Glaucomatous visual field progression with frequency-doubling technology and standard automated perimetry in a longitudinal prospective study

PURPOSE. To compare frequency-doubling technology (FDT) perimetry with standard automated perimetry (SAP) for detecting glaucomatous visual field progression in a longitudinal prospective study.

METHODS. One eye of patients with open-angle glaucoma was tested every 6 months with both FDT and SAP. A minimum of 6 examinations with each perimetric technique was required for inclusion. Visual field progression was determined by two methods: glaucoma change probability (GCP) analysis and linear regression analysis (LRA). For GCP, several criteria for progression were used. The number of locations required to classify progression with FDT compared with SAP, respectively, was 1:2 (least conservative), 1:3, 2:3, 2:4, 2:6, 2:7, 3:6, 3:7, and 3:10 (most conservative). The number of consecutive examinations required to confirm progression was 2-of-3, 2-of-2, and 3-of-3. For LRA, the progression criterion was any significant decline in mean threshold sensitivity over time in each of the following three visual field subdivisions: (1) all test locations, (2) locations in the central 10° and the superior and inferior hemifields, and (3) locations in each quadrant. Using these criteria, the proportion of patients classified as showing progression with each perimetric technique was calculated and, in the case of progression with both, the differences in time to progression were determined.

RESULTS. Sixty-five patients were followed for a median of 3.5 years (median number of examinations, 9). For the least conservative GCP criterion, 32 (49%) patients were found to have progressing visual fields with FDT and 32 (49%) patients with SAP. Only 16 (25%) patients showed progression with both methods, and in most of those patients, FDT identified progression before SAP (median, 12 months earlier). The majority of GCP progression criteria (15/27), classified more patients as showing progression with FDT than with SAP. Contrary to this, more patients showed progression with SAP than FDT, when analysed with LRA; e.g., using quadrant LRA 20 (31%) patients showed progression with FDT, 23 (35%) with SAP, and only 10 (15%) with both.

CONCLUSIONS. FDT perimetry detected glaucomatous visual field progression. However, the proportion of patients who showed progression with both FDT and SAP was small, possibly indicating that the two techniques identify different subgroups of patients. Using GCP, more patients showed progression with FDT than with SAP, yet the opposite occurred using LRA. As there is no independent qualifier of progression, FDT and SAP progression rates vary depending on the method of analysis and the criterion used.

Regulatory theory insights into the past, present and future of general purpose water accounting standard setting

Purpose – Accounting and water industry experts are developing general-purpose water accounting (GPWA) to report information about water and rights to water. The system has the potential to affect water policies, pricing and management, and investment and other decisions that are affected by GPWA report users' understanding of water risks faced by an entity. It may also affect financial returns to accounting and auditing firms and firms in water industries. In this paper the authors aim to examine the roles of the accounting profession, water industries and other stakeholders in governing GPWA. Recognising that the fate of GPWA depends partly upon regulatory power and economics, they seek to apply regulatory theories that explain financial accounting standards development to speculate about the national and international future of GPWA.

Design/methodology/approach – Official documents, internal Water Accounting Standards Board documents and unstructured interviews underpin the authors' analysis.

Findings – The authors speculate about the benefits that might accrue to various stakeholder groups from capturing the GPWA standard-setting process. They also suggest that internationally, water industries may dominate early GPWA standards development in the public interest and that regulatory capture by accounting or water industry professionals will not necessarily conflict with public interest benefits.

Practical implications – Accounting for water can affect allocations of environmental, economic, social and other resources; also, accounting and water industry professional standing and revenues. In this paper the authors identify factors influencing GPWA standards and standard-setting institutional arrangements, and thereby these resource allocations. The paper generates an awareness of GPWA's emergence and practical implications.

Originality/value – This is an early study to investigate water accounting standard-setting regulatory influences and their impact.

