Measuring the macrosystem in post-accord Northern Ireland: A social-ecological approach

The macrosystem refers to the overarching patterns that influence behavior at each level of the social ecology (Bronfenbrenner, 1977), making it a necessary component for assessing human development in contexts of political violence. This article proposes a method for systematically measuring the macrosystem in Northern Ireland that allows for a subnational analysis, multiple time units, and indicators of both low-level violence and positive relations. Articles were randomly chosen for each weekday in 2006-2011 from two prominent Northern Irish newspapers and coded according to their reflection of positive relations and political tensions between Catholics and Protestants. The newspaper data were then compared to existing macro-level measurements in Northern Ireland. We found that the newspaper data provided a more nuanced understanding of fluctuations in intergroup relations than the corresponding measures. This has practical implications for peacebuilding and advances our methods for assessing the impact of macro-level processes on individual development.

The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease

Introduction
Standard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions.

Methods
The Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group.The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists.

Discussion
This trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.