Referral thresholds for an integrated learning disability eye care pathway: a consensus approach

Introduction Local Optometric Support Unit (LOCSU) have published their refreshed clinical pathway for eye care for people with a learning disability. The document sets out the adjustments to practice that a community optometrist might make in order to provide optimal care for a person with learning disability attending a primary eye care assessment. The pathway specifically points to the need to retain patients in primary care where appropriate and ‘reduce the number of people with learning disability who are inappropriately referred into the Hospital Eye Service (HES).’ Pivotal to this refreshed pathway is the integration with secondary care, with local arrangements to facilitate referral and hospital management where appropriate. There are few ophthalmologists nationally who frequently encounter patients with a learning disability in their hospital practice and knowing where to start when creating referral criteria or KPIs may create a barrier to services becoming established. In order to address this gap in experience, we set about developing a set of consensus statements regarding referral thresholds for ocular conditions commonly encountered in adults with learning disability. Method A series of video interviews were undertaken with eye health professionals with a range of experience in eye care for people with learning disability. Each contributor commented on the usability and clarity of each element of the referral criteria. In addition, each contributor was asked to express the overriding principles by which they make decisions regarding referral thresholds for patients with learning disability. These were collated into the final document which was circulated and agreed by all participants. Results A table setting out referral thresholds for commonly encountered eye conditions in adults with learning disabilities is presented. Conclusion We have presented a succinct set of consensus statements relating referral thresholds for common presentations of visual problems in adults with learning disability in the UK distilled from the collective experience of a group of eye health professionals. The intention was not to present a comprehensive review of management of each condition. Rather, the consensus statements may form the starting point from which each area could develop locally agreed criteria, as is suggested by the LOCSU pathway guidance

Findings from an opt-in eye examination service in English special schools. Is vision screening effective for this population?

Our objective was to present the findings of an opt-in, school-based eye care service for children attending 11 special schools in England and use these findings to determine whether a vision screening programme would be appropriate for this population. Data from eye examinations provided to 949 pupils (mean age 10.7 years) was analysed to determine the prevalence and aetiology of visual deficiencies and reported eye care history. For 46.2% (n = 438) of pupils, a visual deficiency was recorded. 12.5% of all the children seen (n = 119) had a visual deficiency that was previously undiagnosed. Referral for a medical opinion was made for 3.1% (n = 29) of pupils seen by the service. Spectacle correction was needed for 31.5% (n = 299) of pupils; for 12.9% (122) these were prescribed for the first time. 3.7% (n = 11) of parents/carers of pupils needing spectacles chose not to use the spectacle dispensing service offered in school. Eye care history was available for 847 pupils (89.3%). Of the pupils for whom an eye care history was available, 44% (n = 373) reported no history of any previous eye care and10.7% (n = 91) reported a history of attending a community optical practice/opticians. Only one pupil from the school entry 4–5 age group (0.6% of age group n = 156) would have passed vision screening using current Public Health England screening guidelines. Children with a diagnosis of autism were significantly less likely to be able to provide a reliable measurement of visual acuity. This study supports previously published evidence of a very high prevalence of visual problems in children with the most complex needs and a significant unmet need in this group. It demonstrates routine school entry vision screening using current Public Health England guidelines is not appropriate for this group of children and very low uptake of community primary eye care services

DISTINGUISHING BETWEEN SPOT AND TORUS MODELS OF HIGH-FREQUENCY QUASIPERIODIC OSCILLATIONS

In the context of high-frequency quasi-periodic oscillation (HF QPOs) we further explore the appearance of an observable signal generated by hot spots moving along quasi-elliptic trajectories close to the innermost stable circular orbit in the Schwarzschild spacetime. The aim of our investigation is to reveal whether observable characteristics of the Fourier power-spectral density can help us to distinguish between the two competing models, namely, the idea of bright spots orbiting on the surface of an accretion torus versus the scenario of intrinsic oscillations of the torus itself. We take the capabilities of the present observatories (represented by the Rossi X-ray Timing Explorer, RXTE) into account, and we also consider the proposed future instruments (represented here by the Large Observatory for X-ray Timing, LOFT)

Time delay measurement of Mg II line in CTS C30.10 with SALT

We report 6 yr monitoring of a distant bright quasar CTS C30.10 (z = 0.90052) with the Southern African Large Telescope (SALT). We measured the rest-frame time-lag of $562\pm 2$ days between the continuum variations and the response of the Mg II emission line, using the Javelin approach. More conservative approach, based on five different methods, imply the time delay of $564^{+109}_{-71}$ days. This time delay, combined with other available measurements of Mg II line delay, mostly for lower redshift sources, shows that the Mg II line reverberation implies a radius-luminosity relation very similar to the one based on a more frequently studied H$\beta$ line.Comment: submitted to ApJ; comments welcom

Comparison of czech insurance market with british insurance market

Předmětem bakalářské práce „Srovnání české pojistného trhu s britským pojistným trhem“ je zkoumání a teoretický opis pojistného trhu České republiky a pojistného trhu Spojeného království a jejich následné praktické srovnání za využití zejména ukazatelů úrovně pojistných trhů. Do své práce jsem si vybral britský pojistný trh, protože je dlouhodobým gigantem na světových finančních trzích a také kvůli legislativním změnám, týkajících se regulace a dohledu, kterými prošel po nedávném Brexitu. Český pojistný trh byl předepsanou součástí práce. Úvodem, v teoretické části autor obeznámí čtenáře s pojmem pojistný trh a budou popsána specifika jednotlivých pojistných trhů. Základem empirické části práce bude statistické srovnání a analýza českého a britského pojistného trhu. Závěrem bude provedeno zhodnocení analýzy domácího a zahraničního pojistného trhu.The subject of the bachelor's thesis "Comparison of the Czech insurance market with the British market" is an investigation and theoretical description of the insurance market of the Czech Republic and the insurance market of the United Kingdom and their subsequent practical comparison using indicators of the level of insurance markets. I chose the UK insurance market for my work because it has long been a giant in the global financial markets and because of the legislative oversight, particularly related to regulation and supervision, which it has undergone after the recent Brexit. At the beginning, in the theoretical part, the author introduces the reader to the term insurance market and the specifics of individual insurance markets will be described. The basis of the empirical part of the work will be a statistical comparison and analysis of the Czech and British insurance market. In conclusion, a foreign evaluation of the analysis of the domestic and insurance market will be carried out