Individualised learning approach (the three ‘p’s) for a small to medium enterprise through work based learning

An ongoing challenge for education and training providers is to ensure learners can achieve maximum learning and recognition for their vocational education pathways. The strategy and case to be presented could best be described as the 3 ‘p’s approach to the provision of vocational education and training, that is: I. How we support people in their education and training II. What processes we use to provide education and training? III. The place where the learning opportunities are provided. The aim of this paper is to share an educational and training strategy that has been successfully implemented in an Australian enterprise. The strategy provided education and training for the members of the enterprise in a multidisciplinary manner from a certificate through to a degree outcome, entirely through work-based learning (WBL) pedagogy. The research was conducted with six candidates (employees of the enterprise) through their educational journey applying a range of WBL activities including projects and initiatives to improve processes and performances in the workplace. Each candidate's program involved designing the learning component following an initial phase of review of their previous learning’s and qualifications with a learning advisor. This process was deemed as 'the learning review'. The other component of this phase was to develop a learning plan to encapsulate an area of study or disciplinary process that would be relevant to the individual candidate. This process was deemed as 'the learning journey plan'. The second phase was for each candidate to prepare and undertake a problem based/research led learning activity through one or more workplace project/s with the support of the employer. The final phase involved a structured review and development of a final project report to outline the outcomes and learning’s achieved through the work based projects. The research undertaken included post-program interviews with the six candidates and the General Manager and provided an example of a relatable model for all workplaces as well as education and training provider

Evolution of testosterone treatment over 25 years: symptom responses, endocrine profiles and cardiovascular changes

Introduction: Testosterone treatment has evolved rapidly over the past 25 years as new, more effective and convenient methods have become available. This study reports experience with seven different methods, introduced on the market in the UK. Aim: To establish the symptom response when testosterone treatment was initiated on the basis of clinical features and symptoms of androgen deficiency, and the resulting endocrine, biochemical and physiological responses. Methods: Of 2693 patients attending the 3 Men’s Health Centers – The UK Androgen Study (UKAS), 2247 were treated. Treatments included pellet implants, oral testosterone undecanoate (Testocaps), mesterolone (Proviron), testosterone gel (Testogel), testosterone scrotal cream (Andromen) and scrotal gel (Tostran). Results: There was no correlation between initial testosterone level, initial symptom score or the success of treatment as defined by adequate resolution of symptoms. Despite the diverse endocrine patterns produced, the testosterone preparations appear equally safe over prolonged periods, with either no change or improvement of cardiovascular risk factors, especially in lowering cholesterol and diastolic blood pressure. Conclusions: It is suggested that because of excessive reliance on laboratory measures of androgens and undue safety concerns, many men who could benefit from symptom relief, improvement in related clinical conditions and given preventive medical benefits remain untreated

Work-based learning: a learning strategy in support of the Australian Qualifications Framework

Purpose – The purpose of this paper is to assess the extent to which work-based learning could potentially improve education and training pathways in Australia. Design/methodology/approach – The paper reviews education and training provision in Australia through a contextualisation of the Australian Qualification Framework (AQF) with work-based learning pedagogy to determine the extent to which it might contribute to improved outcomes for learners. Findings – People seeking to advance their career aspirations can consider the application of work-based learning to support lifelong learning pathways through the AQF. Research limitations/implications – There is a need for further longitudinal studies on the outcomes of work-based learning for organisations, individual learners and education and training institutions. Practical implications – The application of effective WBL approaches has the potential to create a much larger flow of learners from experiential and vocational backgrounds into undergraduate programmes and onto higher education programmes using a consistent and effective pedagogy. Social implications – By actively considering the opportunities for learning at work and through work learners, educators and business managers may recognise that there would be more demand for work-based learning. Originality/value – This paper represents an initial action research study which examines the role WBL can provide for life-long learning

Work-based learning: a learning strategy in support of the Australian Qualifications Framework

Purpose – The purpose of this paper is to assess the extent to which work-based learning could potentially improve education and training pathways in Australia. Design/methodology/approach – The paper reviews education and training provision in Australia through a contextualisation of the Australian Qualification Framework (AQF) with work-based learning pedagogy to determine the extent to which it might contribute to improved outcomes for learners. Findings – People seeking to advance their career aspirations can consider the application of work-based learning to support lifelong learning pathways through the AQF. Research limitations/implications – There is a need for further longitudinal studies on the outcomes of work-based learning for organisations, individual learners and education and training institutions. Practical implications – The application of effective WBL approaches has the potential to create a much larger flow of learners from experiential and vocational backgrounds into undergraduate programmes and onto higher education programmes using a consistent and effective pedagogy. Social implications – By actively considering the opportunities for learning at work and through work learners, educators and business managers may recognise that there would be more demand for work-based learning. Originality/value – This paper represents an initial action research study which examines the role WBL can provide for life-long learning

Work based learning: a flux for learners through the Australian Qualifications Framework

This paper sets out just one element of a long term project in which the authors have employed elements of activity theory and expansive learning theory to analyse both the Australian Qualifications Framework (AQF: 2013) and application of contemporary workbased learning approaches. The framework for the review is built around 6 key areas of performance identified in previous reviews of education systems and qualifications frameworks (AQF Council 2009; Bradley et al., 2008; Burke et al., 2009; CEDEFOP 2010 & 2013; CEDEFOP & ETF 2013; Commonwealth of Australia 2009; deWeert 2011; Education and Culture DG & EQF 2013; Guthrie et al., 2011; Hackett et al., 2012). The researchers are progressively working through the sequence of learning actions within an expansive learning cycle (Engestrom & Kerosuo, 2007) and this paper represents one aspect of the work being undertaken as part of a step two [i.e. analysis] in the seven step expansive learning cycle. Through this analysis we present a possible solution to enable an individual to progress through a vocational pathway into higher education by the application of a workbased learning pedagogy that is assessed against institutional based credentials. This approach tends to be a ‘flipped’ practice to the general principle of asking the learner to align their work based activity to the institution’s pedagogical framework and more then the application of recognition of prior learning

Work based learning as a conduit to business creativity in Australia

The knowledge economy is compelling business leaders to adopt creative approaches to become and remain relevant and competitive. Business has the opportunity to use many of the learnings from art and philosophy in order to effectively respond to this situation. This article takes insights from creative artists and thinkers such as Dante, Yeats, Chomsky and TS Eliot and connects them with contemporary developments in professional learning, practice and reflection (with particular reference to the work of Hager et al., (2012) Kemmis et al., (2012) and Boud et al., (2006). The purpose of these connections is to illustrate the value of an emergent approach to tertiary education known as work based learning. The article is a departure from traditional views of work-based learning as it suggests that work based learning is a creative and innovative response that builds capability for both individuals and organisations. Within this context, significance is afforded through reflective practice. Whilst reflection is more associated with thinkers and artists than business leaders, it is an important skill in contemporary business settings. The authors argue that effective professional reflective practice draws the different elements of contemporary work based learning into a cohesive strategy for building higher levels of individual and organisational capability

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease