Ocular surface changes with short-term contact lens wear

Contact lenses are a common method for the correction of refractive errors of the eye. While there have been significant advancements in contact lens designs and materials over the past few decades, the lenses still represent a foreign object in the ocular environment and may lead to physiological as well as mechanical effects on the eye. When contact lenses are placed in the eye, the ocular anatomical structures behind and in front of the lenses are directly affected. This thesis presents a series of experiments that investigate the mechanical and physiological effects of the short-term use of contact lenses on anterior and posterior corneal topography, corneal thickness, the eyelids, tarsal conjunctiva and tear film surface quality. The experimental paradigm used in these studies was a repeated measures, cross-over study design where subjects wore various types of contact lenses on different days and the lenses were varied in one or more key parameters (e.g. material or design). Both, old and newer lens materials were investigated, soft and rigid lenses were used, high and low oxygen permeability materials were tested, toric and spherical lens designs were examined, high and low powers and small and large diameter lenses were used in the studies. To establish the natural variability in the ocular measurements used in the studies, each experiment also contained at least one “baseline” day where an identical measurement protocol was followed, with no contact lenses worn. In this way, changes associated with contact lens wear were considered in relation to those changes that occurred naturally during the 8 hour period of the experiment. In the first study, the regional distribution and magnitude of change in corneal thickness and topography was investigated in the anterior and posterior cornea after short-term use of soft contact lenses in 12 young adults using the Pentacam. Four different types of contact lenses (Silicone hydrogel/ Spherical/–3D, Silicone Hydrogel/Spherical/–7D, Silicone Hydrogel/Toric/–3D and HEMA/Toric/–3D) of different materials, designs and powers were worn for 8 hours each, on 4 different days. The natural diurnal changes in corneal thickness and curvature were measured on two separate days before any contact lens wear. Significant diurnal changes in corneal thickness and curvature within the duration of the study were observed and these were taken into consideration for calculating the contact lens induced corneal changes. Corneal thickness changed significantly with lens wear and the greatest corneal swelling was seen with the hydrogel (HEMA) toric lens with a noticeable regional swelling of the cornea beneath the stabilization zones, the thickest regions of the lenses. The anterior corneal surface generally showed a slight flattening with lens wear. All contact lenses resulted in central posterior corneal steepening, which correlated with the relative degree of corneal swelling. The corneal swelling induced by the silicone hydrogel contact lenses was typically less than the natural diurnal thinning of the cornea over this same period (i.e. net thinning). This highlights why it is important to consider the natural diurnal variations in corneal thickness observed from morning to afternoon to accurately interpret contact lens induced corneal swelling. In the second experiment, the relative influence of lenses of different rigidity (polymethyl methacrylate – PMMA, rigid gas permeable – RGP and silicone hydrogel – SiHy) and diameters (9.5, 10.5 and 14.0) on corneal thickness, topography, refractive power and wavefront error were investigated. Four different types of contact lenses (PMMA/9.5, RGP/9.5, RGP/10.5, SiHy/14.0), were worn by 14 young healthy adults for a period of 8 hours on 4 different days. There was a clear association between fluorescein fitting pattern characteristics (i.e. regions of minimum clearance in the fluorescein pattern) and the resulting corneal shape changes. PMMA lenses resulted in significant corneal swelling (more in the centre than periphery) along with anterior corneal steepening and posterior flattening. RGP lenses, on the other hand, caused less corneal swelling (more in the periphery than centre) along with opposite effects on corneal curvature, anterior corneal flattening and posterior steepening. RGP lenses also resulted in a clinically and statistically significant decrease in corneal refractive power (ranging from 0.99 to 0.01 D), large enough to affect vision and require adjustment in the lens power. Wavefront analysis also showed a significant increase in higher order aberrations after PMMA lens wear, which may partly explain previous reports of "spectacle blur" following PMMA lens wear. We further explored corneal curvature, thickness and refractive changes with back surface toric and spherical RGP lenses in a group of 6 subjects with toric corneas. The lenses were worn for 8 hours and measurements were taken before and after lens wear, as in previous experiments. Both lens types caused anterior corneal flattening and a decrease in corneal refractive power but the changes were greater with the spherical lens. The spherical lens also caused a significant decrease in WTR astigmatism (WRT astigmatism defined as major axis within 30 degrees of horizontal). Both the lenses caused slight posterior corneal steepening and corneal swelling, with a greater effect in the periphery compared to the central cornea. Eyelid position, lid-wiper and tarsal conjunctival staining were also measured in Experiment 2 after short-term use of the rigid and SiHy contact lenses. Digital photos of the external eyes were captured for lid position analysis. The lid-wiper region of the marginal conjunctiva was stained using fluorescein and lissamine green dyes and digital photos were graded by an independent masked observer. A grading scale was developed in order to describe the tarsal conjunctival staining. A significant decrease in the palpebral aperture height (blepharoptosis) was found after wearing of PMMA/9.5 and RGP/10.5 lenses. All three rigid contact lenses caused a significant increase in lid-wiper and tarsal staining after 8 hours of lens wear. There was also a significant diurnal increase in tarsal staining, even without contact lens wear. These findings highlight the need for better contact lens edge design to minimise the interactions between the lid and contact lens edge during blinking and more lubricious contact lens surfaces to reduce ocular surface micro-trauma due to friction and for. Tear film surface quality (TFSQ) was measured using a high-speed videokeratoscopy technique in Experiment 2. TFSQ was worse with all the lenses compared to baseline (PMMA/9.5, RGP/9.5, RGP/10.5, and SiHy/14) in the afternoon (after 8 hours) during normal and suppressed blinking conditions. The reduction in TFSQ was similar with all the contact lenses used, irrespective of their material and diameter. An unusual pattern of change in TFSQ in suppressed blinking conditions was also found. The TFSQ with contact lens was found to decrease until a certain time after which it improved to a value even better than the bare eye. This is likely to be due to the tear film drying completely over the surface of the contact lenses. The findings of this study also show that there is still a scope for improvement in contact lens materials in terms of better wettability and hydrophilicity in order to improve TFSQ and patient comfort. These experiments showed that a variety of changes can occur in the anterior eye as a result of the short-term use of a range of commonly used contact lens types. The greatest corneal changes occurred with lenses manufactured from older HEMA and PMMA lens materials, whereas modern SiHy and rigid gas permeable materials caused more subtle changes in corneal shape and thickness. All lenses caused signs of micro-trauma to the eyelid wiper and palpebral conjunctiva, although rigid lenses appeared to cause more significant changes. Tear film surface quality was also significantly reduced with all types of contact lenses. These short-term changes in the anterior eye are potential markers for further long term changes and the relative differences between lens types that we have identified provide an indication of areas of contact lens design and manufacture that warrant further development.

