Partnering with governments and other institutions:driving change in diabetes care

The human and material cost of type 2 diabetes is a cause of increasing concern for health professionals, representative organisations and governments worldwide. The scale of morbidity and mortality has led the United Nations to issue a resolution on diabetes, calling for national policies for prevention, treatment and care. There is clearly an urgent need for a concerted response from all interested parties at the community, national and international level to work towards the goals of the resolution and create effective, sustainable treatment models, care systems and prevention strategies. Action requires both a 'bottom-up' approach of public awareness campaigns and pressure from healthcare professionals, coupled with a 'top-down' drive for change, via partnerships with governments, third sector (non-governmental) organisations and other institutions. In this review, we examine how existing collaborative initiatives serve as examples for those seeking to implement change in health policy and practice in the quest to alleviate the health and economic burden of diabetes. Efforts are underway to provide continuous and comprehensive care models for those who already have type 2 diabetes; in some cases, national plans extend to prevention strategies in attempts to improve overall public health. In the spirit of partnership, collaborations with governments that incorporate sustainability, long-term goals and a holistic approach continue to be a driving force for change. It is now critical to maintain this momentum and use the growing body of compelling evidence to educate, inform and deliver a long-term, lasting impact on patient and public health worldwide. © 2007 The Authors.

Impact in contact lenses and the anterior eye:challenges prevailing in 2015

As we settle into a new year, this second issue of Contact Lens and Anterior Eye allows us to reflect on how new research in this field impacts our understanding, but more importantly, how we use this evidence basis to enhance our day to day practice, to educate the next generation of students and to construct the research studies to deepen our knowledge still further. The end of 2014 saw the publication of the UK governments Research Exercise Framework (REF) which ranks Universities in terms of their outputs (which includes their paper, publications and research income), environment (infrastructure and staff support) and for the first time impact (defined as “any effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia” [8]). The REF is a process of expert review, carried out in 36 subject-based units of assessment, of which our field is typically submitted to the Allied Health, Dentistry, Nursing and Pharmacy panel. Universities that offer Optometry did very well with Cardiff, Manchester and Aston in the top 10% out of the 94 Universities that submitted to this panel (Grade point Average ranked order). While the format of the new exercise (probably in 2010) to allocate the more than £2 billion of UK government research funds is yet to be determined, it is already rumoured that impact will contribute an even larger proportion to the weighting. Hence it is even more important to reflect on the impact of our research. In this issue, Elisseef and colleagues [5] examine the intriguing potential of modifying a lens surface to allow it to bind to known wetting agents (in this case hyaluronic acid) to enhance water retention. Such a technique has the capacity to reduced friction between the lens surface and the eyelids/ocular surface, presumably leading to higher comfort and less reason for patients to discontinue with lens wear. Several papers in this issue report on the validity of new high precision, fast scanning imaging and quantification equipment, utilising techniques such as Scheimpflug, partial coherence interferometry, aberrometry and video allowing detailed assessment of anterior chamber biometry, corneal topography, corneal biomechanics, peripheral refraction, ocular aberrations and lens fit. The challenge is how to use this advanced instrumentation which is becoming increasingly available to create real impact. Many challenges in contact lenses and the anterior eye still prevail in 2015 such as: -While contact lens and refractive surgery complications are relatively rare, they are still too often devastating to the individual and their quality of life (such as the impact and prognosis of patients with Acanthmoeba Keratitis reported by Jhanji and colleagues in this issue [7]). How can we detect those patients who are going to be affected and what modifications do we need to make to contact lenses and patient management prevent this occurring? -Drop out from contact lenses still occurs at a rapid rate and symptoms of dry eye seem to be the leading cause driving this discontinuation of wear [1] and [2]. What design, coating, material and lubricant release mechanism will make a step change in end of day comfort in particular? -Presbyopia is a major challenge to hassle free quality vision and is one of the first signs of ageing noticed by many people. As an emmetrope approaching presbyopia, I have a vested interest in new medical devices that will give me high quality vision at all distances when my arms won’t stretch any further. Perhaps a new definition of presbyopia could be when you start to orientate your smartphone in the landscape direction to gain the small increase in print size needed to read! Effective accommodating intraocular lenses that truly mimic the pre-presbyopic crystalline lenses are still a way off [3] and hence simultaneous images achieved through contact lenses, intraocular lenses or refractive surgery still have a secure future. However, splitting light reaching the retina and requiring the brain to supress blurred images will always be a compromise on contrast sensitivity and is liable to cause dysphotopsia; so how will new designs account for differences in a patient's task demands and own optical aberrations to allow focused patient selection, optimising satisfaction? -Drug delivery from contact lenses offers much in terms of compliance and quality of life for patients with chronic ocular conditions such as glaucoma, dry eye and perhaps in the future, dry age-related macular degeneration; but scientific proof-of-concept publications (see EIShaer et al. [6]) have not yet led to commercial products. Part of this is presumably the regulatory complexity of combining a medical device (the contact lens) and a pharmaceutical agent. Will 2015 be the year when this innovation finally becomes a reality for patients, bringing them an enhanced quality of life through their eye care practitioners and allowing researchers to further validate the use of pharmaceutical contact lenses and propose enhancements as the technology matures? -Last, but no means least is the field of myopia control, the topic of the first day of the BCLA's Conference in Liverpool, June 6–9th 2015. The epidemic of myopia is a blight, particularly in Asia, with significant concerns over sight threatening pathology resulting from the elongated eye. This is a field where real impact is already being realised through new soft contact lens optics, orthokeratology and low dose pharmaceuticals [4], but we still need to be able to better predict which technique will work best for an individual and to develop new techniques to retard myopia progression in those who don’t respond to current treatments, without increasing their risk of complications or the treatment impacting their quality of life So what will your New Year's resolution be to make 2015 a year of real impact, whether by advancing science or applying the findings published in journals such as Contact Lens and Anterior Eye to make a real difference to your patients’ lives?

