Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in Canada

Purpose: To assess current recommendations by optometrists for replacement frequency (RF) of silicone hydrogels (SH) and daily disposable (DD) contact lenses in Canada, determine rates of non-compliance with recommendations by both the optometrist and patient, and investigate reasons for non-compliance.

Methods: Survey packages were sent to optometrists in Canada who had agreed to participate. Patients completed survey questions regarding demographics and contact lens wearing patterns, including recommended and actual contact lens RF. Optometrists were asked to provide lens information and their recommendation for RF. Fifty-eight optometrists returned 654 surveys, of which 578 were eligible for analysis.

Results: Seventy percent of patients were female with a median age of 32 years. Lens type distribution was 18% DD, 35% two-week SH, and 47% one-month SH. Six percent were worn for extended wear. Daily wear median wearing time was 12 hours/day, a median of five days/week for DD, seven days/week for SH (two-week and one-month). Optometrists’ recommendations were non-compliant with the manufacturers’ recommended RF for 6% of DD, 35% of two week, and 2% of one-month patients. Patients were non-compliant with recommendations from both the manufacturer and optometrist for 12% of DD, 43% of two-week, and 31% of one-month lens wearers. The most common reason for non-compliance was forgetting which day to replace lenses. Fifty-six percent thought a reminder system would help with compliance. A higher proportion of compliant patients followed the RF because of confidence in their optometrist.

Conclusions: Optometrists generally recommended RFs consistent with manufacturers’ recommendations for DD and one-month SH lenses but often recommended longer intervals for two-week SH lenses. Patients were most compliant when wearing DD lenses and least compliant when wearing two-week SH lenses. Communication between the patient and optometrists concerning the risks of non-compliance, or initiating a reminder system might improve compliance.

Monkey in a cage : the complicated loyalties of mid-level academic women working in higher education

Loyalty raises a dilemma for women’s career progression and leadership because it signals confidence in the organisation, despite the ongoing constraints that organisations present for women and their leadership aspirations. The research investigates women’s loyalty in the context of higher education. Focussing on a select group of mid-level female academics, the paper will argue against a common sense understanding of loyalty as an expression of female care. A critical reconsideration of loyalty as care is made possible by analysing the ‘utility of loyalty’ and how it becomes a legitimate organising principle that operationalises institutional and personal objectives. How women enact loyalty draws on agency theory to explain and analyse the way loyalty is appropriated by women. The results show contradictory actions around loyalty, however, these can be clarified by agency theory to demystify loyalty and critically analyse how specific work actions and practices shape explain seemingly contradictory and emotive responses. The complications around women and loyalty are expressions of a substantive rationality through which mid-level female academics respond to the uneven opportunities, limitations and constraints that influence their work, profession and relationships.

The impact of the expanded nursing practice on professional identify in Denmark

Purpose: This article explores the concept of professional identity of Danish nurses working in an expanded practice. The case study explores the experiences of a small group of Danish nurses with a new professional category that reaches into a domain that customarily belonged to physicians. The aim of this case study was to explore the impact of “nurse consultations,” representing an expanded nursing role, of 5 nurses focusing on their perception of autonomy, self-esteem, and confidence.


Methods: The case study used semistructured interviews with 5 participants triangulated and validated with participant observations, a focus group interview, and theoretically derived insights.


Findings: This study indicates that nurses working within a new expanded professional practice see themselves as still engaged in nursing and not as substitute physicians. The study also suggests that the involved nurses gained a higher sense of autonomy, self-esteem, and confidence in their practice. These elements have a positive impact on their professional identity.


Conclusion: The research demonstrates that for the nurses involved in expanded professional practice, the boundaries of professional practice have shifted significantly. The research indicates that an expanded practice generates a new domain within the professional identity of nurses.

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim: This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses’ capacity to work with farming men and women who misuse alcohol.

Background: In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.

Methods: We developed the AITP to enhance nurses’ capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses’ perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses’ pre-treatment, post-treatment and at 3-month follow-up.

Results: Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.

Conclusion: The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.

Discriminant validity of the sensory profile in Australian children with autism spectrum disorder

Objective. The discriminant validity of the Sensory Profile was evaluated by comparing the sensory processing scores of Australian children, 5 to 8 years of age, diagnosed with autism spectrum disorder (ASD) to a control group of children with typical development matched for age and gender. Method. Twenty-six parents of children with ASD and 26 parents of typically developing children without ASD completed the Sensory Profile. Sensory Profile category, factor, and quadrant scores were compared using multivariate analysis to investigate if there were differences between the two groups. Results. The results indicated that the children with ASD had significantly lower sensory processing scores on all fourteen categories, eight out of nine factors, and all four quadrants of the Sensory Profile. Conclusion. The results also provide evidence of discriminant validity of Sensory Profile scores between children with ASD and children with typical development. In addition, the study findings indicate that the Sensory Profile can be used with confidence in cross-cultural contexts, such as Australia.

