Biochemical markers and contact lens wear

The project objective was to develop a reliable selection procedure to match contact lens materials with individual wearers by the identification of a biochemical marker for assessment of in-eye performance of contact lenses. There is a need for such a procedure as one of the main reasons for contact lens wearers ceasing wearing contact lenses is poor end of day comfort i.e. the lenses become intolerable to the wearer as the day progresses. The selection of an optimal material for individual wearers has the potential benefit to reduce drop Qut, hence increasing the overall contact lens population, and to improve contact lens comfort for established wearers. Using novel analytical methods and statistical techniques, we were able to investigate the interactions between the composition of the tear film and of the biofilm deposited on the contact lenses and contact lens performance. The investigations were limited to studying the lipid components of the tear film; the lipid layer, which plays a key role in preventing evaporation and stabilising the tear film, has been reported to be significantly thinner and of different mixing characteristics during contact lens wear. Different lipid families were found to influence symptomatology, in vivo tear film structure and stability as well as ocular integrity. Whereas the symptomatology was affected by both the tear film lipid composition and the nature of the lipid deposition, the structure of the tear film and its stability were mainly influenced by the tear film lipid composition. The ocular integrity also appeared to be influenced by the nature of the lipid deposition. Potential markers within the lipid species have been identified and could be applied as follows: When required in order to identify a problematic wearer or to match the contact lens material to the contact lens wearer, tear samples collected by the clinician could be dispatched to an analytical laboratory where lipid analysis could be carried out by HPLC. A colorimetric kit based on the lipid markers could also be developed and used by clinician directly in the practice; such a kit would involve tear sampling and classification according to the colour into "Problem", "Border line" and "Good" contact lens wearers groups. A test kit would also have wider scope for marketing in other areas such as general dry-eye pathology.

Proof in the pedagogic pudding? The challenges of promoting evidence-based teaching practice in a research-focused institution

Drawing upon the findings of a mixed methodological study, this paper critically analyses the cultural, pedagogical, and organisational issues encountered by academics and support staff working within a newly established Centre for Learning Innovation and Professional Practice tasked with facilitating a new teaching-focused policy in a previously research-led institution. The aim of this policy is to assure that, across the institution, teaching is given the same priority and kudos as research. Focusing specifically staff perceptions of the impact of the new policy on various aspects of academic life including, pedagogic practice, student support, staff training, and organisational management, the paper critically addresses the cultural and attitudinal challenges of change management (Kotter, 1996) within a ‘grey-brick’ university. In doing so it makes a significant contribution to current academic theory and debate in the areas of pedagogic practice and organisational management.

Consensus on recording of gas permeable contact lens fit

Purpose: To develop a new schematic scheme for efficiently recording the key parameters of gas permeable contact lens (GP) fits based on current consensus. Methods: Over 100 established GP fitters and educators met to discuss the parameters proposed in educational material for evaluating GP fit and concluded on the key parameters that should be recorded. The accuracy and variability of evaluating the fluorescein pattern of GP fit was determined by having 35 experienced contact lens practitioners from across the world, grading 5 images of a range of fits and the topographer simulation of the same fits, in random, order using the proposed scheme. The accuracy of the grading was compared to objective image analysis of the fluorescein intensity of the same images. Results: The key information to record to adequately describe the fit of an GP was agreed as: the manufacturer, brand and lens parameters; settling time; comfort on a 5 point scale; centration; movement on blink on a ±2 scale; and the Primary Fluorescein Pattern in the central, mid-peripheral and edge regions of the lens averaged along the horizontal and vertical lens axes, on a ±2 scale. On average 50-60% of practitioners selected the median grade when subjectively rating fluorescein intensity and this was correlated to objective quantification (r= 0.602, p< 0.001). Objective grading suggesting horizontal median fluorescein intensity was generally symmetrical, as was the vertical meridian, but this was not the case for subjective grading. Simulated fluorescein patterns were subjectively and objectively graded as being less intense than real photographs (p< 0.01). Conclusion: GP fit recording can be standardised and simplified to enhance GP practice. © 2013 British Contact Lens Association.

