The diffusion of policy in contexts of practice : flexible delivery in Australian vocational education and training

Significant changes have occurred over the last decade within the Australian Vocational Education and Training (VET) system. Not least amongst these has been a shift from a predominantly traditional face-to-face classroom model of programme delivery to more flexible models informed by the needs of clients. To lead this revolution, in 1991 the Australian Commonwealth and State Ministers for Training established the Flexible Delivery Working Party. A series of reports followed that sought to develop a policy framework, including a definition of flexible delivery, and its principles and characteristics. Despite these efforts, project funding and national staff development initiatives, several difficulties have been experienced in the ‘take-up’ of flexible delivery; problems that we argue are related to how the dissemination of innovative practice is conceived. Specifically, the literature and research on the diffusion of innovations points to the efficacy of informal social networks ‘in which individuals adopt the new idea as a result of talking with other individuals who have already adopted it’ (Valente, 1995, p. ix). Following a discussion of these issues, the article concludes by arguing the need for research of innovative practice transfer within VET in Australia, using qualitative case study in order to develop an in-depth and rich description of the process, and facilitate greater understanding of how it works in practice

Supported discharge for COVID-19

Aims: Assessment of a supported discharge service for a cohort of patients admitted to Cork University Hospital with COVID-19 that were identified as being appropriate for remote patient monitoring. Methods: Patients uploaded SpO2, subjective breathlessness scores, and temperature readings onto the PatientMpower application, and received a daily phone call from the physiotherapist. Readmission was triggered where appropriate. Patient satisfaction questionnaires were completed following service discharge. Results: Over 12 weeks, 15 patients had a supported discharge. Readmission was triggered for 3 patients (20%). Compared to non-readmitted patient, readmitted patients had more abnormal SpO2 readings (9 (5.5-22.5) vs 1 (0-1), p= 0.022) and all 6 temperature spikes that occurred, but lower subjective breathlessness scores (3 (1-6) vs 4.25 (2-8), p = 0.003). Differences in mean abnormal SpO2% readings were not statistically significant. Conclusion: A supported discharge service including remote monitoring and regular contact with healthcare professionals can facilitate safe, and timely discharges of select patient groups

SLC25A22 is a novel gene for migrating partial seizures in infancy

Objective To identify a genetic cause for migrating partial seizures in infancy (MPSI). Methods We characterized a consanguineous pedigree with MPSI and obtained DNA from affected and unaffected family members. We analyzed single nucleotide polymorphism 500K data to identify regions with evidence of linkage. We performed whole exome sequencing and analyzed homozygous variants in regions of linkage to identify a candidate gene and performed functional studies of the candidate gene SLC25A22. Results In a consanguineous pedigree with 2 individuals with MPSI, we identified 2 regions of linkage, chromosome 4p16.1-p16.3 and chromosome 11p15.4-pter. Using whole exome sequencing, we identified 8 novel homozygous variants in genes in these regions. Only 1 variant, SLC25A22 c.G328C, results in a change of a highly conserved amino acid (p.G110R) and was not present in control samples. SLC25A22 encodes a glutamate transporter with strong expression in the developing brain. We show that the specific G110R mutation, located in a transmembrane domain of the protein, disrupts mitochondrial glutamate transport. Interpretation We have shown that MPSI can be inherited and have identified a novel homozygous mutation in SLC25A22 in the affected individuals. Our data strongly suggest that SLC25A22 is responsible for MPSI, a severe condition with few known etiologies. We have demonstrated that a combination of linkage analysis and whole exome sequencing can be used for disease gene discovery. Finally, as SLC25A22 had been implicated in the distinct syndrome of neonatal epilepsy with suppression bursts on electroencephalogram, we have expanded the phenotypic spectrum associated with SLC25A22. Ann Neurol 2013;74:873-882 © 2013 American Neurological Association

Pulmonary embolism and COVID-19

Aims: There is increasing concern amongst clinicians of a possible increase in venous thromboembolism (VTE) events in patients with COVID-19. There remains limited data defining the incidence of VTE in this population and thus also a paucity of research examining the impact of targeted treatment in patients with thrombotic complications. Methods: We examined the number of symptomatic VTE events amongst proven COVID-19 patients admitted to a tertiary level academic hospital, over a one-month period. Patient characteristics, admission and discharge inflammatory and coagulation markers were included in the analysis. Results: Sixty-one patients were identified. Twelve patients (19.6%) admitted with COVID-19 were treated for a suspected PE. Of these patients, 3 patients were discharged on anticoagulation, 3 died and 6 remain inpatients at the end of the study period. Discussion: COVID-19 patients are at increased risk of VTE. This risk may extend beyond the period of admission. Further research examining the role of extending the duration of thromboprophylaxis in COVID-19 patients beyond hospital discharge is warranted

Computational and Serologic Analysis of Novel and Known Viruses in Species Human Adenovirus D in Which Serology and Genomics Do Not Correlate

In November of 2007 a human adenovirus (HAdV) was isolated from a bronchoalveolar lavage (BAL) sample recovered from a biopsy of an AIDS patient who presented with fever, cough, tachycardia, and expiratory wheezes. To better understand the isolated virus, the genome was sequenced and analyzed using bioinformatic and phylogenomic analysis. The results suggest that this novel virus, which is provisionally named HAdV-D59, may have been created from multiple recombination events. Specifically, the penton, hexon, and fiber genes have high nucleotide identity to HAdV-D19C, HAdV-D25, and HAdV-D56, respectively. Serological results demonstrated that HAdV-D59 has a neutralization profile that is similar yet not identical to that of HAdV-D25. Furthermore, we observed a two-fold difference between the ability of HAdV-D15 and HAdV-D25 to be neutralized by reciprocal antiserum indicating that the two hexon proteins may be more similar in epitopic conformation than previously assumed. In contrast, hexon loops 1 and 2 of HAdV-D15 and HAdV-D25 share 79.13 and 92.56 percent nucleotide identity, respectively. These data suggest that serology and genomics do not always correlate

Mid-Infrared Laser Ablation of Stratum Corneum Enhances In Vitro Percutaneous Transport of Drugs

The precise removal of stratum corneum from cadaveric swine skin by a mid-infrared erbium: yttrium scandium gallium garnet laser (λ = 2.79 μm; 250 μsec pulse width) was assessed by electrical resistance measurements and documented by histology. The effects of stratum corneum removal by laser ablation and by adhesive tape-stripping on the in vitro penetration of 3H-hydrocortisone and 125I-γ-interferon were determined. Excised swine skin was irradiated with laser (1 J/cm2 31 mJ/pulse; 1 Hz; 2mm spot diameter). For skin penetration studies, laser pulses were delivered to discrete 2-mm areas to ablate up to 12.6% of the total 3-cm2 stratum corneum diffusional area. Franz in vitro skin penetration chambers were used to measure the cumulative 48-h penetration of 3H-hydrocortisone and 125I-γ-interferon in laser-treated and tape-stripped skin. Electrical resistance measurements and histologic studies demonstrated that 10-14 laser pulses at the above energy density were required to abolish skin resistance and selectively ablate stratum corneum without damage to adjacent dermal structures. Laser ablation of 12.6% of the surface area of stratum corneum produced a 2.8 and 2.1-times increase in permeability constant (kp) for 3H-hydrocortisone and 125I-λ-interferon, respectively. These studies demonstrate that a pulsed mid-infrared laser can reliably and precisely remove the stratum corneum, facilitating penetration of large molecules such as 125I-λ-interferon that cannot penetrate intact skin. This new technique may be useful for basic and clinical investigation of skin barrier properties