Teachers' perceptions of their abilities to be educational leaders in Victorian childcare settings

In the context of new national regulatory requirements for designated educational leaders in early childhood settings, 11 Victorian teachers participated in semi-structured interviews exploring their perceptions of their ability to act as educational leaders in their childcare centres. Analysis of these interviews showed that, while teachers successfully made changes within their rooms, only those with a formal title or authority expressed confidence in their ability to lead change across their centres. Barriers to leadership included lack of time and a perception that their teacher qualifications 'did not buy authority'. A hierarchical model of leadership appeared dominant within the centres. The findings suggest both time allowance and formal role designation as strategies to support the new leadership roles, but also raise questions about the most effective models for supporting teacher leadership in childcare contexts.

The relationship between neuropsychological performance, cognitive confidence, and obsessive-compulsive phenomena : a pilot study

Drawing on neuropsychological and cognitive-behavioral approaches to Obsessive-Compulsive Disorder (OCD), the present study examined the association between memory performance, cognitive confidence, and OCD phenomena. Forty-six analogue participants completed a series of self-report questionnaires and neuropsychological tasks before and after a manipulation of confidence in memory It was found that cognitive confidence predicts OCD symptoms over and above the influence of depressive symptoms and other OCD-related beliefs. Participants reported higher levels of cognitive confidence following positive feedback on the manipulation task. However, changes in cognitive confidence following the manipulation task were not reflected in neuropsychological performance. Implications for theory and treatment are discussed.

Barriers to avoiding fast-food consumption in an environment supportive of unhealthy eating

Objective
To investigate factors (ability, motivation and the environment) that act as barriers to limiting fast-food consumption in women who live in an environment that is supportive of poor eating habits.

Design
Cross-sectional study using self-reports of individual-level data and objectively measured environmental data. Multilevel logistic regression was used to assess factors associated with frequency of fast-food consumption.

Setting
Socio-economically disadvantaged areas in metropolitan Melbourne, Australia.

Subjects
Women (n 932) from thirty-two socio-economically disadvantaged neighbourhoods living within 3 km of six or more fast-food restaurants. Women were randomly sampled in 2007–2008 as part of baseline data collection for the Resilience for Eating and Activity Despite Inequality (READI) study.

Results
Consuming low amounts of fast food was less likely in women with lower perceived ability to shop for and cook healthy foods, lower frequency of family dining, lower family support for healthy eating, more women acquaintances who eat fast food regularly and who lived further from the nearest supermarket. When modelled with the other significant factors, a lower perceived shopping ability, mid levels of family support and living further from the nearest supermarket remained significant. Among those who did not perceive fruits and vegetables to be of high quality, less frequent fast-food consumption was further reduced for those with the lowest confidence in their shopping ability.

Conclusions
Interventions designed to improve women's ability and opportunities to shop for healthy foods may be of value in making those who live in high-risk environments better able to eat healthily.

How significant is partnership formation in area-based projects to increase parental attendance at maternal and child health services

Objectives: 

A Rational Approach To Sentencing White- Collar Offenders in Australia

There are no overarching (and few settled) principles governing the sentencing of white-collar offenders. This is especially the situation in relation to the relevance of public opprobrium to the sentencing calculus and the manner in which employment deprivations stemming from the penalty impact on the sentence. To the extent that there is general convergence in the approach to sentencing white-collar offenders, the approach is often not sound. This is the case in relation to the minor sentencing discount accorded for previous good character, and the prevailing orthodoxy which assumes that offences targeted at major institutions, such as banks, meaningfully impair community confidence in such institutions. Fundamental reform of the manner in which white-collar offenders are sentenced is necessary in order to make this area of law more coherent and doctrinally sound. These reforms include providing a significant and pre-determined discount for restitution, reducing the weight given to general deterrence in the sentencing calculus, and providing a greater discount for previous good character and employment deprivations suffered as a direct result of the sentence. Further, crimes against individuals should be regarded as being more serious than those committed against large corporations or the public revenue. The article focuses on the existing law in Australia, however, the reform proposals and doctrinal analysis could be applied to all jurisdictions.

