Re-evaluation of the risk of venous thromboembolism after COVID-19 vaccination using haematological criteria

An elevated risk of venous thromboembolism (VTE) following a first dose of the ChAdOx1 adenovirus-vectored vaccine was found in a national epidemiological study in England using routine discharge diagnosis codes. Separately, the syndrome of vaccine-induced immune thrombotic thrombocytopenia (VITT) was identified using haematological criteria based on presence of thrombocytopenia, significantly elevated D-dimers and development of anti-PF4 antibodies. To re-evaluate risk estimates using haematological criteria, we obtained the haematology results for hospital admitted patients aged 18-64 years in 43 National Health Service trusts in England who were included in the national epidemiological study. Diagnoses were confirmed and haematological parameters obtained from local records without knowledge of vaccination status. The haematological parameters in patients admitted for a confirmed VTE following ChAdOx1 or BNT162b2 mRNA vaccination were then compared with those in a randomly selected 40% sample of unvaccinated patients with VTE. Overall, 12 (14%) of the 84 vaccinated cases had a diagnosis compatible with VITT, 11 after a first dose of ChAdOx1 and one after a first dose of BNT162b2. Thrombocytopenia (platelet count <150x109/L) occurred in 17 vaccinated (20%) and 4 (4%) of 108 unvaccinated patients, with all 6 cases of severe thrombocytopenia (<50x109/L) occurring within 42 days of a first dose of ChAdOx1. The attributable risk estimates for a cerebral venous thrombosis (CVT) or other VTE with thrombocytopenia after a first dose of ChAdOx1 vaccine were 2.82 and 9.62 per million doses respectively. However, elevated risks were also found after a first dose of ChAdOx1 for VTE without thrombocytopenia with relative incidences for CVT and other VTE of 2.67 (1.77-3.77) and 1.93 (1.57-2.35) respectively. While we identified a distinct population with features of VITT within 42 days of receiving ChAdOx1 vaccination, confirming current diagnostic criteria, we also found evidence of an increased risk of a VTE without thrombocytopenia after ChAdOx1 vaccine.

Risk of myocarditis and pericarditis after a COVID-19 mRNA vaccine booster and after COVID-19 in those with and without prior SARS-CoV-2 infection: A self-controlled case series analysis in England.

BACKGROUND: An increased risk of myocarditis or pericarditis after priming with mRNA Coronavirus Disease 2019 (COVID-19) vaccines has been shown but information on the risk post-booster is limited. With the now high prevalence of prior Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, we assessed the effect of prior infection on the vaccine risk and the risk from COVID-19 reinfection. METHODS AND FINDINGS: We conducted a self-controlled case series analysis of hospital admissions for myocarditis or pericarditis in England between 22 February 2021 and 6 February 2022 in the 50 million individuals eligible to receive the adenovirus-vectored vaccine (ChAdOx1-S) for priming or an mRNA vaccine (BNT162b2 or mRNA-1273) for priming or boosting. Myocarditis and pericarditis admissions were extracted from the Secondary Uses Service (SUS) database in England and vaccination histories from the National Immunisation Management System (NIMS); prior infections were obtained from the UK Health Security Agency's Second-Generation Surveillance Systems. The relative incidence (RI) of admission within 0 to 6 and 7 to 14 days of vaccination compared with periods outside these risk windows stratified by age, dose, and prior SARS-CoV-2 infection for individuals aged 12 to 101 years was estimated. The RI within 27 days of an infection was assessed in the same model. There were 2,284 admissions for myocarditis and 1,651 for pericarditis in the study period. Elevated RIs were only observed in 16- to 39-year-olds 0 to 6 days postvaccination, mainly in males for myocarditis. Both mRNA vaccines showed elevated RIs after first, second, and third doses with the highest RIs after a second dose 5.34 (95% confidence interval (CI) [3.81, 7.48]; p < 0.001) for BNT162b2 and 56.48 (95% CI [33.95, 93.97]; p < 0.001) for mRNA-1273 compared with 4.38 (95% CI [2.59, 7.38]; p < 0.001) and 7.88 (95% CI [4.02, 15.44]; p < 0.001), respectively, after a third dose. For ChAdOx1-S, an elevated RI was only observed after a first dose, RI 5.23 (95% CI [2.48, 11.01]; p < 0.001). An elevated risk of admission for pericarditis was only observed 0 to 6 days after a second dose of mRNA-1273 vaccine in 16 to 39 year olds, RI 4.84 (95% CI [1.62, 14.01]; p = 0.004). RIs were lower in those with a prior SARS-CoV-2 infection than in those without, 2.47 (95% CI [1.32,4.63]; p = 0.005) versus 4.45 (95% [3.12, 6.34]; p = 0.001) after a second BNT162b2 dose, and 19.07 (95% CI [8.62, 42.19]; p < 0.001) versus 37.2 (95% CI [22.18, 62.38]; p < 0.001) for mRNA-1273 (myocarditis and pericarditis outcomes combined). RIs 1 to 27 days postinfection were elevated in all ages and were marginally lower for breakthrough infections, 2.33 (95% CI [1.96, 2.76]; p < 0.001) compared with 3.32 (95% CI [2.54, 4.33]; p < 0.001) in vaccine-naïve individuals respectively. CONCLUSIONS: We observed an increased risk of myocarditis within the first week after priming and booster doses of mRNA vaccines, predominantly in males under 40 years with the highest risks after a second dose. The risk difference between the second and the third doses was particularly marked for the mRNA-1273 vaccine that contains half the amount of mRNA when used for boosting than priming. The lower risk in those with prior SARS-CoV-2 infection, and lack of an enhanced effect post-booster, does not suggest a spike-directed immune mechanism. Research to understand the mechanism of vaccine-associated myocarditis and to document the risk with bivalent mRNA vaccines is warranted.

