National evaluation of Diplomas: cohort 1 - the second year

The introduction of Diplomas for 14-19 year olds represented a major innovation in educational opportunity for young people in England. The Diplomas are being offered at three levels and across 14 subjects and have been implemented in three phases (from September 2008, 2009 and 2010). Following the establishment of the Coalition government in May 2010, a number of changes to the implementation and delivery of the Diploma qualification were introduced. The Minister of State for Schools announced that development of new Diplomas in science, humanities and languages, which were due to be introduced from September 2011, would be discontinued. Additionally the Diploma entitlement, whereby all young people within an area would be able to access any of the Diploma subjects, would be removed and that the decision about which Diploma subjects would be available to students would in future be made by schools and colleges. Moreover, it was decided that the Gateway application process whereby consortia (of schools, colleges, training providers, employers and Higher Education Institutes (HEIs)) had previously submitted an application to the Department for Education (DfE) for each Diploma subject they wanted to offer would no longer be required for provision commencing from 2012. Other changes included the freedom for institutions to decide whether or not they wanted to work collaboratively to provide Diploma provision

The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors

Background: A multidisciplinary collaboration investigated the world's largest, most catastrophic epidemic thunderstorm asthma event that took place in Melbourne, Australia, on Nov 21, 2016, to inform mechanisms and preventive strategies. Methods: Meteorological and airborne pollen data, satellite-derived vegetation index, ambulance callouts, emergency department presentations, and data on hospital admissions for Nov 21, 2016, as well as leading up to and following the event were collected between Nov 21, 2016, and March 31, 2017, and analysed. We contacted patients who presented during the epidemic thunderstorm asthma event at eight metropolitan health services (each including up to three hospitals) via telephone questionnaire to determine patient characteristics, and investigated outcomes of intensive care unit (ICU) admissions. Findings: Grass pollen concentrations on Nov 21, 2016, were extremely high (>100 grains/m3). At 1800 AEDT, a gust front crossed Melbourne, plunging temperatures 10°C, raising humidity above 70%, and concentrating particulate matter. Within 30 h, there were 3365 (672%) excess respiratory-related presentations to emergency departments, and 476 (992%) excess asthma-related admissions to hospital, especially individuals of Indian or Sri Lankan birth (10% vs 1%, p<0·0001) and south-east Asian birth (8% vs 1%, p<0·0001) compared with previous 3 years. Questionnaire data from 1435 (64%) of 2248 emergency department presentations showed a mean age of 32·0 years (SD 18·6), 56% of whom were male. Only 28% had current doctor-diagnosed asthma. 39% of the presentations were of Asian or Indian ethnicity (25% of the Melbourne population were of this ethnicity according to the 2016 census, relative risk [RR] 1·93, 95% CI 1·74–2·15, p <0·0001). Of ten individuals who died, six were Asian or Indian (RR 4·54, 95% CI 1·28–16·09; p=0·01). 35 individuals were admitted to an intensive care unit, all had asthma, 12 took inhaled preventers, and five died. Interpretation: Convergent environmental factors triggered a thunderstorm asthma epidemic of unprecedented magnitude, tempo, and geographical range and severity on Nov 21, 2016, creating a new benchmark for emergency and health service escalation. Asian or Indian ethnicity and current doctor-diagnosed asthma portended life-threatening exacerbations such as those requiring admission to an ICU. Overall, the findings provide important public health lessons applicable to future event forecasting, health care response coordination, protection of at-risk populations, and medical management of epidemic thunderstorm asthma. Funding: None