A longitudinal, observational study examining the relationships of patient satisfaction with services and mental well-being to their clinical course in young people with Type 1 diabetes mellitus during transition from child to adult health services

AIM: We hypothesized that participant well-being and satisfaction with services would be positively associated with a satisfactory clinical course during transition from child to adult health care. METHODS: Some 150 young people with Type 1 diabetes mellitus from five diabetes units in England were recruited to a longitudinal study of transition. Each young person was visited at home four times by a research assistant; each visit was 1 year apart. Satisfaction with services (Mind the Gap; MTG) and mental well-being (Warwick-Edinburgh Mental Well-being Scale; WEMWBS) were captured. Change in HbA1c , episodes of ketoacidosis, clinic and retinal screening attendance were used to assess clinical course. In total, 108 of 150 (72%) young people had sufficient data for analysis at visit 4. RESULTS: Mean age at entry was 16 years. By visit 4, 81.5% had left paediatric healthcare services. Median HbA1c increased significantly (P = 0.01) from 69 mmol/mol (8.5%) at baseline to 75 mmol/mol (9.0%) at visit 4. WEMWBS scores were comparable with those in the general population at baseline and were stable over the study period. MTG scores were also stable. By visit 4, some 32 individuals had a 'satisfactory' and 76 a 'suboptimal' clinical course. There were no significant differences in average WEMWBS and MTG scores between the clinical course groups (P = 0.96, 0.52 respectively); nor was there a significant difference in transfer status between the clinical course groups. CONCLUSIONS: The well-being of young people with diabetes and their satisfaction with transition services are not closely related to their clinical course. Investigating whether innovative psycho-educational interventions can improve the clinical course is a research priority

Substellar companions and isolated planetary mass objects from protostellar disc fragmentation

Self-gravitating protostellar discs are unstable to fragmentation if the gas can cool on a time scale that is short compared to the orbital period. We use a combination of hydrodynamic simulations and N-body orbit integrations to study the long term evolution of a fragmenting disc with an initial mass ratio to the star of M_disc/M_star = 0.1. For a disc which is initially unstable across a range of radii, a combination of collapse and subsequent accretion yields substellar objects with a spectrum of masses extending (for a Solar mass star) up to ~0.01 M_sun. Subsequent gravitational evolution ejects most of the lower mass objects within a few million years, leaving a small number of very massive planets or brown dwarfs in eccentric orbits at moderately small radii. Based on these results, systems such as HD 168443 -- in which the companions are close to or beyond the deuterium burning limit -- appear to be the best candidates to have formed via gravitational instability. If massive substellar companions originate from disc fragmentation, while lower-mass planetary companions originate from core accretion, the metallicity distribution of stars which host massive substellar companions at radii of ~1 au should differ from that of stars with lower mass planetary companions.Comment: 5 pages, accepted for publication in MNRA

Return to school after acquired brain injury in the UK – the educators' perspectives

Childhood acquired brain injury (ABI) is associated with poorer life outcomes. Increasing numbers of children and young people are surviving severe brain injury and returning to mainstream schools with multiple impairments. It is widely acknowledged that for these children, their school becomes by default their rehabilitation centre. International studies of this transition and a recent UK government report criticize educators' inconsistent implementation of support strategies, lack of educator training and poor communication between clinicians, educators, child and family. The educators' perspectives of the return-to-school are, however, not well represented in the literature. This study therefore explored the experiences of educators in the UK (N = 10) who had recently facilitated a return-to-school of a child with ABI aged 8–12 (N = 5) using semi-structured interviews analysed by data-driven thematic analysis. The findings highlight common experiences: a continuum of intensive problem-solving with heavy reliance on the Special Educational Needs Coordinator; educators valuing collaboration with clinical specialists in context over general ‘training’; uncertainty over the validity of implementing support strategies from prior teaching experience; uncertainty about how to support the child's emotional needs; and frustration with UK statutory processes for Special Educational Needs and Disabilities. Recommendations are made for changes to practice and future research

The large-scale disk fraction of brown dwarfs in the Taurus cloud as measured with Spitzer

Aims. The brown dwarf (BD) formation process has not yet been completely understood. To shed more light on the differences and similarities between star and BD formation processes, we study and compare the disk fraction among both kinds of objects over a large angular region in the Taurus cloud. In addition, we examine the spatial distribution of stars and BD relative to the underlying molecular gas Methods. In this paper, we present new and updated photometry data from the Infrared Array Camera (IRAC) aboard the Spitzer Space Telescope on 43 BDs in the Taurus cloud, and recalculate of the BD disk fraction in this region. We also useed recently available CO mm data to study the spatial distribution of stars and BDs relative to the cloud's molecular gas. Results. We find that the disk fraction among BDs in the Taurus cloud is 41 \pm 12%, a value statistically consistent with the one among TTS (58 \pm 9%). We find that BDs in transition from a state where they have a disk to a diskless state are rare, and we study one isolated example of a transitional disk with an inner radius of \approx 0.1 AU (CFHT BD Tau 12, found via its relatively small mid-IR excess compared to most members of Taurus that have disks. We find that BDs are statistically found in regions of similar molecular gas surface density to those associated with stars. Furthermore, we find that the gas column density distribution is almost identical for stellar and substellar objects with and without disks.Comment: 8 page, 6 figures, Accepted in Astronomy & Astrophysics

First report of generalized face processing difficulties in möbius sequence.

