This new edition of Ann Bowling's well-known and highly respected text has been thoroughly revised and updated to reflect key methodological developments in health research. It is a comprehensive, easy to read, guide to the range of methods used to study and evaluate health and health services. It describes the concepts and methods used by the main disciplines involved in health research, including: demography, epidemiology, health economics, psychology and sociology.The research methods described cover the assessment of health needs, morbidity and mortality trends and rates, costing health services, sampling for survey research, cross-sectional and longitudinal survey design, experimental methods and techniques of group assignment, questionnaire design, interviewing techniques, coding and analysis of quantitative data, methods and analysis of qualitative observational studies, and types of unstructured interviewing. With new material on topics such as cluster randomization, utility analyses, patients' preferences, and perception of risk, the text is aimed at students and researchers of health and health services. It has also been designed for health professionals and policy makers who have responsibility for applying research findings in practice, and who need to know how to judge the value of that research.

Research Methods in Health. Investigating health and health services

The ultimate goal of brain-computer interface (BCI) technology is to provide communication and control capacities to people with severe motor disabilities. BCI research at the Wadsworth Center focuses primarily on noninvasive, electroencephalography (EEG)-based BCI methods. We have shown that people, including those with severe motor disabilities, can learn to use sensorimotor rhythms (SMRs) to move a cursor rapidly and accurately in one or two dimensions. We have also improved P300-based BCI operation. We are now translating this laboratory-proven BCI technology into a system that can be used by severely disabled people in their homes with minimal ongoing technical oversight. To accomplish this, we have: improved our general-purpose BCI software (BCI2000); improved online adaptation and feature translation for SMR-based BCI operation; improved the accuracy and bandwidth of P300-based BCI operation; reduced the complexity of system hardware and software and begun to evaluate home system use in appropriate users. These developments have resulted in prototype systems for every day use in people's homes.

https://www.etsu.edu/cas/psychology/bcilab/documents/vaughan_et_al__2006_.pdf

The wadsworth BCI research and development program: at home with BCI

Aim: To compare the inter-method agreement in intraocular pressure (IOP) measurements made with four different tonometric methods. Methods: IOP was measured with the Goldmann applanation tonometer (GAT), Tono-Pen XL, ocular blood flow tonograph (OBF), and Canon TX-10 non-contact tonometer (NCT) in a randomised order in one eye of each of 105 patients with ocular hypertension or glaucoma. Three measurements were made with each method, and by each of two independent GAT observers. GAT interobserver and tonometer inter-method agreement was assessed by the Bland-Altman method. The outcome measures were 95% limits of agreement for IOP measurements between GAT observers and between tonometric methods, and 95% confidence intervals for intra-session repeated measurements. Results: The mean differences (bias) in IOP measurements were 0.4 mm Hg between GAT observers, and 0.6 mm Hg, 0.1 mm Hg, and 0.7 mm Hg between GAT and Tono-Pen, OBF, and NCT, respectively. The 95% limits of agreement were smallest (bias ±2.6 mm Hg) between GAT observers, and larger for agreement between the GAT and the Tono-Pen, OBF, and NCT (bias ±6.7, ±5.5, and ±4.8 mm Hg, respectively). The OBF and NCT significantly underestimated GAT measurements at lower IOP and overestimated these at higher IOP. The repeatability coefficients for intra-session repeated measurement for each method were ±2.2 mm Hg and ±2.5 mm Hg for the GAT, ±4.3 mm Hg for the Tono-Pen, ±3.7 mm Hg for the OBF, and ±3.2 mm Hg for the NCT. Conclusions: There was good interobserver agreement with the GAT and moderate agreement between the NCT and GAT. The differences between the GAT and OBF and between the GAT and Tono-Pen probably preclude the OBF and Tono-Pen from routine clinical use as objective methods to measure IOP in normal adult eyes.

https://bjo.bmj.com/content/bjophthalmol/89/7/847.full.pdf

A comparison of four methods of tonometry: method agreement and interobserver variability.

