Corneal confocal microscopy : a novel noninvasive test to diagnose and stratify the severity of human diabetic neuropathy

OBJECTIVE: The accurate quantification of human diabetic neuropathy is important to define at-risk patients, anticipate deterioration, and assess new therapies. ---------- RESEARCH DESIGN AND METHODS: A total of 101 diabetic patients and 17 age-matched control subjects underwent neurological evaluation, neurophysiology tests, quantitative sensory testing, and evaluation of corneal sensation and corneal nerve morphology using corneal confocal microscopy (CCM). ---------- RESULTS: Corneal sensation decreased significantly (P = 0.0001) with increasing neuropathic severity and correlated with the neuropathy disability score (NDS) (r = 0.441, P < 0.0001). Corneal nerve fiber density (NFD) (P < 0.0001), nerve fiber length (NFL), (P < 0.0001), and nerve branch density (NBD) (P < 0.0001) decreased significantly with increasing neuropathic severity and correlated with NDS (NFD r = −0.475, P < 0.0001; NBD r = −0.511, P < 0.0001; and NFL r = −0.581, P < 0.0001). NBD and NFL demonstrated a significant and progressive reduction with worsening heat pain thresholds (P = 0.01). Receiver operating characteristic curve analysis for the diagnosis of neuropathy (NDS >3) defined an NFD of <27.8/mm2 with a sensitivity of 0.82 (95% CI 0.68–0.92) and specificity of 0.52 (0.40–0.64) and for detecting patients at risk of foot ulceration (NDS >6) defined a NFD cutoff of <20.8/mm2 with a sensitivity of 0.71 (0.42–0.92) and specificity of 0.64 (0.54–0.74). ---------- CONCLUSIONS: CCM is a noninvasive clinical technique that may be used to detect early nerve damage and stratify diabetic patients with increasing neuropathic severity. Established diabetic neuropathy leads to pain and foot ulceration. Detecting neuropathy early may allow intervention with treatments to slow or reverse this condition (1). Recent studies suggested that small unmyelinated C-fibers are damaged early in diabetic neuropathy (2–4) but can only be detected using invasive procedures such as sural nerve biopsy (4,5) or skin-punch biopsy (6–8). Our studies have shown that corneal confocal microscopy (CCM) can identify early small nerve fiber damage and accurately quantify the severity of diabetic neuropathy (9–11). We have also shown that CCM relates to intraepidermal nerve fiber loss (12) and a reduction in corneal sensitivity (13) and detects early nerve fiber regeneration after pancreas transplantation (14). Recently we have also shown that CCM detects nerve fiber damage in patients with Fabry disease (15) and idiopathic small fiber neuropathy (16) when results of electrophysiology tests and quantitative sensory testing (QST) are normal. In this study we assessed corneal sensitivity and corneal nerve morphology using CCM in diabetic patients stratified for the severity of diabetic neuropathy using neurological evaluation, electrophysiology tests, and QST. This enabled us to compare CCM and corneal esthesiometry with established tests of diabetic neuropathy and define their sensitivity and specificity to detect diabetic patients with early neuropathy and those at risk of foot ulceration.

Destination positioning opportunities elicited through the repertory test with laddering analysis

While in many travel situations consumers have an almost limitless range of destinations to choose from, their actual decision set will usually only comprise between two and six destinations. One of the greatest challenges facing destination marketers is positioning their destination, against the myriad of competing places that offer similar features, into consumer decision sets. Since positioning requires a narrow focus, marketing communications must present a succinct and meaningful proposition, the selection of which is often problematic for destination marketing organisations (DMO), which deal with a diverse and often eclectic range of attributes in addition to numerous self-interested and demanding stakeholders. This paper reports the application of two qualitative techniques used to explore the range of cognitive attributes, consequences and personal values that represent potential positioning opportunities in the context of short break holidays. The Repertory Test is an effective technique for understanding the salient attributes used by a traveller to differentiate destinations, while Laddering Analysis enables the researcher to explore the smaller set of personal values guiding such decision making. A key finding of the research was that while individuals might vary in their repertoire of salient attributes, there was a commonality of shared consequences and values.