Were regulatory changes in reporting "abnormal items" justified? : evidence of intra-period classificatory earnings management practices in Australia

Purpose Managers generally have discretion in determining how components of earnings are presented in financial statements in distinguishing between ‘normal’ earnings and items classified as unusual, special, significant, exceptional or abnormal. Prior research has found that such intra-period classificatory choice is used as a form of earnings management. Prior to 2001, Australian accounting standards mandated that unusually large items of revenue and expense be classified as ‘abnormal items’ for financial reporting, but this classification was removed from accounting standards from 2001. This move by the regulators was partly in response to concerns that the abnormal classification was being used opportunistically to manage reported pre-abnormal earnings. This study extends the earnings management literature by examining the reporting of abnormal items for evidence of intra-period classificatory earnings management in the unique Australian setting. Design/methodology/approach This study investigates associations between reporting of abnormal items and incentives in the form of analyst following and the earnings benchmarks of analysts’ forecasts, earnings levels, and earnings changes, for a sample of Australian top-500 firms for the seven-year period from 1994 to 2000. Findings The findings suggest there are systematic differences between firms reporting abnormal items and those with no abnormal items. Results show evidence that, on average, firms shifted expense items from pre-abnormal earnings to bottom line net income through reclassification as abnormal losses. Originality/value These findings suggest that the standard setters were justified in removing the ‘abnormal’ classification from the accounting standard. However, it cannot be assumed that all firms acted opportunistically in the classification of items as abnormal. With the removal of the standardised classification of items outside normal operations as ‘abnormal’, firms lost the opportunity to use such disclosures as a signalling device, with the consequential effect of limiting the scope of effectively communicating information about the nature of items presented in financial reports.

