Are you a Civil Servant? Discover your colleague’s opinion on the LSE Executive Master of Public Policy

As part of the drive to professionalise policymaking, Civil Service Learning has partnered with the London School of Economics and Political Science to run a bespoke Executive Master of Public Policy programme. The programme is designed to equip civil servants with the cutting-edge analytical tools required to deliver effective policy in an increasingly complex and inter-dependent world. Here, Rhiannon Harries and Emily Bourne, two DECC participants in the first cohort, share their early insights on the programme, which started in December 2015

Biological cell–substrate interactions with few-layered nanomaterials

Biology, fundamental to understanding life, remains a vitally important area of research. There is still much left for humankind to understand even after decades of research. This is clear now more than ever; as I write this, research has been disrupted for about 12 months due to various COVID-19 restrictions. Biology, therefore, is ripe for the fresh, new advances that result from interdisciplinary collaboration. Recent years have seen the exciting development of new few-layered materials, providing new possibilities in biology, as well as other areas. To this end, the work presented herein considers the interactions between different cell lines and various synthesised nanomaterial substrates. To distinguish effects due to the inherent biology of the cell and effects due to the nanomaterial substrate, well-defined substrates are crucial to interdisciplinary research. Thin films created by the Langmuir–Schaefer (L–S) deposition technique are a good candidate. This technique provides an easily controllable method of producing single-layer substrates. Here, a method resulting in improved understanding of the physical and chemical influences on L–S film formation is described. Surface pressure-surface coverage data can be normalised to nanosheet size to account for edge effects. This new approach allows the L–S film density to be determined from standard dispersion properties alone. In addition, this work produced the first demonstration of the production of single layer hexagonal boron nitride films using this method. To test nanomaterial–cellular interactions, various cell lines were seeded onto MoS2 L–S substrates. To the best of our knowledge, this study resulted in the first demonstration of the internalisation of MoS2 through mechanotransduction. The material showed localisation to the endoplasmic reticulum, which combined with the innate fluorescence or Raman signal of the MoS2 nanosheet, could lead to a new theranostic tool. This study was expanded to consider cell interactions with other transition metal dichalcogenide materials, WS2 and MoSe2, to investigate the difference between structure and chemistry seen by the cell. This work provides a step change to studying nanomaterial–cellular interactions, opening the door to new therapies and diagnostics

The clinical relevance of pigment epithelium3 derived factor(PEDF)in wound healing and colorectal cancer

There are similarities between tissue repair and cancer development. Epithelial tumours promote the formation of the stroma by activation of the wound healing process, but unlike healing wounds the process is not self-limiting. Pigment epithelium derived factor(PEDF)is a secreted glycoprotein that has been shown to exhibit multiple biological properties including anti-angiogenesis, anti-tumorigenesis and immune-modulation. Previous studies demonstrated that PEDF expression is downregulated as prognostic factors worsen in a range of cancers and chronic inflammatory conditions and treatment with recombinant PEDF has showed some benefit in cellular functional models. However, there has been little evidence to date to assess the role of PEDF in colorectal cancer and wound healing. The aims of this study were to elucidate more detailed regulatory mechanisms of PEDF in wound healing, and tumour angiogenesis in colorectal cancer and provide evidence to develop PEDF or its fragments as therapeutics for wound healing or colorectal cancer treatment. This study found that PEDF expression was down regulated in colorectal cancer cell lines and tissue and that treatment with recombinant PEDF resulted in significant decreases in the rate of colorectal cancer cellular migration and invasion and an increase in cellular adhesion in some colorectal cancer cell lines examined, suggesting a promising role of the treatment of PEDF in the prevention of colorectal cancer metastatic spread. Within wound healing, our results indicated that PEDF expression was high amongst dermal fibroblasts but less so in keratinocytes and endothelial cell lines, suggesting that fibroblasts are responsible for secretion of PEDF in response to inflammation. In cellular functional models, recombinant PEDF treatment significantly increased the migration of keratinocytes, suggesting a possible role as a chronic wound treatment. Further studies are warranted to assess the role of PEDF in a range of colorectal cancer subsets, other wound healing cells and animal models to identify a suitable delivery vector

