Previous research has reported that inequalities exist in uptake of NHS sight tests in relation to socio-economic status, and that community optometric services have potential to improve system efficiency. The current research found inequalities in sight test outcome related to socio-economic status and the type of practice that a patient visits (multiple, or independent). Patients attending multiples were more likely to receive a ‘new or changed prescription’ relative to ‘no prescription’ compared to patients that attended independent opticians (36-71% more likely). Those living in the least deprived areas were also less likely to receive a new prescription (1-12%) and those aged <16 years were less likely to be referred (9%). The study examining the need for a Minor Eye Condition Service in Leeds and Bradford found it would produce theoretical cost savings, whilst maintaining high patient satisfaction. Subsequently, a MECS was commissioned in Bradford. The study attempting to collect data from MECS across all areas of England found that data is not routinely collected, or shared. The limited data available typically showed that 73-83% of patients were retained in optometric practice with 12-18% receiving a hospital referral. A prospective evaluation of a COVID urgent eye care service found that teleconsultations frequently did not resolve patients’ eye problems (27%). These telephone consultations failed to detect some serious conditions such as scleritis, wet macular degeneration, retinal detachment. The results from the thesis support the view that the current method of delivering eye care in England is contrary to the public health interest.

Thesis (MScConsEcol (Conservation Ecology and Entomology))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Pseudococcus viburni (Signoret) (Hemiptera: Pseudococcidae) (obscure mealybug), is a common and serious pest of apples and pears in South Africa. Consumer and regulatory pressure to produce commodities under sustainable and ecologically compatible conditions has rendered chemical control options increasingly limited. Information on the seasonal occurrence of pests is but one of the vital components of an effective and sustainable integrated pest management system needed for planning the initiation of monitoring and determining when damage can be expected. It is also important to identify which orchards are at risk of developing mealybug infestations while development of effective and early monitoring tools for mealybug populations will help growers in making decisions with regards to pest management and crop suitability for various markets. It is also essential to determine the presence and efficacy of naturally occurring biological control agents in orchards so as to ascertain the potential of biological control as a viable alternative in orchards. However, under the current integrated pest management protocol, it has been difficult to determine this, due to the sporadic and relatively low incidence of mealybug infestations in some orchards, or by simply relying on naturally occurring field populations of biocontrol agents. Knowledge of the environmental conditions under which P. viburni population levels may become destructive is also essential for timing the release of insectary reared natural enemies as well as understanding the population ecology of this pest and its natural enemies. Information was gathered regarding the seasonal phenology of P. viburni and its natural enemies in pome fruit orchards in the Western Cape Province during the 2007/08 and 2008/09 growing seasons. Seasonal population studies showed that P. viburni has multiple overlapping generations with all life stages present throughout the year. The highest orchard infestations occurred during the summer period until early winter (January to early June). This was followed by a decrease in population from late June to November, before another increase in December. Presence-absence sampling of mealybugs on the host plant revealed that woody parts of the tree, such as the trunk and old stems were the most preferred sites for mealybug habitation, due to the availability of protected refuge sites. Migration of mealybug populations to newer growth and the upper sections of the tree crown, such as the new stems, leaves and eventually the fruit, was observed from December throughout the summer period until the early winter in June. Fruit colonization in both apples and pears commenced in January, when the fruit had developed a size sufficient for P. viburni to penetrate and occupy spaces such as the fruit core, calyx and stem end. There was no evidence of P. viburni occurring beneath the soil surface or on the roots of host trees. Two natural enemies of mealybugs, namely Pseudaphycus maculipennis (Mercet) and Coccidoxenoides perminutus (Girault), were found to be active in apple and pear orchards in the Western Cape. However, the status of C. perminutus as a parasite of P. viburni still needs to be verified despite evidence of emergence from P. viburni mummies, which was not sufficient enough to suggest that it is a useful biological control agent. Seasonal abundance trends of the two natural enemies revealed that their lifecycle is synchronized with that of the host. However, there was no evidence of P. maculipennis activity in Ceres. No predators were found during the course of this study. The rate of P. viburni parasitism at harvest was 46.52%, with P. maculipennis and C. perminutus constituting 98.966% and 1.034% of the parasitoids recovered from mealybug mummies, respectively. Studies on the use of pheromone traps as early monitoring tools for P. viburni showed that there was a positive and significant relationship between the fruit infestation and number of P. viburni adult males caught in pheromone-baited traps (r2 = 0.454). The action threshold level was estimated to be 2.5 male P. viburni caught per trap per fortnight at an economic threshold of 2% fruit infestation. / AFRIKAANSE OPSOMMING: Pseudococcus viburni (Signoret) (Hemiptera: Pseudococcidae) (ligrooswitluis), is ‘n algemene en ernstige plaag van appels en pere in Suid-Afrika. Druk deur verbruikers en regulasies om kommoditeite onder volhoubare en ekologies verenigbare toestande te produseer het chemiese beheeropsies toenemend beperk. Inligting oor die seisoenale voorkoms van plae is een van die essensiële komponente van ‘n effektiewe en volhoubare geïntegreerde plaagbestuurprogram. Dit is in die aanvanklike beplanning van monitering en om te bepaal wanneer skade verwag kan word. Dit is ook belangrik om boorde vroegtydig te identifiseer wat die risiko het om witluisbesmettings te ontwikkel. Die ontwikkeling van effektiewe en vroeë moniteringstegnieke vir witluisbevolkings sal produsente help met besluitneming rakende plaagbestuur en die geskiktheid van gewasse vir verskeie markte. Dit is ook noodsaaklik om die teenwoordigheid en effektiwiteit van biologiese beheer agente wat natuurlik in boorde voorkom te bepaal ten einde die potensiaal van biologiese beheer as ‘n lewensvatbare alternatief vas te stel. Onder die huidige geïntegreerde plaagbestuurprotokol was dit egter moeilik om laasgenoemde te bepaal weens die sporadiese en relatiewe lae voorkoms van witluisbesmettings in sommige boorde of deur bloot staat te maak op die veldpopulasies van biologiese beheer agente wat natuurlik voorkom. Kennis van die omgewingstoestande waaronder P. viburni bevolkingsvlakke skadelik raak is ook noodsaaklik vir die beplanning van vrylating van biologiese beheer agente, asook om die bevolkingsekologie van hierdie plaag en sy natuurlike vyande te verstaan. Inligting oor die seisoenale fenologie van P. viburni en sy natuurlike vyande in sagtevrugte boorde in die Westelike Kaapprovinsie is gedurende die 2007/08 en 2008/09 groeiseisoene versamel. Seisoenale bevolkingstudies het getoon dat P. viburni verskeie oorvleuelende generasies het met alle stadia teenwoordig regdeur die jaar.