Coordinate Transition Research Articles

Programmes to support paediatric to adult healthcare transitions for youth with complex care needs and their families: A scoping review.

BackgroundAn increasing number of children have complex care needs (CCN) that impact their health and cause limitations in their lives. More of these youth are transitioning from paediatric to adult healthcare due to complex conditions being increasingly associated with survival into adulthood. Typically, the transition process is plagued by barriers, which can lead to adverse health consequences. There is an increased need for transitional care interventions when moving from paediatric to adult healthcare. To date, literature associated with this process for youth with CCN and their families has not been systematically examined.ObjectivesThe objective of this scoping review is to map the range of programmes in the literature that support youth with CCN and their families as they transition from paediatric to adult healthcare.MethodsThe review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews. A search, last run in April 2021, located published articles in PubMed, CINAHL, ERIC, PsycINFO and Social Work s databases.ResultsThe search yielded 1523 citations, of which 47 articles met the eligibility criteria. A summary of the article characteristics, programme characteristics and programme barriers and enablers is provided. Overall, articles reported on a variety of programmes that focused on supporting youth with various conditions, beginning in the early or late teenage years. Financial support and lack of training for care providers were the most common transition program barriers, whereas a dedicated transition coordinator, collaborative care, transition tools and interpersonal support were the most common enablers. The most common patient‐level outcome reported was satisfaction.DiscussionThis review consolidates available information about interventions designed to support youth with CCN transitioning from paediatric to adult healthcare. The results will help to inform further research, as well as transition policy and practice advancement.

Green technology innovations, urban innovation environment and CO2 emission reduction in China: Fresh evidence from a partially linear functional-coefficient panel model

• We use a partially linear function-coefficient model to explore the nonlinear moderating effect of the urban innovation environment on the impact of green technology innovation on carbon dioxide emissions. • There are heterogeneous impacts of green technology innovations on CO2 emissions in different periods and different types of cities. • Green technology innovation can reduce CO2 emissions indirectly through industrial structure upgrading. • Government fiscal expenditure cannot significantly impact the CO2 reduction effect of green technologies. • The effect of green technology innovations on CO2 emissions is only significant when the human capital level of a city has reached a certain level. Green technology innovations have a better carbon emission reduction effect in cities with higher human capital levels. Green technology innovations are deemed as effective channels through which economic growth and environmental governance are balanced. However, empirical research on the nexus between green technology innovations and CO 2 emissions, especially in developing countries, remains scant. Employing panel data on 264 prefecture-level cities from 2006 to 2017 in China, we explore the impact of the urban innovation environment on the effect of green technological innovations on CO 2 emissions. The empirical results indicate that green technology innovations have a heterogeneous impact in different types of cities. Meanwhile, green technological innovations can contribute to CO 2 emission mitigation after 2010, while the effect is not significant in Chinese cities before 2010. Secondly, green technology innovations can reduce CO 2 emissions indirectly through industrial structure upgrading. Thirdly, when the urban innovation environment is considered, government fiscal expenditure cannot significantly impact the marginal effect of green technologies. Meanwhile, the marginal mitigation effect of green technology innovations on CO 2 emissions is only significant when the human capital level of a city has reached a certain level. There is a better carbon emission reduction effect in cities with higher human capital levels. The results provide important enlightenment to realize the coordination and unity of economic transition to innovation-driven and green and low-carbon development.

Where to next? An exploration of patients with disability and complex needs who leave acute care hospitals via an interim discharge pathway.

Objective To examine the characteristics and circumstances of admitted patients with disability who require individualised supports to leave hospital and who experience interim discharge arrangements. Methods The study used a retrospective exploratory design. Medical chart reviews of patients with disability who required funded support to leave hospital were conducted. The records of 224 patients admitted to one of three hospital facilities in South-East Queensland, Australia, between May 2017 and January 2020 were reviewed. Information about hospital facility, demographic characteristics, disability type, support needs, discharge destination, and reasons for interim discharges were extracted for analysis. Results Forty of 224 patients were discharged to an interim destination. Inter-hospital transfers were the most common interim discharge arrangement. Being divorced or separated was the only demographic variable associated with having an interim discharge arrangement for admitted patients with disability. More patients with disability who experienced an interim discharge required accommodation supports and behavioural supports compared to patients who were not involved in interim discharges. Conclusions Patients with disability with minimal informal support and who rely on a sophisticated mix of individualised supports to leave hospital may be more susceptible to interim discharge arrangements. Early identification of these patients and formal mechanisms for ensuring continuous coordination of ongoing transitions and supports is critical to avoid sub-optimal outcomes. Future research is needed to capture a complete picture of the series of transitions of interim discharged patients with disability leaving acute care facilities and the quality of their supports and outcomes.