Future of contact lens usage

I was recently part of a small committee looking at higher qualifications in contact lens practice and the discussion turned to future technologies. There was mention of different materials and different applications of contact lenses. Drug delivery with contact lenses was discussed as this has been talked about in the literature for a while. The first paper I could find that talked about using contact lenses for drug delivery dates back over 40 years. There was a review paper in CLAE in 2008 that looked specifically at this too [1]. However, where are these products? Why are we not seeing them in the market place? Maybe the technology is not quite there yet, or maybe patents are prohibiting usage or maybe the market is not big enough to develop such products? We do have lenses on the market with slow release of lubricating agents but not therapeutic agents used for ocular or systemic conditions. Contact lenses with pathogen detectors may be part of our contact lens armoury of the future and again we can already see papers in the literature that have trialled this technology for glucose monitoring in diabetics or lactate concentration in the tear film. Future contact lenses may incorporate better optics based on aberration control and we see this starting to emerge with aspheric designs designed to minimise spherical aberration. Irregular corneas can be fitted with topography based designs and again this technology exists and is being used by some manufacturers in their designs already. Moreover, the topography based fitting of irregular corneas is certainly something we see a lot of today and CLAE has seen many articles related to this over the last decade or so. What about further into the future? Well one interesting area must the 3-dimensional contact lenses, or contact lenses with electronic devices built in that simulate a display screen. A little like the virtual display spectacles that are already sold by electronics companies. It does not take much of a stretch of the imagination to see a large electronic company taking this technology on and making it viable. Will we see people on the train watching movies on these electronic virtual reality contact lenses? I think we will, but when is harder to know.

An activity theory approach to strategy as practice

This chapter introduces activity theory as an approach for studying strategy as practice. Activity theory conceptualizes the ongoing construction of activity as a product of activity systems, comprising the actor, the community with which that actor interacts and those symbolic and material tools that mediate between actors, their community and their pursuit of activity. The focus on the mediating role of tools and cultural artefacts in human activity seems especially promising for advancing the strategy-as-practice agenda, for example as a theoretical resource for the growing interest in sociomateriality and the role of tools and artefacts in (strategy) practice (for example, Balogun et al. 2014; Lanzara 2009; Nicolini 2009; Spee and Jarzabkowski 2009; Stetsenko 2005). Despite its potential, in a recent review Vaara and Whittington (2012) identified only three strategy-as-practice articles explicitly applying an activity theory lens. In the wider area of practice-based studies in organizations, activity theory has been slightly more popular (for example, Blackler 1993; 1995; Blackler, Crump and McDonald 2000; Engeström, Kerosuo and Kajamaa 2007; Groleau 2006; Holt 2008; Miettinen and Virkkunen 2005). It still lags behind its potential, however, primarily because of its origins as a social psychology theory developed in Russia with little initial recognition outside the Russian context, particularly in the area of strategy and organization theory, until recently (Miettinen, Samra-Fredericks and Yanow 2009). This chapter explores activity theory as a resource for studying strategy as practice as it is socially accomplished by individuals in interaction with their wider social group and the artefacts of interaction. In particular, activity theory’s focus on actors as social individuals provides a conceptual basis for studying the core question in strategy-as-practice research: what strategy practitioners do. The chapter is structured in three parts. First, an overview of activity theory is provided. Second, activity theory as a practice-based approach to studying organizational action is introduced and an activity system conceptual framework is developed. Third, the elements of the activity system are explained in more detail and explicitly linked to each of the core SAP concepts: practitioners, practices and praxis. In doing so, links are made to existing strategy-as-practice research, with brief empirical examples of topics that might be addressed using activity theory. Throughout the chapter, we introduce key authors in the development of activity theory and its use in management and adjacent disciplinary fields, as further resources for those wishing to make greater use of activity theory.

