Best practice for prevention and treatment of cardiovascular disease through an equity lens : a review

Background: Despite declining rates of cardiovascular disease (CVD) mortality in developed countries, lower socioeconomic groups continue to experience a greater burden of the disease. There are now many evidence-based treatments and prevention strategies for the management of CVD and it is essential that their impact on the more disadvantaged group is understood if socioeconomic inequalities in CVD are to be reduced. Aims: To determine whether key interventions for CVD prevention and treatment are effective among lower socioeconomic groups, to describe barriers to their effectiveness and the potential or actual impact of these interventions on the socioeconomic gradient in CVD. Methods: Interventions were selected from four stages of the CVD continuum. These included smoking reduction strategies, absolute risk assessment, cardiac rehabilitation, secondary prevention medications, and heart failure self-management programmes. Electronic searches were conducted using terms for each intervention combined with terms for socioeconomic status (SES). Results: Only limited evidence was found for the effectiveness of the selected interventions among lower SES groups and there was little exploration of socioeconomic-related barriers to their uptake. Some broad themes and key messages were identified. In the majority of findings examined, it was clear that the underlying material, social and environmental factors associated with disadvantage are a significant barrier to the effectiveness of interventions. Conclusion: Opportunities to reduce socioeconomic inequalities occur at all stages of the CVD continuum. Despite this, current treatment and prevention strategies may be contributing to the widening socioeconomic-CVD gradient. Further research into the impact of best-practice interventions for CVD upon lower SES groups is required.

Confocal microscopy of the bulbar conjunctiva in contact lens wear

Purpose: The aim of this study was to investigate the capabilities of laser scanning confocal microscopy (LSCM) for undertaking qualitative and quantitative investigations of the response of the bulbar conjunctiva to contact lens wear. Methods: LSCM was used to observe and measure morphological characteristics of the bulbar conjunctiva of 11 asymptomatic soft contact lens wearers and 11 healthy volunteer subjects (controls). Results: The appearance of the bulbar conjunctiva is consistent with known histology of this tissue based on light and electron microscopy. The thickness of the bulbar conjunctival epithelium of lens wearers (30.9 ± 1.1 μm) was less than that of controls (32.9 ± 1.1 μm) (P < 0.0001). Superficial and basal bulbar conjunctival epithelial cell densities in contact lens wearers were 91% and 79% higher, respectively, than that in controls (P < 0.0001). No difference was observed in goblet and Langerhans cell density between lens wearers and controls. Conjunctival microcysts were observed in greater numbers, and were larger in size, in lens wearers compared with controls. Conclusions: The effects of contact lens wear on the human bulbar conjunctiva can be investigated effectively at a cellular level using LSCM. The observations in this study suggest that contact lens wear can induce changes in the bulbar conjunctiva such as epithelial thinning and accelerated formation and enlargement of microcysts, increased epithelial cell density, but has no impact on goblet or Langerhans cell density.

Soft toric contact lens prescribing in different countries

There have been significant improvements in toric soft contact lens design over the past decade. Data from our international contact lens prescribing survey were mined to assess recent trends in toric soft contact lens fitting. This survey was conducted by sending up to 1000 survey forms to contact lens fitters in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA each year between 2000 and 2009. Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the forms and to return them to us for analysis. The data revealed a gradual increase in the extent of toric soft lens fitting this century. Excluding Japan – which had a consistently low rate of soft toric lens fitting over the survey period – soft toric lenses now represent over 35% of all soft lenses prescribed; it can be assumed that, on average (and again excluding Japan), all cases of astigmatism 0.75 D or less remains uncorrected among contact lens wearers. Toric lenses are fitted more to those who are older, full-time wearers and reusable lens wearers, and less to those wearing silicone hydrogel and extended wear lenses.

Destination competitiveness through the lens of brand positioning : the case of Australia’s Sunshine Coast

The purpose of the paper is to provide a collaborative practitioner/academic interpretation of a destination’s competitiveness through the lens of brand positioning in the domestic short break drive market. A 173 item questionnaire, which was mailed to a systematic random sample of 3000 households in the target market, attracted a 17% useable response. The paper compares how one destination, the Sunshine Coast, is positioned in its most important market, in relation to the brand identity intended by the destination marketing organisation (DMO). Key constructs were brand salience, brand associations and brand resonance. The Sunshine Coast was found to hold a leadership position in the minds of consumers, and the results indicated a strong level of congruence between actual market perceptions and the brand identity intended by the DMO. There were strong associations between brand salience, brand associations and brand resonance. The findings provided the destination of interest with both a measure of past marketing effectiveness as well as positive indicators of future performance. The paper represents collaboration between a tourism practitioner and a tourism academic, and attempts a contribution to the emerging literature on destination competitiveness through the lens of positioning theory.

