Patients as researchers - innovative experiences in UK National Health Service research

Consumer involvement is an established priority in UK health and social care service development and research. To date, little has been published describing the process of consumer involvement and assessing ‘consumers’ contributions to research. This paper provides a practical account of the effective incorporation of consumers into a research team, and outlines the extent to which they can enhance the research cycle; from project development and conduct, through data analysis and interpretation, to dissemination. Salient points are illustrated using the example of their collaboration in a research project. Of particular note were consumers’ contributions to the development of an ethically enhanced, more robust project design, and enriched data interpretation, which may not have resulted had consumers not been an integral part of the research team

Distinct and redundant functions of cyclin E1 and cyclin E2 in development and cancer

The highly conserved E-type cyclins are core components of the cell cycle machinery, facilitating the transition into S phase through activation of the cyclin dependent kinases, and assembly of pre-replication complexes on DNA. Cyclin E1 and cyclin E2 are assumed to be functionally redundant, as cyclin E1-/- E2-/- mice are embryonic lethal while cyclin E1-/- and E2-/- single knockout mice have primarily normal phenotypes. However more detailed studies of the functions and regulation of the E-cyclins have unveiled potential additional roles for these proteins, such as in endoreplication and meiosis, which are more closely associated with either cyclin E1 or cyclin E2. Moreover, expression of each E-cyclin can be independently regulated by distinct transcription factors and microRNAs, allowing for context-specific expression. Furthermore, cyclins E1 and E2 are frequently expressed independently of one another in human cancer, with unique associations to signatures of poor prognosis. These data imply an absence of co-regulation of cyclins E1 and E2 during tumorigenesis and possibly different contributions to cancer progression. This is supported by in vitro data identifying divergent regulation of the two genes, as well as potentially different roles in vivo

Patient and clinician factors influencing the choice of breast cancer surgery : a qualitative and quantitative study.

Background and aims: In women with breast cancers up to 5 cm diameter, breast conservation therapy (BCT) and mastectomy are equivalent for survival and morbidity, although recurrence and body image vary. This mixed-method study in a UK region (population 5 million) aims to identify reasons for mastectomy rate (MR) variation between units. Methods and findings The study comprised five components; two in 14 units: (1) An audit of the NHS Breast Screening Programme (n=5060 cases from 11 screening units) established MR variation was not due to case-mix or caseload (P=O.OOl). (2) A Discrete Choice Experiment (n=68/93) employing multinomial logistic regression confirmed clinicians surgical preferences (25 scenarios, n=1695) vary based on cancer (size, site and centricitv, P<O.OOl){ patient (age and breast size, P<O.OOl) and clinician variables (gender and clinician role, P=0.015 and P<O.OOl respectively). Three within units representing hiqh, medium and low case-mix adjusted MRs: (3) A validated questionnaire established that patients (n=356) preferred and achieved more autonomy in treatment selection than before; particularly among those choosing mastectomy (P<O.OOl). (4) Interviews with clinicians (n=26; 13 nurses and 13 doctors) highlighted variation in local ethos. Clinicians' focus in the low MR unit was the promotion of BCT and in others, autonomous decision-making. Communication strategies and processes optimised this. (5) Interviews with patients (n=65) demonstrated varied experiences between breast units. While patient factors influenced decisions, breast team factors predominated. Patients from the high and medium MR units described more informed autonomous decision-making processes and support. Conclusions In this study low MRs were associated with clinicians preferring BCT and higher MRs with clinicians supporting patients' decision-making. Clinician factors related to treatment preferences associated with high MRs were not identified. This does not preclude their existence in other regions. Understanding surgical variation factors could facilitate treatment decision- making equity, but is unlikely to reduce MRs.

Case-mix fails to explain variation in mastectomy rates: management of screen-detected breast cancer in a UK region 1997–2003

Wide variation in the surgical management of breast cancer exists at hospital, regional, national and international level. To demonstrate whether variation in surgical practice observed at aggregate level between breast units persists following adjustment for case-mix, individual patient-level data from the Trent Breast Screening Programme Quality Assurance database (1997–2003) was analysed. Expected case-mix adjusted mastectomy rates were derived by logistic regression using the variables tumour size, site and grade, patient age and year of presentation, employing the region's overall case-mix adjusted practice as the reference population. The region's 11 breast screening units detected 5109 (3989 invasive) surgically managed primary breast cancers over the 6-year period. A total of 1828 mastectomies (Mx) were performed (Mx rate 35.8%, 95% confidence interval: 34.5–37.1%). Significant variation in mastectomy rates were observed between units (range 25–45%, P<0.0001), and persists following case-mix adjustment (P<0.0001). Two-fold variation in observed to expected unit mastectomy rate coefficient is demonstrated overall (range 0.66–1.36), increasing to almost four-fold variation in cancers less than 15 mm diameter (range 0.55–1.95). Significant variation in surgery for screen-detected primary breast cancer is not explained by case-mix. Further research is required to investigate potential patient and professional causative factors

Prototipo RegistryUNAD como estrategia de control de entrada y salida del personal en la Universidad Nacional Abierta y a Distancia UNAD UDR La Plata Huila

