Surveillance for ocular hypertension: An evidence synthesis and economic evaluation

OBJECTIVES: To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways.

DESIGN: A discrete event simulation economic modelling evaluation. Data from systematic reviews of risk prediction models and agreement between tonometers, secondary analyses of existing datasets (to validate identified risk models and determine optimal monitoring criteria) and public preferences were used to structure and populate the economic model.

SETTING: Primary and secondary care.

PARTICIPANTS: Adults with ocular hypertension (IOP > 21 mmHg) and the public (surveillance preferences).

INTERVENTIONS: We compared five pathways: two based on National Institute for Health and Clinical Excellence (NICE) guidelines with monitoring interval and treatment depending on initial risk stratification, 'NICE intensive' (4-monthly to annual monitoring) and 'NICE conservative' (6-monthly to biennial monitoring); two pathways, differing in location (hospital and community), with monitoring biennially and treatment initiated for a ≥ 6% 5-year glaucoma risk; and a 'treat all' pathway involving treatment with a prostaglandin analogue if IOP > 21 mmHg and IOP measured annually in the community.

MAIN OUTCOME MEASURES: Glaucoma cases detected; tonometer agreement; public preferences; costs; willingness to pay and quality-adjusted life-years (QALYs).

RESULTS: The best available glaucoma risk prediction model estimated the 5-year risk based on age and ocular predictors (IOP, central corneal thickness, optic nerve damage and index of visual field status). Taking the average of two IOP readings, by tonometry, true change was detected at two years. Sizeable measurement variability was noted between tonometers. There was a general public preference for monitoring; good communication and understanding of the process predicted service value. 'Treat all' was the least costly and 'NICE intensive' the most costly pathway. Biennial monitoring reduced the number of cases of glaucoma conversion compared with a 'treat all' pathway and provided more QALYs, but the incremental cost-effectiveness ratio (ICER) was considerably more than £30,000. The 'NICE intensive' pathway also avoided glaucoma conversion, but NICE-based pathways were either dominated (more costly and less effective) by biennial hospital monitoring or had a ICERs > £30,000. Results were not sensitive to the risk threshold for initiating surveillance but were sensitive to the risk threshold for initiating treatment, NHS costs and treatment adherence.

LIMITATIONS: Optimal monitoring intervals were based on IOP data. There were insufficient data to determine the optimal frequency of measurement of the visual field or optic nerve head for identification of glaucoma. The economic modelling took a 20-year time horizon which may be insufficient to capture long-term benefits. Sensitivity analyses may not fully capture the uncertainty surrounding parameter estimates.

CONCLUSIONS: For confirmed ocular hypertension, findings suggest that there is no clear benefit from intensive monitoring. Consideration of the patient experience is important. A cohort study is recommended to provide data to refine the glaucoma risk prediction model, determine the optimum type and frequency of serial glaucoma tests and estimate costs and patient preferences for monitoring and treatment.

FUNDING: The National Institute for Health Research Health Technology Assessment Programme.

Development and validation of the first high performance-lateral flow immunoassay (HP-LFIA) for the rapid screening of domoic acid from shellfish extracts

A lateral flow immunoassay (LFIA) has been developed and fully validated to detect the primary amnesic shellfish poisoning (ASP) toxin, domoic acid (DA). The performance characteristics of two versions of the test were investigated using spiked and naturally contaminated shellfish (mussels, scallops, oysters, clams, and cockles). The tests provide a qualitative result, to indicate the absence or presence of DA in extracts of shellfish tissues, at concentrations that are relevant to regulatory limits. The new rapid assay (LFIA version 2) was designed to overcome the performance limitations identified in the first version of the assay. The improved test uses an electronic reader to remove the subjective nature of the generated results, and the positive cut-off for screening of DA in shellfish was increased from 10 ppm (version 1) to 17.5 ppm (version 2). A simple extraction and test procedure was employed, which required minimal equipment and materials; results were available 15 min after sample preparation. Stability of the aqueous extracts at room temperature (22 C) at four time points (up to 245 min after extraction) and across a range of DA concentrations was 100.3±1.3% and 98.8±2.4% for pre- and post-buffered extracts, respectively. The assay can be used both within laboratory settings and in remote locations. The accuracy of the new assay, to indicate negative results at or below 10 ppm DA, and positive results at or above 17.5 ppm, was 99.5% (n=216 tests). Validation data were obtained from a 2-day, randomised, blind study consisting of multiple LFIA lots (n=3), readers (n=3) and operators (n=3), carrying out multiple extractions of mussel tissue (n=3) at each concentration (0, 10, 17.5, and 20 ppm). No matrix effects were observed on the performance of the assay with different species (mussels, scallops, oysters, clams, and cockles). There was no impact on accuracy or interference from other phycotoxins, glutamic acid or glutamine with various strip incubations (8, 10, and 12 min). The accuracy of the assay, using naturally contaminated samples to indicate negative results at or below 12.5 ppm and positive results at or above 17.5 ppm, was 100%. Variability between three LFIA lots across a range of DA concentrations, expressed as coefficient of variation (% CV), was 1.1±0.4% (n=2 days) based on quantitative readings from the electronic reader. During an 8 week stability study, accuracy of the method with test strips stored at various temperatures (6, 22, 37 and 50 C) was 100%. Validation for both versions included comparisons with results obtained using reference LC-UV methods. © 2013 Elsevier B.V.

