Repeatability of measuring corneal subbasal nerve fiber length in individuals with Type 2 Diabetes

Purpose: To analyze the repeatability of measuring nerve fiber length (NFL) from images of the human corneal subbasal nerve plexus using semiautomated software. Methods: Images were captured from the corneas of 50 subjects with type 2 diabetes mellitus who showed varying severity of neuropathy, using the Heidelberg Retina Tomograph 3 with Rostock Corneal Module. Semiautomated nerve analysis software was independently used by two observers to determine NFL from images of the subbasal nerve plexus. This procedure was undertaken on two occasions, 3 days apart. Results: The intraclass correlation coefficient values were 0.95 (95% confidence intervals: 0.92–0.97) for individual subjects and 0.95 (95% confidence intervals: 0.74–1.00) for observer. Bland-Altman plots of the NFL values indicated a reduced spread of data with lower NFL values. The overall spread of data was less for (a) the observer who was more experienced at analyzing nerve fiber images and (b) the second measurement occasion. Conclusions: Semiautomated measurement of NFL in the subbasal nerve fiber layer is highly repeatable. Repeatability can be enhanced by using more experienced observers. It may be possible to markedly improve repeatability when measuring this anatomic structure using fully automated image analysis software.

Estimating the cost of health care–associated infections : mind your p’s and q’s

Monetary valuations of the economic cost of health care–associated infections (HAIs) are important for decision making and should be estimated accurately. Erroneously high estimates of costs, designed to jolt decision makers into action, may do more harm than good in the struggle to attract funding for infection control. Expectations among policy makers might be raised, and then they are disappointed when the reduction in the number of HAIs does not yield the anticipated cost saving. For this article, we critically review the field and discuss 3 questions. Why measure the cost of an HAI? What outcome should be used to measure the cost of an HAI? What is the best method for making this measurement? The aim is to encourage researchers to collect and then disseminate information that accurately guides decisions about the economic value of expanding or changing current infection control activities.

Renovating Research and Policy on Creative Industries and Innovation

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Measurement of affect during simulation-based training

Training designed to support and strengthen higher-order mental abilities now often involves immersion in Virtual Reality where dangerous real world scenarios can be safely replicated. However despite the growing popularity of advanced training simulations, methods for evaluating their use rely heavily on subjective measures or analysis of final outcomes. Without dynamic, objective performance measures the outcome of training in terms of impact on cognitive skills and ability to transfer newly acquired skills to the real world is unknown. The relationship between affective intensity and cognitive learning provides a potential new approach to ensure the processing of cognitions which occur prior to final outcomes, such as problem-solving and decision-making, are adequately evaluated. This paper describes the technical aspects of pilot work recently undertaken to develop a new measurement tool designed to objectively track individual affect levels during simulation-based training.

Psychometric validation of the growth and empowerment measure (GEM) applied with Indigenous Australians

Objective: Empowerment is a complex process of psychological, social, organizational and structural change. It allows individuals and groups to achieve positive growth and effectively address the social and psychological impacts of historical oppression, marginalization and disadvantage. The Growth and Empowerment Measure (GEM) was developed to measure change in dimensions of empowerment as defi ned and described by Aboriginal Australians who participated in the Family Well Being programme.---------- Method: The GEM has two components: a 14-item Emotional Empowerment Scale (EES14) and 12 Scenarios (12S). It is accompanied by the Kessler 6 Psychological Distress Scale (K6), supplemented by two questions assessing frequency of happy and angry feelings. For validation, the measure was applied with 184 Indigenous Australian participants involved in personal and/or organizational social health activities.---------- Results: Psychometric analyses of the new instruments support their validity and reliability and indicate two-component structures for both the EES (Self-capacity; Inner peace) and the 12S (Healing and enabling growth, Connection and purpose). Strong correlations were observed across the scales and subscales. Participants who scored higher on the newly developed scales showed lower distress on the K6, particularly when the two additional questions were included. However, exploratory factor analyses demonstrated that GEM subscales are separable from the Kessler distress measure.---------- Conclusion: The GEM shows promise in enabling measurement and enhancing understanding of both process and outcome of psychological and social empowerment within an Australian Indigenous context.

