Search

Purpose: Education policies require inclusive practices across student learning environments internationally. In Canada, provinces and territories oversee their own curriculum development. This study presents a critical discourse analysis of how inclusive education is addressed within Ontario’s 2015 Health and Physical Education Curriculum, Grades 9–12. Method: Fairclough and Chouliaraki’s approach to critical discourse analysis, which encompasses structural, linguistic, and interdiscursive analysis, was used to show how language is interwoven within ideologies of physical education to represent inclusivity. Results: Three discourses were identified: (a) the discourse of equity and inclusion, (b) the discourse of opportunity, and (c) the discourse of positive outcomes. The curriculum reflects inclusivity through overt language and intention, holding the possibility for choice and opportunities beyond traditional notions of physical education. Discussion: Concerns included whether ideals presented in the curriculum reflect the realities of “discourse in action.” Transformative discourses within physical education should emerge from the student voice.

Purpose Patient-reported outcome measures (PROMs) are standardized instruments used to collect data about the subjective assessment of medical care from the patient perspective. Implementing PROMs within pediatric clinical settings has gained increasing importance as health services prioritize patient-centred pediatric care. This study explores the perspectives of pediatric solid organ transplant patients, caregivers, and healthcare practitioners (HCPs) on implementing PROMs into clinical practice. Methods Qualitative description methods were used to elicit stakeholder perspectives. Semi-structured interviews were conducted across five Canadian transplant centres. Purposive sampling was used to obtain maximum variation across age, gender, and transplant program for all participants, as well as discipline for HCPs. Results The study included a total of 63 participants [patients (n = 20), caregivers (n = 22) and HCPs (n = 21)]. Nearly all participants endorsed the implementation of PROMs to enhance pediatric transplant clinical care. Three primary roles for PROMs emerged: (1) to bring a transplant patient’s overall well-being into the clinical care conversation; (2) to improve patient communication and engagement; and, (3) to inform the practice of clinical pediatric transplant care. Insights for effective implementation included completing electronic PROMs remotely and prior to clinical appointments by patients who are eight to 10 years of age or older. Conclusions This study contributes to current research that supports the use of PROMs in clinical pediatric care and guides their effective implementation into practice. Future directions include the development, usability testing, and evaluation of a proposed electronic PROM platform that will inform future research initiatives.

The assessment of quality of life (QOL) is key within pediatric oncology and requires a clearly defined construct of QOL. The purpose of our study was: (1) to conduct a qualitative study to inform the theoretical underpinnings of QOL and (2) to determine the appropriateness of patient-reported outcome (PRO) instruments to assess and evaluate QOL in pediatric cancer patients and survivors. The study used an interpretative description approach. Children diagnosed with childhood cancer, aged 8–18 years, were recruited from four Canadian hospitals. Semi‐structured interviews were completed, transcribed verbatim and coded through methods of constant comparison. In-depth analysis facilitated a comparison between emerging themes and the content of commonly used PRO instruments. Thirty-seven children (19 females; 51 %) participated. The mean age was 13 years, and 19 (51 %) participants were post-treatment. Participant experiences reflected notions of positive and negative duality, including: maintaining physical functioning but longing for the ability to participate in activities; experiencing a new level of intimacy with family and friends amidst isolation; and developing positivity amidst anger, sadness and lingering worry. Analysis showed that existing PRO instruments are missing concerns specific to this population and contain content not reflective of the QOL experiences of childhood cancer patients and survivors. Our research highlights important problems with content validity of existing PRO scales, indicating that the tools we have to date have limited utility in research and clinical practice. The development of a new PRO instrument should be considered to ensure that content validity is achieved.

