Time Of Transition Research Articles

O protagonismo docente no espaço-tempo da transição democrática das décadas de 1970-80, no Brasil e em Portugal

The article revisits and updates questions that guided research that analyzed the repertoires of action adopted by teachers in the face of democratic construction processes that reached their peak in the 1970s, in Brazil and Portugal (Xavier,2013). Its central objective is to analyze the identity negotiations (Dubar, 2005) that permeated the political protagonism exercised by teachers in the actions and associations created in the influx of these movements. In the first topic, it locates the teaching movements in the space and time of the democratic transition and presents the questions that guided the writing of this article. In the second topic, it analyzes printed sources such as the mass circulation newspapers in Rio de Janeiro and the “O Professor” Magazine, with a view to observing the dissonant views regarding the establishment of an image of the teachers who participated in these movements. The third topic takes a statement relating to the experience of self-management lived in aPortuguese secondary school and highlights its reverberations in the interviewee's professional self-perception. In the final considerations, a brief reflection is developed on the disputes over the control of teaching identities and also on possible developments of this study. As a result of the analysis developed, it was possible to perceive the constitution of an engaged and autonomous teaching identity, through the analysis of the Magazine "O Professor". In turn, the mass circulation newspapers in Rio de Janeiro expressed the perspective of establishing a deviant identity in the face of teaching's political protagonism, triggering society's moral panic (Adorno, 1998), by condemning the collective actions that were part of the political repertoire of this professional group

Hybrid fault tolerance in distributed in-memory storage systems

An in-memory storage system provides submillisecond latency and improves the concurrency of user applications by caching data into memory from external storage. Fault tolerance of in-memory storage systems is essential, as the loss of cached data requires access to data from external storage, which evidently increases the response latency. Typically, replication and erasure code (EC) are two fault-tolerant schemes that pose different trade-offs between access performance and storage usage. To help make the best performance and space trade-off, we design ElasticMem, a hybrid fault-tolerant distributed in-memory storage system that supports elastic redundancy transition to dynamically change the fault-tolerant scheme. ElasticMem exploits a novel EC-oriented replication (EOR) that carefully designs the data placement of replication according to the future data layout of EC to enhance the I/O efficiency of redundancy transition. ElasticMem solves the consistency problem caused by concurrent data accesses via a lightweight table-based scheme combined with data bypassing. It detects corelated read and write requests and serves subsequent read requests with local data. We implement a prototype that realizes ElasticMem based on Memcached. Experiments show that ElasticMem remarkably reduces the time of redundancy transition, the overall latency of corelated concurrent data accesses, and the latency of single data access among them.

Training young adults as community health workers specializing in pediatric to adult health care transition to support emerging adults with sickle cell disease

BackgroundTransition to adulthood is a vulnerable time for emerging adults (16–25 years of age) with sickle cell disease (SCD), as there is a seven-fold increase in mortality rates during the transition period. Emerging adults with SCD also have the highest rates of hospitalizations, emergency room visits, and hospital readmissions compared to other age groups. Community health worker (CHW) programs have been developed to address outcomes such as patient activation which includes an individual’s knowledge, skill, and confidence for managing one’s health and healthcare, quality of life, and healthcare utilization for patients with chronic illnesses. However, few programs specifically target transition-age patients with SCD. MethodsThe aims of this study were to (1) create and adapt the existing Penn Center for Community Health Workers IMPaCT model trainings and materials to specifically support CHWs working with transition-age patients with SCD and (2) evaluate the feasibility of this adapted model to improve job readiness of the CHWs and perceived value of the CHWs by patients with SCD. A multidisciplinary workgroup defined specific goal-setting categories and developed a targeted CHW training curriculum. Additionally, the workgroup wrote a job manual including step-by-step guidelines with example talking points and defined an ongoing supervision of CHWs. Measures of implementation and impact on CHW job readiness included CHW training completion, job retention, knowledge evaluation, and patient reported CHW engagement. Results15 individuals completed CHW training with an average employment length of 1 year and 4 months. 7 (47%) CHWs had research experience, 8 (53%) had clinical experience, and 11 (73%) reported SCD experience. On post-training knowledge evaluations, CHWs successfully identified key aspects of SCD, role scope, and research ethics. Patients frequently reported that they reached their goals while working with trained CHWs. ConclusionThis CHW training program provides a novel adaptation to the evidence-based IMPaCT CHW model to support the needs of youth with SCD during the vulnerable time of transition from pediatric-focused to adulthood-focused healthcare.