A simple-to-use calculator for determining the total solar heat gain of a glazing system

Architects and designers could readily use a quick and easy tool to determine the solar heat gains of their selected glazing systems for particular orientations, tilts and climate data. Speedy results under variable solar angles and degree of irradiance would be welcomed by most. Furthermore, a newly proposed program should utilise the outputs of existing glazing tools and their standard information, such as the use of U-values and Solar Heat Gain Coefficients (SHGC’s) as generated for numerous glazing configurations by the well-known program WINDOW 6.0 (LBNL, 2001). The results of this tool provide interior glass surface temperature and transmitted solar radiation which link into comfort analysis inputs required by the ASHRAE Thermal Comfort Tool –V2 (ASHRAE, 2011). This tool is a simple-to-use calculator providing the total solar heat gain of a glazing system exposed to various angles of solar incidence. Given basic climate (solar) data, as well as the orientation of the glazing under consideration the solar heat gain can be calculated. The calculation incorporates the Solar Heat Gain Coefficient function produced for the glazing system under various angles of solar incidence WINDOW 6.0 (LBNL, 2001). The significance of this work rests in providing an orientation-based heat transfer calculator through an easy-to-use tool (using Microsoft EXCEL) for user inputs of climate and Solar Heat Gain Coefficient (WINDOW-6) data. We address the factors to be considered such as solar position and the incident angles to the horizontal and the window surface, and the fact that the solar heat gain coefficient is a function of the angle of incidence. We also discuss the effect of the diffuse components of radiation from the sky and those from ground surface reflection, which require refinement of the calculation methods. The calculator is implemented in an Excel workbook allowing the user to input a dataset and immediately produce the resulting solar gain. We compare this calculated total solar heat gain with measurements from a test facility described elsewhere in this conference (Luther et.al., 2012).

Evidence-based chronic heart-failure management programs : myth or reality?

Background Chronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF). Objective To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes. Design A prospective cross-sectional survey was used to conduct a national audit. Setting Community setting of CHF-MPs for patients postdischarge. Sample All CHF-MPs operating during 2005–2006 (n=55). Also 10–50 consecutive patients from 48 programmes were recruited (n=1157). Main outcome measures (1) Characteristics and interventions used within each CHF-MP; and (2) characteristics of patients enrolled into these programmes. Results Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 postdischarge CHF patients (median: 126; IQR: 26–260) were managed via CHF-MPs, representing only 20% of the potential national case load. Significantly, 16% of the caseload comprised patients in functional New York Heart Association Class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident, with 70% of CHF-MPs offering a hybrid model (a combination of heart-failure outpatient clinics and home visits), 20% conducting home visits and 16% conducting an extended rehabilitation model of care. Less than half (44%) allowed heart-failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n=23, 96%), β-blockers (n=17, 71%), ACE inhibitors (ACEIs) (n=14, 58%) and spironolactone (n=9, 38%). Conclusion CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and questions the quality of health-related outcomes for these patients.

Employment arrangements and mental health in a cohort of working Australians : are transitions from permanent to temporary employment associated with changes in mental health?

We investigated whether being in temporary employment, as compared with permanent employment, was associated with a difference in Short Form 36 mental health and whether transitions from permanent employment to temporary employment were associated with mental health changes. We used fixed-effects regression in a nationally representative Australian sample with 10 waves of data collection (2001–2010). Interactions by age and sex were tested. Two forms of temporary employment were studied: “casual” (no paid leave entitlements or fixed hours) and “fixed-term contract” (a defined employment period plus paid leave). There were no significant mental health differences between temporary employment and permanent employment in standard fixed-effects analyses and no significant interactions by sex or age. For all age groups combined, there were no significant changes in mental health following transitions from stable permanent employment to temporary employment, but there was a significant interaction with age (P = 0.03) for the stable-permanent-to-casual employment transition, because of a small transition-associated improvement in mental health for workers aged 55–64 years (β = 1.61, 95% confidence interval: 0.34, 2.87; 16% of the standard deviation of mental health scores). Our analyses suggest that temporary employment is not harmful to mental health in the Australian context and that it may be beneficial for 55- to 64-year-olds transitioning from stable permanent employment to casual employment.