Objective There is a growing need to assess the long-term quality of life (QOL) of pediatric oncology patients since many children now survive their disease. This paper highlights the subjective perspectives of pediatric cancer patients and specifically explores how experiencing cancer at a young age impacts adolescents in the areas of social functioning, peer relationships, and QOL. The findings emerged from a qualitative research study that explored how pediatric oncology patients ascribe meaning to their illness. Methods Study participants were recruited from four Canadian academic pediatric hospitals. In this study, we used an interpretative description approach. Semistructured interviews were completed, transcribed verbatim, and coded through the method of constant comparison. Results A total of 37 children and adolescents (n = 19 female; 51%) participated. The majority of participants were diagnosed with leukemia (n = 16; 43%) or lymphoma (n = 9; 24%). Sixty-two percent of participants were adolescents between the ages of 13 and 18 years (n = 23). Data illustrated a unique adolescent experience, which has been reported as a subset of the original population. Adolescent participants noted an accelerated experience of maturation, which invited reflections of gratitude as well as feelings of isolation and disconnect from peers. Participants were saddened to have "missed out" on normative parts of childhood. Conclusion Findings highlighted experiences of accelerated maturity that prompted adverse social outcomes for adolescent participants, which impacted their QOL. Future research is needed to explore the intersection of accelerated maturity attributed to illness, social functioning, and QOL. Peer support through technology engagement is suggested for this population.

In this study we explored the ways that mothers and fathers of children who have a chronic health condition coconstructed their parenting roles. We wanted to move beyond the standard focus on individual parenting behaviors and use a grounded theory approach to better capture the dyadic and interpersonal gestalt of how parents worked out their roles. We explored multiple factors that influenced their decision making and the unique models that each couple developed. We held conjoint qualitative interviews with 20 couples from the Toronto area, as well as follow-up interviews with individual partners in five of these couples. Our findings introduce several concepts (such as role negotiation, complementarity and symmetry of roles, and "good enough" role performance) that form an explanatory model. A key finding is the diversity of ways in which couples adapted to the parenting challenges they faced. Implications in conceptual, clinical, and research areas are presented.

Objectives An appraisal of pediatric cancer-specific quality-of-life (QOL) instruments revealed a lack of clarity about what constitutes QOL in this population. This study addresses this concern by identifying the concepts that underpin the construct of QOL as determined by a content analysis of all patient-reported outcome (PRO) instruments used in childhood cancer research. Methods A systematic review was performed of key databases (i.e., MEDLINE, CINAHL, PsychINFO) to identify studies of QOL in children with cancer. A content analysis process was used to code and categorize all items from generic and cancer-specified PRO instruments. Our objective was to provide clarification regarding the conceptual underpinnings of these instruments, as well as to help inform the development of theory and contribute to building a conceptual framework of QOL for children with cancer. Results A total of 6,013 English language articles were screened, identifying 148 studies. Ten generic and ten cancer-specific PRO instruments provided 957 items. Content analysis led to the identification of four major domains of QOL (physical, psychological, social, and general health), with 11 subdomains covering 98 different concepts. While all instruments reflected items relating to the broader domains of QOL, there was substantial heterogeneity in terms of the content and variability in the distribution of items. Conclusions This systematic review and the proposed model represent a useful starting point in the critical appraisal of the conceptual underpinnings of PRO instruments used in pediatric oncology and contribute to the need to place such tools under a critical, yet reflective and analytical lens.

The purpose of the study was to measure the effects of a dose of 0.2 mg/kg dextroamphetamine on body temperature, heart rate, motor activity, and associated behavior changes in Beagle dogs. Reliability of a collar-mounted accelerometer as an objective measure of motor activity was also investigated by comparing motor activity with that observed using video recordings. A total of 12 research colony Beagle dogs (13-20-months-old) served as their own control in this placebo-controlled crossover design, receiving both placebo and 0.2 mg/kg dextroamphetamine as treatment. Baseline and posttreatment values for body temperature, heart rate, and motor activity were obtained using a rectal temperature, heart rate monitor, and a collar-mounted accelerometer, respectively. Behavior sequences were filmed and analyzed. Repeated measures model indicated that dogs receiving a dose of 0.2 mg/kg dextroamphetamine had a significantly ( P = 0.044) reduced heart rate as compared with placebo. There was no effect of treatment on the dogs' body temperature, motor activity, or other behaviors such as "lip-licking," "panting," and "yawning." There was a significant linear and positive relationship between the gross motor activity as measured by observational video and the accelerometer counts ( P 15% reduction in heart rate. However, no data exist on the various effects of a low dose (0.2 mg/kg) of oral dextroamphetamine in dogs. The results of this study indicate that although as a group the medicated dogs showed a significantly lower heart rate than the placebo group, individual Beagle dogs showed variability in changes of heart rate. The use of the accelerometer in this study is a reliable tool for measuring motor activity in the dog.

