Seeking constructive alignment of assessment in teacher education: locating the reflection in reflective writing

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Doctor in EducationThe aim of this thesis is to promote a dialogue about constructive alignment (Biggs, 1996) with a particular focus on the use of reflective writing as an assessed task in courses of teacher education and the influence it has, or does not have, on teacher reflection and/or in improving practice. The work is set against a national context in which time to reflect is being written out of teacher education as a consequence of policy which locates ‘training’ to teach increasingly within the busy-ness of school life. Persuaded by principles of constructive alignment and, therefore, troubled by student teachers’ perceptions of complex assignments which appear to have little relevance to their practice as teachers, I have undertaken an action research study (McAteer, 2013; Norton, 2009; and Wells, 2001), beginning with a conviction that it is possible to design assessment tasks which truly integrate professional and academic requirements and influence the learning activity of student teachers in ways which are meaningful for their development as teachers. Using an adaptation of the Ward and McCotter (2004) ‘Reflection Rubric’ to locate characteristics of reflection within the reflective writing submitted for assessment, the study evaluated the relationship between written reflection and academic and professional attainment and found little evidence that engagement in the reflective writing assignment had contributed to the participants’ development as teachers. I conclude that the assessment strategies of students and of the course had been either not aligned or destructively aligned. The thesis narrates my journey to the adoption of a socio-constructivist perspective, leading to greater insight into the relationship between established assessment practice and the learning activity of student teachers, and a questioning of my practice. Crucially, the notion of a ‘framework for assessment’ is broadened to encompass all assignment-related activity, the people involved and the timeframe, in addition to the task and criteria. I conclude by identifying a desire to know more about the national view of assessment in teacher education, seeking a network of colleagues in order to explore ways in which counterparts in other institutions are supporting student teachers to develop reflective practice and assess reflective writing

Recruiting in surgical trial in the emergency setting: understanding clinician and patient perspectives: a mixed methods study

Background. Undertaking randomised controlled trials (RCT) in emergency surgical setting is associated with methodological and practical challenges. This study explored patients and clinicians’ perspectives associated with the conduct of a RCT comparing laparoscopic and open colorectal surgery in the acute setting.Method. All eligible patients screened/enrolled for the ‘Laparoscopic versus Open Colorectal Surgery in the Acute Setting multicentre, randomised controlled feasibility (LaCeS) trial’ in five NHS Trusts were invited to respond to a survey. Also, patients and healthcare professionals were invited to take part in semi-structured interviews. Survey and interviews explored acceptability of the feasibility trial. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Survey data were analysed descriptively to assess patient views of the trial and intervention. Results. Out of 72 patients enrolled for the LaCeS RCT, survey data was collected from 28 patients (38.9%), and interviews were conducted with 16 patients and 14 healthcare professionals. Thirteen out of 28 patients (46%) had treatment preferences but these were not strong enough to deter participation. Twelve of the patients interviewed believed their surgeon preferred laparoscopic surgery, but this did not deter them from participating in the trial. Half of the surgeons interviewed expressed the view that laparoscopic surgery was of benefit in this setting, but recognised that the need for research evidence outweighed their personal treatment preferences. Eight of the 14 recruiters reported that the emergency setting affected recruitment, especially in centres with fewer recruiting surgeons. Interviewees reported that recruitment was helped significantly by using surgical trainees to consent patients. Conclusion. This study identified specific challenges for the LaCeS2 trial design to address, and adds to our understanding of recruiting to emergency surgical trials more broadly

Reduced LIMK2 expression in colorectal cancer reflects its role in limiting stem cell proliferation

Objective: Colorectal cancer (CRC) is a major contributor to cancer mortality and morbidity. LIM kinase 2 (LIMK2) promotes tumour cell invasion and metastasis. The objectives of this study were to determine how LIMK2 expression is associated with CRC progression and patient outcome, and to use genetically modified Drosophila and mice to determine how LIMK2 deletion affects gastrointestinal stem cell regulation and tumour development.<p></p> Design: LIMK2 expression and activity were measured by immunostaining tumours from CRC-prone mice, human CRC cell lines and 650 human tumours. LIMK knockdown in Drosophila or Limk2 deletion in mice allowed for assessment of their contributions to gastrointestinal stem cell homeostasis and tumour development.<p></p> Results: LIMK2 expression was reduced in intestinal tumours of cancer-prone mice, as well as in human CRC cell lines and tumours. Reduced LIMK2 expression and substrate phosphorylation were associated with shorter patient survival. Genetic analysis in Drosophila midgut and intestinal epithelial cells isolated from genetically modified mice revealed a conserved role for LIMK2 in constraining gastrointestinal stem cell proliferation. Limk2 deletion increased colon tumour size in a colitis-associated colorectal mouse cancer model.<p></p> Conclusions: This study revealed that LIMK2 expression and activity progressively decrease with advancing stage, and supports the hypothesis that there is selective pressure for reduced LIMK2 expression in CRC to relieve negative constraints imposed upon gastrointestinal stem cells.<p></p&gt

Liver resection surgery compared with thermal ablation in high surgical risk patients with colorectal liver metastases: the LAVA international RCT.

