journal article based on thesis

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How to Write a Journal Article from a Thesis

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You are almost done with your PhD thesis and want to convert it into a journal article. Or, you’re initiating a career as a journal writer and intend to use your thesis as a starting point for an article. Whatever your situation, turning a thesis into a journal article is a logical step and a process that eventually every researcher completes. But…how to start?

The first thing to know about converting a thesis into a journal article is how different they are:

Thesis Characteristics:

Meets academic requirements
Reviewed by select committee members
Contains chapters
Lengthy, no word limits
Table of contents
Lengthy research of literature
IRB approval described in detail
Description and copies of tools used
All findings presented
Verb tenses may vary

Journal Article Characteristics:

Meets journalistic standards
Reviewed by a panel of “blind” reviewers
Word limits
Manuscript format
Succinct research of literature
IRB described in 1 to 3 sentences
Essential and succinct tool information
Selected findings presented
Verb tenses are fairly consistent

Converting your thesis to a journal article may be complex, but it’s not impossible.

A thesis is a document of academic nature, so it’s more detailed in content. A journal article, however, is shorter, highlighting key points in a more succinct format. Adapting a thesis for conversion into a journal article is a time-consuming and intricate process that can take you away from other important work. In that case, Elsevier’s Language Editing services may help you focus on important matters and provide a high-quality text for submission in no time at all.

If you are going to convert a thesis into a journal article, with or without professional help, here is a list of some of the steps you will likely have to go through:

1. Identify the best journal for your work

Ensure that your article is within the journal’s aim and scope. How to find the right journal? Find out more .
Check the journal’s recommended structure and reference style

2. Shorten the length of your thesis

Treat your thesis as a separate work
Paraphrase but do not distort meaning
Select and repurpose parts of your thesis

3. Reformat the introduction as an abstract

Shorten the introduction to 100-150 words, but maintain key topics to hold the reader’s attention.
Use the introduction and discussion as basis for the abstract

4. Modify the introduction

If your thesis has more than one research question or hypothesis, which are not all relevant for your paper, consider combining your research questions or focusing on just one for the article
Use previously published papers (at least three) from the target journal as examples

5. Tighten the methods section

Keep the discussion about your research approach short

6. Report main findings in the results

Expose your main findings in the results section in concise statements

7. Discussion must be clear and concise

Begin by providing an interpretation of your results: “What is it that we have learned from your research?”
Situate the findings to the literature
Discuss how your findings expand known or previous perspectives
Briefly present ways in which future studies can build upon your work and address limitations in your study

8. Limit the number of references

To choose the most relevant and recent
To format them correctly
Consider using a reference manager system (e.g. Mendeley ) to make your life easier

If you are not a proficient English speaker, the task of converting a thesis into a journal article might make it even more difficult. At Elsevier’s Language Editing services we ensure that your manuscript is written in correct scientific English before submission. Our professional proofers and editors check your manuscript in detail, taking your text as our own and with the guarantee of maximum text quality.

Language editing services by Elsevier Author Services:

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How to Turn Your Thesis Into a Journal Article

In many cases, publishing thesis is often one of the requirements for graduate students to finish their academic program. Publishing research findings is one of the more important ways to share research data with the scientific community. However, the structure of it is different from that of a research article. In this article, we shall discuss how to turn your thesis to journal article.

Characteristics of a Thesis and a Journal Article

Differences between a thesis and a journal article.

While both contain similar sections, you cannot simply publish your thesis research as a journal article. Converting it into a journal article has many steps. It is important to recognize that an article is much shorter than the thesis. However, turning your thesis into a journal article will not be a simple matter of copy and paste. You will need to use the data in your thesis as the starting point for writing your article.

Related: Planning to publish your Ph.D. research in a good journal? Check these journal selection guidelines now!

The many differences between a thesis research and a journal article are as follows:

A thesis meets academic requirements while a journal article meets journalistic standards.
The abstract of an article is usually shorter than that of a thesis.
The introduction in a thesis is used to show that you are familiar with the literature in your chosen field. In a research paper , the introduction is much shorter as it is assumed that your target audience is familiar with the necessary background to understand your work. The introduction to your paper will, therefore, focus more on setting the stage for the data/research output that you are about to present.
The results section in a thesis will include all your findings. In a paper, this would be too much detail. The data in this section should be only what you need to support your research problem or hypothesis. Often, the results in former may represent two to three different papers.
The discussion in your paper will be much more focused than in your thesis. It will be guided by the results presented in the paper. Finally, only citations of articles actually mentioned in your paper will be listed in the references section.

Turning Thesis Research to Journal Article

As a researcher, you need to publish your work to advance your career and make contributions to the research field. Now that the differences have been outlined, how do you actually write one?

1. Identify a Suitable Journal

You could start by journal selection . Look at your reference list. Chances are at least some of the papers you read were published in journals whose scope would match your work. Selecting a journal also allows you to tailor the paper to the specific requirements of that journal. Ensure that your research article coincides with the aim and scope of the journal. Understand the journal’s guidelines, recommended manuscript structure, and reference style

2. Reduce Redundant Length of Your Thesis

An important aspect of turning your thesis research to journal article is focusing on the word count without deleting crucial information. In order reduce word count , extract the data that answers just one research question. This should result in a more focused information than your thesis research presented. Discuss results in context with your problem statement-that is the focus of your paper. Good language and structure are crucial – your paper may get rejected even though it contains valuable data if it is difficult to understand. Use your data to tell a coherent story and avoid sweeping conclusions your data cannot support. Ensure that your title matches the contents of your paper. Paraphrase the content without changing the meaning.

3. Modify Introduction as Abstract

Repurpose the introduction as an abstract by shortening your thesis introduction to 100-150 words. Remember to maintain key points of the introduction to hold the reader’s attention. Formulate the introduction and discussion of thesis as basis for the journal article’s abstract. Furthermore, consider combining multiple research questions or focus on just one for the journal article.

4. Focus on Relevant and Selective Information

Since the discussion, methods and methodology, and results section of your thesis is an in-detail explanation of your research, these sections must be kept short while writing in a journal article. Familiarize yourself with the target journal’s standards by referring previously published papers and understanding their format. Most importantly, provide interpretation of main findings in the results section in concise statements or tabular formats. Avoid repeating your results in the discussion section. However, discuss how your findings expand and support previous perspectives of the research. Finally, mention how future studies can build upon your work and address limitations in your study.

5. Limit the Number of References

As your thesis is a work of several years put together, it involves numerous literature reviewing. However, while turning your thesis to journal article, you must include only limited references that are relevant to the research question addressed in the journal article. Focus on using most recent references. Consider using reference management tools such as Zotero, Mendeley, Quiqqa, etc. to make the referencing process easier and efficient.

It is an academic requirement that you publish your data for the benefit of the scientific community. Considering that the structure of journal article is different from the structure of a thesis, turning a thesis to journal article must be done following logical steps as mentioned above.

Did you ever have to convert your thesis to journal article? How did you plan it? What strategies did you use while reducing the word count of your thesis? Let us know in the comments section below! You can also visit our Q&A forum for frequently asked questions related to different aspects of research writing and publishing answered by our team that comprises subject-matter experts, eminent researchers, and publication experts.

I was Searching For This From So Many days. Thank you for Sharing

Thanks! Glad you liked it.

Are we also going to talk Code of Conduct in Research, as authorship is part of the conduct (ethics)?

Regards, Elvia

I guess you are referring to our upcoming webinar on Assigning Authorship & Contributorship | Tips for Researchers. We will be discussing the ethical dilemmas in authorship during the session.

We would request you to register and attend the webinar for additional insights on this topic.

Meanwhile, we would recommend you to share your queries with us on our FREE Q&A forum . In addition, you may download our FREE mobile app to stay updated on the latest resources in research writing and academic publishing.

What about the Topic? we need to rephrase the topic or keep it same with Thesis topic?

