International rigid contact lens prescribing

Rigid lenses have been fitted less since the introduction of soft lenses nearly 40 years ago. Data that we have gathered from annual contact lens fitting surveys conducted in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA between 2000 and 2008 facilitate an accurate characterization of the pattern of the decline of rigid lens fitting during the first decade of this century. There is a trend for rigid lenses to be utilized primarily for refitting those patients who are already successful rigid lens wearers—most typically older females being refit with higher Dk materials. Rigid lenses are generally fitted on a full-time basis (four or more days of wear per week) without a planned replacement schedule. Orthokeratology is especially popular in the Netherlands, but is seldom prescribed in the other countries surveyed.

Shall we dance? The story of The Radiance Dance Project

Community workers are often described as unsung heroes who work for, with, and alongside others in order to make qualitative differences to the communities they serve. This paper reports on the story of a community based arts educator, Morgan Jai-Morincome, winner of the ACT Adult Learners Week Award for an outstanding program in 2007. This program, referred to as The Radiance Dance Project, is an inclusive performance project open to women with and without disabilities that culminates in a yearly performance. Via an interview with Morgan, observations of a workshop she provided for the women in her 2009 program, and a viewing of a DVD of the 2008 dance performance, this case study provides an illustration of the power of arts based educative processes for breaking down barriers between people with and without disabilities. It draws upon constructs from ethical leadership theory and empowerment theory to interpret her ideas and practices.

Trends in Australian contact lens prescribing during the first decade of the 21st Century (2000–2009)

Purpose: The aim was to document contact lens prescribing trends in Australia between 2000 and 2009. ---------- Methods: A survey of contact lens prescribing trends was conducted each year between 2000 and 2009. Australian optometrists were asked to provide information relating to 10 consecutive contact lens fittings between January and March each year. ---------- Results: Over the 10-year survey period, 1,462 practitioners returned survey forms representing a total of 13,721 contact lens fittings. The mean age (± SD) of lens wearers was 33.2 ± 13.6 years and 65 per cent were female. Between 2006 and 2009, rigid lens new fittings decreased from 18 to one per cent. Low water content lenses reduced from 11.5 to 3.2 per cent of soft lens fittings between 2000 and 2008. Between 2005 and 2009, toric lenses and multifocal lenses represented 26 and eight per cent, respectively, of all soft lenses fitted. Daily disposable, one- to two-week replacement and monthly replacement lenses accounted for 11.6, 30.0 and 46.5 per cent of all soft lens fittings over the survey period, respectively. The proportion of new soft fittings and refittings prescribed as extended wear has generally declined throughout the past decade. Multi-purpose lens care solutions dominate the market. Rigid lenses and monthly replacement soft lenses are predominantly worn on a full-time basis, whereas daily disposable soft lenses are mainly worn part-time.---------- Conclusions: This survey indicates that technological advances, such as the development of new lens materials, manufacturing methods and lens designs, and the availability of various lens replacement options, have had a significant impact on the contact lens market during the first decade of the 21st Century.

Central and peripheral oxygen transmissibility thresholds to avoid corneal swelling during open eye soft contact lens wear

This study was designed to derive central and peripheral oxygen transmissibility (Dk/t) thresholds for soft contact lenses to avoid hypoxia-induced corneal swelling (increased corneal thickness) during open eye wear. Central and peripheral corneal thicknesses were measured in a masked and randomized fashion for the left eye of each of seven subjects before and after 3 h of afternoon wear of five conventional hydrogel and silicone hydrogel contact lens types offering a range of Dk/t from 2.4 units to 115.3 units. Curve fitting for plots of change in corneal thickness versus central and peripheral Dk/t found threshold values of 19.8 and 32.6 units to avoid corneal swelling during open eye contact lens wear for a typical wearer. Although some conventional hydrogel soft lenses are able to achieve this criterion for either central or peripheral lens areas (depending on lens power), in general, no conventional hydrogel soft lenses meet both the central and peripheral thresholds. Silicone hydrogel contact lenses typically meet both the central and peripheral thresholds and use of these lenses therefore avoids swelling in all regions of the cornea. ' 2009 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 92B: 361–365, 2010

