Prevalence and associated harm of engagement in self-Asphyxial behaviours ('choking game') in young people:A systematic review

OBJECTIVE: To assess the prevalence of engagement in self-asphyxial (risk-taking) behaviour (SAB) (‘choking game’) and associated morbidity and mortality in children and young people up to age 20. DESIGN: Systematic literature review. SEARCH STRATEGY: Electronic database search of MEDLINE, Embase, PsycINFO, CINAHL, PubMed, Web of Science Core Collection, BIOSIS citation index and the Cochrane register with no language or date limits applied. References of key papers were reviewed, and experts were contacted to identify additional relevant papers. ELIGIBILITY CRITERIA: Systematic reviews, cross-sectional, cohort and case–control studies, and case reports examining SAB with regard to individuals aged 0–20 years, without explicitly stated autoerotic, suicidal or self-harm intentions were included. RESULTS: Thirty-six relevant studies were identified, and SAB was reported in 10 countries. In North America, France and Colombia, awareness of SAB ranged from 36% to 91% across studies/settings, and the median lifetime prevalence of engagement in SAB was 7.4%. Six studies identified the potential for SAB to be associated with engagement in other risk behaviours. Ninety-nine fatal cases were reported. Of the 24 cases described in detail, most occurred when individuals engaged in SAB alone and used a ligature. CONCLUSIONS: The current evidence on SAB among young people is limited, and stems predominantly from North America and France. Awareness of SAB among young people is high, and engagement varies by setting. Further research is needed to understand the level of risk and harm associated with SAB, and to determine the appropriate public health response

Detection of transit timing variations in excess of one hour in the Kepler multi-planet candidate system KOI 806 with the GTC

We report the detection of transit timing variations (TTVs) well in excess of one hour in the Kepler multi-planet candidate system KOI 806. This system exhibits transits consistent with three separate planets -- a Super-Earth, a Jupiter, and a Saturn -- lying very nearly in a 1:2:5 resonance, respectively. We used the Kepler public data archive and observations with the Gran Telescopio de Canarias to compile the necessary photometry. For the largest candidate planet (KOI 806.02) in this system, we detected a large transit timing variation of -103.5$\pm$6.9 minutes against previously published ephemeris. We did not obtain a strong detection of a transit color signature consistent with a planet-sized object; however, we did not detect a color difference in transit depth, either. The large TTV is consistent with theoretical predictions that exoplanets in resonance can produce large transit timing variations, particularly if the orbits are eccentric. The presence of large TTVs among the bodies in this systems indicates that KOI806 is very likely to be a planetary system. This is supported by the lack of a strong color dependence in the transit depth, which would suggest a blended eclipsing binary.Comment: 9 pages, 4 figures, accepted into A&A Letter

A systems map of the determinants of child health inequalities in England at the local level

Children and young people in the UK have worse health outcomes than in many similar western countries and child health inequalities are persistent and increasing. Systems thinking has emerged as a promising approach to addressing complex public health issues. We report on a systems approach to mapping the determinants of child health inequalities at the local level in England for young people aged 0–25, and describe the resulting map. Qualitative group concept mapping workshops were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were developed, and augmented using data from qualitative interviews with professionals (N = 16). The resulting local maps were reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online survey (N = 21; N = 8) experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities. The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0–25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal. To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. The study shows how group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities, and it may be a useful tool in demonstrating to stakeholders the importance of policies that tackle the systemic drivers of child health inequalities beyond those traditionally associated with public health

HAT-P-26b: A Low-Density Neptune-Mass Planet Transiting a K Star

We report the discovery of HAT-P-26b, a transiting extrasolar planet orbiting the moderately bright V=11.744 K1 dwarf star GSC 0320-01027, with a period P = 4.234516 +- 0.000015 d, transit epoch Tc = 2455304.65122 +- 0.00035 (BJD), and transit duration 0.1023 +- 0.0010 d. The host star has a mass of 0.82 +- 0.03 Msun, radius of 0.79 + 0.10 - 0.04 Rsun, effective temperature 5079 +- 88 K, and metallicity [Fe/H] = -0.04 +- 0.08. The planetary companion has a mass of 0.059 +- 0.007 MJ, and radius of 0.565 + 0.072 - 0.032 RJ yielding a mean density of 0.40 +- 0.10 g cm-3. HAT-P-26b is the fourth Neptune-mass transiting planet discovered to date. It has a mass that is comparable to those of Neptune and Uranus, and slightly smaller than those of the other transiting Super-Neptunes, but a radius that is ~65% larger than those of Neptune and Uranus, and also larger than those of the other transiting Super-Neptunes. HAT-P-26b is consistent with theoretical models of an irradiated Neptune-mass planet with a 10 Mearth heavy element core that comprises >~ 50% of its mass with the remainder contained in a significant hydrogen-helium envelope, though the exact composition is uncertain as there are significant differences between various theoretical models at the Neptune-mass regime. The equatorial declination of the star makes it easily accessible to both Northern and Southern ground-based facilities for follow-up observations.Comment: 16 pages, 9 figures, 5 tables, submitted to Ap

A novel method for identifying exoplanetary rings

ABSTRACT: The discovery of rings around extrasolar planets (“exorings”) is one of the next breakthroughs in exoplanetary research. Previous studies have explored the feasibility of detecting exorings with present and futuren photometric sensitivities by seeking anomalous deviations in the residuals of a standard transit light curve fit, at the level of ~-100 ppm for Kronian rings. In this work, we explore two much larger observational consequences of exorings: (1) the significant increase in transit depth that may lead to the misclassification of ringed planetary candidates as false-positives and/or the underestimation of planetary density; and (2) the so-called “photo-ring” effect, a new asterodensity profiling effect, revealed by a comparison of the light curve derived stellar density to that measured with independent methods (e.g., asteroseismology). While these methods do not provide an unambiguous detection of exorings, we show that the large amplitude of these effects, combined with their relatively simple analytic description, makes them highly suited to large-scale surveys to identify candidate ringed planets worthy of more detailed investigation. Moreover, these methods lend themselves to ensemble analyses seeking to uncover evidence of a population of ringed planets. We describe the method in detail, develop the basic underlying formalism, and test it in the parameter space of rings and transit configuration. We discuss the prospects of using this method for the first systematic search of exoplanetary rings in the Kepler database and provide a basic computational code for implementing it

What effect have commissioners’ policies for body mass index had on hip replacement surgery?: an interrupted time series analysis from the National Joint Registry for England

Background Despite their widespread use, the impact of commissioners’ policies for body mass index (BMI) for access to elective surgery is not clear. Policy use varies by locality, and there are concerns that these policies may worsen health inequalities. The aim of this study was to assess the impact of policies for BMI on access to hip replacement surgery in England. Methods A natural experimental study using interrupted time series and difference-in-differences analysis. We used National Joint Registry data for 480,364 patients who had primary hip replacement surgery in England between January 2009 and December 2019. Clinical commissioning group policies introduced before June 2018 to alter access to hip replacement for patients with overweight or obesity were considered the intervention. The main outcome measures were rate of surgery and patient demographics (BMI, index of multiple deprivation, independently funded surgery) over time. Results Commissioning localities which introduced a policy had higher surgery rates at baseline than those which did not. Rates of surgery fell after policy introduction, whereas rates rose in localities with no policy. ‘Strict’ policies mandating a BMI threshold for access to surgery were associated with the sharpest fall in rates (trend change of − 1.39 operations per 100,000 population aged 40 + per quarter-year, 95% confidence interval − 1.81 to − 0.97, P < 0.001). Localities with BMI policies have higher proportions of independently funded surgery and more affluent patients receiving surgery, indicating increasing health inequalities. Policies enforcing extra waiting time before surgery were associated with worsening mean pre-operative symptom scores and rising obesity. Conclusions Commissioners and policymakers should be aware of the counterproductive effects of BMI policies on patient outcomes and inequalities. We recommend that BMI policies involving extra waiting time or mandatory BMI thresholds are no longer used to reduce access to hip replacement surgery

Kepler-432: a red giant interacting with one of its two long period giant planets

