Consensus on recording of gas permeable contact lens fit

Purpose: To develop a new schematic scheme for efficiently recording the key parameters of gas permeable contact lens (GP) fits based on current consensus. Methods: Over 100 established GP fitters and educators met to discuss the parameters proposed in educational material for evaluating GP fit and concluded on the key parameters that should be recorded. The accuracy and variability of evaluating the fluorescein pattern of GP fit was determined by having 35 experienced contact lens practitioners from across the world, grading 5 images of a range of fits and the topographer simulation of the same fits, in random, order using the proposed scheme. The accuracy of the grading was compared to objective image analysis of the fluorescein intensity of the same images. Results: The key information to record to adequately describe the fit of an GP was agreed as: the manufacturer, brand and lens parameters; settling time; comfort on a 5 point scale; centration; movement on blink on a ±2 scale; and the Primary Fluorescein Pattern in the central, mid-peripheral and edge regions of the lens averaged along the horizontal and vertical lens axes, on a ±2 scale. On average 50-60% of practitioners selected the median grade when subjectively rating fluorescein intensity and this was correlated to objective quantification (r= 0.602, p< 0.001). Objective grading suggesting horizontal median fluorescein intensity was generally symmetrical, as was the vertical meridian, but this was not the case for subjective grading. Simulated fluorescein patterns were subjectively and objectively graded as being less intense than real photographs (p< 0.01). Conclusion: GP fit recording can be standardised and simplified to enhance GP practice. © 2013 British Contact Lens Association.

Patient experiences of a bariatric group programme for managing obesity:a qualitative interview study

Objectives: People with obesity experience a range of physical and psychological ill-health outcomes. This study examined patients’ experiences of a group-based programme for the management of morbid obesity delivered within the UK National Health Service. The focus of the study was on the emerging dynamic of the group and patients’ perceptions of its impact on health outcomes. Design: A qualitative interview study was conducted and involved patients recruited from a Tier 3 bariatric service in South West England. Verbatim transcripts were analysed using thematic analysis. Methods: Twenty patients (12 females) with a BMI ≥ 35 kg/m2 participated in a semi-structured one-to-one interview. Participants had been registered with the bariatric service for at least 6 months. None of the participants had had bariatric surgery. Results: Most participants felt that they had benefited from participating in the group programme and talked about the group as a resource for lifestyle change. Participants’ narratives centred on the emergence of a sense of self based upon their participation in the group: establishing psychological connections to other patients, or shared social identity, was regarded as a key mechanism through which the programme's educational material was accessed, and underpinned the experience of social support within the group. Through interaction with other patients, involving the sharing of personal experiences and challenges, participants came to experience their weight ‘problem’ through a collective lens that they felt empowered them to initiate and sustain individual lifestyle change. Discussion: Bariatric care groups have the potential to support lifestyle change and weight loss and may help address the psychological needs of patients. Nurturing a sense of shared social identity amongst patients with morbid obesity should be a core aim of the care pathway and may provide the foundation for successful translation of dietetic content in group programmes.

The political discourse and material practice of technology enhanced learning

Technology discloses man’s mode of dealing with Nature, the process of production by which he sustains his life, and thereby also lays bare the mode of formation of his social relations, and of the mental conceptions that flow from them (Marx, 1990: 372) My thesis is a Sociological analysis of UK policy discourse for educational technology during the last 15 years. My framework is a dialogue between the Marxist-based critical social theory of Lieras and a corpus-based Critical Discourse Analysis (CDA) of UK policy for Technology Enhanced Learning (TEL) in higher education. Embedded in TEL is a presupposition: a deterministic assumption that technology has enhanced learning. This conceals a necessary debate that reminds us it is humans that design learning, not technology. By omitting people, TEL provides a vehicle for strong hierarchical or neoliberal, agendas to make simplified claims politically, in the name of technology. My research has two main aims: firstly, I share a replicable, mixed methodological approach for linguistic analysis of the political discourse of TEL. Quantitatively, I examine patterns in my corpus to question forms of ‘use’ around technology that structure a rigid basic argument which ‘enframes’ educational technology (Heidegger, 1977: 38). In a qualitative analysis of findings, I ask to what extent policy discourse evaluates technology in one way, to support a Knowledge Based Economy (KBE) in a political economy of neoliberalism (Jessop 2004, Fairclough 2006). If technology is commodified as an external enhancement, it is expected to provide an ‘exchange value’ for learners (Marx, 1867). I therefore examine more closely what is prioritised and devalued in these texts. Secondly, I disclose a form of austerity in the discourse where technology, as an abstract force, undertakes tasks usually ascribed to humans (Lieras, 1996, Brey, 2003:2). This risks desubjectivisation, loss of power and limits people’s relationships with technology and with each other. A view of technology in political discourse as complete without people closes possibilities for broader dialectical (Fairclough, 2001, 2007) and ‘convivial’ (Illich, 1973) understandings of the intimate, material practice of engaging with technology in education. In opening the ‘black box’ of TEL via CDA I reveal talking points that are otherwise concealed. This allows me as to be reflexive and self-critical through praxis, to confront my own assumptions about what the discourse conceals and what forms of resistance might be required. In so doing, I contribute to ongoing debates about networked learning, providing a context to explore educational technology as a technology, language and learning nexus.