Copyrights and creative commons licensing : pedagogical innovation in a higher education media literacy classroom

This article examines the role of copyrights in contemporary media literacies. It argues that, provided they are ethical, young people’s engagement with text should occur in environments that are as free from restriction as possible. Discussion of open culture ecologies and the emergent education commons is followed by a theorisation of both literacy and copyrights education as forms of epistemology: that is, as effects of knowledge producing discourses and practices. Because Creative Commons licenses respect and are based on existing copyright laws, a brief overview of traditional copyrights for educators is first provided. We then describe the voluntary Creative Commons copyright licensing framework (“some rights reserved”) as an alternative to conventional “all rights reserved” models. This is followed by an account of a series of workshop activities on copyrights and Creative Commons conducted by the authors in the media literacy classes of a preservice teacher education program in Queensland, Australia. It provides one example of a practical program on critical copyrights approaches, which may be adapted and used by other school and higher education institutions.

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.

Reference bias : presentation of extreme health states prior to EQ-VAS improves health-related quality of life scores. A randomised crossover trial.

Background: Clinical practice and clinical research has made a concerted effort to move beyond the use of clinical indicators alone and embrace patient focused care through the use of patient reported outcomes such as healthrelated quality of life. However, unless patients give consistent consideration to the health states that give meaning to measurement scales used to evaluate these constructs, longitudinal comparison of these measures may be invalid. This study aimed to investigate whether patients give consideration to a standard health state rating scale (EQ-VAS) and whether consideration of good and poor health state descriptors immediately changes their selfreport. Methods: A randomised crossover trial was implemented amongst hospitalised older adults (n = 151). Patients were asked to consider descriptions of extremely good (Description-A) and poor (Description-B) health states. The EQ-VAS was administered as a self-report at baseline, after the first descriptors (A or B), then again after the remaining descriptors (B or A respectively). At baseline patients were also asked if they had considered either EQVAS anchors. Results: Overall 106/151 (70%) participants changed their self-evaluation by ≥5 points on the 100 point VAS, with a mean (SD) change of +4.5 (12) points (p < 0.001). A total of 74/151 (49%) participants did not consider the best health VAS anchor, of the 77 who did 59 (77%) thought the good health descriptors were more extreme (better) then they had previously considered. Similarly 85/151 (66%) participants did not consider the worst health anchor of the 66 who did 63 (95%) thought the poor health descriptors were more extreme (worse) then they had previously considered. Conclusions: Health state self-reports may not be well considered. An immediate significant shift in response can be elicited by exposure to a mere description of an extreme health state despite no actual change in underlying health state occurring. Caution should be exercised in research and clinical settings when interpreting subjective patient reported outcomes that are dependent on brief anchors for meaning. Trial Registration: Australian and New Zealand Clinical Trials Registry (#ACTRN12607000606482) http://www.anzctr. org.au

Estimates of crowding in long-term care: Comparing two approaches

Objective: Because studies of crowding in long-term care settings are lacking, the authors sought to: (1) generate initial estimates of crowding in nursing homes and assisted living facilities; and (2) evaluate two operational approaches to its measurement. ----- ----- Background: Reactions to density and proximity are complex. Greater density intensifies people's reaction to a situation in the direction (positive or negative) that they would react if the situation were to occur under less dense conditions. People with dementia are especially reactive to the environment. ----- ----- Methods: Using a cross-sectional correlational design in nursing homes and assisted living facilities involving 185 participants, multiple observations (N = 6,455) of crowding and other environmental variables were made. Crowding, location, and sound were measured three times per observation; ambiance was measured once. Data analyses consisted of descriptive statistics, t-tests, and one-way analysis of variance. ----- ----- Results: Crowding estimates were higher for nursing homes and in dining and activity rooms. Crowding also varied across settings and locations by time of day. Overall, the interaction of location and time affected crowding significantly (N = 5,559, df [47, 511], F = 105.69, p < .0001); effects were greater within location-by-hour than between location-by-hour, but the effect explained slightly less variance in Long-Term Care Crowding Index (LTC-CI) estimates (47.41%) than location alone. Crowding had small, direct, and highly significant correlations with sound and with the engaging subscale for ambiance; a similar, though inverse, correlation was seen with the soothing subscale for ambiance. ----- ----- Conclusions: Crowding fluctuates consistent with routine activities such as meals in long-term care settings. Furthermore, a relationship between crowding and other physical characteristics of the environment was found. The LTC-CI is likely to be more sensitive than simple people counts when seeking to evaluate the effects of crowding on the behavior of elders-particularly those with dementia-in long-term care settings. aging in place.

