How accurate are photographic surrogate markers used to detect macular oedema in the english national Screening Programme?

Introduction: Macular oedema is not directly visible on digital photographs used in screening. Photographic surrogate markers are used to detect patients who may have macular oedema. Evidence suggests that only around 10% of patients with these surrogate markers referred to an ophthalmologist have macular oedema when examined by slit-lamp biomicroscopy. Purpose: The purpose of this audit was to determine how many patients with surrogate markers were truly identified by optical coherence tomography (OCT) as having macular oedema. Method: Data were collected from patients attending digital diabetic retinopathy screening. Patients who presented with surrogate markers for macular oedema also had an OCT scan. The fast macula scan on the Stratus OCT was used and an ophthalmologist reviewed the scans to determine whether macular oedema was present. Results: Out of 66 patients with maculopathy defined as haemorrhages or microaneurysms within one optic disc diameter (DD) of the fovea and visual acuity (VA) worse than 6/9 11 (17%) showed thickening on the OCT, only 4 (6%) had macular oedema. None required laser. Out of 155 patients with maculopathy defined as any exudate within one DD of the fovea or circinate within two DD 45 (29%) showed thickening on the OCT of these 27% required laser. Conclusion: OCT is a useful tool in screening to help identify those who need a true referral to ophthalmology for maculopathy. If exudate is present the chance of having macular oedema and requiring laser treatment is greater than the presence of microaneurysms within one DD and reduced VA.

How accurate are photographic surrogate markers used to detect macular edema in the English national screening programme?

DESIGN. Retrospective analysis PURPOSE. Macular oedema is not directly visible on two dimensional digital photographs such that surrogate markers need to be used. In the English National Screening Programme these are exudate within one optic disc diameter (DD) of the fovea, group of exudates within two DD of the fovea and haemorrhages or microaneurysms (HMA) within one DD of the fovea with best corrected visual acuity (VA) worse than 6/9. All patients who present with any of these surrogate markers at screening are referred to an ophthalmology clinic for slit lamp examination. The purpose of this audit was to determine how many patients with positive maculopathy diagnosis on photography were truly identified by optical coherence tomography (OCT) with macular oedema. METHODS. Data was collected from patients attending digital diabetic retinopathy screening. Patients who presented with surrogate markers for macular oedema also had an OCT scan. The fast macula scan on the Stratus OCT was used and an ophthalmologist reviewed the scans to determine whether macular oedema was present. RESULTS. Maculopathy by exudates: Of 155 patients 45 (29%) showed thickening on the OCT of these 12 required laser. Those who also had pre-proliferative retinopathy (n=20) were more likely to have macular oedema (75%) than those with background diabetic retinopathy. Maculopathy by HMA and VA worse than 6/9: Of 66 patients 11 (16.7%) showed thickening on the OCT. 5 (7.6%) of these had macular oedema, 5 (7.6%) epi-retinal membrane, and 1 (1.5%) age related macular degeneration. None of these patients required laser. CONCLUSIONS. The likelihood of the presence of macular oedema and requiring laser treatment is greater with macular exudation than HMA within one DD and reduced VA. Overall the surrogate markers used show low specificity for macular oedema, however combining OCT with photography does identify those with macular oedema who require a true referral for an ophthalmological slit lamp examination.

Reasoning Methods for Designing and Surveying Relationships Described by Sets of Functional Constraints

This work is supported by the Hungarian Scientific Research Fund (OTKA), grant T042706.