A bridge-monitoring tool based on bridge and vehicle accelerations

Previous research on damage detection based on the response of a structure to a moving load has reported decay in accuracy with increasing load speed. Using a 3D vehicle – bridge interaction model, this paper shows that the area under the filtered acceleration response of the bridge increases with increasing damage, even at highway load speeds. Once a datum reading is established, the area under subsequent readings can be monitored and compared with the baseline reading, if an increase is observed it may indicate the presence of damage. The sensitivity of the proposed approach to road roughness and noise is tested in several damage scenarios. The possibility of identifying damage in the bridge by analysing the acceleration response of the vehicle traversing it is also investigated. While vehicle acceleration is shown to be more sensitive to road roughness and noise and therefore less reliable than direct bridge measurements, damage is successfully identified in favourable scenarios.

Estimation of fetal and effective dose for CT examinations

Doses from CT examinations are difficult to estimate. However, they are requested more frequently due to the increase in CT examinations. In particular, fetal dose estimations are frequently required for patients who have discovered, subsequent to the examination, that they were pregnant when the examination was conducted. A computer model has been developed to facilitate such dose calculations. This model combines empirical beam data with anatomical information. The model has been verified using thermoluminescent dosemeter (TLD) readings of internal and surface dose from both phantoms and patients, including intrauterine doses for patients undergoing afterloading gynaecological intracavitary treatment. Although only limited experimental data were available, the results indicate that the model accurately predicts uterine doses within acceptable errors. This approach has been validated for fetal dose estimation. The model was also used in a comparison with the nationally available CT dose data from the National Radiological Protection Board (NRPB). The two models were found to be in agreement for fetal dose estimations.

Engendering Hope: A person-centred reflection on technology and gender

This paper examines instances of recent musical and artistic works and asks to what extent it makes sense to regard certain practices and technologies as gendered. It looks at a number of strategies for making, suggesting that male gender stereotypes are as prevalent and unhelpful (to practitioners) as female ones. It looks at aspects of the working environments of practitioners to determine whether changes in such conditions might alleviate the gender mismatch in enrolment in higher education courses featuring ubiquitous technologies. The paper identifies historical precedents for technology gendering in which readings of such gendering have shifted radically, suggesting they offer scope for optimism in our longer-term reading of the gendered-ness of current practices. The paper also touches on the extent to which a ‘research’ ethos––the foregrounding of the essential human attributes of inquisitiveness and empathy––may contribute to our capacity to tell better, less binary stories of otherness in all its forms.

Michael Allen: Close Readings: Essays on Irish Poetry

The late Michael Allen was a member of the famous Belfast Group, and one of the most authoritative critical voices on poetry from Northern Ireland, intimately part of the North’s poetic movement since the early 1960s. He taught at Queen’s University, where he was a colleague of Seamus Heaney and tutor to poets such as Paul Muldoon and Medbh McGuckian. Seamus Heaney called him ‘the reader over my shoulder’. Close Readings brings together interlinked critical writings which have crucially influenced approaches to Irish poetry during the last forty years. The book ends with an extended essay, hitherto unpublished: ‘Doubles, Twins and the Feminine: Development in the Poetry of Michael Longley’.

Close Readings contains a Foreword by Fran Brearton, which relates Michael Allen’s essays to continuing critical and cultural debates. Edna Longley’s Afterword offers a personal view of Allen’s involvement with poetry in Belfast.