Severe pulmonary hypertension-interstitial lung disease presenting as right ventricular failure: stabilisation with intravenous prostacyclin and maintenance with inhaled prostacyclin.

Pulmonary hypertension (PH) leads to increased morbidity and mortality in interstitial lung disease (ILD). While the INCREASE trial highlighted the use of inhaled prostacyclin in PH-ILD patients, such therapy may be inadequate when right ventricular failure (RVF) is also present. In this study, we report the use of intravenous prostacyclin in three PH-ILD patients to stabilise right ventricular (RV) function, with a subsequent transition to maintenance therapy with inhaled prostacyclin. We evaluated three consecutive PH-ILD patients with RVF. RV afterload and pulmonary vascular resistance (PVR) were treated with intravenous prostacyclin during the induction phase of the therapy. Patients transitioned from intravenous prostacyclin to the maintenance phase of the treatment with inhaled prostacyclin once three transition criteria were met: cardiac index (CI) >2 L·min-1·m-2, PVR <7 Wood units (WU) and tricuspid annular plane systolic excursion (TAPSE) change >1 mm or TAPSE >1.6 cm. Pre-treatment parameters for the three patients were a mean PVR of 14.3 WU, a mean Fick CI of 1.8 L·min-1·m-2 and a mean TAPSE of 1.4 cm. The average intravenous prostacyclin dose at the time of transition to maintenance therapy was 20.7 ng·kg-1·m-2 of treprostinil. At 3-months follow-up, the mean PVR was 6.3 WU, Fick CI 2.2 L·min-1·m-2 and TAPSE 1.7 cm. This case series of three PH-ILD patients with RVF introduces the concept of an initial intravenous prostacyclin induction phase, followed by a transition to maintenance therapy with inhaled prostacyclin. Further development of this treatment algorithm with a refinement of the transition criteria, potential testing in a clinical trial and a longer-term follow-up period is warranted to improve the outcomes of advanced PH-ILD patients with concomitant RVF.

AJET in 2023: Reflections on educational technology, people, and bibliometrics

In this editorial we reflect on the last three years of AJET achievements, challenges, and opportunities as we reach a time of transition in the lead editorial team. We also reflect on the key themes of 2023, especially the impact that the growing availability of generative artificial intelligence has had on research and practice in the tertiary education sector. We present our annual round up of bibliometrics, thank our hardworking editorial team, and acknowledge the contributions of those who are ending their service with AJET in 2023. In conclusion, we look ahead by outlining our goals for 2024 and discussing the themes and technologies that will be a focus for AJET in the new year.

‘Falling Upward’ into Sports Retirement: A Rohrsian Exploration of the Sports Retirement Experience

Retirement from sport is widely reported as a challenging time of transition in the lives of elite athletes and is one that has been explored from a range of different perspectives both by sport psychologists and socio-cultural scholars of sport. However, of late, a small number of scholars have considered athlete career transition within the context of religion and spirituality, identifying the religious identity and belief of athletes as central to their transition experiences. That said, this work does not go as far as developing a theological understanding of sports retirement. Here, we explore and frame the phenomenon of sports retirement through the theological lens put forward by the neo-Franciscan priest, Richard Rohr in his book Falling Upward: A Spirituality for the Two Halves of Life. In this paper, we suggest how Rohr’s ideas might help develop an alternative and more nuanced understanding of sports retirement, building on those currently promoted in sport psychology and the sociology of sport the literature.

