School Of Child Research Articles

Editorial: Why monitor the injured brain?

Pediatric traumatic brain injury (TBI) and indeed all forms of acute brain injury account for significant mortality and disability in children of all communities. In managing these patients, we aim to limit the progression of the primary injury and avoid secondary insults. This is important because secondary injury plays a major and yet probably underestimated role in determining prognosis, so in theory, there exists an opportunity to intervene and improve functional outcome. However, the brain is the most complex organ of the body, and the multitude of physiological and biochemical derangements that occur after injury often overwhelms the treating clinician. Compounding this is the fact that the tools that we have had to monitor and treat brain injury traditionally have been few in number and blunt in efficacy. We wait for clinical deterioration to occur before intervening, knowing that such intervention may then be too late. We rely on structural assessment of brain injury with conventional imaging, even though these provide no information about dynamic physiological changes or brain function and provide information only on events that have already happened, and we often rely on intracranial pressure (ICP) monitoring alone, a relatively blunt measure of the underlying brain disturbance. When ICP is increased, we respond in a uniform stepwise manner regardless of the several factors that may cause increased ICP. Furthermore, all our treatments for increased ICP may have adverse effects on the brain that contribute to worse outcome (such as hyperventilation), but we are often unaware of these when they occur. For all of these reasons and more, it seems logical that we need better tools to diagnose mechanisms of injury, markers to select and titrate appropriate therapy, and more sensitive measures to predict outcome. In response to this need, the last decade has witnessed a proliferation of publications on newer monitors of brain physiology, biochemistry and function that have the potential to change the way we manage brain injury. However, none of these tools have achieved widespread acceptance yet, in part because no randomized trials have been conducted to definitively demonstrate their impact on patient care and outcome. Even for ICP monitoring, which has long been a cornerstone of care in TBI, no randomized trials have been conducted as yet. Furthermore, as is evident from our experience with ICP monitoring, it is not the presence of the monitor that benefits (or harms) the patient but the interpretation of the monitor’s data and the clinician’s response to it. Misinterpretation of the monitor or incorrect intervention has the potential to undo any potential benefit of monitoring. This may in part explain studies where monitoring did not appear to benefit patients [4, 6]. Several newer methods of monitoring brain metabolism, markers of inflammation, cerebral hemodynamics, brain oxygenation, and serum markers of brain injury are now available, all of which await validation in large studies. There is some evidence that the use of individual monitors, especially along with protocol-driven and guideline-based care in a specialized neurocritical care unit, does improve outcome [1, 3, 7]. However, whether this can be replicated in a general neurosurgical practice and whether the additional cost or effort justifies the benefit still need to A. A. Figaji Division of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa

Guest Editorial on Quality of Life and Its Application

Journal of Policy and Practice in Intellectual DisabilitiesVolume 6, Issue 1 p. 1-1 Guest Editorial on Quality of Life and Its Application Roy I. Brown Ph.D., Roy I. Brown Ph.D. Emeritus Professor, University of Calgary, Canada & Flinders University, Australia. Adjunct Professor, School of Child and Youth Care, University of Victoria E-mail: [email protected]Search for more papers by this author Roy I. Brown Ph.D., Roy I. Brown Ph.D. Emeritus Professor, University of Calgary, Canada & Flinders University, Australia. Adjunct Professor, School of Child and Youth Care, University of Victoria E-mail: [email protected]Search for more papers by this author First published: 18 March 2009 https://doi.org/10.1111/j.1741-1130.2009.00204.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume6, Issue1March 2009Pages 1-1 RelatedInformation

Marian Jacobs: pioneer of child health in South Africa

Marian Jacobs: pioneer of child health in South Africa

Entry to Practice and Beyond: Aspiring to an Accessible Educational Continuum at Ryerson

The School of Child and Youth Care at Ryerson University has, since its inception in 1989, responded to the developing educational aspirations of child and youth care practitioners. The historical roots of the program are examined along with the various modifications made in response to developments in the field. We describe our approach to the challenges of part-time programming and internet-based course delivery. Future goals for the program include laying the groundwork for masters level education at Ryerson, finding the right balance in the post-secondary sector to allow direct entry to as well as advanced standing in a fully developed 4-year B.A. program, and serving a central role in developing both CYC educators and practitioners. At each stage in the development of the Child and Youth Care (CYC) degree completion program at Ryerson, we have attempted to keep our colleagues informed of our activities. The earliest draft of the program was presented at the First International Conference in Vancouver (Hare & McKay, 1985) in which we outlined our proposed response to the growing demand in Ontario for degree-level education in the field. A decade after the first students were admitted in 1989, an article in Children and Youth Services Review (Hare, 1999) described research that assessed student perceptions of the program and aided us in the difficult task of budget-induced program restructuring. As we began to move more vigorously into internet-based program delivery, we again used an international conference, this time in Cleveland, to keep our colleagues up-to-date about what we were up to (Stuart & Hare, 2000). Now, as we move into the next phase of program development guided by the results of recent student surveys, a self-study, and a peer review (School of Child and Youth Care, 2000), we again take the opportunity in this article to share our thoughts and challenges with our colleagues.

