mortality in patients receiving outreach. The lack of evidence on outreach requires further multi-site RCT's to determine potential effectiveness.

Secondary Transfer Effects of Intergroup Contact: Alternative Accounts and Underlying Processes

Although intergroup contact is one of the most prominent interventions to reduce prejudice. the generalization of contact effects is still a contentious issue This research further examined the rarely studied secondary transfer effect (STE, Pettigrew, 2009) by which contact with a primary outgroup reduces prejudice toward secondary groups that are not directly involved in the contact Across 3 cross-sectional studies conducted in Cyprus (N = 1.653), Northern Ireland (N = 1,973). and Texas (N = 275) and 1 longitudinal study conducted in Northern Ireland (N = 411). the present research sought to systematically rule out alternative accounts of the STE and to investigate 2 potential mediating mechanisms (ingroup reappraisal and attitude generalization) Results indicated that, consistent with the STE. contact with a primary outgroup predicts attitudes toward secondary outgroups. over and above contact with the secondary outgroup, socially desirable responding. and prior attitudes Mediation analyses found strong evidence for attitude generalization but only limited evidence for ingroup reappraisal as an underlying process Two out of 3 tests of a reverse model, where contact with the secondary outgroup predicts attitudes toward the primary outgroup. provide further evidence for an indirect effect through attitude generalization Theoretical and practical implications of these results are discussed, and directions for future research are identified

Antecedents and Consequences of Social Identity Complexity: Intergroup Contact, Distinctiveness Threat, and Outgroup Attitudes

Social identity complexity defines people's more or less complex cognitive representations of the interrelationships among their multiple ingroup identities. Being high in complexity is contingent on situational, cognitive, or motivational factors, and has positive consequences for intergroup relations. Two survey studies conducted in Northern Ireland examined the extent to which intergroup contact and distinctiveness threat act as antecedents, and outgroup attitudes as consequences, of social identity complexity. In both studies, contact was positively, and distinctiveness threat negatively, associated with complex multiple ingroup perceptions, whereas respondents with more complex identity structures also reported more favorable outgroup attitudes. Social identity complexity also mediated the effects of contact and distinctiveness threat on attitudes. This research highlights that the extent to which individuals perceive their multiple ingroups in more or less complex and differentiated ways is of central importance to understanding intergroup phenomena.

Contact and Culture: Mechanisms of Reconciliation in Northern Ireland and Israel

In Northern Ireland and Israel schools have long been recognised as key sites for addressing the problems of poor intergroup relations (see Dunn, 1990; Murray, 1985). The developments of integrated schools which welcome members of the main communities have been regarded as a key development which is likely to be instrumental in promoting more harmonious relations. Although the schools have been regarded in the media as a ‘good news story’ the qualitative processes through which teachers within these schools foster reconciliation is not always clear. The purpose of this chapter is thus to explore this question by drawing on contact theory and interviews with teachers in Northern Ireland and Israel.