An international survey of contact lens prescribing for presbyopia

Purpose: The aim was to determine world-wide patterns of fitting contact lenses for the correction of presbyopia. Methods: Up to 1,000 survey forms were sent to contact lens fitters in each of 38 countries between January and March every year over five consecutive years (2005 to 2009). Practitioners were asked to record data relating to the first 10 contact lens fittings or refittings performed after receiving the survey form. Results: Data were received relating to 16,680 presbyopic (age 45 years or older) and 84,202 pre-presbyopic (15 to 44 years) contact lens wearers. Females are over-represented in presbyopic versus pre-presbyopic groups, possibly reflecting a stronger desire for the cosmetic benefits of contact lenses among older women. The extent to which multifocal and monovision lenses are prescribed for presbyopes varies considerably among nations, ranging from 79 per cent of all soft lenses in Portugal to zero in Singapore. There appears to be significant under-prescribing of contact lenses for the correction of presbyopia, although for those who do receive such corrections, three times more multifocal lenses are fitted compared with monovision fittings. Presbyopic corrections are most frequently prescribed for full-time wear and monthly replacement. Conclusions: Despite apparent improvements in multifocal design and an increase in available multifocal options in recent years, practitioners are still under-prescribing with respect to the provision of appropriate contact lenses for the correction of presbyopia. Training of contact lens practitioners in presbyopic contact lens fitting should be accelerated and clinical and laboratory research in this field should be intensified to enhance the prospects of meeting the needs of presbyopic contact lens wearers more fully.

A survey of the use of grading scales for contact lens complications in optometric practice

Purpose:  The aim of this study was to investigate the extent and pattern of use of grading scales for contact lens complications (‘grading scales’) in optometric practice. Methods:  An anonymous postal survey was sent to all 756 members of the Queensland Division of Optometrists Association Australia. Information was elicited relating to level of experience, practice type and location, and mode of usage of grading scales. Results:  Survey forms were returned by 237 optometrists, representing a 31 per cent response rate. The majority of respondents (61 per cent) reported using grading scales frequently in practice, while 65 per cent of these preferred to use the Efron Grading Scales for Contact Lens Complications. Seventy-six per cent of optometrists use a method of incremental grading rather than simply grading with whole numbers. Grading scales are more likely to be used by optometrists who have recently graduated (p < 0.001), have a postgraduate certificate in ocular therapeutics (p = 0.018), see more contact lens patients (p = 0.027) and use other forms of grading scales (p < 0.001). The most frequently graded ocular conditions were corneal staining, papillary conjunctivitis and conjunctival redness. The main reasons for not using grading scales included a preference for sketches, photographs or descriptions (87 per cent) and unavailability of scales (29 per cent). Conclusion:  Grading scales for contact lens complications are used extensively in optometric practice for a variety of purposes. This tool can now be considered as an expected norm in contact lens practice. We advocate the incorporation of such grading scales into professional guidelines and standards for good optometric clinical practice.

(Re)focusing the Lens to Make Diversity and Difference Visible : Teaching for Quality and Equity

Despite the evidence that Australia’s children are learning literacy, there is also significant evidence that the poorest and most disadvantaged children are being left behind. To date our understanding of the place of transitions in this has been limited, although there has been work on the fourth grade slump (Gee, 2000, 2008), the transition from primary years to secondary years (e.g. Bahr & Pendergast, 2007; Pendergast & Bahr, 2005, 2010), and transitions when changing schools (Henderson, 2008). In this chapter, we consider the notion of transitioning, as we unpack issues related to recognising and valuing student diversity and difference. We want to highlight ways of providing high quality and high equity literacy pedagogy and literacy outcomes for middle years students. We will also discuss the importance of recognising that students transit to schools and school learning from other significant contexts, each with their own combinations of literacy practices, rituals and values.

