Supporting children and young people to assume responsibility from their parents for the self-management of their long-term condition: An integrative review

© 2019 John Wiley & Sons Ltd Background: Children and young people with long-term conditions (LTCs) are usually dependent on, or share management with, their families and are expected to develop self-management skills as they mature. However, during adolescence, young people can find it challenging to follow prescribed treatment regimens resulting in poor clinical outcomes. Though reviews have looked at children's and parents' experiences of self-management, none have explicitly examined the parent-to-child transfer of self-management responsibility. Methods: An integrative review was conducted with the aim of exploring the parent-to-child transfer of LTC self-management responsibility, through addressing two questions: (a) How do children assume responsibility from their parents for self-management of their LTC? (b) What influences the parent-to-child transfer of this responsibility? Eight databases were searched for papers published from 1995 to 2017. Methodological quality was assessed; included papers were synthesized to identify themes. Results: Twenty-nine papers were identified. Most papers used qualitative designs and focused on children with diabetes. Participants were predominantly children and/or parents; only two studies included health professionals. Assuming self-management responsibility was viewed as part of normal development but was rarely explored within the context of the child gaining independence in other areas of their life. Children and parents adopted strategies to help the transfer, but there was limited evidence around health professionals' roles and ambivalence around what was helpful. There was a lack of clarity over whether children and parents were aiming for shared management, or self-management, and whether this was a realistic or desired goal for families. Multiple factors such as the child, family, social networks, health professional, and LTC influenced how a child assumed responsibility. Conclusions: Evidence suggests that the parent-to-child transfer of self-management responsibility is a complex, individualized process. Further research across childhood LTCs is needed to explore children's, parents', and professionals' views on this process and what support families require as responsibilities change

The Origin of Sequential Chromospheric Brightenings

Sequential chromospheric brightenings (SCBs) are often observed in the immediate vicinity of erupting flares and are associated with coronal mass ejections. Since their initial discovery in 2005, there have been several subsequent investigations of SCBs. These studies have used differing detection and analysis techniques, making it difficult to compare results between studies. This work employs the automated detection algorithm of Kirk et al. (Solar Phys. 283, 97, 2013) to extract the physical characteristics of SCBs in 11 flares of varying size and intensity. We demonstrate that the magnetic substructure within the SCB appears to have a significantly smaller area than the corresponding H-alpha emission. We conclude that SCBs originate in the lower corona around 0.1 R_sun above the photosphere, propagate away from the flare center at speeds of 35 - 85 km/s, and have peak photosphere magnetic intensities of 148 +/- 2.9 G. In light of these measurements, we infer SCBs to be distinctive chromospheric signatures of erupting coronal mass ejections.Comment: 25 pages, 9 figures, 5 table

Electrical current distribution across a metal-insulator-metal structure during bistable switching

Combining scanning electron microscopy (SEM) and electron-beam-induced current (EBIC) imaging with transport measurements, it is shown that the current flowing across a two-terminal oxide-based capacitor-like structure is preferentially confined in areas localized at defects. As the thin-film device switches between two different resistance states, the distribution and intensity of the current paths, appearing as bright spots, change. This implies that switching and memory effects are mainly determined by the conducting properties along such paths. A model based on the storage and release of charge carriers within the insulator seems adequate to explain the observed memory effect.Comment: 8 pages, 7 figures, submitted to J. Appl. Phy

Kinetic instabilities that limit {\beta} in the edge of a tokamak plasma: a picture of an H-mode pedestal

Plasma equilibria reconstructed from the Mega-Amp Spherical Tokamak (MAST) have sufficient resolution to capture plasma evolution during the short period between edge-localized modes (ELMs). Immediately after the ELM steep gradients in pressure, P, and density, ne, form pedestals close to the separatrix, and they then expand into the core. Local gyrokinetic analysis over the ELM cycle reveals the dominant microinstabilities at perpendicular wavelengths of the order of the ion Larmor radius. These are kinetic ballooning modes (KBMs) in the pedestal and microtearing modes (MTMs) in the core close to the pedestal top. The evolving growth rate spectra, supported by gyrokinetic analysis using artificial local equilibrium scans, suggest a new physical picture for the formation and arrest of this pedestal.Comment: Final version as it appeared in PRL (March 2012). Minor improvements include: shortened abstract, and better colour table for figures. 4 pages, 6 figure

Complex X-ray spectral variability in Mkn 421 observed with XMM-Newton

The bright blazar Mkn 421 has been observed four times for uninterrupted durations of ~ 9 - 13 hr during the performance verification and calibration phases of the XMM-Newton mission. The source was strongly variable in all epochs, with variability amplitudes that generally increased to higher energy bands. Although the detailed relationship between soft (0.1 - 0.75 keV) and hard (2 - 10 keV) band differed from one epoch to the next, in no case was there any evidence for a measurable interband lag, with robust upper limits of $| \tau | < 0.08$ hr in the best-correlated light curves. This is in conflict with previous claims of both hard and soft lags of ~1 hr in this and other blazars. However, previous observations suffered a repeated 1.6 hr feature induced by the low-Earth orbital period, a feature that is not present in the uninterrupted XMM-Newton data. The new upper limit on $|\tau|$ leads to a lower limit on the magnetic field strength and Doppler factor of B \delta^{1/3} \gs 4.7 G, mildly out of line with the predictions from a variety of homogeneous synchrotron self-Compton emission models in the literature of $B \delta^{1/3} = 0.2 - 0.8$ G. Time-dependent spectral fitting was performed on all epochs, and no detectable spectral hysteresis was seen. We note however that the source exhibited significantly different spectral evolutionary behavior from one epoch to the next, with the strongest correlations in the first and last and an actual divergance between soft and hard X-ray bands in the third. This indicates that the range of spectral variability behavior in Mkn 421 is not fully described in these short snippets; significantly longer uninterrupted light curves are required, and can be obtained with XMM-Newton.Comment: 21 pages, 4 figures, accepted for ApJ, scheduled for August 1, 200

Is police misconduct contagious? Non-trivial null findings from Dallas, Texas

Objectives: Understanding if police malfeasance might be “contagious” is vital to identifying efficacious paths to police reform. Accordingly, we investigate whether an officer’s propensity to engage in misconduct is associated with her direct, routine interaction with colleagues who have themselves engaged in misbehavior in the past. Methods: Recognizing the importance of analyzing the actual social networks spanning a police force, we use data on collaborative responses to 1,165,136 “911” calls for service by 3475 Dallas Police Department (DPD) officers across 2013 and 2014 to construct daily networks of front-line interaction. And we relate these cooperative networks to reported and formally sanctioned misconduct on the part of the DPD officers during the same time period using repeated-events survival models. Results: Estimates indicate that the risk of a DPD officer engaging in misconduct is not associated with the disciplined misbehavior of her ad hoc, on-the-scene partners. Rather, a greater risk of misconduct is associated with past misbehavior, officer-specific proneness, the neighborhood context of patrol, and, in some cases, officer race, while departmental tenure is a mitigating factor. Conclusions: Our observational findings—based on data from one large police department in the United States—ultimately suggest that actor-based and ecological explanations of police deviance should not be summarily dismissed in favor of accounts emphasizing negative socialization, where our study design also raises the possibility that results are partly driven by unobserved trait-based variation in the situations that officers find themselves in. All in all, interventions focused on individual officers, including the termination of deviant police, may be fruitful for curtailing police misconduct—where early interventions focused on new offenders may be key to avoiding the escalation of deviance