A qualitative study of stakeholder views regarding participation in locally commissioned enhanced optometric services

Objectives: To explore the views of optometrists, general practitioners (GPs) and ophthalmologists regarding the development and organisation of community-based enhanced optometric services. Design: Qualitative study using free-text questionnaires and telephone interviews. Setting: A minor eye conditions scheme (MECS) and a glaucoma referral refinement scheme (GRRS) are based on accredited community optometry practices. Participants: 41 optometrists, 6 ophthalmologists and 25 GPs. Results: The most common reason given by optometrists for participation in enhanced schemes was to further their professional development; however, as providers of ‘for-profit’ healthcare, it was clear that participants had also considered the impact of the schemes on their business. Lack of fit with the ‘retail’ business model of optometry was a frequently given reason for non-participation. The methods used for training and accreditation were generally thought to be appropriate, and participating optometrists welcomed the opportunities for ongoing training. The ophthalmologists involved in the MECS and GRRS expressed very positive views regarding the schemes and widely acknowledged that the new care pathways would reduce unnecessary referrals and shorten patient waiting times. GPs involved in the MECS were also very supportive. They felt that the scheme provided an ‘expert’ local opinion that could potentially reduce the number of secondary care referrals. Conclusions: The results of this study demonstrated strong stakeholder support for the development of community-based enhanced optometric services. Although optometrists welcomed the opportunity to develop their professional skills and knowledge, enhanced schemes must also provide a sufficient financial incentive so as not to compromise the profitability of their business

Far infrared and submillimeter brightness temperatures of the giant planets

The brightness temperatures of Jupiter, Saturn, Uranus, and Neptune in the range 35 to 1000 micron. The effective temperatures derived from the measurements, supplemented by shorter wavelength Voyager data for Jupiter and Saturn, are 126.8 + or - 4.5 K, 93.4 + or - 3.3 K, 58.3 + or - 2.0 K, and 60.3 + or - 2.0 K, respectively. The implications of the measurements for bolometric output and for atmospheric structure and composition are discussed. The temperature spectrum of Jupiter shows a strong peak at approx. 350 microns followed by a deep valley at approx. 450 to 500 microns. Spectra derived from model atmospheres qualitatively reproduced these features but do not fit the data closely

Clinical safety of a minor eye conditions scheme in England delivered by community optometrists

Objective The aim of this study was to monitor the activity and evaluate the clinical safety of a minor eye conditions scheme (MECS) conducted by accredited community optometrists in Lambeth and Lewisham, London. Methods and analysis Optometrists underwent an accredited training programme, including attendance at hospital eye services (HES) clinics. Patients who satisfied certain inclusion criteria were referred to accredited MECS optometrists by their general practitioners (GPs) or could self-refer. Data were extracted from clinical records. A sample of MECS clinical records was graded to assess the quality of the MECS optometrists’ clinical management decisions. Referrals to the HES were assessed by the collaborating ophthalmologists and feedback was provided. Results A total of 2123 patients (mean age 47 years) were seen over 12 months. Two-thirds of the patients (67.3%) were referred by their GP. The most common reasons for patients needing a MECS assessment were ‘red eye’ (36.7% of patients), ‘painful white eye’ (11.1%), ‘flashes and floaters’ (10.2%); 8.7% of patients had a follow-up appointment. Of the patients seen, 75.1% were retained in the community, 5.7% were referred to their GP and 18.9% were referred to the HES. Of the HES referrals, 49.1% were routine, 22.6% urgent and 28.3% emergency. Of the records reviewed, 94.5% were rated as appropriately managed; 89.2% of the HES referrals were considered appropriate. Conclusion The findings of this study indicate that optometrists are in a good position to work very safely within the remits of the scheme and to assess risk

QUIJOTE Scientific Results. II. Polarisation Measurements of the Microwave Emission in the Galactic molecular complexes W43 and W47 and supernova remnant W44

We present Q-U-I JOint TEnerife (QUIJOTE) intensity and polarisation maps at 10-20 GHz covering a region along the Galactic plane 24<l<45 deg, |b|<8 deg. These maps result from 210 h of data, have a sensitivity in polarisation of ~40 muK/beam and an angular resolution of ~1 deg. Our intensity data are crucial to confirm the presence of anomalous microwave emission (AME) towards the two molecular complexes W43 (22 sigma) and W47 (8 sigma). We also detect at high significance (6 sigma) AME associated with W44, the first clear detection of this emission towards a SNR. The new QUIJOTE polarisation data, in combination with WMAP, are essential to: i) Determine the spectral index of the synchrotron emission in W44, beta_sync =-0.62 +/-0.03, in good agreement with the value inferred from the intensity spectrum once a free-free component is included in the fit. ii) Trace the change in the polarisation angle associated with Faraday rotation in the direction of W44 with rotation measure -404 +/- 49 rad/m2. And iii) set upper limits on the polarisation of W43 of Pi_AME <0.39 per cent (95 per cent C.L.) from QUIJOTE 17~GHz, and <0.22 per cent from WMAP 41 GHz data, which are the most stringent constraints ever obtained on the polarisation fraction of the AME. For typical physical conditions (grain temperature and magnetic field strengths), and in the case of perfect alignment between the grains and the magnetic field, the models of electric or magnetic dipole emissions predict higher polarisation fractions.Comment: Accepted for publication in MNRA

Two bolometer arrays for far-infrared and submillimeter astronomy

We describe the development, construction, and testing of two 384 element arrays of ion-implanted semiconducting cryogenic bolometers designed for use in far-infrared and submillimeter cameras. These two dimensional arrays are assembled from a number of 32 element linear arrays of monolithic Pop-Up bolometer Detectors (PUD) developed at NASA/Goddard Space Flight Center. PUD technology allows the construction of large, high filling factor, arrays that make efficient use of available focal plane area in far-infrared and submillimeter astronomical instruments. Such arrays can be used to provide a significant increase in mapping speed over smaller arrays. A prototype array has been delivered and integrated into a ground-based camera, the Submillimeter High Angular Resolution Camera (SHARC II), a facility instrument at the Caltech Submillimeter Observatory (CSO). A second array has recently been delivered for integration into the High-resolution Airborne Widebandwidth Camera (HAWC), a far-infrared imaging camera for the Stratospheric Observatory for Infrared Astronomy (SOFIA). HAWC is scheduled for commissioning in 2005

Evaluation of a minor eye conditions scheme delivered by community optometrists

BACKGROUND: The establishment of minor eye conditions schemes (MECS) within community optometric practices provides a mechanism for the timely assessment of patients presenting with a range of acute eye conditions. This has the potential to reduce waiting times and avoid unnecessary referrals to hospital eye services (HES). OBJECTIVE: To evaluate the clinical effectiveness, impact on hospital attendances and patient satisfaction with a minor eye service provided by community optometrists. METHODS: Activity and outcome data were collected for 12 months in the Lambeth and Lewisham MECS. A patient satisfaction questionnaire was given to patients at the end of their MECS appointment. A retrospective difference-in-differences analysis of hospital activity compared changes in the volume of referrals by general practitioners (GPs) from a period before (April 2011-March 2013) to after (April 2013-March 2015) the introduction of the scheme in Lambeth and Lewisham relative to a neighbouring area (Southwark) where the scheme had not been commissioned. Appropriateness of case management was assessed by consensus using clinical members of the research team. RESULTS: A total of 2123 patients accessed the scheme. Approximately two-thirds of patients (67.5%) were referred by their GP. The commonest reasons for patients attending for a MECS assessment were 'red eye' (36.7% of patients), 'painful white eye' (11.1%) and 'flashes and floaters' (10.2%). A total of 64.1% of patients were managed in optometric practice and 18.9% were referred to the HES; of these, 89.2% had been appropriately referred. First attendances to HES referred by GPs reduced by 26.8% (95% CI -40.5% to -13.1%) in Lambeth and Lewisham compared to Southwark. CONCLUSIONS: The Lambeth and Lewisham MECS demonstrates clinical effectiveness, reduction in hospital attendances and high patient satisfaction and represents a successful collaboration between commissioners, local HES units and primary healthcare providers

First Dark Matter Limits from a Large-Mass, Low-Background Superheated Droplet Detector

We report on the fabrication aspects and calibration of the first large active mass ($\sim15$ g) modules of SIMPLE, a search for particle dark matter using Superheated Droplet Detectors (SDDs). While still limited by the statistical uncertainty of the small data sample on hand, the first weeks of operation in the new underground laboratory of Rustrel-Pays d'Apt already provide a sensitivity to axially-coupled Weakly Interacting Massive Particles (WIMPs) competitive with leading experiments, confirming SDDs as a convenient, low-cost alternative for WIMP detection.Comment: Final version, Phys. Rev. Lett. (in press

Comparison and relative utility of inequality measurements: as applied to Scotland’s child dental health

This study compared and assessed the utility of tests of inequality on a series of very large population caries datasets. National cross-sectional caries datasets for Scotland’s 5-year-olds in 1993/94 (n = 5,078); 1995/96 (n = 6,240); 1997/98 (n = 6,584); 1999/00 (n = 6,781); 2002/03 (n = 9,747); 2003/04 (n = 10,956); 2005/06 (n = 10,945) and 2007/08 (n = 12,067) were obtained. Outcomes were based on the d3mft metric (i.e. the number of decayed, missing and filled teeth). An area-based deprivation category (DepCat) measured the subjects’ socioeconomic status (SES). Simple absolute and relative inequality, Odds Ratios and the Significant Caries Index (SIC) as advocated by the World Health Organization were calculated. The measures of complex inequality applied to data were: the Slope Index of Inequality (absolute) and a variety of relative inequality tests i.e. Gini coefficient; Relative Index of Inequality; concentration curve; Koolman and Doorslaer’s transformed Concentration Index; Receiver Operator Curve and Population Attributable Risk (PAR). Additional tests used were plots of SIC deciles (SIC10) and a Scottish Caries Inequality Metric (SCIM10). Over the period, mean d3mft improved from 3.1(95%CI 3.0–3.2) to 1.9(95%CI 1.8–1.9) and d3mft = 0% from 41.1(95%CI 39.8–42.3) to 58.3(95%CI 57.8–59.7). Absolute simple and complex inequality decreased. Relative simple and complex inequality remained comparatively stable. Our results support the use of the SII and RII to measure complex absolute and relative SES inequalities alongside additional tests of complex relative inequality such as PAR and Koolman and Doorslaer’s transformed CI. The latter two have clear interpretations which may influence policy makers. Specialised dental metrics (i.e. SIC, SIC10 and SCIM10) permit the exploration of other important inequalities not determined by SES, and could be applied to many other types of disease where ranking of morbidity is possible e.g. obesity. More generally, the approaches described may be applied to study patterns of health inequality affecting worldwide populations