Grading and disease management in national screening for diabetic retinopathy in England and Wales

Aims - A National Screening Programme for diabetic eye disease in the UK is in development. We propose a grading and early disease management protocol to detect sight-threatening diabetic retinopathy and any retinopathy, which will allow precise quality assurance at all steps while minimizing false-positive referral to the hospital eye service. Methods - Expert panel structured discussions between 2000 and 2002 with review of existing evidence and grading classifications. Proposals - Principles of the protocol include: separate grading of retinopathy and maculopathy, minimum number of steps, compatible with central monitoring, expandable for established more complex systems and for research, no lesion counting, no ‘questionable’ lesions, attempt to detect focal exudative, diffuse and ischaemic maculopathy and fast track referral from primary or secondary graders. Sight-threatening diabetic retinopathy is defined as: preproliferative retinopathy or worse, sight-threatening maculopathy and/or the presence of photocoagulation. In the centrally reported minimum data set retinopathy is graded into four levels: none (R0), background (R1), preproliferative (R2), proliferative (R3). Maculopathy and photocoagulation are graded as absent (M0, P0) or present (M1, P1). Discussion - The protocol developed by the Diabetic Retinopathy Grading and Disease Management Working Party represents a new consensus upon which national guidelines can be based leading to the introduction of quality-assured screening for people with diabetes.

Regional interests in Europe:Wales and Saxony as modern regions in Europe

The question of how to organize and manage sustainable regional development has recently come to the fore in many places across the industrialized countries of Central and Western Europe, and especially within the European Union (EU).This book looks at the home-grown natural, economic and social, socio-political, political and administrative conditions which policy makers face, while also being subjected to numerous external influences. Political actors in less important EU regions The question of how to organize and manage sustainable regional development has recently come to the fore in many places across the industrialized countries of Central and Western Europe, and especially within the European Union (EU).This book looks at the home-grown natural, economic and social, socio-political, political and administrative conditions which policy makers face, while also being subjected to numerous external influences. Political actors in less important EU regions attempt to create and implement strategies of regional development in the context of regional policy-making by EU institutions, national governments and the globalization process

Profit, productivity and price performance changes in the water and sewerage industry:an empirical application for England and Wales

This paper aims to analyse the impact of regulation in the financial performance of the Water and Sewerage companies (WaSCs) in England and Wales over the period 1991–2008. In doing so, a panel index approach is applied across WaSCs over time to decompose unit-specific index number-based profitability growth as a function of the profitability, productivity and price performance growth achieved by benchmark firms, and the catch up to the benchmark firm achieved by less productive firms. The results indicated that after 2000 there is a steady decline in average price performance, while productivity improves resulting in a relatively stable economic profitability. It is suggested that the English and Welsh water regulator is now more focused on passing productivity benefits to consumers, and maintaining stable profitability than it was in earlier regulatory periods. This technique is of great interest for regulators to evaluate the effectiveness of regulation and companies to identify the determinants of profit change and improve future performance, even if sample sizes are limited.

Language policy and governmentality in businesses in Wales:a continuum of empowerment and regulation

In this paper, I examine how language policy acts as a means of both empowering the Welsh language and theminority language worker and as a means of exerting power over them. For this purpose, the study focuses on a particular site: private sector businesses in Wales. Therein, I trace two major discursive processes: first, the Welsh Government’s national language policy documents that promote corporate bilingualism and bilingual employees as value-added resources; second, the practice and discourse of company managers who sustain or appropriate such promotional discourses for creating and promoting their own organisational values. By drawing on concepts from governmentality, critical language policy and discourse studies, I show that promoting bilingualism in business is characterised by local and global governmentalities. These not only bring about critical shifts in valuing language as symbolic entities attached to ethnonational concerns or as promotional objects that bring material gain. Language governmentalities also appear to shape new forms of ‘languaging’ the minority language worker as selfgoverning, and yet, governed subjects who are ultimately made responsible for ‘owning’ Welsh.