Accommodating intraocular lenses:a review of design concepts, usage and assessment methods

The correction of presbyopia and restoration of true accommodative function to the ageing eye is the focus of much ongoing research and clinical work. A range of accommodating intraocular lenses (AIOLs) implanted during cataract surgery has been developed and they are designed to change either their position or shape in response to ciliary muscle contraction to generate an increase in dioptric power. Two main design concepts exist. First, axial shift concepts rely on anterior axial movement of one or two optics creating accommodative ability. Second, curvature change designs are designed to provide significant amplitudes of accommodation with little physical displacement. Single-optic devices have been used most widely, although the true accommodative ability provided by forward shift of the optic appears limited and recent findings indicate that alternative factors such as flexing of the optic to alter ocular aberrations may be responsible for the enhanced near vision reported in published studies. Techniques for analysing the performance of AIOLs have not been standardised and clinical studies have reported findings using a wide range of both subjective and objective methods, making it difficult to gauge the success of these implants. There is a need for longitudinal studies using objective methods to assess long-term performance of AIOLs and to determine if true accommodation is restored by the designs available. While dual-optic and curvature change IOLs are designed to provide greater amplitudes of accommodation than is possible with single-optic devices, several of these implants are in the early stages of development and require significant further work before human use is possible. A number of challenges remain and must be addressed before the ultimate goal of restoring youthful levels of accommodation to the presbyopic eye can be achieved.

Investigation of assessment methods for final year optometry undergraduates

This retrospective study was designed to investigate the factors that influence performance in examinations comprised of multiple-choice questions (MCQs), short-answer questions (SAQs), and essay questions in an undergraduate population. Final year optometry degree examination marks were analyzed for two separate cohorts. Direct comparison found that students performed better in MCQs than essays. However, forward stepwise regression analysis of module marks compared with the overall score showed that MCQs were the least influential, and the essay or SAQ mark was a more reliable predictor of overall grade. This has implications for examination design.

Adherence to antiepileptic medicines in children:a multiple-methods assessment involving dried blood spot sampling

Purpose - To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods. Methods - A total of 100 children with epilepsy (≤17 years old) were recruited. Medication adherence was determined via parental and child self-reporting (≥9 years old), medication refill data from general practitioner (GP) prescribing records, and via AED concentrations in dried blood spot (DBS) samples obtained from children at the clinic and via self- or parental-led sampling in children's own homes. The latter were assessed using population pharmacokinetic modeling. Patients were deemed nonadherent if any of these measures were indicative of nonadherence with the prescribed treatment. In addition, beliefs about medicines, parental confidence in seizure management, and the presence of depressed mood in parents were evaluated to examine their association with nonadherence in the participating children. Key Findings - The overall rate of nonadherence in children with epilepsy was 33%. Logistic regression analysis indicated that children with generalized epilepsy (vs. focal epilepsy) were more likely (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.37–15.81) to be classified as nonadherent as were children whose parents have depressed mood (OR 3.6, 95% CI 1.16–11.41). Significance - This is the first study to apply the novel methodology of determining adherence via AED concentrations in clinic and home DBS samples. The present findings show that the latter, with further development, could be a useful approach to adherence assessment when combined with other measures including parent and child self-reporting. Seizure type and parental depressed mood were strongly predictive of nonadherence.

Continuous retinal vessel diameter m easurements: the future in retinal vessel assessment?

PURPOSE. To establish an alternative method, sequential and diameter response analysis (SDRA), to determine dynamic retinal vessel responses and their time course in serial stimulation compared with the established method of averaged diameter responses and standard static assessment. METHODS. SDRA focuses on individual time and diameter responses, taking into account the fluctuation in baseline diameter, providing improved insight into reaction patterns when compared with established methods as delivered by retinal vessel analyzer (RVA) software. SDRA patterns were developed with measurements from 78 healthy nonsmokers and subsequently validated in a group of 21 otherwise healthy smokers. Fundus photography and retinal vessel responses were assessed by RVA, intraocular pressure by contact tonometry, and blood pressure by sphygmomanometry. RESULTS. Compared with the RVA software method, SDRA demonstrated a marked difference in retinal vessel responses to flickering light (P 0.05). As a validation of that finding, SDRA showed a strong relation between baseline retinal vessel diameter and subsequent dilatory response in both healthy subjects and smokers (P 0.001). The RVA software was unable to detect this difference or to find a difference in retinal vessel arteriovenous ratio between smokers and nonsmokers (P 0.243). However, SDRA revealed that smokers’ vessels showed both an increased level of arterial baseline diameter fluctuation before flicker stimulation (P 0.005) and an increased stiffness of retinal arterioles (P 0.035) compared with those in nonsmokers. These differences were unrelated to intraocular pressure or systemic blood pressure. CONCLUSIONS. SDRA shows promise as a tool for the assessment of vessel physiology. Further studies are needed to explore its application in patients with vascular diseases.

