Radiocarbon variations from the southern hemisphere, 10,350-9700 cal BP

We have made AMS measurements on a series of 10-ring samples from a subfossil Huon pine log found in western Tasmania (42degreesS, 145degreesE). The results show a pronounced rise in Delta(14)C over the first 200 years, and a decrease over the following 160 years. Tree-ring width measurements indicate that this log (catalogue SRT-447) can be cross-dated with another subfossil log (SRT-416) for which a series of high-precision radiometric C-14 measurements have previously been made. When the two tree-ring series are thus aligned, SRT-447 is the older of the two logs, and there is a 139-year overlap. We then have a Huon pine floating chronology spanning 680 years, with C-14 measurements attached. The C-14 data sets agree well within the period of overlap indicated by the tree-rings. The C-14 variations from Huon pine show excellent agreement with those from German oak and pine for the period 10,350-9670 cal BP. Aligning the Huon pine C-14 Series with that from German oak and pine allows us to examine the inter-hemispheric offset in C-14 dates in the early Holocene. (C) 2004 Elsevier B.V. All rights reserved.

Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian aboriginal population

The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was $1,210 more per person per year than status quo care, and dialyses avoided gave net savings of $1.0 million at 3 years and $3.4 million at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided. (C) 2005 by the National Kidney Foundation, Inc.

Sociodemographic backgrounds and career decisions of Australian and New Zealand dental students

This article describes the sociodemographic and career selection characteristics of dental students in Australia and New Zealand. A total of 672 dental students participated in the study. The survey covered age, language proficiency, type of school attended, place of residence, parental occupation, and level of education. The respondents had an average age of twenty-two years, with a range of eighteen to fifty. Fifty-six percent of respondents were female, and approximately half had completed secondary education in private schools with 44.3 percent having finished in public schools. The majority of students lived with their parents, with only a few respondents reporting a rural home address (6.8 percent). The majority of students (65.3 percent) had placed dentistry as their first career choice and had most likely made the decision after leaving high school or near the end of high school (81.4 percent), with self-motivation being the major influence on their decision. This study provides a description of the sociodemographic profile of Australian and New Zealand dental students and provides a better understanding of career decision issues. It also highlights areas for further investigation and management by educational institutions and public policy.

How can experience in clinical and community settings contribute to early medical education? A BEME systematic review

Review date: Review period January 1992-December 2001. Final analysis July 2004-January 2005. Background and review context: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. Objectives of review: (1) Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. (2) Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Search strategy: Ovid search of. BEI, ERIC, Medline, CIATAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of: Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Criteria: Definitions: Experience: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Exclusions: Not empirical; not early; post-basic; simulated rather than 'authentic' experience. Data collection: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. Headline results: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. Conclusions: Early experience helps medical students socialize to their chosen profession. It. helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

How the west was once: vegetation change in south-west Queensland from 1930 to 1995

Conflicting perceptions of past and present rangeland condition and limited historical data have led to debate regarding the management of vegetation in pastoral landscapes both internationally and in Australia. In light of this controversy we have sought to provide empirical evidence to determine the trajectory of vegetational change in a semi-arid rangeland for a significant portion of the 20th century using a suite of proxy measures. Ambathala Station, approximately 780 km west of Brisbane, in the semi-arid rangelands of south-western Queensland, Australia. We excavated stratified deposits of sheep manure which had accumulated beneath a shearing shed between the years 1930 and 1995. Multi-proxy data, including pollen and leaf cuticle analyses and analysis of historical aerial photography were coupled with a fine resolution radiocarbon chronology to generate a near annual history of vegetation on the property and local area. Aerial photography indicates that minor (< 5%) increases in the density of woody vegetation took place between 1951 and 1994 in two thirds of the study area not subjected to clearing. Areas that were selectively or entirely cleared prior to the 1950s (approximately 16% of the study area) had recovered to almost 60% of their original cover by the 1994 photo period. This slight thickening is only partially evident from pollen and leaf cuticle analyses of sheep faeces. Very little change in vegetation is revealed over the nearly 65 years based on the relative abundances of pollen taxonomic groups. Microhistological examination of sheep faeces provides evidence of dramatic changes in sheep diet. The majority of dietary changes are associated with climatic events of sustained above-average rainfall or persistent drought. Most notable in the dietary analysis is the absence of grass during the first two decades of the record. In contrast to prevailing perceptions and limited research into long-term vegetation change in the semi-arid areas of eastern Australia, the record of vegetation change at the Ambathala shearing shed indicates only a minor increase in woody vegetation cover and no decrease in grass cover on the property over the 65 years of pastoral activity covered by the study. However, there are marked changes in the abundance of grass cuticles in sheep faeces. The appearance and persistence of grass in sheep diets from the late 1940s can be attributed to the effects of periods of high rainfall and possibly some clearing and thinning of vegetation. Lower stock numbers may have allowed grass to persist through later drought years. The relative abundances of major groups of plant pollen have not changed significantly over the past 65 years.

