Transformative Learning: a research briefing

The term ‘Transformational Learning’ has been used in varied ways and with varied meanings. At its simplest, Transformational Learning is learning that takes learners’ knowledge and skills into a different or new domain, with a step jump in cognitive and affective processes. Theories of transformational learning (TL) have been described as ‘the process of making meaning of one’s experience’. Transformational learning is ‘unsettling’ in that it leads to questioning of accepted assumptions and views and to new ways of knowing and understanding. The focus of research into TL has been primarily on adult learners, with the concept of TL representing a major theme of research and theory building in adult education. This context setting summary provides a very quick entry to some of the background thinking and research in this area before the exploration of some key questions at our conference on ‘Researching TL’. • What does the academic and applied research to date tell us about the nature of TL? • How might we go about researching TL? • How might this research inform our approaches to pedagogy and practice in higher education? This introduction draws on several useful resources available on the web that provide research summaries and are listed on page 4

Physical Activity and Gestational Weight Gain in Hispanic Women

Objective: Hispanic women have high rates of excessive and inadequate gestational weight gain (GWG) according to Institute of Medicine (IOM) guidelines. Observational studies suggest that physical activity may be associated with GWG but have been conflicting and were largely conducted in non-Hispanic white populations. Design and Methods We prospectively evaluated the association between physical activity and compliance with GWG guidelines, total GWG, and rate of GWG among 1,276 Hispanic participants in Proyecto Buena Salud, a cohort study in Western Massachusetts. The Pregnancy Physical Activity Questionnaire was used to assess pre, early, mid, and late pregnancy physical activity according to both intensity (i.e., sedentary, moderate, and vigorous) and type (i.e., housework/caregiving, occupational, and sports/exercise). Results: A total of 26.9% of women gained within IOM guidelines, 21.2% had inadequate GWG, and 51.9% experienced excessive GWG. Overall, we did not observe statistically significant associations between type or intensity of physical activity during pre, early, mid, and late pregnancy and inadequate or excessive GWG, total GWG, or rate of GWG. Conclusions: In this prospective cohort study of Hispanic women, after controlling for important risk factors, pregnancy physical activity did not appear to be associated with GWG

Conversation Patterns between Children with Severe Speech Impairment and their Conversation Partners in Dyadic and Multi-person Interactions

Active engagement in interactions is crucial for the development of identity, social competence, and cognitive abilities. For children with severe speech impairment (SSI) who have little or no intelligible speech, active participation in conversations is challenging and can be critical for their social inclusion and participation. The present study investigated the conversational patterns emerging from interactions between children with SSI who use aided communication and typically speaking conversation partners (CPs) and explored whether active participation was different in interactions with different numbers of partners (dyadic versus multi-person interactions). An unusually large multilingual dataset was used (N= 85 conversations). This allowed us to systematically investigate discourse analysis measures indicating participation: the distribution of conversational control (initiations versus responses versus recodes) and summoning power (obliges versus comments). The findings suggest that (i) conversations were characterized by asymmetrical conversational patterns with CPs assuming most of the conversational control and (ii) multi-person interactions were noticeably more symmetric compared to dyadic, as children's active participation in multi-person interactions was significantly increased. Clinical implications and best practice recommendations are discussed.Peer reviewe

Transformative Learning: a research briefing

The term ‘Transformational Learning’ has been used in varied ways and with varied meanings. At its simplest, Transformational Learning is learning that takes learners’ knowledge and skills into a different or new domain, with a step jump in cognitive and affective processes. Theories of transformational learning (TL) have been described as ‘the process of making meaning of one’s experience’. Transformational learning is ‘unsettling’ in that it leads to questioning of accepted assumptions and views and to new ways of knowing and understanding. The focus of research into TL has been primarily on adult learners, with the concept of TL representing a major theme of research and theory building in adult education. This context setting summary provides a very quick entry to some of the background thinking and research in this area before the exploration of some key questions at our conference on ‘Researching TL’. • What does the academic and applied research to date tell us about the nature of TL? • How might we go about researching TL? • How might this research inform our approaches to pedagogy and practice in higher education? This introduction draws on several useful resources available on the web that provide research summaries and are listed on page 4

Learning Enhancement for Active Student Community Engagement (LEAPSE).

