Signature for Pain Recovery IN Teens (SPRINT): protocol for a multisite prospective signature study in chronic musculoskeletal pain

INTRODUCTION: Current treatments for chronic musculoskeletal (MSK) pain are suboptimal. Discovery of robust prognostic markers separating patients who recover from patients with persistent pain and disability is critical for developing patient-specific treatment strategies and conceiving novel approaches that benefit all patients. Given that chronic pain is a biopsychosocial process, this study aims to discover and validate a robust prognostic signature that measures across multiple dimensions in the same adolescent patient cohort with a computational analysis pipeline. This will facilitate risk stratification in adolescent patients with chronic MSK pain and more resourceful allocation of patients to costly and potentially burdensome multidisciplinary pain treatment approaches. METHODS AND ANALYSIS: Here we describe a multi-institutional effort to collect, curate and analyse a high dimensional data set including epidemiological, psychometric, quantitative sensory, brain imaging and biological information collected over the course of 12 months. The aim of this effort is to derive a multivariate model with strong prognostic power regarding the clinical course of adolescent MSK pain and function. ETHICS AND DISSEMINATION: The study complies with the National Institutes of Health policy on the use of a single internal review board (sIRB) for multisite research, with Cincinnati Children's Hospital Medical Center Review Board as the reviewing IRB. Stanford's IRB is a relying IRB within the sIRB. As foreign institutions, the University of Toronto and The Hospital for Sick Children (SickKids) are overseen by their respective ethics boards. All participants provide signed informed consent. We are committed to open-access publication, so that patients, clinicians and scientists have access to the study data and the signature(s) derived. After findings are published, we will upload a limited data set for sharing with other investigators on applicable repositories. TRIAL REGISTRATION NUMBER: NCT04285112

Design and in pandemic validation of correlation visualisation for sleep data analytics

Sleep plays an important role in the overall health and well-being of a child. The relationship between sleep and daytime behaviours of children with sleep disorders is understood poorly; different aspects of a child’s routine may interact with each other to contribute to sleep disorders. To diagnose, monitor and successfully treat many medical conditions pertaining to sleep, it becomes imperative to analyse the many aspects of a child’s daytime and sleep behaviours. We built a visual analytic tool for studying the correlation between different variables pertaining to the daily life of the child. The tool allows clinicians to explore how the different aspects of a child’s behaviour and activities affect their sleep and overall well-being. This tool is developed as an extension of an existing tool SWAPP, which allows caregivers and clinicians to log and monitor the child’s everyday data. Later, we performed a remote usability study on the tool to demonstrate the efficacy of the tool. Finally, we generated actionable guidelines for improving the tool from the results of the study

Ability of early neurological assessment and continuous EEG to predict long term neurodevelopmental outcome at 5 years in infants following hypoxic-ischaemic encephalopathy

Hypoxic-ischaemic encephalopathy (HIE) symptoms evolve during the first days of life and their monitoring is critical for treatment decisions and long-term outcome predictions. This thesis aims to report the five-year outcome of a HIE cohort born in the pre-therapeutic hypothermia era and to evaluate the predictive value of (a) neonatal neurological and EEG markers and (b) development in the first 24 months, for outcome. Methods: Participants were recruited at age five from two birth cohorts; HIE and Comparison. Repeated neonatal neurological assessments using the Amiel-TisonNeurological-Assessment-at-Term, continuous video EEG monitoring in the first 72 hours, and Sarnat grading at 24 hours were recorded. EEG severity grades were assigned at 6, 12 and 24 hours. Development was assessed in the HIE cohort at 6, 12 and 24 months using the Griffiths Mental Development (0-2) Revised Scales. At age five, intellectual (WPPSI-IIIUK scale), neuropsychological (NEPSY-II scales), neurological and ophthalmic testing was completed. Results: 5-year outcomes were available for 81.5% (n=53) of HIE and 71.4% (n=30) of Comparison cohorts. In HIE, 47.2% (27% mild, 47% moderate, 83% severe Sarnat), had non-intact outcome vs. 3.3% of the Comparison cohort. Non-intact outcome rates by 6-hour EEG-grade were: grade0=3%, grade1=25%, grade2=54%, grade3/4=79%. In HIE, processing speed (p=0.01) and verbal short-term memory (p=0.005) were below test norms. No significant differences were found in IQ, NEPSY-II or ocular biometry scores between children following mild and moderate HIE. Median IQ scores for mild (99(94-112),p=grade 2) at 24hours had superior positive predictive value (74%; AUROC(95%CI)=0.70(0.55-0.85) for non-intact 5-year outcome than abnormal EEG at 6 hours (68%; AUROC(95%CI)=0.71(0.56-0.87). Within-child development scores were inconsistent across the first 24 months. Although all children with intact 24-month Griffiths quotient (n=30) had intact 5-year IQ, 8/30 had non-intact overall outcome. Conclusion: Predictive value of neonatal neurological assessments and an EEG grading system for outcome was confirmed. Intact early childhood outcomes post-HIE may mask subtle adverse neuropsychological sequelae into the school years. This thesis supports emerging evidence that mild-grade HIE is not a benign condition and its inclusion in studies of neuroprotective treatments for HIE is warranted