Job changes, occupational mobility and human capital acquisition : an empirical analysis

Most individuals have more than one job or occupation in their working lives. Most employees are repeatedly faced with the choice of whether to remain in their present job (with the possibility of promotion), or quit to another job in the same occupation with a different firm, or - more radically change occupation. At each stage in an individual's career, the scope for future job or occupational mobility is largely conditioned by the type and quantity of their human capital. This paper presents an empirical study of the factors which link occupational mobility and the acquisition of either firm-based, occupation-specific or general human capital. The data employed are from a cohort of 1980 UK graduates drawn from the Department of Employment Survey 1987. The econometric work presents estimates of the role of firm-based training and occupation-specific training in the career mobility of qualified manpower in the first seven years in the labour market

Using communicative ecology theory to scope the emerging role of social media in the evolution of urban food systems

Urban agriculture plays an increasingly vital role in supplying food to urban populations. Changes in Information and Communications Technology (ICT) are already driving widespread change in diverse food-related industries such as retail, hospitality and marketing. It is reasonable to suspect that the fields of ubiquitous technology, urban informatics and social media equally have a lot to offer the evolution of core urban food systems. We use communicative ecology theory to describe emerging innovations in urban food systems according to their technical, discursive and social components. We conclude that social media in particular accentuate fundamental social interconnections normally effaced by conventional industrialised approaches to food production and consumption.

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: Stakeholder perspectives, barriers, supports, and incentives

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes. © 2014 Morris et al.

The scope for biomanipulation in improving water quality

Biomanipulation is a form of biological engineering in which organisms are selectively removed or encouraged to alleviate the symptoms of eutrophication. Most examples involve fish and grazer zooplankton though mussels have also been used. The technique involves continuous management in many deeper lakes and is not a substitute for nutrient control. In some lakes, alterations to the lake environment have given longer-term positive effects. And in some shallow lakes, biomanipulation may be essential, alongside nutrient control, in re- establishing former aquatic-plant-dominated ecosystems which have been lost through severe eutrophication. The emergence of biomanipulation techniques emphasises that lake systems are not simply chemical reactors which respond simply to engineered chemical changes, but very complex and still very imperfectly understood ecosystems which require a yet profounder understanding before they can be restored with certainty.

Knowledge and perceptions among overweight and obese employees about lifestyle-related health benefit changes.

We investigated perceptions among overweight and obese state employees about changes to health insurance that were designed to reduce the scope of health benefits for employees who are obese or who smoke. Before implementation of health benefit plan changes, 658 state employees who were overweight (ie, those with a body mass index [BMI] of 25-29.9) or obese (ie, those with a BMI of > or = 30) enrolled in a weight-loss intervention study were asked about their attitudes and beliefs concerning the new benefit plan changes. Thirty-one percent of employees with a measured BMI of 40 or greater self-reported a BMI of less than 40, suggesting they were unaware that their current BMI would place them in a higher-risk benefit plan. More than half of all respondents reported that the new benefit changes would motivate them to make behavioral changes, but fewer than half felt confident in their ability to make changes. Respondents with a BMI of 40 or greater were more likely than respondents in lower BMI categories to oppose the new changes focused on obesity (P < .001). Current smokers were more likely than former smokers and nonsmokers to oppose the new benefit changes focused on tobacco use (P < .01). Participants represented a sample of employees enrolled in a weight-loss study, limiting generalizability to the larger population of state employees. Benefit plan changes that require employees who are obese and smoke to pay more for health care may motivate some, but not all, individuals to change their behaviors. Since confidence to lose weight was lowest among individuals in the highest BMI categories, more-intense intervention options may be needed to achieve desired health behavior changes.