A ‘cost-per-wear’ model based on contact lens replacement frequency

Purpose: The aim was to construct and advise on the use of a cost-per-wear model based on contact lens replacement frequency, to form an equitable basis for cost comparison. ---------- Methods: The annual cost of professional fees, contact lenses and solutions when wearing daily, two-weekly and monthly replacement contact lenses is determined in the context of the Australian market for spherical, toric and multifocal prescription types. This annual cost is divided by the number of times lenses are worn per year, resulting in a ‘cost-per-wear’. The model is presented graphically as the cost-per-wear versus the number of times lenses are worn each week for daily replacement and reusable (two-weekly and monthly replacement) lenses.---------- Results: The cost-per-wear for two-weekly and monthly replacement spherical lenses is almost identical but decreases with increasing frequency of wear. The cost-per-wear of daily replacement spherical lenses is lower than for reusable spherical lenses, when worn from one to four days per week but higher when worn six or seven days per week. The point at which the cost-per-wear is virtually the same for all three spherical lens replacement frequencies (approximately AUD$3.00) is five days of lens wear per week. A similar but upwardly displaced (higher cost) pattern is observed for toric lenses, with the cross-over point occurring between three and four days of wear per week (AUD$4.80). Multifocal lenses have the highest price, with cross-over points for daily versus two-weekly replacement lenses at between four and five days of wear per week (AUD$5.00) and for daily versus monthly replacement lenses at three days per week (AUD$5.50).---------- Conclusions: This cost-per-wear model can be used to assist practitioners and patients in making an informed decision in relation to the cost of contact lens wear as one of many considerations that must be taken into account when deciding on the most suitable lens replacement modality.

Global trends in prescribing contact lenses for extended wear

Extended wear has long been the ‘holy grail’ of contact lenses by virtue of the increased convenience and freedom of lifestyle which they accord; however, this modality enjoyed only limited market success during the last quarter of the 20th century. The introduction of silicone hydrogel materials into the market at the beginning of this century heralded the promise of successful extended wear due to the superior oxygen performance of this lens type. To assess patterns of contact lens fitting, including extended wear, over the past decade, up to 1000 survey forms were sent 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 survey form. Analysis of returned forms revealed that, averaged over this period, 9% of all soft lenses prescribed were for extended wear, with national figures ranging from 2% in Japan to 17% in Norway. The trend over the past decade has been for an increase from about 5% of all soft lens fits in 2000 to a peak of between 9 and 12% between 2002 and 2007, followed by a decline to around 7% in 2009. A person receiving extended wear lenses is likely to be an older female who is being refitted with silicone hydrogel lenses for full-time wear. Although extended wear has yet again failed to fulfil the promise of being the dominant contact lens wearing modality, it is still a viable option for many people.

Twenty first century trends in silicone hydrogel contact lens fitting : an international perspective

Silicone hydrogel contact lenses were introduced into the market in 1999. To assess prescribing trends of this lens type since then, up to 1000 survey forms were sent to contact lens fitters in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA each year between 2000 and 2008. Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Analysis of returned forms revealed a rapid increase in the prescribing of silicone hydrogel lenses over the survey period. In 2008, silicone hydrogel lenses represented 36% of all soft lenses prescribed. The categorization of the majority of lenses prescribed as ‘refits’ is primarily attributed to the mass conversion of lens wearers from hydrogel to silicone hydrogel lenses. Silicone hydrogels may soon represent the majority of soft contact lenses prescribed.

Daily disposable contact lens prescribing around the world

Daily disposable contact lenses were introduced into the market 16 years ago. Data that we have gathered from annual contact lens fitting surveys conducted in Australia, Canada, Japan, The Netherlands, Norway, the UK and the USA between 2000 and 2008 indicates an overall increase in daily disposable lens fitting during this period. Daily disposable lenses are especially popular in Japan, Norway and the UK. There is a trend for these lenses to be fitted on a part-time basis. Males are over-represented in daily disposable lens fitting—a trend that is especially evident in Canada. Daily disposable lens wearers are about two years younger than wearers of reusable lenses in Japan and The Netherlands. The convenience and health benefits of daily disposable lenses are expected to fuel continued growth in this sector.

Demographics of international contact lens prescribing

Knowledge of differences in the demographics of contact lens prescribing between nations, and changes over time, can assist (a) the contact lens industry in developing and promoting various product types in different world regions, and (b) practitioners in understanding their prescribing habits in an international context. Data that we have gathered from annual contact lens fitting surveys conducted in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA between 2000 and 2008 reveal an ageing demographic, with Japan being the most youthful. The majority of fits are to females, with statistically significant differences between nations, ranging from 62 per cent of fits in Norway to 68 per cent in Japan. The small overall decline in the proportion of new fits, and commensurate increase in refits, over the survey periodmay indicate a growing rate of conversion of lens wearers to more advanced lens types, such as silicone hydrogels. � 2009 British Contact Lens Association.

Is it necessary to re-fuse a non-union of a hallux metatarsophalangeal joint arthrodesis?

BACKGROUND: The standard treatment for a non-union of the hallux metatarsophalangeal joint fusion has been to revise the fusion. Revision fusion is technically more demanding, often involving bone grafting, more substantial fixation and prolonged period of immobilization postoperatively. We present data to suggest that removal of hardware and debridement alone is an alternative treatment option. ---------- MATERIALS AND METHODS: A case note review identified patients with a symptomatic non-union after hallux metatarsophalangeal joint (MTPJ) fusion. It is our practice to offer these patients revision fusion or removal of hardware and debridement. For the seven patients that chose hardware removal and were left with a pseudarthrosis, a matched control group was selected from patients who had had successful fusions. Three outcome scores were used. Hallux valgus and dorsiflexion angles were recorded.---------- RESULTS: One hundred thirty-nine hallux MTPJ arthrodeses were carried out. Fourteen non-unions were identified. The rate of non-union in males and following previous hallux MTPJ surgery was 19% and 24%, respectively. In females undergoing a primary MTPJ fusion, the rate was 2.4%. Twelve non-union patients were reviewed at 27 months (mean). Eleven patients had elected to undergo removal of hardware and debridement. Four patients with pseudarthrosis were unhappy with the results and proceeded to either revision fusion or MTPJ replacement. Seven non-union patients, who had removal of hardware alone, had outcome scores marginally worse compared to those with successful fusions.---------- CONCLUSION: Removal of hardware alone is a reasonable option to offer as a relatively minor procedure following a failed arthrodesis of the first MTPJ. This must be accepted on the proviso that in this study four out of 11 (36%) patients proceeded to a revision first MTPJ fusion or first MTPJ replacement. We also found that the rate of non-union in primary first MTPJ fusion was significantly higher in males and those patients who had undergone previous surgery.

Model interoperability in building information modelling

The exchange of design models in the design and construction industry is evolving away from 2-dimensional computer-aided design (CAD) and paper towards semantically-rich 3-dimensional digital models. This approach, known as Building Information Modelling (BIM), is anticipated to become the primary means of information exchange between the various parties involved in construction projects. From a technical perspective, the domain represents an interesting study in model-based interoperability, since the models are large and complex, and the industry is one in which collaboration is a vital part of business. In this paper, we present our experiences with issues of model-based interoperability in exchanging building information models between various tools, and in implementing tools which consume BIM models, particularly using the industry standard IFC data modelling format. We report on the successes and challenges in these endeavours, as the industry endeavours to move further towards fully digitised information exchange.