Hi Shahid, Thank you for your question. Your thesis topic would be a cumulative title for all the chapters described in your thesis. When you publish your thesis as a journal article, every chapter would be published as an individual article in most cases. You may or may not use the same title that you have used for that particular chapter in the thesis. Your thesis would have chapter names that are more suited to the overall objective of your thesis. On the other hand, your manuscript should ideally have a catchy and search-optimized title highlighting a general perspective. It may not be the same as your thesis title. However, if your thesis chapter title meets the requirement of the manuscript you intend to publish, you can go ahead with the same.

You could also go through our articles on writing good research paper titles: https://www.enago.com/academy/top-10-tips-on-choosing-an-attractive-research-title/ https://www.enago.com/academy/writing-a-good-research-title-things-to-avoid/ https://www.enago.com/academy/write-irresistible-research-paper-title/

Did you get a chance to install our FREE mobile app . Make sure you subscribe to our weekly newsletter: https://www.enago.com/academy/subscribe-now/ .

Hi Dr. Durga, Amazing article and I am sure it will surely help the writers to write more carefully and also plagiarised free.

Greeting from Enago Academy! Thank you for your positive comment. We are glad to know that you found our resources useful. Your feedback is very valuable to us. Happy reading!

i just read the article and also the comments section it’s so helpful. thank you so much for sharing it.. good work!

Thanks a lot for this informational blog which surely going to help the students pursuing the Phd. Nowdays due to assignment burden students started taking the help of professional academic experts. There are many writing services.

Thank you for the very useful article. I will definitely look into it.

Writing a book: needed advice and help at one point. I found enago academy in my search of Answers. You were a Great Help! I hope to use your services again, if I am stuck on correct writing principles! Thank You for being here. K.R. Plante

This helped me a lot; thank you for this informative article.

Thanks for writing such an informative blog which will surely be a great help for the students as well as the institutions

Great article! One question…. should I cite the thesis in the paper? If so, how do I do that efficiently since it would be all over the place?

good, insightful piece of text.

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Submit and publish your thesis.

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Turning Your Thesis into an Article

Creating an article from your thesis means more than just copying and pasting. The audience for the thesis is your committee whereas for an article it may be fellow researchers, professionals working in the field, policy makers, educators, or the general audience. Your article manuscript will need to be modified accordingly. This section is based on Extracting a journal article from your thesis from Taylor & Francis publishing tips for authors.

Plan the article

Identify the central message that you want to get across. This could be a new theory, novel methodology or original findings. Make sure that your article follows a coherent argument and targets the journal audience.

Decide on the kind of article you want to write - will it be a report, position paper, critique or review? What makes your argument or research interesting? How might it add value to the field?

Select a journal

Selecting the right journal means reaching the audience you intend for your article to speak to. To start identifying potential journals:

Look at your own bookshelf / reference list. Where have authors published on similar topics?
Search the library catalogue
Consult Ulrich’s Web serials database (subscription resource)
For open access journals specifically - search the Directory of Open Access Journals (DOAJ)
For student journals - see the Directory of Student Journals at UofT
Talk to your advisor, colleagues or liaison librarians

Automatic journal finders can recommend a journal based on your manuscript title/abstract:

Jane: the Journal/Author Name Estimator
Enago Open Access Journal Finder
Elsevier journal finder

To further narrow down the list:

Study the “Aim and Scope” or similar section on editorial policies on the website to evaluate the fit and any specific content requirements;
Skim through past issues, abstracts, table of contents - are there similar papers that have been published?
How will your paper be reviewed? The journal’s website should mention the details of peer review process;
Check details of copyright / license agreements and whether publication before or after your thesis submission is allowed .

Is it a trusted journal or publisher?

How to identify a deceptive publisher? See the Deceptive Publishing Checklist created by U of T.

Identifying deceptive publishers - a checklist.

Write the article

You may choose to approach writing your thesis with an aim to publish it as an article or several articles, known as an integrated/publication-based/sandwich thesis. Alternatively, you can reformat and convert your completed thesis into an article to fit the scope and style of a journal article. In both cases it will be helpful to:

Carefully read and follow “Author Guidelines” for instructions on on preferred layout, word limits, reference style
Use the criteria the reviewers will use and make sure your article addresses them
Request and consider the input of your supervisor, colleagues, or other contributors to the research on which your thesis is based
Reach out to friends or colleagues to prood-read your manuscript prior to submission

Additional resources on converting your thesis into an article:

Adapting a Dissertation or Thesis Into a Journal Article by APA
Eight top tips to help you turn your PhD thesis into an article by Elsevier
Extracting a journal article from your thesis by Taylor & Francis
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Initial Thesis Submission
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FAQ on manuscript-based theses

As an alternative to the traditional format, a thesis may be presented as a collection of scholarly papers of which the student is the first author or co-first author. A manuscript-based doctoral thesis must include the text of a minimum of two manuscripts published, submitted or to be submitted for publication. A manuscript-based Master’s thesis must include the text of one or more manuscripts. Articles must be formatted according to the requirements described below. Note that a manuscript-based thesis must follow the general structure of a thesis as explained here . An FAQ explaining the difference between a standard and a manuscript-based thesis is available here .

Manuscripts for publication in journals are frequently very concise documents. A thesis, however, is expected to consist of more detailed, scholarly work. A manuscript-based thesis will be evaluated by the examiners as a unified, logically coherent document in the same way a traditional thesis is evaluated. Publication of manuscripts, or acceptance for publication by a peer-reviewed journal, does not guarantee that the thesis will be found acceptable for the degree sought.

A manuscript-based thesis must:

be presented with uniform font size, line spacing, and margin sizes (see Thesis Format under Preparation of a Thesis );
conform to all other requirements listed under Thesis Components on the Preparation of a Thesis page;
contain additional text that connects the manuscript(s) in a logical progression from one chapter to the next, producing a cohesive, unitary focus, and documenting a single program of research - the manuscript(s) alone do not constitute the thesis;
stand as an integrated whole.

Any manuscripts that are under review, accepted or published in a journal must be included in your manuscript-based thesis without changes (i.e. identical to the published or submitted versions). The only change is with respect to the font/size which should be the same as the one used for the rest of the thesis for consistency and homogeneity reasons. So each chapter represents a full manuscript and has its own reference list. Then at the end of the thesis, you have a master reference list which includes all the other references cited throughout the other sections of the thesis, mostly within the general introduction but also from the general discussion.

Depending on the feedback of your examiners and/or the oral defence committee, you may be required to make revisions to your thesis before final submission. The committee’s comments must be addressed in the connecting text between chapters and/or the discussion section. You must not make any changes to the manuscripts themselves in your final thesis.

In the case of multiple-authored articles, the student must be the first author . Multiple-authored articles cannot be used in more than one thesis. In the case of students who have worked collaboratively on projects, it may be preferable for both students to write a traditional format thesis, identifying individual contributions. Consult this page for information on intellectual property and required permissions/waivers.

In the case of co-first authored articles , only one student can use the article in a manuscript-based thesis and must have a written agreement from the other co-first author student(s).

This work is licensed under a Creative Commons Attribution Non-Commercial 4.0 International License . Graduate and Postdoctoral Studies, McGill University .

Department and University Information

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Writing a compelling integrated discussion: a guide for integrated discussions in article-based theses and dissertations

Affiliations.

1 School of Nursing, University of Ottawa, Ottawa, ON, Canada.
2 University of Ottawa Heart Institute, Ottawa, ON, Canada.
3 School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada.
4 Ottawa Hospital Research Institute, Ottawa, Canada.
5 Western University, London, Canada.
PMID: 33657283
DOI: 10.1515/ijnes-2020-0057

Article-based theses and dissertations are increasingly being used in nursing and the health sciences as an alternate format to the traditional five-chapter monograph. A unique chapter in the article-based thesis is the integrated discussion, which differs in breadth and depth as compared to the discussion for a traditional thesis monograph or journal article. For many students and faculty, the integrated discussion is a challenging chapter to write, with minimal or no published guidance available. In this article, we offer a four-step approach with templates for planning and writing an integrated discussion. We also share several lessons learned with examples from published theses and dissertations. Writing an integrated discussion can be facilitated and written more efficiently by developing a clear and detailed outline of the chapter and broad discussion points prior to drafting the text, to achieve a higher-level synthesis, analysis, and interpretation of the overall significance of the thesis findings.

