Search

Introduction: Over 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility., Methods: A 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants' performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal-Wallis tests, and Wilcoxon rank-sum tests., Results: Twenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others., Conclusions: Completion of global TRIK improved surgeons' confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The productivity of lexical categories was studied longitudinally in a sample of 17 young hearing-impaired French-speaking children with cochlear implants. Age of implantation ranged from 22 months to 76 months. Spontaneous speech samples were collected at six-month intervals over a period of 36 months, starting at the one-word stage. Four general measures of their linguistic production (number of utterances, verbal fluency, vocabulary, and grammatical production) as well as 36 specific lexical categories, according to the CHILDES codes, were computed in terms of tokens, i.e., total number of words. Cochlear-implanted children (CI) were compared to a French database of normally hearing children aged 2-4 compiled by the first author. Follow-up results indicate that, at the two-year post-implantation follow-up, noun, and verb morphology was significantly impaired. At the three-year follow-up, the cochlear-implanted group had recovered on adjectives, determiners and nouns, main verbs, and auxiliaries. The two groups differed significantly in processing locative adverbs, prepositions, pronouns, and verbs (infinitive verb, modal, and modal lexical), but individual variability within the cochlear-implanted group was substantial. Results are discussed in terms of recovery and developmental trends and variability in the acquisition of lexical categories by French children two years and three years post-implantation.

The capacity to incorporate significant words into the existing vocabulary and to use these words to form sentences with more mature syntactic structures emerges over a considerable time course in young deaf children who have undergone a cochlear implantation. The purpose of this follow-up study is to document the nature and time span of language production--in morphosyntactic and lexical skills--when a child's first experience with language sounds is provided artificially through electrical stimulation. To examine the development of these two aspects of linguistic processing, five deaf French children, all enrolled in similar postimplantation educational settings, were individually assessed at 6-month intervals over a period of 18 months. Computerized analyses were derived from their spontaneous speech in a 20-min standardized play session. Results for mean length of utterance and vocabulary revealed gradually improving performance for most children, in spite of the generally low starting point. Both measures of production nevertheless remained well below the norms established for normally hearing children. Although the achievement of higher production scores, which underlies more effective interpersonal exchanges, is evident after only 1 year of device use, it is clear that improvement does not always occur at the same pace, as shown by two of the children. This emphasizes the importance of longitudinal studies in documenting intersubject variability and intrasubject stability throughout the experience with an implant.

A longitudinal study was conducted to document and compare evolution of children with linguistic acquisition impairment. To determine whether development of the analytic mechanisms underlying linguistic processing occured in similar fashion, two children with mixed developmental dysphasia were assessed from 4 to 5:6 years of age with psycholinguistic tests at 6-months interval. Spontaneous speech and language production (consonant repertory in initial word position, MLU, and lexical diversity) were investigated in a standardized symbolic play context. The phonologic and lexico-morphologic evolution analyses revealed a marked improvement in motor control of phonology and in the application of morphosyntaxic rules in child 1, whereas child 2 was still impaired in phonology and morphosyntax. The singular developmental changes in spontaneous speech results indicate dynamic relationships between various language production facets and variability in the kind of deficit and lexical automation presented by these children. These contrasts in the evolution of language production profiles between child 1 and child 2 also underline the importance of longitudinal studies in the analysis of the atypical linguistic processing paths used by children with developmental dysphasia.