Asthma management : implementation of short-acting beta agonist guidelines in Western Australia:a unique collaboration

Background: The Respiratory Health Network in Western Australia developed the Asthma Model of Care in 2010 which incorporates best practice guidelines. At the same time short-acting beta agonist guidelines (SABA) were developed by stakeholder consensus at University of Western Australia (UWA) and incorporated the use of an Asthma Action Plan Card. Objective: To report on the implementation of a key component of the WA Asthma Model of Care, the SABA guidelines that incorporate the Asthma Action Plan card. Methods: Implementation strategies included lectures, direct pharmacy detailing, media releases, and information packs (postal and electronic). Groups targeted included pharmacists, consumers and medical practitioners. Results: State-based (n=18) and national (n=6) professional organisations were informed about the launch of the guidelines into practice in WA. In the four-month implementation period more than 47,000 Asthma Action Plan Cards were distributed, primarily to community pharmacies. More than 500 pharmacies were provided with information packs or individual detailing. More than 10,000 consumers were provided with information about the guidelines. Conclusions and implications: The collaboration of stakeholders in this project allowed for widespread access to various portals which, in turn, resulted in a multifaceted approach in disseminating information. Ongoing maintenance programs are required to sustain and build on the momentum of the implementation program and to ultimately address patient outcomes and practice change, which would be the longer-term goals of such a project. Future research will seek to ascertain the impact of the card on patient outcomes in WA.

Experimental comparison of coherent polarization-switched QPSK to polarization-multiplexed QPSK for 10 x 100 km WDM transmission

Polarization-switched quadrature phase-shift keying has been demonstrated experimentally at 40.5Gb/s with a coherent receiver and digital signal processing. Compared to polarization-multiplexed QPSK at the same bit rate, its back-to-back sensitivity at 10-3 bit-error-ratio shows 0.9dB improvement, and it tolerates about 1.6dB higher launch power for 10 × 100km, 50GHz-spaced WDM transmission allowing 1dB penalty in required optical-signal-to-noise ratio relative to back-to-back.

Nonlinear penalties in dynamic optical networks employing autonomous transponders

We report for the first time on the limitations in the operational power range of network traffic in the presence of heterogeneous 28-Gbaud polarization-multiplexed quadrature amplitude modulation (PM-mQAM) channels in a nine-channel dynamic optical mesh network. In particular, we demonstrate that transponders which autonomously select a modulation order and launch power to optimize their own performance will have a severe impact on copropagating network traffic. Our results also suggest that altruistic transponder operation may offer even lower penalties than fixed launch power operation.

"Magic" dispersion maps with distributed Raman amplification

We analyze pulse propagation in an optical fiber with a periodic dispersion map and distributed amplification. Using an asymptotic theory and a momentum method, we identify a family of dispersion management schemes that are advantageous for massive multichannel soliton transmission. For the case of two-step dispersion maps with distributed Raman amplification to compensate for the fiber loss, we find special schemes that have optimal (chirp-free) launch point locations that are independent of the fiber dispersion. Despite the variation of dispersion with wavelength due to the fiber dispersion slope, the transmission in several different channels can be optimized simultaneously using the same optimal launch point. The theoretical predictions are verified by direct numerical simulations. The obtained results are applied to a practical multichannel transmission system.

Optimal dispersion maps for multichannel soliton transmission with distributed Raman amplification

Using an asymptotic theory and a momentum method, we identify a family of dispersion management schemes with distributed Raman amplification, which are advantageous for massive multichannel soliton transmission. For the case of two-step dispersion maps, special schemes are found that have optimal (chirp-free) launch point locations that are independent of the fibre dispersion. Despite the variation of dispersion with wavelength due to the fibre dispersion slope, the transmission in several different channels can be optimized simultaneously using the same optimal launch point. The theoretical results are verified by direct numerical simulations.