Anexos A. Formulario de Loguin , Anexos B. Panel de navegación principal , Anexos C. modelo de la encuestaEl presente proyecto aplicado tuvo como propósito brindar una solución de manera eficaz y eficiente en la sede de la UNAD de la plata Huila en cuanto a su sistema de ingreso y salida y ofreciendo ideas innovadoras para un mejor control de ingreso y salida a sus usuarios. El objetivo primordial que se busca con el desarrollo de este proyecto es aportar al progreso de la institución y la innovación así mismo que con los resultados obtenidos poder expandir esta solución para el uso del sistema en los procesos de ingreso y salida en las demás sedes de la universidad en las cuales no cuenten con un sistema novedosoThe purpose of this applied project was to provide an effective and efficient solution at the UNAD headquarters in La Plata Huila regarding its entry and exit system and offering innovative ideas for better entry and exit control to its users. The primary objective that is sought with the development of this project is to contribute to the progress of the institution and innovation as well as with the results obtained to be able to expand this solution for the use of the system in the processes of entry and exit in the other headquarters of the university in which they do not have a novel system. Keywords: Php, MySql, Hosting, Html, Ajax

Finding the right words - a systematic approach to word selection for a special purpose science dictionary

First year undergraduate science students frequently report difficulties grappling with the technical and semi-technical vocabulary of academic science. Most first year science students undertake studies in several scientific disciplines (e.g., Biology, Chemistry, Geology, Physics etc.), each with their own set of technical vocabulary. Yet the students not only deal with specific and obvious jargon, but must also tackle more indirect jargon where commonly used words may have a different and special meaning in the scientific context (e.g., control, contract) Inability to master scientific language represents ‘a major barrier to learning’ for a significant number of students (Wellington and Osborne 2001), or a ‘lexical bar’ to be overcome (Corson 1995). Such problems are exacerbated when the students come from non-English speaking backgrounds (NESB), whether they be local or international students

Radiographers and COVID-19 pneumonia: diagnostic performance using CO-RADS

Introduction: A more structured role of radiographers is advisable to speed up the management of patients with suspected COVID-19. The purpose of our study was to evaluate the diagnostic performance of radiographers in the detection of COVID-19 pneumonia on chest CT using CO-RADS descriptors. Methods: CT images of patients who underwent RT-PCR and chest CT due to COVID-19 suspicion between March and July 2020 were analysed retrospectively. Six readers, including two radiologists, two highly experienced radiographers and two less experienced radiographers, independently scored each CT using the CO-RADS lexicon. ROC curves were used to investigate diagnostic accuracy, and Fleiss’κ statistics to evaluate inter-rater agreement. Results: 714 patients (419 men; 295 women; mean age: 64 years ±19SD) were evaluated. CO-RADS&gt; 3 was identified as optimal diagnostic threshold. Highly experienced radiographers achieved an average sensitivity of 58.7% (95%CI: 52.5–64.7), an average specificity of 81.8% (95%CI: 77.9–85.2), and a mean AUC of 0.72 (95%CI: 0.68–0.75). Among less experienced radiographers, an average sensitivity of 56.3% (95%CI: 50.1–62.2) and an average specificity of 81.5% (95%CI: 77.6–84.9) were observed, with a mean AUC of 0.71 (95%CI: 0.68–0.74). Consultant radiologists achieved an average sensitivity of 60.0% (95%CI: 53.7–65.8), an average specificity of 81.7% (95%CI: 77.8–85.1), and a mean AUC of 0.73 (95%CI: 0.70–0.77). Conclusion: Radiographers can adequately recognise the classic appearances of COVID-19 on CT, as described by the CO-RADS assessment scheme, in a way comparable to expert radiologists. Implications for practice: Radiographers, as the first healthcare professionals to evaluate CT images in patients with suspected SARS-CoV-2 infection, could diagnose COVID-19 pneumonia by means of a categorical reporting scheme at CT in a reliable way, hence playing a primary role in the early management of these patients

Identificación de un plan prospectivo para la empresa ladrillera las brisas en el municipio de la Plata – Huila.

Identificación de un plan prospectivo para la empresa Ladrillera Las Brisas en el municipio de La Plata – Huila, se establece como una estrategia de oportunidades aplicando la estructura metodológica orientada hacia las estratégicas; el análisis para posibilitar diversidad de alternativas que contribuyen a mejorar los espacios y de esta forma posicionar la empresa en el contexto local, regional y nacional. El plan se ciñe a la metodología prospectiva garantizando de esta forma la veracidad de los procesos e instrumentos utilizados para lograr los objetivos propuestos en actividades de trabajo. En el contexto contemporáneo indiscutiblemente todas las organizaciones y empresas se proyectan en una dinámica constante de acción para lograr efectividad, posicionamiento en los mercados frente a la competencia. Básicamente se resume la actividad en tres procesos; prospectiva estratégica, análisis prospectivo y análisis estratégico; de las cuales surgirá las conclusiones finales y los aspectos a tener en cuenta para el desarrollo integral aplicable a la empresa Ladrillera Las Brisas en el plan de análisis estratégico prospectivo. Con esta nueva visión se pretende implementar modelos prácticos para contribuir al desarrollo y gestión empresarial en el sector específicamente en el municipio de La Plata y para que la Universidad Nacional Abierta y a Distancia – UNAD, trascienda en su conocimiento desde las aulas a la práctica.Identifying a prospective plan for the company in the brickyard breezes municipality Plate - Huila, is established as a strategy of applying the methodology framework opportunities oriented strategic analysis to enable diversity of alternatives that improve the spaces and thus positioning the company in the local, regional and national levels. The plan adheres to the prospective methodology thus ensuring the accuracy of the processes and tools used to achieve the objectives in work activities. In the contemporary context indisputably all organizations and companies are projected in a constant dynamic of action to ensure effectiveness, market positioning against the competition. Basically summarizes the activity in three processes strategic prospective, prospective analysis and strategic analysis, of which emerge the final conclusions and issues to consider for the integral development applicable to the company in the brickyard Las Brisas prospective strategic analysis plan . With this new vision is to implement practical ways to contribute to the business development and management in the sector specifically in the town of La Plata and the National Open University and Distance - UNAD, transcend their knowledge from the classroom into practice