Multiple sclerosis -key biomarkers that predict disability discovered

A pioneering study presented today at ECTRIMS 2024 has identified critical biomarkers that can predict disability worsening in multiple sclerosis
A pioneering study presented has identified critical biomarkers that can predict disability worsening in multiple sclerosis.


His breakthrough research can potentially transform treatment strategies for millions of MS patients worldwide, paving the way for more personalised and effective treatment plans.

In a multicenter observational study conducted across 13 hospitals in Spain and Italy, Dr. Enric Monreal and his team discovered that elevated serum neurofilament light chain (sNfL) levels, a protein indicating nerve cell damage at the onset of MS, can predict both relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA). Furthermore, they found that serum glial fibrillary acidic protein (sGFAP) levels, a protein derived from astrocytes that enter the bloodstream when the central nervous system (CNS) is injured or inflamed, correlate with PIRA in patients with low levels of safety.

Key findings reveal that higher sNfL levels, indicative of acute inflammation within the CNS in MS, are associated with a 45% increased risk of RAW and a 43% increased risk of PIRA. Patients with high sNfL levels often did not respond well to standard disease-modifying treatments (DMTs) but showed significant benefits from high-efficacy DMTs (HE-DMTs) such as Natalizumab, Alemtuzumab, Ocrelizumab, Rituximab, and Ofatumumab.

In contrast, patients with high sGFAP levels—which indicate more localised inflammation driven by microglia in the CNS—and low sNfL levels experienced an 86% increased risk of PIRA. This group did not respond to current DMTs.

Interestingly, while sGFAP is known to be associated with progression, high sNfL levels limited the ability of sGFAP to predict this outcome. Specifically, sGFAP values were predictive of PIRA only in patients with low sNfL levels.“”The discovery of sNfL and sGFAP as predictive biomarkers enables us to customize treatment plans for MS patients more effectively,” says Dr. Monreal, a researcher in MS at Ramón y Cajal University Hospital and the study’s lead author. “Patients with low levels of both biomarkers have a positive prognosis and can be treated with injectable or oral DMTs. However, high sNfL levels indicate a need for HE-DMTs to prevent disability progression, while patients with high sGFAP levels and low sNfL values may require new therapeutic approaches. These distinct pathways in MS have significant therapeutic implications, as current DMTs primarily target the peripheral adaptive immune system without affecting CNS immunity. Therefore, identifying patients with higher levels of peripheral inflammation is crucial for preventing disability and improving patient outcomes.”

“The results of this study underscore the critical need for personalised treatment approaches to effectively manage the millions of people affected by MS worldwide, many of whom have chronic disability that significantly impacts their quality of life,” says Dr. Monreal.

“By measuring both sNfL and sGFAP levels at disease onset, we gain valuable insights into the progression pathways of MS, enabling clinicians to identify the optimal patients for specific DMTs. This approach aims to prevent disability while avoiding unnecessary treatment-related risks for those at lower risk.”

Barriers complicate exercise for disability community

Exergame

An exergame is type of accessible exercise equipment with a video game component that keeps users engaged while monitoring their activity Photo courtesy UT Arlington

An estimated 16% of people worldwide live with a significant disability that impacts their daily life. Of this population, only about 40% engage in aerobic activity. Due to this lack of exercise, people with disabilities (PWD) are more likely to suffer from chronic conditions such as heart disease, stroke, diabetes, or cancer and are at higher risk of mental illnesses like depression and anxiety.

“Many PWD struggle with psychological issues such as low self-esteem and negative body image, which can further reduce their motivation to participate in exercise activities, especially in public places like gyms,” said Alexandra Jamieson, research scientist at The University of Texas at Arlington Research Institute (UTARI) and lead author of a new peer-reviewed study on adaptive exercise technologies for PWD. Former UTARI student researcher Helara D. Wijesundara is also an author on the paper.

Even PWD who are interested in exercising face challenges, as most commercial gyms lack adaptive equipment and properly trained staff to ensure their safety. Jamieson found that although some nonprofit organizations aim to promote fitness for PWD, there are few commercial efforts to reach the wider community to encourage exercise.

“The biggest barriers to fitness are accessibility and cost,” said Jamieson. “Standard gyms are not legally required to have adaptive machines for users of differing abilities. Plus, there is generally a lack of data about the demand for these adaptive machines that would help gyms justify the higher costs of adding them.”

She also noted that transportation to and from the gym can be an issue for PWD. Although ride-sharing and disabled transit options exist, they are not always reliable, and many are not equipped for PWD.

Home gyms are a popular option for PWD, but a lot of adaptative exercise equipment is produced by smaller manufacturers and has higher production costs, making it cost-prohibitive for individuals to purchase it. Jamieson suggests expanding government assistance programs around acquiring adaptative exercise machines for home use.

“Medicaid does have purchasing assistance programs for PWD to buy assistive technology, but they are not well known and only cover exercise machines that are deemed medically necessary by an individual’s doctor,” she said. Raising public awareness among physicians and PWD about how to apply for assistance to acquire adaptive exercise equipment could be a way to help.

