bluuebunny/crossref_metadata_2025_split huggingface dataset:
International multicentre retrospective cohort study of ocular adnexal marginal zone B-cell lymphoma
Authors: Hindsø Tine Gadegaard , Esmaeli Bita , Holm Frederik , Mikkelsen Lauge Hjorth , Rasmussen Peter Kristian , Coupland Sarah E , Finger Paul T , Graue Gerardo F , Grossniklaus Hans E , Honavar Santosh G , Khong Jwu Jin , McKelvie Penelope A , Mulay Kaustubh , Sjö Lene Dissing , Vemuganti Geeta K , Thuro Bradley A , Heegaard Steffen 
Published: June 2019

Backgrounds/aimsTo date, this is the largest cohort study on extranodal marginal zone B-cell lymphoma (EMZL) of the ocular adnexa (OA). The aim of the study was to characterise the clinical features of OA-EMZL.MethodsA retrospective multicentre study involving seven international eye cancer centres. Data were collected from 1 January 1980 through 31 December 2017. A total of 689 patients with OA-EMZL were included.ResultsThe median follow-up time was 42 months. The median age was 62 years (range, 8–100 years), and 55 % (378/689 patients) of patients were women. The majority of patients (82%, 558/680 patients) were diagnosed with primary OA-EMZL with Ann Arbor stage IE (90%, 485/541 patients) and American Joint Committee on Cancer stage T2 (61%, 340/557 patients) at the time of diagnosis. The orbit (66%, 452/689 patients) and the conjunctiva (37%, 255/689 patients) were the most frequently involved anatomical structures. The 5-year, 10-year and 20-year disease-specific survival (DSS) were 96%, 91% and 90%, respectively. Stage IE patients treated with external beam radiation therapy (EBRT) as monotherapy (10-year DSS, 95%) were found to have a better DSS than stage IE patients treated with chemotherapy (10-year DSS, 86%). Stage IIIE/IVE patients treated with chemotherapy and rituximab had a better DSS (10-year DSS, 96%) than stage IIIE/IVE patients treated with chemotherapy without rituximab (10-year DSS, 63%).Conclusions and relevanceEMZL is a slow-growing tumour with an excellent long-term survival. Low-dose EBRT as monotherapy should be considered in localised OA-EMZL. Rituximab-based chemotherapy should be chosen in those patients with disseminated disease.
Utility of digitally assisted vitreoretinal surgery systems (DAVS) for high-volume vitreoretinal surgery centre: a pilot study
Authors: Babu Naresh , Kohli Piyush , Jena Soumya , Ramasamy Kim 
Published: June 2019

AimTo compare the surgical experience and preferred imaging platform, between digitally assisted vitreoretinal surgery systems (DAVS) and analogue microscope (AM), for performing various surgical manoeuvres.Material and methodsA questionnaire was used to evaluate the experience of surgeons who used DAVS for at least 6 months in the last 1 year.ResultsTwenty-three surgeons, including 12 fellows, answered the questionnaire. Eighty-two per cent of surgeons got accustomed to DAVS in <10 surgeries. The higher magnification provided by DAVS was perceived as helpful by 87.0% surgeons. Seventy-eight per cent surgeons felt that DAVS provided a bigger field of view. Colours displayed on DAVS appeared unnatural to 39.1%. Difficulty using three-dimensional glasses over spectacles, asthenopia and dry eye symptoms while using DAVS were faced by 17.4%, 17.4% and 21.7% surgeons, respectively. Difficulty in frequent switching between DAVS and AM was faced by 30.4% surgeons. Difficulty in depth perception, hand–eye coordination and performance anxiety while using DAVS was faced by 43.5%, 21.7 % and 30.4 % surgeons, respectively. Majority consultants did not have any imaging platform preference for most posterior segment procedures, while majority fellows preferred DAVS. Majority surgeons preferred AM for anterior segment procedures and complicated situations like small pupil, corneal oedema and surgical surprise(s). Once the surgeons became accustomed to DAVS, none of them had to shift back to AM during any case.ConclusionIt was easy to adapt to DAVS. DAVS was preferred for performing most posterior segment surgeries. Drawbacks like unnatural colours of the projected image and difficulty in performing anterior segment manoeuvres need to be addressed.
Visual acuity outcomes in Coats disease by classification stage in 160 patients
Authors: Shields Carol L , Udyaver Sanika , Dalvin Lauren A , Lim Li-Anne S , Atalay Hatice T , Khoo Chloe , Mazloumi Mehdi , Shields Jerry A 
Published: June 2019

