Audit of medical (non-targeted) liver biopsy specimen quality, pathology reporting and effect on patient management

Aims: To evaluate our medical liver pathology practice and its influence on patient management, using audit templates published by the UK Royal College of Pathologists (RCPath). Methods: We audited medical liver biopsies reported in our centre in 2019 using RCPath proformas. Data were collected from pathology reports and corresponding electronic patient record. Results: 60 cases were selected for audit from 135 eligible biopsies reported in 2019. 58/60 cases were core biopsies and 2/60 were laparoscopic wedge biopsies. 53/57 (93%) core biopsies with available data met RCPath adequacy criteria (length >15 mm and/or ≥6 portal tracts). Most reports (57/60; 95%) were judged to have helped patient management. 25/60 (42%) biopsy reports helped to clarify the clinical diagnosis and 48/60 (80%) led to altered management. Conclusions: We demonstrate the utility of the RCPath audit templates, highlighting the clinical value of medical liver biopsies in the diagnostic work-up and management of patients with liver disease

Emotional intelligence and British expatriates’ cross-cultural adjustment in international construction projects

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Today’s internationalized business demands global mindset, intercultural sensitivity and the ability to skilfully negotiate through cross-cultural interactions. Therefore, the overall aim was to investigate the influence of emotional intelligence (EI) on cross-cultural adjustment (CCA) of British expatriates working on International Architectural, Engineering and Construction assignments in Sub-Saharan Africa, China, Middle East and Indian Sub-Continent. Specifically, the causal relationship between EI and three facets of CCA i.e. work, general and interaction adjustment was explored. A sequential exploratory mixed methods design was adopted. These include extensive review of existing literature, eighteen unstructured interviews, and questionnaire survey of 191 British expatriates operating in 29 different countries from the four regions under investigation. Structural equation modelling was used to assess the causal relationship between EI and CCA. Results show that EI accounted for 91, 64 and 24% of the variance in work, interaction and general adjustment respectively. Overall, the model was able to explain 60% variance in CCA, suggesting that EI competencies play a huge role in facilitating an expatriate understand and adapt to host country culture. The findings would help decision-makers (HR managers) during expatriate selection process, in understanding that along with technical skills, it is the emotional competencies that are crucial in assisting expatriates adjust to foreign way of life

Relationship between immune checkpoint proteins, tumour microenvironment characteristics, and prognosis in primary operable colorectal cancer

The tumour microenvironment is an important factor for colorectal cancer prognosis, affecting the patient's immune response. Immune checkpoints, which regulate the immune functions of lymphocytes, may provide prognostic power. This study aimed to investigate the prognostic value of the immune checkpoints TIM‐3, LAG‐3 and PD‐1 in patients with stage I–III colorectal cancer. Immunohistochemistry was employed to detect TIM‐3, LAG‐3, PD‐1 and PD‐L1 in 773 patients with stage I–III colorectal cancer. Immune checkpoint protein expression was assessed in tumour cells using the weighted histoscore, and in immune cells within the stroma using point counting. Scores were analysed for associations with survival and clinical factors. High tumoural LAG‐3 (hazard ratio [HR] 1.45 95% confidence interval [CI] 1.00–2.09, p = 0.049) and PD‐1 (HR 1.34 95% CI 1.00–1.78, p = 0.047) associated with poor survival, whereas high TIM‐3 (HR 0.60 95% CI 0.42–0.84, p = 0.003), LAG‐3 (HR 0.58 95% CI 0.40–0.87, p = 0.006) and PD‐1 (HR 0.65 95% CI 0.49–0.86, p = 0.002) on immune cells within the stroma associated with improved survival, while PD‐L1 in the tumour (p = 0.487) or the immune cells within the stroma (p = 0.298) was not associated with survival. Furthermore, immune cell LAG‐3 was independently associated with survival (p = 0.017). Checkpoint expression scores on stromal immune cells were combined into a Combined Immune Checkpoint Stromal Score (CICSS), where CICSS 3 denoted all high, CICSS 2 denoted any two high, and CICSS 1 denoted other combinations. CICSS 3 was associated with improved patient survival (HR 0.57 95% CI 0.42–0.78, p = 0.001). The results suggest that individual and combined high expression of TIM‐3, LAG‐3, and PD‐1 on stromal immune cells are associated with better colorectal cancer prognosis, suggesting there is added value to investigating multiple immune checkpoints simultaneously