BACKGROUND: Although surgical resection has been considered the only curative option for colorectal liver metastases, thermal ablation has recently been suggested as an alternative curative treatment. There have been no adequately powered trials comparing surgery with thermal ablation. OBJECTIVES: Main objective - to compare the clinical effectiveness and cost-effectiveness of thermal ablation versus liver resection surgery in high surgical risk patients who would be eligible for liver resection. Pilot study objectives - to assess the feasibility of recruitment (through qualitative study), to assess the quality of ablations and liver resection surgery to determine acceptable standards for the main trial and to centrally review the reporting of computed tomography scan findings relating to ablation and outcomes and recurrence rate in both arms. DESIGN: A prospective, international (UK and the Netherlands), multicentre, open, pragmatic, parallel-group, randomised controlled non-inferiority trial with a 1-year internal pilot study. SETTING: Tertiary liver, pancreatic and gallbladder (hepatopancreatobiliary) centres in the UK and the Netherlands. PARTICIPANTS: Adults with a specialist multidisciplinary team diagnosis of colorectal liver metastases who are at high surgical risk because of their age, comorbidities or tumour burden and who would be suitable for liver resection or thermal ablation. INTERVENTIONS: Thermal ablation conducted as per local policy (but centres were encouraged to recruit within Cardiovascular and Interventional Radiological Society of Europe guidelines) versus surgical liver resection performed as per centre protocol. MAIN OUTCOME MEASURES: Pilot study - patients' and clinicians' acceptability of the trial to assist in optimisation of recruitment. Primary outcome - disease-free survival at 2 years post randomisation. Secondary outcomes - overall survival, timing and site of recurrence, additional therapy after treatment failure, quality of life, complications, length of hospital stay, costs, trial acceptability, and disease-free survival measured from end of intervention. It was planned that 5-year survival data would be documented through record linkage. Randomisation was performed by minimisation incorporating a random element, and this was a non-blinded study. RESULTS: In the pilot study over 1 year, a total of 366 patients with colorectal liver metastases were screened and 59 were considered eligible. Only nine participants were randomised. The trial was stopped early and none of the planned statistical analyses was performed. The key issues inhibiting recruitment included fewer than anticipated patients eligible for both treatments, misconceptions about the eligibility criteria for the trial, surgeons' preference for one of the treatments ('lack of clinical equipoise' among some of the surgeons in the centre) with unconscious bias towards surgery, patients' preference for one of the treatments, and lack of dedicated research nurses for the trial. CONCLUSIONS: Recruitment feasibility was not demonstrated during the pilot stage of the trial; therefore, the trial closed early. In future, comparisons involving two very different treatments may benefit from an initial feasibility study or a longer period of internal pilot study to resolve these difficulties. Sufficient time should be allowed to set up arrangements through National Institute for Health Research (NIHR) Research Networks. TRIAL REGISTRATION: Current Controlled Trials ISRCTN52040363. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 21. See the NIHR Journals Library website for further project information

Interplay in galectin expression predicts patient outcomes in a spatially restricted manner in PDAC

BACKGROUND: Galectins (Gal's) are a family of carbohydrate-binding proteins that are known to support the tumour microenvironment through their immunosuppressive activity and ability to promote metastasis. As such they are attractive therapeutic targets, but little is known about the cellular expression pattern of galectins within the tumour and its neighbouring stromal microenvironment. Here we investigated the cellular expression pattern of Gals within pancreatic ductal adenocarcinoma (PDAC).METHODS: Galectin gene and protein expression were analysed by scRNAseq (n=4) and immunofluorescence imaging (n=19) in fibroblasts and epithelial cells of pancreatic biopsies from PDAC patients. Galectin surface expression was also assessed on tumour adjacent normal fibroblasts and cancer associated primary fibroblasts from PDAC biopsies using flow cytometry.RESULTS: scRNAseq revealed higher Gal-1 expression in fibroblasts and higher Gal-3 and -4 expression in epithelial cells. Both podoplanin (PDPN+, stromal/fibroblast) cells and EpCAM+ epithelial cells expressed Gal-1 protein, with highest expression seen in the stromal compartment. By contrast, significantly more Gal-3 and -4 protein was expressed in ductal cells expressing either EpCAM or PDPN, when compared to the stroma. Ductal Gal-4 cellular expression negatively correlated with ductal Gal-1, but not Gal-3 expression. Higher ductal cellular expression of Gal-1 correlated with smaller tumour size and better patient survival. CONCLUSIONS: In summary, the intricate interplay and cell-specific expression patterns of galectins within the PDAC tissue, particularly the inverse correlation between Gal-1 and Gal-4 in ducts and its significant association with patient survival, highlights the complex molecular landscape underlying PDAC and provides valuable insights for future therapeutic interventions.</p