Exploring retinal and functional markers of diabetic neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most debilitating complications of diabetes. DPN is a major cause of foot ulceration and lower limb amputation. Early diagnosis and management is a key factor in reducing morbidity and mortality. Current techniques for clinical assessment of DPN are relatively insensitive for detecting early disease or involve invasive procedures such as skin biopsies. There is a need for less painful, non-invasive and safe evaluation methods. Eye care professionals already play an important role in the management of diabetic retinopathy; however recent studies have indicated that the eye may also be an important site for the diagnosis and monitoring of neuropathy. Corneal nerve morphology has been shown to be a promising marker of diabetic neuropathy occurring elsewhere in the body, and emerging evidence tentatively suggests that retinal anatomical markers and a range of functional visual indicators could similarly provide useful information regarding neural damage in diabetes – although this line of research is, as yet, less well established. This review outlines the growing body of evidence supporting a potential diagnostic role for retinal structure and visual functional markers in the diagnosis and monitoring of peripheral neuropathy in diabetes.

A prioritised fuzzy constraint satisfaction approach to model agent negotiation for railway scheduling

With the recent regulatory reforms in a number of countries, railways resources are no longer managed by a single party but are distributed among different stakeholders. To facilitate the operation of train services, a train service provider (SP) has to negotiate with the infrastructure provider (IP) for a train schedule and the associated track access charge. This paper models the SP and IP as software agents and the negotiation as a prioritized fuzzy constraint satisfaction (PFCS) problem. Computer simulations have been conducted to demonstrate the effects on the train schedule when the SP has different optimization criteria. The results show that by assigning different priorities on the fuzzy constraints, agents can represent SPs with different operational objectives.

Aligning project stakeholder motivation through incentivisation : a client-driven approach

The use of appropriate financial incentives within construction projects can contribute to strong alignment of project stakeholder motivation with project goals. However, effective incentive system design can be a challenging task and takes skillful planning by client managers in the early stages of a project. In response to a lack of information currently available to construction clients in this area, this paper explores the features of a successful incentive system and identifies key learnings for client managers to consider when designing incentives. Our findings, based on data from a large Australian case study, suggest that key stakeholders place greater emphasis on the project management processes that support incentives than on the incentive itself. Further, contractors need adequate time and information to accurately estimate construction costs prior to their tender price submission to ensure cost-focused incentive goals remain achievable. Thus, client managers should be designing incentives as part of a supportive procurement strategy to maximize project stakeholder motivation and prevent goal misalignment.

Using a design led disruptive innovation approach to develop new services : practising innovation in times of discontinuity

Organisations face increasing competition from new firms in emerging markets and their past superior products may no longer provide competitive advantage in markets based on different cost and value differentials. A shift in design practices from product solutions to health services which are accessible and affordable by all is required. This paper explores a design led approach to innovation to assist medical device companies develop new services and experiences and reshape their notions of the nature, development and deployment of health care services. This approach uses design tools and methodologies that are grounded in the authentic understandings of stakeholder experiences, to assist an organisation create a vision of likely future health care scenarios. Through this process, organisations can explore the complexities in the delivery of future health care services in new and emerging markets allowing them to tailor product and service solutions which focus on being accessible and affordable by all. The industry based case study for the design of health services in carried out in emerging economies. The contribution of this work in advancing research into design innovation and future research directions are also presented.

Effect of surgical approach on bone vascularisation, fracture and soft tissue healing : comparison of less invasive to open approach

Over the past ten years, minimally invasive plate osteosynthesis (MIPO) for the fixation of long bone fractures has become a clinically accepted method with good outcomes, when compared to the conventional open surgical approach (open reduction internal fixation, ORIF). However, while MIPO offers some advantages over ORIF, it also has some significant drawbacks, such as a more demanding surgical technique and increased radiation exposure. No clinical or experimental study to date has shown a difference between the healing outcomes in fractures treated with the two surgical approaches. Therefore, a novel, standardised severe trauma model in sheep has been developed and validated in this project to examine the effect of the two surgical approaches on soft tissue and fracture healing. Twenty four sheep were subjected to severe soft tissue damage and a complex distal femur fracture. The fractures were initially stabilised with an external fixator. After five days of soft tissue recovery, internal fixation with a plate was applied, randomised to either MIPO or ORIF. Within the first fourteen days, the soft tissue damage was monitored locally with a compartment pressure sensor and systemically by blood tests. The fracture progress was assessed fortnightly by x-rays. The sheep were sacrificed in two groups after four and eight weeks, and CT scans and mechanical testing performed. Soft tissue monitoring showed significantly higher postoperative Creatine Kinase and Lactate Dehydrogenase values in the ORIF group compared to MIPO. After four weeks, the torsional stiffness was significantly higher in the MIPO group (p=0.018) compared to the ORIF group. The torsional strength also showed increased values for the MIPO technique (p=0.11). The measured total mineralised callus volumes were slightly higher in the ORIF group. However, a newly developed morphological callus bridging score showed significantly higher values for the MIPO technique (p=0.007), with a high correlation to the mechanical properties (R2=0.79). After eight weeks, the same trends continued, but without statistical significance. In summary, this clinically relevant study, using the newly developed severe trauma model in sheep, clearly demonstrates that the minimally invasive technique minimises additional soft tissue damage and improves fracture healing in the early stage compared to the open surgical approach method.

