Protocol for The Toxin Study: Understanding clinical and patient reported response of children and young people with cerebral palsy to intramuscular lower limb Botulinum neurotoxin-A injections, exploring all domains of the ICF. A pragmatic longitudinal observational study using a prospective one-group repeated measures design

INTRODUCTION: Botulinum neurotoxin-A (BoNT-A) is an accepted treatment modality for the management of hypertonia in children and young people with cerebral palsy (CYPwCP). Nevertheless, there are concerns about the long-term effects of BoNT-A, with a lack of consensus regarding the most meaningful outcome measures to guide its use. Most evidence to date is based on short-term outcomes, related to changes at impairment level (restrictions of body functions and structures), rather than changes in adaptive skills (enabling both activity and participation). The proposed study aims to evaluate clinical and patient reported outcomes in ambulant CYPwCP receiving lower limb BoNT-A injections over a 12-month period within all domains of the WHO's International Classification of Functioning, Disability and Health and health-related quality of life (HRQoL). METHODS AND ANALYSIS: This pragmatic prospective longitudinal observational study will use a one-group repeated measures design. Sixty CYPwCP, classified as Gross Motor Function Classification System (GMFCS) levels I-III, aged between 4 and 18 years, will be recruited from an established movement disorder service in London, UK. Standardised clinical and patient reported outcome measures within all ICF domains; body structures and function, activity (including quality of movement), goal attainment, participation and HRQoL, will be collected preinjection and at 6 weeks, 6 months and up to 12 months postinjection. A representative subgroup of children and carers will participate in a qualitative component of the study, exploring how their experience of BoNT-A treatment relates to clinical outcome measures. ETHICS AND DISSEMINATION: Central London Research Ethics Committee has granted ethics approval (#IRAS 211617 #REC 17/LO/0579). Findings will be disseminated in peer-reviewed publications, conferences and via networks to participants and relevant stakeholders using a variety of accessible formats including social media

"LEARN"ing what is important to children and young people with intellectual disabilities when they are in hospital

© 2018 John Wiley & Sons Ltd. Background: The need to review health service provision for children and young people (CYP) with disabilities and their families in the United Kingdom has been expressed in multiple reports: the most consistent message being that services need to be tailored to meet their individual needs. Our aim was to understand the hospital-related needs and experiences of CYP with intellectual disabilities. Method: An ethnographic study of a neurosciences ward and outpatient department was conducted within a paediatric tertiary hospital setting. Results: Five themes, developed using the acronym LEARN, explained what is important to CYP with intellectual disabilities in hospital: (i) little things make the biggest difference, (ii) eliminate unnecessary waiting, (iii) avoid boredom, (iv) routine and home comforts are key and (v) never assume. Conclusions: It is imperative that the present authors continue to challenge the idea that it is acceptable to exclude CYP with intellectual disabilities from research because of their inability to participate

Room temperature plasmon laser by total internal reflection

Plasmon lasers create and sustain intense and coherent optical fields below light's diffraction limit with the unique ability to drastically enhance light-matter interactions bringing fundamentally new capabilities to bio-sensing, data storage, photolithography and optical communications. However, these important applications require room temperature operation, which remains a major hurdle. Here, we report a room temperature semiconductor plasmon laser with both strong cavity feedback and optical confinement to 1/20th of the wavelength. The strong feedback arises from total internal reflection of surface plasmons, while the confinement enhances the spontaneous emission rate by up to 20 times.Comment: 8 Page, 2 Figure

"The Score Matters": Wide Variations in Predictive Performance of 18 Paediatric Track and Trigger Systems

Objective: To compare the predictive performance of 18 Paediatric Early Warning Systems (PEWS) in predicting critical deterioration. / Design: Retrospective case-controlled study. PEWS values were calculated from existing clinical data and the area under the receiver operator characteristic curve (AUROC) compared. / Setting: UK tertiary referral children’s hospital. / Patients: Patients without a ‘do not attempt resuscitation’ order admitted between 1st January 2011 and 31st December 2012. All patients on paediatric wards who suffered a critical deterioration event were designated ‘cases’ and matched with a control closest in age who was present on the same ward at the same time. / Main outcome measures: Respiratory and/or cardiac arrest, unplanned transfer to paediatric intensive care and/or unexpected death. / Results: Twelve ‘scoring’ and 6 ‘trigger’ systems were suitable for comparative analysis. 297 case events in 224 patients were available for analysis. 244 control patients were identified for the 311 events. Three PEWS demonstrated better overall predictive performance with an AUROC of 0.87 or greater. Comparing each system to the highest performing PEWS with Bonferroni’s correction for multiple comparisons resulted in statistically significant differences for 13 systems. Trigger systems performed worse than scoring systems, occupying the 6 lowest places in the AUROC rankings. / Conclusion: There is considerable variation in the performance of published PEWS and as such the choice of PEWS has the potential to be clinically important. Trigger based systems performed poorly overall but it remains unclear what factors determine optimum performance. More complex systems did not necessarily demonstrate improved performance

Boundary restriction for negative emotional images is an example of memory amplification

We investigated whether boundary restriction—misremembering proximity to traumatic stimuli—is a form of memory amplification and whether re-experiencing trauma plays a role in boundary restriction errors. In four experiments, subjects viewed a series of traumatic photographs. Later, subjects identified the photographs they originally saw among distracters that could be identical, close-up, or wide-angled versions of the same photographs. Subjects also completed measures of mood, analogue PTSD symptoms, phenomenological experience of intrusions, and processing style. Across experiments, subjects were more likely to incorrectly remember the photographs as having extended boundaries: boundary extension. Despite this tendency, the extent to which subjects re-experienced traumatic aspects of the photographs predicted how often they incorrectly remembered the photographs as having narrower boundaries: boundary restriction. Our data suggest that although boundary extension is more common, boundary restriction is related to individual differences in coping mechanisms post-trauma. These results have theoretical implications for understanding how people remember trauma.Australian Research Council ARC DP14010266