Longitudinal Transition Research Articles

Learning in Practice: A Valuation of Context in Time-Variable Medical Training.

The logical consequence of implementing competency-based education is moving to time-variable training. Competency-based, time-variable training (CBTVT) requires an understanding of how learners interact with their learning context and how that leads to competence. In this article, the authors discuss this relationship. They first explain that the time required to achieve competence in clinical practice depends on the availability of clinical experiences that are conducive to ongoing competence development. This requires both curricular flexibility in light of the differences in individual learners' development and a balance between longitudinal placements and transitions to different environments.Along with the deliberate use of the opportunities that learning environments offer, there is value for learners in spending ample time-in-context. For instance, guided independence is possible when trainees do not progress immediately after meeting curricular learning objectives. Next, the potential implications of CBTVT can be illustrated by two learning perspectives-Sfard's acquisition and participation metaphors-which leads to the assertion that competence is both an individual characteristic and a quality that emerges from a purposeful social interaction between individuals and their context. This theory recognizes that the deliberate use of context could be used to approach learning as acquiring collective competence.Based on this relationship between learner, context, and competence, the authors propose an approach to CBTVT that recognizes that all learners will have to meet a number of standard preset learning targets in their workplace, while still having room for further context-specific competence development and personal growth within strategically organized learning environments.

An Approach to Using Orientation and Mobility (O&M) Variables from the Second National Longitudinal Transition Study

An Approach to Using Orientation and Mobility (O&M) Variables from the Second National Longitudinal Transition Study

Assessing public transit service equity using route-level accessibility measures and public data

The benefits and burdens of public transit service changes can be quantified using many different metrics. In the United States, the Federal Transit Administration requires transit agencies to assess the equity of proposed service changes using the demographic shares of affected riders. The purpose of the work presented here is to inform the development of more robust transit equity analyses than are currently conducted by integrating measures of accessibility – the ease with destinations can be reached – into FTA-required analyses. The measures are calculated using publicly available data, including the US Census Bureau's Longitudinal Employer-Household Dynamics dataset and transit route and schedule information in the General Transit Feed Specification (GTFS) format. The results demonstrate that relying on a single measure (e.g. population shares or accessibility) to associate a route with a particular demographic group is likely to be deficient. Previous academic work on accessibility has not translated well to practice in part because the calculation of accessibility relied upon regional travel demand model outputs that were difficult to obtain. This work thus fills an important gap in the literature and practice by tying advances in the academic literature to FTA-mandated analysis with publicly available data.

Predicting College Completion Among Students With Learning Disabilities

The authors analyzed National Longitudinal Transition Study–2 (NLTS2) data to examine the role of high school academic preparation and receipt of postsecondary academic support services (PASS) in predicting college completion among students with learning disabilities. Logistic regression analyses revealed that students who earned a 3.0 grade point average (GPA) in a college preparatory curriculum were more than twice as likely to complete college than those with a similar GPA who did not complete a college preparatory curriculum. Furthermore, among students who completed a college preparatory curriculum, earning a higher GPA and accessing PASS both dramatically increased the likelihood that they would complete college. Results underscore the importance of incorporating a college preparatory curriculum into transition planning for college-bound students with learning disabilities.

P628 Transfer of care of adolescent IBD patients without longitudinal transition: Lesson from 10-year experiences

P628 Transfer of care of adolescent IBD patients without longitudinal transition: Lesson from 10-year experiences

Within-host evolution of Enterococcus faecium during longitudinal carriage and transition to bloodstream infection in immunocompromised patients

BackgroundEnterococcus faecium is a leading cause of hospital-acquired infection, particularly in the immunocompromised. Here, we use whole genome sequencing of E. faecium to study within-host evolution and the transition from gut carriage to invasive disease.MethodsWe isolated and sequenced 180 E. faecium from four immunocompromised patients who developed bloodstream infection during longitudinal surveillance of E. faecium in stool and their immediate environment.ResultsA phylogenetic tree based on single nucleotide polymorphisms (SNPs) in the core genome of the 180 isolates demonstrated several distinct clones. This was highly concordant with the population structure inferred by Bayesian methods, which contained four main BAPS (Bayesian Analysis of Population Structure) groups. The majority of isolates from each patient resided in a single group, but all four patients also carried minority populations in stool from multiple phylogenetic groups. Bloodstream isolates from each case belonged to a single BAPS group, which differed in all four patients. Analysis of 87 isolates (56 from blood) belonging to a single BAPS group that were cultured from the same patient over 54 days identified 30 SNPs in the core genome (nine intergenic, 13 non-synonymous, eight synonymous), and 250 accessory genes that were variably present. Comparison of these genetic variants in blood isolates versus those from stool or environment did not identify any variants associated with bloodstream infection. The substitution rate for these isolates was estimated to be 128 (95% confidence interval 79.82 181.77) mutations per genome per year, more than ten times higher than previous estimates for E. faecium. Within-patient variation in vancomycin resistance associated with vanA was common and could be explained by plasmid loss, or less often by transposon loss.ConclusionsThese findings demonstrate the diversity of E. faecium carriage by individual patients and significant within-host diversity of E. faecium, but do not provide evidence for adaptive genetic variation associated with invasion.

Desistance and Severity of Alcohol Use Disorder: A Lifespan-Developmental Investigation.

Key to an understanding of alcohol use disorder (AUD) are the drinking-related reductions that begin in young adulthood and continue throughout the adult lifespan. Research is needed to precisely characterize the form of these reductions, including possible developmental differences across the lifespan. Using U.S.-representative data, we estimated multiple-group Markov models characterizing longitudinal transitions among five drinking statuses and differences in transition patterns across six adult age periods. While past research indicates relative developmental stability in overall AUD-desistance rates, we found far higher rates of Severe-AUD desistance in young adulthood relative to later ages. Especially considering the dramatic change reflected by Severe-AUD desistance (from 6+ symptoms to 0-1 symptoms), this result indicates a substantial developmental shift, with Severe-AUD-desistance rates peaking at 43-50% across ages 25-34 and then dropping to 22-24% across ages 35-55. We discuss implications regarding practical significance of young-adult "maturing out" and predictions regarding lifespan variability in desistance mechanisms.

In-School Predictors of Postschool Employment for Youth Who Are Deaf-Blind

Youth with deaf-blindness have difficulty transitioning to adulthood and experience poor employment outcomes, yet research on this population is limited. To identify predictors of postschool employment outcomes for transition-age youth who are deaf-blind, we conducted multiple logistic regression analyses using data from Waves 1 through 5 of the National Longitudinal Transition Study–2. Significant predictors of postschool employment were paid high school work experiences and parent expectations. Significant predictors of continuous employment were number of additional disabilities, vocational education services, and parent expectations. Implications for practice include educating parents about employment options early in youths’ lives, encouraging youth to obtain early work experiences, and ensuring that youth have access to vocational education services.

Multisector Involvement Among Adolescents With Disabilities

When youth experience psychosocial difficulties, multiple sectors of care may intervene. The present study examined the prevalence and sociodemographic predictors of multisector involvement related to psychosocial difficulties among adolescents with disabilities. Using a nationally representative sample of 9,230 students who participated in the National Longitudinal Transition Study–2, we estimated students’ rates of involvement in school, health, social service, and juvenile justice sectors and used logistic regression models to ascertain the relations to student characteristics. Students with disabilities were frequently involved with a variety of sectors of care, but schools remain the primary provider. Multisector involvement was commonplace, particularly for adolescents with emotional disturbance or autism. Disability and insurance type consistently predicted involvement of each sector, but other sociodemographic characteristics commonly related to disparities in involvement were not significant in most of our models. Communication and collaboration across systems can support the school-based problem solving and individualized planning for students with disabilities.

Developmental problems in adolescence: A person-centered analysis across time and domains

This longitudinal study investigated patterns of developmental problems across depression, aggression, and academic achievement during adolescence, using two measurement points two years apart (N=1665; age T1: M=13.14; female=49.6%). Latent Profile Analyses and Latent Transition Analyses yielded four main findings: A three-type solution provided the best fit to the data: an asymptomatic type (i.e., low problem scores in all three domains), a depressed type (i.e., high scores in depression), an aggressive type (i.e., high scores in aggression). Profile types were invariant over the two data waves but differed between girls and boys, revealing gender-specific patterns of comorbidity. Stabilities over time were high for the asymptomatic type and for types that represented problems in one domain, but moderate for comorbid types. Differences in demographic variables (i.e., age, socio-economic status) and individual characteristics (i.e., self-esteem, dysfunctional cognitions, cognitive capabilities) predicted profile type memberships and longitudinal transitions between types.