Children with Sleep-Disordered Breathing and the Role of Attention in Executive Functioning Deficits

This item is only available electronically.Sleep-disordered breathing (SDB) is a common disorder found in children, with up to a third of children affected. SDB ranges from acute snoring to Obstructive Sleep Apnea (OSA), characterised by partial or complete cessation of airflow in the upper airway during sleep. Neurocognitive deficits as a result of SDB in children have been extensively examined, particularly in relation to executive functioning. However, these findings are inconsistent and it is possible that underlying attentional deficits in SDB are the cause of reported executive dysfunction, rather than these being a direct result of SDB. Using previously collected data, this study’s focus is on whether attentional deficits play an underlying role in producing executive dysfunction. In the present study, children with SDB (18 males, 12 females, mean age, 8.30 ± 2.46 in years) and healthy matched control children (19 males, 21 females, mean age, 8.26 ± 2.15 in years) completed a battery of executive and attention tasks, as well as overnight monitoring of sleep. Despite deficits in planning ability and overall attention/executive performance amongst SDB children, there was no interaction between group and task (attention vs executive functioning), indicating that deficits in executive function are not likely the result of underlying attention problems. BMI z-score was a significant predictor of planning deficiency, alongside IQ to a lesser extent. This study offers a new perspective in the current conversation by expanding upon underlying mechanisms in children with SDB, and a deeper understanding on the individual characteristics that play a role in executive functioning deficits.Thesis (B.PsychSc(Hons)) -- University of Adelaide, School of Psychology, 202

Development, psychometrics and feasibility of the School Participation Questionnaire: A teacher measure of participation related constructs

Background: We report development of the SPQ (School Participation Questionnaire) a teachercompleted measure of participation related constructs. The SPQ was developed to support participation-related assessment, interventions, and research in the inclusive school context. Methods: Several iterative steps were undertaken. An international panel of experts reviewed content validity. A 66-item pilot questionnaire was administered in schools. Mokken and Rasch model analysis were applied. Internal consistency was assessed using Cronbach’s alpha. Analyses were conducted on associations with teacher and child demographic variables. Feedback was sourced from users. Participants were teachers of 101 children (5− 12 years old) with a range of disabilities, including intellectual disability, autism spectrum disorder and learning difficulties. Results: Four participation-related dimensions of the SPQ were confirmed. Rasch person and item reliability were good, and 2–4 strata were confirmed per scale. Internal consistency was good (all scales, Cronbach α > 0.8). Mean administration time was 11.7 min. Mean SPQ scores were independent of teacher characteristics. A significant effect of school support level, eligibility for free school meals and gender was found. Through synthesising analytic results and feedback, a new 46-item tool was obtained. Conclusion: The results of this study provide evidence of acceptability, practicality and validity. The SPQ is the first tool developed to assess participation related constructs in schools, and it contains novel information not given by other assessments. The SPQ may be used by practitioners and researchers to understand and improve the participation of children with a range of disabilities in schools.NHS LothianCity of Edinburgh CouncilScottish Governmen