Pediatric rheumatology: addressing the transition to adult-orientated health care.

The transition from pediatric to adult health care is often a challenging process due to multiple interwoven complexities, especially for children with chronic medical conditions. Health care transition (HCT) is a process of moving from a pediatric to an adult model of health care with or without a transfer to a new clinician. This paper focuses on what is known about HCT for youth and young adults (Y/YA) with rheumatic diseases within a larger context of HCT recommendations. HCT barriers for youth, families, and providers and current evidence for a structured HCT processes are reviewed. Practical advice is offered on how to approach transition for Y/YA, what tools are available to assist in a successful transition process, and what are the areas of future research that are needed to improve the HCT evidence base

The Ages of A-Stars I: Interferometric Observations and Age Estimates for Stars in the Ursa Major Moving Group

We have observed and spatially resolved a set of seven A-type stars in the nearby Ursa Major moving group with the Classic, CLIMB, and PAVO beam combiners on the CHARA Array. At least four of these stars have large rotational velocities ($v \sin i$ $\gtrsim$ 170 $\mathrm{km~s^{-1}}$) and are expected to be oblate. These interferometric measurements, the stars' observed photometric energy distributions, and $v \sin i$ values are used to computationally construct model oblate stars from which stellar properties (inclination, rotational velocity, and the radius and effective temperature as a function of latitude, etc.) are determined. The results are compared with MESA stellar evolution models (Paxton et al. 2011, 2013) to determine masses and ages. The value of this new technique is that it enables the estimation of the fundamental properties of rapidly rotating stars without the need to fully image the star. It can thus be applied to stars with sizes comparable to the interferometric resolution limit as opposed to those that are several times larger than the limit. Under the assumption of coevality, the spread in ages can be used as a test of both the prescription presented here and the MESA evolutionary code for rapidly rotating stars. With our validated technique, we combine these age estimates and determine the age of the moving group to be 414 $\pm$ 23 Myr, which is consistent with, but much more precise than previous estimates.Comment: Accepted by Ap

The ages of a-stars. I. Interferometric observations and age estimates for stars in the ursa major moving group

We have observed and spatially resolved a set of seven A-type stars in the nearby Ursa Major moving group with the Classic, CLIMB, and PAVO beam combiners on the Center for High Angular Resolution Astronomy Array. At least four of these stars have large rotational velocities (v sin i ≳ 170 km s-1) and are expected to be oblate. These interferometric measurements, the stars observed photometric energy distributions, and v sin i values are used to computationally construct model oblate stars from which stellar properties (inclination, rotational velocity, and the radius and effective temperature as a function of latitude, etc.) are determined. The results are compared with MESA stellar evolution models to determine masses and ages. The value of this new technique is that it enables the estimation of the fundamental properties of rapidly rotating stars without the need to fully image the star. It can thus be applied to stars with sizes comparable to the interferometric resolution limit as opposed to those that are several times larger than the limit. Under the assumption of coevality, the spread in ages can be used as a test of both the prescription presented here and the MESA evolutionary code for rapidly rotating stars. With our validated technique, we combine these age estimates and determine the age of the moving group to be 414 ± 23 Myr, which is consistent with, but much more precise than previous estimates

Dynamically Driven Evolution of the Interstellar Medium in M51

Massive star formation occurs in giant molecular clouds (GMCs); an understanding of the evolution of GMCs is a prerequisite to develop theories of star formation and galaxy evolution. We report the highest-fidelity observations of the grand-design spiral galaxy M51 in carbon monoxide (CO) emission, revealing the evolution of GMCs vis-a-vis the large-scale galactic structure and dynamics. The most massive GMCs (giant molecular associations (GMAs)) are first assembled and then broken up as the gas flow through the spiral arms. The GMAs and their H_2 molecules are not fully dissociated into atomic gas as predicted in stellar feedback scenarios, but are fragmented into smaller GMCs upon leaving the spiral arms. The remnants of GMAs are detected as the chains of GMCs that emerge from the spiral arms into interarm regions. The kinematic shear within the spiral arms is sufficient to unbind the GMAs against self-gravity. We conclude that the evolution of GMCs is driven by large-scale galactic dynamics—their coagulation into GMAs is due to spiral arm streaming motions upon entering the arms, followed by fragmentation due to shear as they leave the arms on the downstream side. In M51, the majority of the gas remains molecular from arm entry through the interarm region and into the next spiral arm passage

Parents' perception of self-advocacy of children with myositis: an anonymous online survey