To improve adaptive exercise options, Jamieson is working with colleagues from UTARI, the Department of Kinesiology, and the Department of Art to create an adaptive exergame machine, a type of accessible exercise equipment with a video game component that keeps users engaged while monitoring their activity. The team is currently recruiting individuals to participate in a pilot study of the technology. Please contact Jamieson if you would like additional information.

ChatGPT is biased against resumes with credentials that imply a disability or autism

Artificial intelligence
Artificial intelligence

Last year, while looking for research internships, University of Washington graduate student Kate Glazko noticed that recruiters were using OpenAI’s ChatGPT and other AI tools to summarize resumes and evaluate candidates. As a doctoral student in the UW’s Paul G. Allen School of Computer Science & Engineering, she researches how generative AI can replicate and amplify biases, including those against disabled individuals. This led her to wonder how such a system would assess resumes that hinted at a candidate having a disability.

In a recent study, researchers at the University of Washington found that ChatGPT consistently rated resumes with disability-related awards and credentials, such as the “Tom Wilson Disability Leadership Award,” lower than identical resumes without those honours. When asked to justify the ratings, the system produced biased views of people with disabilities. For example, it asserted that a resume with an autism leadership award placed “less emphasis on leadership roles,” thus perpetuating the stereotype that individuals with autism are not effective leaders.

Following specific written instructions to avoid bias, researchers found that the tool significantly reduced bias for all but one of the disabilities tested. The tool showed improvement in handling five out of six implied disabilities, such as deafness, blindness, cerebral palsy, autism, and the general term “disability.” However, only three ranked higher than resumes that didn’t mention disability. of these ranked higher than resumes that didn’t mention disability.

“Ranking resumes with AI is starting to proliferate, yet there’s not much research behind whether it’s safe and effective,” said Ms Glazko, the study’s lead author. “For a disabled job seeker, there’s always this question when you submit a resume of whether you should include disability credentials. I think disabled people consider that even when humans are the reviewers.”

The researchers used the publicly available curriculum vitae (CV) of one of the study’s authors, which was around 10 pages long. Then, they created six modified CVs, each suggesting a different disability by adding four disability-related credentials: a scholarship, an award, a seat on a diversity, equity, and inclusion (DEI) panel, and membership in a student organization.

The researchers utilized ChatGPT’s GPT-4 model to compare the improved resumes with the original versions for a genuine “student researcher” job posting at a major software company in the United States. They conducted 10 comparisons for each, resulting in 60 total trials. Surprisingly, the system ranked the enhanced resumes, which differed only in implied disability, as the top choice in only 1 out of every 4 trials.

“In a fair world, the enhanced resume should always be ranked first,” said senior author Jennifer Mankoff, a UW professor in the Allen School. “I can’t think of a job where someone recognized for their leadership skills, for example, shouldn’t be ranked ahead of someone with the same background who hasn’t.”

Researchers found that when GPT-4 was asked to explain the rankings, its responses showed signs of explicit and implicit ableism. For example, it mentioned that a candidate with depression had “additional focus on DEI and personal challenges,” which “detract from the core technical and research-oriented aspects of the role.”

“According to Ms Glazko, some of GPT’s descriptions unfairly associated a person’s entire resume with their disability. It claimed that involvement in diversity, equity, and inclusion (DEI) or disability could detract from other parts of the resume. For example, it created the notion of ‘challenges’ in the context of comparing resumes of individuals with and without depression, even though ‘challenges’ weren’t mentioned at all. This led to the emergence of certain stereotypes.”

Researchers were curious about whether the system could be trained to be less biased. They used the GPT-4 Editor tool to customize the chatbot with written instructions (no coding required). The instructions were to ensure that the chatbot does not exhibit any ableist biases and instead operates according to disability justice and DEI (Diversity, Equity, and Inclusion) principles.

The experiment was repeated using the newly trained chatbot. In this trial, the system preferred the enhanced CVs over the control CV 37 times out of 60. However, for certain disabilities, the improvements were minimal or absent. For example, the autism CV ranked first only three out of 10 times, and the depression CV only twice, which was the same as the original GPT-4 results.

“People must understand the system’s biases when utilizing AI for real-world tasks,” Glazko mentioned. “Otherwise, a recruiter using ChatGPT may be unable to make these corrections or be aware that, even with instructions, bias can persist.”

Researchers note that some organizations, such as ourability.com and inclusively.com, are working to improve outcomes for disabled job seekers who face biases about whether or not AI is used for hiring. They also emphasize that more research is needed to document and remedy AI biases.

“It is so important that we study and document these biases,” Mankoff said. “We’ve learned a lot from and will hopefully contribute back to a larger conversation — not only regarding disability, but also other minoritized identities — around making sure technology is implemented and deployed in ways that are equitable and fair.”a disability

Big firms are failing to reduce unconscious bias against disabled people. Was this true for you? Please share in the comments below!

Working for a big company or in an HR role does not lower the likelihood of showing unconscious bias against disabled people at work, a new study finds
Working for a big company or in an HR role does not lower the likelihood of showing unconscious bias against disabled people at work, a new study finds


Working for a big company or in an HR role does not lower the likelihood of showing unconscious bias against disabled people at work, a new study finds.