Objective.TO evaluate whether a hybrid electronic screening algorithm using a total joint replacement (TJR) registry, electronic surgical site infection (SSI) screening, and electronic health record (EHR) review of SSI is sensitive and specific for SSI detection and reduces chart review volume for SSI surveillance.Design.Validation study.Setting.A large health maintenance organization (HMO) with 8.6 million members.Methods.Using codes for infection, wound complications, cellullitis, procedures related to infections, and surgeon-reported complications from the International Classification of Diseases, Ninth Revision, Clinical Modification, we screened each TJR procedure performed in our HMO between January 2006 and December 2008 for possible infections. Flagged charts were reviewed by clinical-content experts to confirm SSIs. SSIs identified by the electronic screening algorithm were compared with SSIs identified by the traditional indirect surveillance methodology currently employed in our HMO. Positive predictive values (PPVs), negative predictive values (NPVs), and specificity and sensitivity values were calculated. Absolute reduction of chart review volume was evaluated.Results.The algorithm identified 4,001 possible SSIs (9.5%) for the 42,173 procedures performed for our TJR patient population. A total of 440 case patients (1.04%) had SSIs (PPV, 11.0%; NPV, 100.0%). The sensitivity and specificity of the overall algorithm were 97.8% and 91.5%, respectively.Conclusion.An electronic screening algorithm combined with an electronic health record review of flagged cases can be used as a valid source for TJR SSI surveillance. The algorithm successfully reduced the volume of chart review for surveillance by 90.5%.

This study examines the experiences of fathers of children diagnosed with cancer. In this grounded theory study, participating fathers were qualitatively interviewed using a theoretical sampling approach. Results indicate fathers to be profoundly affected by their child's condition of cancer. Fathers' experiences include isolation and heightened sadness and uncertainty. Paternal roles comprise providing family support, sufficient resources, and seeking to maintain family stabilization. Post-diagnosis lived experience is described to hold new meaning as fathers reconcile the presence of childhood cancer within the life of their child and family. Strategies of resistance are demonstrated as fathers combat the devastating impacts of cancer through a commitment to family integration, healthy personal lifestyle and attitudes, support seeking, spirituality, and reframing of priorities. An emerging model is presented, as are implications for practice and recommendations.

Objectives: This research study addresses health policy and patient care considerations, and outlines policy and practice implications resulting from a crisis in a pediatric setting. This crisis, an epidemic outbreak of Severe Acute Respiratory Syndrome (SARS), dramatically impacted the delivery of health care in Canada. Despite the passage of time since the last diagnosed case of SARS in April 2004, researchers have warned the global community to be prepared for future outbreaks of SARS or other infectious diseases. Methods: Qualitative interviews were conducted with 23 participants representing key stakeholder groups: (a) pediatric patients with probable or suspected SARS, (b) their parents, and (c) health care professionals providing direct care to SARS patients. Results: Participants conveyed key areas in which health policy and practice were affected. These included the development of communication strategies for responding to SARS easing vulnerability among all stakeholders; and the rapid development of practice guidelines. Conclusion: Given the continuing threat of current and future airborne viruses with potential for epidemic spread and devastating outcomes, preparedness strategies are certainly needed. Effective strategies in pediatrics include practices that provide family centered care while minimizing disease transmission. Toward this end, lessons learned from previous outbreaks merit consideration and may inform future epidemics.

