The clinical assessment of systemic hypertension in optometric practice

This thesis sets out to examine in detail the condition of systemic hypertension (high Blood Pressure) in relation to optometric practice in the United Kingdom. Systemic hypertension, which is asymptomatic in the early stages, is diagnosed from the Blood Pressure (BP) measurement recorded by a sphygmomanometer and/or from the complications that have developed in target organs. Optometric practice based surveys revealed that diagnosed systemic hypertension was the most prevalent cardiovascular medical condition (20.5%). Measurement of BP of patients in this sample revealed that if an optometrist included sphygmomanometry into the sight examination then at least one patient each day would be referred for suspect systemic hypertension. Optometric opinion felt that the measurement of BP in optometric practice would advance the profession, being appreciated by both patients and General Practitioners (GPs), but was felt to be an unnecessary routine procedure. The present sight examination for the systemic hypertensive is similar to that of the normotensive patient, but may involve an altered fundus examination and a visual field test. The GPs were in favour of optometric BP measurement and a future role in the share care management of the systemic hypertensive. The application of a new pictorial grading scale for the grading of vascular changes associated with pre-malignant systemic hypertension was found to be both accurate and reliable. Clinical trial of the grading scale in optometric practice found positive correlations between BP and increasing severity of the retinal vascular features. The subtle pre-malignant vascular changes require reliable accurate detection and analysis to assist in the management of the systemic hypertensive patient. Vessel width was shown to decrease with increasing age. Image analysis of the A/V ratio, arteriolar tortuosity and focal calibre changes revealed a positive correlation to the patient's BP (p<0.001). The retinal vasculature is relatively stable longitudinally with only minor changes in response to early disease states. Age and elevated BP increased a patient's risk of developing systemic medical conditions over a two-year period. The application of the pictorial grading scale to optometric practice and training the optometrist in the use of sphygmomanometry would improve the management of the systemic hypertensive patient in optometric practice. Future advances in image analysis hold substantial benefits for the detection and monitoring of subtle vascular changes associated with systemic hypertension.

A low-cost remote sensing system for agricultural applications

This research develops a low cost remote sensing system for use in agricultural applications. The important features of the system are that it monitors the near infrared and it incorporates position and attitude measuring equipment allowing for geo-rectified images to be produced without the use of ground control points. The equipment is designed to be hand held and hence requires no structural modification to the aircraft. The portable remote sensing system consists of an inertia measurement unit (IMU), which is accelerometer based, a low-cost GPS device and a small format false colour composite digital camera. The total cost of producing such a system is below GBP 3000, which is far cheaper than equivalent existing systems. The design of the portable remote sensing device has eliminated bore sight misalignment errors from the direct geo-referencing process. A new processing technique has been introduced for the data obtained from these low-cost devices, and it is found that using this technique the image can be matched (overlaid) onto Ordnance Survey Master Maps at an accuracy compatible with precision agriculture requirements. The direct geo-referencing has also been improved by introducing an algorithm capable of correcting oblique images directly. This algorithm alters the pixels value, hence it is advised that image analysis is performed before image georectification. The drawback of this research is that the low-cost GPS device experienced bad checksum errors, which resulted in missing data. The Wide Area Augmented System (WAAS) correction could not be employed because the satellites could not be locked onto whilst flying. The best GPS data were obtained from the Garmin eTrex (15 m kinematic and 2 m static) instruments which have a highsensitivity receiver with good lock on capability. The limitation of this GPS device is the inability to effectively receive the P-Code wavelength, which is needed to gain the best accuracy when undertaking differential GPS processing. Pairing the carrier phase L1 with the pseudorange C/A-Code received, in order to determine the image coordinates by the differential technique, is still under investigation. To improve the position accuracy, it is recommended that a GPS base station should be established near the survey area, instead of using a permanent GPS base station established by the Ordnance Survey.

