Increased serum neurofilament light chain concentration indicates poor outcome in Guillain-Barré syndrome

BACKGROUND Guillain-Barré syndrome (GBS) is an autoimmune disease that results in demyelination and axonal damage. Five percent of patients die and 20% remain significantly disabled on recovery. Recovery is slow in most cases and eventual disability is difficult to predict, especially early in the disease. Blood or cerebrospinal fluid (CSF) biomarkers that could help identify patients at risk of poor outcome are required. We measured serum neurofilament light chain (sNfL) concentrations from blood taken upon admission and investigated a correlation between sNfL and clinical outcome. METHODS Baseline sNfL levels in 27 GBS patients were compared with a control group of 22 patients with diagnoses not suggestive of any axonal damage. Clinical outcome parameters for GBS patients included (i) the Hughes Functional Score (HFS) at admission, nadir, and discharge; (ii) the number of days hospitalised; and (iii) whether intensive care was necessary. RESULTS The median sNfL concentration in our GBS sample on admission was 85.5 pg/ml versus 9.1 pg/ml in controls. A twofold increase in sNfL concentration at baseline was associated with an HFS increase of 0.6 at nadir and reduced the likelihood of discharge with favourable outcome by a factor of almost three. Higher sNfL levels upon admission correlated well with hospitalisation time (rs = 0.69, p < 0.0001), during which transfer to intensive care occurred more frequently at an odds ratio of 2.4. Patients with baseline sNfL levels below 85.5 pg/ml had a 93% chance of being discharged with an unimpaired walking ability. CONCLUSIONS sNfL levels measured at hospital admission correlated with clinical outcome in GBS patients. These results represent amounts of acute axonal damage and reflect mechanisms resulting in disability in GBS. Thus, sNfL may serve as a convenient blood-borne biomarker to personalise patient care by identifying those at higher risk of poor outcome

A framework for assessing work integrated learning

The aim of our research is to provide a unified model for the composition and management of consumer care services. We identify design, composition, distribution and management as key stages of this model and propose an Intelligent Collaborative Care Management (ICCM) System as its realisation. The distribution and management stages are implemented as multi-agent systems. Agents in the distribution stage carry out domain-specific negotiation and distribution processes for the assignment of tasks in the care plan. Through the agents in the management stage, we introduce the notion of &#039;failure prevention&#039; and &#039;adherence support&#039; in contrast to &#039;failure recovery&#039; in planning. The key to failure prevention is to identify what has to be carried out to prevent care plan failures. The healthcare domain is used to demonstrate the ICCM system

Greenhouse gas reduction in industry: A multidisciplinary approach to project-based learning

Since 2004, ten to fifteen final year undergraduate mechanical engineering students at RMIT University have worked on projects with local firms aimed at reducing greenhouse gas emissions by enhancing energy efficiency, reducing waste and/or using renewable energy. This Greenhouse Challenge Plus Support Program is a collaborative project with NORTH Link under the auspices of the Australian Greenhouse Office. In 2007, this project was extended to include students from other disciplines with the help of additional funding from RMIT&#039;s Design the Future initiative. In addition to the engineering projects, five multidisciplinary teams of undergraduate students - from the disciplines of mechanical engineering, social science and environment, industrial design, and management - were formed to work on more extensive projects with local firms. On completion of the project, the students and industry representatives were interviewed and the findings evaluated. In this paper, we report on our preliminary findings

The role of industry supervisors in providing feedback to students as part of the assessment process in Work Integrated Learning (WIL)

The workplace has been identified as providing a rich and rewarding source of learning for students. The provision of feedback is viewed as an integral part of assessing workplace learning or work integrated learning (WIL). However, the educational value of providing feedback to students by workplace supervisors on the full range of skills and competencies used in the professional setting has not been extensively studied. The practice of providing feedback to students from workplace supervisors clearly prevails both in Australia and more broadly in the international context, but documentation and research does not match the practice. Limited literature has been found on the process of providing feedback assessment by workplace supervisors, either formative or summative to students undertaking work-based learning. This study investigates best-practice models of industry feedback practices for WIL activities. These practices include the early involvement of students in defining goals/objectives and expectations with their supervisor; and clearly stated criteria for evaluating performance against the stated goals. The study builds on this prior literature to report desirable methods of workplace supervisor feedback that recognises ‘learning by doing’ through academic value attribution to data collected in the workplace. In particular, the study incorporates input from experienced industry supervisors in terms of defining their roles with students and academic mentors and delineating the criteria for student performance. A qualitative analysis of interviews with 15 industry supervisors of WIL students contributes to the body of knowledge on preferred modes for evaluating and reporting student performance. Sample feedback tools and guidelines which serve as models for industry supervisors are reported in the study. These feedback tools and guidelines fall within the broader context of holistic assessment processes for work integrated learning and provide educators with direction for effective engagement and feedback from industry supervisors

Mortality and Inherited Thrombophilia: results from the European Prospective Cohort on Thrombophilia (EPCOT).

Background: Data on the survival of individuals with hereditary thrombophilia are rare and only come from retrospective studies. Objective: We aimed to assess mortality in individuals with known thrombophilia with and without a history of thrombosis in comparison to a control group. Patients/Methods: The European Prospective Cohort on Thrombophilia (EPCOT) study is a prospective multi-centre observational study performed to assess the risk of thrombosis in persons with inherited thrombophilia. In an extension of this study the vital status was assessed in 1,240 individuals with thrombophilia (mean age 40.9 years, 59% women, 196 with antithrombin-, 341 with protein C-, 276 with protein S-deficiency, 330 with factor V Leiden and 97 with combined defects, 62% with a VT history) and 875 controls (mean age 42.5 years, 48% women, 7% with a VT history). Results: Seventy-two individuals with thrombophilia and 45 controls died during follow-up. The risk of death, adjusted for sex, thrombosis-history and centre, was not associated with thrombophilia (hazard ratio (HR) thrombophilia individuals versus controls: 1.09, 95% confidence interval (CI) 0.66-1.78). When individuals with thrombophilia were evaluated separately, a history of thrombosis was not associated with mortality: the risk of death after adjustment for sex, anticoagulation and center was HR 0.79 (95% CI 0.41-1.54). Conclusions: No increased risk of death in individuals with thrombophilia, not even in those with a history of thrombosis, was observed

Languages at Work: Defining the Place of Work-Integrated Learning in Language Studies

This chapter makes an argument for the place of Work-Integrated Learning (WIL) in tertiary language studies, with specific reference to the Spanish and German programs at the University of Melbourne. Incorporating WIL into our curricula has enabled us to connect students with local communities and cultural institutions, as well as provide them with work-relevant skills, in particular intercultural competence. Providing students with opportunities to develop work-relevant skills has seen us focus our energies not just on the more advanced-level language subjects where students are clearly suited to placements and internships, but also on beginner- and intermediate-level language subjects. An advantage of this whole-of-curriculum approach is that students understand the contemporary relevance of language study from the outset of their degree. Language study is often seen as something that adds value to another core degree and, as we incorporate WIL into our curriculum, it is our hope that we are able to articulate more clearly the value of language study to our diverse cohort of students