Background The National Nosocomial Infection Surveillance System (NNIS) has historically provided the infection control community with the most accurate benchmark for healthcare-associated infections. However, NNIS does not require postdischarge surveillance. For medical centers where comprehensive postdischarge surveillance is possible, the efficiency of surgical site infection (SSI) detection is enhanced and rates may be higher than those provided by NNIS. Methods From 1999 to 2004, a large integrated healthcare system (IHCS) used a standard surveillance methodology inclusive of the postdischarge period. This article compares IHCS and NNIS SSI data. Results IHCS infection rates, stratified and weighted average (hip, 1.7; knee, 2.1) for the study period are higher than the corresponding NNIS rates (hip, 1.4; knee, 1.2) (hip, P = .006; knee, P = .012) when infections detected by the IHCS during the postdischarge period are included. Conclusions The data from the study period show that when comprehensive postdischarge surveillance is used by the IHCS, SSI rates are higher than those reflected in the NNIS database.

Objective:To determine the motivating and behavioral factors responsible for improving compliance with hand washing among physicians.Design:Five unobtrusive, observational studies recording hand washing after direct patient contact, with study results reported to physicians.Setting:A 450-bed hospital in a health maintenance organization with an 18-bed medical-surgical intensive care unit (ICU) and a 12-bed cardiac care unit.Methods:An infectious disease physician met individually with participants to report study results and obtain a commitment to hand washing guidelines. Follow-up interviews were conducted to evaluate behavioral factors and educational programs. Hand washing study results were presented to all staff physicians by live and videotaped inservice presentations and electronic mail (e-mail) newsletters. The importance of influencing factors and the educational effectiveness of the hand washing program were evaluated.Results:Five observational hand washing studies were conducted in the ICU between April 1999 and September 2000. Rates of physician compliance with hand washing were 19%, 85%, 76%, 74%, and 68%, respectively. There were 71 initial encounters and 55 follow-up interviews with the same physicians. Physician interviews revealed that 73% remembered the initial encounter, 70% remembered the hand washing inservice presentations, and 18% remembered the e-mail newsletters. Personal commitment and meeting with an infectious disease physician had the most influence on hand washing behavior. Direct inservice presentations (either live or videotaped) had more influence than did e-mail information. Rates of ventilator-associated pneumonia did not significantly change before and during the study periods. A decrease in the rate of central-line–related bloodstream infections from 3.2 to 1.4 per 1,000 central-line days was found, but could not be solely attributed to improved physician compliance with hand washing.Conclusions:Physician compliance with hand washing can improve. Personal encounters, direct meetings with an infectious disease physician, and videotaped presentations had the greatest impact on physician compliance with hand washing at our medical center, compared with newsletters sent via e-mail. Local data on compliance with hand washing and physician involvement are factors to be considered for physician hand washing compliance programs in other medical centers.

We developed software that provides intelligent hands-on bench-top dynamic help to students as they study in laboratories for introductory circuit analysis. Tutoring help is available at “teachable moments” as opposed to students waiting days or weeks for traditional teacher-graded labs reports. Quantitative and qualitative studies show that using the software leads to improved learning, verbalization and conceptual knowledge and relieves teachers' workload. Students also reported that they enjoyed using the software.

The UV-induced alignment of nematic liquid crystals on Probimide 32 preimidized polyamide-imide surfaces is investigated. Exposing the polymer layer to linearly polarized deep UV (λ = 254 nm) produces an aligning effect comparable to that achieved by mechanically brushing the polymer film. A laser optical transmission method is used to evaluate the efficacy of the process. It is shown that strong alignment is produced within minutes of exposure and is maintained with very long exposures. Atomic force microscopy and dichroic Fourier transform infrared spectroscopy reveal that brushed polyamide-imide surfaces are highly grooved and oriented, while the UV-exposed polymer surfaces are not.