Predictive factors of contact lens case contamination

PURPOSE: To examine the relationship between contact lens (CL) case contamination and various potential predictive factors. METHODS: 74 subjects were fitted with lotrafilcon B (CIBA Vision) CLs on a daily wear basis for 1 month. Subjects were randomly assigned one of two polyhexamethylene biguanide (PHMB) preserved disinfecting solutions with the corresponding regular lens case. Clinical evaluations were conducted at lens delivery and after 1 month, when cases were collected for microbial culture. A CL care non-compliance score was determined through administration of a questionnaire and the volume of solution used was calculated for each subject. Data was examined using backward stepwise binary logistic regression. RESULTS: 68% of cases were contaminated. 35% were moderately or heavily contaminated and 36% contained gram-negative bacteria. Case contamination was significantly associated with subjective dryness symptoms (OR 4.22, CI 1.37–13.01) (P<0.05). There was no association between contamination and subject age, ethnicity, gender, average wearing time, amount of solution used, non-compliance score, CL power and subjective redness (P>0.05). The effect of lens care system on case contamination approached significance (P=0.07). Failure to rinse the case with disinfecting solution following CL insertion (OR 2.51, CI 0.52–12.09) and not air drying the case (OR 2.31, CI 0.39–13.35) were positively correlated with contamination; however, did not reach statistical significance. CONCLUSIONS: Our results suggest that case contamination may influence subjective comfort. It is difficult to predict the development of case contamination from a variety of clinical factors. The efficacy of CL solutions, bacterial resistance to disinfection and biofilm formation are likely to play a role. Further evaluation of these factors will improve our understanding of the development of case contamination and its clinical impact.

Understanding the phenomenon of IS success in China through the lens of the IS-Impact model

This study is conducted within the IS-Impact Research Track at Queensland University of Technology (QUT). The goal of the IS-Impact Track is, “to develop the most widely employed model for benchmarking information systems in organizations for the joint benefit of both research and practice” (Gable et al, 2006). IS-Impact is defined as “a measure at a point in time, of the stream of net benefits from the IS, to date and anticipated, as perceived by all key-user-groups” (Gable Sedera and Chan, 2008). Track efforts have yielded the bicameral IS-Impact measurement model; the “impact” half includes Organizational-Impact and Individual-Impact dimensions; the “quality” half includes System-Quality and Information-Quality dimensions. The IS-Impact model, by design, is intended to be robust, simple and generalizable, to yield results that are comparable across time, stakeholders, different systems and system contexts. The model and measurement approach employ perceptual measures and an instrument that is relevant to key stakeholder groups, thereby enabling the combination or comparison of stakeholder perspectives. Such a validated and widely accepted IS-Impact measurement model has both academic and practical value. It facilitates systematic operationalization of a main dependent variable in research (IS-Impact), which can also serve as an important independent variable. For IS management practice it provides a means to benchmark and track the performance of information systems in use. The objective of this study is to develop a Mandarin version IS-Impact model, encompassing a list of China-specific IS-Impact measures, aiding in a better understanding of the IS-Impact phenomenon in a Chinese organizational context. The IS-Impact model provides a much needed theoretical guidance for this investigation of ES and ES impacts in a Chinese context. The appropriateness and soundness of employing the IS-Impact model as a theoretical foundation are evident: the model originated from a sound theory of IS Success (1992), developed through rigorous validation, and also derived in the context of Enterprise Systems. Based on the IS-Impact model, this study investigates a number of research questions (RQs). Firstly, the research investigated what essential impacts have been derived from ES by Chinese users and organizations [RQ1]. Secondly, we investigate which salient quality features of ES are perceived by Chinese users [RQ2]. Thirdly, we seek to answer whether the quality and impacts measures are sufficient to assess ES-success in general [RQ3]. Lastly, the study attempts to address whether the IS-Impact measurement model is appropriate for Chinese organizations in terms of evaluating their ES [RQ4]. An open-ended, qualitative identification survey was employed in the study. A large body of short text data was gathered from 144 Chinese users and 633 valid IS-Impact statements were generated from the data set. A generally inductive approach was applied in the qualitative data analysis. Rigorous qualitative data coding resulted in 50 first-order categories with 6 second-order categories that were grounded from the context of Chinese organization. The six second-order categories are: 1) System Quality; 2) Information Quality; 3) Individual Impacts;4) Organizational Impacts; 5) User Quality and 6) IS Support Quality. The final research finding of the study is the contextualized Mandarin version IS-Impact measurement model that includes 38 measures organized into 4 dimensions: System Quality, information Quality, Individual Impacts and Organizational Impacts. The study also proposed two conceptual models to harmonize the IS-Impact model and the two emergent constructs – User Quality and IS Support Quality by drawing on previous IS effectiveness literatures and the Work System theory proposed by Alter (1999) respectively. The study is significant as it is the first effort that empirically and comprehensively investigates IS-Impact in China. Specifically, the research contributions can be classified into theoretical contributions and practical contributions. From the theoretical perspective, through qualitative evidence, the study test and consolidate IS-Impact measurement model in terms of the quality of robustness, completeness and generalizability. The unconventional research design exhibits creativity of the study. The theoretical model does not work as a top-down a priori seeking for evidence demonstrating its credibility; rather, the study allows a competitive model to emerge from the bottom-up and open-coding analysis. Besides, the study is an example extending and localizing pre-existing theory developed in Western context when the theory is introduced to a different context. On the other hand, from the practical perspective, It is first time to introduce prominent research findings in field of IS Success to Chinese academia and practitioner. This study provides a guideline for Chinese organizations to assess their Enterprise System, and leveraging IT investment in the future. As a research effort in ITPS track, this study contributes the research team with an alternative operationalization of the dependent variable. The future research can take on the contextualized Mandarin version IS-Impact framework as a theoretical a priori model, further quantitative and empirical testing its validity.