A measurement instrument for process modeling research : development, test and procedural model

Process modeling is an emergent area of Information Systems research that is characterized through an abundance of conceptual work with little empirical research. To fill this gap, this paper reports on the development and validation of an instrument to measure user acceptance of process modeling grammars. We advance an extended model for a multi-stage measurement instrument development procedure, which incorporates feedback from both expert and user panels. We identify two main contributions: First, we provide a validated measurement instrument for the study of user acceptance of process modeling grammars, which can be used to assist in further empirical studies that investigate phenomena associated with the business process modeling domain. Second, in doing so, we describe in detail a procedural model for developing measurement instruments that ensures high levels of reliability and validity, which may assist fellow scholars in executing their empirical research.

A test of podcasting effectiveness for lecture revision

It is important to understand how student performance when higher education is delivered by via new technology. Podcasting is a relatively recent new technology gaining widespread use across the world. We present the results of a quasi-experimental research project that finds when podcasts are used as a revision tool, student performance in Accounting improves. We highlight that aligning podcast use with pedagological design is important and discuss constraints on and barriers to the use of podcasting in higher education.

A virtual test assessment tool for second year signal processing students

The development and use of a virtual assessment tool for a signal processing unit is described. It allows students to take a test from anywhere using a web browser to connect to the university server that hosts the test. While student responses are of the multiple choice type, they have to work out problems to arrive at the answer to be entered. CGI programming is used to verify student identification information and record their scores as well as provide immediate feedback after the test is complete. The tool has been used at QUT for the past 3 years and student feedback is discussed. The virtual assessment tool is an efficient alternative to marking written assignment reports that can often take more hours than actual lecture hall contact from a lecturer or tutor. It is especially attractive for very large classes that are now the norm at many universities in the first two years.

A controlled rapid approach to curriculum change : addressing the pressures of increased test-based accountability on schools

Increasingly, large amounts of public and private money are being invested in education and as a result, schools are becoming more accountable to stakeholders for this financial input. In terms of the curriculum, governments worldwide are frequently tying school funding to students‟ and schools‟ academic performances, which are monitored through high-stakes testing programs. To accommodate the resultant pressures from these testing initiatives, many principals are re-focussing their school‟s curriculum on the testing requirements. Such a re-focussing, which was examined critically in this thesis, constituted an externally facilitated rapid approach to curriculum change. In line with previously enacted change theories and recommendations from these, curriculum change in schools has tended to be a fairly slow, considered, collaborative process that is facilitated internally by a deputy-principal (curriculum). However, theoretically based research has shown that such a process has often proved to be difficult and very rarely successful. The present study reports and theorises the experiences of an externally facilitated process that emerged from a practitioner model of change. This case study of the development of the controlled rapid approach to curriculum change began by establishing the reasons three principals initiated curriculum change and why they then engaged an outsider to facilitate the process. It also examined this particular change process from the perspectives of the research participants. The investigation led to the revision of the practitioner model as used in the three schools and challenged the current thinking about the process of school curriculum change. The thesis aims to offer principals and the wider education community an alternative model for consideration when undertaking curriculum change. Finally, the thesis warns that, in the longer term, the application of study‟s revised model (the Controlled Rapid Approach to Curriculum Change [CRACC] Model) may have less then desirable educational consequences.

A test of the job demands : resources model with HIV/AIDS volunteers

Burnout has been identified as a significant factor in HIV/AIDS volunteering. It has been associated with depression, anxiety and the loss of volunteers from the health care delivery system. The aim of this study was to test the independence of the health and motivational processes hypothesized within the Job Demands – Resources model of burnout in HIV/AIDS volunteers. Participants were 307 HIV/AIDS volunteers from state AIDS Councils throughout Australia who completed self-report measures pertaining to role ambiguity and role conflict, social support, burnout, intrinsic and organizational satisfaction, and depression. Findings suggested that the independence of the dual processes hypothesized by the model was only partially supported. These findings provide a model for burnout which gives a framework for interventions at both the individual and organizational level which would contribute to the prevention of burnout, depression, and job dissatisfaction in HIV/AIDS volunteers.