An integrated gene-to-outcome multimodal database for metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the commonest cause of chronic liver disease worldwide and represents an unmet precision medicine challenge. We established a retrospective national cohort of 940 histologically defined patients (55.4% men, 44.6% women; median body mass index 31.3; 32% with type 2 diabetes) covering the complete MASLD severity spectrum, and created a secure, searchable, open resource (SteatoSITE). In 668 cases and 39 controls, we generated hepatic bulk RNA sequencing data and performed differential gene expression and pathway analysis, including exploration of gender-specific differences. A web-based gene browser was also developed. We integrated histopathological assessments, transcriptomic data and 5.67 million days of time-stamped longitudinal electronic health record data to define disease-stage-specific gene expression signatures, pathogenic hepatic cell subpopulations and master regulator networks associated with adverse outcomes in MASLD. We constructed a 15-gene transcriptional risk score to predict future hepatic decompensation events (area under the receiver operating characteristic curve 0.86, 0.81 and 0.83 for 1-, 3- and 5-year risk, respectively). Additionally, thyroid hormone receptor beta regulon activity was identified as a critical suppressor of disease progression. SteatoSITE supports rational biomarker and drug development and facilitates precision medicine approaches for patients with MASLD

Big data innovation and diffusion in projects teams: Towards a conflict prevention culture

Despite the enormous literature on how team conflicts can be managed and resolved, this study diverges, by examining factors that facilitate conflict prevention culture in project teams, especially when introducing Big Data Technology. Relying on findings from relevant literatures and focus group discussions, 28 attributes for embedding conflict prevention culture were identified and put together in questionnaire survey. Series of statistical tests including reliability analysis and exploratory factor-analysis. The results identified five critical success factors for entrenching the culture of conflict prevention in project teams introducing big data driving innovations. The five-factor solution include “building effective relationship”, “effective project communications”, “project team efficacy”, “pro-active conflict management approach” and “effectual project documentation”. Result of this study presents a Conceptual framework for effective management of human resource in relation to conflict prevention among project teams, as an effective strategy for facilitating seamless adoption and diffusion of big data innovation in organisations

SteatoSITE: an Integrated Gene-to-Outcome Data Commons for Precision Medicine Research in NAFLD

Nonalcoholic fatty liver disease (NAFLD) is the commonest cause of chronic liver disease worldwide and a growing healthcare burden. The pathobiology of NAFLD is complex, disease progression is variable and unpredictable, and there are no qualified prognostic biomarkers or licensed pharmacotherapies that can improve clinical outcomes; it represents an unmet precision medicine challenge. We established a retrospective multicentre national cohort of 940 patients, across the complete NAFLD spectrum, integrating quantitative digital pathology, hepatic RNA-sequencing and 5.67 million days of longitudinal electronic health record follow-up into a secure, searchable, open resource (SteatoSITE) to inform rational biomarker and drug development and facilitate personalised medicine approaches for NAFLD. A complementary web-based gene browser was also developed. Here, our initial analysis uncovers disease stage-specific gene expression signatures, pathogenic hepatic cell subpopulations and master regulator networks associated with disease progression in NAFLD. Additionally, we construct novel transcriptional risk prediction tools for the development of future hepatic decompensation events

Factors Influencing the Implementation of Site Waste Management Plans on UK Projects of all sizes

The purpose of this research is to identify and assess the opportunities and challenges of implementing a Site Waste Management Plan (SWMP) on projects irrespective of size. In the UK, construction and demolition waste accounts for a third of all UK waste. There are a number of factors that influence the implementation of SWMPs. In order to identify and analyse these factors, 4 unstructured interviews were carried out and a sample of 56 participants completed a questionnaire survey. The scope of the study was limited to UK construction industry professionals. The analysis revealed that more needs to be done if the industry is to meet government targets of reduction in construction related waste going to landfill. In addition, although SWMP may not yet be legally required on all construction projects, clients and contractors need to realise the benefits to cut costs and implement best practice by adopting a SWMP. The benefits of implementing a SWMP will not only help to achieve this but also gain significant cost savings on projects and is also extremely beneficial to the environment. This study presents evidence that contractors need to do more to reduce waste and draws a clear link between waste reduction and the implementation of SWMPs. The findings are useful in the ongoing efforts to encourage the industry to find smarter, more efficient and less damaging ways to operate