A prospective study of the effect of education on non-compliant behaviour in contact lens wear

The contact lens practitioner and patient present a specific case for the study of non-compliance in areas such as hygiene, solution use, appointment attendance and wearing times. Education is one of the factors thought to influence compliance among patients in general health care situations and contact lens practitioners are encouraged to educate patients in the care and maintenance of contact lenses. A prospective, randomized, controlled and double masked study was performed to assess the effect of a‘compliance enhancement strategy’ on levels of compliance among contact lens wearers over twelve months. Eighty experienced contact lens patients were randomly allocated to two experimental groups. A standard level of contact lens instruction was applied to the first group and in addition the compliance enhancement strategy was applied to patients assigned to the second group. The strategy consisted of extra education for patients using a video, booklets, posters, a checklist and a health care contract. Patients were given free supplies of RelMu multipurpose solution and Medalist 38 soft contact lenses IBausch and Lomb, Rochester. New York). Compliance levels were assessed at a twelve month aftercare appointment by demonstration and questionnaire. The results indicate that the compliance enhancement strategy had little significant effect on the compliance levels of the patients to whom it was applied. The population of contact lens wearers were generally very compliant and the contact lenses and care regimen were clinically successful. The possibility that the assessment of non–compliance was not adequately sensitive to highlight small differences in non-compliant, behaviour is discussed. The standard level of eduction applied to this sample of contact lens patients was adequate to ensure generally high levels of compliance with the simple care and maintenance regimen recommended.

Impact of a rub and rinse on solution-induced corneal staining

Purpose. To investigate whether the inclusion of a rub and rinse step before contact lens disinfection has an impact on solution-induced corneal staining.

Methods. This was a prospective, double-masked, single investigator study. Twenty participants were recruited for two visits, where balafilcon-A lenses were worn bilaterally for 2 h. Each pair of lenses was prepared using two different methodologies. The “control” lens was transferred from the blister pack directly into a storage case containing polyhexamethylene biguanide-based lens care solution. The contralateral “test” lens was rubbed and simultaneously rinsed using the same polyhexamethylene biguanide-based care solution, for either 60 s (visit 1) or 20 s (visit 2). Both lenses were then soaked in the solution overnight. After baseline corneal staining assessments, the lenses were inserted following a randomized contralateral model. After 2 h, lenses were removed, corneal staining was regraded, and comfort scores were obtained.

Results. Rubbed and rinsed test lenses induced significantly less corneal staining than control lenses for all participants during visit 1 (mean ± SD: 516 ± 843 vs. 2170 ± 902; p < 0.001) and visit 2 (522 ± 417 vs. 2091 ± 965; p < 0.001). There was no significant difference between the test lenses during visits 1 and 2 (p = 0.72) or controls (p = 0.50). Comfort scores did not differ between eyes (p > 0.05).

Conclusions. Corneal staining induced after 2 h of lens wear with the combination of balafilcon-A and polyhexamethylene biguanide-based lens care solution can be significantly reduced by including a rub and rinse step before overnight soaking. Further work is required to establish the longevity of this effect during the monthly wearing cycle.

Fine-scale spatial and temporal variations in diets of the pipefish Stigmatopora nigra within seagrass patches

Diets of the pipefish Stigmatopora nigra were analysed to determine if food availability was causing S. nigra to distribute according to habitat edge effects. Gut analysis found little difference in the diets of S. nigra at the edge and interior of seagrass patches, regardless of time of day or season. Fish diets did, however, vary with seagrass density: S. nigra in denser seagrass consumed more harpacticoid copepods and fewer planktonic copepods. The lack of difference in prey eaten by S. nigra at the edge and interior of patches suggests either that food was not determining S. nigra distribution patterns within patches or that differences in fish densities across patches meant that relative fish–prey densities were similar at edge and interior positions. Alternatively, any edge effects in diet might be masked by gradients in seagrass structure.

Knowledge, desire and power in global politics : western representations of China's rise

How is the rise of China perceived in the West? Why is it often labelled as ‘threat’ and/or ‘opportunity’? What are the implications of these China imageries for global politics?

Taking up these important questions, this ground-breaking book argues that the dominant Western perceptions of China’s rise tell us less about China and more about Western self-imagination and its desire for certainty. Chengxin Pan expertly illustrates how this desire, masked as China ‘knowledge’, is bound up with the political economy of fears and fantasies, thereby both informing and complicating foreign policy practice in Sino-Western relations. Insofar as this vital relationship is shaped not only by China’s rise, but also by the way we conceptualise its rise, this book makes a compelling case for critical reflection on China watching.

Knowledge, Desire and Power in Global Politics is the first systematic and deconstructive analysis of contemporary Western representation of China’s rise. Setting itself apart from the mainstream empiricist literature, its critical interpretative approach and unconventional and innovative perspective will not only strongly appeal to academics, students and the broader reading public, but also likely spark debate in the field of Chinese international relations.