Measuring the impact of innovative human capital on small firms' propensity to innovate

The ability to identify and evaluate the competitive advantage of employees' transferable and innovative characteristics is of importance to firms and policymakers. This research extends the standard measure of human capital by developing a unique and far reaching concept of Innovative Human Capital and emphasises its effect on small firm innovation and hence growth (jobs, sales and productivity). This new Innovative Human Capital concept encapsulates four elements: education, training, willingness to change in the workplace and job satisfaction to overcome the limitations of measurements used previously. An augmented innovation production function is used to test the hypothesis that small firms who employ managers with Innovative Human Capital are more likely to innovate. There is evidence from the results that Innovative Human Capital may be more valuable to small firms (i.e. less than 50 employees) than larger-sized firms (i.e. more than 50 employees). The research expands innovation theory to include the concept of Innovative Human Capital as a competitive advantage and determinant of small firm innovation; and distinguishes Innovative Human Capital as a significant concept to consider when creating public support programmes for small firms.

Clinical oxidative stress during leprosy multidrug therapy:impact of dapsone oxidation

This study aims to assess the oxidative stress in leprosy patients under multidrug therapy (MDT; dapsone, clofazimine and rifampicin), evaluating the nitric oxide (NO) concentration, catalase (CAT) and superoxide dismutase (SOD) activities, glutathione (GSH) levels, total antioxidant capacity, lipid peroxidation, and methemoglobin formation. For this, we analyzed 23 leprosy patients and 20 healthy individuals from the Amazon region, Brazil, aged between 20 and 45 years. Blood sampling enabled the evaluation of leprosy patients prior to starting multidrug therapy (called MDT 0) and until the third month of multidrug therapy (MDT 3). With regard to dapsone (DDS) plasma levels, we showed that there was no statistical difference in drug plasma levels between multibacillary (0.518±0.029 μg/mL) and paucibacillary (0.662±0.123 μg/mL) patients. The methemoglobin levels and numbers of Heinz bodies were significantly enhanced after the third MDTsupervised dose, but this treatment did not significantly change the lipid peroxidation and NO levels in these leprosy patients. In addition, CAT activity was significantly reduced in MDT-treated leprosy patients, while GSH content was increased in these patients. However, SOD and Trolox equivalent antioxidant capacity levels were similar in patients with and without treatment. These data suggest that MDT can reduce the activity of some antioxidant enzyme and influence ROS accumulation, which may induce hematological changes, such as methemoglobinemia in patients with leprosy. We also explored some redox mechanisms associated with DDS and its main oxidative metabolite DDS-NHOH and we explored the possible binding of DDS to the active site of CYP2C19 with the aid of molecular modeling software. © 2014 Schalcher et al.