An Inquiry of Changes in Environmental Governance by Community-driven Process

Urban environmental depletion has been a critical problem among industrialized-transformed societies, especially at the local level where administrative authorities’ capacity lags behind changes. Derived from governance concept, the idea of civil society inclusion is highlighted. Focusing on an agglomerated case study, Bang Plee Community in Thailand, this research investigates on a non-state sector, 201-Community organization, as an agent for changes to improve urban environments on solid waste collection. Two roles are contested: as an agent for neighborhood internal change and as an intermediary toward governance changes in state-civil society interaction. By employing longitudinal analysis via a project intervention as research experiment, the outcomes of both roles are detected portrayed in three spheres: state, state-civil society interaction, and civil society sphere. It discovers in the research regarding agglomerated context that as an internal changes for environmental betterment, 201-Community organization operation brings on waste reduction at the minimal level. Community-based organization as an agent for changes – despite capacity input it still limited in efficiency and effectiveness – can mobilize fruitfully only at the individual and network level of civil society sectors, while fails managing at the organizational level. The positive outcomes result by economic waste incentive associated with a limited-bonded group rather than the rise of awareness at large. As an intermediary agent for shared governance, the community-based organization cannot bring on mutual dialogue with state as much as cannot change the state’s operation arena of solid waste management. The findings confine the shared governance concept that it does not applicable in agglomerated locality as an effective outcome, both in terms of being instrumental toward civil society inclusion and being provocative of internal change. Shared environmental governance as summarized in this research can last merely a community development action. It distances significantly from civil society inclusion and empowerment. However, the research proposes that community-based environmental management and shared governance toward civil society inclusion in urban environmental improvement are still an expectable option and reachable if their factors and conditions of key success and failure are intersected with a particular context. Further studies demand more precise on scale, scope, and theses factors of environmental management operation operated by civil society sectors.

Palm heart harvesting in the Brazilian Atlantic forest: changes in industry structure and the illegal trade

1. Until the late 1960s, Euterpe edulis was the most important edible palm species in the Brazilian markets. Since then, overharvesting of natural stands and the limited scope of plantations have caused the industry to shift to the multistemmed E, oleracea from the Amazon river estuary.2, As a result of the relocation of the industry, the structure of the palm harvesting industry has changed and illegal trade has continued to exploit the remaining natural stands of E, edulis.3, it is suggested that, to avoid the total harvesting of E. edulis and to achieve sustainable management of the palm heart, it will be necessary to diversify the local economy, create incentives for small land owners to improve their management practices, while keeping their competitiveness against the illegal trade, create the incentive of new sources of palm hearts and create a 'green stamping' For management palms.4, Transformation of the illegal structure of the palm heart industry is probably the only solution to avoid the total depletion of the wild stands of E. edulis.

Latin America and the Caribbean in the World Economy 2013: A sluggish postcrisis, mega trade negotiations and value chains: scope for regional action

Incluye bibliografía.

Language Boxes: Bending the Host Language with Modular Language Changes

As domain-specific modeling begins to attract widespread acceptance, pressure is increasing for the development of new domain-specific languages. Unfortunately these DSLs typically conflict with the grammar of the host language, making it difficult to compose hybrid code except at the level of strings; few mechanisms (if any) exist to control the scope of usage of multiple DSLs; and, most seriously, existing host language tools are typically unaware of the DSL extensions, thus hampering the development process. Language boxes address these issues by offering a simple, modular mechanism to encapsulate (i) compositional changes to the host language, (ii) transformations to address various concerns such as compilation and highlighting, and (iii) scoping rules to control visibility of language extensions. We describe the design and implementation of language boxes, and show with the help of several examples how modular extensions can be introduced to a host language and environment.

Effectiveness for Ddtecting faults within and outside the scope of testing techniques: an independent replication

The verification and validation activity plays a fundamental role in improving software quality. Determining which the most effective techniques for carrying out this activity are has been an aspiration of experimental software engineering researchers for years. This paper reports a controlled experiment evaluating the effectiveness of two unit testing techniques (the functional testing technique known as equivalence partitioning (EP) and the control-flow structural testing technique known as branch testing (BT)). This experiment is a literal replication of Juristo et al. (2013).Both experiments serve the purpose of determining whether the effectiveness of BT and EP varies depending on whether or not the faults are visible for the technique (InScope or OutScope, respectively). We have used the materials, design and procedures of the original experiment, but in order to adapt the experiment to the context we have: (1) reduced the number of studied techniques from 3 to 2; (2) assigned subjects to experimental groups by means of stratified randomization to balance the influence of programming experience; (3) localized the experimental materials and (4) adapted the training duration. We ran the replication at the Escuela Politécnica del Ejército Sede Latacunga (ESPEL) as part of a software verification & validation course. The experimental subjects were 23 master?s degree students. EP is more effective than BT at detecting InScope faults. The session/program andgroup variables are found to have significant effects. BT is more effective than EP at detecting OutScope faults. The session/program and group variables have no effect in this case. The results of the replication and the original experiment are similar with respect to testing techniques. There are some inconsistencies with respect to the group factor. They can be explained by small sample effects. The results for the session/program factor are inconsistent for InScope faults.We believe that these differences are due to a combination of the fatigue effect and a technique x program interaction. Although we were able to reproduce the main effects, the changes to the design of the original experiment make it impossible to identify the causes of the discrepancies for sure. We believe that further replications closely resembling the original experiment should be conducted to improve our understanding of the phenomena under study.