The Effects of the Ward Environment and Language in Palliative Care: A Qualitative Exploratory Study of Victorian Nurses' Perspectives.

OBJECTIVES: The current study aimed to explore regional nurses' perspectives of how bad news is delivered and the physical, natural, social, and symbolic environments where these conversations occur. BACKGROUND: In regional hospitals within Victoria, Australia, palliative and end-of-life patients are cared for in acute wards that are often busy, noisy, and do not have a palliative psychosocial focus. On the other hand, Palliative Care Units (PCUs) have more home-like dedicated spaces, yet nearly all these facilities are in metropolitan areas. Diagnostic/prognostic (bad news) conversations about life-limiting illnesses often occur at the bedside in both environments. METHOD: Nurses providing palliative or end-of-life care in regional or metropolitan Victorian hospital inpatient wards were invited to interview and recruited through social media and snowballing. Six semi-structured, audio-recorded online interviews were conducted between March and May 2022, and themes were developed using reflexive thematic analysis. RESULTS: Semi-structured online interviews were conducted with six female, registered nurses, four of whom worked in regional Victorian hospitals and two in metropolitan PCUs as Nurse Unit Managers. Three central themes were developed: "conducting family meetings," "palliative care practice," and "the environment matters." CONCLUSIONS: A therapeutic environment for palliative patients and their families consists of home-like ambience and aesthetics and a psychosocial environment created by staff who can provide holistic palliative care. Holistic palliative care requires mentoring and mirroring of expert practice to increase the expertise and capacity of the palliative care workforce in acute general hospital wards.

Effectiveness of BNT162b2 and ChAdOx1 against SARS-CoV-2 household transmission: a prospective cohort study in England

Background: The ability of SARS-CoV-2 vaccines to protect against infection and onward transmission determines whether immunisation can control global circulation. We estimated the effectiveness of Pfizer-BioNTech mRNA vaccine (BNT162b2) and Oxford AstraZeneca adenovirus vector vaccine (ChAdOx1) vaccines against acquisition and transmission of the Alpha and Delta variants in a prospective household study in England. Methods: : Households were recruited based on adult purported index cases testing positive after reverse transcription-quantitative (RT-q)PCR testing of oral-nasal swabs. Purported index cases and their household contacts took oral-nasal swabs on days 1, 3 and 7 after enrolment and a subset of the PCR-positive swabs underwent genomic sequencing conducted on a subset. We used Bayesian logistic regression to infer vaccine effectiveness against acquisition and transmission, adjusted for age, vaccination history and variant. Results: : Between 2 February 2021 and 10 September 2021, 213 index cases and 312 contacts were followed up. After excluding households lacking genomic proximity (N=2) or with unlikely serial intervals (N=16), 195 households with 278 contacts remained, of whom 113 (41%) became PCR positive. Delta lineages had 1.53 times the risk (95% Credible Interval: 1.04 – 2.20) of transmission than Alpha;contacts older than 18 years old were 1.48 (1.20 – 1.91) and 1.02 (0.93 – 1.16) times more likely to acquire an Alpha or Delta infection than children. Effectiveness of two doses of BNT162b2 against transmission of Delta was 36% (-1%, 66%) and 49% (18%, 73%) for ChAdOx1, similar to their effectiveness for Alpha. Protection against infection with Alpha was higher than for Delta, 69% (9%, 95%) vs. 18% (-11%, 59%), respectively, for BNT162b2 and 24% (-41%, 72%) vs. 9% (-15%, 42%), respectively, for ChAdOx1. Conclusions: : BNT162b2 and ChAdOx1 reduce transmission of the Delta variant from breakthrough infections in the household setting, although their protection against infection within this setting is low.

