The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College ...of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving CI-DMO, or non-centre involving nCI-DMO, systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections IVT of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.
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•Retailer power leads to lower product quality if quality is noncontractible.•The weaker retailer sometimes may not communicate its higher quality.•Consumer surplus rises with retail ...power.
A number of consumer and business reports suggest that slightly lower quality (or feature) versions of products are being sold through dominant retailers, while higher quality versions continue to be sold through weaker retailers and, customers are uninformed about such subtle differences. We study two intriguing questions based on this phenomenon namely (1.) why are lower quality-lower priced versions sold primarily through dominant retailers and not the weaker retailers? (2.) Why do sometimes the weaker retailers not inform customers about these quality differences? Using a game theoretic model, we find that when quality is noncontractible an increase in retail dominance leads to a decrease in quality offered by the dominant retailer vis-à-vis the weaker retailer. However, we show that the weaker retailer does not have an incentive to advertise its higher quality if quality differences are not too high. This situation arises endogenously when the dominant retailer is not too powerful as compared to the weaker retailer or when retail differentiation is high. The motivation for this result is traced to the threat of increased competition in the event of such advertising.
The General Medical Council (GMC) is a public body which regulates doctors in the United Kingdom (UK). One of its main roles is to investigate any concerns raised regarding a doctor. We aimed to ...study the current trends in referrals of ophthalmologists to the GMC.
A request was made to the GMC under the Freedom of Information Act 2000 for all complaints of ophthalmologists received by the GMC between 2007 and 2019, their outcomes and types of allegations. We have also calculated the annual incidences of suspension and erasure.
There were 1032 complaints received by the GMC against ophthalmologists in 2007-2019. No actions were taken in 569 cases (55%). GMC investigations were carried out in 347 cases (34%). Sixty cases were referred to the Medical Practitioners Tribunal Service tribunal (6%), some of which cases resulted in suspension (28, 3%) and erasure (11, 1%). The commonest allegation types were Clinical Care, Knowledge, Skills and Performance, Maintaining Trust, Communication, Partnership and Teamwork and Probity. Annual incidences of complaints and serious outcomes between 2009 and 2017 were 30.54 (range 18.7-42.4) and 1.1 (range 0.8-2.0) per 1000 ophthalmologists respectively.
There is an overall increase in the number of complaints to the GMC for ophthalmologists from 2007 to 2015 but since then there has been a gradual reduction. The annual incidences of complaints and serious outcomes have remained stable.
With an aim to understand the photophysical behavior of twisted organic fluorescent molecules in their aggregated state, two twisted biaryl molecules, namely, 9,9′-bianthryl and ...10,10′-dicyano-9,9′-bianthryl, have been synthesized and characterized by conventional spectroscopic methods. To understand the role of C–C bond twisting on the photophysical response of biaryl aggregates, monoaryl counterparts (anthracene and 9-anthracenecarbonitrile) of the biaryl systems are also investigated. Photophysical behaviors of these systems along with their monoaryl counterpart are investigated in both solution and aggregated state. Investigations reveal that fluorescence spectra of the biaryl compounds show blue-shifted emission upon aggregation. Interestingly, no blue shift of the emission has been observed for monoaryl aggregates. Photophysical data of biaryl systems compared to monoaryl unit reveal that change in geometry, during self-assembly process, disfavors the formation of charge-transfer state, which eventually causes blue shift in the emission upon aggregation. In addition to this, potential of these systems toward signaling of nitroaromatic explosive has also been explored. Among all of the nitroaromatics, the highest fluorescence quenching is observed for nitrophenols (say picric acid (PA)). The investigation also reveals that compared to monoaryl systems, biaryl systems are more responsive to fluorescence quenching by nitroaromatics. Perrin’s model of quenching sphere action has been attributed to nitrophenol (PA) selective signaling behavior of biaryl systems.
With the rising wave of travelers and changing market landscape, understanding marketplace dynamics in commoditized accommodations in the hotel industry has never been more important. In this ...research, a machine learning approach is applied to build a framework that can forecast the unconstrained and constrained market demand (aggregated and segmented) by leveraging data from disparate sources. Several machine learning algorithms are explored to learn traveler’s booking patterns and the latent progression of the booking curve. This solution can be leveraged by independent hoteliers in their revenue management strategy by comparing their behavior to the market.
ADHD in children and adolescents is a neurodevelopmental disorder, which is recognized by the clinicians all over the world. ADHD is a clinical diagnosis based on reliable history, reports from home ...and school and a physical examination to rule out any other underlying medical conditions. ADHD can cause low self-esteem in the child and impair quality of life for the child and the family. It is known that ADHD is a chronic illness and that clinicians needed to use chronic illness principles in treating it. The last 10 years have seen an increase in the number of medications that have been approved for the treatment of ADHD. This book has tried to address some of the issues in ADHD.
Firms engaged in personal selling in business and retail markets tend to invest substantial portions of their marketing budgets on lead generation through marketing agents and conversion by sales ...reps. However, such an arrangement of marketing-sales interface has often been found to be inefficient due to the multi-channel attribution problem. We use analytical models to find optimal sales compensation designs to solve the multi-channel attribution problem. Findings suggest that contracts involving revenue incentives, lead qualification, and sales autarky leave a gap between the first-best and the achieved profit due to budget balance, costs of lead qualification, and the sales force's lack of specialization in marketing, respectively. An increase in risk aversion favors sales autarky and lead qualification contracts over the revenue incentive contracts while an increase in overall uncertainty favors lead qualification. A certain type of contest (or stack ranking-based pay) achieves first-best profit when uncertainty is moderate.
•Effect of multichannel attribution problem on sales compensation is studied.•Revenue based incentive is optimal when risk aversion and uncertainty are low.•Lead qualification is optimal when uncertainty related to lead qualification is low.•Self-generation of leads is optimal when uncertainty is high.•A type of contest may solve the attribution problem when uncertainty is moderate.
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