Higher prevalence of retinopathy in diabetic patients of South Asian ethnicity compared with white Europeans in the community:a cross-sectional study

OBJECTIVE—The purpose of this study was to compare prevalence and risk factors for diabetic retinopathy among U.K. residents of South Asian or white European ethnicity. RESEARCH DESIGN AND METHODS—This was a community-based cross-sectional study involving 10 general practices; 1,035 patients with type 2 diabetes were studied: 421 of South Asian and 614 of white European ethnicity. Diabetic retinopathy, sight-threatening retinopathy, maculopathy, and previous laser photocoagulation therapy were assessed after grading of retinal photographs. Data were collected on risk factors including age, duration, and treatment of diabetes, blood pressures, serum total cholesterol, and A1C. RESULTS—Patients of South Asian ethnicity had significantly higher systolic (144 vs. 137 mmHg, P < 0.0001) and diastolic (84 vs. 74 mmHg, P < 0.0001) blood pressure, A1C (7.9 vs. 7.5%, P < 0.0001), and total cholesterol (4.5 vs. 4.2 mmol/l, P < 0.0001). Diabetic retinopathy was detected in 414 (40%) patients (189 South Asian [45%] versus 225 white European [37%]; P = 0.0078). Sight-threatening retinopathy was detected in 142 (14%) patients (68 South Asian [16%] versus 74 white European [12%]; P = 0.0597). After adjustment for confounders, there were significantly elevated risks of any retinopathy and maculopathy for South Asian versus white European patients. CONCLUSIONS—Patients of South Asian ethnicity had a significantly higher prevalence of diabetic retinopathy and maculopathy, with significantly elevated systolic and diastolic blood pressure, A1C, and total cholesterol; lower attained age; and younger age at diagnosis. Earlier onset of disease and higher levels of modifiable risk factors make early detection of diabetes, annual referral for retinal screening, and intensive risk factor control key elements in addressing this health inequality.

Screening for eye disease in the elderly:is it worth it?

Should we be screening for eye disorders in the elderly population? Visual impairment in the elderly can be associated with reduced functional status and quality of life, low social contact, depression, and falls and hip fractures (Dargent-Molina et al, 1996). It therefore would seem sensible to identify those elderly patients who have or are at risk of developing sight-threatening eye disorders, and offer them treatment. However, screening for disease of any kind raises a number of issues.

Evaluating digital diabetic retinopathy screening in people aged 90 years and over

Introduction: The English National Screening Programme determines that all people with diabetes aged 12 and over should be screened annually for diabetic retinopathy (DR) until they die. Purpose: This study aimed to evaluate digital DR screening in patients aged 90 and over to establish whether it is appropriate to cease screening at age 90. Methods: A retrospective analysis of 200 randomly selected patients with diabetes aged 90 and over within the Birmingham and Black Country Screening Programme. Results: 179 (90%) patients attended screening at least once after turning 90 years of age. To date, the mean number of screens per person 90+ was two (range 1–6) and the mean age of the first of these screens was 91 years (range 90–98 years). 133 (74%) were put on annual recall after their first screen in their 90’s, of which 58% had no visible DR bilaterally. 38 (21%) were referred to ophthalmology - 35 (92%) for non-DR reasons and three for maculopathy. Of the 133 patients put on annual recall, 75 (56%) were screened at least once more. Seven improved, 36 remained stable, three became unsuitable and 29 deteriorated. Of the latter, 18 patients were referred to ophthalmology; one of these for DR. Conclusion: Patients with diabetes aged 90 and over are at low risk of sight threatening DR and annual screening in this age group may be unnecessary. However, annual screening does provide opportunistic identification.

Political radicalism in France:perspectives on a protean concept

This introductory article reflects on the new momentum that political radicalism has taken on in France. The ebb and flow of radical aspiration featured regularly in French politics under the Fourth and early Fifth Republics, before the failure of the "Socialist experiment" in the early 1980s brought about a paradigm shift. In the wake of this failure and with the "end of ideology" supposedly in sight, political leaders and parties tempered their appeals to radical solutions and conspired, not least through recurrent power-sharing, to vacate mainstream political discourse of much of its former radicalism. Since the presidential election of 2007, however, there has been a marked return to promises of radical change as the common currency of political discourse across the full left-right spectrum in France. This article introduces a special issue of French Politics, Culture & Society that brings together scholars from France, Britain, and Canada to discuss some of the meanings, expressions, and prospects of political radicalism in France today.