Better means more:property rights and high-growth aspiration entrepreneurship

This paper contrasts the determinants of entrepreneurial entry and high-growth aspiration entrepreneurship. Using the Global Entrepreneurship Monitor (GEM) surveys for 42 countries over the period 1998-2005, we analyse how institutional environment and entrepreneurial characteristics affect individual decisions to become entrepreneurs and aspirations to set up high-growth ventures. We find that institutions exert different effects on entrepreneurial entry and on the individual choice to launch high-growth aspiration projects. In particular, a strong property rights system is important for high-growth aspiration entrepreneurship, but has less pronounced effects for entrepreneurial entry. The availability of finance and the fiscal burden matter for both.

A decade of silicone hydrogel development:surface properties, mechanical properties, and ocular compatibility

Since the initial launch of silicone hydrogel lenses, there has been a considerable broadening in the range of available commercial material properties. The very mobile silicon–oxygen bonds convey distinctive surface and mechanical properties on silicone hydrogels, in which advantages of enhanced oxygen permeability, reduced protein deposition, and modest frictional interaction are balanced by increased lipid and elastic response. There are now some 15 silicone hydrogel material variants available to practitioners; arguably, the changes that have taken place have been strongly influenced by feedback based on clinical experience. Water content is one of the most influential properties, and the decade has seen a progressive rise from lotrafilcon-A (24%) to efrofilcon-A (74%). Moduli have decreased over the same period from 1.4 to 0.3 MPa, but not solely as a result of changes in water content. Surface properties do not correlate directly with water content, and ingenious approaches have been used to achieve desirable improvements (e.g., greater lubricity and lower contact angle hysteresis). This is demonstrated by comparing the hysteresis value of the earliest (lotrafilcon-A, >40°) and most recent (delefilcon-A, <10°) coated silicone hydrogels. Although wettability is important, it is not of itself a good predictor of ocular response because this involves a much wider range of physicochemical and biochemical factors. The interference of the lens with ocular dynamics is complex leading separately to tissue–material interactions involving anterior and posterior lens surfaces. The biochemical consequences of these interactions may hold the key to a greater understanding of ocular incompatibility and end of day discomfort.

Impact of power allocation strategies in long-haul few-mode fiber transmission systems

We report for the first time on the limitations in the operational power range of few-mode fiber based transmission systems, employing 28Gbaud quadrature phase shift keying transponders, over 1,600km. It is demonstrated that if an additional mode is used on a preexisting few-mode transmission link, and allowed to optimize its performance, it will have a significant impact on the pre-existing mode. In particular, we show that for low mode coupling strengths (weak coupling regime), the newly added variable power mode does not considerably impact the fixed power existing mode, with performance penalties less than 2dB (in Q-factor). On the other hand, as mode coupling strength is increased (strong coupling regime), the individual launch power optimization significantly degrades the system performance, with penalties up to ∼6dB. Our results further suggest that mutual power optimization, of both fixed power and variable power modes, reduces power allocation related penalties to less than 3dB, for any given coupling strength, for both high and low differential mode delays. © 2013 Optical Society of America.

40 Gbit/s dispersion managed soliton transmission over 1160 km in standard fibre with 75 km span length

In dispersion managed high bit rate systems, the importance of correctly choosing the pulse launch position is investigated. Using this technique, error free transmission has been achieved of a 40 Gbit/s 231-1 nonlinear RZ PRBS over 1160 km in a dispersion compensated standard fiber propagation experiment with a 75 km standard fiber span.

42.6Gb/s RZ-ASK transmission over 2500km using quasi-lossless transmission spans

Here, for the first time, we experimentally demonstrate optical data transmission through such quasi-lossless fibre spans, which provide an entirely different nonlinear propagation regime to conventionally EDFA/Raman amplified systems. We demonstrate 42.6 Gb/s transmission over 2500 km of SMF-28 with an 82 km span length, and investigate the optimisation of the system in terms of launch power and nonlinear tolerance. Our results show the first ever data transmission experiment using an ultra-long Raman laser to provide quasi-lossless conditions in the transmission fibre. For a span length of 82 km we have shown 2500 km transmission over SMF-28 fibre at 42.6 Gb/s. Our quasi-lossless configuration had 6 dB lower optimum power and improved nonlinear tolerance compared with a conventional EDFA only system.

