Decision-making with children, young people, and parents

The origin and importance of support in decision-making in paediatric palliative care (PPC) is rooted in its primary goal: to reduce suffering and maintain and even improve the quality of life of seriously ill children and their families. Decisions take place throughout the trajectory of a child’s illness and many are straight forward and barely noticed. However, often at pivotal points such as changes in treatment plans and the focus of care, the outcomes of the decisions assume much more importance and how they are made becomes a significant task for the family and clinicians involved

'I have to live with the decisions I make': laying a foundation for decision making for children with life-limiting conditions and life-threatening illnesses.

The relationship between parents and clinician is critical to the care and treatment of children with life-limiting conditions (LLCs) and life-threatening illnesses (LTIs). This relationship is built and maintained largely in consultations. In this article we lay out factors that bear on the success of clinical consultations and the maintenance of the essential clinician-parent relationship at progression or deterioration of LLCs or LTIs. We suggest an approach to engaging parents in conversations about care and treatment that recognises and appreciates the dilemmas which clinicians and parents face and in so doing provides a way for everyone to live with the decisions that are made. A close analysis of a consultation at progression and excerpts of encounters among parents, clinician and researcher are used to illustrate our approach to research, analysis and development of recommendations for clinical practice

Current understanding of decision-making in adolescents with cancer: A narrative systematic review

BACKGROUND: Policy guidance and bioethical literature urge the involvement of adolescents in decisions about their healthcare. It is uncertain how roles and expectations of adolescents, parents and healthcare professionals influence decision-making and to what extent this is considered in guidance. AIMS: To identify recent empirical research on decision-making regarding care and treatment in adolescent cancer: (1) to synthesise evidence to define the role of adolescents, parents and healthcare professionals in the decision-making process and (2) to identify gaps in research. DESIGN: A narrative systematic review of qualitative, quantitative and mixed-methods research. We adopted a textual approach to synthesis, using a theoretical framework of interactionism to interpret findings. DATA SOURCES: The databases MEDLINE, PsycINFO, SCOPUS, EMBASE and CINHAL were searched from 2001 through May 2015 for publications on decision-making for adolescents (13-19 years) with cancer. RESULTS: Twenty-eight articles were identified. Adolescents and parents initially find it difficult to participate in decision-making due to a lack of options in the face of protocol-driven care. Parent and adolescent preferences for information and response to loss of control vary between individuals and over time. No studies indicate parental or adolescent preference for a high degree of independence in decision-making. CONCLUSION: Striving to make parents and adolescents fully informed or urge them towards more independence than they prefer may add to distress and confusion. This may interfere with their ability to participate in their preferred way in decisions about care and treatment. Future research should include analysis of on-ground interactions among parents, adolescents and clinicians across the trajectory

Children's views of death

Death is very much a part of the everyday thoughts of children. It is part of the games they play, the stories they hear, and the videos they watch. Sadly, for some children it is also part of their everyday lives—their lived experience in the face of a life-threatening illness, war, violence, or natural disaster. Starting from the position that a child is a sentient, social, emotional, spiritual being embodied in a biological organism we look at how children’s views develop, and how they are manifest in art, play, and conversations with family, friends, and professionals. We see children as active agents in their worlds—interpreting the behaviour of others and acting on the basis of those interpretations. Children see, sense, and notice, and correspondingly, register and make inferences from what they observe inside and outside of themselves. We attend not only to age and stage of development, but also to the dynamic relationship between age, stage, and experience as they come to bear on the children and their worlds at given points in time. Working from this perspective we explore children’s views of death and dying in a variety of situations, from a variety of perspectives—cognitive, cultural, social, and emotional—as a first step in developing guidance for talking with children who are themselves ill and dying, and their siblings. We address three questions and offers suggestions for talking with ill children and their siblings about death: 1. What do children know and understand about death and dying? / 2. Where do children’s ideas about death and dying come from? / 3. How should we address their questions and concerns on this most fundamental question of human existence? The chapter draws on an extensive review of the literature on well and ill children’s views of death as well as the co-authors’ ethnographically based research with ill children, their parents, siblings, and clinicians involved in their care and treatment; highlighting the social nature of death and dyin

Abrupt transition in quasiparticle dynamics at optimal doping in a cuprate superconductor system