Can computer-based testing achieve quality and efficiency in assessment?

This paper reports findings of a two year study concerning the development and implementation of a general-purpose computer-based assessment (CBA) system at a UK University. Data gathering took place over a period of nineteen months, involving a number of formative and summative assessments. Approximately 1,000 students, drawn from undergraduate courses, were involved in the exercise. The techniques used in gathering data included questionnaires, observation, interviews and an analysis of student scores in both conventional examinations and computer-based assessments. Comparisons with conventional assessment methods suggest that the use of CBA techniques may improve the overall performance of students. However it is clear that the technique must not be seen as a "quick fix" for problems such as rising student numbers. If one accepts that current systems test only a relatively narrow range of skills, then the hasty implementation of CBA systems will result in a distorted and inaccurate view of student performance. In turn, this may serve to reduce the overall quality of courses and - ultimately - detract from the student learning experience. On the other hand, if one adopts a considered and methodical approach to computer-based assessment, positive benefits might include increased efficiency and quality, leading to improved student learning.

Quality-driven resource utilization methods for video streaming in wireless communication networks

This research is focused on the optimisation of resource utilisation in wireless mobile networks with the consideration of the users’ experienced quality of video streaming services. The study specifically considers the new generation of mobile communication networks, i.e. 4G-LTE, as the main research context. The background study provides an overview of the main properties of the relevant technologies investigated. These include video streaming protocols and networks, video service quality assessment methods, the infrastructure and related functionalities of LTE, and resource allocation algorithms in mobile communication systems. A mathematical model based on an objective and no-reference quality assessment metric for video streaming, namely Pause Intensity, is developed in this work for the evaluation of the continuity of streaming services. The analytical model is verified by extensive simulation and subjective testing on the joint impairment effects of the pause duration and pause frequency. Various types of the video contents and different levels of the impairments have been used in the process of validation tests. It has been shown that Pause Intensity is closely correlated with the subjective quality measurement in terms of the Mean Opinion Score and this correlation property is content independent. Based on the Pause Intensity metric, an optimised resource allocation approach is proposed for the given user requirements, communication system specifications and network performances. This approach concerns both system efficiency and fairness when establishing appropriate resource allocation algorithms, together with the consideration of the correlation between the required and allocated data rates per user. Pause Intensity plays a key role here, representing the required level of Quality of Experience (QoE) to ensure the best balance between system efficiency and fairness. The 3GPP Long Term Evolution (LTE) system is used as the main application environment where the proposed research framework is examined and the results are compared with existing scheduling methods on the achievable fairness, efficiency and correlation. Adaptive video streaming technologies are also investigated and combined with our initiatives on determining the distribution of QoE performance across the network. The resulting scheduling process is controlled through the prioritization of users by considering their perceived quality for the services received. Meanwhile, a trade-off between fairness and efficiency is maintained through an online adjustment of the scheduler’s parameters. Furthermore, Pause Intensity is applied to act as a regulator to realise the rate adaptation function during the end user’s playback of the adaptive streaming service. The adaptive rates under various channel conditions and the shape of the QoE distribution amongst the users for different scheduling policies have been demonstrated in the context of LTE. Finally, the work for interworking between mobile communication system at the macro-cell level and the different deployments of WiFi technologies throughout the macro-cell is presented. A QoEdriven approach is proposed to analyse the offloading mechanism of the user’s data (e.g. video traffic) while the new rate distribution algorithm reshapes the network capacity across the macrocell. The scheduling policy derived is used to regulate the performance of the resource allocation across the fair-efficient spectrum. The associated offloading mechanism can properly control the number of the users within the coverages of the macro-cell base station and each of the WiFi access points involved. The performance of the non-seamless and user-controlled mobile traffic offloading (through the mobile WiFi devices) has been evaluated and compared with that of the standard operator-controlled WiFi hotspots.