Restarting trains under moving block signalling : an expert system approach

A high peak power demand at substations will result under Moving Block Signalling (MBS) when a dense queue of trains begins to start from a complete stop at the same time in an electrified railway system. This may cause the power supply interruption and in turn affect the train service substantially. In a recent study, measures of Starting Time Delay (STD) and Acceleration Rate Limit (ARL) are the possible approaches to reduce the peak power demand on the supply system under MBS. Nevertheless, there is no well-defined relationship between the two measures and peak power demand reduction (PDR). In order to attain a lower peak demand at substations on different traffic conditions and system requirements, an expert system is one of the possible approaches to procure the appropriate use of peak demand reduction measures. The main objective of this paper is to study the effect of the train re-starting strategies on the power demand at substations and the time delay suffered by the trains with the aid of computer simulation. An expert system is a useful tool to select various adoptions of STD and ARL under different operational conditions and system requirements.

Copyright and creative innovation in China : an evolutionary approach?

China has made great progress in constructing comprehensive legislative and judicial infrastructures to protect intellectual property rights. But levels of enforcement remain low. Estimates suggest that 90% of film and music products consumed in China are ‘pirated’ and in 2009 81% of the infringing goods seized at the US border originated from China. Despite of heavy criticism over its failure to enforce IPRs, key areas of China’s creative industries, including film, mobile-music, fashion and animation, are developing rapidly. This paper explores how the rapid expansion of China’s creative economy might be reconciled with conceptual approaches that view the CIs in terms of creativity inputs and IP outputs. It argues that an evolutionary understanding of copyright’s role in creative innovation might better explain China’s experiences and provide more general insights into the nature of the creative industries and the policies most likely to promote growth in this sector of the economy.

Minimising transport disadvantage to support knowledge city formation : applying the capability approach to select indicators

Purpose–The aims of this paper are to demonstrate the application of Sen’s theory of well-being, the capability approach; to conceptualise the state of transportation disadvantage; and to underpin a theoretical sounds indicator selection process. Design/methodology/approach–This paper reviews and examines various measurement approaches of transportation disadvantage in order to select indicators and develop an innovative framework of urban transportation disadvantage. Originality/value–The paper provides further understanding of the state of transportation disadvantage from the capability approach perspective. In addition, building from this understanding, a validated and systematic framework is developed to select relevant indicators. Practical implications –The multi-indicator approach has a high tendency to double count for transportation disadvantage, increase the number of TDA population and only accounts each indicator for its individual effects. Instead, indicators that are identified based on a transportation disadvantage scenario will yield more accurate results. Keywords – transport disadvantage, the capability approach, accessibility, measuring urban transportation disadvantage, indicators selection Paper type – Academic Research Paper

A 'conceptual models' approach to organisational resilience

Gibson and Tarrant discuss the range of inter-dependant factors needed to manage organisational resilience. Over the last few years there has been considerable interest in the idea of resilience across all areas of society. Like any new area or field this has produced a vast array of definitions, processes, management systems and measurement tools which together have clouded the concept of resilience. Many of us have forgotten that ultimately resilience is not just about ‘bouncing back from adversity’ but is more broadly concerned with adaptive capacity and how we better understand and address uncertainty in our internal and external environments. The basis of organisational resilience is a fundamental understanding and treatment of risk, particularly non-routine or disruption related risk. This paper presents a number of conceptual models of organisational resilience that we have developed to demonstrate the range of inter-dependant factors that need to be considered in the management of such risk. These conceptual models illustrate that effective resilience is built upon a range of different strategies that enhance both ‘hard’ and ‘soft’ organisational capabilities . They emphasise the concept that there is no quick fix, no single process, management system or software application that will create resilience.