Asma, abitudini e stile di vita "Analisi retrospettiva di un campione di pazienti asmatici seguito in ambulatorio di terzo livello"

Growing evidence suggest the importance of different environments in promoting the pathogenesis and/or exacerbation of asthma. Indoor air pollution is a major contributor to human exposure, since people spend up to 90% of their day indoors. Apart from active smoking, indoor pollution is considered one of the major preventable risk factors of chronic respiratory diseases. The professional activity can also be dangerous because it exposes the subject to environments that can promote the onset of asthma or worsening of the latter in those already affected. Even bad habits such as incorrect diet, lead to more difficulty in controlling their disease. However asthma is a multifactorial disease in nature so it is not easy to distinguish the role of occupational exposure, pollution and normal habits such as smoking, nutrition, sports, etc. This retrospective study was conducted on a sample of asthma patients residing in the metropolitan area of Parma. 116 patients were selected among those who are followed up at least two years at the Asthma outpatient Clinic of Parma University Hospital. The sample in question is therefore closely controlled and monitored; it comes to patients who are well educated on the control of their disease, are able to take appropriate measures to minimize the symptomatology. With this tight approach is proposed to minimize the effect of confounding and then traced with greater certainty the possible cause of the failure to control the disease. For this purpose, each patient was subjected to regular checkups; we took as a reference the period of time between April and October 2015. During each visit, in addition to general data for each patient, we were collected personal information about their habits and way of life through a validated questionnaire delivered and completed by the patient during the visit in the presence of the permanent staff. The questionnaire covers mainly the qualification of the patient, its possible occupational exposure, his home, with information about nearby traffic, time spent outside, physical activity (place and time), exposure to chemicals, exposure to various fumes (fireplace or stove) and cigarette smoke, comorbidities and any drugs taken during the visits considered. Regarding the respiratory conditions of patients during every examination we were considered: Asthma Control Test (a test performed by patients to assess the state of the disease during the month preceding the test), the measurement of exhaled nitric oxide (FeNO) as an index of airways inflammation, measuring the resistance level of small airways (R5-R20) and some spirometric values observed in experiment; in particular the forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), FEV1/FVC ratio, forced expiratory flow rate over the middle 50% of the FVC (FEF25–75) and FEF25-75/FVC were recorded. The sample has been studied considering both the changes of the respiratory parameters for every patient in their examinations, and the respiratory parameters of all the examinations took as a whole in relation with the variables considered. From the results obtained, the patients are clinically stable; their adopted lifestyle and the exposure to possible sources of outdoor pollution, seems not affect the overall control of their disease. Some findings of our study are of interest. First, the subjects who carry a steroid therapy show a clinical worst, as revealed by the decrease of most spirometric indices, particularly FEF25, FEF75, FEF25-75 and R5-R20; also, the presence of comorbidities and the subsequent intake of other drugs, in addition to normal therapy for asthma, seem to be conditions associated with poorer performance in the functional respiratory parameters in particular FEV1/FVC, FEF75 and FEF25-75. Spirometric indexes that are down are mainly those related to obstruction imposed on small airways; this suggests a neglect to the latter on the contrary should be further explored and treated accordingly. It is also observed that both patients are overweight than those living on the lower floors and/or who have the most windows exposed to traffic, showed a decrease of pulmonary function, especially those relate to an obstruction at the small airways level. In conclusion, our results provided the evidence that a most appropriate therapy, specific to reach the small airways, associated with a healthy lifestyle, can help improve the management of asthma.

