Deconstructing Evidence-Based Practice and Its Application in Children to with Mental Health Disorders

This is a mixed methodology study that uses an autoethnographic approach to combine both an autobiography and a survey of practitioners who work in children’s mental health. It is largely about the implementation of Evidence-Based Practice (EBP), and the questions, concerns, experiences that I have had, and compared them with those of my fellow practitioners. In addition, it is about my journey as a mental health professional, and how I have come to recognize that in order to achieve the goals I wanted to achieve, I needed to return to university to pursue a Master’s degree. Within the research, I identify and discuss different definitions of EBP and identify several themes. I deconstruct the implementation of EBPs through the lens of Foucault and his notions of governmentality. I offer policy and practice recommendations to improve the implementation of EBP and the services received by children facing mental health issues.

Back to School, Back to Normal? Exploring the Lived Experiences of Childhood Cancer Survivors and their Families Throughout the School Re-Entry Process

This study investigated parent and child perspectives of childhood cancer survivors' return to school. Four specific areas were examined including cognitive and academic concerns, social issues, perceived support, and the impact on siblings. Participants consisted of parents and childhood cancer survivors who were recruited through a regional parent support group. Data was collected during a focus group and interviews. Using a descriptive content analysis, results indicated that participants generally received the necessary resources, however issues such as consistency and having to advocate in order to attain these resources served as barriers for the families.

Returning to Play after Concussion: A Phenomenological Study

This study examines and describes athletes’ felt sense of readiness returning to play following a concussion. Analyses of the interviews yielded a description of each participant’s experiences with concussions. Descriptions of this phenomenon generated by informants provide a detailed account of the unique issues athletes face when returning to play following a concussion. Participants’ descriptions highlight that in order to play, an athlete knows that he/she ought to be emotionally and physically ready to play. However, the athletes in this study believe that there is not an actual test that can “prove” this and that they can choose to lie and/or cheat the tests to return to play while they are still symptomatic. Athletes, parents, coaches, and trainers will benefit from learning to be better educated on the severity of concussions, concussion detection, assessment and the serious health consequences that can result from playing with a concussion.

Letter - E.C. Schmon to Arthur A. Schmon, Friday A.M.

This letter begins with telling Arthur how much she misses him and that she would like to return to see him before Xmas. This letter is undated.

Letter - E.C. Schmon to Arthur A. Schmon, 6 May 1919

Eleanore Celeste has just received four letters from Arthur. She includes a poem by Darrach: "The weakness that you know is yours, She in her strength would vitally sustain, And that fine strength you drew from her, You would when she had need, return to her again. Yes, where your strength were great and she were weak, You'd courage her and strengthen her, Until the heavy burdens given her to hear, Would be tasks easy for her new formed will." The letter is labelled number 272.

Letter written by Napoleon Buonaparte (Bonaparte) to Guillaume Thomas Francois Raynal, June 24, 1790

Translation: Sir, It will probably be difficult for you to remember among the many strangers who annoy you with their admiration of a person to whom you kindly made civilities last year1 during a pleasant conversation about Corsica. I would be grateful if you could take a look at this sketch of his history.2 I present here the first of two letters. If you agree to them, I will send you the end. My brother, whom I recommend not to forget his deputies' commission to escort Paoli to his country,3 and to come and receive a lesson in virtue and humanity, will give them to you. I respectfully your most humble and obedient servant.4 Buonaparte, artillery officer Ajaccio, [Corsica] June 24 the first year of freedom [1790]5 1 Relations between Napoleon and Raynal have begun in 1789, which seems to confirm a confidence to Las Cases ( Memorial of St. Helena , La Pléiade , vol. I, p. 83) . 2 Latest version of history project of Corsica : Letters on Corsica to Abbe Raynal . 3 Joseph is part of a delegation sent by the city of Ajaccio to host Paoli 's return from exile in London . In doing so he has to go through Marseille where Raynal resides. 4 Shipping autograph, National Archives , 400 AP Biography 1. In the first years of Napoleon Bonaparte (1840) , Coston gives a rough version of this letter that it dates from 1786 , which is impossible because Raynal did not return to France that ' in 1787. Published for the first time in the Memories of Lord Holland (1851) , shipping is now kept in the national Archives Napoleons funds . 5 The letter is dated "June 24, the first year of freedom" (the word "freedom" is underlined twice). Given the dates of stay in Corsica Napoleon, it seems that is present in Ajaccio the month of June in 1790.

Politics in extraordinary times : a study of the reaction of political parties and elites to terrorism

Cette thèse porte sur le comportement des élites politiques durant les périodes de crise nationale et plus particulièrement sur leurs réactions aux attentats terroristes. Elle démontre que les crises terroristes sont tout comme les conflits militaires ou diplomatiques propices aux unions nationales et notamment aux ralliements des partis d’opposition auprès du gouvernement. L’analyse statistique d’actes terroristes s’étant produits dans cinq états démocratiques (Allemagne, Espagne, États-Unis d’Amérique, France et Royaume-Uni) entre 1990 et 2006 révèle que l’ampleur d’un attentat en termes de pertes humaines ainsi que la répétition de ces attentats influencent dans une large mesure la réaction des élites politiques. Ainsi plus l’ampleur d’un attentat est élevée, plus la probabilité d’un ralliement est grande. En revanche, la multiplication des attentats augmente la possibilité de dissension entre l’opposition et le gouvernement. Par ailleurs, l’opposition est plus susceptible de se rallier au gouvernement lorsque l’attentat est perpétré par des terroristes provenant de l’étranger. L’analyse quantitative indique également que l’existence d’un accord formel de coopération dans la lutte antiterroriste entre le gouvernement et l’opposition favorise l’union des élites. Enfin, les données analysées suggèrent que la proportion des ralliements dans les cinq pays est plus importante depuis les attentats du 11 septembre 2001. Une analyse qualitative portant exclusivement sur la France et couvrant la période 1980-2006 confirme la validité des variables identifiées dans la partie quantitative, mais suggère que les élites réagissent au nombre total de victimes (morts mais aussi blessés) et que la répétition des actes terroristes a moins d’impact lors des vagues d’attentats. Par ailleurs, les analyses de cas confirment que les élites politiques françaises sont plus susceptibles de se rallier quand un attentat vise un haut-fonctionnaire de l’État. Il apparaît également que les rivalités et rancœurs politiques propre à la France (notamment suite à l’arrivée de la gauche au pouvoir en 1981) ont parfois empêché le ralliement des élites. Enfin, cette analyse qualitative révèle que si l’extrême gauche française soutient généralement le gouvernement, qu’il soit de gauche ou de droite, en période de crise terroriste, l’extrême droite en revanche saisit quasi systématiquement l’opportunité offerte par l’acte terroriste pour critiquer le gouvernement ainsi que les partis de l’establishment. La thèse est divisée en sept chapitres. Le premier chapitre suggère que le comportement des élites politiques en période de crises internationales graves (guerres et conflits diplomatiques) est souvent influencé par la raison d’État et non par l’intérêt électoral qui prédomine lors des périodes plus paisibles. Le second chapitre discute du phénomène terroriste et de la littérature afférente. Le troisième chapitre analyse les causes du phénomène d’union nationale, soumet un cadre pour l’analyse de la réaction des élites aux actes terroristes, et présente une série d’hypothèses. Le quatrième chapitre détaille la méthodologie utilisée au cours de cette recherche. Les chapitres cinq et six présentent respectivement les résultats des analyses quantitatives et qualitatives. Enfin, le chapitre sept conclut cette thèse en résumant la contribution de l’auteur et en suggérant des pistes de recherche.

A virtual reality approach to the study of visually driven postural control in developing and aging humans