Functional status, postural stability and falls among older adults with glaucoma

Visual impairment is an important contributing factor in falls among older adults, which is one of the leading causes of injury and injury-related death in this population. Visual impairment is also associated with greater disability among older adults, including poorer health-related quality of life, increased frailty and reduced postural stability. The majority of this evidence, however, is based on measures of central visual function, rather than peripheral visual function. As such, there is comparatively limited research on the associations between peripheral visual function, disability and falls, and even fewer studies involving older adults with specific diseases which affect peripheral visual function, the most common of which is glaucoma. Glaucoma is one of the leading causes of irreversible vision loss among older adults, affecting around 3 per cent of adults aged over 60 years. The condition is characterised by retinal nerve fibre loss, primarily affecting peripheral visual function. Importantly, the number of older adults with glaucomatous visual impairment is projected to increase as the ageing population grows. The first component of the thesis examined the cross-sectional association between glaucomatous visual impairment and health-related quality of life (Study 1a), functional status (Study 1b) and postural stability (Study 1c) among older adults. A cohort of 74 community-dwelling adults with glaucoma (mean age 74.2 ± 5.9 years) was recruited and completed a baseline assessment. A number of visual function measures was assessed, including central visual function (visual acuity and contrast sensitivity), motion sensitivity, retinal nerve fibre analysis and monocular and binocular visual field measures (monocular 24-2 and binocular integrated visual fields (IVF): IVF-60 and IVF-120). The analyses focused on the associations between the outcomes measures and severity and location of visual field loss, as this is the primary visual function affected by glaucoma. In Study 1a, we examined the association between visual field loss and health-related quality of life, measured by the Short Form 36-item Health Survey (SF-36). Greater binocular visual field loss, on both IVF measures, was associated with lower SF-36 physical component scores, adjusted for age and gender (Pearson's r =|0.32| to |0.36|, p<0.001). Furthermore, inferior visual field loss was more strongly associated with the SF-36 physical component than superior field loss. No association was found between visual field loss and SF-36 mental component scores. The association between visual field loss and functional status was examined in Study 1b. Functional status outcomes measures included a physical activity questionnaire (Physical Activity Scale for the Elderly, PASE), performance tests (six-minute walk test, timed up and go test and lower leg strength) and an overall functional status score. Significant, but weak, correlations were found between binocular visual field loss and PASE and overall functional status scores, adjusted for age and gender (Pearson's r =|0.24| to |0.33|, p<0.05). Greater inferior visual field loss, independent of superior visual field loss, was significantly associated with poorer physical performance results and lower overall functional status scores. In Study 1c, we examined the association between visual field loss and postural stability, using a swaymeter device which recorded body movement during four conditions: eyes open and closed, on a firm and foam surface. Greater binocular visual field loss was associated with increased postural sway, both on firm and foam surfaces, independent of age and gender (Pearson’s r =|0.44| to |0.46|, p <0.001). Furthermore, inferior visual field was a stronger contributor to postural stability, more so than the superior visual field, particularly on the foam condition with the eyes open. Greater visual field loss was associated with a reduction in the visual contribution to postural sway, which underlies the observed association with postural sway. The second component of the thesis examined the association between severity and location of visual field loss and falls during a 12-month longitudinal follow-up. The number of falls was assessed prospectively using monthly fall calendars. Of the 71 participants who successfully completed the follow up (mean age 73.9 ± 5.7 years), 44% reported one or more falls, and around 20% reported two or more falls. After adjusting for age and gender, every 10 points missed on the IVF-120 increased the rate of falls by 25% (rate ratio 1.25, 95% confidence interval 1.08 - 1.44) or every 5dB reduction in IVF-60 increased the rate of falls by 47% (rate ratio 1.47, 95% confidence interval 1.16 - 1.87). Inferior visual field loss was a significant predictor of falls, more so than superior field loss, highlighting the importance of the inferior visual field area in safe and efficient navigation. Further analyses indicated that postural stability, more so than functional status, may be a potential mediating factor in the relationship between visual field loss and falls. Future research is required to confirm this causal pathway. In addition, the use of topical beta-blocker medications was not associated with an increased rate of falls in this cohort, compared with the use of other topical anti-glaucoma medications. In summary, greater binocular visual field loss among older adults with glaucoma was associated with poorer health-related quality of life in the physical domain, reduced functional status, greater postural instability and higher rates of falling. When the location of visual field loss was examined, inferior visual field loss was consistently more strongly associated with these outcomes than superior visual field loss. Insights gained from this research improve our understanding of the association between glaucomatous visual field loss and disability, and its link with falls among older adults. The clinical implications of this research include the need to include visual field screening in falls risk assessments among older adults and to raise awareness of these findings to eye care practitioners and adults with glaucoma. The findings also assist in developing further research to examine strategies to reduce disability and prevent falls among older adults with glaucoma to promote healthy ageing and independence for these individuals.

