The lived experience of juvenile idiopathic arthritis in young people receiving etanercept

BACKGROUND: This study explores young people's daily experiences of living with Juvenile Idiopathic Arthritis (JIA) and their thoughts, beliefs and feelings related to the biological drug Etanercept, prescribed as part of their treatment. METHODS: An Interpretive Phenomenological approach was used to allow in-depth examinations of the young people's personal accounts of their lived experiences. Data were obtained from 6 young people between the ages of 10-13 years, from one tertiary institution's Paediatric Rheumatology department using audio-taped open-ended interviews. RESULTS: The transcripts yielded seven thousand words of data and two hundred significant statements, which were reduced to five themes; 1) Who understands me, 2) Medicines and injections, 3) Challenges of schooling and friendships, 4) Being different, and 5) Exclusion from sports. There were marked similarities between the young people's statements; however, there were also some striking differences. The theme 'Who understands me' yielded the biggest section of data, but also produced the biggest disparity between the young people. Two patients were very clear that they thought everyone 'understands', whilst two other patients held the belief that 'no one understood'. This paper explores these statements in further detail. CONCLUSIONS: The findings from this study can give healthcare professionals novel insight into the likely reactions to treatment for JIA and, through this, enable them to offer improved support, education and early intervention before these issues become a concern. This study also provides insight into the emotional resilience of young people with JIA

The development and implementation of a peer support model for a specialist mental health service for older people: lessons learned

© 2018, Emerald Publishing Limited. Purpose: There has been a significant growth in the employment of peer workers over the past decade in youth and adult mental health settings. Peer work in mental health services for older people is less developed, and there are no existing peer work models for specialist mental health services for older people in Australia. The authors developed and implemented a peer work model for older consumers and carers of a specialist mental health service. The purpose of this paper is to describe the model, outline the implementation barriers experienced and lesson learned and comment on the acceptability of the model from the perspective of stakeholders. Design/methodology/approach: To ensure the development of the peer work model met the needs of key stakeholders, the authors adopted an evaluation process that occurred alongside the development of the model, informed by action research principles. To identify stakeholder preferences, implementation barriers and potential solutions, and gain insight into the acceptability and perceived effectiveness of the model, a range of methods were used, including focus groups with the peer workers, clinicians and steering committee, consumer and carer surveys, field notes and examination of project documentation. Findings: While the model was overall well received by stakeholders, the authors experienced a range of challenges and implementation barriers, in particular around governance, integrating the model into existing systems, and initial resistance to peer work from clinical staff. Originality/value: Older peer workers provide a valuable contribution to the mental health sector through the unique combination of lived experience and ageing. The authors recommend that models of care are developed prior to implementation so that there is clarity around governance, management, reporting lines and management of confidentiality issues

The construction of exact Taylor states. I: The full sphere

The dynamics of the Earth's fluid core are described by the so-called magnetostrophic balance between Coriolis, pressure, buoyancy and Lorentz forces. In this regime the geomagnetic field is subject to a continuum of theoretical conditions, which together comprise Taylor's constraint, placing restrictions on its internal structure. Examples of such fields, so-called Taylor states, have proven difficult to realize except in highly restricted cases. In previous theoretical developments, we showed that it was possible to reduce this infinite class of conditions to a finite number of coupled quadratic homogeneous equations when adopting a certain regular truncated spectral expansion for the magnetic field. In this paper, we illustrate the power of these results by explicitly constructing two families of exact Taylor states in a full sphere that match the same low-degree observationally derived model of the radial field at the core—mantle boundary. We do this by prescribing a smooth purely poloidal field that fits this observational model and adding to it an expediently chosen unconstrained set of interior toroidal harmonics of azimuthal wavenumbers 0 and 1. Formulated in terms of the toroidal coefficients, the resulting system is purely linear and can be readily solved to find Taylor states. By calculating the extremal members of the two families that minimize the Ohmic dissipation, we argue on energetic ground that the toroidal field in the Earth's core is likely to be dominated by low order azimuthal modes, similar to the observed poloidal field. Finally, we comment on the extension of finding Taylor states within a general truncated spectral expansion with arbitrary poloidal and toroidal coefficient

A taxonomy of simulated geomagnetic jerks

Geomagnetic jerks - abrupt changes in the acceleration of Earth’s magnetic field that punctuate geomagnetic records - have been richly documented over the past decades by taking advantage of the complementary strengths of ground observatory and satellite measurements. It has recently been proposed that these events originate from the interplay and time scale separation between slow convection and rapid hydromagnetic wave propagation in Earth’s outer core, with these latter waves playing a key role in the generation of jerk signals. To assess the generality of this explanation, here we analyse a catalog of 14 events obtained during a 14000 year long temporal sequence from a numerical geodynamo simulation that is the closest to date to Earth’s core conditions regarding time scale separation. Events are classified according to their dynamical origin and the depth at which they are triggered in the outer core. The majority of jerk events are found to arise from intermittent local disruptions of the leading-order force balance between the pressure, Coriolis, buoyancy and Lorentz forces (the QG-MAC balance), that leads to an inertial compensation through the emission of rapid, non-axisymmetric, quasi-geostrophic Alfvén waves from the region where this force balance is disrupted. Jerk events of moderate strength arise from the arrival at low latitudes at the core surface of hydromagnetic wave packets emitted from convective plumes rooted at the inner core boundary. As in an earlier simulation, these account well for jerk features that have recently been documented by satellite and ground observations. The more realistic timescales in the simulation reported here allow further details to be distinguished, such as multiple temporal alternations of geomagnetic acceleration pulses at low latitudes, long-range synchronisation of pulse foci in space and rapid longitudinal drift of these foci at the core surface. The strongest events in the catalog arise from disruption of the leading-order force balance near or at the core surface, from the combined influence of the arrival of buoyancy plumes and magnetic field rearrangement. The hydromagnetic waves that are sent laterally and downwards generate signals that clearly illustrate the presence of nearly synchronous ‘V-shaped’ magnetic variation patterns over a wide portion of Earth’s surface and also at mid to high latitudes, despite the source being confined to low latitudes at the core surface. Other well-known characteristics of strong geomagnetic jerks such as surges in the intensity of the secular variation and inflexions in the length-of-day variations are also reproduced in these events. Irrespectively of the event strength, our results support the hypothesis of a single physical root cause - the emission of magneto-inertial waves following a disruption of the QG-MAC balance - for jerks observed throughout the geomagnetic record

Dephasing Effect in Photon-Assisted Resonant Tunneling through Quantum Dots

We analyze dephasing in single and double quantum dot systems. The decoherence is introduced by the B\"{u}ttiker model with current conserving fictitious voltage leads connected to the dots. By using the non-equilibrium Green function method, we investigate the dephasing effect on the tunneling current. It is shown that a finite dephasing rate leads to observable effects. The result can be used to measure dephasing rates in quantum dots.Comment: 4 pages, 3 figures, to be published in Rapid Communications of Phys. Rev.