Tablet-based disclosure counselling for HIV-infected children, adolescents, and their caregivers: a pilot study

BACKGROUND: Overwhelmed, under-trained medical staff working in resource-limited settings need efficient resources for HIV disclosure counselling. The objective of this study was to describe providers' experiences using tablet computers for disclosure-related counselling with HIV-infected children and their caregivers in western Kenya, with additional perspectives from adolescents. METHODS: A qualitative study design was implemented at three HIV clinics in western Kenya (Bumala, Busia and Port Victoria) within the Academic Model Providing Access to Healthcare (AMPATH) partnership. Twenty-one healthcare providers involved with paediatric disclosure were recruited and enrolled in the study. Initial interviews focused on understanding current disclosure practices and barriers. Tablets containing disclosure-related resources were distributed. Resources included short narrative videos created in this context to highlight issues relevant to child HIV disclosure. RESULTS: Providers reported tablets improved disclosure, child participation, and medication adherence. All reported that reviewing materials increased their knowledge and comfort with disclosure. The most frequently used materials were the narrative videos and an animated video explaining the importance of medication adherence. Time was a major barrier for using the tablet. Clinician self-education persisted at one-year follow-up. Adolescents expressed enjoyment from viewing the tablet resources and had a better understanding of the importance of medication adherence. CONCLUSIONS: Tablet computers containing resources for disclosure are an acceptable and potentially effective resource to help providers support families with disclosure. Further work is needed to train the clinical providers in using the resources in a developmentally appropriate manner, and to develop new resources on adolescent-specific and HIV-related topics

25 Years of Self-Organized Criticality: Solar and Astrophysics

Shortly after the seminal paper “Self-Organized Criticality: An explanation of 1/fnoise” by Bak et al. (1987), the idea has been applied to solar physics, in “Avalanches and the Distribution of Solar Flares” by Lu and Hamilton (1991). In the following years, an inspiring cross-fertilization from complexity theory to solar and astrophysics took place, where the SOC concept was initially applied to solar flares, stellar flares, and magnetospheric substorms, and later extended to the radiation belt, the heliosphere, lunar craters, the asteroid belt, the Saturn ring, pulsar glitches, soft X-ray repeaters, blazars, black-hole objects, cosmic rays, and boson clouds. The application of SOC concepts has been performed by numerical cellular automaton simulations, by analytical calculations of statistical (powerlaw-like) distributions based on physical scaling laws, and by observational tests of theoretically predicted size distributions and waiting time distributions. Attempts have been undertaken to import physical models into the numerical SOC toy models, such as the discretization of magneto-hydrodynamics (MHD) processes. The novel applications stimulated also vigorous debates about the discrimination between SOC models, SOC-like, and non-SOC processes, such as phase transitions, turbulence, random-walk diffusion, percolation, branching processes, network theory, chaos theory, fractality, multi-scale, and other complexity phenomena. We review SOC studies from the last 25 years and highlight new trends, open questions, and future challenges, as discussed during two recent ISSI workshops on this theme.Fil: Aschwanden, Markus J.. Lockheed Martin Corporation; Estados UnidosFil: Crosby, Norma B.. Belgian Institute For Space Aeronomy; BélgicaFil: Dimitropoulou, Michaila. University Of Athens; GreciaFil: Georgoulis, Manolis K.. Academy Of Athens; GreciaFil: Hergarten, Stefan. Universitat Freiburg Im Breisgau; AlemaniaFil: McAteer, James. University Of New Mexico; Estados UnidosFil: Milovanov, Alexander V.. Max Planck Institute For The Physics Of Complex Systems; Alemania. Russian Academy Of Sciences. Space Research Institute; Rusia. Enea Centro Ricerche Frascati; ItaliaFil: Mineshige, Shin. Kyoto University; JapónFil: Morales, Laura Fernanda. Canadian Space Agency; Canadá. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Nishizuka, Naoto. Japan National Institute Of Information And Communications Technology; JapónFil: Pruessner, Gunnar. Imperial College London; Reino UnidoFil: Sanchez, Raul. Universidad Carlos Iii de Madrid. Instituto de Salud; EspañaFil: Sharma, A. Surja. University Of Maryland; Estados UnidosFil: Strugarek, Antoine. University Of Montreal; CanadáFil: Uritsky, Vadim. Nasa Goddard Space Flight Center; Estados Unido