Bunker-de-bunk 2012

Factors to drive clinical practice improvement in a Malaysian intensive care unit : assessment of organisational readiness using a mixed method approach

This study assessed organisational readiness and factors to drive clinical practice improvement for VAP, CRBSI and PU in a Malaysian intensive care unit (ICU). A mixed method study approach was undertaken in a 16-bed ICU in regional Malaysia using an environmental scan, key informant interviews, staff surveys, and patient audit to elucidate factors contributing to planning for clinical practice improvement. Measurements of sustainability of practice and regard for the practice environment were assessed using validated measures. An environmental scan demonstrated high patient occupancy and case load. Nineteen percent of ICU patients developed complications according to validated measures. Survey results indicated that the majority of nurses had a good knowledge of strategies to prevent ICU complications and a positive attitude toward change processes. Engaging executive leadership was identified as crucial in priming the clinical site for practice change. Providing nurses with tools to monitor their clinical practice and empowering them to change practices are important in improving clinical outcomes.

How much should Australians know about Papua New Guinea?

In the last week Papua New Guinea (PNG) has received more exposure in the Australian media than it has for a very long time indeed. Ever since news of the ‘Regional Resettlement Arrangement Between Australia and Papua New Guinea’ agreement between Prime Ministers Rudd and O’Neill appeared on 19 July, discussion and criticism of the so-called ‘PNG Solution’ has been widespread on the internet, on television, radio, and even in the few newspapers still being published. Media outlets which negligently had let their regional coverage slip away – preferring to invest their remaining funds into reportage of last night’s Masterchef – are now scrambling to find copy from anyone with either opinions on the subject, but little knowledge, or some direct knowledge of PNG, alas in short supply.

The avalanche of reporting and commentary has masked the complexity of the issues involved here. On the one hand, we have Australia’s response to boat-borne visa-less immigrants: there is a whole universe of pain tied up in this, as any quick glance at the commentary will demonstrate. On the other, there is Australia and its place in the world and in the region: are we embarrassed to be Australians, or proud to be Aussies who ‘grew here’? And within the region, there is Papua New Guinea.

What can one learn from the reporting of PNG so far in 2013?

Integrated depression management: a proposed trial of a new model of care in a low vision rehabilitation setting

Purpose:
Depression is a common problem among people with visual impairment and contributes to functional decline. This article presents a study protocol to evaluate a new model of care for those patients with depressive symptoms in which psychological treatment is integrated into low vision rehabilitation services. Low vision staff will be trained to deliver "problem solving therapy for primary care" (PST-PC), an effective psychological treatment developed specifically for delivery by non-mental health care staff. PST-PC is delivered in 8 weekly telephone sessions of 30-45 minutes duration and 4 monthly maintenance sessions. We predict this new integrated model of care will significantly reduce depressive symptoms and improve the quality of life for people with visual impairment.

Methods and Design:
A randomized controlled trial of PST-PC will be implemented nationally across low vision rehabilitation services provided by Vision Australia. Clients who screen positive for depressive symptoms and meet study criteria will be randomized to receive PST-PC or usual care, consisting of a referral to their general practitioner for more detailed assessment and treatment. Outcome measures include depressive symptoms and behaviors, quality of life, coping and psychological adjustment to visual impairment. Masked assessments will take place pre- and post-intervention as well as at 6- and 12-month follow-up.

Conclusion:
We anticipate that this innovative service delivery model will lead to sustained improvements in clients' quality of life in a cost effective manner and provide an innovative service delivery model suitable for other health care areas in which depression is co-morbid.

Does timing matter? How priority effects influence the outcome of parasite interactions within hosts

In nature, hosts are exposed to an assemblage of parasite species that collectively form a complex community within the host. To date, however, our understanding of how within-host–parasite communities assemble and interact remains limited. Using a larval amphibian host (Pacific chorus frog, Pseudacris regilla) and two common trematode parasites (Ribeiroia ondatrae and Echinostoma trivolvis), we experimentally examined how the sequence of host exposure influenced parasite interactions within hosts. While there was no evidence that the parasites interacted when hosts were exposed to both parasites simultaneously, we detected evidence of both intraspecific and interspecific competition when exposures were temporally staggered. However, the strength and outcome of these priority effects depended on the sequence of addition, even after accounting for the fact that parasites added early in host development were more likely to encyst compared to parasites added later. Ribeiroia infection success was reduced by 14 % when Echinostoma was added prior to Ribeiroia, whereas no such effect was noted for Echinostoma when Ribeiroia was added first. Using a novel fluorescent-labeling technique that allowed us to track Ribeiroia infections from different exposure events, we also discovered that, similar to the interspecific interactions, early encysting parasites reduced the encystment success of later arriving parasites by 41 %, which could be mediated by host immune responses and/or competition for space. These results suggest that parasite identity interacts with host immune responses to mediate parasite interactions within the host, such that priority effects may play an important role in structuring parasite communities within hosts. This knowledge can be used to assess host–parasite interactions within natural communities in which environmental conditions can lead to heterogeneity in the timing and composition of host exposure to parasites.