Understanding the IT-related attitudes and needs of persons with age-related macular degeneration : a case study

In the UK, 20 per cent of people aged 75 years and over are living with sight loss; this percentage is expected to increase as the population ages (RNIB, 2011). Age-Related Macular Degeneration (AMD) is the UK’s leading cause of severe visual impairment amongst the elderly. It accounts for 16,000 blind/partial sight registrations per year and is the leading cause of blindness among people aged 55 years and older in western countries (Bressler, 2004). Our ultimate goal is to develop an assistive mobile application to support accurate and convenient diet data collection on which basis to then provide customised dietary advice and recommendations in order to help support individuals with AMD to mitigate their ongoing risk and retard the progression of the disease. In this paper, we focus on our knowledge elicitation activities conducted to help us achieve a deep and relevant understanding of our target user group. We report on qualitative findings from focus groups and observational studies with persons with AMD and interviews with domain experts which enable us to fully appreciate the impact that technology may have on our intended users as well as to inform the design and structure of our proposed mobile assistive application.

How can HRM promote organizational innovation

Our work investigating managerial practices in UK manufacturing organisations has shown that people management practices play an important role in promoting innovation. Having developed an instrument to analyse innovation (defined by West and Farr in 1990 as “the intentional introduction and application in a job, work team or organisation of ideas, processes, products or procedures which are new, and designed to benefit the job, the work team or the organisation”), we were able to give each of the 30 organisations in our sample a score of between one and seven to capture innovation in a range of domains. This instrument took into account the magnitude of the innovation in terms of the number of people involved in its implementation, and how new and different it was. We found that much innovation involves relatively minor, ongoing improvements, rather than major change. To achieve sustained innovation, organisations must be able to draw upon the skills and knowledge of employees at all levels of the business. So which HRM practices are most likely to promote a positive learning environment? We developed a scale to take into account three facets of HRM that shape the learning environment and predict the extent to which individuals can gain the skills to promote innovation. First, organisations should have a vision statement capturing their approach to learning and development and communicating to staff the importance that they attach to these processes. Second, they must implement and endorse mentoring schemes. Last, they should consider offering staff the opportunity to have regular career development meetings. Where a positive learning climate exists, organisations tend to be more innovative. The results also show that organisations that make explicit the link between appraisal and remuneration perform relatively less well in innovation terms than those whose appraisal systems have no relationship with pay. Many have argued (for example, Lawler,1995) that pay-for-performance schemes provide a “line of sight” between performance and reward, thereby enabling individuals to make appropriate decisions about where best to direct the effort. Our findings do not imply that performance-related pay is ill advised in all circumstances, but we suggest that organisations should exercise caution before introducing such schemes. People are central to innovation, and this study suggests that high innovation can be achieved when people are empowered to make changes at local levels. HRM has an important, perhaps crucial, role to play in creating an environment that enables people to develop the skills and confidence necessary to affect change. Key points: Organisational innovation is an important determinant of competitive performance and advancement, enabling organisations to anticipate and respond to the challenges of globalisation. HRM has an important, perhaps crucial, role to play in promoting organisational innovation – to the extent that it creates a positive environment for learning and removes barriers that may inhibit creative performance (for example, linking appraisal to remuneration).

Gender and autistic personality traits predict perspective-taking ability in typical adults

Adopting another’s visual perspective is exceedingly common and may underlie successful social interaction and empathizing with others. The individual differences responsible for success in perspective-taking, however, remain relatively undiscovered. We assessed whether gender and autistic personality traits in normal college student adults predict the ability to adopt another’s visual perspective. In a task differentially recruiting VPT-1 which involves following another’s line of sight, and VPT-2 which involves determining how another may perceive an object differently given their unique perspective (VPT-2), we found effects of both gender and autistic personality traits. Specifically, we demonstrate slowed VPT-2 but not VPT-1 performance in males and females with relatively high ASD-characteristic personality traits; this effect, however was markedly stronger in males than females. Results contribute to knowledge regarding ASD-related personality traits in the general population and the individual differences modulating perspective-taking abilities.