Primary students’ interpretation of maps : gesture use and mapping knowledge

Maps are used to represent three-dimensional space and are integral to a range of everyday experiences. They are increasingly used in mathematics, being prominent both in school curricula and as a form of assessing students understanding of mathematics ideas. In order to successfully interpret maps, students need to be able to understand that maps: represent space, have their own perspective and scale, and their own set of symbols and texts. Despite the fact that maps have an increased prevalence in society and school, there is evidence to suggest that students have difficulty interpreting maps. This study investigated 43 primary-aged students’ (aged 9-12 years) verbal and gestural behaviours as they engaged with and solved map tasks. Within a multiliteracies framework that focuses on spatial, visual, linguistic, and gestural elements, the study investigated how students interpret map tasks. Specifically, the study sought to understand students’ skills and approaches used to solving map tasks and the gestural behaviours they utilised as they engaged with map tasks. The investigation was undertaken using the Knowledge Discovery in Data (KDD) design. The design of this study capitalised on existing research data to carry out a more detailed analysis of students’ interpretation of map tasks. Video data from an existing data set was reorganised according to two distinct episodes—Task Solution and Task Explanation—and analysed within the multiliteracies framework. Content Analysis was used with these data and through anticipatory data reduction techniques, patterns of behaviour were identified in relation to each specific map task by looking at task solution, task correctness and gesture use. The findings of this study revealed that students had a relatively sound understanding of general mapping knowledge such as identifying landmarks, using keys, compass points and coordinates. However, their understanding of mathematical concepts pertinent to map tasks including location, direction, and movement were less developed. Successful students were able to interpret the map tasks and apply relevant mathematical understanding to navigate the spatial demands of the map tasks while the unsuccessful students were only able to interpret and understand basic map conventions. In terms of their gesture use, the more difficult the task, the more likely students were to exhibit gestural behaviours to solve the task. The most common form of gestural behaviour was deictic, that is a pointing gesture. Deictic gestures not only aided the students capacity to explain how they solved the map tasks but they were also a tool which assisted them to navigate and monitor their spatial movements when solving the tasks. There were a number of implications for theory, learning and teaching, and test and curriculum design arising from the study. From a theoretical perspective, the findings of the study suggest that gesturing is an important element of multimodal engagement in mapping tasks. In terms of teaching and learning, implications include the need for students to utilise gesturing techniques when first faced with new or novel map tasks. As students become more proficient in solving such tasks, they should be encouraged to move beyond a reliance on such gesture use in order to progress to more sophisticated understandings of map tasks. Additionally, teachers need to provide students with opportunities to interpret and attend to multiple modes of information when interpreting map tasks.

Effects of reduced contrast on the perception and control of speed when driving

Misperception of speed under low-contrast conditions has been identified as a possible contributor to motor vehicle crashes in fog. To test this hypothesis, we investigated the effects of reduced contrast on drivers’ perception and control of speed while driving under real-world conditions. Fourteen participants drove around a 2.85 km closed road course under three visual conditions: clear view and with two levels of reduced contrast created by diffusing filters on the windscreen and side windows. Three dependent measures were obtained, without view of the speedometer, on separate laps around the road course: verbal estimates of speed; adjustment of speed to instructed levels (25 to 70 km h-1); and estimation of minimum stopping distance. The results showed that drivers traveled more slowly under low-contrast conditions. Reduced contrast had little or no effect on either verbal judgments of speed or estimates of minimum stopping distance. Speed adjustments were significantly slower under low-contrast than clear conditions, indicating that, contrary to studies of object motion, drivers perceived themselves to be traveling faster under conditions of reduced contrast. Under real-world driving conditions, drivers’ ability to perceive and control their speed was not adversely affected by large variations in the contrast of their surroundings. These findings suggest that perceptions of self-motion and object motion involve neural processes that are differentially affected by variations in stimulus contrast as encountered in fog.

Test and evaluation of non conventional instrument transformers and sampled value process bus on Powerlink's transmission network