Design Led Innovation : exploring the synthesis of needs, technologies and business models

The term Design is used to describe a wide range of activities. Like the term innovation, it is often used to describe both an activity and an outcome. Many products and services are often described as being designed, as they describe a conscious process of linking form and function. Alternatively, the many and varied processes of design are often used to describe a cost centre of an organisation to demonstrate a particular competency. However design is often not used to describe the ‘value’ it provides to an organisation and more importantly the ‘value’ it provides to both existing and future customers. Design Led Innovation bridges this gap. Design Led Innovation is a process of creating a sustainable competitive advantage, by radically changing the customer value proposition. A conceptual model has been developed to assist organisations apply and embed design in a company’s vision, strategy, culture, leadership and development processes.

Diversity management for innovation in social enterprises in the UK

This paper examines the linkages between diversity management (DM), innovation and high performance in social enterprises. These linkages are explicated beyond traditional framing of DM limited to workforce composition, to include discussions of innovation through networked diversity practices; reconciliation; and funding options. The paper draws upon a UK-based national survey and the case study data. Multiple data collection methods were used, including semi-structured interviews, questionnaires and workshops with participant observation. NVivo and SPSS software packages were utilized in order to analyse the qualitative and quantitative data, respectively. We used thematic coding and cropping techniques in analysing the case studies in the paper. A broad range of conflicting and supporting literature was enfolded into the conversations and discussion. The paper demonstrates that social enterprises exhibit unique characteristics in terms of size and location, as well as their double remit to add value both economically and socially. As a conclusion, we argue for social enterprises to consider options for DM in the interests of maximization of innovation and business performance. We contend that further research is needed to describe how social entrepreneurs draw upon their various ‘diversity resources’ in the process of innovation

Education for the creative economy : innovation, transdisciplinarity, and networks

The question posed in this chapter is: To what extent does current education theory and practice prepare graduates for the creative economy? We first define what we mean by the term creative economy, explain why we think it is a significant point of focus, derive its key features, describe the human capital requirements of these features, and then discuss whether current education theory and practice are producing these human capital requirements. The term creative economy can be critiqued as a shibboleth, but as a high level metaphor, it nevertheless has value in directing us away from certain sorts of economic activity and toward other kinds. Much economic activity is in no way creative. If I have a monopoly on some valued resource, I do not need to be creative. Other forms of economic activity are intensely creative. If I have no valued resources, I must create something that is valued. At its simplest and yet most profound, the idea of a creative economy suggests a capacity to compete based on engaging in a gainful activity that is different from everyone else’s, rather than pursuing the same endeavor more competitively than everyone else. The ability to differentiate on novelty is key to the concept of creative economy and key to our analysis of education for this economy. Therefore, we follow Potts and Cunningham (2008, p. 18) and Potts, Cunningham, Hartley, and Ormerod (2008) in their discussion of the economic significance of the creative industries and see the creative economy not as a sector but as a set of economic processes that act on the economy as a whole to invigorate innovation based growth. We see the creative economy as suffused with all industry rather than as a sector in its own right. These economic processes are essentially concerned with the production of new ideas that ultimately become new products, service, industry sectors, or, in some cases, process or product innovations in older sectors. Therefore, our starting point is that modern economies depend on innovation, and we see the core of innovation as new knowledge of some kind. We commence with some observations about innovation.

Measurement of the net environmental benefit of offsetting in Queensland

The process of offsetting land against unavoidable disturbance of development sites in Queensland will benefit from a method that allows the best possible selection to be made of alternative lands. With site selection now advocated through a combination of Regional Ecosystem and Land Capability classifications state-wide, a case study has determined methods of assessing the functional lift – that is, measures of net environmental gain – of such action. Outcomes with potentially high functional lift are determined, that offer promise not only for endangered ecosystems but also for managing adjacent conservation reserves.