A qualitative synthesis of the perceived factors that affect participation in physical activity among children and adolescents with type 1 diabetes

Aims To explore the qualitative literature on the perceived factors, positive and negative, affecting participation by children and adolescents with type 1 diabetes in physical activity, from the perspective of children and adolescents with type 1 diabetes, their family members, teachers or sports coaches, and healthcare professionals. Methods MEDLINE, SPORTDiscus, PsycINFO, CINAHL and Scopus were systematically searched in July 2019. Eligible studies included any that reported qualitative findings on the perceived factors that affect participation in physical activity from either the perspective of children or adolescents with type 1 diabetes, their family members, teachers or coaches, and healthcare professionals. Results The literature search yielded a total of 7859 studies, of which 14 (13 qualitative studies and one mixed‐methods study) met the review inclusion criteria. In total there were 12 unique populations containing 270 individuals, 105 children or adolescents with type 1 diabetes,108 family members, 37 teachers and 20 healthcare professionals. The main factors thought to influence physical activity for this population were the individual characteristics of children and adolescents, the requirement for self‐blood glucose regulation, support systems including friends, family, teachers and professionals, education and knowledge, and communication. Conclusions This review synthesizes views on the perceived factors from several different perspectives. The findings suggest that it is important to consider the needs of the wider support network, as well as the child's or adolescent’s concerns and preferences, when developing new or existing strategies and programmes to promote physical activity in children and adolescents with type 1 diabetes

Validating the FLASH Code: Vortex-Dominated Flows

As a component of the Flash Center's validation program, we compare FLASH simulation results with experimental results from Los Alamos National Laboratory. The flow of interest involves the lateral interaction between a planar Ma=1.2 shock wave with a cylinder of gaseous sulfur hexafluoride (SF_6) in air, and in particular the development of primary and secondary instabilities after the passage of the shock. While the overall evolution of the flow is comparable in the simulations and experiments, small-scale features are difficult to match. We focus on the sensitivity of numerical results to simulation parameters.Comment: 10 pages, 5 figures, presented at the 5th International Conference on High Energy Laboratory Astrophysics, Tucson, AZ, March 10-13, 200

Staring into the abyss? The state of UK rugby's Super League

Rugby League's Super League was formed in 1995, due to unprecedented turmoil experienced in rugby league in Australia and a desire to run a season parallel to the Australian game during the British summer. The predicted outcomes of the Super League included greater uncertainty of outcome, increased attendances, and higher revenues for clubs, ultimately leading to the transformation of rugby league from a northern minority sport into a national/international sport. However, twenty years on, it appears that the Super League is running short of the objectives that it set itself. This paper analyses the financial health of Super League clubs alongside trends in attendance and participation. In summary, all three indicators of performance are poor in relation to the objectives set. These factors point to a bleak future for the sport and rugby league needs to produce a sustainable business model to keep both the clubs and the sport alive

Computational Eulerian Hydrodynamics and Galilean Invariance

Eulerian hydrodynamical simulations are a powerful and popular tool for modeling fluids in astrophysical systems. In this work, we critically examine recent claims that these methods violate Galilean invariance of the Euler equations. We demonstrate that Eulerian hydrodynamics methods do converge to a Galilean-invariant solution, provided a well-defined convergent solution exists. Specifically, we show that numerical diffusion, resulting from diffusion-like terms in the discretized hydrodynamical equations solved by Eulerian methods, accounts for the effects previously identified as evidence for the Galilean non-invariance of these methods. These velocity-dependent diffusive terms lead to different results for different bulk velocities when the spatial resolution of the simulation is kept fixed, but their effect becomes negligible as the resolution of the simulation is increased to obtain a converged solution. In particular, we find that Kelvin-Helmholtz instabilities develop properly in realistic Eulerian calculations regardless of the bulk velocity provided the problem is simulated with sufficient resolution (a factor of 2-4 increase compared to the case without bulk flows for realistic velocities). Our results reiterate that high-resolution Eulerian methods can perform well and obtain a convergent solution, even in the presence of highly supersonic bulk flows.Comment: Version accepted by MNRAS Oct 2, 2009. Figures degraded. For high-resolution color figures and movies of the numerical simulations, please visit http://www.astro.caltech.edu/~brant/Site/Computational_Eulerian_Hydrodynamics_and_Galilean_Invariance.htm

Piecewise Parabolic Method on a Local Stencil for Magnetized Supersonic Turbulence Simulation

Stable, accurate, divergence-free simulation of magnetized supersonic turbulence is a severe test of numerical MHD schemes and has been surprisingly difficult to achieve due to the range of flow conditions present. Here we present a new, higher order-accurate, low dissipation numerical method which requires no additional dissipation or local "fixes" for stable execution. We describe PPML, a local stencil variant of the popular PPM algorithm for solving the equations of compressible ideal magnetohydrodynamics. The principal difference between PPML and PPM is that cell interface states are evolved rather that reconstructed at every timestep, resulting in a compact stencil. Interface states are evolved using Riemann invariants containing all transverse derivative information. The conservation laws are updated in an unsplit fashion, making the scheme fully multidimensional. Divergence-free evolution of the magnetic field is maintained using the higher order-accurate constrained transport technique of Gardiner and Stone. The accuracy and stability of the scheme is documented against a bank of standard test problems drawn from the literature. The method is applied to numerical simulation of supersonic MHD turbulence, which is important for many problems in astrophysics, including star formation in dark molecular clouds. PPML accurately reproduces in three-dimensions a transition to turbulence in highly compressible isothermal gas in a molecular cloud model. The low dissipation and wide spectral bandwidth of this method make it an ideal candidate for direct turbulence simulations.Comment: 28 pages, 18 figure