Developing strong social enterprises : a documentary approach

Social enterprises are diverse in their mission, business structures and industry orientations. Like all businesses, social enterprises face a range of strategic and operational challenges and utilize a range of strategies to access resources in support of their venture. This exploratory study examined the strategic management issues faced by Australian social enterprises and the ways in which they respond to these. The research was based on a comprehensive literature review and semi-structured interviews with 11 representatives of eight social enterprises based in Victoria and Queensland. The sample included mature social enterprises and those within two years of start-up. In addition to the research report, the outputs of the project include a series of six short documentaries, which are available on YouTube at http://www.youtube.com/user/SocialEnterpriseQUT#p/u. The research reported on here suggests that social enterprises are sophisticated in utilizing processes of network bricolage (Baker et al. 2003) to mobilize resources in support of their goals. Access to network resources can be both enabling and constraining as social enterprises mature. In terms of the use of formal business planning strategies, all participating social enterprises had utilized these either at the outset or the point of maturation of their business operations. These planning activities were used to support internal operations, to provide a mechanism for managing collective entrepreneurship, and to communicate to external stakeholders about the legitimacy and performance of the social enterprises. Further research is required to assess the impacts of such planning activities, and the ways in which they are used over time. Business structures and governance arrangements varied amongst participating enterprises according to: mission and values; capital needs; and the experiences and culture of founding organizations and individuals. In different ways, participants indicated that business structures and governance arrangements are important ways of conferring legitimacy on social enterprise, by signifying responsible business practice and strong social purpose to both external and internal stakeholders. Almost all participants in the study described ongoing tensions in balancing social purpose and business objectives. It is not clear, however, whether these tensions were problematic (in the sense of eroding mission or business opportunities) or productive (in the sense of strengthening mission and business practices through iterative processes of reflection and action). Longitudinal research on the ways in which social enterprises negotiate mission fulfillment and business sustainability would enhance our knowledge in this area. Finally, despite growing emphasis on measuring social impact amongst institutions, including governments and philanthropy, that influence the operating environment of social enterprise, relatively little priority was placed on this activity. The participants in our study noted the complexities of effectively measuring social impact, as well as the operational difficulties of undertaking such measurement within the day to day realities of running small to medium businesses. It is clear that impact measurement remains a vexed issue for a number of our respondents. This study suggests that both the value and practicality of social impact measurement require further debate and critically informed evidence, if impact measurement is to benefit social enterprises and the communities they serve.

Childhood experiences of cancer : an interpretative phenomenological analysis approach

Pediatric oncology has emerged as one of the great medical success stories of the last 4 decades. The cure rate of childhood cancer has increased from approximately 25% in the 1960’s to more than 75% in more recent years. However, very little is known about how children actually experience the diagnosis and treatment of their illness. A total of 9 families in which a child was diagnosed with cancer were interviewed twice over a 12-month period. Using the qualitative methodology of interpretative phenomenological analysis (IPA), children’s experiences of being patients with a diagnosis of cancer were explicated. The results revealed 5 significant themes: the experience of illness, the upside of being sick, refocusing on what is important, acquiring a new perspective, and the experience of returning to wellbeing. Changes over time were noted because children’s experiences’ were often pertinent to the stage of treatment the child had reached. These results revealed rich and intimate information about a sensitive issue with implications for understanding child development and medical and psychosocial treatment.

Cyberbullying prevention : one primary school’s approach

Bullying in all its forms including cyberbullying is a continuing problem in schools. Given the severe consequences it can have on students (socially, psychologically and physically) it is not surprising that a number of intervention programs have been developed, with most advocating a whole school approach. The current study compared students’ self-reports on bullying between schools with and without a Philosophy for Children (P4C) approach. A sample of 35 students in the P4C school and a matched sample of 35 students in other schools between the ages of 10 and 13 completed the Student Bullying Survey. Results indicated that while there were significant differences in incidences of face-to-face bullying, there were similar results from both cohorts in relation to cyberbullying. Both groups of students felt that teachers were more likely to prevent face-to-face bullying than cyberbullying. Findings indicate that teachers and guidance counsellors need to be as overt in teaching strategies about cyberbullying as they are in teaching strategies about reducing face-to-face bullying.

Carbon capture and storage laws in Australia : project facilitation or a precautionary approach?

Carbon capture and storage (CCS) is considered to be an integral transitionary measure in the mitigation of the global greenhouse gas emissions from our continued use of fossil fuels. Regulatory frameworks have been developed around the world and pilot projects have been commenced. However, CCS processes are largely untested at commercial scales and there are many unknowns associated with the long terms risks from these storage projects. Governments, including Australia, are struggling to develop appropriate, yet commercially viable, regulatory approaches to manage the uncertain long term risks of CCS activities. There have been numerous CCS regimes passed at the Federal, State and Territory levels in Australia. All adopt a different approach to the delicate balance facilitating projects and managing risk. This paper will examine the relatively new onshore and offshore regimes for CCS in Australia and the legal issues arising in relation to the implementation of CCS projects. Comparisons will be made with the EU CCS Directive where appropriate.