Report of the inaugural meeting of the TFOS i2 = initiating innovation Series:targeting the unmet need for dry eye treatment

On March 21, 2015, a meeting was held in London, United Kingdom, to address the progress in targeting the unmet need for dry eye disease (DED) treatment. The meeting, which launched the i2 = initiating innovation series, was sponsored by the Tear Film & Ocular Surface Society (TFOS; www.TearFilm.org) and supported by Dompé. The TFOS i2 meeting was designed to review advances in the understanding of DED since publication of the 2007 TFOS International Dry Eye WorkShop (DEWS) report, and to help launch the highly anticipated sequel, DEWS II. The meeting was structured to discuss the scope of the DED problem, to review the clinical challenges of DED, and to consider the treatment challenges of DED. This article provides a synopsis of the presentations of this TFOS i2 meeting.

Advanced perturbation technique for digital backward propagation in WDM systems

An improved digital backward propagation (DBP) is proposed to compensate inter-nonlinear effects and dispersion jointly in WDM systems based on an advanced perturbation technique (APT). A non-iterative weighted concept is presented to replace the iterative in analytical recursion expression, which can dramatically simplify the complexity and improve accuracy compared to the traditional perturbation technique (TPT). Furthermore, an analytical recursion expression of the output after backward propagation is obtained initially. Numerical simulations are executed for various parameters of the transmission system. The results indicate that the advanced perturbation technique will relax the step size requirements and reduce the oversampling factor when launch power is higher than -2 dBm. We estimate this technique will reduce computational complexity by a factor of around seven with respect to the conventional DBP. © 2013 Optical Society of America.

Finding the Relationship between a Search Algorithm and a Class of Functions on Discrete Space by Exhaustive Search

* The work is supported by RFBR, grant 04-01-00858-a.

Pharmacotherapies to manage diabesity:an update

Several pharmacotherapies have recently become available for addition to lifestyle measures to assist the management of coexistent type 2 diabetes and obesity. These are mostly administered as add-on to metformin or as alternative therapies if metformin is not appropriate. The sodium–glucose cotransporter 2 inhibitors (dapagliflozin, canagliflozin and empagliflozin) act by eliminating excess glucose in the urine. These agents provide a non-insulin-dependent mechanism to reduce hyperglycaemia and facilitate weight loss without causing frank hypoglycaemia. Their efficacy requires the individual to have adequate renal function. The glucagon-like peptide-1 (GLP-1) receptor agonists (exenatide, liraglutide, lixisenatide, dulaglutide and albiglutide [the last at the pre-launch stage at the time of writing]) are injected subcutaneously. Different members of the class offer different time courses for their onset and duration of action. Each potentiates insulin secretion and reduces glucagon secretion in a glucose-dependent manner to address prandial glycaemic excursions while avoiding interprandial hypoglycaemia. A satiety effect of these agents assists weight reduction, but delayed gastric emptying can cause initial nausea. The dipeptidyl peptidase-4 inhibitor class now comprises sitagliptin, vildagliptin, saxagliptin, linagliptin and alogliptin. These agents offer similar glucose-lowering efficacy without weight gain or hypoglycaemia by boosting the half-life of endogenous incretins, particularly GLP-1. A fixed-ratio injected combination of insulin degludec with liraglutide (IDegLira) has recently been launched and further agents to address hyperglycaemia and assist weight loss are advancing in development.