Improving the cost-effectiveness of photographic screening for diabetic macular oedema:a prospective, multi-centre, UK study

Background/aims: Retinal screening programmes in England and Scotland have similar photographic grading schemes for background (non-proliferative) and proliferative diabetic retinopathy, but diverge over maculopathy. We looked for the most cost-effective method of identifying diabetic macular oedema from retinal photographs including the role of automated grading and optical coherence tomography, a technology that directly visualises oedema. Methods: Patients from seven UK centres were recruited. The following features in at least one eye were required for enrolment: microaneurysms/dot haemorrhages or blot haemorrhages within one disc diameter, or exudates within one or two disc diameters of the centre of the macula. Subjects had optical coherence tomography and digital photography. Manual and automated grading schemes were evaluated. Costs and QALYs were modelled using microsimulation techniques. Results: 3540 patients were recruited, 3170 were analysed. For diabetic macular oedema, England's scheme had a sensitivity of 72.6% and specificity of 66.8%; Scotland 's had a sensitivity of 59.5% and specificity of 79.0%. When applying a ceiling ratio of £30 000 per quality adjusted life years (QALY) gained, Scotland's scheme was preferred. Assuming automated grading could be implemented without increasing grading costs, automation produced a greater number of QALYS for a lower cost than England's scheme, but was not cost effective, at the study's operating point, compared with Scotland's. The addition of optical coherence tomography, to each scheme, resulted in cost savings without reducing health benefits. Conclusions: Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies.

Photographic Plate Libraries at European Astronomical Observatories

ACM Computing Classification System (1998): J.2.

Potsdam Library of Astronomical Photographic Plates

ACM Computing Classification System (1998): J.2.

Software Tools for Digitization of Astronomical Photographic Plates

ACM Computing Classification System (1998): J.2.

Technology for Scanning Astronomical Photographic Plates

ACM Computing Classification System (1998): J.2.

Weighted ICP Algorithm for Alignment of Stars from Scanned Astronomical Photographic Plates

ACM Computing Classification System (1998): I.2.8, I.2.10, I.5.1, J.2.

Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema:a prospective, multicentre, UK study

Objectives: To determine the best photographic surrogate markers for detecting sight-threatening macular oedema (MO) in people with diabetes attending UK national screening programmes. Design: A multicentre, prospective, observational cohort study of 3170 patients with photographic signs of diabetic retinopathy visible within the macular region [exudates within two disc diameters, microaneurysms/dot haemorrhages (M/DHs) and blot haemorrhages (BHs)] who were recruited from seven study centres. Setting: All patients were recruited and imaged at one of seven study centres in Aberdeen, Birmingham, Dundee, Dunfermline, Edinburgh, Liverpool and Oxford. Participants: Subjects with features of diabetic retinopathy visible within the macular region attending one of seven diabetic retinal screening programmes. Interventions: Alternative referral criteria for suspected MO based on photographic surrogate markers; an optical coherence tomographic examination in addition to the standard digital retinal photograph. Main outcome measures: (1) To determine the best method to detect sight-threatening MO in people with diabetes using photographic surrogate markers. (2) Sensitivity and specificity estimates to assess the costs and consequences of using alternative strategies. (3) Modelled long-term costs and quality-adjusted life-years (QALYs). Results: Prevalence of MO was strongly related to the presence of lesions and was roughly five times higher in subjects with exudates or BHs or more than two M/DHs within one disc diameter. Having worse visual acuity was associated with about a fivefold higher prevalence of MO. Current manual screening grading schemes that ignore visual acuity or the presence of M/DHs could be improved by taking these into account. Health service costs increase substantially with more sensitive/less specific strategies. A fully automated strategy, using the automated detection of patterns of photographic surrogate markers, is superior to all current manual grading schemes for detecting MO in people with diabetes. The addition of optical coherence tomography (OCT) to each strategy, prior to referral, results in a reduction in costs to the health service with no decrement in the number of MO cases detected. Conclusions: Compared with all current manual grading schemes, for the same sensitivity, a fully automated strategy, using the automated detection of patterns of photographic surrogate markers, achieves a higher specificity for detecting MO in people with diabetes, especially if visual acuity is included in the automated strategy. Overall, costs to the health service are likely to increase if more sensitive referral strategies are adopted over more specific screening strategies for MO, for only very small gains in QALYs. The addition of OCT to each screening strategy, prior to referral, results in a reduction in costs to the health service with no decrement in the number of MO cases detected. © Queen's Printer and Controller of HMSO 2013.

