Study protocol for Running for health (Run4Health CP) : a multicentre, assessor-blinded randomised controlled trial of 12 weeks of two times weekly Frame Running training versus usual care to improve cardiovascular health risk factors in children and youth with cerebral palsy

Introduction: Children and youth with moderate-severe (Gross Motor Function Classification System (GMFCS) levels II–V) cerebral palsy (CP) participate less frequently in physical activities compared with peers without CP and have elevated risk of cardiorespiratory morbidity and mortality in adulthood. Frame Running (RaceRunning) is a new athletics discipline that is an accessible option for physical activity participation for people with moderate-severe CP. There is no high-quality evidence for the effect of Frame Running on cardiovascular disease in children and young people with CP. The primary aim of this study is to conduct a randomised controlled trial of the effect of 12 weeks of Frame Running training on risk factors for cardiovascular disease. Methods and analysis: Sixty-two children and youth with CP (age 8–20 years) in GMFCS levels II–V will be recruited across four sites and randomised to receive either 12 weeks of Frame Running training two times weekly for 60 min, or usual care. Outcomes will be measured at baseline, immediately postintervention (primary endpoint) and 12 weeks later for retention of training effects. The primary outcome is cardiorespiratory fitness as measured by distance covered on Six Minute RaceRunner Test with 1 min heart rate recovery. Other outcomes include blood pressure, objectively measured physical activity, body mass index, waist circumference, percentage body fat, gross motor function capacity, community participation, feasibility, tolerability and safety. Adverse events will be monitored, and participants and their caregivers will be interviewed to discern their experiences of participation in Frame Running. Ethics and dissemination: The Children’s Health Queensland Hospital and Health Service and the University of Queensland Human Research Ethics Committees have approved this study. Results will be disseminated in peer-reviewed journals and scientific conferences; through professional and athletic organisations; and to people with CP and their families. Trial registration number: ACTRN12621000317897; Australian New Zealand Clinical Trials Registry number

Developing rubrics to assess the reading-into-writing skills: a case study

The integrated assessment of language skills, particularly reading-into-writing, is experiencing a renaissance. The use of rating rubrics, with verbal descriptors that describe quality of L2 writing performance, in large scale assessment is well-established. However, less attention has been directed towards the development of reading-into-writing rubrics. The task of identifying and evaluating the contribution of reading ability to the writing process and product so that it can be reflected in a set of rating criteria is not straightforward. This paper reports on a recent project to define the construct of reading-into-writing ability for designing a suite of integrated tasks at four proficiency levels, ranging from CEFR A2 to C1. The authors discuss how the processes of theoretical construct definition, together with empirical analyses of test taker performance, were used to underpin the development of rating rubrics for the reading-into-writing tests. Methodologies utilised in the project included questionnaire, expert panel judgement, group interview, automated textual analysis and analysis of rater reliability. Based on the results of three pilot studies, the effectiveness of the rating rubrics is discussed. The findings can inform decisions about how best to account for both the reading and writing dimensions of test taker performance in the rubrics descriptors

Shiga toxin-producing Escherichia coli clonal complex 32, including serotype O145:H28, in the UK and Ireland