English picturebook illustrations and language development in early years education

Este estudo investiga a influência da interação imagem-texto de três álbuns ilustrados de língua inglesa no desenvolvimento do repertório linguístico de crianças pré-leitoras. Numa metodologia de estudo de caso, adotando uma abordagem qualitativa e socio construtivista num contexto real de educação pré-escolar, três grupos de crianças portuguesas foram filmados ao longo de várias sessões de leitura repetida em voz alta e em inglês, e de sessões de recontos trabalhados em pequenos grupos. Após a transcrição das gravações, o corpus resultante foi analisado com base numa teoria fundamentada de compreensão literária e em escalas de leitura emergente. Os resultados mostraram que as crianças adotaram uma postura fortemente analítica face aos álbuns, direcionando as suas respostas para as ilustrações e usando-as como apoio na construção de significados. Os resultados mostraram também que cada interanimação visual e verbal ofereceu diversas oportunidades para o uso das línguas em presença, o português e o inglês, tendo o formato e a estrutura inerentes a cada álbum contribuído de forma muito relevante para as respostas das crianças. Contudo, os álbuns com uma dinâmica imagem-texto mais complexa proporcionaram um maior envolvimento das crianças, provocando mais discussão em torno das ilustrações e criando mais oportunidades para mediação do uso da segunda língua. Os resultados revelaram ainda a importância da interação durante as leituras repetidas, na compreensão e na análise narrativa, num processo de desenvolvimento da linguagem. Com base nestes resultados, apontam-se conclusões, com implicações para os contextos educativos, quer ao nível da língua materna, quer ao nível da segunda língua, nomeadamente em relação: à seleção de álbuns e à valorização das ilustrações e ainda à importância de leituras repetidas em voz alta e à discussão realizada pelas crianças.

The rise and demise of a book-review magazine interpreting the cultural work of Books in Canada (1971-2008)

This interdisciplinary study examines the contribution that a book-review magazine makes to the cultural identity of its readers. It is the result of reflections on the cultural work of Books in Canada , on whether or not this periodical was a cultural worksite and if that is the case how it performed that cultural work. In addition, it interrogates factors that may have contributed to the magazine's demise. The study affirms that Books in Canada, a cultural enterprise from 1971 to 2008, mirrored and helped to shape book and literary culture in Canada through its circulation, through the personalities of its editors, through its front covers and through its reviewers and their reviews. Furthermore, it proposes that the demise of the enterprise was due to a combination of factors. The study begins with an introduction to book reviewing and special-interest magazines. Chapter I examines the interplay between selected visual and textual contents published in Books in Canada in its founding years. These components reflected and helped to fuel the cultural nationalism that was sweeping Canada subsequent to the 1967 World's Fair in Montreal. There were also persistent rumours and comments about the magazine that caused certain"cracks in the foundation" to appear. Chapter II compares the aims and editorial challenges of Val Clery, founder of Books in Canada , with those of Adrien Thério, founder of Lettres québécoises, and of the editors of the magazines' twentieth-anniversary issues, Paul Stuewe in the case of the former and André Vanasse in the case of the latter. Evidence in the content of the magazine, editorial and otherwise, indicated that the"contracts" that the editors made with their readers over the years were similar, to reflect and shape a cultural identity, but the result of their"projects," that is, the nature of those identities, was distinctly different. Evidently then, personal aims, preferences and political leanings of editors can have a major impact on the content of a book-review magazine and thus on the cultural work that it does. Therefore, in Chapter III, I focus on selected contents published during the tenures of two of Books in Canada 's key editors, Paul Stuewe and Olga Stein, in order to understand ways that their choices constituted a form of cultural work. The second part of this chapter moves from an analysis of the cultural work of editors to an examination of the cultural work of reviewers. Here, through a close-reading of a selection of reviews published in Books in Canada, and in other periodicals, I argue that reviewers do cultural work in the way that they negotiate their presence in a review, and in how they signal that presence through lexical choices and through the degree of intellectual interaction that they invite. Intellectual interaction is at the core of Chapter IV.This chapter consists of close readings of some of the"billboards" of the enterprise, that is, the front covers of Books in Canada , in order to show how these important components do cultural work by requiring readers to make an intellectual leap from image to text. Chapter V suggests that book reviews, the company's"bills of goods," do cultural work in much the same way as the paratexts of a book. One of my own reviews is offered as a case-study along with a number of other reviews of how central components of a book-review magazine do cultural work through the illocutionary force of their sentences. The first part of Chapter VI, the final chapter, measures the legacy of the magazine, in particular, the annual Books in Canada First Novel Award. Created in 1976, this prize is awarded to the author of the novel judged by a Books in Canada prize committee to be the best first novel in English of the year. The second part of Chapter VI sheds light on factors that may have contributed to the closure of the enterprise, including the copyright uproar that accompanied the agreement that Adrian Stein, publisher of Books in Canada and Olga Stein's husband, made in 2001 with the online book merchant, Amazon.com. Furthermore, this penultimate section of the study suggests that one of the most important factors in the magazine's demise was the decision by the Steins to exploit their position as owners, publisher, and editor of a book-review periodical, a government-subsidized one at that, to publish their own lengthy pre-trial defense of Conrad Black. The chapter then zooms back from the particular to the general with a broader consideration of the impact of technology and globalization on the book industry and on the ability of Books in Canada to survive in any form, print or digital.

