Children as partners with adults in their medical care

Aims: To investigate the seldom published views of children with type 1 diabetes about their condition and ways in which they share in managing their medical and health care with adults. Methods: Semi-structured, tape recorded interviews, during 2003, with a purposive sample of 24 children aged 3–12 years who have type I diabetes and who attend two inner London hospitals and one hospital in a commuter town. Results: The children reported high levels of understanding, knowledge, and skill gained from their experience of living with diabetes and constantly having to take account of the condition and their paediatrician’s guidance. Their key goals were to be “normal” and “just get on with their lives”. Discussion: The interviews showed that children’s experiences of diabetes tended to enable them to make informed, “wise” decisions in their own best interests, even at a young age. They achieved a complicated balance between the sometimes competing goals of social health “being normal” and physiological health in controlling glycaemia. Their competence supports approaches in children’s rights and in policy makers’ aims that people with diabetes—including children—gain more knowledge, skills, and responsibility for their own care in partnership with healthcare professionals. Consent is usually considered in relation to surgery; however the children showed how they constantly dealt with decisions about consent or refusal, compliance with, or resistance to their prescribed treatment. Their health depends on their informed commitment to medical guidance; more research is needed about the daily realities of children’s committed and responsible co-management of their chronic illness

Deformation mechanisms leading to auxetic behaviour in the α-cristobalite and α-quartz structures of both silica and germania

Analytical expressions have been developed in which the elastic behaviour of the α-quartz and α-cristobalite molecular tetrahedral frameworks of both silica and germania are modelled by rotation, or dilation or concurrent rotation and dilation of the tetrahedra. Rotation and dilation of the tetrahedra both produce negative Poisson’s ratios (auxetic behaviour), whereas both positive and negative values are possible when these mechanisms act concurrently. Concurrent rotation and dilation of the tetrahedra reproduces with remarkable accuracy both the positive and negative nu31 Poisson’s ratios observed in silica α-quartz and α-cristobalite, respectively, when loaded in the x3 direction. A parametric fit of the concurrent model to the germania α-quartz experimental nu31 Poisson’s ratio is used to predict nu31 for germania α-cristobalite, for which no experimental value exists. This is predicted to be +0.007. Strain-dependent nu31 trends, due to concurrent rotation and dilation in the silica structures, are in broad agreement with those predicted from pair-potential calculations, although significant differences do occur in the absolute values. Concurrent dilation and rotation of the tetrahedra predicts that an alternative uniaxial stress (sigma3)-induced phase exists for both silica α-quartz and α-cristobalite and germania α-cristobalite, having geometries in reasonable agreement with beta-quartz and idealised beta-cristobalite, respectively

Elastic constants of 3-, 4- and 6-connected chiral and anti-chiral honeycombs subject to uniaxial in-plane loading

Finite Element models are developed for the in-plane linear elastic constants of a family of honeycombs comprising arrays of cylinders connected by ligaments. Honeycombs having cylinders with 3, 4 and 6 ligaments attached to them are considered, with two possible configurations explored for each of the 3- (trichiral and anti-trichiral) and 4- (tetrachiral and anti-tetrachiral) connected systems. Honeycombs for each configuration have been manufactured using rapid prototyping and subsequently characterised for mechanical properties through in-plane uniaxial loading to verify the models. An interesting consequence of the family of 'chiral' honeycombs presented here is the ability to produce negative Poisson's ratio (auxetic) response. The deformation mechanisms responsible for auxetic functionality in such honeycombs are discussed

Adapting clinical guidelines to take account of multimorbidity

Most people with a chronic condition have multimorbidity, but clinical guidelines almost entirely focus on single conditions. It will never be possible to have good evidence for every possible combination of conditions, but guidelines could be made more useful for people with multimorbidity if they were delivered in a format that brought together relevant recommendations for different chronic conditions and identified synergies, cautions, and outright contradictions. We highlight the problem that multimorbidity poses to clinicians and patients using guidelines for single conditions and propose ways of making them more useful for people with multimorbidity

The in-plane linear elastic constants and out-of-plane bending of 3-coordinated ligament and cylinder-ligament honeycombs

Four novel cylinder-ligament honeycombs are described, where each cylinder has 3 tangentially-attached ligaments to form either a hexagonal or re-entrant hexagonal cellular network. The re-entrant cylinder-ligament honeycombs are reported for the first time. The in-plane linear elastic constants and out-of-plane bending response of these honeycombs are predicted using Finite Element (FE) modelling and comparison made with hexagonal and re-entrant hexagonal honeycombs without cylinders. A laser-crafted re-entrant cylinder-ligament honeycomb is manufactured and characterized to verify the FE model. The re-entrant honeycombs display negative Poisson's ratios and synclastic curvature upon out-of-plane bending. The hexagonal and 'trichiral' honeycombs possess positive Poisson's ratios and anticlastic curvature. The 'anti-trichiral' honeycomb (short ligament limit) displays negative Poisson's ratios when loaded in the plane of the honeycomb, but positive Poisson's ratio behaviour (anticlastic curvature) under out-of-plane bending. These responses are understood qualitatively through considering deformation occurs via direct ligament flexure and cylinder rotation-induced ligament flexure

Children as partners in their diabetes care: An exploratory research study September-December 2003

Can young children understand and also take an active part in managing their diabetes care? In-depth interviews were conducted with 24 children who have type I diabetes, and 29 parents, to elicit their views on these questions. The children were aged 3-12 years; they attend diabetes clinics in an inner London teaching hospital, and two large district general hospitals, one in inner London, the other in a commuter town. Two paediatricians and two specialist diabetes nurses were also interviewed. The children and parents reported: • their high levels of knowledge and skill; • high levels of satisfaction with the care from the specialist diabetes staff; • criticism that non-diabetes-specialist health practitioners often severely lacked knowledge about diabetes and were unable to provide adequate and safe care for the children; • the importance of direct experience of diabetes as a source of knowledge and skills, and therefore: the need for practitioners to recognise and learn from the wealth of knowledge amongst children and their parents to help practitioners to provide the best possible care and support, working as partners with children and parents

A critical realist analysis of consent to surgery for children, human nature and dialectic: the pulse of freedom

Consent can only be voluntary, freely given and uncoerced. Can this legal adult standard also apply to children? High-risk surgery is seldom a wanted choice, but compared with the dangers of the untreated problem, surgery can become the least unwanted option. Critical realism helps to reveal explicit and hidden levels of informed and voluntary consent at empirical, actual and real levels, on the four planes of social being and through the four-stage dialectic. Instead of starting with the rational-legal adult patient standard of consent, and assessing how young children fail this, understanding of consent could start at the other end of life. What does innate physical-social-moral-intuitive human nature in the emotional embodied person tell us about the meaning and purpose of consent/refusal for self-preservation, for avoiding suffering and promoting wellbeing? This discussion paper considers examples of life-giving treatment for children, and ethical dilemmas including one of conjoined twins, when only one child could survive separation

Parents' and children's informed and voluntary consent to heart surgery: Protocol

This research is intended to increase understanding of the views and experiences of children aged 6-15 years having heart surgery, their needs, hopes and fears, in order that parents and practitioners may provide children with more research-based information and support. The aim is to contribute to ways of involving children in the decision making process before heart surgery, so that their acceptance or consent, as well as their parents’ consent, are well informed and voluntary. The research will also examine children’s, parents and staff views about the age of consent, and when children become competent to give consent to heart surgery ‘as well as their parents can’