PurposeTo assess visual outcomes of Coats disease by classification stage.MethodsA retrospective review was conducted on consecutive patients with Coats disease, classified according to Shields classification and with available Snellen visual acuity before and after treatment.ResultsThere were 160 eyes with Coats disease (stage 1 (n=2) vs stage 2A (n=17) vs stage 2B (n=22) vs stage 3A1 (n=26) vs stage 3A2 (n=40) vs stage 3B (n=42) vs stage 4 (n=9) vs stage 5 (n=2)). By comparison, more advanced stage showed greater frequency of poor presenting visual acuity (<20/200) (0% vs 0% vs 50% vs 35% vs 38% vs 83% vs 100% vs 100%, p<0.001) and higher mean intraocular pressure (17 vs 15 vs 15 vs 15 vs 15 vs 15 vs 37 vs 26, p<0.001). More advanced stage was less likely managed with laser photocoagulation (100% vs 87% vs 48% vs 62% vs 74% vs 35% vs 0% vs 0%, p<0.001) and more likely with cryotherapy (0% vs 47% vs 81% vs 81% vs 82% vs 88% vs 50% vs 100%, p=0.001). More advanced stage was associated with lower frequency of visual acuity ≥20/40 (100% vs 71% vs 5% vs 42% vs 23% vs 5% vs 0% vs 0%, p<0.001) and greater frequency of visual acuity <20/200 (0% vs 12% vs 36% vs31 % vs 45% vs 88% vs 0% vs 100%, p<0.001).ConclusionVisual acuity in eyes with Coats disease parallels staging with more advanced stage demonstrating poorer visual acuity at presentation and final visit.
Academic factors in medical recruitment: evidence to support improvements in medical recruitment and retention by improving the academic content in medical posts
Authors: Rees Michael Ralph , Bracewell Martyn 
Published: June 2019

AbstractThere is a major problem with medical recruitment and retention in the UK. The 2018 General Medical Council (GMC) report ‘The state of medical education and practice in the UK’ has indicated that a high proportion of doctors are thinking of either giving up medical practice or reducing their hours in the next 3 years. If this trend continues the shortage of doctors in the UK will increase despite a modest increase in the supply of doctors.This paper investigates the evidence that increasing the academic component of medical posts may help retain doctors in practice by providing experience and support in an area of medical practice, which appears to fulfil a significant number of doctors’ aspirations. The paper shows that this aspect of medical practice is poorly represented in medical workforce strategic thinking and should be considered as an integral aspect of policy and practice in medical workforce delivery.
Predictors of remission in patients with non-radiographic axial spondyloarthritis receiving open-label adalimumab in the ABILITY-3 study
Authors: Sieper Joachim , Landewé Robert , Magrey Marina , Anderson Jaclyn K , Zhong Sheng , Wang Xin , Lertratanakul Apinya 
Published: June 2019

BackgroundThis analysis assessed baseline predictors of remission in patients with non-radiographic axial spondyloarthritis (nr-axSpA) who received open-label adalimumab therapy.MethodsABILITY-3 enrolled 673 adult patients with nr-axSpA who had objective evidence of inflammation by MRI or elevated high-sensitivity C reactive protein at screening, active disease and an inadequate response to two or more non-steroidal anti-inflammatory drugs. Patients received adalimumab 40 mg every other week during a 28-week open-label lead-in period. Clinical remission was defined as Ankylosing Spondylitis Disease Activity Score inactive disease (ASDAS ID; score <1.3) and Assessment of SpondyloArthritis international Society partial remission (ASAS PR; score <2/10 in each of the four ASAS domains). Stepwise logistic regression was used to identify baseline predictors of remission at week 12 and at final visit (last postbaseline visit up to week 28). Only patients without missing data were included.ResultsOverall, 593 patients were included in the ASDAS ID and 596 in the ASAS PR analysis at week 12. Younger age (≤45 years), male sex, positive human leucocyte antigen (HLA)-B27 and higher Spondyloarthritis Research Consortium of Canada (SPARCC) MRI sacroiliac joint score were consistent predictors of remission by both ASAS ID and ASDAS PR at week 12. Results were generally similar in the final visit analysis. Other variables did not consistently predict remission.ConclusionsIn ABILITY-3, consistent and strong baseline predictors of remission included younger age, male sex, HLA-B27 positivity and higher SPARCC MRI sacroiliac joint score among patients with active nr-axSpA receiving adalimumab therapy, similar to previous findings in ankylosing spondylitis.
Methods comparison biases due to differing uncertainties and data censoring
Authors: Sadler William A 
Published: June 2019