Keywords: academic dissertation; graduate education; scholarly communication; thesis-by-article; writing.

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Writing a compelling integrated discussion: a guide for integrated discussions in article-based theses and dissertations

Krystina B. Lewis , Ian D. Graham , Laura Boland and Dawn Stacey

Introduction

An increasing number of university graduate programs in nursing and the health sciences offer the option of writing an article-based thesis or dissertation as an alternate format to the traditional five-chapter monograph ( De Jong, Moser, & Hall, 2005 ; Graves et al., 2018 ; Robinson & Dracup, 2008 ; Smaldone, Heitkemper, Jackman, Joanne Woo, & Kelson, 2019 ). This format has gained traction internationally to facilitate the earlier and more frequent publication of graduate student research for the timelier advancement of knowledge and impact on clinical practice ( Evans, Amaro, Herbert, Blossom, & Roberts, 2018 ; Maynard, Vaughn, Sarteschi, & Berglund, 2012 ; Smaldone et al., 2019 ). An article-based thesis, also known as the manuscript option, thesis-by manuscript, integrated thesis, or PhD by published works, typically includes one or more articles suitable for publication in peer-reviewed journals and bounded together with an introduction chapter and integrated discussion chapter ( Baggs, 2011 ). The integrated discussion is a unique chapter in an article-based thesis. Integrated (2020) is defined as “ many different parts [that] are closely connected and work successfully together ” (“Integrated,” 2020). The general purpose of the integrated discussion chapter is to provide an overall synthesis and demonstrate high level abstraction, analysis, and interpretation of the thesis findings. It is an opportunity to showcase the thesis’ findings, the student’s reflections about the findings, and its implications ( Smith, 2015 ).

Requirements and expectations for the integrated discussion chapter vary by institution and department. Supervising faculty within individual institutions may also have differing approaches and expectations. We found no general rules or expectations in the literature for writing an integrated discussion. An inquiry of select institutional guidance documents in various international jurisdictions revealed that academic institutions provide few details about this chapter. Descriptions focus more on the overall contribution of the integrated discussion chapter to the thesis, rather than guidance on how to write it ( Table 1 ).

Examples of institutional guidelines for the integrated discussion chapter in an article-based thesis.

Writing a compelling integrated discussion can be challenging, and there is a scarcity of resources, instructions, or published guidance for students and supervising faculty on this subject. Existing guidance is focused primarily on writing discussions for a single journal article or a traditional thesis monograph. Yet, the integrated discussion chapter differs in breadth and depth. In journal articles, a discussion usually consists of a statement of the main findings, interpretation of the results in the context of the broader literature, strengths and limitations of the study, and implications for potential users of the findings (clinicians, administrators, policy makers, and others), the discipline, and future research ( Makar, Foltz, Lendner, & Vaccaro, 2018 ). The discussion section of the traditional monograph thesis has a similar format to that of a journal article as it discusses a single study but is often more detailed. In comparison, the integrated discussion chapter of the article-based thesis provides students with a space in which to weave the results and discussion points from the individual articles comprising the thesis, elaborate on the logic and linkages between them, and convincingly argue for the unified, coherent, and original nature of their findings and contributions to the field-at-large. Smith (2015) refers to this as the golden thread. Grant (2011) refers to it as the logic of connectivity . Ultimately, it is about how the student links the key ideas from the individual papers and articulates the connectedness between them, so as to make readers understand the thesis’ broader meaning which make it accessible to a larger audience ( Smith, 2015 ).

The educational value of conceptualizing and writing an integrated discussion can be best classified at the highest level of Bloom’s revised taxonomy of educational objectives, to Create — formerly known as Synthesis in Bloom’s original taxonomy — whereby parts are combined in novel ways to produce a coherent whole and to formulate new points of view ( Anderson & Krathwohl, 2001 ; Bloom, 1956 ). According to the taxonomy, the integrated discussion represents the pinnacle of cognitive tasks and processes by requiring higher-order thinking and critical reflections expected of graduate level students. Hence, the integrated discussion chapter provides the graduate student an opportunity to synthesize, integrate, and raise the discussion to a higher level of abstraction; allowing them to demonstrate the coherence between all articles reported in the thesis. It is often in the integrated discussion where thesis advisory committee members and examiners can assess the student’s depth of theoretical and applied knowledge of the subject matter, capacity for critical inquiry, and judge the overall value of the student’s conclusions and contributions to the substantive area of study ( Gould, 2016 ). Specifically in nursing, this higher-level thinking can be articulated by discussing how the knowledge generated advances nursing practice, education and research, and how it contributes to the delivery of high quality health care, and improved health and health system outcomes ( Institute of Medicine [US] Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, 2011 ). Yet, with little guidance available on how to think about and write an integrated discussion, graduate students may miss the opportunity to engage in this higher-order thinking and critical reflections.

In this paper, we offer a practical four-step approach with templates for writing an integrated discussion for article-based theses. KBL initially developed the steps and templates as she conceptualized and wrote her integrated discussion for her PhD dissertation. The steps and templates were refined as a result of (a) her own integrated discussion writing process; (b) discussion with her thesis supervisor and thesis advisory committee members; and, (c) feedback from several graduate students who have used it successfully. As recent doctoral graduates and faculty supervisors, we are sharing this approach and our lessons learned with examples from published theses and dissertations.

Writing an integrated discussion chapter

Step 1: outlining the integrated discussion chapter.

To begin, we propose drafting an outline for the integrated discussion chapter with six major sections ( Table 2 ). First, provide an opening paragraph introducing the information to be presented in the chapter. Second, present a summary of the overall purpose of the thesis as a unified piece of work and a brief summary of each individual article prepared for publication. Each article summary should include the study aim, study design, and key results. Keep in mind that by the time supervisors, thesis advisory committee members, and examiners read the integrated discussion chapter, they have probably just finished reading the previous chapters and articles, so there is no need to repeat information in detail. Rather, the purpose of this section is to refresh the readers’ focus and to begin demonstrating how the articles logically link to each other. Third, outline the main points of the integrated discussion as clearly and concisely as possible (see Step 2 and 3 for more details). Fourth, discuss the strengths and limitations of the thesis, as a whole, if applicable. Typically, strengths and limitations are only presented at the individual article level, but if there are broader strengths or limitations that apply to the thesis, they can be discussed in this chapter. Fifth, discuss the implications of the thesis for the specific discipline (e.g., nursing, medicine, population health, epidemiology, rehabilitation) in terms of the findings’ applicability to practice, education, leadership, and/or policy. Sixth, describe implications for future research. Finally, this chapter should end with a strong, clear, and logical conclusion summarizing the entire work across all elements of the thesis. The conclusions should clearly state the original contribution(s) to the advancement of knowledge and overall significance for the field at-large.

Suggested structure for an integrated discussion.

a Approximate length based on 12-point type font, double spacing, left-justified, 1-inch margins, and format for 8 ½ × 11 paper.

Step 2. Mapping individual articles’ findings to inform the integrated discussion

The next step is to draft the main integrated discussion points. Using Template I, capture the main discussion points from each individual article ( Table 3 ). If there is only one article in the thesis, these can be generated from the literature review, guiding theoretical framework, and/or chosen methodology. This exercise is intended to facilitate the student’s thinking about how to build convincing overarching discussion points and explore the key messages they want readers to come away with after reading the thesis.

Template I to summarize individual article discussion points to identify overarching discussion points.

a If there is only one article in the thesis, additional discussion points/contributions/implications can come from the literature review, guiding theoretical framework, and/or chosen methodology. b Whether these implications are included in the individual article or not, this explicitly offers a starting point to think of the implications arising from individual articles.