L'être humain utilise trois systèmes sensoriels distincts pour réguler le maintien de la station debout: la somesthésie, le système vestibulaire, et le système visuel. Le rôle de la vision dans la régulation posturale demeure peu connu, notamment sa variabilité en fonction de l'âge, du type développemental, et des atteintes neurologiques. Dans notre travail, la régulation posturale induite visuellement a été évaluée chez des participants au développement et vieillissement normaux âgés de 5-85 ans, chez des individus autistes (développement atypique) âgés de 12-33 ans, ainsi que chez des enfants entre 9-18 ans ayant subi un TCC léger. À cet effet, la réactivité posturale des participants en réponse à un tunnel virtuel entièrement immersif, se mouvant à trois niveaux de vélocité, a été mesurée; des conditions contrôles, où le tunnel était statique ou absent, ont été incluses. Les résultats montrent que la réactivité (i.e. instabilité) posturale induite visuellement est plus élevée chez les jeunes enfants; ensuite, elle s'atténue pour rejoindre des valeurs adultes vers 16-19 ans et augmente de façon linéaire en fonction de l'âge après 45 ans jusqu'à redevenir élevée vers 60 ans. De plus, à la plus haute vélocité du tunnel, les plus jeunes participants autistes ont manifesté significativement moins de réactivité posturale comparativement à leurs contrôles; cette différence n'était pas présente chez des participants plus âgés (16-33 ans). Enfin, les enfants ayant subi un TCC léger, et qui étaient initialement modérément symptomatiques, ont montré un niveau plus élevé d'instabilité posturale induite visuellement que les contrôles, et ce jusqu'à 12 semaines post-trauma malgré le fait que la majorité d'entre eux (89%) n'étaient plus symptomatiques à ce stade. En somme, cela suggère la présence d'une importante période de transition dans la maturation des systèmes sous-tendant l'intégration sensorimotrice impliquée dans le contrôle postural vers l'âge de 16 ans, et d'autres changements sensorimoteurs vers l'âge de 60 ans; cette sur-dépendance visuelle pour la régulation posturale chez les enfants et les aînés pourrait guider l'aménagement d'espaces et l'élaboration d'activités ajustés à l'âge des individus. De plus, le fait que l'hypo-réactivité posturale aux informations visuelles chez les autistes dépende des caractéristiques de l'environnement visuel et de l'âge chronologique, affine notre compréhension des anomalies sensorielles propres à l'autisme. Par ailleurs, le fait que les enfants ayant subi un TCC léger montrent des anomalies posturales jusqu'à 3 mois post-trauma, malgré une diminution significative des symptômes rapportés, pourrait être relié à une altération du traitement de l'information visuelle dynamique et pourrait avoir des implications quant à la gestion clinique des patients aux prises avec un TCC léger, puisque la résolution des symptômes est actuellement le principal critère utilisé pour la prise de décision quant au retour aux activités. Enfin, les résultats obtenus chez une population à développement atypique (autisme) et une population avec atteinte neurologique dite transitoire (TCC léger), contribuent non seulement à une meilleure compréhension des mécanismes d'intégration sensorimotrice sous-tendant le contrôle postural mais pourraient aussi servir comme marqueurs sensibles et spécifiques de dysfonction chez ces populations. Mots-clés : posture, équilibre, vision, développement/vieillissement sensorimoteur, autisme, TCC léger symptomatique, réalité virtuelle.

Rest-activity cycle disturbances in the acute phase of moderate to severe traumatic brain injury

Background. Sleep-wake disturbances are among the most persistent sequelae after traumatic brain injury (TBI) and probably arise during the hospital stay following TBI. These disturbances are characterized by difficulties sleeping at night and staying awake during the day. Objective. The aim of the present study was to document rest-activity cycle consolidation in acute moderate/severe TBI using actigraphy and to assess its association with injury severity and outcome. Methods. In all, 16 hospitalized patients (27.1 ± 11.3 years) with moderate/severe TBI wore actigraphs for 10 days, starting in the intensive care unit (ICU) when continuous sedation was discontinued and patients had reached medical stability. Activity counts were summed for daytime (7:00-21:59 hours) and nighttime periods (22:00-6:59 hours). The ratio of daytime period activity to total 24-hour activity was used to quantify rest-activity cycle consolidation. An analysis of variance was carried out to characterize the evolution of the daytime activity ratio over the recording period. Results. Rest-activity cycle was consolidated only 46.6% of all days; however, a significant linear trend of improvement was observed over time. Greater TBI severity and longer ICU and hospital lengths of stay were associated with poorer rest-activity cycle consolidation and evolution. Patients with more rapid return to consolidated rest-activity cycle were more likely to have cleared posttraumatic amnesia and have lower disability at hospital discharge. Conclusions. Patients with acute moderate/ severe TBI had an altered rest-activity cycle, probably reflecting severe fragmentation of sleep and wake episodes, which globally improved over time. A faster return to rest-activity cycle consolidation may predict enhanced brain recovery.

