Higher surgical training in ophthalmology: trends in cumulative surgical experience 1993-2008

INTRODUCTION

Recent years have seen significant changes in the provision surgical training for ophthalmology. The aim of this study is to establish the patterns in long-term trends of cumulative surgical experience of ophthalmology trainees in the United Kingdom.

MATERIALS AND METHODS

Data were obtained from the department of training and education at the Royal College of Ophthalmologists (RCOphth). The cumulative surgical experience of all ophthalmology higher surgical trainees attaining accreditation, CCST, or CCT between 1993-2001 and 2005-2008 was included for descriptive analysis.

RESULTS

Cumulative cataract surgical experience per trainee has been relatively stable at levels between 500 and 600 for most years. The cumulative experience vitreoretinal and corneal graft surgery have historically been low with a large outlier effect, although trends demonstrate a decrease in the median numbers of procedures. Squint surgery has seen a downward trend with a decrease in the median numbers from 121 in 1993 to 43 in 2008. Oculoplastics procedures demonstrate a decrease in overall numbers from 46 in 1993 to 15 in 2001. A jump from 2005 coincides with changes in the definition of what is counted as an oculoplastics procedure. The role of the RCOphth in legislating minimum levels of experience has had an impact on the data distribution manifest by the truncation of the inferior quartile of many of the dataspreads.

DISCUSSION

These data demonstrate that although the cumulative experience of cataract surgery for trainees has remained stable, there has been a reduction in the median numbers of subspecialty procedures performed over the past 15 years.

Search for the associated production of a b quark and a neutral supersymmetric Higgs boson that decays into tau pairs

We report results from a search for production of a neutral Higgs boson in association with a b quark. We search for Higgs decays to tau pairs with one tau subsequently decaying to a muon and the other to hadrons. The data correspond to 2.7 fb(-1) of pp collisions recorded by the D0 detector at square root(s)=1.96 TeV. The data are found to be consistent with background predictions. The result allows us to exclude a significant region of parameter space of the minimal supersymmetric model.

Search for the standard model higgs Boson in the ZH-->nunubb channel in 5.2 fb{-1} of pp collisions at sqrt[s]=1.96 TeV

A search is performed for the standard model Higgs boson in 5.2 fb{-1} of pp collisions at sqrt[s]=1.96 TeV, collected with the D0 detector at the Fermilab Tevatron Collider. The final state considered is a pair of b jets and large missing transverse energy, as expected from pp-->ZH-->nunubb production. The search is also sensitive to the WH-->lnubb channel when the charged lepton is not identified. For a Higgs boson mass of 115 GeV, a limit is set at the 95% C.L. on the cross section multiplied by branching fraction for [pp-->(Z/W)H](H-->bb) that is a factor of 3.7 larger than the standard model value, consistent with the factor of 4.6 expected.

Search for a resonance decaying into WZ boson pairs in pp collisions

We present the first search for an electrically charged resonance W' decaying to a WZ boson pair using 4.1 fb(-1) of integrated luminosity collected with the D0 detector at the Fermilab Tevatron pp collider. The WZ pairs are reconstructed through their decays into three charged leptons (l=e, mu). A total of 9 data events is observed in good agreement with the background prediction. We set 95% C.L. limits on the W'WZ coupling and on the W' production cross section multiplied by the branching fractions. We also exclude W' masses between 188 and 520 GeV within a simple extension of the standard model and set the most restrictive limits to date on low-scale technicolor models.

Search for Higgs boson production in dilepton and missing energy final states with 5.4 fb(-1) of pp collisions at square root(s) = 1.96 TeV

A search for the standard model Higgs boson is presented using events with two charged leptons and large missing transverse energy selected from 5.4 fb(-1) of integrated luminosity in pp collisions at square root(s) = 1.96 TeV collected with the D0 detector at the Fermilab Tevatron collider. No significant excess of events above background predictions is found, and observed (expected) upper limits at 95% confidence level on the rate of Higgs boson production are derived that are a factor of 1.55 (1.36) above the predicted standard model cross section at m(H) = 165 GeV.

Combination of Tevatron searches for the standard model Higgs boson in the W+W- decay mode

We combine searches by the CDF and D0 Collaborations for a Higgs boson decaying to W+W-. The data correspond to an integrated total luminosity of 4.8 (CDF) and 5.4 (D0) fb(-1) of pp collisions at square root(s) = 1.96 TeV at the Fermilab Tevatron collider. No excess is observed above background expectation, and resulting limits on Higgs boson production exclude a standard model Higgs boson in the mass range 162-166 GeV at the 95% C.L.

Direct measurement of the W boson width

We present a direct measurement of the width of the W boson using the shape of the transverse mass distribution of W --> enu candidate events. Data from approximately 1 fb(-1) of integrated luminosity recorded at square root of s = 1.96 TeV by the D0 detector at the Fermilab Tevatron pp collider are analyzed. We use the same methods and data sample that were used for our recently published W boson mass measurement, except for the modeling of the recoil, which is done with a new method based on a recoil library. Our result, 2.028 +/- 0.072 GeV, is in agreement with the predictions of the standard model.