SALA DE RECURSOS EM SÃO BERNARDO DO CAMPO: POSSIBILIDADES E LIMITES DO APOIO EDUCACIONAL ESPECIALIZADO NA CONSTRUÇÃO DE UMA ESCOLA INCLUSIVA

Este trabalho investiga as possibilidades e os limites do serviço de apoio educacional especializado na construção de uma escola inclusiva. Atualmente, ao se falar em inclusão escolar é possível verificar, tanto nas produções teóricas quanto na legislação nacional e internacional, duas tendências divergentes: inclusão total e continuum de serviços. O serviço de apoio educacional especializado está presente nas duas propostas, porém com nuances diferenciadas. A pesquisa empírica buscou estabelecer um paralelo entre as concepções que embasam essas propostas e o serviço de apoio educacional especializado no município estudado. Trata-se de um estudo de caso do tipo etnográfico, em que foram utilizados como instrumentos de pesquisa: observação participante, análise documental, aplicação de questionários e entrevistas semi-estruturadas com professoras itinerantes. Foram convidadas para contribuir com esse estudo, através da resposta aos questionários e participação nas entrevistas, professoras habilitadas em educação especial/deficiência mental, que atuam em sala de recursos nos quatro primeiros anos do ensino fundamental de uma rede municipal. Verificou-se que o serviço de apoio especializado no município estudado é oferecido a partir da perspectiva de um continuum de serviços. Nesse contexto, os alunos matriculados nas classes comuns, geralmente, são aqueles que conseguem, de alguma forma, adaptar-se ao que está posto, não exigindo mudanças na estrutura curricular. Cabe ao professor itinerante contribuir no ajuste do aluno ao que é estabelecido. Apesar dessa constatação é possível ver como possibilidade para a atuação desse profissional, sua contribuição para a o acesso e permanência de alunos que historicamente foram excluídos do ensino regular. (AU)

Editorial

This second issue of Knowledge Management Research & Practice (KMRP) continues the international nature of the first issue, with papers from authors based on four different continents. There are five regular papers, plus the first of what is intended to be an occasional series of 'position papers' from respected figures in the knowledge management field, who have specific issues they wish to raise from a personal standpoint. The first two regular papers are both based on case studies. The first is 'Aggressively pursuing knowledge management over two years: a case study a US government organization' by Jay Liebowitz. Liebowitz is well known to both academics and practictioners as an author on knowledge management and knowledge based systems. Government departments in many Western countries must soon face up to the problems that will occur as the 'baby boomer' generation reaches retirement age over the next decade. This paper describes how one particular US government organization has attempted to address this situation (and others) through the introduction of a knowledge management initiative. The second case study paper is 'Knowledge creation through the synthesizing capability of networked strategic communities: case study on new product development in Japan' by Mitsuru Kodama. This paper looks at the importance of strategic communities - communities that have strategic relevance and support - in knowledge management. Here, the case study organization is Nippon Telegraph and Telephone Corporation (NTT), a Japanese telecommunication firm. The third paper is 'Knowledge management and intellectual capital: an empirical examination of current practice in Australia' by Albert Zhou and Dieter Fink. This paper reports the results of a survey carried out in 2001, exploring the practices relating to knowledge management and intellectual capital in Australia and the relationship between them. The remaining two regular papers are conceptual in nature. The fourth is 'The enterprise knowledge dictionary' by Stuart Galup, Ronald Dattero and Richard Hicks. Galup, Dattero and Hicks propose the concept of an enterprise knowledge dictionary and its associated knowledge management system architecture as offering the appropriate form of information technology to support various different types of knowledge sources, while behaving as a single source from the user's viewpoint. The fifth and final regular paper is 'Community of practice and metacapabilities' by Geri Furlong and Leslie Johnson. This paper looks at the role of communities of practice in learning in organizations. Its emphasis is on metacapabilities - the properties required to learn, develop and apply skills. This discussion takes work on learning and core competences to a higher level. Finally, this issue includes a position paper 'Innovation as an objective of knowledge management. Part I: the landscape of management' by Dave Snowden. Snowden has been highly visible in the knowledge management community thanks to his role as the Director of IBM Global Services' Canolfan Cynefin Centre. He has helped many government and private sector organizations to consider their knowledge management problems and strategies. This, the first of two-part paper, is inspired by the notion of complexity. In it, Snowden calls for what he sees as a 20th century emphasis on designed systems for knowledge management to be consigned to history, and replaced by a 21st century emphasis on emergence. Letters to the editor on this, or any other topic related to knowledge management research and practice, are welcome. We trust that you will find the contributions stimulating, and again invite you to contribute your own paper(s) to future issues of KMRP.

Communities of implementation

The concept of communities of practice (CoPs) has rapidly gained ground in fields such as knowledge management and organisational learning since it was first identified by Lave and Wenger (1991) and Brown and Duguid (1991). In this article, we consider a related concept that we have entitled “communities of implementation.” Communities of implementation (CoIs) are similar to communities of practice in that they offer an opportunity for a collection of individuals to support each other and share knowledge in a dynamic environment and on a topic in which they share interest. In addition, and to differentiate them from CoPs, a community of implementation extends the responsibilities of a CoP by having as its focus the implementation of a programme of change. This may well extend to designing the change programme. Thus, whereas a main purpose of a CoP is to satisfy “a real need to know what each other knows” (Skyrme, 1999) in an informal way, we argue that a main purpose of a community of implementation is to “pool individual knowledge (including contacts and ways of getting things done) to stimulate collective enthusiasm in order to take more informed purposeful action for which the members are responsible.” Individual and collective responsibility and accountability for successfully implementing the actions/change programme is a key feature of a community of implementation. Without these pressures the members might lower the priority of implementation, allowing competing priorities to dominate their attention and resources. Without responsibility and accountability, the result is likely to be (at best) an organisation which has not begun a change programme, or (at worst) an organisation which is stuck halfway through another failing initiative. To achieve these additional objectives beyond those of a CoP, the CoI needs to provide heightened support to its members. In fact often the members will collectively strategise the development and implementation of the change programme they are leading in the organisation. Other concepts similar to CoPs have appeared in the literature, for example “communities of knowing” (Boland & Tenkasi, 1995), but none have a specific focus on implementation. Perhaps the closest example of a CoI, as suggested by our definition, is reported by Karsten, Lyytinen, Hurskainen, and Koskelainen (2001) who describe a CoP in a paper machinery manufacturer which seems to have the necessary focus on implementation. The theoretical aspects of this article will explore the relationship between CoPs and CoIs, and the needs for different arrangements for a CoI. The practical aspect of this article will consist of a report on a case study of a CoI that was successful in its implementation of a programme of change that aimed to improve its organisation’s knowledge management activities. Over two years the CoI implemented a suite of complementary actions across the organisation. These actions transformed the organisation and moved it towards achieving its ‘core values’ and overall objectives. The article will explore: the activities that formed and gelled the community, the role of the community in the implementation of actions, and experiences from key members of this community on its success and potential improvements.

Adopting the experiential values propositions as e-atmospherics:an illustration through the case of e-banking

For a couple of years now, the Columbia Business School and in particular Bernd Schmitt have been advocating for more work to be done regarding 'experiential marketing'. Taking the case of e-atmospherics in Turkish e-banking practices, we revisit the theory of strategic experiential modules which are sense, feel, think, act and relate. Two major ebanking experience providers' types of communication, product design, retail presence and epresence have been unpacked. These are Garanti Bank, who's known with its many award winning web site, and Akbank who has a standard web site. The Turkish banking at the border of the EU and under global influences has expended and liberalized dramatically over the last decade making the most of new technologies, hence offering an interesting perspective in a non-homogenous society where the technological divide remains important. First a qualitative content analysis of both bank's homepages is conducted. This is followed by 43 online surveys, where 18 is Garanti Bank consumer, 19 is Akbank consumer and 6 is both Garanti and Akbank consumer, to explore how e-atmospherics experiential features currently recognized by users. Our findings indicate that experiential marketing in e-banking can be expected to be the key to greater online migration of consumers and differentiation among the players. Yet, while the first two steps sense and feel are explicitly developed by both players, act and relate still remain poor. Moreover, 'think' is discovered to be a key moderator where both banks seem to lack clear strategy.

Pharmacist monitoring of patient health in the community

The Government has established essential principles in order to make significant improvements in the health of the people and has placed an emphasis on shifting care to the primary sening. This research has explored the potential role of the community pharmacist in health promotion in the pharmacy, and at general medical practices. The feasibility of monitoring patients' health status in the community was evaluated by intervention to assess and alter cardiovascular risk factors.68, hypertensive patients, monitored at one surgery, had a change in mean systolic blood pressure from 158.28 to 146.55 mmHg, a reduction of 7.4%, and a change in mean diastolic bood pressure from 90.91 to 84.85 mmHg, a reduction of 6.7%.120 patients, from a cohort of 449 at the major practice, with an initial serum total cholesterol of 6.0+mmol/L, experienced a change in mean value from 6.79 to 6.05 mmol/L, equivalent to a reduction of 10.9%. 86% of this patient cohort showed a decrease in cholesterol concentration. Patients, placed in a high risk category according to their coronary rank score, assessed at the first health screening, showed a consistent and significant improvement in coronary score throughout the study period of two years. High risk and intermediate risk patients showed improvements in coronary score of 52% and 14% respectively. Patients in the low risk group maintained their good coronary score. In some cases, a patient's improvement was effected in liaison with the GP, after a change or addition of medication and/or dosage.Pharmacist intervention consisted of advice on diet and lifestyle and adherence to medication regimes. It was concluded that a pharmacist can facilitate a health screening programme in the primary care setting, and provide enhanced continuity of care for the patient.

