Page 78 - Encyclopedia of Nursing Research

CHILD DELInQUEnTS n 45

2003). Similar techniques are adapted to CT infarct such as blood–brain barrier disrup-
scanners with the capability for rapid sequen- tion (Barr et al., 2010).
tial scanning. Future directions in cerebral ischemia C
The threshold for irreversible brain include more specific and sensitive clinical
damage from cerebral ischemia is generally criteria for stages of cerebral ischemia and
defined as below 20 ml/100 g of tissue/minute infarction, noninvasive techniques to mea-
(Jones et al., 1981; Yonas, Sekhar, Johnson, & sure regional blood flow, and the develop-
Gur, 1989). CBF below this level alters the ment of assays of ischemia and/or infarct. As
functioning of the mitochondria to produce techniques become increasingly more por-
energy. Studies show that the threshold for table and useable, there will be a translation
irreversible brain damage is volume and from the radiology department to application
time dependent. Global brain ischemia that is by nurses in the community or at the bedside
sustained for longer than 4 to 5 minutes will to assess, to predict, to identify, and to moni-
result in permanent brain damage (Brierley, tor patients at risk for cerebral ischemia.
Meldrum, & Brown, 1973). The majority
of studies show that above 23 ml/100 g/ Mary E. Kerr
minute, little impairment occurs; however,
below 20 ml/100 g/minute, symptoms of
neurologic impairment develop (Branston,
Symon, Crockard, & Pasztor, 1974). Below 18 Child delinquents
to 20 ml/100 g/minute, evidence of dimin-
ished electrical activity by evoked poten-
tials or electroencephalogram occurs (Sundt, Child delinquents, those children who
Sharbrough, Anderson, & Michenfelder, 1974). become delinquent at a young age, are two
Below 15 ml/100 g/minute is considered to to three times more likely to become seri-
be a threshold for synaptic transmission ous, violent, and chronic offenders (Loeber,
(Astrup, Siesjo, & Symon, 1981). In addition, Farrington, & Petechuk, 2003). Because of
factors including temperature, drug admin- their early entry into the criminal system,
istration, and individual variation contribute these children have longer offending careers
to the complexity of defining this threshold. and, as a result, are perceived to constitute a
Recent work focuses on methods that “non- threat to public safety and property (Loeber &
invasively” detect, track changes in, or treat Farrington, 2001) as they consume a dispro-
cerebral ischemia. portionately large amount of educational,
The determination and prediction of social, child welfare, mental, and health
cerebral ischemia is subject to the strengths care resources. Following a report by Snyder
and limitations of the technique used to (2001) noting a 33% increase in the number of
detect low-flow states. As dynamic perfu- juveniles between the ages of 7 and 12 years
sion CT imaging (Kim et al., 2010) and diffu- handled by U.S. juvenile courts, attention on
sion-weighted magnetic resonance imaging the problem of child delinquency and chronic
(Chalela et al., 2007; Totaro et al., 2010) evolve, criminality dramatically increased. The clin-
they improve a clinician’s ability to differen- ical impact nurses can make in health, social,
tiate between cerebral infarct and ischemia education, and legal systems can signifi-
(Saver, 2008). To date, there are no serum bio- cantly alter the life course trajectory of child
markers or assays available that can detect delinquents.
the presence of cerebral ischemia; however, Child delinquents are not legally
advances are being made in the identifica- defined in the same way across the United
tion of serum biomarkers associated with States (Wiig, 2001). only 14 states have a
complications of cerebral ischemia and legally defined minimum age of criminal