The two forms of visuo-spatial perspective taking are differently embodied and subserve different spatial prepositions

We set out to distinguish level 1 (VPT-1) and level 2 (VPT-2) perspective taking with respect to the embodied nature of the underlying processes as well as to investigate their dependence or independence of response modality (motor vs. verbal). While VPT-1 reflects understanding of what lies within someone else’s line of sight, VPT-2 involves mentally adopting someone else’s spatial point of view. Perspective taking is a high-level conscious and deliberate mental transformation that is crucially placed at the convergence of perception, mental imagery, communication, and even theory of mind in the case of VPT-2. The differences between VPT-1 and VPT-2 mark a qualitative boundary between humans and apes, with the latter being capable of VPT-1 but not of VPT-2. However, our recent data showed that VPT-2 is best conceptualized as the deliberate simulation or emulation of a movement, thus underpinning its embodied origins. In the work presented here we compared VPT-2 to VPT-1 and found that VPT-1 is not at all, or very differently embodied. In a second experiment we replicated the qualitatively different patterns for VPT-1 and VPT-2 with verbal responses that employed spatial prepositions. We conclude that VPT-1 is the cognitive process that subserves verbal localizations using “in front” and “behind,” while VPT-2 subserves “left” and “right” from a perspective other than the egocentric. We further conclude that both processes are grounded and situated, but only VPT-2 is embodied in the form of a deliberate movement simulation that increases in mental effort with distance and incongruent proprioception. The differences in cognitive effort predict differences in the use of the associated prepositions. Our findings, therefore, shed light on the situated, grounded and embodied basis of spatial localizations and on the psychology of their use.

Designing a mobile diet diary application with and for older adults with AMD:a case ctudy

Age-Related Macular Degeneration (AMD) is the UK’s leading cause of severe visual impairment amongst the elderly. It accounts for 16,000 blind/partial sight registrations per year and is the leading cause of blindness among people aged 55 years and older in western countries (Bressler, 2004). Our research aims to design and develop a self-monitoring, ability-reactive technology (SMART) for users with AMD to support their dietary-based AMD risk mitigation and progression retardation over time. In this paper, we reflect on our experience of adapting and applying a participatory design (PD) approach to support the effective design of our application with and for older adults with AMD. We introduce the outcome of a series of PD sessions with older adults with AMD - that is, a paper prototype of our proposed application which focuses on accessibility for our target users - and discuss implications for the eventual prototype development

A cross-culture, cross-gender comparison of perspective taking mechanisms

Being able to judge another person's visuo-spatial perspective is an essential social skill, hence we investigated the generalizability of the involved mechanisms across cultures and genders. Developmental, cross-species, and our own previous research suggest that two different forms of perspective taking can be distinguished, which are subserved by two distinct mechanisms. The simpler form relies on inferring another's line-of-sight, whereas the more complex form depends on embodied transformation into the other's orientation in form of a simulated body rotation. Our current results suggest that, in principle, the same basic mechanisms are employed by males and females in both, East-Asian (EA; Chinese) and Western culture. However, we also confirmed the hypothesis that Westerners show an egocentric bias, whereas EAs reveal an other-oriented bias. Furthermore, Westerners were slower overall than EAs and showed stronger gender differences in speed and depth of embodied processing. Our findings substantiate differences and communalities in social cognition mechanisms across genders and two cultures and suggest that cultural evolution or transmission should take gender as a modulating variable into account.

Photodynamic therapy:a treatment option in choroidal neovascularisation secondary to punctate inner choroidopathy

Punctate inner choroidopathy is an idiopathic inflammatory ocular disorder characteristically seen in young myopic women. Visual prognosis is generally good but sight threatening choroidal neovascularisation may develop in up to 40% patients.1 We discuss verteporfin photodynamic therapy in subfoveal choroidal neovascularisation secondary to punctate inner choroidopathy that failed to respond to oral corticosteroids and had poor results with submacular surgery in the contralateral eye.

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.

Older adults with AMD as co-designers of an assistive mobile application

In the UK, 20% of people aged 75 years and over are living with sight loss and age-related macular degeneration (AMD) is the most common cause of sight loss in the UK, impacting nearly 10% of those over 80; regrettably, these fgures are expected to increase in coming decades as the population ages (RNIB, 2012). This paper reports on the authors' design activities conducted for the purpose of informing the development of an assistive self-monitoring, ability-reactive technology (SMART) for older adults with AMD. The authors refect on their experience of adopting and adapting the PICTIVE (Plastic Interface for Collaborative Technology Initiatives through Video Exploration) participatory design approach (Muller, 1992) to support effective design with and for their special needs user group, refect on participants' views of being part of the process, and discuss the design themes identifed via their PD activities.