Oculomotor function in incipient presbyopia

The incipient phase of presbyopia represents a loss in accommodative amplitude of approximately 3 dioptres between the ages of 35 and 45 and is the prelude to the need for a reading addition. The need to maintain single binocular vision during this period requires re-calibration of the correspondence between accommodation and vergence response. No previous study has specifically attempted to correlate change in accommodative status with the profile of oculomotor responses occurring within the incipient phase of presbyopia. Measurements were made of the amplitude of accommodation, stimulus and response AC/A ratios, CA/C ratio, tonic accommodation, tonic vergence, proximal vergence, vergence adaptation and accommodative adaptation of 38 subjects. Twenty subjects were aged 35 to 45 years of age and 10 subjects were aged 20 to 30 years of age at the commencement of the study. The measurements were repeated at four-monthly intervals for a total of two years. The results of this study fail to support the Hess-Gullstrand theory of presbyopia with evidence that the effort to produce a unit change in accommodation increases with age. The data obtained has enabled the analysis of how each individual oculomotor function varies with the decline in amplitude of accommodation. MATLAB/SIMULINK software has been used to assist in the analysis and to allow the amendment of existing models to represent accurately the ageing oculomotor system. This study has proposed that with the decline in the amplitude of accommodation there is an increase in the accommodative convergence response per unit of accommodative response. To compensate for this increase, evidence has been found of a decrease in tonic vergence with age. If this decline in tonic vergence is not sufficient to counteract the increase in accommodative convergence, it is proposed that the near vision response is limited to the maximum vergence response that can be tolerated, with the resulting lower accommodative response being compensated for by an increase in the subjective depth-of-focus. When the blur due to the decrease in accommodative response can no longer be tolerated, the first reading addition will be required.

Teachers' conceptions of their role

An analysis is made of the conceptions which serving teachers have of their role, though no attempt is made to relate this to their practice of teaching. A series of role items was collected to afford a description of the teacher's role in terms of school and society expectations as well as classroom behaviours. These were taken from the literature and from interviews with teachers, and confirmed in a preliminary survey. Presented as a questionnaire, replies to the main investigation were made by 881 teachers, working in a variety of schools from nurseries to comprehensives. Two attempts have been made to construct a role model. The first, depending on the judgement of items fitting theoretically derived roles, failed, due to diffuseness in the role of teacher. The second used factor analysis; six factors were extracted which represent meaningful and distinct areas of role. The analysis has depended largely on examination of scores taken from these factors. Teachers in all types of school have similar conceptions of discipline. Nursery-infant and junior staff generally agree on the other areas investigated, but the concepts of secondary teachers are distinct. They are more conservative and less child-centered. When the class being taught is held constant, few differences in role conception are found to be related to sex, being a parent, graduate status, or personality, as measured in terms of the extrovert and neurotic dimensions. The first few years of teaching bring considerable changes in role conception, and further changes occur with prolonged experience. Deputy heads in junior schools and nursery nurses have quite distinct role conceptions; those of all other teachers, including those holding senior posts in secondary schools, are similar. The perception of school climate influences the role conception of primary teachers directly, but it does not influence that of secondary teachers. The greatest variation in role conception is related to scores on the radical scale of Oliver and Butcher. Primary school teachers experience little constraint, but that reported by secondary school teachers is considerable, especially that coming from the head. Despite difficulties caused by the wide division between primary and secondary education, teachers have an accurate perception of the roles their colleagues adopt. A few misunderstandings may be due to a feeling of idealism amongst nursery and infant teachers. There is evidence in their conception of role that would enhance the professional standing of teachers, but this is not in a form which is likely to be recognised by the public.

Proliferative diabetic retinopathy (R3) referrals from the digital diabetic retinopathy screening program:urgency of appointment in the hospital eye service achieved and needed?