The Gas Content in Galactic Disks: Correlation with Kinematics

We consider the relationship between the total HI mass in late-type galaxies and the kinematic properties of their disks. The mass $M_HI$ for galaxies with a wide variety of properties, from dwarf dIrr galaxies with active star formation to giant low-brightness galaxies, is shown to correlate with the product $V_c R_0$ ($V_c$ is the rotational velocity, and $R_0$ is the radial photometric disks scale length), which characterizes the specific angular momentum of the disk. This relationship, along with the anticorrelation between the relative mass of HI in a galaxy and $V_c$, can be explained in terms of the previously made assumption that the gas density in the disks of most galaxies is maintained at a level close to the threshold (marginal) stability of a gaseous layer to local gravitational perturbations. In this case, the regulation mechanism of the star formation rate associated with the growth of local gravitational instability in the gaseous layer must play a crucial role in the evolution of the gas content in the galactic disk.Comment: revised version to appear in Astronomy Letters, 8 pages, 5 EPS figure

A physical activity intervention for children with type 1 diabetes- steps to active kids with diabetes (STAK-D): a feasibility study

Background This study describes the development and feasibility evaluation of a physical activity intervention for children with type 1 diabetes called ‘Steps to Active Kids with Diabetes’ (STAK-D). It aims to explore the feasibility and acceptability of the intervention and study design. Methods Thirteen children aged 9-11 years and their parents were recruited from one paediatric diabetes clinic. A process evaluation was conducted alongside a two-arm randomised feasibility trial, including assessment of rate of recruitment, adherence, retention, data completion and burden, implementation fidelity and adverse events. Qualitative interviews with children (n=9), parents (n=8), healthcare professionals (n=3) and STAK-D volunteers (n=8) explored intervention acceptability. Interviews were analysed thematically. Results Rate of recruitment was 25%, with 77% retention at 3-month follow-up. Study burden was low, data completion was high and the intervention was delivered as per protocol. No serious adverse event was reported. Engagement with intervention materials was generally good, but attendance at group activity sessions was low due to logistical barriers. Interview analysis identified preferred methods of recruitment, motivations for recruitment, barriers and facilitators to adherence, the experience of data collection, experience of the STAK-D programme and its perceived benefits. Conclusions STAK-D was feasible and acceptable to children, their parents and healthcare professionals, but group sessions may present logistical issues. Recruitment and retention may be improved with a clinic-wide approach to recruitment. Trial registration This trial was registered on ClinicalTrials.gov: NCT02144337 (16/01/2014). Keywords Children, feasibility study, intervention, paediatric diabetes, physical activity, process evaluation, self-efficacy, type 1 diabete

“Having diabetes shouldn’t stop them”: healthcare professionals’ perceptions of physical activity in children with Type 1 diabetes

Background Healthcare professionals (HCP) working with children who have Type 1 Diabetes Mellitus (T1DM) have an important role in advising about and supporting the control of blood glucose level in relation to physical activity. Regular physical activity has known benefits for children with T1DM, but children with chronic conditions may face barriers to participation. The perceptions of HCPs were explored in an effort to understand what influences physical activity in children with T1DM and to inform the practice of those working with children who have T1DM. Methods Semi-structured interviews with 11 HCPs involved in the care of children with T1DM in the UK were conducted. Interviews were recorded, transcribed verbatim and data were analysed using thematic analysis. Results The factors perceived to influence participation in physical activity are presented as five major themes and eleven sub-themes. Themes included the positive influence of social support, the child’s motivation to be active, the potential for formal organisations such as school and diabetes clinic to support physical activity, the challenges faced by those who have T1DM and the perceived barriers to HCPs fulfilling their role of promoting physical activity. Conclusions Healthcare professionals recognised their role in helping children with T1DM and their parents to incorporate physical activity into diabetes management and everyday life, but perceived barriers to the successful fulfilment of this role. The findings highlight the potential for clinical and non-clinical supportive systems to be sensitive to these challenges and facilitate children’s regular participation in physical activity

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed

Examining the effects of national initiatives to improve the physical health of people with psychosis in England: secondary analysis of data from the National Clinical Audit of Psychosis

Background: There are longstanding concerns regarding physical health inequalities for people with psychotic disorders. In recent years concerted efforts have been made to address these. Aims: To examine whether recent national initiatives in England have led to improvements in the physical health of people with schizophrenia and related psychoses. Methods: Secondary analysis of data from multiple rounds of a national audit of services for people with psychosis, conducted over a 9-year period. Proportions of patients in ‘good health’ according to seven discrete measures, and one composite measure derived from national standards, were compared between each round of the audit. Results: The proportion of patients in overall ‘good health’ under the care of ‘Early Intervention in Psychosis’ (EIP) teams increased between 2014 and 2019 (OR=4.65, 95% CI 3.32 to 6.52, P<0.001). There were isolated improvements for these patients in measures of ‘good health’ relating to smoking (OR=1.22, 95% CI 1.11 to 1.35, P<0.001), alcohol use (OR=1.43, 95% CI 1.23 to 1.68, P<0.001) and illicit substance use (OR=1.86, 95% CI 1.68 to 2.07, P<0.001). There was no significant change in the proportion of patients in overall ‘good health’ under the care of ‘Community Mental Health Teams’ (CMHTs) between 2011 and 2017. However, there were improvements for these patients in specific measures relating to alcohol use (OR=1.48, 95% CI 1.31 to 1.67, P=<0.001), blood glucose levels (OR=2.12, 95% CI 1.89 to 2.36, P<0.001) and blood lipids (OR=1.78, 95% CI 1.60 to 1.98, P<0.001). Conclusions: There have been modest improvements in the physical health of people with psychotic disorders over the last nine years, particularly those who are under the care of EIP teams. Continuing efforts are required if these improvements are to translate into reductions in premature mortality among people with psychosis