BSCC Code of Practice--fine needle aspiration cytology

The British Society for Clinical Cytology Code of Practice on fine needle aspiration cytology complements that on exfoliative cytopathology, which was published in the last issue (Cytopathology 2009;20:211-23). Both have been prepared with wide consultation within and outside the BSCC and have been endorsed by the Royal College of Pathologists. A separate code of practice for gynaecological cytopathology is in preparation. Fine needle aspiration (FNA) cytology is an accepted first line investigation for mass lesions, which may be targeted by palpation or a variety of imaging methods. Although FNA cytology has been shown to be a cost-effective, reliable technique its accurate interpretation depends on obtaining adequately cellular samples prepared to a high standard. Its accuracy and cost-effectiveness can be seriously compromised by inadequate samples. Although cytopathologists, radiologists, nurses or clinicians may take FNAs, they must be adequately trained, experienced and subject to regular audit. The best results are obtained when a pathologist or an experienced and trained biomedical scientist (cytotechnologist) provides immediate on-site assessment of sample adequacy whether or not the FNA requires image-guidance. This COP provides evidence-based recommendations for setting up FNA services, managing the patients, taking the samples, preparing the slides, collecting material for ancillary tests, providing rapid on-site assessment, classifying the diagnosis and providing a final report. Costs, cost-effectiveness and rare complications are taken into account as well as the time and resources required for quality control, audit and correlation of cytology with histology and outcome. Laboratories are expected to have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd.

Improving prediction of malignancy of cytologically indeterminate thyroid nodules

Background

Fine-needle aspiration (FNA) is essential in the investigation of thyroid nodules. The British Thyroid Association guidelines recommend clarification of whether follicular nodules are probable follicular neoplasms that require surgical excision. This study assessed the value of the subclassification of cytologically indeterminate thyroid nodules into either follicular neoplasms or other pathology.

Methods

The cytology reports of all thyroid FNAs performed between November 2005 and December 2007 at a single institution reported as Thy 3 (follicular lesions) were reviewed. They were reclassified as Thy 3A (probable follicular neoplasm) or Thy 3B (probable non-neoplastic lesion), and subsequently correlated with final clinical outcome to determine the predictive value of this subclassification.

Results

Forty-nine specimens were categorized as Thy 3A and 55 as Thy 3B. Of excised lesions, 14 (29 per cent) of 48 Thy 3A and 4 (10 per cent) of 42 Thy 3B nodules were malignant. If Thy 3A were to predict malignancy and Thy 3B benign disease, the sensitivity of the classification was 88 per cent, with a specificity of 55 per cent and negative predictive value of 91 per cent.

Conclusion

Subclassification of Thy 3 nodules into Thy 3A and Thy 3B improves the assessment of risk for thyroid malignancy.

Measurement of dijet angular distributions at square root(s) = 1.96 TeV and searches for quark compositeness and extra spatial dimensions

We present the first measurement of dijet angular distributions in pp collisions at square root(s) = 1.96 TeV at the Fermilab Tevatron Collider. The measurement is based on a dataset corresponding to an integrated luminosity of 0.7 fb(-1) collected with the D0 detector. Dijet angular distributions have been measured over a range of dijet masses, from 0.25 TeV to above 1.1 TeV. The data are in good agreement with the predictions of perturbative QCD and are used to constrain new physics models including quark compositeness, large extra dimensions, and TeV(-1) scale extra dimensions. For all models considered, we set the most stringent direct limits to date.

Measurement of the WW production cross section with dilepton final states in pp collisions at square root(s) = 1.96 TeV and limits on anomalous trilinear gauge couplings

We provide the most precise measurement of the WW production cross section in pp collisions to date at a center of mass energy of 1.96 TeV, and set limits on the associated trilinear gauge couplings. The WW-->lnul'nu (l, l' = e, mu) decay channels are analyzed in 1 fb(-1) of data collected by the D0 detector at the Fermilab Tevatron Collider. The measured cross section is sigma(pp --> WW) = 11.5+/-2.1(stat+syst)+/-0.7(lumi) pb. One- and two-dimensional 95% C.L. limits on trilinear gauge couplings are provided.

Measurement of the W boson mass

We present a measurement of the W boson mass in W-->e(nu) decays using 1 fb-1 of data collected with the D0 detector during Run II of the Fermilab Tevatron collider. With a sample of 499830 W-->e(nu) candidate events, we measure M(W)=80.401+/-0.043 GeV. This is the most precise measurement from a single experiment.

Direct measurement of the mass difference between top and antitop quarks

We present a measurement of the mass difference between t and t[over] quarks in lepton + jets final states of tt[over] events in 1 fb;{-1} of data collected with the D0 detector from Fermilab Tevatron Collider pp[over] collisions at sqrt[s] = 1.96 TeV. The measured mass difference of 3.8 +/- 3.7 GeV is consistent with the equality of t and t[over ] masses. This is the first direct measurement of a mass difference between a quark and its antiquark partner.

Observation of single top-quark production

We report observation of the electroweak production of single top quarks in pp[over ] collisions at sqrt[s]=1.96 TeV based on 2.3 fb(-1) of data collected by the D0 detector at the Fermilab Tevatron Collider. Using events containing an isolated electron or muon and missing transverse energy, together with jets originating from the fragmentation of b quarks, we measure a cross section of sigma(pp[over ]--> tb + X, tqb + X) = 3.94 + or - 0.88 pb. The probability to measure a cross section at this value or higher in the absence of signal is 2.5 x 10(-7), corresponding to a 5.0 standard deviation significance for the observation.

Search for dark photons from supersymmetric hidden valleys

We search for a new light gauge boson, a dark photon, with the D0 experiment. In the model we consider, supersymmetric partners are pair produced and cascade to the lightest neutralinos that can decay into the hidden sector state plus either a photon or a dark photon. The dark photon decays through its mixing with a photon into fermion pairs. We therefore investigate a previously unexplored final state that contains a photon, two spatially close leptons, and large missing transverse energy. We do not observe any evidence for dark photons and set a limit on their production.