We report on a curing study of Probimide 32, a preimidized polyamide-imide. The polymer was in a solution of N-methyl pyrrolidone (NMP) and xylene and was spun cast or doctor-bladed to form films for study. The films were cured by drying under a variety of conditions to effect solvent removal. We characterized the effects of cure by thermogravimetric analysis, dynamic mechanical analysis, Fourier transform infrared spectroscopy, and differential scanning calorimetry. Index of refraction was measured by waveguide prism coupling. Although the polymer did not require postprocessing thermal closure of its imide group, the physiochemical makeup of the system, and consequently, the properties of the Probimide 32 films, were highly dependent upon the curing temperature and environment. The properties/thermal stability improved as residual solvent was driven from the films. In the films hard baked at 300°C, the extent of thermally induced crosslinking was substantially greater in air-cured films than in nitrogen-cured films. The crosslinking markedly affected the properties and relaxation behavior of the material. © 1997 John Wiley & Sons, Inc. J Appl Polym Sci 63: 1113–1126, 1997

The effects of curing on removal of solvent and the development of chemical crosslinks were studied in a preimidized, intrinsically photosensitive polyimide. The polymer, Probimide 412, was in solution of γ-butyrolactone (GBL), and spun cast or doctor bladed to form samples for analysis. The films were systematically studied from soft (100°C) to hard bake (400°C), as the effects of cure environment (i.e., air vs. nitrogen) and UV exposure were monitored. The samples were characterized by thermogravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), and dynamic mechanical analysis (DMA). The index of refraction was measured by waveguide propagation mode determination. TGA results show that there is a distribution of solvent removal temperatures, probably due to polymer-solvent binding. Solvent is removed from the polymer as it is thermally cured from ∼150°C to 300°C, and UV curing aids in the removal of solvent. Chemical crosslinks induced by both thermal and UV curing increase the refractive index and darken the material. Crosslinking broadens the glass transition and reinforces the rubbery modulus. FTIR results show that thermally induced crosslinking occurs in the polymer at 400°C in nitrogen and at 300°C in air but does not occur appreciably at 300°C in nitrogen or at any lower temperature. Ultraviolet curing also crosslinks the polymer and is caused by hydrogen abstraction from alkyl substituents and subsequent crosslinking at the benzophenone carbonyl group. During thermal curing, although there is evidence from FTIR spectroscopy that a similar reaction may occur, there are probably multiple reactions simultaneously taking place.

Relatively little is known about how children perceive and manage end-stage renal disease (ESRD) in daily life. To address this gap in the literature, the experiences and perceptions of children with ESRD were examined in this study. Study design comprised ethnographic interviews with 25 children and adolescents ages 7 to 18 years. Semistructured interviews were audiotaped, transcribed verbatim, and subjected to content analysis. Participants received a range of ESRD treatments including transplantation and dialysis. Findings indicate that ESRD has a profound impact on children. They described a range of challenges and experiences including not feeling “normal”; developing ESRD knowledge; frequent absence from school; gaining responsibility for ESRD care; relying on family, friends, and health care providers; and adjusting despite adversity. These findings depict a multifaceted, dynamic perspective engendered in tensions as children and adolescents grapple with adversity yet experience personal growth and resiliency. Implications and recommendations for clinical practice and research are discussed.