Analyses and comparison of counter-movement jump performance and self-rated recovery in state under-18s Australian Rules Football players during a national championship

Recovery of team sport athletes during multiple competitive games is an important area for strength and conditioning coaches to monitor as it facilitates for athletes to be ready to perform (11,13). Utilising athletic performance data in conjunction with self-rated reporting measures can help determine if in fact a player or team has recovered sufficiently or shown a trend towards recovery prior to a competitive match (11). Positive improvement in recovery variables can provide confidence in the effectiveness of recovery methods used and assist in determining the training schedule in order to positively manipulate the fitness-fatigue relationship (3).

Various methods of analysing the recovery of athletes have been reported in the literature and are available to the strength and conditioning coach. These include subjective, self-rated scales and perceived level of recovery questionnaires (11,12,13). Athletic performance measures during exercises such as the counter movement jump (CMJ) have also been analysed, predominantly utilising force plates to obtain kinetic data. (5,13,14). However, such equipment can be difficult to transport, requires continual calibration and is costly to purchase. A linear transducer can provide important information on CMJ variables in the assessment of athletic movements and due to its size and portability could serve as a valuable tool to assist strength and conditioning coaches, (8,10), and potentially enable the monitoring of recovery.

Previous studies have investigated the fatigue effects of competitive games in various sports (11,13,14) including Australian Rules Football (AFL) at the senior elite league level (5, 6). To the authors’ knowledge, however, there is yet to be a study investigating the recovery response in AFL players, specifically in players 18 years and under competing in the National Under 18s Championships. Australian Rules football is an extremely physically demanding and fatiguing sport where players participate in games time exceeding 120 minutes duration, covering large distances (~12-18km, position dependent) with many high intensity efforts performed at random times throughout the game (2,6,16). Hence, it would seem pertinent to analyse the fatigue effects of competitive matches in an Australian Rules Under-18’s National Championship and the subsequent recovery from these games.

The aim of this study was to analyse and compare two self-rated subjective measures of recovery; they being muscle soreness (MS) of the lower body, overall perceived total recovery (TR), and the performance measure of peak velocity (PV) obtained from a CMJ analysed with a linear transducer. Data collection occurred between rounds four and five of the Australian Football League Under-18’s National Championship, representing a four-day recovery analysis period between matches.

The expectation-performance gap in generic skills in accounting graduates : Evidence from Sri Lanka

Purpose
The purpose of this paper is to investigate the generic skills that are important for the career success of accounting graduates in Sri Lanka from the perspectives of university educators and employers.

Design/methodology/approach
Bui and Porter's (2010) expectation-performance gap framework was modified to match with the context of the current study. Data collected via questionnaire survey was analysed for non-parametric tests: the Wilcoxon signed-rank test and the Mann-Whitney test, using SPSS version 20, and quantified the expectation-performance gap and its components.

Findings
The major finding of this research is that the main cause for the expectation-performance gap, as identified in the analysis of the constraint gap is university educators’ low confidence in teaching the required generic skills for career success of graduates. However, university educators are aware of the employer expectations of graduate accountants in terms of generic skills. Employers indicated that many of the generic skills are not achieved by the accounting graduates.

Practical implications
Findings of this study reflect the importance of expanding the accounting curricula by embedding and assessing generic skill development activities. In addition, it is vital to develop the capacities of university educators in terms of teaching and assessing generic skills in accounting degree programmes.

Originality/value
This study contributes to the literature as one of few studies that investigate the generic skills development of accounting graduates in Asia, particularly in Sri Lanka.

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30–50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women’s weight and related lifestyle behaviours in child-bearing years is an outstanding ‘missed opportunity’ for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

Policing services with mentally ill people : developing greater understanding and best practice

Although it is now well known that there is a disproportionate number of people with mental illnesses in the criminal justice system, surprising little attention has been paid to the challenges faced by policing people with mental illnesses in the community. This article provides an overview of some of the key findings from a programme of research undertaken in Victoria to further understand and develop a best practice model at this interface. The areas covered will include the prevalence of psychiatric symptoms and mental illnesses among police cell detainees; the existing knowledge base and attitudes of police towards mentally ill people; the relationship between mental illness and offending; the frequency and nature of police apprehensions of mentally ill people under the Mental Health Act; the association among mental disorder, police shootings, and other injuries to people as a result of these encounters; and police interactions with victims of crime. The work highlights the need for ongoing improvements in policing people with mental illnesses, and particularly the need for improved inter-agency practices for dealing with them.