We report time-resolved measurements of the photoinduced change in reflectivity, Delta R, in the Bi2Sr2Ca(1-y)Dy(y)Cu2O(8+delta) (BSCCO) system of cuprate superconductors as a function of hole concentration. We find that the kinetics of quasiparticle decay and the sign of Delta R both change abruptly where the superconducting transition temperature Tc is maximal. These coincident changes suggest that a sharp transition in quasiparticle dynamics takes place precisely at optimal doping in the BSCCO system.Comment: 10 pages, 4 figure

Parallel Exhaustive Search without Coordination

We analyze parallel algorithms in the context of exhaustive search over totally ordered sets. Imagine an infinite list of "boxes", with a "treasure" hidden in one of them, where the boxes' order reflects the importance of finding the treasure in a given box. At each time step, a search protocol executed by a searcher has the ability to peek into one box, and see whether the treasure is present or not. By equally dividing the workload between them, $k$ searchers can find the treasure $k$ times faster than one searcher. However, this straightforward strategy is very sensitive to failures (e.g., crashes of processors), and overcoming this issue seems to require a large amount of communication. We therefore address the question of designing parallel search algorithms maximizing their speed-up and maintaining high levels of robustness, while minimizing the amount of resources for coordination. Based on the observation that algorithms that avoid communication are inherently robust, we analyze the best running time performance of non-coordinating algorithms. Specifically, we devise non-coordinating algorithms that achieve a speed-up of $9/8$ for two searchers, a speed-up of $4/3$ for three searchers, and in general, a speed-up of $\frac{k}{4}(1+1/k)^2$ for any $k\geq 1$ searchers. Thus, asymptotically, the speed-up is only four times worse compared to the case of full-coordination, and our algorithms are surprisingly simple and hence applicable. Moreover, these bounds are tight in a strong sense as no non-coordinating search algorithm can achieve better speed-ups. Overall, we highlight that, in faulty contexts in which coordination between the searchers is technically difficult to implement, intrusive with respect to privacy, and/or costly in term of resources, it might well be worth giving up on coordination, and simply run our non-coordinating exhaustive search algorithms

Thermal conductance of thin film YIG determined using Bayesian statistics

Thin film YIG (Y$_3$Fe$_5$O$_{12}$) is a prototypical material for experiments on thermally generated pure spin currents and the spin Seebeck effect. The 3-omega method is an established technique to measure the cross-plane thermal conductance of thin films, but can not be used in YIG/GGG (Ga$_3$Gd$_5$O$_{12}$) systems in its standard form. We use two-dimensional modeling of heat transport and introduce a technique based on Bayesian statistics to evaluate measurement data taken from the 3-omega method. Our analysis method allows us to study materials systems that have not been accessible with the conventionally used 3-omega analysis. Temperature dependent thermal conductance data of thin film YIG are of major importance for experiments in the field of spin-caloritronics. Here we show data between room temperature and 10 K for films covering a wide thickness range as well as the magnetic field effect on the thermal conductance between 10 K and 50 K

The heliospheric modulation of cosmic ray protons during increased solar activity: effects of the position of the solar wind termination shock and of the heliopause

International audienceThe effects on the modulation of cosmic ray protons of different positions for the solar wind termination shock and for the heliopause are illustrated for moderate solar maximum conditions. This is done with a numerical model which includes diffusive termination shock acceleration, a heliosheath and drifts. The modulation is computed for the heliospheric equatorial plane and at 35° heliolatitude and for both magnetic polarity cycles of the Sun. It was found that the differences between the modulation for the two solar polarity cycles are less significant at a heliolatitude of 35° than in the equatorial plane. The modulation for the different heliopause positions are qualitatively similar, although there are clear quantitative differences which should be observable with the two Voyager spacecraft in the outer heliosphere. It is illustrated that the motion of the termination shock from 90 AU to 100 AU, with the heliopause fixed at 120 AU, is not crucially important to global modulation. What is of primary importance is the location of the heliopause. It can also be concluded from the results that significant asymmetric modulation is to be expected between the up-wind and down-wind directions of the heliosphere but this may become measureable only when spacecraft move beyond the termination shock into the heliosheath. Keywords. Interplanetary physics (Cosmic rays; Heliopause and solar wind termination) ? Space plasma physics (Transport processes