Networks as transnational agents of development

The term network has become a hallmark of the development industry. In principle networks have the potential to provide a more flexible and non-hierarchical means of exchange and interaction that is also more innovative, responsive and dynamic whilst overcoming spatial separation and providing scale economies. Although the label networks currently pervades discourses about the relationships between organisations in development, there has been surprisingly little research or theorisation of them. This article is a critical evaluation of the claims of developmental networks from a theoretical perspective. While networks are regarded as a counter hegemonic force we argue that networks are not static entities but must be seen as an ongoing and emergent process. Moreover theory overlooks power relationships within networks and is unable to conceptualise the relationship between power and values. These observations open up a research agenda that the authors are exploring empirically in forthcoming publications

Tweeting the meeting: Quantitative and qualitative twitter activity during the 38th ESSO conference

Introduction: Social media is increasingly used to share information with the potential for fast and wide reach. Data on use during surgical oncology conferences is limited. We aimed to monitor twitter usage during a surgical oncology conference to audit impact of activity. Methods: A prospective, time-restricted, observational study of twitter activity using the #ESSO38 hashtag in the week before and during the 38th ESSO conference (10–12 October 2018; Budapest, Hungary). Data on individual tweets and retweets, including date and tweeter or retweeter were collected using NodeXL, FollowTheHashtag, Twitonomy and TAGS. Results: The study period (10–13 October) documented 328 tweets by 58 tweeters with 1167 retweets, with a soaring activity and mentions during the conference days, with a potential reach at over 7.5 million. The nodal network of tweets, the most active tweeters and retweeters are presented as well as the most frequently used hashtags. The top 3 hashtags used were #ESSO38, #SoMe4Surgery# and #EYSAC. A positive influence on the @ESSOweb twitter handle was noted, with the numbers of followers growing from 1.5 K to over 1.8 K representing a 20% growth in just over a week. Conclusions: Activity on tweeter during the conference was considerable, with a potential for a wide reach beyond those attending the conference. A more structured approach to the use of twitter for future conferences may enhance experience, activity and reach.publishedVersio

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

Tweeting the meeting: Quantitative and qualitative twitter activity during the 38th ESSO conference.

Abstract Introduction Social media is increasingly used to share information with the potential for fast and wide reach. Data on use during surgical oncology conferences is limited. We aimed to monitor twitter usage during a surgical oncology conference to audit impact of activity. Methods A prospective, time-restricted, observational study of twitter activity using the #ESSO38 hashtag in the week before and during the 38th ESSO conference (10–12 October 2018; Budapest, Hungary). Data on individual tweets and retweets, including date and tweeter or retweeter were collected using NodeXL, FollowTheHashtag, Twitonomy and TAGS. Results The study period (10–13 October) documented 328 tweets by 58 tweeters with 1167 retweets, with a soaring activity and mentions during the conference days, with a potential reach at over 7.5 million. The nodal network of tweets, the most active tweeters and retweeters are presented as well as the most frequently used hashtags. The top 3 hashtags used were #ESSO38, #SoMe4Surgery# and #EYSAC. A positive influence on the @ESSOweb twitter handle was noted, with the numbers of followers growing from 1.5 K to over 1.8 K representing a 20% growth in just over a week. Conclusions Activity on tweeter during the conference was considerable, with a potential for a wide reach beyond those attending the conference. A more structured approach to the use of twitter for future conferences may enhance experience, activity and reach

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

LRRK1 regulation of actin assembly in osteoclasts involves serine 5 phosphorylation of L-plastin

Mice with disruption of Lrrk1 and patients with nonfunctional mutant Lrrk1 exhibit severe osteopetrosis phenotypes because of osteoclast cytoskeletal dysfunction. To understand how Lrrk1 regulates osteoclast function by modulating cytoskeleton rearrangement, we examined the proteins that are differentially phosphorylated in wild-type mice and Lrrk1-deficient osteoclasts by metal affinity purification coupled liquid chromatography/mass spectrometry (LC/MS) analyses. One of the candidates that we identified by LC/MS is L-plastin, an actin bundling protein. We found that phosphorylation of L-plastin at serine (Ser) residues 5 was present in wild-type osteoclasts but not in Lrrk1-deficient cells. Western blot analyses with antibodies specific for Ser5 phosphorylated L-plastin confirmed the reduced L-plastin Ser5 phosphorylation in Lrrk1 knockout (KO) osteoclasts. micro computed tomography (Micro-CT) analyses revealed that the trabecular bone volume of the distal femur was increased by 27% in the 16 to 21-week-old L-plastin KO females as compared with the wild-type control mice. The ratio of bone volume to tissue volume and connectivity density were increased by 44% and 47% (both P \u3c 0.05), respectively, in L-plastin KO mice. Our data suggest that targeted disruption of L-plastin increases trabecular bone volume, and phosphorylation of Ser5 in L-plastin in the Lrrk1 signaling pathway may in part contribute to actin assembly in mature osteoclasts