Unbelievable Bodies: Audience Readings of Action Heroines as a Post-Feminist Visual Metaphor

Thesis (Master's)--University of Washington, 2013

In Protection of Whose “Wellbeing”? Considerations of “Clauses and A/Effects” in Athlete Contracts

Contractual agreements have become an accepted part of participation processes for athletes in a variety of sport contexts. Closer readings of these contracts,however, pose several questions regarding organizational intentions and motivations,the conceptualization of athletes as “workers,” and representation parity. In this article, we draw on four types of athlete contractual documents from both select international “amateur” and “professional” sport settings. Our key considerations include athletes’ ownership over their image and identities; medical and health disclosures; lifestyle, behavioral and body choices, and restrictions beyond sport; adherence to organizational philosophy and commitments; and social media and publicity constraints. Our exegesis here encourages sport researchers to deliberate whose “wellbeing” matters most when signing that seductive dotted line.

'It was as if she had said....': May Sinclair and reading narratives of cure

May Sinclair was one of the most widely read and successful English women novelists of the first half of the twentieth century. She had interests and themes in common with many of those now considered to have been at the heart of English modernism. In terms of formal experimentation too her concerns chime with the aesthetic innovations of, for example, pound, Eliot and Woolf. Her early interest in psychoanalysis and support for the suffrage campaign also mark her out as a modern. Despite some work from feminist literary critics and her partial categorisation as modernist, however, her work still lacks a critical framework within which it can be read. Indeed, some of the work done by feminist critics on her has paradoxically re-marginalised her. In this thesis I aim to provide one critical framework through which Sinclair's work can be read. My contention is that the occluding of one aspect of her work and thought- its movement toward intellectual, emotional and aesthetic wholeness - has marred previous critical readings of her. By paying attention to this through a focus on discourses of cure, this thesis reads Sinclair's work with an awareness of its language, cultural context and intertextual relations. Early twentieth-century medical discourse, psychoanalysis, mysticism, the chivalric and the psychical are all used to read the works. At the same time, my aim is to read Sinclair's work without eliding its difficulties. Rather, I aim to read her in a way that acknowledges the difficulties of and fraught moments in her writing as markers of its significance.

Transforming relationship marketing via subversive readings

Where is the consumer represented within the discourses of Relationship Marketing? In our paper we deconstruct and critically (but productively) interrogate current Relationship Marketing discourse; and we argue for reconceptualising RM as a field of study through a transformatory process which involves the subversive reading of its academic texts. We argue that the consumer is silenced within relationship marketing discourse in a way that is fundamentally analogous with the gynopia (absence of women) in early sociological enquiry. Given that the means of transformation can potentially be found within contemporary feminist research, one of the main aims of this paper is to examine the parameters of feminist research and theory by presenting and explaining three representative frameworks (Fonow & Cook 1991, Maynard & Purvis 1994 and Harding 1988). The interrogative questions generated from the reading of feminist texts provide a framework to enable a close reading of RM ‘texts’. Using a form of discourse analysis, we read both ‘with the text’ and ‘against the grain’ (Tonkiss 1998:258) looking for ‘silences and gaps’ and making ‘conjectures about alternative accounts which are excluded by omission’ as well as those deliberately ‘countered by rhetoric’ (Tonkiss 1998:258). By striking together feminist methodology and a selected Relationship Marketing text to see if they spark (Brown 1999) our stance is activist and our purpose is to accelerate a restoration of the consumer’s voice as a central theoretical concern of this branch of Marketing.