A framework and process for educating students to apply developmental theory in child and youth care practice

In this paper, we describe a course in which students learn to apply developmental theory and an ecological framework to their everyday child and youth care practice. The educational philosophy of the School of Child and Youth Care at the University of Victoria is presented as the context in which this course meets both programmatic and course-related objectives. The philosophy, content, and students' evaluations of the course are discussed. The role of group work in course learning is also explained along with a perspective of students as partners in the teaching-learning process. The connection between course content and principles and guidelines for child care personnel preparation programs (VanderVen, Mattingly, & Morris, 1982) is made; we argue that more College, University and in-service and continuing education courses should focus on helping child and youth care students and front line workers learn to apply developmental theories and an ecological perspective to everyday practice.

Generative curriculum: A model of university and First Nations co-operative post-secondary education

The Meadow Lake Tribal Council (MLTC) and the University of Victoria's School of Child and Youth Care (SCYC) are working co-operatively to develop a culturally appropriate, post-secondary education training program for Cree and Dene child and youth care workers. The approach under development is termed the generative curriculum model. An initial step in the development of this innovative model involved joint MLTC, SCYC and advisor team meetings to identify foundation elements and principles that would guide the project over its 3 year funding period. Six of the seven elements are described briefly in the article, while the operationalization of the seventh element, the generative curriculum model, is discussed in greater detail. Utilizing the model, students are learning Meadow Lake First Nations (MLFN) Cree and Dene caregiving traditions, values and practices as well as those of the majority culture. The generative approach integrates text-based material with information from students, elders, and other community members resulting, over time, in courses tailored to the First Nations of Meadow Lake, Saskatchewan. The project is in its mid-term development stage and the information provided is primarily descriptive of the model. As the project evolves, insights gathered through formative evaluation are leading to the further refinement and elaboration of the model.

Developing a model for cross-cultural education in child and youth care

The nine Meadow Lake Tribal Council (MLTC) communities in Saskatchewan. Canada, and the University of Victoria's School of Child and Youth Care (SCYC) are working in partnership to create a culturally appropriate training program for Cree and Dene child and youth care workers. This model of cross-cultural child and youth care education is based upon a unique philosophy that encompasses seven basic principles. In this paper, the authors discuss each of these philosophical principles in terms of the MLTC/SCYC joint project. They conclude with a brief statement of the broader cross-cultural implications of the project's philosophy on child and youth care education and practice.

Normalizing the return to school of the child with cancer.

Normalizing the return to school of the child with cancer.

An Experiment in the Development of Readiness in a Culturally Disadvantaged Group of First Grade Children

The great challenge to the schools in America which teach the poor, and thus the culturally disadvantaged groups, is that of overcoming the operation of age-grade decrements in intelligence and achievement in their pupil populations and thereby of developing children and youth who can realize the American dream of equality of economic opportunity regardless of the circumstances of birth. As a rule, the child from the disadvantaged home will come to the school slightly less prepared in both literacy and social leamings than will his more fortunate middle or upper income counterpart. As a result he carries from the school a disproportionately smaller gain in learning. This decrement is reflected in a gradual decrease in intelligence and achievement test scores as the child moves through the school. Generally, such children can be expected to lose 15-20 points in intelligence by the end of junior high school and to be from two to three years behind in school work. The solution to this inexcusable devastation of human potential is, perhaps, a corps of teachers who will search very diligently for ways and means to narrow the cultural gaps very quickly upon induction into school of the disadvantaged child and to keep it narrowed as he moves through it. PURPOSE

THE CORRELATION OF LANGUAGE ATTITUDES OF DELINQUENT BOYS TO THEIR PREVIOUS INSTITUTIONAL BEHAVIOR

Individuals' attitudes are intimately related to definite values which they have established in their struggles to gain and protect feelings of prestige and security. Consequently, attitudes always involve problems of relationship between a person and his environment and may be thought of as being preparatory reactions for actual behavior. The complex nature and genesis of most attitudes and their continuous change under the influences of daily life make their systematic detection in the clinical situation very difficult. When discovered, however, they indicate the direction and extent of personal difficulty because, as Sherman has pointed out, many attitudes develop as a result of problems and conflicts (10). The determination of attitudinal patterns is, therefore, ipso facto, one of the major problems in the differential diagnosis of children's problems. In. clinical practice a person's attitudes are considered with reference to his background. Theoretically, if the examiner is familiar with the home, school, neighborhood, and special environments of the behaviorproblem child and discovers how that child feels about multiple aspects of these environments, he is able to detect the causative factors in the disorder and to substitute treatment which will alleviate the tensions or assist in adjustment to them. Such a diagnostic foundation presupposes, among other things, two factors: first, a reliably accurate and comprehensive sampling of attitudes toward crucial situations; second, the interpretation of these attitudes according to the tenets of some psychological system so as logically to explain the behavior. With the second factor, interpretation, this study has no dealings, the investigation being limited to a discussion of the factual reliability of verbally expressed attitudes particularly as this pertains to attitudes toward social situations where the subject is able to surmise the desirable and socially approved points-of-view. The average delinquent boy facing the examiner for the first time is usually conscious of what brought him there, desirous of creating a favorable impression, and frequently comes fortified with a good understanding of right and wrong especially as he must make moral and ethical distinctions in regard to his own activities and inclinations. Beside being partially unaware of many of his basic attitudes, a boy will commonly evade, distort, exaggerate, minimize, and endeavor to focus attention upon unimportant matters. Hartshorne and May have pointed out that lying and cheating are closely related to classroom association, emotional instability, poor resistance to suggestion, and cultural and social limitations in the home background. Where conflict arises between a child and his environment, deception is a natural mode of adjustment . . . The motives for cheating, lying, and stealing are complex and inhere for the most Dart in the general situations themselves. The