Vascular Access Placement Order and Outcomes in Hemodialysis Patients: A Longitudinal Study

Background: Arteriovenous accesses (AVA) in patients performing hemodialysis (HD) are labeled “permanent” for AV fistulas (AVF) or grafts (AVG) and “temporary” for tunneled central venous catheters (TCVC). Durability and outcomes of permanent vascular accesses based on the sequence in which they were placed or used receives little attention. This study analyzed longitudinal transitions between TCVC-based and AVA-based HD outcomes according to the order of placement. Methods: All 391 patients initiating chronic HD via a TCVC between 2012 and 2013 at 12 outpatient academic dialysis units were included in this study. Chronological distributions of HD vascular accesses were recorded over a mean (SD) of 2.8 (0.9) years and sequentially grouped into periods for TCVC-delivered and AVA-delivered (AVF or AVG) HD. Primary AVA failure and cumulative access survival were evaluated based on access placement sequence and type, adjusting for age. Results: In total, 92.3% (361/391) of patients underwent 497 AVA placement surgeries. Analyzing the initial 3 surgeries, primary AVF failure rates increased with each successive fistula placement (p = 0.008). Among the 82.9% (324/391) of TCVC patients successfully converted to an AVA, 30.9% returned to a TCVC, followed by a 58.0% conversion rate to another AVA. Annual per-patient vascular access transition rates were 2.02 (0.09) HD periods using a TCVC and 0.54 (0.03) HD periods using an AVA. Comparing the first AVA used with the second, cumulative access survivals were 701.0 (370.0) vs. 426.5 (275.0) days, respectively. Excluding those never converting to an AVF or AVG, 169 (52.2%) subsequently converted from a TCVC to a permanent access and received HD via AVA for ≥80% of treatments. Conclusions: HD vascular access outcomes differ based on the sequence of placement. In spite of frequent AVA placements, only half of patients effectively achieved a “permanent” vascular access and used an AVA for the majority of HD treatments.

Finding time over time: Longitudinal links between employed mothers' work-family conflict and time profiles.

Drawing upon the Work-Home Resources model (ten Brummelhuis & Bakker, 2012), this study examined the links between work-family conflict and employed mothers' profiles of time resources for work and parenting roles. Using a person-centered latent profile approach, we identified 3 profiles of time use and perceived time adequacy in a sample of mothers employed in the extended-care industry (N = 440): a Work-Oriented profile, characterized by spending relatively more time at work, perceiving lower time adequacy for work, spending less time with children, and perceiving lower time adequacy for children; a Parenting-Oriented profile, characterized by the opposite pattern; and a Role-Balanced profile, characterized by average levels across the 4 dimensions. Mothers in the Work-Oriented profile reported greater work-to-family conflict and family to-work conflict than those in the Role-Balanced and Parenting-Oriented profiles. Greater work-to-family conflict was linked to membership in the Work-Oriented profile, net of personal, family, and work characteristics. Longitudinal latent profile transition analysis showed that increases in work-to-family conflict across 12 months were linked to greater odds of moving toward the Work-Oriented profile (relative to staying in the same profile), whereas decreases in work-to-family conflict were linked to greater odds of moving toward the Parenting-Oriented profile. Results illuminate the heterogeneity in how employed mothers perceive and allocate time in work and parenting roles and suggest that decreasing work-to-family conflict may preserve time resources for parenting. Intervention efforts should address ways of increasing employees' family time resources and decreasing work-family conflict. (PsycINFO Database Record

Tensile behavior of tailor rolled blanks with longitudinal thickness transition zone: Introducing a new tensile specimen

In this study, a new design for tensile specimens made from tailor rolled blanks (TRB) with longitudinal thickness transition zone (TTZ) has been proposed. To this end, an additional lateral wedge angle is introduced to obtain a uniform stress field along the gauge length, which enables one to study the tailored properties of TRBs via stress-strain curves without considering the effects of geometrical inhomogeneities. Parallel finite element simulations were carried out to study the stress and strain fields resulted from different geometries of tensile specimens. The results were then used to obtain stress triaxiality factors to analyze the deformation prior to failure. In addition, a mathematical model was developed to study the contribution of different parts of TTZ to the total deformation. The results of uniaxial tension test along with results of simulation revealed that the deformation is controlled by the side with lower load-bearing ability in the new-developed tensile specimen. Furthermore, it was concluded that the conventional tensile specimens are more appropriate to study the effect of thickness changes on the elongation of TRBs. However, the presented tensile specimens can be used to study the strength of TRBs. Finally, the fracture mechanisms were investigated utilizing SEM and optical observations.