An ichnofabric approach to the depositional interpretation of the intensely burrowed Bateig Limestone, Miocene, SE Spain

The foraminiferal-rich pelagic Bateig Limestone forms several varieties of the important building stones quarried at Bateig Hill in southeastern Spain. Three principal ichnofabrics (Bichordites, mottled-Palaeophycus and mottled-Ophiomorpha) are recognized, which are present in at least two (possibly up to four) repeated successions (cycles). Each succession begins with an erosional event. The Bichordites ichnofabric represents a new type of facies, formed as thin turbidity/grain flow, stratiform units derived from sediment slips off a fault into deep water. Each slipped unit became almost completely bioturbated by infaunal echinoids, colonizing by lateral migration. Because of the thinness of the units, successive colonizations tended to truncate the underlying burrows giving rise to a pseudo-stratification. As the Bichordites ichnofabric accumulated on the fault apron, thus reducing the effective height of the fault scarp, the substrate gradually came under the influence of currents traversing the shelf. This led to a change in hydraulic regime, and to the mottled-Palaeophycus and mottled-Ophiomorpha ichnofabrics in sediment deposited under bed load transport, and associated with laminar and cross-stratified beds and local muddy intervals. Reactivation of the fault triggered erosion and channeling and a return to grain flow sedimentation, and to the Bichordites ichnofabric of the succeeding cycle. The highest unit of the Bateig Limestone is formed entirely of cross-stratified calcarenites with occasional Ophiomorpha (Ophiomorpha-primary lamination ichnofabric) and is similar to many shallow marine facies but they still bear a significant content of pelagic foraminifera. The sedimentary setting bears resemblance with that described for the Pleistocene Monte Torre Paleostrait and the modem Strait of Messina (Italy), where the narrow morphology of the depositional area enhanced tidal currents and allowed for high-energy sandy deposition in relatively deep areas. More data on the Miocene paleogeography of the Bateig area should provide further testing for this hypothesis. The ichnofacies and stacking of the Bateig Limestone differ from the classic Seilacherian model in that they reflect changes in hydraulic process and are associated with faulting and subsidence and changes in sediment supply. Recognition of the unusual ichnofabrics and their relationships provides a clear indication of the overall dynamic setting. (c) 2006 Elsevier B.V. All rights reserved.

Both black and symbolically white: The 'Bajan-Brit' return migrant as post-colonial hybrid

The research presented in this article centres on an under-researched demographic group of young return migrants, namely, second-generation Barbadians, or 'Bajan-Brits', who have decided to 'return' to the birthplace of their parents. Based on 51 in-depth interviews, the essay examines the experiences of second-generation return migrants from an interpretative perspective framed within post-colonial discourse. The article first considers the Bajan-Brits and issues of race in the UK before their decision to migrate. It is then demonstrated that on 'return', in certain respects, these young, black English migrants occupy a liminal position of cultural, racial and economic privilege, based on their 'symbolic' or 'token' whiteness within the post-colonial context of Barbados. But this very hybridity and inbetweeness means that they also face difficulties and associated feelings of social alienation and discrimination. The ambivalent status of this transnational group of migrants serves to challenge traditional notions of Barbadian racial identity.

"The past is still right here in the present": second-generation Bajan-Brit transnational migrants' views on issues relating to race and colour class

This paper deals with second-generation Barbadians or 'Bajan-Brits', who have decided to,return' to the birthplace of their parents, focusing on their reactions to matters relating to race relations and racialised identities. The importance of race and the operation of the 'colour-class' system in the Caribbean are established at the outset. Based on fifty-two qualitative in-depth interviews, the paper initially considers the positive things that the second-generation migrants report about living in a majority black country and the salience of such racial affirmation as part of their migration process. The paper then presents an analysis of the narratives provided by the Bajan-Brits concerning their reactions to issues relating to race relations in Barbadian society. The impressions of the young returnees provide clear commentaries on what are regarded as (i) the 'acceptance of white hegemony' within Barbadian society, (ii) the occurrence of de facto 'racial segregation, (iii) perceptions of the 'existence of apartheid, and (iv) 'the continuation of slavery'. The account then turns to the contemporary operation of the colour-class system. It is concluded that, despite academic arguments that the colour-class dimension has to be put to one side as the principal dimension of social stratification in the contemporary Caribbean, the second-generation migrants are acutely aware of the continued existence and salience of such gradations within society. Thus, the analysis not only serves to emphasise the continued importance of racial-based stratification in the contemporary Caribbean, but also speaks of the 'hybrid' and 'in-between' racialised identities of the second-generation migrants.

