Sustainable Change: Education for Sustainable Development in the Business School

This paper examines the implementation of education for sustainable development (ESD) within a business school. ESD is of growing importance for business schools, yet its implementation remains a challenge. The paper examines how barriers to ESD's implementation are met through organisational change as a sustainable process. It evaluates change brought about through ESD in a UK-based business school, through the lens of Beer and Eisenstat's three principles of effective strategy implementation and organisational adaptation, which state: 1) the change process should be systemic; 2) the change process should encourage open discussion of barriers to effective strategy implementation and adaptation; and 3) the change process should develop a partnership among all relevant stakeholders. The case incorporates, paradoxically, both elements of a top-down and an emergent strategy that resonates with elements of life-cycle, teleological and dialectic frames for process change. Insights are offered into the role of individuals as agents and actors of institutional change in business schools. In particular, the importance of academic integrity is highlighted for enabling and sustaining integration. Findings also suggest a number of implications for policy-makers who promote ESD, and for faculty and business school managers implementing, adopting and delivering ESD programmes

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Strategies and outcomes in translating alcohol harm reduction research into practice: the Alcohol Linking Program

Harm associated with consumption of alcohol on licensed premises is an issue of community concern. Interventions to reinforce responsible sale of alcohol such as server training and accords between licensees, police and health advocates are well known. However, while generally supported by police and licensees as 'a good thing', evaluations demonstrating that they reduce alcohol-related harm are rare. Lack of enforcement is often an issue. This paper reports on system intervention to enhance police enforcement of liquor laws by providing data-based feedback to police and licensees about alcohol-related crime following drinking on specific licensed premises. The system has been shown to contribute to a reduction of alcohol-related crime and has been adopted into routine practice by NSW police state-wide. It is a good example of how research can be conducted in a way that bridges the gap between policy research and policy practice

PcP-specific IgG1⁺ and IgG2⁺ ASCs in HIV patients and HIV seronegative subjects at day 7 post-vaccination with PcPs.

<p><b>(A)</b> IgG1⁺ ASC to PcP 4, 6B, 9V and 14 <b>(B)</b> IgG2⁺ ASC to PcP 4, 6B, 9V and 14. Data are presented as ASC/2x10⁵ PBMC. The horizontal lines indicate median values. Median values of IgG1⁺ ASC/2 x10⁵ PBMC in ART-treated, ART-naive and HIV seronegative subjects to PcP 4: 0.5, 0 and 6, respectively; PcP 6B: 2, 1 and 6, respectively; PcP 9V: 1, 1 and 6, respectively and PcP 14: 0, 2 and 7, respectively. Median values of IgG2⁺ ASC/ 2x10⁵ PBMC in ART-treated, ART-naive and HIV seronegative subjects to PcP 4: 6, 7 and 21, respectively; PcP 6B: 7, 7 and 22, respectively; PcP 9V: 6, 3 and 21, respectively and PcP 14: 3, 8 and 22, respectively. Differences between groups were tested using Mann-Whitney tests. n.s., not significant and p<0.05 considered significant.</p

Proportions of ICOS⁺ and ICOS^- cmT_FH cells pre- and post- vaccination in HIV patients and HIV seronegative subjects.

<p><b>(A)</b> ICOS⁺ cmT_FH cells, <b>(B)</b> ICOS^- cmT_FH cells. Data are presented on a log scale and were analysed by Mann-Whitney tests. n.s., not significant and p<0.05 considered significant, <b>(C)</b> Following vaccination with PcPs, ICOS⁺ cmT_FH cells increased at D7, compared with D0, in HIV seronegative subjects but not in ART-naive HIV patients and to a lesser and more variable degree in ART-treated patients and <b>(D</b>) ICOS^- cmT_FH cells did not increase in any of the study groups. Data were analysed by Wilcoxon signed-rank test and Kruskal Wallis test. n.s., not significant and p<0.05 considered significant.</p

Circulating SPB in HIV patients and HIV seronegative subjects at day 7 post-vaccination with PcPs.

<p>(<b>A</b>) SPB (CD20^-CD27⁺⁺CD38⁺⁺) at D0, D7 and D28 in the 3 study groups. The increase in SPB between D0 and D7 is shown for (<b>B</b>) ART-treated patients (<b>C</b>) ART-naive patients and (<b>D</b>) HIV seronegative subjects. Data were analysed using linear mixed models. n.s., not significant and p<0.05 considered significant.</p

PcP-specific IgG1⁺ and IgG2⁺ ASCs correlated with ICOS⁺ cmT_FH cells in HIV seronegative subjects at D7 post-vaccination.

<p><b>(A)</b> IgG1⁺ ASC <b>(B)</b> IgG2⁺ ASC. Data were analysed using Spearman’s rank correlation test.</p