We report the discovery of Kepler-432b, a giant planet ($M_b = 5.41^{+0.32}_{-0.18} M_{\rm Jup}, R_b = 1.145^{+0.036}_{-0.039} R_{\rm Jup}$) transiting an evolved star $(M_\star = 1.32^{+0.10}_{-0.07} M_\odot, R_\star = 4.06^{+0.12}_{-0.08} R_\odot)$ with an orbital period of $P_b = 52.501129^{+0.000067}_{-0.000053}$ days. Radial velocities (RVs) reveal that Kepler-432b orbits its parent star with an eccentricity of $e = 0.5134^{+0.0098}_{-0.0089}$, which we also measure independently with asterodensity profiling (AP; $e=0.507^{+0.039}_{-0.114}$), thereby confirming the validity of AP on this particular evolved star. The well-determined planetary properties and unusually large mass also make this planet an important benchmark for theoretical models of super-Jupiter formation. Long-term RV monitoring detected the presence of a non-transiting outer planet (Kepler-432c; $M_c \sin{i_c} = 2.43^{+0.22}_{-0.24} M_{\rm Jup}, P_c = 406.2^{+3.9}_{-2.5}$ days), and adaptive optics imaging revealed a nearby (0\farcs87), faint companion (Kepler-432B) that is a physically bound M dwarf. The host star exhibits high signal-to-noise asteroseismic oscillations, which enable precise measurements of the stellar mass, radius and age. Analysis of the rotational splitting of the oscillation modes additionally reveals the stellar spin axis to be nearly edge-on, which suggests that the stellar spin is likely well-aligned with the orbit of the transiting planet. Despite its long period, the obliquity of the 52.5-day orbit may have been shaped by star-planet interaction in a manner similar to hot Jupiter systems, and we present observational and theoretical evidence to support this scenario. Finally, as a short-period outlier among giant planets orbiting giant stars, study of Kepler-432b may help explain the distribution of massive planets orbiting giant stars interior to 1 AU.Comment: 22 pages, 19 figures, 5 tables. Accepted to ApJ on Jan 24, 2015 (submitted Nov 11, 2014). Updated with minor changes to match published versio

Small is beautiful? Emerging organizational strategies among Italian professionals

The traditional debate about professional groups has mainly focused on conflicts between professions and organizations, reinforcing dualisms and dichotomies. Few scholars have investigated the extent to which professionalism and organizations are intertwined while focusing on the case of professionals integrated into large organizations, and even less attention has been paid to emerging forms of organization among self-employed professionals. Taking as an example organizational trends among architects (liberal professionals) and management consultants (emerging professionals) in Italy, this article investigates how small, flexible, and (often) interprofessional organizations promoted by self-employed professionals are increasingly instrumental in overcoming market pressures and responding to emerging social needs in times of crisis and austerity.Le debat traditionnel à propos des groupes professionnels a principalement concerné les conflits entre professions et organisations, renforçant ainsi les dualisations et dichotomies entre ces deux groupes. Peu de chercheurs ont enquêté à quel point la profession et l'organisationnel sont interdependants lors de l'étude de l'integration de professionnels à de grandes organisations. En fait, moins d'attention a été portée aux formes organisationnelles émergentes entre les professionnels indépendants. En prenant exemple sur les architectes (professionnels libéraux) et les professionnels dans le conseil en management (professionnels émergents) qui travaillent en Italie, cet article analyse comment les organisations des professionnels indépendants, qui sont petites, flexibles et (souvent) interprofessionnelles, se transforment en outils pour faire face à la pression du marché et pour répondre aux besoins émergents en temps de crises et austérité

Constructing global firms? National, transnational and neocolonial effects in international management consultancies

Drawing on an empirical study of four major international management consultancies, this article examines managerial efforts to construct ‘global’ organizations. We show how these efforts are undermined by inter-office conflicts over the staffing of client projects. We argue that such constraints cannot be adequately understood as an outcome of inappropriate organizational structures and incentives since this explanation ignores the important role of institutional contexts. In this vein, we outline and develop four different institutionalist lenses and apply them to the empirical findings. In so doing, we reveal the need to adopt a multi-dimensional institutionalist approach to the study of ‘global’ firms, one that can account for not only national effects but also transnational and neocolonial influences on these organizations