The last row in this template is reserved for listing the actual and potential disciplinary implications arising from each article, which may address any of the following domains: practice, education, leadership, policy and/or research. Depending on journal requirements, these implications may be directly discussed in the individual articles. If not, this section offers the student a starting point for thinking about the disciplinary implications arising from their thesis as a whole.

Completing Template I as individual articles are finalized, and sharing it with a faculty supervisor or thesis advisory committee can facilitate discussion about the evolving integrated discussion points. It can also facilitate requisite critical thinking and reflection necessary for linking findings across the individual articles.

Step 3. Drafting the main integrated discussion points

Consider the discussion points and disciplinary implications across all individual articles of the thesis to identify commonalities or differences;

Draft main integrated discussion points, logically connecting the individual articles;

Identify findings from, ideally, two individual articles that support (or refute) the proposed main integrated discussion points (aiming for evidence from two articles helps achieve a higher level integrated discussion); and

Identify and classify theoretical and empirical literature relevant to the main integrated discussion points. Select regional, national, and international empirical studies, theoretical works, clinical practice guidelines, technical reports, and/or policy documents; highlight what the thesis adds to the field (of knowledge) and how it will enhance understanding of the subject.

Template II to build the main integrated discussion points from the individual articles and summarize implications.

a If there is only one article in the thesis, the supporting contributions/arguments can come from the literature review, guiding theoretical framework, and/or chosen methodology. b Broader literature can include empirical studies, theoretical works, practice guidelines, technical reports, and/or policy documents. c List the disciplinary implications identified across all articles. This explicitly offers a starting point to think of the disciplinary implications arising across the individual articles’ findings and discussion points.

This exercise is intended to help organize the content of the integrated discussion early in the writing process. We recommend sharing the evolving Templates I and II with the faculty supervisor or thesis advisory committee and use it as a tool for discussion before writing the integrated discussion chapter. As supervisors (DS, IDG), we also initiate Template I in discussion with our graduate students – often using a blank piece of paper. This reflective exercise may save time in the long run, as it facilitates staying focused on the key points and avoids repeating elements of the discussions within the individual papers. The more detailed the completed templates, the more content is available to transform into text.

Step 4. Writing the integrated discussion chapter

The final step is to turn the planned outline (Step 1) and the drafted main integrated discussion points (Step 3) into narrative prose. To remain focused, start by adding subheadings from the outline and lower level subheadings for each of the main integrated discussion points. A compelling integrated discussion is often preceded by multiple revisions. It should not be written when rushing to meet the thesis submission deadline as writing this chapter requires considerable reflection and introspection. For these reasons, we remind students that the integrated discussion is the last chapter their examiners will read, and it will leave a lasting impression. Getting this chapter right allows the student to demonstrate their mastery of the totality of their thesis work and sets the stage for the examination. In our experience, when an integrated discussion is well-written, the examiners’ comments indicate that the integrated discussion chapter tied all elements of the thesis together and helped them understand the thesis in its entirety.

Lessons learned

When applying this approach for writing our own integrated discussions, or when guiding graduate students through the process, we have learned several lessons. To exemplify these lessons, we offer examples of published theses and dissertations in nursing and other health professions.

Lesson 1. Use stepwise approach with templates to plan and structure the chapter

Using the attached templates and proposed stepwise approach to structure the writing process reduces the inclination to simply repeat the discussion points found in the individual articles. The templates may also help graduate students overcome procrastination resulting from not knowing where to start with the integrated discussion. Further, Templates I and II may be used to guide discussions between graduate student and faculty supervisor, allowing for progress to be monitored prior to writing. Another advantage to doing this early is that some supervisors are less familiar with the article-based thesis format and may have little experience guiding their students in writing the integrated discussion. As such, using the template to walk through this process may be helpful for both parties.

Lesson 2. Think ahead

Avoid delaying until all the individual thesis articles are written before thinking about the integrated discussion. We recommend filling out the templates as individual articles are completed. When analyzing the results for individual articles and thinking about the discussion sections for these, we often identified relevant discussion points that were too broad for the articles. Keeping a log of discussions with faculty supervisors and thesis advisory committee members throughout the thesis writing process, and keeping record of personal reflections that were beyond the scope of individual articles, may help gather ideas early. For example, when first considering her integrated discussion, Hoefel (2019) chose the Walker and Avant (2011) theory testing approach to validate the decisional needs concept and test the main hypothesis of the Ottawa Decision Support Framework ( O’Connor et al., 1998 ). For her thesis, Hoefel (2019) wrote two articles based upon this framework. Her first was a systematic review article on decisional needs of people making health decisions and the second was a sub-analysis of a systematic review on patient decision aids. Hence, evidence from these articles contributed to the higher level discussion about validating the concepts and testing the hypotheses in the framework.

Lesson 3. Dedicate sufficient time

Dedicating sufficient time to writing the integrated discussion is important. For many students, the integrated discussion is a challenging chapter to write. It calls for a different style of writing than that which is required for individual research study articles. It requires conveying abstract and conceptual ideas to generate broader insights. Prior to developing and using these templates, our experience with many students has been that it can take many months of re-writing the integrated discussion chapter for it to adequately reflect the breadth and depth of the student’s thesis work and its vital contribution to the field. We have found that our stepwise approach involves more careful planning and conceptualizing of the integrated discussion prior to drafting the chapter, and therefore results in a more efficient writing and editing process.

Lesson 4. Consider theoretical and methodological implications

Theoretical and methodological implications may be considered as integrated discussion points. A student may choose to closely examine their selected theoretical perspective in light of their thesis findings. For example, in Lewis’ (2018) integrated discussion, she provided a discourse on the use of complementary theoretical frameworks across individual studies: the Ottawa Decision Support Framework ( O’Connor et al., 1998 ) and Normalization Process Theory ( May et al., 2009 ). This provided a link between intervention development and implementation planning, proposing a novel theory-informed approach for the development of decision support interventions ( Lewis, 2018 ). Likewise, methodological implications may be discussed in cases where a student’s thesis advances methods, or to discuss the influence of chosen methodology on key findings where similar research questions are answered using distinct study designs. Wu’s (2014) integrated discussion focused on the methods used for conducting a survey for data collection. He used a set of reminders, with the last reminder being a courier package and return envelope. He then discussed how testing this reminder strategy in his thesis study contributed to survey design methods.

Lesson 5. An integrated discussion is feasible with one article

In cases where there is only one article comprising an article-based thesis, key findings from a more detailed literature review, a theoretical framework guiding the entire research project, or chosen methodology can provide the additional linkages to build the main integrated discussion points. For instance, in her Master of Nursing thesis integrated discussion, Demery Varin (2018) compared and contrasted her secondary analysis findings on the predictors of nurses’ research use in long-term care settings (as reported in one published article) with her review of the literature on the individual and contextual factors to nurses’ research use in all settings.

Lesson 6. Integrated discussions are publishable

The integrated discussion (or elements of it) may be publishable in its own right. When written well, the integrated discussion often results in an important academic contribution to the body of knowledge. Some graduate students have used the integrated discussion as the basis for a commentary paper or an updated theoretical framework paper. In her integrated discussion chapter of her doctoral thesis, Jull (2014) described the development of a collaborative framework for community-research partnerships co-produced by First Nations, Inuit, and Metis women’s community members and researchers. This framework was based on her findings and experience conducting the studies comprising her thesis. Jull et al. (2018) subsequently published a paper based on her integrated discussion.

Lesson 7. Integrated discussions can lay the foundation for subsequent research

Many students who are completing a Master’s or PhD thesis also intend to pursue further research. A well thought out and articulated integrated discussion can inform subsequent research projects, grant proposals, or programs of research. For example, Boland (2018) drew from her PhD integrated discussion to identify evidence-practice gaps and potential solutions in pediatric shared decision-making, which she used to underpin a successful Canadian Institutes of Health Research post-doctoral fellowship and guide the establishment of her research program.

In this paper, we propose an approach to writing an integrated discussion chapter for an article-based thesis. Our advice provided in this paper is intended to position graduate students to adequately plan and produce a unified, coherent, and higher-level synthesis of the articles comprising their thesis. Challenges in writing an integrated discussion include avoiding repetition of discussion points already included within the individual articles comprising the thesis and achieving a higher-level discussion to integrate findings across the individual articles. Writing an integrated discussion can be facilitated by developing a clear and detailed outline of the chapter and, in particular, by identifying broader, more overarching points of discussion, than those presented within the individual articles. We encourage graduate students, faculty supervisors and thesis advisory committees to use the templates provided and share their experiences.

Acknowledgments

The authors wish to thank the graduate students who have used this approach, reported that it was useful, and offered feedback to improve it. The authors also wish to thank the reviewers. Their critical read and constructive comments strengthened this manuscript.

Research funding: The authors received no financial support for the authorship and publication of this manuscript. IDG is a recipient of a CIHR Foundation Grant (FDN# 143237). DS holds a University Research Chair in Knowledge Translation to Patients at the University of Ottawa.

Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

Competing interest: Authors state no conflict of interest.

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Guidelines for the introductory chapter of article-based theses at the Faculty of Humanities

From the programme plan:

"The scope of a PhD thesis should be such that it can be completed within the framework of the PhD programme, nominally 3 years net time for research training. A PhD thesis will normally consist of 200-250 pages (550-700,000 characters).

The thesis can consist of one continuous work or several smaller works. A thesis based on several smaller works shall normally consist of at least 3 works, as well as a summary/introductory article. In case of co-authorship, the thesis shall normally encompass more than 3 works. The candidate shall normally be the sole author of at least one of the contributions."

Introductory chapter

Theses that are composed of a number of individual works must have an introductory chapter, or if relevant an introduction and a conclusion (known in Norwegian as a ’kappe’), that explains how the individual works are interconnected. The introductory chapter must be a scholarly text of high academic standard. It shall both summarize and compare the issues and conclusions presented in the individual works, giving them an overall perspective and thus ensuring that the thesis forms a coherent whole. Even though the individual works may have co-authors, the candidate shall be the sole author of the introductory chapter. If the thesis contains previously-published articles, the introductory chapter shall if necessary also contain updated information so that the thesis as a whole is presented as academically updated. Each article can be updated if appropriate.

The length will vary, but the introductory chapter will normally consist of between 40 and 80 pages (110-220,000 strokes including spaces), excluding references and appendices.

Although the guidelines and practices for different subjects may vary, the introductory chapter should normally contain the components given below.

Introduction

The introduction presents the overarching topic of the thesis, the issue(s) discussed and the research questions, and gives grounds for the choice of issue(s). In addition the titles of the articles on which the thesis is based should be listed, along with information on how far the articles have progressed in the publication process.

Research status

The introductory chapter shall contain a literature review that shows the results that other researchers have previously reported in the relevant subject area. To demonstrate that the thesis makes a significant contribution, the candidate must document that he/she is familiar with the current state of knowledge in the field in question.

Theoretical framework

This part shall present the overarching theoretical approach that ties the theoretical suppositions and the issues discussed in the individual articles together. Here the candidate may discuss relevant theory and research literature in more detail than in the individual articles, although in a way that is justified in relation to the articles. It is important that the candidate operationalises and clearly specifies how theories and key concepts will be used in the rest of the thesis.

Methodology

There is often insufficient room in thesis articles for an in-depth discussion of methodological considerations and choices. The methodology of the thesis should therefore be assigned more space in the introductory chapter. In this part the methodological and strategic research choices made in the articles are justified and accounted for. The data collection process is presented, and the quality of the data and the data analysis work are discussed.

The introductory chapter shall provide a short summary of each article. The main findings of the thesis shall be reported in a brief and systematic manner that allows the main theme of the thesis and the connection between the content of the various articles to be clearly seen.

Discussion and conclusion

The candidate shall give an account of how findings presented in the articles contribute to existing research literature in the field and shall discuss the theoretical implications of the results. The introductory chapter also gives the candidate the opportunity to update the content of the articles. Such academic updating can be necessary due to the publication dates of the articles or the completion date. However, the candidate shall not introduce new empirical data.

The discussion shall also allow for competing interpretations of the results in the thesis, and shall show that the candidate has the critical distance and ability to reflect on the limitations of his/her research and that of others. The candidate is expected to address any research-methodological issues such as the validity of the methods in the light of the issues discussed and the limitations of the work that has been performed. Where relevant the candidate shall also address ethical problems associated with his/her research and shall demonstrate the practical implications of the findings and the need for future research. The conclusion of the introductory chapter shall be clearly related to the issues and research questions of the thesis.

Reference list

In connection with the introductory chapter, a complete reference list shall be compiled that conforms to the standard that is used in the relevant academic field.

The thesis may have an appendix if required. Interview guides, questionnaires and other documents of significance for understanding the results, and which are not covered by the articles, shall be included here. The appendix is given at the end of the thesis after the individual articles.

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eTable 1. Patient and Clinical Characteristics of Men With Localized Prostate Cancer, Overall and Stratified by Quintiles of PDI and hPDI Scores

eTable 2. Multivariable Associations Between Each of the Three Food Groups and Risk of Prostate Cancer Progression

eTable 3. Multivariable Associations Between the hPDI and Risk of Prostate Cancer Progression Among Men Initially Diagnosed With Nonmetastatic Prostate Cancer, Stratified by Gleason Grade

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Liu VN , Van Blarigan EL , Zhang L, et al. Plant-Based Diets and Disease Progression in Men With Prostate Cancer. JAMA Netw Open. 2024;7(5):e249053. doi:10.1001/jamanetworkopen.2024.9053

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Plant-Based Diets and Disease Progression in Men With Prostate Cancer

1 Department of Epidemiology and Biostatistics, University of California, San Francisco
2 Menwell Limited, London, England, United Kingdom
3 Department of Urology, University of California, San Francisco
4 Department of Medicine, University of California, San Francisco
5 Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York
6 Real World Solutions, IQVIA, Durham, North Carolina

Question What is the association between postdiagnostic plant-based dietary patterns and risk of prostate cancer progression?

Findings In a cohort study of 2062 men diagnosed with nonmetastatic prostate cancer, individuals with the highest intake of plant foods in the overall plant-based diet index had lower risk of prostate cancer progression compared with those with the lowest intake.

Meaning These findings suggest that consuming a primarily plant-based diet may be associated with better prostate cancer–specific health outcomes among men with prostate cancer.

Importance Plant-based diets are associated with many health and environmental benefits, including primary prevention of fatal prostate cancer, but less is known about postdiagnostic plant-based diet patterns in individuals with prostate cancer.

Objective To examine whether postdiagnostic plant-based dietary patterns are associated with risk of prostate cancer progression and prostate cancer–specific mortality.

Design, Setting, and Participants This longitudinal observational cohort study included men with biopsy-proven nonmetastatic prostate cancer (stage ≤T3a) from the diet and lifestyle substudy within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) enrolled at 43 urology practices across the US from 1999 to 2018. Participants completed a comprehensive diet and lifestyle questionnaire (including a validated food frequency questionnaire [FFQ]) between 2004 and 2016. Data were analyzed from August 2022 to April 2023.

Exposures Overall plant-based diet index (PDI) and healthful plant-based diet index (hPDI) scores were calculated from the FFQ.

Main Outcomes and Measures The primary outcome was prostate cancer progression (recurrence, secondary treatment, bone metastases, or prostate cancer–specific mortality). The secondary outcome was prostate cancer–specific mortality.

Results Among 2062 participants (median [IQR] age, 65.0 [59.0-70.0] years), 61 (3%) identified as African American, 3 (<1%) identified as American Indian or Alaska Native, 9 (<1%) identified as Asian or Pacific Islander, 15 (1%) identified as Latino, and 1959 (95%) identified as White. Median (IQR) time from prostate cancer diagnosis to FFQ was 31.3 (15.9-62.0) months after diagnosis. During a median (IQR) follow-up of 6.5 (1.3-12.8) years after the FFQ, 190 progression events and 61 prostate cancer–specific mortality events were observed. Men scoring in the highest vs lowest quintile of PDI had a 47% lower risk of progression (HR, 0.53; 95% CI, 0.37-0.74; P for trend = .003). The hPDI was not associated with risk of progression overall. However, among 680 individuals with Gleason grade 7 or higher at diagnosis, the highest hPDI quintile was associated with a 55% lower risk of progression compared with the lowest hPDI quintile (HR 0.45; 95% CI, 0.25-0.81; P for trend = .01); no association was observed in individuals with Gleason grade less than 7.