Principal led school improvement and teacher capacity building in the Barwon South Network : final report, May 2013

The period of interest for this report is the beginning of 2011 to the end of 2012. The period commenced when the Regional Network Leader of the Barwon South Network of schools in the Barwon South Region of the Department of Education and Early Childhood contacted the School of Education at Deakin University, Waurn Ponds Campus Geelong. The Regional Network Leader outlined a desire to engage with Deakin University to research a short-term-cycle model of school improvement to be implemented in the region. While the model was expected to be taken on by all schools in the region the research was limited to the 23 schools in the Barwon South Network with four schools to be investigated more closely for each of two years (2001 & 2012) – eight focus schools in total.

Many positive outcomes flowed from the implementation of short-term-cycle school improvement plans and their associated practices but there was wide variation in the nature and degrees of success and of the perception of the process. The research team asked the following questions of the data:

1. What aspects of the School Improvement Plan (SIP) approach were important for initiating and supporting worthwhile change?
2. What might we take from this, to provide guidance on how best to support change in teaching and learning processes in schools?

The School Improvement Plan (SIP) worked in a range of ways. At one level it was strongly focused on school leadership, and a need to improve principals’ capacity to initiate worthwhile teaching and learning processes in their schools. Underlying this intent, one might think an assumption is operation is that the leadership process involves top down decision-making and a willingness to hold staff accountable for the quality of their practice.

The second strong focus was on the translation into practice and the consequent effect on student learning, involving an emphasis on data and evidence led practice. Hence, along with the leadership focus there was a demand for the process of school improvement to reach down into students and classrooms. Thus, the SIP process inevitably involved a chain of decision-making by which student learning quality drove the intervention, and teachers responsible for this had a common view. The model therefore should not be seen as an intervention only on the principal, but rather on the school decision-making system and focus. Even though it was the principal receiving the SIP planning template, and reporting to the network, the reporting was required to include description of the operation of the school processes, of classroom processes, and of student learning. This of course placed significant constraints on principals, which may help explain the variation in responses and outcomes described above.

The findings from this study are based on multiple data sources: analysis of both open and closed survey questions which all teachers in the 23 schools in the network were invited to complete; interviews with principals, teachers and leaders in the eight case study schools; some interviews with students in the case study schools; and interviews with leaders who worked in the regional network office; and field notes from network meetings including the celebrations days. Celebrations days occurred each school term when groups of principals came together to share and celebrate the improvements and processes happening in their schools. Many of the themes emerging from the analysis of the different data sources were similar or overlapping, providing some confidence in the evidence-base for the findings.

The study, conducted over two years of data collection and analysis, has demonstrated a range of positive outcomes in at the case study schools relating to school communication and collaboration processes, professional learning of principals, leadership teams and classroom teachers. There was evidence in the survey responses and field notes from ‘celebration days’ that these outcomes were also represented in other schools in the network. The key points of change concerned the leadership processes of planning for improvement, and the rigorous attention to student data in framing teaching and learning processes. This latter point of change had the effect of basing SIP processes on a platform of evidence-based change. The research uncovered considerable anecdotal and observational evidence of improvements in student learning, in teacher accounts in interview, and presentations of student work. Interviews with students, although not as representative as the team would have liked, showed evidence of student awareness of learning goals, a key driver in the SIP improvement model. It was, however, not possible over this timescale to collect objective comparative evidence of enhanced learning outcomes.

A number of features of the short-term-cycle SIP were identified that supported positive change across the network. These were: 1) the support structures represented by the network leader and support personnel within schools, 2) the nature of the SIP model – focusing strongly on change leadership but within a collaborative structure that combined top-down and bottom-up elements, 3) the focus on data-led planning and implementation that helped drill down to explicit elements of classroom practice, and 4) the accountability regimes represented by network leader presence, and the celebration days in which principals became effectively accountable to their peers. We found that in the second year of the project, momentum was lost in the case study schools, as the network was dismantled. This raised issues also for the conduct of research in situations of systemic change.

Alongside the finding of evidence of positive outcomes in the case study schools overall, was the finding that the SIP processes and outcomes varied considerably across schools. A number of contextual factors were identified that led to this variation, including school histories of reform, principal management style, and school size and structure that made the short-term-cycle model unmanageable. In some cases there was overt resistance to the SIP model, at least in some part, and this led to an element of performativity in which the language of the SIP was conscripted to other purposes. The study found that even with functioning schools the SIP was understood differently and the processes performed differently, raising the question of whether in the study we are dealing with one SIP or many. The final take home message from the research is that schools are complex institutions, and models of school improvement need to involve both strong principled features, and flexibility in local application, if all schools’ interests in improving teaching and learning processes and outcomes are to be served.