10 years later: revisiting the patchwork quilt of child protection in Canada.

BACKGROUND: In 2007, a Paediatrics & Child Health article characterized the Canadian academic Child and Youth Protection Programs (CYPPs) depicting the wide variation in clinical services and resources across the country as 'a threadbare patchwork quilt'. This study aimed to expand and update the knowledge gained from that original project a decade later. The aim of this research was to understand the current structure, functioning, and experiences of the existing Canadian CYPPs. METHODS: A mixed-methods design was utilized and all program directors of Canadian CYPPs were invited to participate. An online survey was distributed using REDCap to collect quantitative data on program characteristics. Program directors participated in one-on-one semi-structured telephone interviews to gather qualitative information regarding their program's strengths and needs, resources, as wellas reflections on their experiences working within this evolving field. RESULTS: In total, 15 of 16 CYPP directors participated in the online survey. CYPPs remained relatively consistent in the variety of allied health care professionals on their team, and have ongoing work in research, education, and advocacy. Recurrent themes that emerged from the qualitative interview data included the strength of the team, comments on stress and wellness, expertise in the field, and desire for additional advocacy. CONCLUSION: Current information was gathered on the structure, function, and experiences of Canadian CYPPs. Areas of growth include collaborative practice at the Child and Youth Advocacy Centres and deliberate attention to wellness. Child maltreatment continues to be an important health and social issue and review of the present-day landscape is critical to better inform research, education, and resource planning.

The effects of usual footwear on balance amongst elderly women attending a day hospital.

OBJECTIVE: to examine the effects of footwear on balance in a sample of older women attending a day hospital. DESIGN: this was a crossover trial with a quasi-randomised allocation. SETTING: assessments took place in the geriatric day hospital. SUBJECTS: a cohort of 100 older women aged 60 years and over attending a day hospital. METHODS: demographic data and a brief falls history were recorded. Participant's footwear was assessed using a footwear assessment form. A Berg Balance Scale (BBS) was completed under two conditions--shoes on and shoes off with order counter-balanced. RESULTS: the mean BBS was 39.07 (SD 9.14) with shoes on and 36.54 (SD 10.39) with shoes off (P < 0.0001). Balance scores were significantly higher with shoes on for 10 of the 14 Berg subcategories. Lower barefoot BBS scores were associated with a greater beneficial effect of footwear on balance (P < 0.001). Shoe characteristics were not associated with change in the BBS score. CONCLUSIONS: Wearing their own footwear significantly improved participants' balance compared to being barefoot. The greatest benefit of footwear was seen in those with the poorest balance. Further studies should investigate whether particular types of footwear are associated with greater benefit.

Wallerian degeneration in the optic nerve stretch-injury model of traumatic brain injury: a stereological analysis.

Patients with chronic traumatic encephalopathy (CTE) show loss of central white matter, central gray matter, and cortical gray matter with increasing post-traumatic survival. The majority of experimental studies using animals have, however, discussed only the ultrastructural pathophysiology of injured central white matter leading to secondary axotomy and the formation of axonal terminal bulbs. Using the stretch-injured optic nerve model in adult guinea pigs, the present study provides novel quantitative data concerning Wallerian degeneration of disconnected axonal fragments following secondary axotomy out to 12 weeks after injury to an optic nerve. The time course of Wallerian degeneration at the level of an individual nerve fiber is comparable to that reported in earlier studies over 48 h to two weeks after secondary axotomy. But only a relatively small proportion of nerve fibers within the optic tract degenerate via Wallerian degeneration during the first two weeks. Rather, examples of each of the three stages of Wallerian degeneration-acute axonal degeneration, latency of the distal axonal segment, and granular fragmentation-occur within the optic tract across the entire experimental survival of 12 weeks used in the present study. This data suggests that some nerve fibers initiate Wallerian degeneration days and weeks after the initial time of mechanical injury to an optic nerve. The number of intact nerve fibers continues to fall over at least three months after injury in the stretch-injury model of traumatic axonal injury. It is suggested that these novel findings relate to the mechanism(s) whereby central white matter volume decreases over months and years in CTE patients.