From art for arts sake to art as means of knowing:a rationale for advancing arts-based methods in research, practice and pedagogy

This paper advances a philosophically informed rationale for the broader, reflexive and practical application of arts-based methods to benefit research, practice and pedagogy. It addresses the complexity and diversity of learning and knowing, foregrounding a cohabitative position and recognition of a plurality of research approaches, tailored and responsive to context. Appreciation of art and aesthetic experience is situated in the everyday, underpinned by multi-layered exemplars of pragmatic visual-arts narrative inquiry undertaken in the third, creative and communications sectors. Discussion considers semi-guided use of arts-based methods as a conduit for topic engagement, reflection and intersubjective agreement; alongside observation and interpretation of organically employed approaches used by participants within daily norms. Techniques span handcrafted (drawing), digital (photography), hybrid (cartooning), performance dimensions (improvised installations) and music (metaphor and structure). The process of creation, the artefact/outcome produced and experiences of consummation are all significant, with specific reflexivity impacts. Exploring methodology and epistemology, both the "doing" and its interpretation are explicated to inform method selection, replication, utility, evaluation and development of cross-media skills literacy. Approaches are found engaging, accessible and empowering, with nuanced capabilities to alter relationships with phenomena, experiences and people. By building a discursive space that reduces barriers; emancipation, interaction, polyphony, letting-go and the progressive unfolding of thoughts are supported, benefiting ways of knowing, narrative (re)construction, sensory perception and capacities to act. This can also present underexplored researcher risks in respect to emotion work, self-disclosure, identity and agenda. The paper therefore elucidates complex, intricate relationships between form and content, the represented and the representation or performance, researcher and participant, and the self and other. This benefits understanding of phenomena including personal experience, sensitive issues, empowerment, identity, transition and liminality. Observations are relevant to qualitative and mixed methods researchers and a multidisciplinary audience, with explicit identification of challenges, opportunities and implications.

Practice based learning approaches in collaborative design and engineering education:a case study investigation into the benefits of a crossdisciplinary practice based learning strategy

This study explores the ongoing pedagogical development of a number of undergraduate design and engineering programmes in the United Kingdom. Observations and data have been collected over several cohorts to bring a valuable perspective to the approaches piloted across two similar university departments while trialling a number of innovative learning strategies. In addition to the concurrent institutional studies the work explores curriculum design that applies the principles of Co-Design, multidisciplinary and trans disciplinary learning, with both engineering and product design students working alongside each other through a practical problem solving learning approach known as the CDIO learning initiative (Conceive, Design Implement and Operate) [1]. The study builds on previous work presented at the 2010 EPDE conference: The Effect of Personality on the Design Team: Lessons from Industry for Design Education [2]. The subsequent work presented in this paper applies the findings to mixed design and engineering team based learning, building on the insight gained through a number of industrial process case studies carried out in current design practice. Developments in delivery also aligning the CDIO principles of learning through doing into a practice based, collaborative learning experience and include elements of the TRIZ creative problem solving technique [3]. The paper will outline case studies involving a number of mixed engineering and design student projects that highlight the CDIO principles, combined with an external industrial design brief. It will compare and contrast the learning experience with that of a KTP derived student project, to examine an industry based model for student projects. In addition key areas of best practice will be presented, and student work from each mode will be discussed at the conference.

Global trends in myopia management attitudes and strategies in clinical practice

PURPOSE: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established.

Practice based learning for automotive engineering design students

The automotive industry combines a multitude of professionals to develop a modern car successfully. Within the design and development teams the collaboration and interface between Engineers and Designers is critical to ensure design intent is communicated and maintained throughout the development process. This study highlights recent industry practice with the emergence of Concept Engineers in design teams at Jaguar Land Rover Automotive group. The role of the Concept Engineer emphasises the importance of the Engineering and Design/Styling interface with the Concept engineer able to interact and understand the challenges and specific languages of each specialist area, hence improving efficiency and communication within the design team. Automotive education tends to approach design from two distinct directions, that of engineering design through BSc courses or a more styling design approach through BA and BDes routes. The educational challenge for both types of course is to develop engineers and stylist's who have greater understanding and experience of each other's specialist perspective of design and development. The study gives examples of two such courses in the UK who are developing programmes to help students widen their understanding of the engineering and design spectrum. Initial results suggest the practical approach has been well received by students and encouraged by industry as they seek graduates with specialist knowledge but also a wider appreciation of their role within the design process.