Imagining oneself in a stereotyped role may stifle generalized tendencies to support social change

Imagining oneself in a stereotyped role may not only increase women's endorsement of stereotypes about women and science, but also stifle broader concerns about social change. In the experiment, 81 women imagined themselves on a stereotypical or a counter-stereotypical career path (vs. a control condition). Participants in the stereotypical imagery condition endorsed to a higher extent the stereotypes about women and science, and crucially, were more resistant to social change in general. Stereotype endorsement mediated the relationship between exposure to stereotypes and resistance to social change. Results imply that tackling occupational gender stereotypes is crucial not only because they exclude women from male-dominated careers, but also because of a potentially pervasive negative impact on broader egalitarian concerns.

Modelling Covariates in Multipath Change

2000 Mathematics Subject Classification: 62N02

A longitudinal evaluation of the acceptability and impact of a diet diary app for older adults with age-related macular degeneration

Ongoing advances in technology are increasing the scope for enhancing and supporting older adults’ daily living. The digital divide between older and younger adults raises concerns, however, about the suitability of technological solutions for older adults, especially for those with impairments. Taking older adults with Age-Related Macular Degeneration (AMD) as a case study, we used user-centred and participatory design approaches to develop an assistive mobile app for self-monitoring their intake of food [12,13]. In this paper we report on findings of a longitudinal field evaluation of our app that was conducted to investigate how it was received and adopted by older adults with AMD and its impact on their lives. Demonstrating the benefit of applying inclusive design methods for technology for older adults, our findings reveal how the use of the app raises participants’ awareness and facilitates self-monitoring of diet, encourages positive (diet) behaviour change, and encourages learning.

Action research: minimising the impact of disruptive incidents for rail passengers through improved sharing of information

This paper reports on an action research project based in the UK rail industry; it used a novel type of Soft Systems Methodology (known as PrOH Modelling) to facilitate change in a major Train Operating Company (TOC). The project looked at a number of different disruptive incidents to compare and contrast practice via the Mitigate, Prevent, React and Recover (MPRR) Framework. One incident is detailed in depth. The paper also looks at the general process of conducting action research. This work will be of interest for researchers in the rail sector and for those conducting operations action research projects.

A piacorientáció hatása a vállalati versenyképességre = The Impact of Market Orientation on Competitiveness

A tanulmány a piacorientáció és a versenyképesség összefüggését elemzi egy átfogóbb koncepcionális modell keretében, amely a piacorientáció szervezeti előzményeire, a piacorientáció egyes dimenziói és a vállalati teljesítmény közötti kapcsolatra, valamint a környezetből származó bizonytalanság moderáló hatásaira fókuszál. Ahhoz, hogy növeljük a tanulmány érvényességét, az elemzés során olyan változókat kontrolláltunk, amelyekről úgy véltük, hogy a piacorientáció mellett szintén befolyásolhatják a vállalatok versenyképességét, mint például a vállalati stratégia, illetve néhány releváns vállalati jellemző. Az eredmények alapján megállapíthatjuk, hogy a piacorientáció pozitív vagy semleges hatással van a vállalati versenyképesség különböző indikátoraira. Kutatásunk tehát nem támasztotta alá egyes, a válságidőszakokban készült tanulmányok következtetéseit, amely szerint gazdasági válság időszakában a piacorientáció gátolja a vállalatokat abban, hogy megfelelően reagáljanak a környezetben bekövetkezett változásokra. A piacorientáció eltérő dimenzióinak szerepe ugyanakkor átértékelődik a környezetből fakadó bizonytalanság egyes típusainak eltérő mértékű erősödésével. ----- Abstract: The study investigates the association between market orientation and corporate competitiveness in frame of a wider conceptual model that focuses on the organisational antecedents of market orientation, the relationship between the dimensions of market orientation and corporate performance and the moderating role of environmental uncertainty. To increase the validity of our study, we controlled other variables that had also been expected to influence competitiveness such as corporate strategy and some relevant characteristics of companies. Based on the results we can conclude that the effects of market orientation on the different indicators of competitiveness are either positive or neutral. Our research did not support the conclusions of previous studies which stated that in times of economic crisis market orientation inhibits companies to react to the changes of the environment in an appropriate way. The importance of the dimensions of market orientation however can change due to the diverse extent to which the different kinds of environmental uncertainty intensify.