Researchers say this is ‘surprising’ because of the money many large firms spend on EDI and unconscious bias training – in 2017 up to $8bn in the US alone – and the fact HR professionals are often specifically trained in EDI issues.

The research, a collaboration between the University of Exeter’s Business School and Medical School and funded through The Inclusivity Project, is also the first to link health status and unconscious bias, with lower levels of unconscious bias against disabled people found among those with a lower health status.

The study also found women to be less biased against disabled people than men.

Around half of the study’s 108 participants, recruited from businesses across the South West, either worked in HR or were involved in making recruitment decisions in their roles, while 50% reported working for a small to medium-sized enterprise.

They were required to perform a number of tasks, including answering questions on their own disability status and past experiences of interacting with people with a disability.

They also completed the Health Related Quality of Life survey – which focuses on an individual’s quality of mobility, self-care, usual activities, pain/discomfort and anxiety/depression – as well as taking the Implicit Association Test (IAT).

The IAT uncovers unconscious attitudes by measuring how quickly people link stimuli such as pictures of disabled and non-disabled people to positive or negative words.

Just under three-quarters of the participants showed some level of implicit bias against disabled people in favour of non-disabled people, a figure in line with existing research studies.

But the researchers found that levels of unconscious bias against disabled people were roughly the same whether participants worked for a large company or an SME.

Working in HR or in a role where you make recruitment and retention decisions was also found not to have a significant effect on implicit bias.

The finding that participants’ own disability or health status was associated with lower implicit bias is consistent with previous studies on race or gender that show people are less biased towards groups they belong to or identify with, the researchers say.

Reducing implicit bias against disabled people requires greater disability representation in the workplace, the researchers recommend.

Dr Daniel Derbyshire, a Postdoctoral Research Fellow at the University of Exeter and lead author of the study, said: “It is clear that there is a need for greater disability representation – especially within HR and at senior levels where people make hiring decisions – and that bridging this gap in representation may improve both attitudes towards disabled people and the disability employment gap.

“Addressing negative attitudes towards disabled people in the workplace should be a high priority for policy makers interested in the disability employment gap.”

Large companies may now need to rethink their EDI strategies to address the findings, the researchers suggest.

“It is surprising that neither working for a large company nor being involved in HR have a significant effect on implicit attitudes towards disabled people, which require deeper and more structural reimagining of paradigms and modes of thinking with respect to disability to meaningfully change,” said Dr Derbyshire.

“This may suggest that the current efforts of large companies compared to SMEs are not effective at reducing implicit bias and that current strategies require rethinking.”

How to Live an Independent Life When Using a Wheelchair

Adapting to life with a disability can feel overwhelming, as you might fear you will be stripped of your independence. Using a wheelchair will result in various physical limitations, but there are ways to overcome the hurdles you will face and enjoy a better quality of life.

If you want to not only survive but thrive with a disability, read the following advice on how to live an independent life when using a wheelchair.

Learn How to Use a Wheelchair

Mastering a wheelchair will take time and experience. You will need to develop a rhythm, make mistakes along the way, and practice maneuvers to feel confident in the chair. It might feel frustrating when using a wheelchair for the first time, but you must have some patience and persevere.

Also, you might find helpful training in your city or online, which can help you learn the basics and even some complex or skillful moves. If you are unsure where to visit, ask your doctor for more information.

Buy or Hire a Wheelchair-Accessible Vehicle

You might worry about how you will travel from A to B without a car. However, you can buy or hire a wheelchair-accessible vehicle from alliedmobility.com, for example, which will allow you to make short or long journeys without hassle or fuss. It is the best way to maintain an independent lifestyle, as you can visit loved ones with ease, go shopping regularly, and enjoy fun days out during your spare time.

Join a Disability Support Group

A disability support group provides members with many benefits. Talking to others will make you feel less alone with a disability, as you will realize many people face the same challenges and emotions as you. In addition to sharing stories and struggles, you will likely find various helpful solutions to help you enjoy more daily independence and process your new way of life.

Download Wheelchair Access Apps

It is natural to worry if a venue is wheelchair-accessible before you arrive, as unfortunately, not all restaurants, stores, and buildings will be. Eliminate fears in advance by downloading helpful apps to find wheelchair-accessible places. Great app options include WheelMap, Wheely, WheelMate, and Google Maps, to name but a few apps.

Exercise Regularly & Play Sports

Exercise allows you to lead a more independent lifestyle when using a wheelchair. For example, weightlifting and cardio will improve your upper body strength and resilience, which will help you to lift items with ease and improve your wheelchair speed and technique.

Completing various exercises or fun activities with other wheelchair users will allow you to challenge yourself while lifting your mood and providing a sense of satisfaction. For instance, you can go swimming or participate in a team sport, such as basketball, rugby, tennis, or fencing. Many sports can be modified for wheelchair users, and if you can’t find a team in your neighborhood, consider creating one to play your favorite sport with other wheelchair users.