IEC 61850 Process Bus technology has the potential to improve cost, performance and reliability of substation design. Substantial costs associated with copper wiring (designing, documentation, construction, commissioning and troubleshooting) can be reduced with the application of digital Process Bus technology, especially those based upon international standards. An IEC 61850-9-2 based sampled value Process Bus is an enabling technology for the application of Non-Conventional Instrument Transformers (NCIT). Retaining the output of the NCIT in its native digital form, rather than conversion to an analogue output, allows for improved transient performance, dynamic range, safety, reliability and reduced cost. In this paper we report on a pilot installation using NCITs communicating across a switched Ethernet network using the UCAIug Implementation Guideline for IEC 61850-9-2 (9-2 Light Edition or 9-2LE). This system was commissioned in a 275 kV Line Reactor bay at Powerlink Queensland’s Braemar substation in 2009, with sampled value protection IEDs 'shadowing' the existing protection system. The results of commissioning tests and twelve months of service experience using a Fibre Optic Current Transformer (FOCT) from Smart Digital Optics (SDO) are presented, including the response of the system to fault conditions. A number of remaining issues to be resolved to enable wide-scale deployment of NCITs and IEC 61850-9-2 Process Bus technology are also discussed.

Test and evaluation system for multi-protocol sampled value protection schemes

Proposed transmission smart grids will use a digital platform for the automation of substations operating at voltage levels of 110 kV and above. The IEC 61850 series of standards, released in parts over the last ten years, provide a specification for substation communications networks and systems. These standards, along with IEEE Std 1588-2008 Precision Time Protocol version 2 (PTPv2) for precision timing, are recommended by the both IEC Smart Grid Strategy Group and the NIST Framework and Roadmap for Smart Grid Interoperability Standards for substation automation. IEC 61850-8-1 and IEC 61850-9-2 provide an inter-operable solution to support multi-vendor digital process bus solutions, allowing for the removal of potentially lethal voltages and damaging currents from substation control rooms, a reduction in the amount of cabling required in substations, and facilitates the adoption of non-conventional instrument transformers (NCITs). IEC 61850, PTPv2 and Ethernet are three complementary protocol families that together define the future of sampled value digital process connections for smart substation automation. This paper describes a specific test and evaluation system that uses real time simulation, protection relays, PTPv2 time clocks and artificial network impairment that is being used to investigate technical impediments to the adoption of SV process bus systems by transmission utilities. Knowing the limits of a digital process bus, especially when sampled values and NCITs are included, will enable utilities to make informed decisions regarding the adoption of this technology.

Development and pilot test of a peer-support based Cardiac-Diabetes Self-Management program : a study protocol

Background: People with cardiac disease and type 2 diabetes have higher hospital readmission rates (22%)compared to those without diabetes (6%). Self-management is an effective approach to achieve better health outcomes; however there is a lack of specifically designed programs for patients with these dual conditions. This project aims to extend the development and pilot test of a Cardiac-Diabetes Self-Management Program incorporating user-friendly technologies and the preparation of lay personnel to provide follow-up support. Methods/Design: A randomised controlled trial will be used to explore the feasibility and acceptability of the Cardiac-Diabetes Self-Management Program incorporating DVD case studies and trained peers to provide follow-up support by telephone and text-messaging. A total of 30 cardiac patients with type 2 diabetes will be randomised, either to the usual care group, or to the intervention group. Participants in the intervention group will received the Cardiac-Diabetes Self-Management Program in addition to their usual care. The intervention consists of three faceto- face sessions as well as telephone and text-messaging follow up. The face-to-face sessions will be provided by a trained Research Nurse, commencing in the Coronary Care Unit, and continuing after discharge by trained peers. Peers will follow up patients for up to one month after discharge using text messages and telephone support. Data collection will be conducted at baseline (Time 1) and at one month (Time 2). The primary outcomes include self-efficacy, self-care behaviour and knowledge, measured by well established reliable tools. Discussion: This paper presents the study protocol of a randomised controlled trial to pilot evaluates a Cardiac- Diabetes Self-Management program, and the feasibility of incorporating peers in the follow-ups. Results of this study will provide directions for using such mode in delivering a self-management program for patients with both cardiac condition and diabetes. Furthermore, it will provide valuable information of refinement of the intervention program.

HyperCard test engine using Rasch Analysis

This paper will focus on the development of an interactive test engine using Rasch analysis of item responses for question selection and reporting of results. The Rasch analysis is used to determine student ability and question difficulty. This model is widely used in the preparation of paper-based tests and has been the subject of particular use and development at the Australian Council for Education Research (ACER). This paper presents an overview of an interactive implementation of the Rasch analysis model in HyperCard, where student ability estimates are generated 'on the fly' and question difficulty values updated from time to time. The student ability estimates are used to determine question selection and are the basis of scoring and reporting schemes.