<p>Abstract</p> <p>Background</p> <p>Children with complex medical issues experience barriers to the transition of care from pediatric to adult providers. We sought to identify these barriers by elucidating the experiences of patients with idiopathic inflammatory muscle disorders.</p> <p>Methods</p> <p>We collected anonymous survey data using an online website. Patients and their families were solicited from the US and Canada through established clinics for children with idiopathic inflammatory muscle diseases as well as with the aid of a nonprofit organization for the benefit of such individuals. The parents of 45 older children/young adults suffering from idiopathic inflammatory muscle diseases were surveyed. As a basis of comparison, we similarly collected data from the parents of 207 younger children with inflammatory muscle diseases. The survey assessed transition of care issues confronting families of children and young adults with chronic juvenile myositis.</p> <p>Results</p> <p>Regardless of age of the patient, respondents were unlikely to have a designated health care provider assigned to aid in transition of care and were unlikely to be aware of a posted policy concerning transition of care at their pediatrician's office. Additionally, regardless of age, patients and their families were unlikely to have a written plan for moving to adult care.</p> <p>Conclusions</p> <p>We identified deficiencies in the health care experiences of families as pertain to knowledge, self-advocacy, policy, and vocational readiness. Moreover, as children with complex medical issues grow up, parents attribute less self-advocacy to their children's level of independence.</p

Dynamically Driven Evolution of the Interstellar Medium in M51

We report the highest-fidelity observations of the spiral galaxy M51 in CO emission, revealing the evolution of giant molecular clouds (GMCs) vis-a-vis the large-scale galactic structure and dynamics. The most massive GMCs (so-called GMAs) are first assembled and then broken up as the gas flow through the spiral arms. The GMAs and their H2 molecules are not fully dissociated into atomic gas as predicted in stellar feedback scenarios, but are fragmented into smaller GMCs upon leaving the spiral arms. The remnants of GMAs are detected as the chains of GMCs that emerge from the spiral arms into interarm regions. The kinematic shear within the spiral arms is sufficient to unbind the GMAs against self-gravity. We conclude that the evolution of GMCs is driven by large-scale galactic dynamics --their coagulation into GMAs is due to spiral arm streaming motions upon entering the arms, followed by fragmentation due to shear as they leave the arms on the downstream side. In M51, the majority of the gas remains molecular from arm entry through the inter-arm region and into the next spiral arm passage.Comment: 6 pages, including 3 figures. Accepted, ApJ

Circumbinary Gas Accretion onto a Central Binary: Infrared Molecular Hydrogen Emission from GG Tau A

We present high spatial resolution maps of ro-vibrational molecular hydrogen emission from the environment of the GG Tau A binary component in the GG Tau quadruple system. The H2 v= 1-0 S(1) emission is spatially resolved and encompasses the inner binary, with emission detected at locations that should be dynamically cleared on several hundred-year timescales. Extensions of H2 gas emission are seen to ~100 AU distances from the central stars. The v = 2-1 S(1) emission at 2.24 microns is also detected at ~30 AU from the central stars, with a line ratio of 0.05 +/- 0.01 with respect to the v = 1-0 S(1) emission. Assuming gas in LTE, this ratio corresponds to an emission environment at ~1700 K. We estimate that this temperature is too high for quiescent gas heated by X-ray or UV emission from the central stars. Surprisingly, we find that the brightest region of H2 emission arises from a spatial location that is exactly coincident with a recently revealed dust "streamer" which seems to be transferring material from the outer circumbinary ring around GG Tau A into the inner region. As a result, we identify a new excitation mechanism for ro-vibrational H2 stimulation in the environment of young stars. The H2 in the GG Tau A system appears to be stimulated by mass accretion infall as material in the circumbinary ring accretes onto the system to replenish the inner circumstellar disks. We postulate that H2 stimulated by accretion infall could be present in other systems, particularly binaries and "transition disk" systems which have dust cleared gaps in their circumstellar environments.Comment: 18 pages, including 4 figures. Accepted for publication in Ap

Socialization, Adaptation, Transnationalism, and the Reproductive Behavior of Sub-Saharan African Migrants in France

Background:&nbsp; Migrants from Sub-Saharan Africa (SSA) move from a region with high fertility to regions with low fertility. Yet very few studies have examined the reproductive behavior of international migrants from SSA. Objective: This study examines the roles of origin and destination socialization on the fertility and fertility ideals of SSA migrants in France. The study draws on measures of assimilation to systematically examine the effects of socialization and adaptation as well as transnationalism for the effects of sustained origin ties.&nbsp; Methods: Data are from the TEO (“Trajectoires et Origines”) survey conducted in France (2008/2009). Logistic regression is used to examine current fertility (the odds of having a birth in the preceding five years), and Poisson regression is used to examine cumulative fertility (children ever born) and fertility ideals (reported ideal number of children in a family). Results: Controlling for sociodemographic factors, first-generation SSA migrants have higher fertility than second-generation SSA migrants and non-immigrants. But first and second-generation SSA migrants have higher fertility ideals than non-immigrants. Among SSA migrants, first and second-generation migrants do not differ in fertility and fertility ideals when adaptation is accounted for. Most measures of adaptation are negatively associated with actual fertility and fertility ideals. Transnationalism is associated with higher fertility ideals but less so with actual fertility. Conclusion: The study finds some evidence for origin socialization, but the findings are more strongly supportive of adaptation to the host society. Origin socialization appears to have a stronger influence on fertility ideals than actual fertility

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome