Key challenges in bringing CRISPR-mediated somatic cell therapy into the clinic.

Genome editing using clustered regularly interspersed short palindromic repeats (CRISPR) and CRISPR-associated proteins offers the potential to facilitate safe and effective treatment of genetic diseases refractory to other types of intervention. Here, we identify some of the major challenges for clinicians, regulators, and human research ethics committees in the clinical translation of CRISPR-mediated somatic cell therapy

Transform Autism Education - Final Report

The Transform Autism Education (TAE) project focused on the domain of ‘good autism practice’ in the education of pupils with autism in the UK, Greece and Italy with the overall objectives to: • Research good autism practice in education. • Create professional development programmes in Greece and Italy. • Enhance the knowledge and practice of school staff. • Facilitate the inclusion of autistic children in primary schools in those countries. Funded by the European Commission through Erasmus Plus Key Action 2, Strategic Partnerships scheme, and led by Principal Investigator Dr. Karen Guldberg, the project involved a range of Greek, Italian and UK partners. It employed the Autism Education Trust (AET) collaborative training schemes in the UK as a founding model. While the requirements of each country were distinct, and so necessitated careful adaptations of the materials to their specific needs, what united all aspects of the project was a desire to improve the educational inclusion of autistic children, as well as their general experiences in school and their outcomes

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Seeing the action: neuropsychological evidence for action-based effects on object selection.

Previous studies have shown that selection for perceptual report is often limited to one object at a time, with elements being selected together if they belong to part of the same perceptual group. Here we used the neuropsychological phenomenon of extinction in human patients with parietal lesions to show that selection is influenced also by action relations between objects. Performance was better for objects that were positioned spatially so that they could be used together, relative to objects that were positioned inappropriately for their combined use. The action relation was critical, as performance for pictures did not improve if the items were only verbally associated. We found the opposite result with words. Effects of action relations emerged even on trials where only one object could be reported, showing implicit coding of 'action' units for selection. The effects of verbal associations may instead reflect priming between lexical entries

A review of the key issues associated with the commercialization of biobanks

This 'issues paper' was generated through a 'virtual workshop process' over the course of severalmonths.The authors first outlined relevant issues and key literature. A draft was then distributed, comments were received, and a revised draft was circulated among authors for approval.The use of a 'virtual workshop process' shaped both the tone and coverage of this article, though we hope in a way that still provides a detailed and useful summary of central issues on this topic.We believe that this paper-the collaborative work of globally situated ELSI researchers-exemplifies 'ELSI 2.0' (Jane Kaye et al., Research Priorities. ELSI 2.0 for Genomics and Society, 336 Science 673 (2012))