The potential to narrow uncertainty in projections of stratospheric ozone over the 21st century

Future stratospheric ozone concentrations will be determined both by changes in the concentration of ozone depleting substances (ODSs) and by changes in stratospheric and tropospheric climate, including those caused by changes in anthropogenic greenhouse gases (GHGs). Since future economic development pathways and resultant emissions of GHGs are uncertain, anthropogenic climate change could be a significant source of uncertainty for future projections of stratospheric ozone. In this pilot study, using an "ensemble of opportunity" of chemistry-climate model (CCM) simulations, the contribution of scenario uncertainty from different plausible emissions pathways for ODSs and GHGs to future ozone projections is quantified relative to the contribution from model uncertainty and internal variability of the chemistry-climate system. For both the global, annual mean ozone concentration and for ozone in specific geographical regions, differences between CCMs are the dominant source of uncertainty for the first two-thirds of the 21st century, up-to and after the time when ozone concentrations return to 1980 values. In the last third of the 21st century, dependent upon the set of greenhouse gas scenarios used, scenario uncertainty can be the dominant contributor. This result suggests that investment in chemistry-climate modelling is likely to continue to refine projections of stratospheric ozone and estimates of the return of stratospheric ozone concentrations to pre-1980 levels.

Multi-model assessment of stratospheric ozone return dates and ozone recovery in CCMVal-2 models

Projections of stratospheric ozone from a suite of chemistry-climate models (CCMs) have been analyzed. In addition to a reference simulation where anthropogenic halogenated ozone depleting substances (ODSs) and greenhouse gases (GHGs) vary with time, sensitivity simulations with either ODS or GHG concentrations fixed at 1960 levels were performed to disaggregate the drivers of projected ozone changes. These simulations were also used to assess the two distinct milestones of ozone returning to historical values (ozone return dates) and ozone no longer being influenced by ODSs (full ozone recovery). The date of ozone returning to historical values does not indicate complete recovery from ODSs in most cases, because GHG-induced changes accelerate or decelerate ozone changes in many regions. In the upper stratosphere where CO2-induced stratospheric cooling increases ozone, full ozone recovery is projected to not likely have occurred by 2100 even though ozone returns to its 1980 or even 1960 levels well before (~2025 and 2040, respectively). In contrast, in the tropical lower stratosphere ozone decreases continuously from 1960 to 2100 due to projected increases in tropical upwelling, while by around 2040 it is already very likely that full recovery from the effects of ODSs has occurred, although ODS concentrations are still elevated by this date. In the midlatitude lower stratosphere the evolution differs from that in the tropics, and rather than a steady decrease in ozone, first a decrease in ozone is simulated from 1960 to 2000, which is then followed by a steady increase through the 21st century. Ozone in the midlatitude lower stratosphere returns to 1980 levels by ~2045 in the Northern Hemisphere (NH) and by ~2055 in the Southern Hemisphere (SH), and full ozone recovery is likely reached by 2100 in both hemispheres. Overall, in all regions except the tropical lower stratosphere, full ozone recovery from ODSs occurs significantly later than the return of total column ozone to its 1980 level. The latest return of total column ozone is projected to occur over Antarctica (~2045–2060) whereas it is not likely that full ozone recovery is reached by the end of the 21st century in this region. Arctic total column ozone is projected to return to 1980 levels well before polar stratospheric halogen loading does so (~2025–2030 for total column ozone, cf. 2050–2070 for Cly+60×Bry) and it is likely that full recovery of total column ozone from the effects of ODSs has occurred by ~2035. In contrast to the Antarctic, by 2100 Arctic total column ozone is projected to be above 1960 levels, but not in the fixed GHG simulation, indicating that climate change plays a significant role.

How difficult is it to recover from dangerous levels of global warming?

Climate models provide compelling evidence that if greenhouse gas emissions continue at present rates, then key global temperature thresholds (such as the European Union limit of two degrees of warming since pre-industrial times) are very likely to be crossed in the next few decades. However, there is relatively little attention paid to whether, should a dangerous temperature level be exceeded, it is feasible for the global temperature to then return to safer levels in a usefully short time. We focus on the timescales needed to reduce atmospheric greenhouse gases and associated temperatures back below potentially dangerous thresholds, using a state-of-the-art general circulation model. This analysis is extended with a simple climate model to provide uncertainty bounds. We find that even for very large reductions in emissions, temperature reduction is likely to occur at a low rate. Policy-makers need to consider such very long recovery timescales implicit in the Earth system when formulating future emission pathways that have the potential to 'overshoot' particular atmospheric concentrations of greenhouse gases and, more importantly, related temperature levels that might be considered dangerous.