Successful ABO and HLA incompatible kidney transplantation in children in the UK

Background: There is increasing evidence of good short-term and medium-term outcomes of ABO incompatible (ABOi) and HLA incompatible (HLAi) kidney transplantation with pre-transplant positive crossmatches in paediatric practice. However, there remain concerns regarding the higher risks of infective complications and antibody-mediated rejections. The aim of our study is to show longer-term follow-up on all ABOi and HLAi paediatric kidney transplant recipients (pKTR) in the UK. / Methods: Questionnaires specifying kidney transplant type, desensitisation requirement and kidney allograft function were sent to 13 paediatric nephrology centres that performed kidney transplantation in children and young people under 18 years of age who received an ABOi and/or HLAi transplant between 1 January 2006 and 31 December 2016. Patient and kidney allograft survival were compared between ABOi, HLAi and ABO/HLA compatible (ABOc/HLAc) groups. / Results: Among 711 living donor kidney transplants performed in the UK, 23 were ABOi and 6 were HLAi. Patient survival was 87%, 100% and 96% in ABOi, HLAi and ABOc/HLAc groups, respectively, at median follow-up of 6.8 (3.6–14.0) years post-transplant. Death-censored kidney allograft survival was 100% in all 3 groups at last follow-up. There were no cases of primary non-function in ABOi or HLAi groups, but 2% in the ABOc/HLAc group. There was one reported case of Epstein-Barr viral-induced post-transplant lymphoproliferative disorder. / Conclusion: Longer term follow-up has shown that ABOi and HLAi kidney transplantation are feasible for pKTR where no compatible donors are available, and that minimising desensitisation should be achieved where possible

Surgical experience and identification of errors in laparoscopic cholecystectomy

BACKGROUND: Surgical errors are acts or omissions resulting in negative consequences and/or increased operating time. This study describes surgeon-reported errors in laparoscopic cholecystectomy. METHODS: Intraoperative videos were uploaded and annotated on Touch SurgeryTM Enterprise. Participants evaluated videos for severity using a 10-point intraoperative cholecystitis grading score, and errors using Observational Clinical Human Reliability Assessment, which includes skill, consequence, and mechanism classifications. RESULTS: Nine videos were assessed by 8 participants (3 junior (specialist trainee (ST) 3-5), 2 senior trainees (ST6-8), and 3 consultants). Participants identified 550 errors. Positive relationships were seen between total operating time and error count (r2 = 0.284, P < 0.001), intraoperative grade score and error count (r2 = 0.578, P = 0.001), and intraoperative grade score and total operating time (r2 = 0.157, P < 0.001). Error counts differed significantly across intraoperative phases (H(6) = 47.06, P < 0.001), most frequently at dissection of the hepatocystic triangle (total 282; median 33.5 (i.q.r. 23.5-47.8, range 15-63)), ligation/division of cystic structures (total 124; median 13.5 (i.q.r. 12-19.3, range 10-26)), and gallbladder dissection (total 117; median 14.5 (i.q.r. 10.3-18.8, range 6-26)). There were no significant differences in error counts between juniors, seniors, and consultants (H(2) = 0.03, P = 0.987). Errors were classified differently. For dissection of the hepatocystic triangle, thermal injuries (50 in total) were frequently classified as executional, consequential errors; trainees classified thermal injuries as step done with excessive force, speed, depth, distance, time or rotation (29 out of 50), whereas consultants classified them as incorrect orientation (6 out of 50). For ligation/division of cystic structures, inappropriate clipping (60 errors in total), procedural errors were reported by junior trainees (6 out of 60), but not consultants. For gallbladder dissection, inappropriate dissection (20 errors in total) was reported in incorrect planes by consultants and seniors (6 out of 20), but not by juniors. Poor economy of movement (11 errors in total) was reported more by consultants (8 out of 11) than trainees (3 out of 11). CONCLUSION: This study suggests that surgical experience influences error interpretation, but the benefits for surgical training are currently unclear