Emerging of human factor in risk analysis of home care service

Risk management in healthcare represents a group of various complex actions, implemented to improve the quality of healthcare services and guarantee the patients safety. Risks cannot be eliminated, but it can be controlled with different risk assessment methods derived from industrial applications and among these the Failure Mode Effect and Criticality Analysis (FMECA) is a largely used methodology. The main purpose of this work is the analysis of failure modes of the Home Care (HC) service provided by local healthcare unit of Naples (ASL NA1) to focus attention on human and non human factors according to the organization framework selected by WHO. © Springer International Publishing Switzerland 2014.

Objective grading of the anterior eye

Purpose. To convert objective image analysis of anterior ocular surfaces into recognisable clinical grades, in order to provide a more sensitive and reliable equivalent to current subjective grading methods; a prospective, randomized study correlating clinical grading with digital image assessment. Methods. The possible range of clinical presentations Of bulbar and palpebral hyperaemia, palpebral roughness and corneal staining were represented by 4 sets of 10 images. The images were displayed in random order and graded by 50 clinicians using both subjective CCLRU and Efron grading scales. Previously validated objective image analysis was performed 3 times oil each of the 40 images. Digital measures included edge-detection and relative-coloration components. Step-wise regression analysis determined correlations between the average subjective grade and the objective image analysis measures. Results. Average subjective grades Could be predicted by a combination of the objective image analysis components. These digital ``grades'' accounted for between 69%, (for Efron scale-graded palpebral redness) and 98% (for Efron scale-graded bulbar hyperaemia) of the subjective variance. Conclusions. The results indicate that clinicians may use a combination of vessel areas and overall hue in their judgment of clinical severity for certain conditions. Objective grading call take these aspects into account, and be used to predict an average ``objective grade'' to be used by a clinician in describing the anterior eye. These measures are more sensitive and reliable than subjective grading while still utilizing familiar terminology, and can be applied in research or practice to improve the detection, and monitoring of ocular surface changes.

Encouraging student to reflect on their employment experience

The purpose behind this case study is to share with a wider audience of placement officers, tutors and those who are involved in the management of placement students or employment of graduates, the approach taken to encourage reflective learning in undergraduate placement students at Aston Business School. Reflective learning forms an important foundation of the placement year at Aston Business School, where a professional placement is a mandatory element of the four year degree, for all Home/EU students (optional for International students) who are taking a Single Honours degree (i.e. a fully business programme). The placement year is not compulsory for those students taking a Combined Honours degree (i.e. a degree where two unrelated subjects are studied), although approximately 50% of those students taking an Aston Business School subject opt to take a placement year. Students spend their year out undertaking a ‘proper’ job within a company or public sector organisation. They are normally paid a reasonable salary for their work (in 2004/5 the average advertised salary was £13,700 per annum). The placement year is assessed, carrying credits which amount to a contribution of 10% towards the students’ final degree. The assessment methods used require the students to submit an academic essay relating theory to practice, a factual report about the company which can be of use to future students, and a log book, the latter being the reflective piece of work. Encouragement to reflect on the placement year has always been an important feature of Aston Business School’s approach to learning. More recently, however, feedback from employers indicated that, although our students have excellent employability skills, “they do not think about them” (Aston Business School Advisory Panel, 2001). We, therefore, began some activities which would encourage students to go beyond the mere acquisition of skills and knowledge. This work became the basis of a programme of introductions to reflective learning, mentoring and awareness of different learning styles written up in Higson and Jones (2002). The idea was to get students used to the idea of reflection on their experiences well before they entered the placement year.

Good practice guide in learning and teaching

This is the second edition of our Aston Business School (ABS) Good Practice Guide and the enthusiasm of the contributors appears undiminished. I am again reminded that I work with a group of very committed, dedicated and professional colleagues. Once again this publication is produced to celebrate and promote good teaching across the School and to offer encouragement to those imaginative and innovative staff who continue to wish to challenge students to learn to maximum effect. It is hoped that others will pick up some good ideas from the articles contained in this volume. Contributors to this Guide were not chosen because they are the best teachers in the School, although they are undoubtedly all amongst my colleagues who are exponents of enthusiastic and inspiring approaches to learning. The Quality Unit approached these individuals because they declared on their Annual Module Reflection Forms that they were doing something interesting and worthwhile which they thought others might find useful. Amongst those reading the Guide I am sure that there are many other individuals who are trying to operate similar examples of good practice in their teaching, learning and assessment methods. I hope that this publication will provoke these people into providing comments and articles of their own and that these will form the basis of next year’s Guide. It may also provoke some people to try these methods in their own teaching. The themes of the articles this year can be divided into two groups. The first theme is the quest to help students to help themselves to learn via student-run tutorials, surprise tests and mock examinations linked with individual tutorials. The second theme is making learning come to life in exciting practical ways by, for example, hands-on workshops and simulations, story telling, rhetorical questioning and discussion groups. A common theme is one of enthusiasm, reflection and commitment on behalf of the lecturers concerned. None of the approaches discussed in this publication are low effort activities on the part of the facilitator, but this effort is regarded as worthwhile as a means of creating greater student engagement. As Biggs (2003)[1] says, in his similarly inspiring way, students learn more the less passive they are in their learning. (Ref). The articles in this publication bear witness of this and much more. Since last year Aston Business School has launched its Research Centre in Higher Education Learning and Management (HELM) which is another initiative to promote excellent learning and teaching. Even before this institution has become fully operational, at least one of the articles in this publication has seen the light of day in the research arena and at least two others are ripe for dissemination to a wider audience via journal publication. More news of our successes in this activity will appear in next year’s edition. May I thank the contributors for taking time out of their busy schedules to write the articles this summer, and to Julie Green who runs the ABS Quality Unit, for putting our diverse approaches into a coherent and publishable form and for chasing us when we have needed it! I would also like to thank Ann Morton and her colleagues in the Centre for Staff Development who have supported this publication. During the last year the Centre has further stimulated the learning and teaching life of the School (and the wider University) via their Learning and Teaching Week and sponsorship of Teaching Quality Enhancement Fund (TQEF) projects. Pedagogic excellence is in better health at Aston than ever before – long may this be because this is what life in HE should be about.

Science or practice? UK undergraduate experiences and attitudes to the MPharm degree

Objective: The debate surrounding the science/practice balance in the teaching of undergraduate pharmacy has been played out in the professional literature for years. The objective of this work was to explore the attitudes of pharmacy undergraduates on the practice-science debate. Setting: The study was undertaken as part of a national study of teaching, learning and assessment methods in United Kingdom (UK) schools of pharmacy. Method: Six focus groups were carried out. The sample was 44 volunteer students from nine UK schools of pharmacy, representing all 4 years of the MPharm programme. Groups were tape recorded and transcribed. Analysis of the transcripts was theme based by topic. Main Outcome Measure: Qualitative data on student attitudes and experiences. Results: Most students thought that there was too strong an emphasis placed on the science components of the course in the early part of their studies. Later in the course they realised that the majority of the science was necessary; it just had not been apparent to them at the time. There were strongly held attitudes across all 4 years that it would be beneficial to include more practice-related material at the beginning of their studies. This would be beneficial for three reasons: to make the course more interesting, to aid in the contextualisation of the science component and to assist the students in any early placement or vacational work. Conclusion: Internationally, changes to the role of the pharmacist from a traditional supply function to a more clinical role has resulted in differing educational needs for the pharmacist of the future. Pharmacy will remain a degree built on a strong scientific background, but students advise that the contextualisation and sequencing of material within the degree could make a considerable improvement to their learning. Consulting students helps us to understand the teaching, learning and assessment experience better by giving insights into ways of improving the delivery. In the case of the UK, there are legislative changes impending which may provide an opportunity to review the balance of practice-and science in the curriculum. © 2006 Springer Science+Business Media B.V.

Specialist business skills of international students

This paper follows on from that presented at the last BEST conference in Edinburgh (Higson & Hamilton-Jones(2004)). At that stage, the authors outlined their initial research work with students studying on the yearlong International Foundation programmes. at three local FE Colleges allied to Aston University. The research (funded by the University's Teaching Quality Enhancement Funds (TQEF) involved questionnaires and interviews with staff and students (the latter all from overseas). it aimed to identify ways to improve the learning experience of students on the International Foundation programmes, to aid their smooth transition to full degree programmes in Business and Management and to improve the progression rates of such students while studying at Aston. The initial research findings were used to design a module for those students' progress to degree programmes in Aston Business School. This paper discusses how the module was designed, its content and the assessment methods used to help determine whether students are achieving the learning outcomes. The basic principle was to identify areas of study where the International Foundation Programme students needed help in order to improve their learning styles to assist them with the requirements of other modules that they would be studying during their time at Aston. Particular emphasis was put on the need to develop active learners who were not disadvantaged by their lack of awareness of UK culture and society and who were as comfortable performing written work under examination conditions or presenting orally as their UK counterparts. An additional aim was to prepare these students for the placement year which was a compulsory part of their degree. The module, therefore, comprises a range of inputs for a number of staff, a company visit, weekly reflective learning leading to Personal Development Plan (PDP) work, formal examinations, presentations, group work •and individual case studies. This paper also reports on the initial reaction of the students and tutors to the new learning experience with currently 30 participants undertaking the module. Provisional findings suggest that the International Foundation programme has prepared the students well for degree-level work and that as a group of international students they are much more analytical and, after studying the module interactive than their counterparts who have come directly onto Aston degrees. It has shown them still to be quite passive learners, comfortable with facts and lecture-style learning environments, but less comfortable when asked to use their own initiatives. Continuing progress needs to be made in terms of encouraging them to develop a reflective approach to learning with the students taking some time to feel comfortable with an analytical approach to learning. In addition, im account of the students' reactions to having to work through a formal (PDP) and the results of their first assessments will be provided. At Aston, this work is being used as a pilot to recognise good practice with regards to work with further groups of international students. it is hoped that this would have widespread application across the sector.

Resource-efficient supply chains:a research framework, literature review and research agenda

Purpose: To define a research agenda for creating Resource-Efficient Supply Chains (RESC) by identifying and analysing their key characteristics as well as future research opportunities. Design/methodology/approach: We follow a systematic review method to analyse the literature and to understand RESC taking a substantive theory approach. Our approach is grounded in a specific domain, the agri-food sector, because it is an intensive user of an extensive range of resources. Findings: The review shows that literature has looked at the use of resources primarily from the environmental impact perspective. It shows a lack of understanding of the specific RESC characteristics, and concludes more research is needed on multi-disciplinary methods for resource use and impact analyses as well as assessment methods for resource sensitivity and responsiveness. There is a need to explore whether or not, and how, logistics/supply chain decisions will affect the overall configuration of future food supply chains in an era of resource scarcity and depletion and what the trade-offs will be. Research limitations/implications: The paper proposes an agenda for future research in the area of resource–efficient supply chain. The framework proposed along with the key characteristics identified for RESC can be applied to other sectors. Practical implications: Our research should facilitate further understanding of the implications and trade-offs of supply chain decisions taken on the use of resources by supply chain managers. Originality/value: The paper explores the interaction between supply chains and natural resources and also defines the key characteristics of RESC.

Driving licensing renewal policy using neural network-based probabilistic decision support system

This paper investigates neural network-based probabilistic decision support system to assess drivers' knowledge for the objective of developing a renewal policy of driving licences. The probabilistic model correlates drivers' demographic data to their results in a simulated written driving exam (SWDE). The probabilistic decision support system classifies drivers' into two groups of passing and failing a SWDE. Knowledge assessment of drivers within a probabilistic framework allows quantifying and incorporating uncertainty information into the decision-making system. The results obtained in a Jordanian case study indicate that the performance of the probabilistic decision support systems is more reliable than conventional deterministic decision support systems. Implications of the proposed probabilistic decision support systems on the renewing of the driving licences decision and the possibility of including extra assessment methods are discussed.

Dialogic education:reflections from an accounting course

Our paper aims to contribute to the growing body of literature that has suggested that tertiary accounting education should not simply transfer technical/functional/vocational accounting knowledge. This literature suggests that a more critical accounting educational content complemented by a more dialogical teaching approach is more appropriate. Our paper provides further reflections on just such a course and the challenges that this raises. Specifically, it comments on learner resistance and engagement, syllabus design, delivery and assessment methods. In addition, this paper introduces the role that theory, secondary research and debates have played in this course. The value of this type of course, in terms of developing and transforming the learners is discussed.