NAVIGATION PATHS AND URBANISM IN THE BASIN OF MEXICO BEFORE THE CONQUEST

AbstractThe island nature of the Aztec capital, Tenochtitlan, is an under-studied aspect in our understanding of this unique urban space, located in the Mexican highlands of Mesoamerica. The island location induces cross-links from aquatic and terrestrial paths to create connectivity and continuity within the lacustrine cultural landscape of the Basin of Mexico during the Postclassic period (a.d. 900–1521). Although Cortés described this city as the “Venice of the New World,” no specific and systematic investigation of facilities related to water transport has been carried out. In this article, I fill this gap through a study of navigation routes which were conceived to facilitate the continuous movement of people and goods through the numerous canals crisscrossing the Aztec capital, and which are identifiable by means of anthropic markers that respond to functional needs. Transition zones (piers, quays, shoreline areas), coordination zones (ports), and activity zones (customs facilities, warehouses, bridges, sacred sites) are all related to the practice of water transport and intimately related to terrestrial roads. I identify and locate these areas using a multidisciplinary methodology based on archaeological data, ethnohistorical testimonies, and pictographic and iconographic documents.

Improving the performance of first- and last-mile mobility services through transit coordination, real-time demand prediction, advanced reservations, and trip prioritization

Socio-demographic trends and recent economic development patterns have resulted in travel behavior changes that call for more flexible and accessible public transit options. Because flexible transit services vary in scope, size, and service type, new data-informed methods are useful to optimize services based on the specific needs of local communities and riders. In this study, real-world demand and vehicle trajectory data were used to evaluate and optimize system performance for an existing first-mile–last-mile (FMLM) service in Robinson Township, PA. A general FMLM model for arbitrary demand and service supply was then developed to quantify system performance—both travel time costs and day-to-day reliability—for various operational polices considering spatio-temporal demand variation and transportation network dynamics. Heuristics were used for optimal real-time vehicle routing in sizable real-world networks accommodating various service types and scopes. In this case study, total user costs were reduced by 18.6% when rides were coordinated with mainline fixed-route transit. Predictive routing strategies were shown to marginally improve system performance under sparse and variable spatio-temporal demand. The case study also highlights potentially large travel time and user reliability improvements—reductions of 51% and 53.8%, respectively—when trip requests were made in advance of their desired pickup time. Finally, we show that travel time reliability can be improved for time-inflexible trips with trip prioritization without increasing total user costs. These results were stable to changes in demand density.

The Temporal-Spatial Pattern and Coupling Coordination of the Green Transition of Farmland Use: Evidence from Hubei Province

The green transition of farmland use is a future trend in China’s modern agriculture and green development. However, its research framework, including its evaluation system, temporal-spatial distribution, and driving mechanisms, has not been established in the existent literature. With the 17 cities in Hubei Province as an example, we evaluated the green transition of farmland use and explore the characteristics and driving mechanisms of the temporal and spatial evolution from 2000–2019. The findings were as follows: First, the green transition of farmland use in Hubei Province is in infancy, but it has great potential. Second, the growth rate of the green transition of farmland use has noticeable regional differences in the east, central, and western areas of the province. Third, the three dimensions of spatial transition, functional transition, and model transition in the green transition of farmland use have significant spatial differences in coupling and coordination, and decoupling is becoming increasingly prominent. Based on the research findings, we put forward targeted countermeasures and suggestions.

Multidisciplinarity in Transition Pathways for Patients With Kidney Disease: The Current State of Play.