Introduction. Shiga toxin-producing Escherichia coli (STEC) O157:H7 has been the most clinically significant STEC serotype in the UK for over four decades. Over the last 10 years we have observed a decrease in STEC O157:H7 and an increase in non-O157 STEC serotypes, such as O145:H28. Gap Statement. Little is known about the microbiology and epidemiology of STEC belonging to CC32 (including O145:H28) in the UK. The aim of this study was to integrate genomic data with patient information to gain a better understanding of the virulence, disease severity, epidemic risk assessment and population structure of this clinically significant clonal complex. Methodology. Isolates of E. coli belonging to CC32 (n=309) in the archives of public health agencies in the UK and Ireland were whole-genome-sequenced, virulence-profiled and integrated with enhanced surveillance questionnaire (ESQ) data, including exposures and disease severity. Results. Overall, diagnoses of STEC belonging to CC32 (290/309, 94 %) in the UK have increased every year since 2014. Most cases were female (61 %), and the highest proportion of cases belonged to the 0–4 age group (53/211,25 %). The frequency of symptoms of diarrhoea (92 %), abdominal pain (84 %), blood in stool (71 %) and nausea (51 %) was similar to that reported in cases of STEC O157:H7, although cases of STEC CC32 were more frequently admitted to hospital (STEC CC32 48 % vs O157:H7  34 %) and/or developed haemolytic uraemic syndrome (HUS) (STEC CC32 9 % vs O157:H7 4 %). The majority of STEC isolates (268/290, 92 %) had the stx2a/eae virulence gene combination, most commonly associated with progression to STEC HUS. There was evidence of person-to-person transmission and small, temporally related, geographically dispersed outbreaks, characteristic of foodborne outbreaks linked to nationally distributed products. Conclusion. We recommend more widespread use of polymerase chain reaction (PCR) for the detection of all STEC serogroups, the development of consistent strategies for the follow-up testing of PCR-positive faecal specimens, the implementation of more comprehensive and standardized collection of epidemiological data, and routine sharing of sequencing data between public health agencies worldwide

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Implementation of the Early Diagnosis of Cerebral Palsy Guidelines: Exploring E-Learning for Practice Change and Improved Patient Outcomes

Background: Health professionals can provide an early cerebral palsy (CP) diagnosis and intervention in a critical neuroplastic window, but late diagnosis and generic intervention are common. Clinical guidelines must be implemented to improve outcomes. Education is key to guideline adoption; e-learning is wanted but evidence for its learning design and practice change is limited. This thesis explores CP diagnosis implementation strategies to drive practice change for early CP diagnosis and intervention. Methods: Theory-based CP guideline implementation studies were conducted: systematic review of impact of CP guideline adoption on patient outcomes; Delphi study of physician barriers to early diagnosis; guidelines for communicating CP diagnosis; scoping review of differential motor impairment interventions; development of physician adaptive and non- adaptive e-learning and e-book for early CP diagnosis; validation of physician key-features examination of CP diagnosis decision-making; e-learning clinical trial to evaluate physician practice, patient outcomes and costs; and tailoring e-learning to other contexts. Results: CP guideline adoption reduces age of diagnosis by 7.5 months; physician communication, referrals, decision-making delay diagnosis; SPIKES protocol aids CP diagnosis communication; therapies specific to motor impairment type exist; adaptive e- learning converges behaviour and practice change specific to users, and e-book provides point of care information; validity evidence established with Kane’s framework for key- features assessment of CP diagnosis decision-making; e-learning trial collects evidence of CP diagnosis, physician practice and patient outcomes, comparing designs and costs; e-learning tailored to high- and low-income contexts. Conclusions: Implementing CP diagnosis guidelines improves patient outcomes. Clinical trial data will provide e-learning comparative effectiveness outcomes and clarify practice change drivers, enabling replication

MRI - Key evidence

This fact sheet provides an overview of the key evidence supporting the use of MRI in the early diagnosis of cerebral palsy

Clinical Utility of the Hammersmith Infant Neurological Examination (HINE)

This fact sheet provides information on the clinical utility of the Hammersmith Infant Neurological Examination (HINE)

Algorithm for the Early Diagnosis of Cerebral Palsy Clinical Guideline Recommendations for Health Professionals.

This fact sheet outlines an algorithm for the early diagnosis of cerebral palsy or high-risk of cerebral palsy from the clinical practice guideline

Communicating the results of The General Movements Assessment

This fact sheets provides information on how to communicate the results of The General Movements Assessment with parents or carers and the multi-disciplinary team

Prechtl's General Movements Assessment - key evidence

This fact sheet provides an overview of the systematic review evidence of the General Movements Assessment and predictive value for cerebral palsy