Conclusions and Relevance In this cohort study of 2062 men with prostate cancer, higher intake of plant foods after prostate cancer diagnosis was associated with lower risk of cancer progression. These findings suggest nutritional assessment and counseling may be recommended to patients with prostate cancer to help establish healthy dietary practices and support well-being and overall health.

Prostate cancer is the second most common cancer among men in the US. Plant-based diets (ie, diets incorporating a greater proportion of one’s daily caloric intake from plant sources) are increasingly popular 1 and have nutritional benefits among people diagnosed with various chronic diseases, including prostate cancer. 2 - 6 Current dietary recommendations for patients with cancer and the general population emphasize a plant-based diet high in fruits, vegetables, and whole grains. 7

Yet, little is known about plant-based dietary patterns and prostate cancer–specific clinical outcomes after diagnosis. Many studies have reported that greater intake of individual plant-based foods (eg, cruciferous vegetables, cooked tomatoes, vegetable fats) is associated with lower risk of prostate cancer recurrence or mortality, 8 - 14 but single dietary factors in isolation may not accurately capture the health effects of whole diets. 15 Given the increasing interest in plant-based food at the population level, examining whether plant-based dietary patterns are associated with disease outcomes has important implications for public health.

Therefore, we evaluated postdiagnosis intake of plant-based foods in relation to clinical outcomes among patients with prostate cancer. We focused on 2 plant-based diet indices: the overall plant-based diet index (PDI) and healthful plant-based index (hPDI). These indices were developed in 2016 in 3 large cohort studies and have been associated with risk of diabetes, coronary heart disease, and total mortality. 2 , 3 In addition, in the Health Professionals Follow-Up Study, they were associated with a lower risk of fatal prostate cancer and better scores for quality of life among men diagnosed with prostate cancer. 16 , 17 We hypothesized that greater consumption of plant foods in both indices would be associated with lower risk of prostate cancer progression and prostate cancer–specific mortality.

This cohort study was conducted in accordance with the Belmont Report and the US Common Rule under local institutional review board approval. All participants provided written informed consent. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline for cohort studies. We used data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a longitudinal observational study of 15 310 men with biopsy-proven prostate cancer. Participants were enrolled concurrently from 43 urology practices across the US from 1999 to 2018. 18 Participating urologists collected data on clinical and pathological factors, treatments, and recurrence.

A subset of individuals from the CaPSURE study were invited to participate in the CaPSURE Diet and Lifestyle substudy, consisting of a comprehensive diet and lifestyle questionnaire with a validated food frequency questionnaire (FFQ). Invitations to participate in the substudy were sent to all active participants at 3 time points between 2004 and 2016. If more than 1 survey was completed, we used the first completed FFQ to standardize exposure assessment.

Participants with a last clinical follow-up or documented progression (defined as recurrence, secondary treatment, bone metastases, or prostate cancer–specific mortality) prior to completion of a diet and lifestyle questionnaire were excluded. To reduce measurement error in usual diet, 19 , 20 individuals with an extreme or unknown caloric intake (<800 kcal/d or >4200 kcal/d) or missing 70 or more FFQ items were excluded. Lastly, individuals with unknown clinical T-stage or T-stage T3a or higher were excluded. For the prostate cancer–specific mortality analyses (secondary outcome), we included individuals who had documented progression prior to completing the FFQ, since these people were still at risk for prostate cancer–specific mortality.

Dietary data were collected with a validated semiquantitative FFQ based on the one used to develop the diet indices. 21 Participants were asked on average, how often (ranging from never or <1 serving/mo to ≥6 servings/d) they consumed a standard portion size of approximately 140 distinct foods and beverages in the past year.

To compute the plant-based diet indices, 18 food groups were created based on nutrients and culinary similarities, then classified into 3 larger categories of 7 healthful plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea and coffee), 5 unhealthful plant foods (fruit juices, sugar-sweetened beverages, refined grains, potatoes, and sweets or desserts), and 6 animal foods (animal fats, dairy, eggs, fish and seafood, meat, and miscellaneous animal-based foods). 2 Intakes of the 18 food groups (servings per day) were ranked into quintiles (Qs). For PDI, greater amounts of both the healthful and unhealthful plant groups were given higher scores (ie, Q1 indicates a score 1; Q2, 2; Q3, 3; Q4, 4; Q5, 5), whereas animal food groups were given lower scores (ie, Q5 indicates a score of 1; Q4, 2; Q3, 3; Q2, 4; Q1, 5). For hPDI, the healthful plant food group was given increasing scores, while unhealthful plant food and animal food groups were given decreasing scores. Scores for the 18 groups were summed, ranging from 18 (lowest plant intake) to 90 (highest plant intake).

Our primary outcome was time to prostate cancer progression, a composite outcome comprised of biochemical recurrence, secondary treatment, bone metastases, or death attributed to prostate cancer. If participants had multiple progression events, the first reported date was used. Biochemical recurrence was defined as either 2 consecutive prostate-specific antigen (PSA) levels at least 0.2 ng/mL (to convert to micrograms per liter, multiply by 1) after radical prostatectomy or 2 consecutive PSA levels at least 2.0 ng/mL greater than the postradiation nadir. 22 Date of recurrence was recorded as the date of the second elevated PSA. Secondary treatment was defined as any treatment that started at least 6 months after primary treatment completion. Bone metastases were attributed to prostate cancer if a urologist reported prostate cancer progression to bone or advancement to stage M1b, the patient had a positive bone scan, or the patient underwent radiation to treat bone metastases. Cause of death was determined by the registry data coordinating center and confirmed by state death certificate or the National Center for Health Statistics National Death Index. For analyses focused on clinical progression, participants were administratively censored at their last known clinical follow-up date up until January 31, 2019.

Prostate cancer–specific mortality was our secondary outcome, given the small number of prostate cancer–specific mortality events in this cohort. For these analyses, participants with a last known clinical follow-up date beyond December 30, 2020 (last National Death Index search), were administratively censored on December 30, 2020.

Medians and IQRs were calculated for continuous patient and clinical characteristics, and number and percentage was calculated for categorical characteristics, overall and by quintile, of the index scores. Median and IQR consumption of the 18 individual food groups were also computed in servings per day.

Pearson correlation coefficient was used to describe the correlation between the PDI and hPDI. We used Cox proportional hazards models and cause-specific models to evaluate the associations between the PDIs and the risk of prostate cancer progression and prostate cancer–specific mortality, respectively. All models were clustered by CaPSURE clinical site, with robust standard errors used to calculate 95% CIs. Simple models were adjusted for days from diagnosis to FFQ, age at diagnosis (years), year of diagnosis, and total energy intake (kcal). In the full multivariable models, we additionally adjusted for clinical T-stage (T1, T2, T3a), Gleason score (<7, 7, >7), and PSA (≤6, >6 to 10, >10 ng/mL) at diagnosis, primary treatment (radical prostatectomy, radiation, hormonal therapy, watchful waiting or active surveillance, other); self-reported race and ethnicity; smoking status (current, former, never); walking pace (<2, 2 to <3, 3 to <4, >4 mph, unable), and body mass index. Race and ethnicity were self reported and categorized as African American, Asian or Pacific Islander, Latino, multiple, Native American, White, and unknown; race and ethnicity were used in adjustment as White or other. Race and ethnicity were included in analysis because they are strongly associated with prostate cancer outcomes. Additional covariates, including diabetes, family history of prostate cancer, household income, education level, height, alcohol use, multivitamin use, calcium supplement use, and selenium supplement use, were considered but did not meaningfully change results, so they were not included in final models. Log-minus-log plots and Schoenfeld tests were used to test the proportional hazards assumption, and Martingale residuals and smoothing were used to assess the linearity of predictors assumption. Contrast analyses were used to assess for linear trends.