Fair flow control of ABR service by per-VC virtual queuing

In this paper, a rate-based flow control scheme based upon per-VC virtual queuing is proposed for the Available Bit Rate (ABR) service in ATM. In this scheme, each VC in a shared buffer is assigned a virtual queue, which is a counter. To achieve a specific kind of fairness, an appropriate scheduler is applied to the virtual queues. Each VC's bottleneck rate (fair share) is derived from its virtual cell departure rate. This approach of deriving a VC's fair share is simple and accurate. By controlling each VC with respect to its virtual queue and queue build-up in the shared buffer, network congestion is avoided. The principle of the control scheme is first illustrated by max–min flow control, which is realised by scheduling the virtual queues in round-robin. Further application of the control scheme is demonstrated with the achievement of weighted fairness through weighted round robin scheduling. Simulation results show that with a simple computation, the proposed scheme achieves the desired fairness exactly and controls network congestion effectively.

The organic fraction of bubble-generated, accumulation mode Sea Spray Aerosol (SSA)

Recent studies have detected a dominant accumulation mode (~100 nm) in the Sea Spray Aerosol (SSA) number distribution. There is evidence to suggest that particles in this mode are composed primarily of organics. To investigate this hypothesis we conducted experiments on NaCl, artificial SSA and natural SSA particles with a Volatility-Hygroscopicity-Tandem-Differential-Mobility-Analyser (VH-TDMA). NaCl particles were atomiser generated and a bubble generator was constructed to produce artificial and natural SSA particles. Natural seawater samples for use in the bubble generator were collected from biologically active, terrestrially-affected coastal water in Moreton Bay, Australia. Differences in the VH-TDMA-measured volatility curves of artificial and natural SSA particles were used to investigate and quantify the organic fraction of natural SSA particles. Hygroscopic Growth Factor (HGF) data, also obtained by the VH-TDMA, were used to confirm the conclusions drawn from the volatility data. Both datasets indicated that the organic fraction of our natural SSA particles evaporated in the VH-TDMA over the temperature range 170–200°C. The organic volume fraction for 71–77 nm natural SSA particles was 8±6%. Organic volume fraction did not vary significantly with varying water residence time (40 secs to 24 hrs) in the bubble generator or SSA particle diameter in the range 38–173 nm. At room temperature we measured shape- and Kelvin-corrected HGF at 90% RH of 2.46±0.02 for NaCl, 2.35±0.02 for artifical SSA and 2.26±0.02 for natural SSA particles. Overall, these results suggest that the natural accumulation mode SSA particles produced in these experiments contained only a minor organic fraction, which had little effect on hygroscopic growth. Our measurement of 8±6% is an order of magnitude below two previous measurements of the organic fraction in SSA particles of comparable sizes. We stress that our results were obtained using coastal seawater and they can’t necessarily be applied on a regional or global ocean scale. Nevertheless, considering the order of magnitude discrepancy between this and previous studies, further research with independent measurement techniques and a variety of different seawaters is required to better quantify how much organic material is present in accumulation mode SSA.

Patterns, heuristics for architectural design support: making use of evolutionary modelling in design

Software used by architectural and industrial designers – has moved from becoming a tool for drafting, towards use in verification, simulation, project management and project sharing remotely. In more advanced models, parameters for the designed object can be adjusted so a family of variations can be produced rapidly. With advances in computer aided design technology, numerous design options can now be generated and analyzed in real time. However the use of digital tools to support design as an activity is still at an early stage and has largely been limited in functionality with regard to the design process. To date, major CAD vendors have not developed an integrated tool that is able to both leverage specialized design knowledge from various discipline domains (known as expert knowledge systems) and support the creation of design alternatives that satisfy different forms of constraints. We propose that evolutionary computing and machine learning be linked with parametric design techniques to record and respond to a designer’s own way of working and design history. It is expected that this will lead to results that impact on future work on design support systems-(ergonomics and interface) as well as implicit constraint and problem definition for problems that are difficult to quantify.