International cooperation against climate change: institutions, policies and their efficiency

In the 20th century nature of the world economy has started to change significantly, and the former state-centric constellation disappeared. Several development factors that induced the change are still active and nowadays we live in a much different world. The world economy consists of transnational networks; these complicated systems have a great impact on the world of states. The transnational actors’ (multinational corporations, non-governmental organizations etc) influence became very essential as they are able to mobilize the society, have high expertise (think tanks), but it is also important to note their financial strength and moral effects (norm entrepreneurs).

Stability of Ampelometric Characteristics of Vitis vinifera L. cv. 'Syrah' and 'Sauvignon blanc' Leaves: Impact of Within-vineyard Variability and Pruning Method/Bud Load

Historically, grapevine (Vitis vinifera L.) leaf characterisation has been a driving force in the identification of cultivars. In this study, ampelometric (foliometric) analysis was done on leaf samples collected from hand-pruned, mechanically pruned and minimally pruned ‘Sauvignon blanc’ and ‘Syrah’ vines to estimate the impact of within-vineyard variability and a change in bud load on the stability of leaf properties. The results showed that within-vineyard variability of ampelometric characteristics was high within a cultivar, irrespective of bud load. In terms of the O.I.V. coding system, zero to four class differences were observed between minimum and maximum values of each characteristic. The value of variability of each characteristic was different between the three levels of bud load and the two cultivars. With respect to bud load, the number of shoots per vine had a significant effect on the characteristics of the leaf laminae. Single leaf area and lengths of veins changed significantly for both cultivars, irrespective of treatment, while angle between veins proved to be a stable characteristic. A large number of biometric data can be recorded on a single leaf; the data measured on several leaves, however, are not necessarily unique for a specific cultivar. The leaf characteristics analysed in this study can be divided into two groups according to the response to a change in bud load, i.e. stable (angles between the veins, depths of sinuses) and variable (length of the veins, length of the petiole, single leaf area). The variable characteristics are not recommended to be used in cultivar identification, unless the pruning method/bud load is known.

Regional climate change impacts on wild animals' living territory in Central Europe

In this paper the projected future impact of climate change has been analyzed for the quality of living conditions of the European terrestrial vertebrates (amphibians, reptiles, birds, mammals) in the Carpathian Basin. According to the climate scenarios, warmer and drier climatic conditions are likely to occur in the Carpathian Basin by end of this century. Simultaneous analysis of climate parameters, climate simulations and animal range datasets enables us to evaluate the vulnerability of different European species to regional warming and climate change. The spatial climate analogy technique is used to analyze the estimated rapid change of the wild animals’ habitats and their northward migration. For the reference climate data of Debrecen is considered, and three spatial analogue regions are compared. The results suggest that generally a significant decline in habitats is very likely for most of the analyzed animal groups by the end of the 21st century. The largest rate of decline is estimated for birds. However, living conditions for reptiles may improve in the future due to the warmer and drier climatic conditions, which are favourable for these species.