Ending Hunger: How COVID-19 Revealed a Path to Food Access for All

This article explores how a devastating hunger crisis, which seemed destined to accompany the COVID-19 pandemic in the United States, was thwarted by historic federal emergency food policy interventions. We outline the vital public policy innovations in food access launched during the COVID-19 pandemic as well as the nonprofit emergency food network programs designed to implement and accompany these policies. In particular, we focus on innovations that addressed hunger for two vulnerable groups, children and the elderly, and we describe how these innovations increased food access. Finally, we advocate for the continuation of COVID-19 anti-hunger pandemic policies in the "next normal” because they reveal a path to end hunger that preserves people's dignity and provides healthy and affordable food access for all.

Health Equity and the Impact of Racism on Adolescent Health.

Racism is woven within the fabric of the United States culture, structures, and systems, including its healthcare system. There is extensive research on adults demonstrating racial discrimination's physical and mental health impacts, and the evidence showing similar disproportionate effects for adolescents of color continues to grow. Furthermore, the devastation of the coronavirus pandemic has paralleled the resurgence of white nationalism movements and adverse outcomes associated with the over-policing of Black and Brown communities. Scientific evidence continues to illustrate how sociopolitical determinants of health and experiencing vicarious racism amplify overt racism and implicit bias actions individually and within health care structures. Therefore, evidence-based strategic interventions are desperately needed to ensure the health and well-being of adolescents and young adults.

Pilot study of an undergraduate college course to support student mental health: Wellness and resilience for college and beyond

The purpose of this study was to investigate preliminary outcomes associated with an undergraduate course titled, "Wellness and Resilience for College and Beyond” (WRC), which teaches students evidence-based skills for emotional health. Three campuses in Southwestern Pennsylvania with no previous experience delivering this course implemented the one-semester WRC during the Fall 2019 semester;24 students completed a baseline survey and at least 1 follow-up survey. Participants completed electronic surveys at baseline, post-semester, and 3-month follow-up. Paired t-tests were used to compare baseline scores to scores at post-semester and 3-month follow-up. At post-semester, students reported significant improvements in psychological inflexibility, resilience, mindfulness, emotion dysregulation, distress tolerance, life satisfaction, dysfunctional coping, and adaptive skills use. With the exceptions of life satisfaction and emotion dysregulation, significant gains were maintained at 3-month follow-up. Notably, the follow-up assessment occurred at the beginning of the COVID-19 lockdown in the U.S. (March 2020), which may have affected life satisfaction and emotion dysregulation for participants. There was a nonsignificant decline in anxiety at post-semester which became statistically significant at 3-month follow-up. These preliminary data show proof of concept that WRC can be implemented successfully on new campuses with no previous expertise in this course and can achieve meaningful improvements on several emotional health outcomes with high relevance to collegiate mental health. In addition to these data, barriers to implementation and scale-up are discussed at length with "lessons learned” that may have broad relevance to the implementation of emotional wellbeing coursework in higher education and support such efforts to address student mental health at the population level.

From Vaccines to Vitality: The Progression of a Community-Academic Collaboration.