Predictors of Risky Behavior and Offending for Adolescents With Mild Intellectual Disability

Adolescents with intellectual disability (ID) engage in risky behavior and offending. However, little is known on the impact school-related predictors have on engagement in risky behaviors for adolescents with ID. This study analyzed secondary data from the National Longitudinal Transition Study-2 (NLTS2) to determine levels of engagement in risky behaviors and offending for adolescents with mild and moderate/severe ID. School-related predictors of engagement for adolescents with mild ID were also explored. Results indicated adolescents with mild ID engage in risky behaviors and offending at significantly higher rates as compared to adolescents with moderate/severe ID. Participation in a social skills or life skills class was a significant predictor of less engagement in risky behaviors for individuals with mild ID.

Study of the Optical Properties of Barium Selenide Crystals. II. Elementary Transition Bands and Their Fundamental Parameters

The spectral dependences of the imaginary parts of the dielectric permittivity e2(E), bulk (–Im e–1) and surface (–Im (1 + e)–1) characteristic electron energy losses for a barium selenide crystal are decomposed into 34 elementary bands in the 3–5.5 eV region at 2 K and in the 5.5–26 eV region at 77 K by an improved combined Argand diagram method. For each band in the three types of spectra, we determined the energy maxima Ei, the half-widths Hi, the amplitudes Ii, the areas Si, and the oscillator strengths fi. The parameter fi is calculated using a modification of the familiar formula for the effective number of valence electrons neff (E). We have established the main features of the 34 elementary bands of barium selenide in the 3–26 eV region, due to excitons and transverse and longitudinal interband transitions.

Compound channel flow with a longitudinal transition in hydraulic roughness over the floodplains

Flows in a compound open-channel (two-stage geometry with a main channel and adjacent floodplains) with a longitudinal transition in roughness over the floodplains are experimentally investigated in an 18 m long and 3 m wide flume. Transitions from submerged dense vegetation (meadow) to emergent rigid vegetation (wood) and vice versa are modelled using plastic grass and vertical wooden cylinders. For a given roughness transition, the upstream discharge distribution between main channel and floodplain (called subsections) is also varied, keeping the total flow rate constant. The flows with a roughness transition are compared to flows with a uniformly distributed roughness over the whole length of the flume. Besides the influence of the downstream boundary condition, the longitudinal profiles of water depth are controlled by the upstream discharge distribution. The latter also strongly influences the magnitude of the lateral net mass exchanges between subsections, especially upstream from the roughness transition. Irrespective of flow conditions, the inflection point in the mean velocity profile across the mixing layer is always observed at the interface between subsections. The longitudinal velocity at the main channel/floodplain interface, denoted $$U_{int}$$ , appeared to be a key parameter for characterising the flows. First, the mean velocity profiles across the mixing layer, normalised using $$U_{int}$$ , are superimposed irrespective of downstream position, flow depth, floodplain roughness type and lateral mass transfers. However, the profiles of turbulence quantities do not coincide, indicating that the flows are not fully self-similar and that the eddy viscosity assumption is not valid in this case. Second, the depth-averaged turbulent intensities and Reynolds stresses, when scaled by the depth-averaged velocity $$U_{d,int}$$ exhibit two plateau values, each related to a roughness type, meadow or wood. Lastly, the same results hold when scaling by $$U_{d,int}$$ the depth-averaged lateral flux of momentum due to secondary currents. Turbulence production and magnitude of secondary currents are increased by the presence of emergent rigid elements over the floodplains. The autocorrelation functions show that the length of the coherent structures scales with the mixing layer width for all flow cases. It is suggested that coherent structures tend to a state where the magnitude of velocity fluctuations (of both horizontal vortices and secondary currents) and the spatial extension of the structures are in equilibrium.