(Table 2, page 10) Bulk spectroscopic, X-ray fluorescence and colorimetric analyses of samples from the San Pablo ferro-manganese pavement

The Bedford Institute of Oceanography provided ship time on the C.S.S. Hudson during the B.I.0. 1967 Metrology and IODAL Cruise for surveying two separate bottom features in the North Atlantic; the Flemish Cap and the San Pablo Seamount one of the Kelvin Seamounts (also known as the New England Seamounts) about 400 miles SSE of Halifax, Nova Scotia. Underwater photography, dredging, and drilling showed San Pablo seamount to have a very considerable covering of manganese deposit, which may be recoverable by mining. San Pablo Seamount was surveyed and sampled; good hauls were made both on the top and on the slopes, at various depths from 500-1000 fathoms; in all cases samples of an unusual stratified manganese-iron ore were recovered. In the hope of gaining additional information in the immediate sample area, one of the dredges had been previously modified to accommodate underwater photographic equipment. X-ray chemical analyses indicate that the ore contains 20 to 25 per cent MnO2, with similar amounts of Fe2O3. Since bottom photographs indicate that these deposits form a continuous cover 1 foot to 3 feet thick over most of the seamount, it is estimated that there are ore reserves in the order of 10 to 30 M tons above 1,000 fathoms.

Annotated record of the detailed examination of Mn deposits from C.S.S. Hudson Cruise 19 (1967) stations

The Bedford Institute of Oceanography provided ship time on the C.S.S. Hudson during the B.I.0. 1967 Metrology and IODAL Cruise for surveying two separate bottom features in the North Atlantic; the Flemish Cap and the San Pablo Seamount one of the Kelvin Seamounts (also known as the New England Seamounts) about 400 miles SSE of Halifax, Nova Scotia. Underwater photography, dredging, and drilling showed San Pablo seamount to have a very considerable covering of manganese deposit, which may be recoverable by mining. San Pablo Seamount was surveyed and sampled; good hauls were made both on the top and on the slopes, at various depths from 500-1000 fathoms; in all cases samples of an unusual stratified manganese-iron ore were recovered. In the hope of gaining additional information in the immediate sample area, one of the dredges had been previously modified to accommodate underwater photographic equipment. X-ray chemical analyses indicate that the ore contains 20 to 25 per cent MnO2, with similar amounts of Fe2O3. Since bottom photographs indicate that these deposits form a continuous cover 1 foot to 3 feet thick over most of the seamount, it is estimated that there are ore reserves in the order of 10 to 30 M tons above 1,000 fathoms.

Evaluation of a ToF Camera for Remote Surveying of Underground Cavities Excavated by Jet Boring

Cigar Lake is a high-grade uranium deposit, located in northern Saskatchewan, Canada. In order to extract the uranium ore remotely, thus ensuring minimal radiation dose to workers and also to access the ore from stable ground, the Jet Boring System (JBS) was developed by Cameco Corporation. This system uses a high-powered water jet to remotely excavate cavities. Survey data is required to determine the final shape, volume, and location of the cavity for mine planning purposes and construction. This paper provides an overview of the challenges involved in remotely surveying a JBS-mined cavity and studies the potential use of a time-of-flight (ToF) camera for remote cavity surveying. It reports on data collected and analyzed from inside an experimental environment as well as on real data acquired on site from the Cigar Lake and Rabbit Lake mines.

The ecology of the ePundit: surveying the new opinion-making landscape.

This paper explores hybrid forms of contemporary political opinion-making online, which we name ePunditry. The ePundit utilizes Web 2.0 technologies and networks to distribute their work: changing and challenging the boundaries and hierarchies of the existing opinion space, across multiple platforms. Drawing on the language of media ecology we define and give examples of ePunditry. We also consider the impact of the ePundit upon the wider media landscape, alongside the empowered role of the readership.

Design of a Novel Auto-Rotating UAV Platform for Underground Mine Cavity Surveying

The purpose of this paper is to investigate the potential for use of UAVs in underground mines and present a prototype design for a novel autorotating UAV platform for underground 3D data collection.