CLAE to move to online format

Editorial: The 2015 BCLA annual conference was another fantastic affair. It was the first time the conference was held in the beautiful city of Liverpool. The venue was great and the programme was excellent. The venue overlooked the River Mersey and many of the hotels were local boutique hotels. I stayed in one which was formerly the offices of White Star Liners—where the RMS Titanic was originally registered. The hotel decor was consistent with its historic significance. The BCLA gala dinner was held in the hugely impressive Anglican Cathedral with entertainment from a Beatles tribute band. That will certainly be a hard act to follow at the next conference in 2017. Brian Tompkins took the reigns as the new BCLA president. Professor Fiona Stapleton was the recipient of the BCLA Gold Medal Award. The winner of the poster competition was Dorota Szczesna-Iskander with a poster entitled ‘Dry Contact lens poor wettability and visual performance’. Second place was Renee Reeder with her poster entitled ‘Abnormal Rosacea as a differential diagnosis in corneal scarring’. And third place was Maria Jesus Gonzalez-Garcia with her poster entitled ‘Dry Effect of the Environmental Conditions on Tear Inflammatory Mediators Concentration in Contact Lens Wearers’. The photographic competition winner was Professor Wolfgang Sickenberger from Jena in Germany. The Editorial Panel of CLAE met at the BCLA conference for their first biannual meeting. The journal metrics were discussed. In terms of number of submissions of new papers CLAE seems to have plateaued after seeing a rapid growth in the number of submissions over the last few years. The increase over the last few years could be attributed to the fact that CLAE was awarded an impact factor for the first time in 2012. This year it seems that impact factors across nearly all ophthalmic related journals has dropped. This could in part be due to the fact that last year was a ‘Research Exercise Framework (REF) year for UK universities, where they are judged on quality of their research output. The next REF is in 2020 so we may see changes nearing that time. Looking at article downloads, there seems to be a continued rise in figures. Currently CLAE attracts around 85,000 downloads per year (this is an increase of around 10,000 per year for the last few years) and the 2015 prediction is 120,000! With this in mind and with other contributing factors too, the BCLA has decided to move to online delivery of CLAE to its members starting from issue 5 of 2015. Some members do like to flick through the pages of a hard copy of the journal so members will still have the option of receiving a hard copy through the post but the default journal delivery method will now be online. The BCLA office will send various alerts and content details to members email addresses. To access CLAE online you will need to log in via the BCLA web page, currently you then click on ‘Resources’ and then under ‘Free and Discounted Publications’ you will see CLAE. This actually takes you to CLAE’s own webpage (www.contactlensjournal.com) but you need to log in via the BCLA web page. The BCLA plans to change these weblinks so that from the BCLA web page you can link to the journal website much more easily and you have the choice of going directly into the general website for CLAE or straight to the current issue. In 2016 you will see an even easier way of accessing CLAE online as the BCLA will launch a CLAE application for mobile devices where the journal can be downloaded as a ‘flick-book’. This is a great way of bringing CLAE into the modern era where people access their information in newer ways. For many the BCLA conference was part of a very busy conference week as it was preceded by the International Association of Contact Lens Educators’ (IACLE) Third World Congress, held in Manchester on the 4 days before the BCLA conference. The first and second IACE World Congresses were held in Waterloo, Canada in 1994 and 2000 respectively and hosted by Professor Des Fonn. Professor Fonn was the recipient of the first ever IACLE lifetime achievement award. The Third IACLE World Congress saw more than 100 contact lens educators and industry representatives from around 30 countries gather in the UK for the four-day event, hosted by The University of Manchester. Delegates gained hands-on experience of innovations in teaching, such as learning delivery systems, the use of iPads in the classroom and for creating ePub content, and augmented and virtual reality technologies. IACLE members around the world also took part via a live online broadcast. The Third IACLE World Congress was made possible by the generous support of Sponsors Alcon, CooperVision and Johnson & Johnson Vision Care., for more information look at the IACLE web page (www.iacle.org).