In this practice note, we document the progression of the Community Vaccine Collaborative (CVC), on which we first published in 2021. The CVC convened to address deep COVID-19-related disparities affecting the Black, Latine, immigrant/refugee, and lesbian, gay, bisexual, transgender, queer, (questioning), intersex, asexual, and (agender) (LGBTQIA+) communities. The COVID-19 pandemic is rooted in centuries of oppression and marginalization leading to inequities and required dedicated focus to support marginalized communities in times of crisis. The CVC comprises community members, community-based organizations, health care providers, researchers, health systems leaders, and public health practitioners (among others), all of whom are dedicated to promoting COVID-19 vaccine equity. As the pandemic shifts and changes, so too has our group, to remain relevant to community needs and priorities. This article details Year 2 of the CVC, focusing on how we have grown and sustained this unique partnership. We also share results from an evaluation of the CVC, documenting participation in the collaborative space and alignment with CVC core principles. Finally, we discuss next steps and implications for the CVC including our pivot from vaccines to community vitality as we expand and sustain our collaborative efforts to address the ongoing COVID-19 pandemic and intersecting public health crises.

Decreased access to therapeutic services for children with disabilities during COVID-19 stay-at-home orders in Western Pennsylvania.

PURPOSE: Assess the effects of stay-at-home orders on access to services utilized by families of children with disabilities (CWD). METHODS: Cross-sectional weekly surveys were fielded over four weeks, during which western Pennsylvania was under stay-at-home orders. Respondents were divided into families of CWD (N = 233) or without CWD (N = 1582). Survey questions included measures of socio-economic status, and families of CWD answered questions regarding access to services pre and post-initiation of stay-at-home orders. Differences between families with and without CWD were analyzed using chi-square tests. RESULTS: Among families of CWD that had used services previously, 76.6% of survey respondents stated that they had decreased access, with the greatest percentage experiencing loss among those previously utilizing early intervention (75.5%), outpatient therapies (69.1%), or school-based therapies (80.7%). Compared to families without CWD, families of CWD were more likely to report lower pre-COVID-19 annual incomes (p < 0.001), job or income loss related to COVID-19 (p < 0.001), and higher levels of perceived stress (p < 0.001). CONCLUSION: CWD experienced loss of services during stay-at-home orders implemented as COVID-19 mitigation measures. Due to decreased access to needed services, CWD may be at risk of medical complications and loss of developmental progress.

COVID-19 Information Sources for Black and Latine Communities: A Community Co-created Survey.

BACKGROUND: To ensure equity in coronavirus disease 2019 (COVID-19) vaccine access, it is critical that Black and Latine communities receive trustworthy COVID-19 information. This study uses community-based participatory research to understand sources of COVID-19 information for Black and Latine adults, how trustworthy that information is, and relationships between information sources and COVID-19 vaccine intention. METHODS: We co-created a survey in Spanish and English and distributed it to Black and Latine adults residing in the Pittsburgh area. Data were analyzed using descriptive statistics and multivariate logistic regression. RESULTS: There were 574 participants who completed the survey. Participants reported accessing a variety of COVID-19 information sources and generally trusted these sources. Few sources of information were associated with COVID-19 vaccine intention. We also review lessons learned from our community-academic collaboration. CONCLUSIONS: Trustworthy COVID-19 information sources may not be sufficient for increasing vaccine intention. Results can help other community-academic partnerships working to improve COVID-19 vaccine equity.

Language matters: humanizing service robots through the use of language during the COVID-19 pandemic.

Service robots are emerging quickly in the marketplace (e.g., in hotels, restaurants, and healthcare), especially as COVID-19-related health concerns and social distancing guidelines have affected people's desire and ability to interact with other humans. However, while robots can increase efficiency and enable service offerings with reduced human contact, prior research shows a systematic consumer aversion toward service robots relative to human service providers. This potential dilemma raises the managerial question of how firms can overcome consumer aversion and better employ service robots. Drawing on prior research that supports the use of language for building interpersonal relationships, this research examines whether the type of language (social-oriented vs. task-oriented language) a service robot uses can improve consumer responses to and evaluations of the focal service robot, particularly in light of consumers' COVID-19-related stress. The results show that consumers respond more favorably to a service robot that uses a social-oriented (vs. task-oriented) language style, particularly when these consumers experience relatively higher levels of COVID-19-related stress. These findings contribute to initial empirical evidence in marketing for the efficacy of leveraging robots' language style to improve customer evaluations of service robots, especially under stressful circumstances. Overall, the results from two experimental studies not only point to actionable managerial implications but also to a new avenue of research on service robots that examines customer-robot interactions through the lens of language and in contexts that can be stressful for consumers (e.g., healthcare or some financial service settings). Supplementary Information: The online version contains supplementary material available at 10.1007/s11002-022-09630-x.