Background Measurements on clinical specimens that contain no analyte, or very low amounts of analyte, unavoidably generate assay response (signal) measurements that fall on the ‘negative’ side of the fitted zero response. It is virtually universal practice to left-censor such measurements to zero and this is frequently extended by left-censoring to the assay limit of detection (LoD) value for reporting purposes. This study considers the effect of censoring on methods comparison analysis. Methods Paired results were randomly generated from two hypothetical assays with zero bias, firstly assuming equal uncertainty near zero and secondly with uncertainties that differed by a moderate 50% near zero. In both cases results were left-censored to zero and to LoD and further subsets were extracted representing partial and complete removal of censored results. All data sets were subjected to overall bias evaluation and Bland–Altman and Deming regression analyses. Results The combination of differing uncertainties and data censoring produced spurious biases by both Bland–Altman and regression analysis, regardless of whether censored results were retained or discarded. Biases were small for data left-censored to zero but were non-trivial with LoD-censoring. Imposing a lower limit aimed at eliminating the influence of censored results did not resolve the problem. Conclusions When high proportion of clinical results are located near zero, caution is required when using censored data (and especially LoD-censored data) in methods comparison studies. Optional access to negative results would rectify the problem, but requires the cooperation of manufacturers.
Juggling to survive: Master of Science postgraduate nursing students’ experiences of studying far from home
Authors: Markey Kathleen , O’Brien Brid , Graham Margaret M , O’Donnell Claire 
Published: June 2019

Background Globally, government and higher education institutions are expected to increase international student numbers. Programme development, marketing international collaboration and management has been the focus of strategy roll out. Aims This study aimed to explore international student experiences while undertaking Master of Science postgraduate education far from home. Methods A qualitative descriptive design was used. Following ethical approval, 11 students studying on a Master of Science Nursing postgraduate programme in one health education institute in Ireland volunteered to participate. Students were of Asian origin and mixed gender and the average age was 27. Data were collected using face-to-face semi-structured interviews and data analysis followed Burnard’s thematic framework. Results The data provide evidence of the complexities and challenges experienced when studying on a Master of Science postgraduate nursing programme. Students described a process of juggling to survive and succeed. Three overarching categories emerged: differing realities, working through, and learning new ways. Conclusions This study adds to international debate regarding structures and processes supporting international nurse education. In meeting ethnic and culturally-diverse student learning needs, consideration of learning and teaching approaches is warranted. For globalisation in nurse education to prosper, investment needs to move from focusing on recruitment towards structures and processes to nurture intercultural learning.
Art in debrief: a small-scale three-step narrative inquiry into the use of art to facilitate emotional debriefing for undergraduate nurses
Authors: Kinsella Frost Carol 
Published: June 2019

Background The context of the research was in a setting where undergraduate nursing students spend 50% of their programme in clinical practice and 50% in a higher education institute. Research participants were undertaking the adult branch of nursing education. Aims • To explore emotional debriefing in relation to nursing practice. • To highlight the emotional concerns of the research participants regarding clinical placement. • To gain an insight into the use of art/creativity in emotional debriefing. Methods Narrative inquiry was used to gain an insight into, and a deeper understanding of, how undergraduate nurses feel about their clinical placement experiences. The research was carried out in three stages: the art intervention, a diary account of the art intervention, and a follow-up face-to-face discussion between each participant and the researcher. Results The findings suggest the intervention helped the participants to articulate and process their emotions. All participants acknowledged the importance of the three-step approach, with follow-up to the art intervention. Conclusions This research project has highlighted the potential value of a creative approach to emotional debriefing. A wider inclusion of the arts could be explored. Facilitation of emotional debriefing may help build resilience in undergraduate nurses. There is growing recognition for the need to foster resilience in undergraduate nursing student programmes.
Shared learning from national to international contexts: a research and innovation collaboration to enhance education for patient safety
Authors: Steven Alison , Tella Susanna , Turunen Hannele , Flores Vizcaya-Moreno M , Pérez-Cañaveras Rosa M , Porras Jari , Bagnasco Annamaria , Sasso Loredana , Myhre Kristin , Sara-aho Arja , Ringstad Øystein , Pearson Pauline 
Published: June 2019