Less Than Full-time Training in surgical specialities: Consensus recommendations for flexible training by the Association of Surgeons in Training

AbstractChanges in lifestyle, career expectations, and working environments, alongside the feminisation of the workforce have resulted in an increased demand for Less Than Full-time Training (LTFT) within surgery. However, provision of and adequacy of flexible training remain variable. It is important that LTFT options are provided to ensure surgery is an attractive and viable career option, and can compete with other specialties to attract and retain the best candidates to maintain high standards of patient care. LTFT options should be readily available to both genders within surgical specialities. Furthermore, improved information for those considering LTFT should be available, locally, regionally and nationally. Training within LTFT posts should be tailored to the training requirements of the individual, in order to achieve the competencies necessary for completion of training. The recommendations set out in this consensus statement should inform the trainee's position and help guide discussions with respect to the provision of LTFT within surgery

The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials

BACKGROUND: Simulation training can improve the learning curve of surgical trainees. This research aimed to systematically review randomized clinical trials (RCT) evaluating the performance of junior surgical trainees following virtual reality training (VRT) and other training methods in laparoscopic cholecystectomy. METHODS: MEDLINE (PubMed), Embase (Ovid SP), Web of Science, Scopus and LILACS were searched for trials randomizing participants to VRT or no additional training (NAT) or simulation training (ST). Outcomes of interest were the reported performance using global rating scores (GRS), the Objective Structured Assessment of Technical Skill (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS), error counts and time to completion of task during laparoscopic cholecystectomy on either porcine models or humans. Study quality was assessed using the Cochrane Risk of Bias Tool. PROSPERO ID: CRD42020208499. RESULTS: A total of 351 titles/abstracts were screened and 96 full texts were reviewed. Eighteen RCT were included and 15 manuscripts had data available for meta-analysis. Thirteen studies compared VRT and NAT, and 4 studies compared VRT and ST. One study compared VRT with NAT and ST and reported GRS only. Meta-analysis showed OSATS score (mean difference (MD) 6.22, 95%CI 3.81 to 8.36, P < 0.001) and time to completion of task (MD -8.35 min, 95%CI 13.10 to 3.60, P = <0.001) significantly improved after VRT compared with NAT. No significant difference was found in GOALS score. No significant differences were found between VRT and ST groups. Intraoperative errors were reported as reduced in VRT groups compared with NAT but were not suitable for meta-analysis. CONCLUSION: Meta-analysis suggests that performance measured by OSATS and time to completion of task is improved with VRT compared with NAT for junior trainee in laparoscopic cholecystectomy. However, conclusions are limited by methodological heterogeneity and more research is needed to quantify the potential benefit to surgical training

Variations in competencies needed to complete surgical training

Background This study aimed to analyse the degree of relative variation in specialty‐specific competencies required for certification of completion of training (CCT) by the UK Joint Committee on Surgical Training. Methods Regulatory body guidance relating to operative and non‐operative surgical skill competencies required for CCT were analysed and compared. Results Wide interspecialty variation was demonstrated in the required minimum number of logbook cases (median 1201 (range 60–2100)), indexed operations (13 (5–55)), procedure‐based assessments (18 (7–60)), publications (2 (0–4)), communications to learned associations (0 (0–6)) and audits (4 (1–6)). Mandatory courses across multiple specialties included: Training the Trainers (10 of 10 specialties), Advanced Trauma Life Support (6 of 10), Good Clinical Practice (9 of 10) and Research Methodologies (8 of 10), although no common accord was evident. Discussion Certification guidelines for completion of surgical training were inconsistent, with metrics related to minimum operative caseload and academic reach having wide variation

Hughes Abdominal Repair Trial (HART)—abdominal wall closure techniques to reduce the incidence of incisional hernias: feasibility trial for a multicentre, pragmatic, randomised controlled trial