Összegződnek-e az egyéni törekvések? A cselekvés és az eredmény közötti szakadék problémája (Can individual efforts be aggregated? The problem of the action-impact gap)

A szerző arra a kérdésre keresi a választ, hogyan alakulhat ki látványos szakadék az egyéni cselekvések iránya és azok együttes hatása között. A szándékok és tettek hatását felülírhatja a társadalmi gazdasági tényezőkből adódó tehetetlenség: a kritikus tömeg hiánya, szervezeti-infrastrukturális tényezők, kompenzációs hatások, egymás hatását kioltó cselekvések. A szerző a környezettudatosság és az ökológiai lábnyom példáján - ezerfős reprezentatív felmérésre alapozva - mutatja be, hogy az önkéntességre alapozó megközelítés sokszor túlbecsüli a fogyasztó - társadalmi-gazdasági tényezők által korlátozott - lehetőségeit és szuverenitását. _____ Behaviour impact gaps are demonstrably present in everyday life. It is increasingly found that environmental awareness in individuals fails to lead to reductions in the ecological footprint. Intensive agricultural practice reduces biodiversity in the EU even in areas where massive agri-environmental grant schemes are available and applied. Labour market training programmes do not necessarily facilitate job-finding for underprivileged segments of the society. So individual efforts may not add up or induce the expected effect. This outcome appears even for programmes that are successful in attaining the required behavioural change in a target group. The impact of attitudes and individual acts may be wiped out by structural and economic lock-ins such as trade-offs made for the gains, lack of a critical mass of actions, infrastructural deficiencies, or interfering acts of economic actors. The discrepancy between environmental awareness and ecological footprint is used to point out how awareness-raising programmes may miss their targets by overestimating the sovereignty and capabilities of consumers. Consumers are unwillingly locked into unsustainable practices and cannot be moved from that position unless economic and structural premises are also changed.

Integration of Satellite and Financial Data to Model Future Economic Impact of Citrus Crops (Final Project Report)

This study analyzed the health and overall landcover of citrus crops in Florida. The analysis was completed using Landsat satellite imagery available free of charge from the University of Maryland Global Landcover Change Facility. The project hypothesized that combining citrus production (economic) data with citrus area per county derived from spectral signatures would yield correlations between observable spectral reflectance throughout the year, and the fiscal impact of citrus on local economies. A positive correlation between these two data types would allow us to predict the economic impact of citrus using spectral data analysis to determine final crop harvests.

Regional growth, structural change, and natural disaster

Hurricanes, earthquakes, floods, and other serious natural hazards have been attributed with causing changes in regional economic growth, income, employment, and wealth. Natural disasters are said to cause; (1) an acceleration of existing economic trends; (2) an expansion of employment and income, due to recovery operations (the so-called silver lining); and (3) an alteration in the structure of regional economic activity due to changes in "intra" and "inter" regional trading patterns, and technological change.^ Theoretical and stylized disaster simulations (Cochrane 1975; Haas, Cochrane, and Kates 1977; Petak et al. 1982; Ellson et al. 1983, 1984; Boisvert 1992; Brookshire and McKee 1992) point towards a wide scope of possible negative and long lasting impacts upon economic activity and structure. This work examines the consequences of Hurricane Andrew on Dade County's economy. Following the work of Ellson et al. (1984), Guimaraes et al. (1993), and West and Lenze (1993; 1994), a regional econometric forecasting model (DCEFM) using a framework of "with" and "without" the hurricane is constructed and utilized to assess Hurricane Andrew's impact on the structure and level of economic activity in Dade County, Florida.^ The results of the simulation exercises show that the direct economic impact associated with Hurricane Andrew on Dade County is of short duration, and of isolated sectoral impact, with impact generally limited to construction, TCP (transportation, communications, and public utilities), and agricultural sectors. Regional growth, and changes in income and employment reacted directly to, and within the range and direction set by national economic activity. The simulations also lead to the conclusion that areal extent, infrastructure, and sector specific damages or impacts, as opposed to monetary losses, are the primary determinants of a disaster's effects upon employment, income, growth, and economic structure. ^