In secondary analyses, we examined each of the 3 food groups comprising the indices (healthful, unhealthful, animal) in association with prostate cancer progression. We also explored potential modification by walking pace (<3 vs ≥3 mph), age (<65 years vs ≥65 years), stage (T1, T2, or T3a), PSA (<6, 6-10, or >10 ng/mL), and Gleason grade at diagnosis (<7, ≥7). To evaluate the significance of interactions between the PDI or hPDI and these variables, we used separate multivariable models including cross product terms between the index and effect modifier of interest. We then used likelihood ratio tests to compare models with and without these interaction terms. For the covariates that demonstrated statistically significant interactions, stratified subgroup analyses were performed.

All analyses were performed in Stata software version 17 (StataCorp) using a 2-sided α = .05 to assess statistical significance. Data were analyzed from August 2022 to April 2023.

A total of 2891 participants completed at least 1 survey, and a total of 2062 participants (median [IQR] age at diagnosis, 65.0 [59.0-70.0] years) met the inclusion criteria; 61 (3%) identified as African American, 3 (<1%) identified as American Indian or Alaska Native, 9 (<1%) identified as Asian or Pacific Islander, 15 (1%) identified as Latino, and 1959 (95%) identified as White. Participant characteristics, overall and by quintile of the PDI and hPDI at baseline, are displayed in Table 1 . Compared with participants in the lowest PDI and hPDI quintile, participants in the highest quintile of PDI and hPDI had a faster walking pace, lower body mass index, and lower diagnostic PSA and were less likely to smoke ( Table 1 ). Participants in the highest PDI quintile consumed more calories than those in the lowest PDI quintile, whereas individuals in hPDI Q5 consumed fewer calories and were younger than those in Q1. Characteristics for participants in the prostate cancer–specific mortality analyses were nearly identical (eTable 1 in Supplement 1 ). PDI and hPDI scores were moderately positively correlated ( r = 0.34; P < .001). PDI scores ranged from 27 to 76, and hPDI scores ranged from 29 to 84.

Servings per day of individual dietary score components by lowest and highest quintile of PDI and hPDI are shown in Table 2 . Participants in the highest vs lowest quintile, consumed a mean of approximately 1.9 additional servings of vegetables, 1.6 additional servings of fruit, 0.9 more servings of whole grains, 1.0 less serving of dairy, 0.4 less servings of animal fat, slightly less egg, and marginally less meat ( Table 2 ).

Table 3 shows hazard ratios (HRs) and 95% CIs for associations between the PDIs and prostate cancer progression. Of 2062 participants who met the inclusion criteria for the primary end point analyses, we observed 190 progression events (170 participants with biochemical recurrence, 7 participants with bone metastases, and 13 deaths related to prostate cancer; there were no secondary treatment events that were not preceded by 1 of the other outcomes) as the first recorded event over a median (IQR) follow-up of 6.5 (1.3-12.8) years after FFQ completion. In the fully adjusted models, participants in the highest quintile of PDI had a 47% lower risk of progression compared with individuals in the lowest quintile (HR, 0.53; 95% CI, 0.37-0.74; P for trend = .003). In contrast, there was no evidence of an association with the hPDI (Q5 vs Q1: HR, 0.81; 95% CI, 0.54-1.20; P for trend = .34). There was no statistically significant difference in analysis in the healthful plant food group (Q5 vs Q1: HR , 0.58; 95% CI, 0.34-1.00; P for trend = .08) (eTable 2 in Supplement 1 ). No associations were seen between the unhealthful plant nor animal food groups with risk of prostate cancer progression.

The sample for our secondary analysis of prostate cancer–specific mortality included 2274 participants, with 61 prostate cancer–specific deaths and 302 other deaths. While there were no statistically significant associations between either dietary index and risk of prostate cancer–specific mortality ( Table 3 ), CIs were too wide to draw meaningful conclusions from point estimates (Q4 vs Q1: HR, 0.33; 95% CI, 0.14-0.78; Q5 vs Q1: HR, 0.53; 95% CI, 0.17-1.66; P for trend = .16).

For both indices, we found no evidence of interactions between age, PSA, stage at diagnosis, or walking pace. For hPDI, Gleason grade at diagnosis was associated with modifying the association of hPDI with prostate cancer progression ( P for interaction = .03). Among participants with Gleason grade 7 or higher, participants in the highest quintile had a 55% lower risk of progression compared with the lowest quintile (HR, 0.45; 95% CI, 0.25-0.81; P for trend = .01) (eTable 3 in Supplement 1 ). There was no statistically significant association in individuals with Gleason grade less than 7. We did not detect association modification by any factors for the associations of the indices with prostate cancer–specific mortality.

This longitudinal cohort study investigated associations of plant-based dietary patterns after a diagnosis of localized prostate cancer with risk of prostate cancer progression. We did not evaluate the unhealthful plant-based diet index, as it would not be recommended for improving health outcomes. We observed an association whereby individuals who scored the highest on the overall PDI had lower risk of prostate cancer progression compared with those who scored the lowest.

Our findings align with previous reports that plant-based diets may improve prostate cancer outcomes. For example, in a study that evaluated PDI in association with risk of incident prostate cancer (47 243 men followed up for 28 years), Loeb et al 16 reported that a higher PDI score was associated with 19% lower risk of incident prostate cancer that went on to be fatal (HR, 0.81; 95% CI, 0.64-1.01; P for trend = .04).

Our results contribute to the evolving body of research indicating the positive associations of plant-based diets with health outcomes. The PDI and its subindices were originally developed by Satija et al 2 , 3 to evaluate the associations of PDI with type 2 diabetes and coronary heart disease. Satija et al 2 , 3 found inverse associations between the overall PDI and hPDI for both outcomes. For PDI, other studies have observed a lower risk for diabetes, 5 cardiovascular disease risk, 23 cardiovascular mortality, 6 , 23 and total mortality. 6 , 23 For hPDI, studies have reported lower risk for diabetes, 5 cardiovascular disease risk, 4 cardiovascular mortality, 6 and total mortality. 4 , 6 These results are important in the context of localized prostate cancer, where men are more likely to die from these chronic diseases than their cancer.

We did not observe statistically significant associations for hPDI. Inconsistencies between the hPDI and overall PDI have been noted by others as well. In a 2022 study, Loeb et al 16 observed associations between PDI and risk of developing fatal prostate cancer, whereas associations for hPDI were only seen for risk of developing localized prostate cancer. A study by Kim et al 23 also reported statistically significant associations of PDI, but not hPDI, with risk of CVD. 23 It may be that because the distribution of hPDI was relatively compressed compared with the distribution of PDI, the variance of the estimator increased corresponding with the association of hPDI. There were modest differences in servings per day between highest and lowest categories of fruit juice, refined grains, and sweets and desserts—all of which are categorized with equal weighting into the unhealthful food group and run in opposite directions for the PDI vs hPDI. Moreover, when looking at the healthful, unhealthful, and animal components of the subindices separately, there was no association with the unhealthful component with prostate cancer progression. Perhaps classifying some of these unhealthful plant foods as “bad actors” in the absence of an established detrimental association specifically with prostate cancer outcomes have attenuated the findings for hPDI. For PDI, we observed that people in Q5 (compared with Q1) consumed a mean of an additional 0.9 to 1.9 servings per day of healthful plant foods (particularly vegetables, fruits, and whole grains), while they consumed 0.3 to 1.0 fewer servings per day of animal products (particularly dairy, animal fat, and egg). These particular healthful foods have been associated with reduced risk in prostate cancer outcomes. 24 - 26 While the similar consumption of fish and seafood, meat, and miscellaneous animal products among the extreme quintiles were unexpected, these results suggest that slightly reducing intake of animal products and placing more emphasis on more nutrient-dense plant-based foods may be advantageous.