School-Day Routines Positively Impact Time in Range for Children with Type 1 Diabetes

The impact of school day routines on glycemic control in children is unclear. We compared continuous glucose monitor (CGM) metrics for youth with type 1 diabetes during weekday school hours (8AM-3PM) between two 4-week periods before and during the COVID-pandemic, when children had transitioned to virtual school. Youth with >70% CGM wear (n=209) were included;46% male, mean±SD age 10.6±1.5 years, hemoglobin A1c 7.5±0.8%, 64% on insulin pumps. Time in range (TIR, 80-180 mg/dL) was similar during the pandemic (51.6±24.1%) compared to pre-pandemic (50.8±23.3%) . Using random coefficient multilevel linear mixed models, younger age (p=0.025) and pump use (p=0.043) predicted TIR, but not race (p=0.76) , diabetes duration (p=0.07) , body mass index (p=0.54) , or insurance status (p=0.45) . TIR pre- vs. during the pandemic varied significantly by time of day (p<0.001) . With in-person school pre-pandemic, TIR increased over school hours;with virtual school during the pandemic, TIR decreased in the morning and then remained steady (Figure) . Time above range (TAR, >180 mg/dL) had the opposite pattern. These findings suggest that in-person school can contribute to better TIR and lower TAR. Possible explanations include classroom and physical activity routines, plus school nurse support. During virtual school, continued routines are important and interventions to optimize diabetes care in school may benefit glycemic control.

Supporting Children Experiencing Family Violence During the COVID-19 Pandemic: IPV and CPS Provider Perspectives.

OBJECTIVES: Children experiencing family violence (child abuse and neglect and exposure to intimate partner violence) are at a particularly elevated risk for compounding challenges during the COVID-19 pandemic. In this study, we interviewed intimate partner violence (IPV) advocates, child protective services (CPS) caseworkers, and IPV and CPS administrators on the needs of children experiencing family violence during the pandemic. METHODS: We conducted semistructured interviews with IPV advocates, CPS caseworkers, and IPV and CPS administrators. Recruitment occurred through emails to national and state listservs, networks of the study team, and word of mouth. Interviews were completed through Zoom, took 45 to 60 minutes and were audio recorded. We used a mixed deductive-inductive content analysis approach. RESULTS: Fifty-nine IPV advocates, 35 IPV administrators, 21 CPS workers and 16 CPS administrators participated in this study. Four themes emerged from this work. Participants discussed the role of social isolation, school closures, and distance learning on children experiencing family violence. They also noted child custody and visitation challenges, particularly in the context of abusive partners using custody to control IPV survivors and limitations to virtual visitation more broadly. Compounding challenges were described for children from marginalized communities due to structural-level inequities. Collaboration was discussed by participants from both IPV and CPS sectors. CONCLUSION: This study is one of the first to describe the way the COVID-19 pandemic has impacted children experiencing family violence. Future studies should triangulate these results with children, families, and other child-serving providers.

The Pittsburgh Study: Learning with Communities About Child Health and Thriving.

The COVID-19 pandemic has highlighted structural inequities that are barriers to thriving for children in neighborhoods with concentrated disadvantage. Health systems are increasingly addressing health-related social needs. The "Pittsburgh Study" is a longitudinal, community-partnered study focused on child and adolescent thriving and racial equity. This initiative will elucidate critical influences on childhood health and thriving, evaluate developmentally appropriate interventions to improve outcomes from birth to high school, and establish a child health data hub. Integration of community members into scientific inquiry, rapid data-to-action cycles, and workforce development are strategies health systems may consider to enhance child health equity.

Regional extent, environmental relevance, and spatiotemporal variability of neonicotinoid insecticides detected in Florida's ambient flowing waters.