Characteristics of Students Receiving Occupational Therapy Services in Transition and Factors Related to Postsecondary Success.

This study had a twofold purpose: (1) identify the characteristics of people with disabilities who received occupational therapy services during their transition to adulthood and (2) determine factors associated with their successful postsecondary transition. This study was a secondary analysis of National Longitudinal Transition Study-2 data. Data analyses include descriptive statistics, binary logistic regression, and simple linear regression. Autism, cerebral palsy, and intellectual disability were the most commonly reported disability classifications. Participation in postsecondary education was significantly associated with functional use of arms and hands. Postsecondary employment was significantly associated with verbal comprehension. Participation in community activities was significantly related to students' health status, and participation in community service was significantly related to students' functional use of arms and hands. Providing transition services to students with disabilities remains an emerging area of practice. Occupational therapy practitioners may contribute to transition teams by intervening to improve functional abilities and health status.

Developmental dynamics between young adults’ life satisfaction and engagement with studies and work

The present five-wave longitudinal study investigated the cross-lagged associations between young adults’ life satisfaction and study/work engagement over the transition from post-comprehensive studies to higher education or work during the second and third decades of life. Gender, educational track, academic performance and family socioeconomic status were also examined. The study is part of the longitudinal Finnish Educational Transitions (FinEdu) study, and used data from secondary education onwards, following 821 participants from age 17 to 25. The developmental dynamics showed that, in particular, young adults’ life satisfaction predicted their study/work engagement both during their post-comprehensive education and after the transition to higher education or work. Moreover, study/work engagement positively predicted young adults’ life satisfaction during their third decade of life. In addition, high initial life satisfaction was more typical among males. However, no differences related to gender or academic track were observed in the developmental dynamics of life satisfaction and study/work engagement. These results suggested that general wellbeing spills over to study/work domain-specific characteristics of wellbeing and promotes positive personal development and adjustment to study/work transitions during the third decade of life.

Longitudinal transition trajectory of gouty arthritis and its comorbidities: a population-based study.

The aim of the study was to investigate the longitudinal transition trajectory of gout and its comorbidities in male patients with gout in different age groups. A total of 3973 male patients who received a new diagnosis of gouty arthritis were identified from the Taiwan Longitudinal Health Insurance Database and divided into two age cohorts (<50 and ≥50years). Each patient was individually followed from 2000 to 2009 to identify associated comorbidities, namely hypertension, hypercholesterolemia, diabetes mellitus, cardiovascular diseases, and chronic kidney disease. Two outcome measurements of stroke and all-cause cancer were further identified until 2010. The transition trajectory was divided into the following five phenotype groups: persistent hypertension combined with a high prevalence of various gout-related comorbidities, persistent hypercholesterolemia combined with a moderate prevalence of various gout-related comorbidities, persistent low prevalence of various gout-related comorbidities, moderate to high prevalence of various gout-related comorbidities, and low to high prevalence of various gout-related comorbidities. Although the younger and older patients had a similar longitudinal transition trajectory of gout-related comorbidities, the older patients had a higher 10-year likelihood of transition from a low or moderate to a high prevalence of various gout-related comorbidities. In addition, the incidences of stroke and all-cause cancer were higher in the groups with high and moderate to high prevalences of various gout-related comorbidities than in the other groups. The occurrence of gouty arthritis in different life stages can cause cluster effects involving varying degrees of comorbidities over time. The findings of the current study can provide additional knowledge and increase clinical awareness regarding the early assessment and management of gout-related comorbidities in clinical practice.

An Examination of the Relationship Between Postschool Outcomes and Autonomy, Psychological Empowerment, and Self-Realization

This study examined, using data from the National Longitudinal Transition Study–2, the impact of constructs associated with self-determination (i.e., autonomy, self-realization, and psychological empowerment measured while youth were in secondary school) on postschool—(a) employment and payment/benefits, (b) education, (c) independent living, and (d) social engagement—outcomes. Findings suggest that up to 8 years after youth exited school, autonomy, self-realization, and psychological empowerment predict postschool outcomes. Psychological empowerment showed a strong relationship with employment wages and benefits, and autonomy and self-realization contributed to predicting independent living and postsecondary education enrollment. Implications for future research and practice are discussed.