In the field of medical care, successful transition from pediatric-centered to adult-oriented healthcare can provide a sense of continuity in the development of youth, and prepare them to accept responsibility for and manage their own chronic kidney condition in complete autonomy. The so-called transition process requires the presence of some basic aspects: a multidisciplinary team, which acts as a bridge between child and adult services; a comprehensive clinical, cognitive, psychological, and social change for the young people; the involvement of family and caregivers. Within the framework of transition and chronicity during the developmental age, we selected international papers explaining models which agreed on some important steps in the transition process, although many differences can be observed between different countries. In fact, in Europe, the situation appears to be heterogeneous as regards certain aspects: the written transition plan, the educational programmes, the timing of transfer to adult services, the presence of a transition coordinator, a dedicated off-site transition clinic. We then analyzed some studies focusing on patients with renal diseases, including the first to contain a standardized protocol for transition which was launched recently in the USA, and which seems to have already achieved important positive, although limited, results. In Italy, the issue of transition is still in its infancy, however important efforts in the management of chronic kidney disease have already been initiated in some regions, including Emila Romagna, which gives us hope for the future of many young people.

Gastro-intestinal dysfunctions in Parkinson's disease (Review).

In patients with Parkinson's disease (PD), gastrointestinal dysfunction occurs from the early stages of the disease and even in the pre-motor phase. This condition can include the entire digestive tract, with symptoms ranging from delays in gastric emptying to dysphagia, constipation and even malnutrition. Excess saliva accumulates in the mouth due to the low frequency of swallowing. Dysphagia develops in about 50% of patients and may be a reflection of both central nervous system and enteric nervous system disorder. Gastroparesis can cause a variety of symptoms, including nausea, and also may be responsible for some of the motor fluctuations observed with levodopa therapy. Intestinal dysfunction in PD may be the result of both delayed colon transit and impaired anorectal muscle coordination. In addition, recent studies have demonstrated the role of Helicobacter pylori infection in the pathogenesis of diseases but also the occurrence of motor fluctuations by affecting the absorption of anti-parkinsonian medication. In this review, the main gastrointestinal dysfunctions associated with PD are presented.

Transition of Care Model for Pediatric Patients With Nonalcoholic Fatty Liver Disease.

Transition of Care Model for Pediatric Patients With Nonalcoholic Fatty Liver Disease.

Function and Evolution of Nuclear Receptors in Environmental-Dependent Postembryonic Development.

Nuclear receptors (NRs) fulfill key roles in the coordination of postembryonal developmental transitions in animal species. They control the metamorphosis and sexual maturation in virtually all animals and by that the two main environmental-dependent developmental decision points. Sexual maturation and metamorphosis are controlled by steroid receptors and thyroid receptors, respectively in vertebrates, while both processes are orchestrated by the ecdysone receptor (EcR) in insects. The regulation of these processes depends on environmental factors like nutrition, temperature, or photoperiods and by that NRs form evolutionary conserved mediators of phenotypic plasticity. While the mechanism of action for metamorphosis and sexual maturation are well studied in model organisms, the evolution of these systems is not entirely understood and requires further investigation. We here review the current knowledge of NR involvement in metamorphosis and sexual maturation across the animal tree of life with special attention to environmental integration and evolution of the signaling mechanism. Furthermore, we compare commonalities and differences of the different signaling systems. Finally, we identify key gaps in our knowledge of NR evolution, which, if sufficiently investigated, would lead to an importantly improved understanding of the evolution of complex signaling systems, the evolution of life history decision points, and, ultimately, speciation events in the metazoan kingdom.

Mechanisms of impact and experiences of a person-centred transition programme for adolescents with CHD: the Stepstones project

BackgroundDuring the past decade there has been some evaluation of transition programmes for adolescents with chronic conditions. However, this has rarely involved process evaluations focusing on mechanisms leading to outcomes, thus hampering implementation of these complex interventions. Our aim was to (I) describe adolescents’ and parents’ experiences of participating in a person-centred transition programme aiming to empower them in transition to adulthood and (II) explore the mechanisms of impact.MethodsA qualitative process evaluation was performed, embedded in a randomized controlled trial evaluating the effectiveness of a transition programme for adolescents with congenital heart disease in Sweden. A purposive sample of 14 adolescents and 12 parents randomized to the intervention group were interviewed after participation in the programme. Data were analysed deductively and inductively in NVivo v12.ResultsExperiences of participation in the transition programme were generally positive. Meeting a transition coordinator trained in person-centred care and adolescent health and embarking on an educational process based on the adolescents’ prerequisites in combination with peer support were considered key change mechanisms. However, support to parents were not sufficient for some participants, resulting in ambivalence about changing roles and the unmet needs of parents who required additional support.ConclusionsParticipants experienced increased empowerment in several dimensions of this construct, thus demonstrating that the transition programme was largely implemented as intended and the evidence-based behaviour-change techniques used proved effective in reaching the outcome. These findings can inform future implementation of transition programmes and illuminate challenges associated with delivering a complex intervention for adolescents with chronic conditions.