DESIGN. Retrospective analysis PURPOSE. To assess the clinical characteristics and outcomes of patients identified with proliferative diabetic retinopathy (PDR) referred from the screening program to the hospital eye services (HES) METHODS. a retrospective analysis of urgently referred PDR cases to Birmingham Heartlands HES from august 2008 until July 2010 RESULTS. 130 urgent diabetic retinopathy referrals were made and reviewed. 103 (68% male, 80% type 2 diabetes) were referred for PDR with a mean age of 59 years, mean diabetes duration of 17.8years. 69% were on insulin treatment at the time of the screening, with mean HbA1c of 10.4% (range-5.7 to 16.5%). 65% of the patients were offered appointments at HES within two weeks after referral from the screening. 50.5% of the patients were seen in the HES within 2 weeks, 22 and 16 % were seen 2-4 and 4-8 weeks after referral respectively. 6 patients never attended ophthalmology examination during the two years of review. Of all the attendees, 56% were booked for pan retinal photocoagulation (PRP) & 9(9.3%) for macular laser respectively on their 1st HES visit. 75% of the patients were newly diagnosed PDR and 26 had previous PRP laser but lost to follow up. 63 patients ( 66%) received either PRP or macular laser treatment (85.7% of which is PRP). 63% of the PRP treatment was performed within a month of first HES attendance. Retinopathy grading discrepancy between the screening program and HES was noted in 20% (21 patients). CONCLUSIONS. This data suggests that the digital screening programme is appropriately identifying high risk patients with PDR with timely PRP laser treatment in the majority of patients but raises concern over patients lost to follow up (hence failsafe tracking of appointment attendance), and review of grading discrepancies between the ophthalmology and screening service.

Editorial

Readers may have noted that a short but very important announcement was made in the last issue of CLAE, at the top of the contents page. CLAE has been accepted by Thomson Reuters for abstracting and indexing in its SciSearch, Journal Citation Reports, and Current Contents services. This will ensure a greater visibility to the international research community. In addition, in June 2012 CLAE will receive its very first official Impact Factor – a measure of journal influence of importance to authors and readers alike. The impact factor value has not yet been decided but internal estimates by Elsevier estimate it will be around 1, and it will be applied to all CLAE issue back to January 2009 (volume 32). I would guess readers at this stage would have one of two responses – either ‘that's good news’ or perhaps ‘what's an impact factor?’ If you are in the latter camp then allow me to try and explain. Basically the impact factor or citation index of a journal is based on how many times in the previous year papers published in that journal in the previous two years were cited by authors publishing in other journals. So the 2012 impact factor for CLAE is calculated on how many times in 2011 papers that were published in CLAE in 2010 and 2009 were cited in other journals in 2011, divided by the number of papers published in CLAE 2010 and 2009. Essentially authors will try and get their work published in journals with a higher impact factor as it is thought that the paper will be cited more by other authors or the paper will have higher visibility in the arena. For universities having its published output in higher journals is one of the markers used to judge esteem. For individual authors publishing in journals with a higher impact factor or the number of times one of their papers is published is something that they are likely to add to their CVs or demonstrate the importance of their work. Journals with higher impact factors tend to be more review journals or journals with a wider spectrum so for a relatively small journal with a specialised field like CLAE it is great to be listed with a citation index. The awarding of a citation index crowns many changes that CLAE has undergone since the current Editor took the reins in 2005. CLAE has increased from four issues (in 2004) to six issues per year with at least one review article per issue and one article with continuing education per issue. The rejection rate has gone up significantly meaning that only best papers are published (currently it stands at 37%). CLAE has been Medline/Pubmed indexed for a few years now which is also a very important factor in improving visibility of the journal. The submission and reviewing process for CLAE in now entirely online and finally the editorial board has changed from being merely a list of keynote people to being an active group of keynote people who are enthusiastically involved with the journal. From the editorial board one person is appointed as a Reviews Editor plus we have two additional editors who work as Regional Editors. As ever, on behalf of CLAE I would like to thank the BCLA Council for their continued support (especially Vivien Freeman) and Elsevier for their continuing guidance (in particular Andrew Miller and Rosie Davey) and the excellent Editorial Board (Christopher Snyder, Pauline Cho, Eric Papas, Jan Bergmanson, Roger Buckley, Patrick Caroline, Dwight Cavanagh, Robin Chalmers, Michael Doughty, Nathan Efron, Michel Guillon, Nizar Hirji, Meng Lin, Florence Malet, Philip Morgan, Deborah Sweeney, Brian Tighe, Eef van Der Worp, Barry Weissman, Mark Willcox, James Wolffsohn and Craig Woods). And finally, a big thanks to the authors and reviewers who work tirelessly putting manuscripts together for publication in CLAE. Copyright © 2012 Published by Elsevier Ltd.