The use of imidacloprid and, to a lesser degree, other neonicotinoid insecticides is widespread in FL (and globally). The moderate to high water solubility and environmental persistence of neonicotinoids allows these compounds to readily enter, and be retained in, water resources where they may harm nontarget organisms and impact biological communities and associated trophic structures negatively. To better understand imidacloprid's chronic long-term exposure potential to aquatic invertebrate communities in FL, grab water samples were collected monthly in 2015 at 77 monitoring stations statewide. Fifty-eight stations (75%), representing 24 of the 25 drainage basins sampled, had detectable concentrations of imidacloprid, with concentrations ranging from 2 to 660 nanograms per liter [ng/L]. Imidacloprid basin medians were found to be correlated with two of six land use categories (urban, transportation, agriculture, and three crop classes) examined; urban (rho = 0.43, p-value = 0.03), and orchards and vineyards (rho 0.49, p-value = 0.01). The resampling of 12 select stations, representing eight basins, between August 2019 and July 2020, for the neonicotinoids acetamiprid, clothianidin, dinotefuran, imidacloprid, and thiamethoxam, showed that (1) median values of imidacloprid continued to exceed the US EPA chronic freshwater Invertebrate Aquatic Life Benchmark (IALB) (10 ng/L), (2) imidacloprid concentration was directly correlated with flow measurements, and (3) while median imidacloprid concentration decreased between the two sampling events (48.5 vs. 34.5 ng/L, p-value = 0.01) differences in event 1 and 2 streamflow regimes and disruptions due to the COVID-19 pandemic likely affected this outcome. Clothianidin was the only other neonicotinoid found to have values greater than a US EPA IALB, with detections at three stations exceeding the chronic IALB (50 ng/L). This study highlights the challenges associated with limiting neonicotinoids from entering water resources and identifies means to reduce their entry into and persistence within FL water resources.

Gender-Diverse Youth's Experiences and Satisfaction with Telemedicine for Gender-Affirming Care During the COVID-19 Pandemic.

Purpose: Telemedicine holds potential to improve access to gender-affirming care for gender-diverse youth (GDY), but little is known about youth's perspectives regarding its use. The purpose of this study was to explore GDY's experiences and satisfaction with telemedicine for gender-affirming care during the COVID-19 pandemic. Methods: An online, cross-sectional survey was completed by 12-17-year-old GDY after a telemedicine gender clinic visit. Demographic characteristics, responses to a 12-item telemedicine satisfaction scale, and items assessing interest in future telemedicine use were analyzed using descriptive statistics. Open-ended items exploring GDY's experiences were coded qualitatively to identify key themes. Results: Participants' (n=57) mean age was 15.6 years. A majority were satisfied with telemedicine (85%) and willing to use it in the future (88%). Most GDY preferred in-person visits for their first gender care visit (79%), with fewer preferring in-person for follow-up visits (47%). Three key themes emerged from the open-ended comments: (1) benefits of telemedicine including saving time and feeling safe; (2) usability of telemedicine such as privacy concerns and technological difficulties; and (3) telemedicine acceptability, which included comfort, impact on anxiety, camera use, and patient preference. Conclusions: Despite their preference for in-person visits, a majority of GDY were satisfied and comfortable with telemedicine, and expressed their interest in continuing to have telemedicine as an option for care. Pediatric gender care providers should continue services through telemedicine while implementing protocols related to privacy and hesitation regarding camera use. While adolescents may find telemedicine acceptable, it remains unclear whether telemedicine can improve access to gender-affirming care.

Using reflective, authentic assessments to embed employability skills in higher education

Purpose>Reflection on performance and progress prepares students for workplace environments where self-management is expected, and yet this is something students are not often required to do formally in higher education (HE). This paper explores this gap in students' ability and seeks to address it through a reconsideration of summative assessment practices which, particularly in light of COVID-19, must align with the needs of graduates and their employers.Design/methodology/approach>The paper draws from data collected from the summative reflective assessment reports that degree apprentices (DAs) submitted during the final year of their Business Management degree while undertaking a problem-based module. We undertook a document analysis of these reports and used thematic analysis where we systematically looked for repeated themes in students' reflections.Findings>Students problematise the skills needed during COVID-19, and beyond, both in their academic studies and the workplace. Authentic assessment provides opportunities for students to work on skills and projects which are relevant to them. Through reflective accounts of skills they developed, students were able to bridge academic and professional practice and identify areas of convergence. Students engaged with academic theories in a constructive and meaningful way which suggests that authentic reflective accounts as part of assessment have the potential to maintain academic rigour.Originality/value>Skills development can bring the workplace into HE in a meaningful and systematic way and this article provides guidance for those looking to introduce reflection on skills to other courses. We suggest how this model can be utilised across modules which do not have work-integrated learning in their delivery.