Overcoming Free-Energy Barriers with a Seamless Combination of a Biasing Force and a Collective Variable-Independent Boost Potential.

Amid collective-variable (CV)-based importance-sampling algorithms, a hybrid of the extended adaptive biasing force and the well-tempered metadynamics algorithms (WTM-eABF) has proven particularly cost-effective for exploring the rugged free-energy landscapes that underlie biological processes. However, as an inherently CV-based algorithm, this hybrid scheme does not explicitly accelerate sampling in the space orthogonal to the chosen CVs, thereby limiting its efficiency and accuracy, most notably in those cases where the slow degrees of freedom of the process at hand are not accounted for in the model transition coordinate. Here, inspired by Gaussian-accelerated molecular dynamics (GaMD), we introduce the same CV-independent harmonic boost potential into WTM-eABF, yielding a hybrid algorithm coined GaWTM-eABF. This algorithm leans on WTM-eABF to explore the transition coordinate with a GaMD-mollified potential and recovers the unbiased free-energy landscape through thermodynamic integration followed by proper reweighting. As illustrated in our numerical tests, GaWTM-eABF effectively overcomes the free-energy barriers in orthogonal space and correctly recovers the unbiased potential of mean force (PMF). Furthermore, applying both GaWTM-eABF and WTM-eABF to two biologically relevant processes, namely, the reversible folding of (i) deca-alanine and (ii) chignolin, our results indicate that GaWTM-eABF reduces the uncertainty in the PMF calculation and converges appreciably faster than WTM-eABF. Obviating the need of multiple-copy strategies, GaWTM-eABF is a robust, computationally efficient algorithm to surmount the free-energy barriers in orthogonal space and maps with utmost fidelity the free-energy landscape along selections of CVs. Moreover, our strategy that combines WTM-eABF with GaMD can be easily extended to other biasing-force algorithms.

Healthcare Utilisation and Satisfaction with Care in Patients with Amyotrophic Lateral Sclerosis - An Observational Study.

Background:Patients with amyotrophic lateral sclerosis (ALS) need a large amount of healthcare services. Knowledge on use of and satisfaction with healthcare is, however, scarce.Objective:The objectives were to explore use and satisfaction of healthcare in patients with ALS.Methods:The sample consisted of patients with ALS, recruited from the ALS clinic at the Karolinska University Hospital, Stockholm, Sweden, participating in a three-year observational study. Data on healthcare utilisation were retrieved from the computerised register at Region Stockholm, Sweden. Information regarding disability, contextual factors and satisfaction with care was collected by home visits.Results:Over time, half, or less of the patients used inpatient care, whereas all used outpatient care. Half of all outpatient contacts were with providers of advanced healthcare in the home and one-fifth with allied health professionals. Nurses performing home visits composed the largest proportion of outpatient contacts. A small amount of the utilised outpatient care emerged from the ALS clinic. Patients with severe disease and longer time since diagnosis had fewer contacts with the ALS clinic. Satisfaction with care was in general stable over time with around two-thirds or more of patients being satisfied. Most patients wanted to participate in care planning, but few had.Conclusion:Patients with ALS use hospital-based specialist care and other outpatient care in parallel with many healthcare providers involved. Our findings highlight the need for implementation of person-centred care to improve both coordination of care, care transitions and satisfaction with healthcare services.

Exploring antibiotics as ligands in metal–organic and hydrogen bonding frameworks: Our novel approach towards enhanced antimicrobial activity (mini-review)

Even though antibiotics were a major breakthrough a few decades ago, leading to a drastic reduction of deaths caused by infectious diseases, this class of compounds is nowadays demanding for a new approach as their efficiency has been challenged. Different approaches have been explored to increase the effectiveness of the antibiotics. The development of bio-inspired metal–organic frameworks and antibiotic coordination frameworks have been revealing promising results, showing that these novel forms of already existing antibiotics can tune their properties at the same time that may also increase their antimicrobial activity, maintaining their stability and cytotoxicity. Amongst other results, it is worth to highlight that: (i) the coordination of potassium to azelaic acid led to an increased activity against the Gram-positive bacteria Staphylococcus aureus and Staphylococcus epidermidis responsible for skin infections; (ii) the coordination of transition and alkali earth metals (Ca(II), Zn(II), Mn(II), and Mg(II)) to quinolone antibiotics (nalidixic and pipemidic acids) revealed increased activity against different Gram-positive and Gram-negative bacteria.

Impending Transition From Pediatric to Adult Health Services: A Qualitative Study of the Experiences of Adolescents With Eating Disorders and Their Caregivers.

Background: There is a dearth of research that identifies pediatric to adult health care transition practices that yield positive outcomes for young people with eating disorders (EDs). Further, adolescent and caregiver perspectives are poorly understood and underrepresented in the literature. The purpose of this study, focused on the impending transition from pediatric to adult health services, was twofold: (a) to identify adolescent and caregiver perspectives of barriers and facilitators of a successful transition for adolescents with EDs; and (b) to understand adolescent and caregiver suggestions of interventions for a successful transition.Design/Method: We recruited five adolescents with EDs who were about to be transferred out of pediatric care as well as their caregivers. We conducted a qualitative study in accordance with the principles of interpretive description. Through conducting semi-structured, in-depth interviews with adolescents and caregivers, we investigated their knowledge about health system transitions and anticipated experiences. We identified participants' perceptions of barriers and facilitators regarding a successful transition, as well as their recommendations to improve the transfer of care.Results: Participants possessed a limited understanding of transition processes despite the fact that they were about to be transferred to adult care. From our analyses, the following themes were identified as barriers during the transition process: re-explaining information to adult healthcare providers, lack of professional support while waiting for uptake into the adult health system, and late timing of transition of care discussions. Both adolescents and caregivers expressed that involvement of parents and the pediatric healthcare team helped to facilitate a successful transfer of care. In addition, participants expressed that the implementation of a Transition Coordinator and Transition Passport would be helpful in facilitating a seamless transfer between systems of care.Discussion: These findings demonstrate a significant gap in the system and highlight the importance of developing interventions that facilitate a successful transition. The themes that emerged from this study can inform the development of interventions to facilitate a coordinated transition from pediatric to adult health services for adolescents with EDs.

Defining Themselves: Transition Coordinators’ Conceptions of Their Roles in Schools

Transition coordinators are key players in the delivery of high-quality transition services, but little is known about how they interpret and enact their roles. This qualitative study examined how transition coordinators conceptualize their role and the factors that shape their effectiveness. Emergent themes revealed that transition coordinators broadly conceptualized their role as ambiguous, autonomous, evolving, and relational. They identified the responsibilities and initiatives they prioritized to drive structural and cultural change. Participants further identified relational and logistical factors that affected implementation of transition practices, highlighting the importance of buy-in from stakeholders. Clearly defined and well-supported roles may help transition coordinators leverage their specialized knowledge to ensure students with disabilities are prepared to pursue self-determined life goals.

Series of new coordination polymers based flexible tricarboxylate as photocatalysts for Rh B dye degradation

Four new transition coordination polymers (CPs), including [M(H2L)2] (CuII for 1, and CdII for 4) and [M(H2L)2(H2O)2] (CoII for 2 and NiII for 3) (H4L ​= ​2-(4-(3,5-dicarboxylphenoxy)phenyl) benzimidazole-5-carboylic acid) have been hydrothermally synthesized and structurally characterized. All the isophthalic acid ligands coordinate with M(II) to form 2D coordination layers in 1–4. The title compounds showed efficient photocatalytic performances to degrade rhodamine B (RhB) under UV irradiation. The percentage degradation of Rh B are 83.5%, 74.4%, 68.4% and 53.2% in presence of 1–4 as photocatalysts after 150 ​min of UV irradiation, respectively. The final degradation products were detected using LC–MS and the possible disassemble pathways for the degradation of dyes were suggested and listed.

Making care more patient centered; experiences of healthcare professionals and patients with multimorbidity in the primary care setting

BackgroundThe present study describes how primary care can be improved for patients with multimorbidity, based on the evaluation of a patient-centered care (PCC) improvement program designed to foster the eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, coordination of care, continuity and transition, emotional support, and family and friends). This study characterizes the interventions implemented in practice as part of the PCC improvement program and describes the experiences of healthcare professionals and patients with the resulting PCC delivery.MethodsThis study employed a mixed-methods design. Semi-structured interviews were conducted with nine general practitioners and nurse practitioners from seven primary care practices in Noord-Brabant, the Netherlands, that participated in the program (which included interventions and workshops). The qualitative interview data were examined using thematic analysis. A longitudinal survey was conducted with 138 patients with multimorbidity from these practices to assess perceived improvements in PCC and its underlying dimensions. Paired sample t tests were performed to compare survey responses obtained at a 1-year interval corresponding to program implementation.ResultsThe PCC improvement program is described, and themes necessary for PCC improvement according to healthcare professionals were generated [e.g. Aligning information to patients’ needs and backgrounds, adapting a coaching role]. PCC experiences of patients with multimorbidity improved significantly during the year in which the PCC interventions were implemented (t = 2.66, p = 0.005).ConclusionThis study revealed how primary PCC can be improved for patients with multimorbidity. It emphasizes the importance of investing in PCC improvement programs to tailor care delivery to heterogenous patients with multimorbidity with diverse care needs. This study generates new perspectives on care delivery and highlights opportunities for its improvement according to the eight dimensions of PCC for patients with multimorbidity in a primary care setting.

Intercellular bridges coordinate the transition from pluripotency to meiosis in mouse fetal oocytes.

Meiosis is critical to generating oocytes and ensuring female fertility; however, the mechanisms regulating the switch from mitotic primordial germ cells to meiotic germ cells are poorly understood. Here, we implicate intercellular bridges (ICBs) in this state transition. We used three-dimensional in toto imaging to map meiotic initiation in the mouse fetal ovary and revealed a radial geometry of this transition that precedes the established anterior-posterior wave. Our studies reveal that appropriate timing of meiotic entry across the ovary and coordination of mitotic-meiotic transition within a cyst depend on the ICB component Tex14, which we show is required for functional cytoplasmic sharing. We find that Tex14 mutants more rapidly attenuate the pluripotency transcript Dppa3 upon meiotic initiation, and Dppa3 mutants undergo premature meiosis similar to Tex14 Together, these results lead to a model that ICBs coordinate and buffer the transition from pluripotency to meiosis through dilution of regulatory factors.

Needs and Experiences of Adolescents with Congenital Heart Disease and Parents in the Transitional Process: A Qualitative Study

Purpose: Most patients with congenital heart disease (CHD) need lifelong cardiac follow-up. Transitioning to adulthood and transferring to adult-focused care are often challenging. We explored the experiences and needs of adolescents with CHD and parents during the entire transitional process, including the post-transfer period.Design and methods: We performed a qualitative study according to the phenomenological approach, focusing on adolescents with CHD and parents. Semi-structured interviews were carried out with patients (n = 9) and parents (n = 12) after being transferred to adult care facilities. Data were analyzed with inductive thematic analysis. Data collection and -analysis of both samples were done separately in a first step, after which results were merged to discover common themes.Results: Five common themes were identified: 1) Having mixed feelings about leaving pediatric care; 2) Being prepared and informed; 3) Shifting responsibilities and roles; 4) Being accompanied during consultations; and 5) Gaining trust in new healthcare providers.Conclusion: Adolescents with CHD and parents express a need for adequate preparation and personalized guidance to reduce anxiety and uncertainty during transition. The process may benefit from focusing on improving the adolescents´ transitional skills and disease-related knowledge, which may, in turn, facilitate handing over responsibilities and adapting to new roles by the parents. Adolescents appreciate the presence of parents during the consultation, albeit with reduced input. Finally, a transition coordinator and a joint transfer consultation involving the pediatric cardiologist seem paramount for a fluent transitional process, especially in establishing new treatment relationships.