Objectives: To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways. Design: A discrete event simulation economic modelling evaluation. Data from systematic reviews of risk prediction models and agreement between tonometers, secondary analyses of existing datasets (to validate identified risk models and determine optimal monitoring criteria) and public preferences were used to structure and populate the economic model. Setting: Primary and secondary care. Participants: Adults with ocular hypertension (IOP > 21mmHg) and the public (surveillance preferences). Interventions: We compared five pathways: two based on National Institute for Health and Clinical Excellence (NICE) guidelines with monitoring interval and treatment depending on initial risk stratification, 'NICE intensive' (4-monthly to annual monitoring) and 'NICE conservative' (6-monthly to biennial monitoring); two pathways, differing in location (hospital and community), with monitoring biennially and treatment initiated for a ≥ 6% 5-year glaucoma risk; and a 'treat all' pathway involving treatment with a prostaglandin analogue if IOP > 21 mmHg and IOP measured annually in the community. Main outcome measures: Glaucoma cases detected; tonometer agreement; public preferences; costs; willingness to pay and quality-adjusted life-years (QALYs). Results: The best available glaucoma risk prediction model estimated the 5-year risk based on age and ocular predictors (IOP, central corneal thickness, optic nerve damage and index of visual field status). Taking the average of two IOP readings, by tonometry, true change was detected at two years. Sizeable measurement variability was noted between tonometers. There was a general public preference for monitoring; good communication and understanding of the process predicted service value. 'Treat all' was the least costly and 'NICE intensive' the most costly pathway. Biennial monitoring reduced the number of cases of glaucoma conversion compared with a 'treat all' pathway and provided more QALYs, but the incremental cost-effectiveness ratio (ICER) was considerably more than £30,000. The 'NICE intensive' pathway also avoided glaucoma conversion, but NICE-based pathways were either dominated (more costly and less effective) by biennial hospital monitoring or had a ICERs > £30,000. Results were not sensitive to the risk threshold for initiating surveillance but were sensitive to the risk threshold for initiating treatment, NHS costs and treatment adherence. Limitations: Optimal monitoring intervals were based on IOP data. There were insufficient data to determine the optimal frequency of measurement of the visual field or optic nerve head for identification of glaucoma. The economic modelling took a 20-year time horizon which may be insufficient to capture long-term benefits. Sensitivity analyses may not fully capture the uncertainty surrounding parameter estimates. Conclusions: For confirmed ocular hypertension, findings suggest that there is no clear benefit from intensive monitoring. Consideration of the patient experience is important. A cohort study is recommended to provide data to refine the glaucoma risk prediction model, determine the optimum type and frequency of serial glaucoma tests and estimate costs and patient preferences for monitoring and treatment. Funding: The National Institute for Health Research Health Technology Assessment Programme. © Queen's Printer and Controller of HMSO 2012.

https://njl-admin.nihr.ac.uk/document/download/2002258

Surveillance for Ocular Hypertension: An Evidence Synthesis and Economic Evaluation

Further development of the objective version of the Howland and Howland [(1976) Science, 193, 580-582; (1977) Journal of the Optical Society of America, 67, 1508-1518 aberroscope technique for measuring ocular aberrations is described. Compensation for refractive corrections and calibration is discussed. The technique was used to investigate the effect of accommodation upon the monochromatic aberrations of the right eyes of 15 subjects. Coma and coma-like aberrations were the dominant aberrations for most people at different accommodation levels, thus confirming previous findings.

Variations in aberrations were considerable between subjects. About half the subjects showed the classical trend towards negative spherical aberration with accommodation. Changes in spherical aberration with accommodation in this study were less than that found in previous studies where all monochromatic aberration was considered to be spherical aberration.

Measurement of Monochromatic Ocular Aberrations of Human Eyes as a Function of Accommodation by the Howland Aberroscope Technique

Clinical comparison of the Keeler Pulsair 2000, American Optical MkII and Goldmann applanation tonometers.

Visual field defects due to spectacle frames: their prediction and relationship to UK driving standards

The materials that have been reported as causing allergic contact dermatitis within spectacle frames are identified, and their most likely location on the frame is highlighted. The lack of any real control over spectacle frame quality and content is indicated to be a problem, as is the difficulty in determining the true source of many frames. Much of the information must be obtained from anonymous sources in the industry, historical ‘common knowledge’ of indeterminate source or reports of dermatological problems.

/pdf/materials-and-allergens-within-spectacle-frames-a-review-3okd8ddq5l.pdf

Glyn Walsh

Papers

Clinical comparison of the Keeler Pulsair 2000, American Optical MkII and Goldmann applanation tonometers.

Visual field defects due to spectacle frames: their prediction and relationship to UK driving standards

Materials and allergens within spectacle frames: a review.

Contrast and glare sensitivity in diabetic patients with and without pan-retinal photocoagulation

A new computerised video-aberroscope for the determination of the aberration of the human eye