This project explored the potential of public-student engagement to enhance the student experience through active community and public engagement activities. The project evaluates existing models of public engagement activities to build capacity in both the University and communities to gain greater benefit from the potential such co-generative relationships can provide. This project focused on one university with the intention of complementing this primary activity with collecting case study material from a range of contexts. The context for graduate employment is rapidly changing and there is evidence that students derive benefits when their programmes include opportunities for authentic engagement with real-world problems. There is evidence to suggest that communities can benefit from genuine engagement with universities and their staff and students. Over a two-year period at the University of Gloucestershire, the project team worked with academics, students and community groups with the aim that universities and communities can make the most of the relationships and in particular to enhance the students’ experience. This exciting and innovative project worked closely with the National Coordination Centre for Public Engagement to ensure transferability of the project outcomes and to promote outputs from the project. It finds that an estimated 63% students at the University of Gloucestershire are engaged in voluntary work of some kind (63% nationally), of whom, 22% have arranged this through the University or the Student Union (SU) (38 % nationally). Work carried out as part of a project to log voluntary and community engagement across the university involving staff and students has found that approximately 10,000 hours of voluntary work has been carried out in the 2012/13 academic year. The range of work makes understanding and planning this kind of engagement complex. This comprises • Individual self-organised voluntary work, such as brownie or cub scout leadership. • Individual volunteering through a university programme, such as a sports programme working with local teams, or a school mentoring programme (though some of these are paid and therefore not included here). • Individual or team volunteering through Student Union brokerage, such as the SU-run VolunteerShop, campus-based community gardens and an annual tea dance for elderly residents living near the university. • Individual voluntary work within the context of an internship or placement, which may or may not include work for academic credit, such as for a local community project or voluntary organisation, such as the for sports clubs. However, this does not include undergraduate community based research as part of a module that can also account for a considerable contribution of time, effort and expertise

COVID-19 TestNorm: A tool to normalize COVID-19 testing names to LOINC codes.

Large observational data networks that leverage routine clinical practice data in electronic health records (EHRs) are critical resources for research on coronavirus disease 2019 (COVID-19). Data normalization is a key challenge for the secondary use of EHRs for COVID-19 research across institutions. In this study, we addressed the challenge of automating the normalization of COVID-19 diagnostic tests, which are critical data elements, but for which controlled terminology terms were published after clinical implementation. We developed a simple but effective rule-based tool called COVID-19 TestNorm to automatically normalize local COVID-19 testing names to standard LOINC (Logical Observation Identifiers Names and Codes) codes. COVID-19 TestNorm was developed and evaluated using 568 test names collected from 8 healthcare systems. Our results show that it could achieve an accuracy of 97.4% on an independent test set. COVID-19 TestNorm is available as an open-source package for developers and as an online Web application for end users (https://clamp.uth.edu/covid/loinc.php). We believe that it will be a useful tool to support secondary use of EHRs for research on COVID-19

Small molecule activators of SIRT1 replicate signaling pathways triggered by calorie restriction in vivo

<p>Abstract</p> <p>Background</p> <p>Calorie restriction (CR) produces a number of health benefits and ameliorates diseases of aging such as type 2 diabetes. The components of the pathways downstream of CR may provide intervention points for developing therapeutics for treating diseases of aging. The NAD⁺-dependent protein deacetylase SIRT1 has been implicated as one of the key downstream regulators of CR in yeast, rodents, and humans. Small molecule activators of SIRT1 have been identified that exhibit efficacy in animal models of diseases typically associated with aging including type 2 diabetes. To identify molecular processes induced in the liver of mice treated with two structurally distinct SIRT1 activators, SIRT501 (formulated resveratrol) and SRT1720, for three days, we utilized a systems biology approach and applied Causal Network Modeling (CNM) on gene expression data to elucidate downstream effects of SIRT1 activation.</p> <p>Results</p> <p>Here we demonstrate that SIRT1 activators recapitulate many of the molecular events downstream of CR <it>in vivo</it>, such as enhancing mitochondrial biogenesis, improving metabolic signaling pathways, and blunting pro-inflammatory pathways in mice fed a high fat, high calorie diet.</p> <p>Conclusion</p> <p>CNM of gene expression data from mice treated with SRT501 or SRT1720 in combination with supporting <it>in vitro </it>and <it>in vivo </it>data demonstrates that SRT501 and SRT1720 produce a signaling profile that mirrors CR, improves glucose and insulin homeostasis, and acts via SIRT1 activation <it>in vivo</it>. Taken together these results are encouraging regarding the use of small molecule activators of SIRT1 for therapeutic intervention into type 2 diabetes, a strategy which is currently being investigated in multiple clinical trials.</p

International cohort study indicates no association between alpha-1 blockers and susceptibility to COVID-19 in benign prostatic hyperplasia patients

Purpose: Alpha-1 blockers, often used to treat benign prostatic hyperplasia (BPH), have been hypothesized to prevent COVID-19 complications by minimising cytokine storm release. The proposed treatment based on this hypothesis currently lacks support from reliable real-world evidence, however. We leverage an international network of large-scale healthcare databases to generate comprehensive evidence in a transparent and reproducible manner.Methods: In this international cohort study, we deployed electronic health records from Spain (SIDIAP) and the United States (Department of Veterans Affairs, Columbia University Irving Medical Center, IQVIA OpenClaims, Optum DOD, Optum EHR). We assessed association between alpha-1 blocker use and risks of three COVID-19 outcomes-diagnosis, hospitalization, and hospitalization requiring intensive services-using a prevalent-user active-comparator design. We estimated hazard ratios using state-of-the-art techniques to minimize potential confounding, including large-scale propensity score matching/stratification and negative control calibration. We pooled database-specific estimates through random effects meta-analysis.Results: Our study overall included 2.6 and 0.46 million users of alpha-1 blockers and of alternative BPH medications. We observed no significant difference in their risks for any of the COVID-19 outcomes, with our meta-analytic HR estimates being 1.02 (95% CI: 0.92-1.13) for diagnosis, 1.00 (95% CI: 0.89-1.13) for hospitalization, and 1.15 (95% CI: 0.71-1.88) for hospitalization requiring intensive services.Conclusion: We found no evidence of the hypothesized reduction in risks of the COVID-19 outcomes from the prevalent-use of alpha-1 blockers-further research is needed to identify effective therapies for this novel disease.</p

Renin-angiotensin system blockers and susceptibility to COVID-19:an international, open science, cohort analysis

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been postulated to affect susceptibility to COVID-19. Observational studies so far have lacked rigorous ascertainment adjustment and international generalisability. We aimed to determine whether use of ACEIs or ARBs is associated with an increased susceptibility to COVID-19 in patients with hypertension.Methods: In this international, open science, cohort analysis, we used electronic health records from Spain (Information Systems for Research in Primary Care [SIDIAP]) and the USA (Columbia University Irving Medical Center data warehouse [CUIMC] and Department of Veterans Affairs Observational Medical Outcomes Partnership [VA-OMOP]) to identify patients aged 18 years or older with at least one prescription for ACEIs and ARBs (target cohort) or calcium channel blockers (CCBs) and thiazide or thiazide-like diuretics (THZs; comparator cohort) between Nov 1, 2019, and Jan 31, 2020. Users were defined separately as receiving either monotherapy with these four drug classes, or monotherapy or combination therapy (combination use) with other antihypertensive medications. We assessed four outcomes: COVID-19 diagnosis; hospital admission with COVID-19; hospital admission with pneumonia; and hospital admission with pneumonia, acute respiratory distress syndrome, acute kidney injury, or sepsis. We built large-scale propensity score methods derived through a data-driven approach and negative control experiments across ten pairwise comparisons, with results meta-analysed to generate 1280 study effects. For each study effect, we did negative control outcome experiments using a possible 123 controls identified through a data-rich algorithm. This process used a set of predefined baseline patient characteristics to provide the most accurate prediction of treatment and balance among patient cohorts across characteristics. The study is registered with the EU Post-Authorisation Studies register, EUPAS35296.Findings: Among 1 355 349 antihypertensive users (363 785 ACEI or ARB monotherapy users, 248 915 CCB or THZ monotherapy users, 711 799 ACEI or ARB combination users, and 473 076 CCB or THZ combination users) included in analyses, no association was observed between COVID-19 diagnosis and exposure to ACEI or ARB monotherapy versus CCB or THZ monotherapy (calibrated hazard ratio [HR] 0·98, 95% CI 0·84-1·14) or combination use exposure (1·01, 0·90-1·15). ACEIs alone similarly showed no relative risk difference when compared with CCB or THZ monotherapy (HR 0·91, 95% CI 0·68-1·21; with heterogeneity of &gt;40%) or combination use (0·95, 0·83-1·07). Directly comparing ACEIs with ARBs demonstrated a moderately lower risk with ACEIs, which was significant with combination use (HR 0·88, 95% CI 0·79-0·99) and non-significant for monotherapy (0·85, 0·69-1·05). We observed no significant difference between drug classes for risk of hospital admission with COVID-19, hospital admission with pneumonia, or hospital admission with pneumonia, acute respiratory distress syndrome, acute kidney injury, or sepsis across all comparisons.Interpretation: No clinically significant increased risk of COVID-19 diagnosis or hospital admission-related outcomes associated with ACEI or ARB use was observed, suggesting users should not discontinue or change their treatment to decrease their risk of COVID-19.</p