Effectiveness for detecting faults within and outside the scope of testing techniques: an independent replication

The verification and validation activity plays a fundamental role in improving software quality. Determining which the most effective techniques for carrying out this activity are has been an aspiration of experimental software engineering researchers for years. This paper reports a controlled experiment evaluating the effectiveness of two unit testing techniques (the functional testing technique known as equivalence partitioning (EP) and the control-flow structural testing technique known as branch testing (BT)). This experiment is a literal replication of Juristo et al. (2013). Both experiments serve the purpose of determining whether the effectiveness of BT and EP varies depending on whether or not the faults are visible for the technique (InScope or OutScope, respectively). We have used the materials, design and procedures of the original experiment, but in order to adapt the experiment to the context we have: (1) reduced the number of studied techniques from 3 to 2; (2) assigned subjects to experimental groups by means of stratified randomization to balance the influence of programming experience; (3) localized the experimental materials and (4) adapted the training duration. We ran the replication at the Escuela Polite?cnica del Eje?rcito Sede Latacunga (ESPEL) as part of a software verification & validation course. The experimental subjects were 23 master?s degree students. EP is more effective than BT at detecting InScope faults. The session/program and group variables are found to have significant effects. BT is more effective than EP at detecting OutScope faults. The session/program and group variables have no effect in this case. The results of the replication and the original experiment are similar with respect to testing techniques. There are some inconsistencies with respect to the group factor. They can be explained by small sample effects. The results for the session/program factor are inconsistent for InScope faults. We believe that these differences are due to a combination of the fatigue effect and a technique x program interaction. Although we were able to reproduce the main effects, the changes to the design of the original experiment make it impossible to identify the causes of the discrepancies for sure. We believe that further replications closely resembling the original experiment should be conducted to improve our understanding of the phenomena under study.

Geographic Scope Under Conditions Of Confined And Connected Change: The Case Of Telefónica (Spain). ACES Working Papers, 2012

Traditional explanations of MNE geographic scope formation fit somewhat uncomfortably with recent empirical and theoretical work in IB that suggests (1) that wholesale (not just gradual) changes in MNE geographic scope may be more frequent than previously thought, and (2) that managers’ responses to a world increasingly characterized by random, unpredictable change are more experimental and less optimizing in nature than assumed in most models of international expansion. In this paper we draw from studies portraying industries as dynamic networks, and from the literature on managerial cognition to provide a complementary explanation of the evolution of MNE geographic scope that reconciles the insights of traditional IB models with the questions raised by more recent studies in this field. We illustrate the proposed model through a detailed account of the internationalization process of Telefonica, the Spanish telecommunications company.

Signalling changes to individuals who show resistance to change can reduce challenging behaviour

Background & objectives Several neurodevelopmental disorders are associated with resistance to change and challenging behaviours – including temper outbursts – that ensue following changes to routines, plans or expectations (here, collectively: expectations). Here, a change signalling intervention was tested for proof of concept and potential practical effectiveness. Methods Twelve individuals with Prader-Willi syndrome participated in researcher- and caregiver-led pairing of a distinctive visual-verbal signal with subsequent changes to expectations. Specific expectations for a planned subset of five participants were systematically observed in minimally manipulated natural environments. Nine caregivers completed a temper outburst diary during a four week baseline period and a two week signalling evaluation period. Results Participants demonstrated consistently less temper outburst behaviour in the systematic observations when changes imposed to expectations were signalled, compared to when changes were not signalled. Four of the nine participants whose caregivers completed the behaviour diary demonstrated reliable reductions in temper outbursts between baseline and signalling evaluation. Limitations An active control group for the present initial evaluation of the signalling strategy using evidence from caregiver behaviour diaries was outside the scope of the present pilot study. Thus, findings cannot support the clinical efficacy of the present signalling approach. Conclusions Proof of concept evidence that reliable pairing of a distinctive cue with a subsequent change to expectation can reduce associated challenging behaviour is provided. Data provide additional support for the importance of specific practical steps in further evaluations of the change signalling approach.