Comfort response of three silicone hydrogel daily disposable contact lenses

To evaluate subjective ocular comfort across the day with three silicone hydrogel daily disposables (SHDDs) in a group of adapted lens wearers. Masked subjects (asymptomatic or symptomatic of end-of-day (EOD) dryness with habitual lenses) wore three SHDDs: DAILIES TOTAL1 (DT1), Clariti 1day (C1D), or 1-DAY ACUVUE TRUEYE (AVTE), each for 3 days. On day 2, wearing time (WT) and comfort ratings after insertion, at 4, 8, and 12 hours, and at EOD were recorded. Because not all subjects wore lenses for 12 hours, comfort was analyzed across the day (up to 8 hours, 8 to 12 hours), and a new variable (“cumulative comfort” [CC]) was calculated for EOD. One hundred four subjects completed the study (51 asymptomatic, 53 symptomatic). The two groups had different WTs (mean WT, 14.0 and 12.7 hours, respectively; p < 0.001). Ocular comfort was rated higher in the asymptomatic group throughout the day (p < 0.001). One hundred four subjects wore all three SHDDs for at least 8 hours, whereas 74 (45 asymptomatic, 29 symptomatic) subjects wore them for 12 hours or longer. Comfort ratings were higher with DT1 (least square means [LSM] = 91.0) than with C1D (LSM = 86.5; p < 0.001) and AVTE (LSM = 87.7; p = 0.011) for the first 8 hours and lower with C1D compared with DT1 (p = 0.012) from 8 to 12 hours. Mean EOD (± SD) comfort with the C1D lens was 72 ± 21, lower than both DT1 (mean, 79 ± 17; p = 0.001) and AVTE (mean, 78 ± 21; p = 0.010). Mean CC was higher in the asymptomatic group (mean, 1261 ± 59) compared with that in the symptomatic group (mean, 1009 ± 58; p < 0.001) and higher for DT1 (mean, 1184 ± 258) than C1D (mean, 1094 ± 318; p = 0.002) and AVTE (mean, 1122 ± 297; p = 0.046). All three SHDDs had average WTs of 12 hours or longer for 1 day. Comfort during the first 12 hours was highest with DT1 (similar to AVTE between 8 and 12 hours) and lowest with C1D. End-of-day comfort was lowest with C1D, and CC was highest for DT1. Cumulative comfort may be a valuable new metric to assess ocular comfort during the day.

Seasonal stress physiology and body condition differ among co-occurring tropical finch species.

Seasonal changes in avian hormonal stress responses and condition are well known for common species found at temperate and arctic latitudes, but declining and tropical species are poorly studied. This study compares stress and condition measures of co-occurring declining and non-declining tropical grass finch species in Australia. We monitored declining Gouldian finches (Erythrura gouldiae) and non-declining long-tailed and masked finches (Poepila acuticauda and P. personata) during two seasons that are potentially stressful: peak breeding (early dry season when food is plentiful) and moult (late dry to early wet season when food may be scarce). We measured body condition (muscle and fat), haematocrit, and stress response to capture using plasma corticosterone and binding globulin concentrations. All species had higher muscle and lower fat indices during breeding than moult. Haematocrit did not consistently differ between seasons. Long-tailed finches had higher stress responses during breeding than moult, similar to other passerines studied. Masked finches showed no seasonal changes in stress response. Gouldian finches had stress response patterns opposite to those of long-tailed finches, with higher stress responses during moult. However, seasonal trends in Gouldian and long-tailed finch stress responses sometimes differed between years or sites. The differences in stress response patterns between species suggest that the declining Gouldian finch is more sensitive to recent environmental changes which are thought to further reduce grass seed food resources during the late dry to early wet season. Retention of stress responsiveness during a protracted moult could increase the survival potential of Gouldian finches. This study highlights the utility of stress and condition indices to determine the sensitivity of co-occurring species to environmental conditions.

CD8+ T cells from a novel T cell receptor transgenic mouse induce liver-stage immunity that can be boosted by blood-stage infection in rodent malaria

To follow the fate of CD8+ T cells responsive to Plasmodium berghei ANKA (PbA) infection, we generated an MHC I-restricted TCR transgenic mouse line against this pathogen. T cells from this line, termed PbT-I T cells, were able to respond to blood-stage infection by PbA and two other rodent malaria species, P. yoelii XNL and P. chabaudi AS. These PbT-I T cells were also able to respond to sporozoites and to protect mice from liver-stage infection. Examination of the requirements for priming after intravenous administration of irradiated sporozoites, an effective vaccination approach, showed that the spleen rather than the liver was the main site of priming and that responses depended on CD8α+ dendritic cells. Importantly, sequential exposure to irradiated sporozoites followed two days later by blood-stage infection led to augmented PbT-I T cell expansion. These findings indicate that PbT-I T cells are a highly versatile tool for studying multiple stages and species of rodent malaria and suggest that cross-stage reactive CD8+ T cells may be utilized in liver-stage vaccine design to enable boosting by blood-stage infections.