Smoking in Systemic Sclerosis: a Longitudinal European Scleroderma Trials and Research Group Study

Data on the role of tobacco exposure in systemic sclerosis (SSc) severity and progression are scarce. We aimed to assess the effects of smoking on the evolution of pulmonary and skin manifestations in the EUSTAR database

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort.

Objectives To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS >5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. Results Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p<0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). Conclusions Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

Abstract: Background: Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. Results: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction

Critical thinking skills in the International Baccalaureate’s “Theory of Knowledge” subject

There is considerable debate both in Australia and internationally about the best way for schools to deliver the thinking skills required for university study and professional work life – skills that are often referred to by the term “critical thinking”. This article reviews the literature on the effective teaching of critical thinking and looks at one example of a secondary school subject aimed at developing critical thinking skills in its graduates, namely the Theory of Knowledge (ToK) subject in the International Baccalaureate Diploma Program (DP). ToK, a core element of the DP, has no set curriculum. Instead, ToK requires students to think deeply about knowledge problems and to formulate coherent views on the nature of knowledge. This article reports on an Australian study into the teaching and learning of ToK and presents associated outcomes in cohorts of both secondary and tertiary students

Evaluation of the Widening Participation Student Ambassadors Initiative: Project Report for Office of Widening Participation, Western Sydney University

The Office of Widening Participation at Western Sydney University delivers more than 50 programs in schools and around the university that aim to increase young people's educational engagement and aspirations for higher study. These programs are particularly focused on students from low SES backgrounds, and equity groups identified by the Bradley Review (2008) into higher education. These are supported by WSU students who have received training as Student Ambassadors. Although evaluations of specific programs and impacts on school students have been undertaken, there has never been a focus on the Student Ambassadors themselves, on their experiences and perceptions of the program, and the impact of their contributions. This evaluation aims to fill that gap. The Student Ambassadors deliver programs to ensure that educational and life pathways are open to young people of all backgrounds and circumstances; however Student Ambassadors’ own experiences within these programs and the impact of program participation on their own academic, social and civic outcomes has, thus far, been overlooked. Many of the Student Ambassadors themselves have experienced challenges to participation in higher education that parallel those of the school students with whom they work. Further, participation in the program as Student Ambassadors is likely to enhance their own engagement in higher education. Accordingly, the purpose of this project was to evaluate the impact of Western Sydney University students’ participation in the WP Student Ambassadors program in terms of their self-efficacy beliefs, academic and professional resilience, professional skill development, civic and social awareness, connectedness to community and academic outcomes. These dimensions of impact were evaluated through a mixed-method, multi-cohort evaluation over the course of the 2016 academic year. As one of the aims of this research project was to explore how engaging with low-SES/high-need primary and secondary school students as role models may have influenced their sense of civic and social responsibility, this research can directly inform the future practice of WP program in increasing students' sense of community connections with the Western Sydney University academic community as well as the broader Western Sydney region

Bolstering graduates’ success through working as student ambassadors in university widening participation programs

Since 2010, the Higher Education Participation and Partnerships Program (HEPPP) has provided funding for Australian universities to ‘raise aspiration’ among under-represented groups. Underpinned by utilitarian discourses of human capital and individual capacitation, these resources have transformed the ways that universities seek to engage prospective students. This paper turns to an overlooked cohort that is integral to widening participation initiatives, but has rarely been the focus of research. These are the student ambassadors – university students who work within HEPPP programs. This paper reports findings from the alumni component of a mixed-method study which examines how widening participation programs, which are ostensibly directed at future university enrolments, might also help university students who work as student ambassadors to become successful professionals and citizens once they graduate from university. Alumni accounts of their experiences and self-reported impact of their ambassador work advocate a more holistic view of graduate success and how activities beyond mandatory coursework can contribute to success beyond university graduation. Evidence from student ambassador alumni suggests that these positive impacts are broad and long-lasting, contributing to students’ professional successes and personal lives

IB Programme: Theory of Knowledge (TOK): Exploring Learning Outcomes, Benefits, and Perceptions

This study examines one of the central elements of the International Baccalaureate Diploma Programme, the Theory of Knowledge (TOK) course. Four case study schools in Sydney, Australia have collaborated with the research team in 2013 in order to share their perceptions, implementation strategies and evaluation of the TOK course. The case study schools have contextually varied situations, locations, histories and philosophies, which collectively provide information on how the TOK has been taken up, interpreted and adapted by particular school communities. All data arising from these case studies has been coded and thematically analysed by the research team. In addition to the case studies, the University of Western Sydney research team have prepared two online surveys, one for teachers and one for students of the International Baccalaureate Diploma Programme (IB DP), which all Australian IB DP schools were invited to complete. Data from these surveys were analysed using bivariate and multivariate statistical analysis. In a further quantitative component of the study, the research team examined mixed cohorts of first year International Baccalaureate (IB) and non-IB university students from a number of Australian universities using the California Critical Thinking Disposition Inventory (CCTDI). Together these data sources provide an analysis of the current functioning of the TOK course in Australia and in relation to academic self-concept and critical thinking