Previous studies suggest several mechanisms through which plant-based diets may improve prostate cancer outcomes. Fruits and vegetables contain a variety of phytochemicals, including antioxidants and anti-inflammatory compounds, that have been shown to protect against prostate cancer. 24 , 26 , 27 Plant foods are also a source of dietary fiber, which may promote satiety and regulate blood glucose levels. 28 In addition, animal-based foods (including meat and dairy) have been associated with increased exposure to potentially harmful substances, such as hormones and heterocyclic amines. 29 - 31 High intake of red and processed meats has been associated with increased insulin resistance and insulin-like growth factor-1, which have been linked to increased prostate cancer risk and potentially mortality. 32 - 37 Furthermore, milk and dairy (a primary source of insulin-like growth factor-1), have been associated with increased risk of prostate cancer 37 - 41 ; whole milk, in particular, has been associated with increased risk of prostate cancer recurrence. 38

There are several limitations to the study. First, measurement error is a known limitation of self-reported data, including nutritional information. However, the FFQ used in this cohort has been validated, and the dietary data were collected prior to events of progression. Therefore, we expect measurement error in dietary intakes to be comparable in participants who experienced an event and those who did not. Second, even participants in the highest quintile of PDI consumed meat and dairy products; therefore we are unable to assess the associations of fully plant-based diets (eg, vegan, vegetarian). Third, the CaPSURE registry also is comprised of primarily of college-educated White men, which limits generalizability. Fourth, given that this was an observational study, we could not control for any unknown or unmeasured confounders. Other healthy behaviors and social determinants of health may be common causes of consuming more plant-based food and risk of prostate cancer progression. However, adjustment for income and education did not alter associations. Additionally, we were unable to adjust for prediagnostic diet in this cohort, so cannot conclude that the results are independent of prediagnostic exposure. Conversely, this study has several notable strengths, including a well-characterized cohort with extensive clinical follow-up and detailed diet data, as well as being the first to examine PDI and oncologic outcomes after prostate cancer diagnosis, to our knowledge.

The findings of this cohort study suggest that plant-based dietary patterns may be inversely associated with risk of prostate cancer progression, although future research and replication of our findings is needed. These data are consistent with prior research demonstrating the importance of dietary factors in overall health and well-being.

Accepted for Publication: March 1, 2024.

Published: May 1, 2024. doi:10.1001/jamanetworkopen.2024.9053

Corresponding Author: Stacey A. Kenfield, ScD, Department of Urology, University of California, San Francisco, 550 16th St, 6th Floor, San Francisco, CA 94158 ( [email protected] ).

Author Contributions: Drs Liu and Kenfield had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Liu, Van Blarigan, Kenfield.

Acquisition, analysis, or interpretation of data: Liu, Van Blarigan, Zhang, Graff, Loeb, Langlais, Cowan, Carroll, Chan, Kenfield.

Drafting of the manuscript: Liu.

Critical review of the manuscript for important intellectual content: Liu, Van Blarigan, Zhang, Graff, Loeb, Langlais, Cowan, Carroll, Chan, Kenfield.

Statistical analysis: Liu, Zhang, Kenfield.

Obtained funding: Chan.

Administrative, technical, or material support: Langlais, Cowan, Carroll, Kenfield.

Supervision: Van Blarigan, Loeb, Kenfield.

Conflict of Interest Disclosures: Dr Van Blarigan reported serving as an advisor or reviewer for the American Institute for Cancer Research and Fight Colorectal Cancer outside the submitted work. Dr Zhang reported receiving personal fees from Smith-Kettlewell Eye Research Institute outside the submitted work. Dr Graff reported receiving personal fees from Hunton Andrews Kurth LLP outside the submitted work. Dr Loeb reported a family member owning equity in Gilead Sciences outside the submitted work. Dr Chan and Dr Kenfield reported receiving research support from Veracyte in the form of analysis of some biospecimens without charges outside the submitted work. Dr Kenfield reported receiving personal fees from Fellow Health outside the submitted work. No other disclosures were reported.

Funding/Support: Dr Graff is supported by a Young Investigator Award from the Prostate Cancer Foundation. Dr Loeb is supported by the New York State Department of Health, and by Tricia and Michael Berns. Dr Chan is supported by the Steven & Christine Burd Safeway Distinguished Professorship. Dr Kenfield is supported by the Helen Diller Family Chair in Population Science for Urologic Cancer. The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) has been supported by grants from the Department of Defense (grant No. W81XWH-13-2-0074 and W81XWH-04-1-0850), Prostate Cancer Foundation, TAP Pharmaceuticals, National Cancer Institute Cancer Center Support (grant No. P30 CA 82103-18), and the Goldberg Benioff Program in Translational Cancer Biology.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

Additional Contributions: We thank the CaPSURE participants for making this research possible, and the research team who diligently worked on ensuring data quality.

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Journal of Materials Chemistry C

Optical up-conversion devices based on organic and inorganic quantum dots materials.

Infrared to visible up-conversion devices made by incorporating infrared detector with visible emitting unit are able to direct-ly convert infrared light into visible light. They are currently of great significance in engineering monitoring, medical imaging and night vision imaging applications. The up-conversion devices without complex readout circuits can be fabricated entirely by organic or inorganic materials, additionally organic/inorganic hybrid devices have also been accomplished. Strong absorp-tion of infrared light and efficient emission of visible light can be achieved by novel infrared up-conversion devices based on organic emitting units and inorganic quantum dots photodetectors. Organic/inorganic up-conversion devices act as an effec-tive substitute for the previous infrared imagers that consist of traditional semiconductor photodiode arrays connected with readout circuits. In this review, which is the first of its kind, the characteristics and design principles of up-conversion device are described. The merits and defects of up-conversion devices with all kinds of semiconductor materials are analyzed. Final-ly, the challenges and opportunities encountered by these materials and devices are summarized.

This article is part of the themed collection: Journal of Materials Chemistry C Recent Review Articles

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J. Xiao, Z. Yin, Z. Tang, Z. Gao, L. Zhang and J. Ren, J. Mater. Chem. C , 2024, Accepted Manuscript , DOI: 10.1039/D4TC00083H

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How to Write a Journal Article from a Thesis

Thesis Characteristics:

Journal Article Characteristics:

Converting your thesis to a journal article may be complex, but it’s not impossible.

1. Identify the best journal for your work

2. Shorten the length of your thesis

3. Reformat the introduction as an abstract

4. Modify the introduction

5. Tighten the methods section

6. Report main findings in the results

7. Discussion must be clear and concise

8. Limit the number of references

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How to Turn Your Thesis Into a Journal Article

Characteristics of a Thesis and a Journal Article

Turning Thesis Research to Journal Article

1. Identify a Suitable Journal

2. Reduce Redundant Length of Your Thesis

3. Modify Introduction as Abstract

4. Focus on Relevant and Selective Information

5. Limit the Number of References

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Writing a compelling integrated discussion: a guide for integrated discussions in article-based theses and dissertations

Writing a compelling integrated discussion: a guide for integrated discussions in article-based theses and dissertations

Introduction

Writing an integrated discussion chapter

Step 2. Mapping individual articles’ findings to inform the integrated discussion

Step 3. Drafting the main integrated discussion points

Step 4. Writing the integrated discussion chapter

Lessons learned

Lesson 1. Use stepwise approach with templates to plan and structure the chapter

Lesson 2. Think ahead

Lesson 3. Dedicate sufficient time

Lesson 4. Consider theoretical and methodological implications

Lesson 5. An integrated discussion is feasible with one article

Lesson 6. Integrated discussions are publishable

Lesson 7. Integrated discussions can lay the foundation for subsequent research

Acknowledgments

Supplementary Materials

Journal and Issue

Writing Your Doctoral Thesis with Style

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Guidelines for the introductory chapter of article-based theses at the Faculty of Humanities

Introductory chapter

Introduction

Research status

Theoretical framework

Methodology

Discussion and conclusion

Reference list

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