Plusieurs articles scientifiques et manuels de référence en médecine comportementale distinguent l'hyperactivité ou hyperkinésie de l’activité excessive en évaluant la réponse physiologique et comportementale des chiens suite à l’administration per os de 0.2 à 1.0 mg/kg de dextroamphétamine. Selon ces références, le chien atteint d’un syndrome hyperactif ou hyperkinésie, répondra de façon paradoxale à cette médication par une diminution de l’activité motrice accompagnée d’une réduction minimale de 15% de la fréquence respiratoire et de la fréquence cardiaque. L’objectif de la présente étude était de mesurer la variation de la température corporelle, de la fréquence cardiaque, de l’activité motrice et de différents comportements spécifiques chez un groupe de Beagles ayant reçu de la dextroamphétamine. La fiabilité d'un accéléromètre comme mesure objective d’activité motrice a aussi été évaluée. Dans le cadre de cette étude croisée contrôlée par placebo, douze Beagles de la colonie de recherche âgés entre 13 et 20 mois ont reçu une dose orale de 0.2 mg/kg de dextroamphétamine. Le moniteur cardiaque Polar® et un accéléromètre Actical® ont été utilisés pour enregistrer la fréquence cardiaque et l’activité motrice avant et après l’administration de la médication. La durée de chacun des comportements spécifiques a été compilée à l’aide du logiciel Noldus® et la température corporelle a été prise par thermomètre rectal. Le modèle équilibré de mesures répétées indique que les sujets ayant reçu la dextroamphétamine montrent une réduction significative (p = 0.044) de leur fréquence cardiaque comparativement aux chiens ayant reçu le placebo. Aucune variation significative n'a été observée concernant la température corporelle, l'activité motrice, et les autres comportements (léchage des babines, halètements, et bâillements) suite à l’administration de la dextroamphétamine. Une corrélation significative, linéaire et positive (p < 0,0001) entre les périodes de mouvements observées (vidéo) et les mesures d’activité enregistrées par l’accéléromètre a été observée. Les résultats de cette étude indiquent que les Beagles peuvent afficher des effets paradoxaux dans les 90 minutes suivant l’administration per os de dextroamphétamine à raison de 0.2 mg/kg., Several veterinary behaviour texts/handbooks used in practice, distinguish hyperactivity or hyperkinesis from over-activity by using the physiological and behavioural responses of dogs given amphetamines. It is presumed that true hyperactive or hyperkinetic dogs given 0.2 - 1.0 mg/kg dextroamphetamine orally will paradoxically calm down, and have at least a 15% reduction in heart and respiratory rates. The purpose of the study was to measure the effects of an oral dose of 0.2 mg/kg dextroamphetamine on heart rate, body temperature, motor activity, and discrete behaviour sequences in Beagle dogs. Reliability of a collar mounted accelerometer, Actical® as an objective measure of motor activity was also investigated. The study design was a placebo controlled cross-over study. Twelve research colony Beagle dogs (13 - 20 months old) received an oral dose of 0.2 mg/kg dextroamphetamine as treatment. Baseline and post-treatment values for body temperature, heart rate, motor activity, and general behavioural changes, were obtained using rectal temperature, video recordings and Noldus® software, Polar® monitor (heart rate), and a collar mounted Actical®. A repeated measures model indicates that dogs receiving an oral dose of 0.2 mg/kg dextroamphetamine had a significantly (p = 0.044) reduced heart rate compared to placebo. There was no effect of treatment on the dogs’ body temperature, motor activity, or other behaviours such as “lip-licking”, “panting” and “yawning”. There is a significant linear and positive relationship between the gross motor activity as measured by observational video and the Actical® counts (p < 0.0001). Results from this study indicate that Beagle dogs may display some paradoxical effects in the 90 minutes following an oral dose of 0.2 mg/kg dextroamphetamine.

The purpose of this study was to evaluate newly developed educational resources for children with asthma. Children with asthma, their parents, and pediatric health care professionals were invited to review age-appropriate asthma resources. Key findings revealed: (1) the perceived usefulness of these resources, particularly for creating discussion opportunities between children and their caregivers through implemented resource use; (2) the need for health education materials to balance goals of depth of information versus child enjoyment in order to increase effective knowledge transfer and application; and (3) a renewed call for future educational resources to be both relevant and interactive in their outreach and engagement of children, potentially involving mediums of advanced technology. Clinical experience and the literature note a current lack of pediatric asthma education materials. The positive findings of this review of novel educational materials in asthma address an important gap relative to pediatric practice, resource evaluation, and knowledge translation.