Reverse simulation models of facial expression recognition suggest that we recognize the emotions of others by running implicit motor programmes responsible for the production of that expression. Previous work has tested this theory by examining facial expression recognition in participants with Möbius sequence, a condition characterized by congenital bilateral facial paralysis. However, a mixed pattern of findings has emerged, and it has not yet been tested whether these individuals can imagine facial expressions, a process also hypothesized to be underpinned by proprioceptive feedback from the face. We investigated this issue by examining expression recognition and imagery in six participants with Möbius sequence, and also carried out tests assessing facial identity and object recognition, as well as basic visual processing. While five of the six participants presented with expression recognition impairments, only one was impaired at the imagery of facial expressions. Further, five participants presented with other difficulties in the recognition of facial identity or objects, or in lower-level visual processing. We discuss the implications of our findings for the reverse simulation model, and suggest that facial identity recognition impairments may be more severe in the condition than has previously been noted

Modeling high-energy light curves of the PSR B1259-63/LS 2883 binary based on 3-D SPH simulations

Temporal changes of X-ray to very-high-energy gamma-ray emissions from the pulsar-Be star binary PSR B1259-63/LS 2883 are studied based on 3-D SPH simulations of pulsar wind interaction with Be-disk and wind. We focus on the periastron passage of the binary and calculate the variation of the synchrotron and inverse-Compton emissions using the simulated shock geometry and pressure distribution of the pulsar wind. The characteristic double-peaked X-ray light curve from observations is reproduced by our simulation under a dense Be disk condition (base density ~10^{-9} g cm^{-3}). We interpret the pre- and post-periastron peaks as being due to a significant increase in the conversion efficiency from pulsar spin down power to the shock-accelerated particle energy at orbital phases when the pulsar crosses the disk before periastron passage, and when the pulsar wind creates a cavity in the disk gas after periastron passage, respectively. On the contrary, in the model TeV light curve, which also shows a double peak feature, the first peak appears around the periastron phase. The possible effects of cooling processes on the TeV light curve are briefly discussed.Comment: 32 pages, 6 figues. Accepted for publication in Ap

Star formation at very low metallicity. II: On the insignificance of metal-line cooling during the early stages of gravitational collapse

We study the influence of low levels of metal enrichment on the cooling and collapse of ionized gas in small protogalactic halos using three-dimensional, smoothed particle hydrodynamics simulations. Our initial conditions represent protogalaxies forming within a fossil HII region -- a previously ionized HII region which has not yet had time to cool and recombine. Prior to cosmological reionization, such regions should be relatively common, since the characteristic lifetimes of the likely ionizing sources are significantly shorter than a Hubble time. We show that in these regions, H_2 is the dominant and most effective coolant, and that it is the amount of H_2 formed that determines whether or not the gas can collapse and form stars. At the low metallicities (Z < 10^{-3} Z_sun) thought to be associated with the transition from population III to early population II star formation, metal line cooling has an almost negligible effect on the evolution of low density gas, altering the density and temperature evolution of the gas by less than 1% compared to the metal-free case at densities below 1 cm^{-3} and temperatures above 2000 K. Although there is evidence that metal line cooling becomes more effective at higher density, we find no significant differences in behaviour from the metal-free case at any density below our sink particle creation threshold at n = 500 cm^{-3}. Increasing the metallicity also increases the importance of metal line cooling, but it does not significantly affect the dynamical evolution of the low density gas until Z = 0.1 Z_sun. This result holds regardless of whether or not an ultraviolet background is present.Comment: 38 pages, 8 figures, AASTex. Accepted by ApJ. Corrected typos and reference

Identifying Hallmark Symptoms of Developmental Prosopagnosia for Non-Experts

Developmental prosopagnosia (DP) is characterised by a severe and relatively selective deficit in face recognition, in the absence of neurological injury. Because public and professional awareness of DP is low, many adults and children are not identified for formal testing. This may partly result from the lack of appropriate screening tools that can be used by non-experts in either professional or personal settings. To address this issue, the current study sought to (a) explore when DP can first be detected in oneself and another, and (b) identify a list of the condition’s everyday behavioural manifestations. Questionnaires and interviews were administered to large samples of adult DPs, their unaffected significant others, and parents of children with the condition; and data were analysed using inductive content analysis. It was found that DPs have limited insight into their difficulties, with most only achieving realisation in adulthood. Nevertheless, the DPs’ reflections on their childhood experiences, together with the parental responses, revealed specific indicators that can potentially be used to spot the condition in early childhood. These everyday hallmark symptoms may aid the detection of individuals who would benefit from objective testing, in oneself (in adults) or another person (for both adults and children)