Background Patient safety is key for healthcare across the world and education is critical in improving practice. We drew on existing links to develop the Shared LearnIng from Practice to improve Patient Safety (SLIPPS) group. The group incorporates expertise in education, research, healthcare, healthcare organisation and computing from Norway, Spain, Italy, the UK and Finland. In 2016 we received co-funding from the Erasmus + programme of the European Union for a 3-year project. Aim SLIPPS aims to develop a tool to gather learning events related to patient safety from students in each country, and to use these both for further research to understand practice, and to develop educational activities (virtual seminars, simulation scenarios and a game premise). Study outline The SLIPPS project is well underway. It is underpinned by three main theoretical bodies of work: the notion of diverse knowledge contexts existing in academia, practice and at an organisational level; the theory of reflective practice; and experiential learning theory. The project is based on recognition of the unique position of students as they navigate between contexts, experience and reflect on important learning events related to patient safety. To date, we have undertaken the development of the SLIPPS Learning Event Recording Tool (SLERT) and have begun to gather event descriptions and reflections. Conclusions Key to the ongoing success of SLIPPS are relationships and reciprocal openness to view things from diverse perspectives and cultures.
Service user involvement in teaching and learning: student nurse perspectives
Authors: Kuti Bimpe , Houghton Trish 
Published: June 2019

Background Service user involvement in educating healthcare professionals in higher education can help student nurses develop a compassionate approach to care practice. This article explains one university’s initiative, the Patient as Coach Team (PaCT), and presents evaluation results from phase 1. The PaCT strategy involved a service user-led session with student nurses, in small groups, sharing experiences of care from a service user perspective. Aim Our aim was to evaluate nursing students’ views of the PaCT session, involving service users in their teaching and learning. Design Survey. Method Structured questionnaires with a free-text box were completed by student nurses ( n = 321). Structured question responses were analysed manually and free-text data thematically. Data collection took place from June 2016 to June 2017. Results There were very positive responses to the survey questions, with students perceiving a positive impact on their learning. Five themes emerged from the students’ free-text responses: ‘Usefulness of the session’, ‘Seeing patients’ perspectives’, ‘Inspiring and motivating session’, ‘Good discussions with patient coach’ and ‘Overall views about the PaCT session’. Conclusion The PaCT session provides a valid learning strategy, utilising coaching as a technique to enable student nurses to learn from service users’ experiences and perspectives of care. In addition, it contributes to students’ reflective practice about their individual professional practice in care settings.
The association between self‐reported poor oral health and gastrointestinal cancer risk in the UK Biobank: A large prospective cohort study
Authors: Jordão Haydée WT , McKenna Gerry , McMenamin Úna C , Kunzmann Andrew T , Murray Liam J , Coleman Helen G 
Published: June 2019

BackgroundControversy remains as to whether poor oral health is independently associated with gastrointestinal cancers, due to potential confounding by smoking, alcohol and poor nutrition. The aim of this study was to investigate the association between oral health conditions and gastrointestinal cancer risk.MethodsData from the large, prospective UK Biobank cohort, which includes n = 475,766 participants, were analysed. Cox proportional hazard models were applied to estimate the relationship between gastrointestinal cancer risk and self‐reported poor oral health (defined as painful gums, bleeding gums and/or having loose teeth), adjusting for confounders.ResultsDuring an average six years of follow‐up, n = 4069 gastrointestinal cancer cases were detected, of which 13% self‐reported poor oral health. Overall, there was no association between self‐reported poor oral health and risk of gastrointestinal cancer detected (hazard ratio 0.97, 95% confidence interval 0.88–1.07). In site‐specific analysis, an increased risk of hepatobiliary cancers was observed in those with self‐reported poor oral health (hazard ratio 1.32, 95% confidence interval 0.95–1.80), which was stronger for hepatocellular carcinoma (hazard ratio 1.75, 95% confidence interval 1.04–2.92).ConclusionOverall there was no association between self‐reported poor oral health and gastrointestinal cancer risk. However, there was a suggestion of an increased risk of hepatobiliary cancer, specifically hepatocellular carcinoma.
Decision making for patients categorised as ‘amber’ in a rural setting
Authors: Ingram Catherine , Rees Nigel , Sujan Mark A 
Published: June 2019