Water sensitive urban design through the lens of urban metabolism

Stormwater pollution has been recognised as one of the main causes of aquatic ecosystem degradation and poses a significant threat to both the goal of ecological sustainable development as well as human health and wellbeing. In response, water sensitive urban design (WSUD) practices have been put forward as a strategy to mitigate the detrimental impacts of urban stormwater runoff quality and to safeguard ecosystem functions. However, despite studies that support its efficiency in urban stormwater management, the mainstreaming of WSUD remains a significant challenge. This paper proposes that viewing WSUD through the lens of the integrated urban metabolism framework which encourages an interdisciplinary approach and facilitates dialogue through knowledge transfer is a strategy in which the implementation of WSUD can be mainstreamed.

Practical improvements to simultaneous computation of multi-view geometry and radial lens distortion

This paper discusses practical issues related to the use of the division model for lens distortion in multi-view geometry computation. A data normalisation strategy is presented, which has been absent from previous discussions on the topic. The convergence properties of the Rectangular Quadric Eigenvalue Problem solution for computing division model distortion are examined. It is shown that the existing method can require more than 1000 iterations when dealing with severe distortion. A method is presented for accelerating convergence to less than 10 iterations for any amount of distortion. The new method is shown to produce equivalent or better results than the existing method with up to two orders of magnitude reduction in iterations. Through detailed simulation it is found that the number of data points used to compute geometry and lens distortion has a strong influence on convergence speed and solution accuracy. It is recommended that more than the minimal number of data points be used when computing geometry using a robust estimator such as RANSAC. Adding two to four extra samples improves the convergence rate and accuracy sufficiently to compensate for the increased number of samples required by the RANSAC process.

Government initiative and start-up firms’ eco-innovation : A case study through the ecological modernisation lens

Government programs to finance small firms or start-ups have attracted a little empirical attention. From an economical perspective, the effect of government grants is evaluated by a measure of innovation or firm productivity. Yet, this paper takes a different approach from economical view aiming to address the research question “How do start ups firms view the relationship between government grants and their co-efficient innovation effort?” Semi-structured interviews with grant recipients (start-up business owners revealed that the grants assist firms to leverage their resource limitations but at the same time the grants also act as a major roadblock for their product development success.

MRI study of the changes in crystalline lens shape with accommodation and ageing in humans

Magnetic Resonance Imaging was used to study changes in the crystalline lens and ciliary body with accommodation and aging. Monocular images were obtained in 15 young (19-29 years) and 15 older (60-70 years) emmetropes when viewing at far (6m) and at individual near points (14.5 to 20.9 cm) in the younger group. With accommodation, lens thickness increased (mean±95% CI: 0.33±0.06mm) by a similar magnitude to the decrease in anterior chamber depth (0.31±0.07mm) and equatorial diameter (0.32±0.04mm) with a decrease in the radius of curvature of the posterior lens surface (0.58±0.30mm). Anterior lens surface shape could not be determined due to the overlapping region with the iris. Ciliary ring diameter decreased (0.44±0.17mm) with no decrease in circumlental space or forward ciliary body movement. With aging, lens thickness increased (mean±95% CI: 0.97±0.24mm) similar in magnitude to the sum of the decrease in anterior chamber depth (0.45±0.21mm) and increase in anterior segment depth (0.52±0.23mm). Equatorial lens diameter increased (0.28±0.23mm) with no change in the posterior lens surface radius of curvature. Ciliary ring diameter decreased (0.57±0.41mm) with reduced circumlental space (0.43±0.15mm) and no forward ciliary body movement. Accommodative changes support the Helmholtz theory of accommodation including an increase in posterior lens surface curvature. Certain aspects of aging changes mimic accommodation.