Objectives Incisional hernias are common complications of midline abdominal closure. The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. There is evidence to suggest this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared Hughes repair with standard mass closure for the prevention of incisional hernia formation. This paper aims to test the feasibility of running a randomised controlled trial of a comparison of abdominal wall closure methods following midline incisional surgery for colorectal cancer, in preparation to a definitive randomised controlled trial. Design and setting A feasibility trial (with 1:1 randomisation) conducted perioperatively during colorectal cancer surgery. Participants Patients undergoing midline incisional surgery for resection of colorectal cancer. Interventions Comparison of two suture techniques (Hughes repair or standard mass closure) for the closure of the midline abdominal wound following surgery for colorectal cancer. Primary and secondary outcomes A 30-patient feasibility trial assessed recruitment, randomisation, deliverability and early safety of the surgical techniques used. Results A total of 30 patients were randomised from 43 patients recruited and consented, over a 5-month period. 14 and 16 patients were randomised to arms A and B, respectively. There was one superficial surgical site infection (SSI) and two organ space SSIs reported in arm A, and two superficial SSIs and one complete wound dehiscence in arm B. There were no suspected unexpected serious adverse reactions reported in either arm. Independent data monitoring committee found no early safety concerns. Conclusions The feasibility trial found no early safety concerns and demonstrated that the trial was acceptable to patients. Progression to the pilot and main phases of the trial has now commenced following approval by the independent data monitoring committee

Impact of pigment epithelium-derived factor on colorectal cancer in vitro and in vivo

Pigment epithelial derived factor (PEDF) is a secreted glycoprotein that is a non-inhibitory member of the serine protease inhibitor (serpin) family. PEDF exhibits multiple biological properties including neuroprotective, anti-angiogenic, and immune-modulating. Interestingly, PEDF exerts the inhibitory effects in cancers derived from certain tissues, including prostatic, ovarian, and pancreatic carcinomas. The current study aimed to elucidate its role in colorectal cancer development. PEDF expression in human colorectal cancer tissue was assessed using quantitative polymerase chain reaction (qPCR) and immunohistochemical staining (IHC). The effect of treatment with recombinant PEDF on cellular function was examined using in vitro functional assays. PEDF expression was downregulated in colorectal cancer cell tissue. Treatment with recombinant PEDF resulted in significant decreases in the rate of colorectal cancer cell migration and invasion and an increase in cellular adhesion in colorectal cancer cell lines examined. These results indicate that upregulation of PEDF expression may serve as a new strategy for further investigation of therapeutic relevance to the prevention of the metastatic spread of colorectal cancer

Healthy Hearts – A community-based primary prevention programme to reduce coronary heart disease

Background The ten year probability of cardiovascular events can be calculated, but many people are unaware of their risk and unclear how to reduce it. The aim of this study was to assess whether a community based intervention, for men and women aged between 45 and 64 years without pre-existing coronary heart disease, would reduce their Framingham scores when reassessed one year later. Methods Individuals in the relevant age group from a defined geographical area were sent an invitation to attend for an assessment of their cardiovascular risk. Individuals with pre-existing cardiovascular disease or terminal illness were excluded. The invitation was in the form of a "Many Happy Returns" card with a number of self-screening questions including the question, "If you put the enclosed string around your waist, is it too short?" The card contained a red 80 cm piece of string in the case of women, or a green 90 cm piece of string in the case of men. At the assessment appointment, Framingham scores were calculated and a printout was given to each individual. Advice was provided for relevant risk factors identified using agreed guidelines. If appropriate, onward referral was also made to a GP, dietician, an exercise referral scheme, or to smoking cessation services, using a set of guidelines. Individuals were sent a second invitation one year later to return for re-assessment. Results and discussion 2031 individuals were asked to self-assess their eligibility to participate, 596 individuals attended for assessment and 313 of these attended for follow-up one year later. The mean reduction in the Framingham risk score, was significantly lower at one year (0.876, 95% CI 0.211 to 1.541, p = 0.01). The mean 10-year risk of CHD at baseline was 13.14% (SD 9.18) and had fallen at follow-up to 12.34% (SD 8.71), a mean reduction of 6.7% of the initial 10-year Framingham risk. If sustained, the estimated NNT to prevent each year of CHD would be 1141 (95% CI 4739 to 649) individual appointments. Conclusion This community intervention for primary prevention of CHD reduces Framingham risk scores at one year in those who engage with the programme