Background: Reducing unnecessary conveyances to hospital can help relieve pressure on emergency departments. Making decisions about conveyance in rural areas is particularly challenging because of the travel distances involved. Aims: To explore perceptions of paramedics in a rural setting about how they make decisions regarding conveyance and non-conveyance for patients categorised as ‘amber’ (serious but not life-threatening). Methods: Data were collected through interviews with 17 paramedics working in rural areas, which were analysed using inductive thematic analysis. Findings: Paramedics perceive hospitals as places of safety for themselves (psychological safety) and for patients (patient safety). Lower levels of psychological safety (e.g. because of an organisational blame culture) and perceived increased risks to patient safety (e.g. because of a lack of health resources in the community) influence paramedic decision making on conveying patients to hospital. Conclusion: Current practice contributes to increasing pressures on emergency departments. Ambulance services should work towards a non-punitive culture of safety where paramedics feel they can make decisions based on their experience and expertise rather than to protect themselves.
Continuing Professional Development: Diabetes and associated diabetic emergencies
Authors: Higginson Ray , Burrows Paul , Jones Bridie 
Published: June 2019

OverviewDiabetes is a group of metabolic diseases characterised by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic complications of diabetes include accelerated development of cardiovascular disease, end-stage renal disease, loss of visual acuity, and limb amputations. However, in the acute situation, diabetes can result in conditions such as diabetic ketoacidosis and hyperosmolar hyperglycemic state, both of which have the same cause: insufficient insulin. This article explores the physiology of glucose control, the pathophysiology of diabetes and the role of the paramedic in the prehospital treatment of the diabetic emergencies, diabetic ketoacidosis and hyperosmolar hyperglycemic state.
The TOR Pathway Plays Pleiotropic Roles in Growth and Stress Responses of the Fungal Pathogen Cryptococcus neoformans
Authors: So Yee-Seul , Lee Dong-Gi , Idnurm Alexander , Ianiri Giuseppe , Bahn Yong-Sun 
Published: June 2019

Abstract
The target of rapamycin (TOR) pathway is an evolutionarily conserved signal transduction system that governs a plethora of eukaryotic biological processes, but its role in Cryptococcus neoformans remains elusive. In this study, we investigated the TOR pathway by functionally characterizing two Tor-like kinases, Tor1 and Tlk1, in C. neoformans. We successfully deleted TLK1, but not TOR1. TLK1 deletion did not result in any evident in vitro phenotypes, suggesting that Tlk1 is dispensable for the growth of C. neoformans. We demonstrated that Tor1, but not Tlk1, is essential and the target of rapamycin by constructing and analyzing conditionally regulated strains and sporulation analysis of heterozygous mutants in the diploid strain background. To further analyze the Tor1 function, we constructed constitutive TOR1 overexpression strains. Tor1 negatively regulated thermotolerance and the DNA damage response, which are two important virulence factors of C. neoformans. TOR1 overexpression reduced Mpk1 phosphorylation, which is required for cell wall integrity and thermoresistance, and Rad53 phosphorylation, which governs the DNA damage response pathway. Tor1 is localized to the cytoplasm, but enriched in the vacuole membrane. Phosphoproteomics and transcriptomics revealed that Tor1 regulates a variety of biological processes, including metabolic processes, cytoskeleton organization, ribosome biogenesis, and stress response. TOR inhibition by rapamycin caused actin depolarization in a Tor1-dependent manner. Finally, screening rapamycin-sensitive and -resistant kinase and transcription factor mutants revealed that the TOR pathway may crosstalk with a number of stress signaling pathways. In conclusion, our study demonstrates that a single Tor1 kinase plays pleiotropic roles in C. neoformans.