PENGARUH PROSES REKRUTMEN DAN SELEKSI TERHADAP KINERJA KARYAWAN PADA SETULUS KOFFEE

Abstract : The purpose of this study is to know the hiring and selection plans of employees on the quarter of the race, and the preening of the recruiting and selection process against the actual performance of an employee of the Setulus koffee. This method of research employs the process of triangulation techniques of observation, interview, and documentation. The population of this study was 43 applicants and employees at Setulus koffee, and two samples were selected of the new ones who took the positions of cashier and the old barista. Many times the manager of Setulus koffee tried to hire an employee but the result was always unsatisfactory, while the human resource facility was the most important thing for a manager at Setulus koffee to run the coffee shop operational. A problem that often arises is the unprofessional of employees sensations, such as not following the standard oprational procedure, retiring to a time of transition, deviousness, etc. Researchers are trying to do research on a new recruiting process on sehonesthearted at Setulus koffee to observe the actual event. In the process of recruiting and new selection on June 29, 2022 The researchers found that the methods employed by the recruiter improved by more attitude and attitude than the work experience of recruiting new staff potential, according to the experience of the previous recruiter that the candidate who is too professional and has too much experience tends to be difficult to control and not follow the SOP on as well as Setulus koffee. Based on those experiences can result in better employee performance.

Oriented Triplet Excitons as Long-Lived Electron Spin Qutrits in a Molecular Donor-Acceptor Single Cocrystal.

The photogeneration of multiple unpaired electron spins within molecules is a promising route to applications in quantum information science because they can be initialized into well-defined, multilevel quantum states (S > 1/2) and reproducibly fabricated by chemical synthesis. However, coherent manipulation of these spin states is difficult to realize in typical molecular systems due to the lack of selective addressability and short coherence times of the spin transitions. Here, these challenges are addressed by using donor-acceptor single cocrystals composed of pyrene and naphthalene dianhydride to host spatially oriented triplet excitons, which exhibit promising photogenerated qutrit properties. Time-resolved electron paramagnetic resonance (TREPR) spectroscopy demonstrates that spatially orienting triplet excitons in a single crystal platform imparts narrow, well-resolved, tunable resonances in the triplet EPR spectrum, allowing selective addressability of the spin sublevel transitions. Pulse-EPR spectroscopy reveals that at temperatures above 30 K, spin decoherence of these triplet excitons is driven by exciton diffusion. However, coherence is limited by electronic spin dipolar coupling below 30 K, where T2 varies nonlinearly with the optical excitation density due to exciton annihilation. Overall, an optimized coherence time of T2 = 7.1 μs at 20 K is achieved. These results provide important insights into designing solid-state molecular excitonic materials with improved spin qutrit properties.

Transforming transitions to primary school: using children’s funds of knowledge and identity

ABSTRACT Transition to school experiences influence children’s wellbeing, development, and learning at the time of transition and future transitions. Effective transitions require schools to engage with children and families in ways that connect and empower them in the transition process. In this study children aged 3–6 years and their teachers used a Funds of Knowledge (FoK) and Funds of Identity (FoI) lens to reimagine transition practices for children and their families. Through a design-based thinking process, qualitative data was collected from four professional learning days, as well as individual coaching sessions, observations of the first days of school, and stakeholder interviews. Case studies were developed in collaboration with each participating school. Findings showed three design principles developed by the teacher participants positively impacted teachers’ and schools’ preparation for transitions. All stakeholders described the design-based process as useful in transforming transition practices and thinking about transitions from different perspectives.

몽골의 체제전환기 정치 엘리트 연구

The Mongolian People’s Revolutionary Party has maintained its political status as the ruling party in Mongolia for 70 years of socialism and 30 years of democracy. Therefore, in this paper, the political elites who were in power at the time of regime transformation of the Mongolian People’s Revolutionary Party, their formation background, characteristics, and policy decision factors were examined.&#x0D; Prior to the transition to democracy, Mongolia was a country with a one-party system in which the party and the state were integrated. As the party dominated all areas of the country and society, the political elite had overwhelming influence. At the time of system transition, the Mongolian People’s Revolutionary Party formed factions into reformers, conservatives opposed to reform, and centrists. Among them, the reformist faction led by General Secretary J. Batmunkh, who had the most powerful influence, listened to the positions of those who demanded democratization and led a compromise.&#x0D; In addition, he took the position of ‘absolutely no’ as to whether or not to use force against the democratization forces, which was decided at the party convention. The reformers included most of the members of the Politburo and the Secretary General, including the Secretary General of the Party Central Committee. At the request of the democratization forces, they gave up all the power they had as high-ranking elites and prioritized the safety of the people and the country. With this, the reformist forces within the Mongolian People’s Revolutionary Party demonstrated a great practice of compromise and peaceful democratization.&#x0D; Following the resignation of reformers, the next generation of political elites emerge. These are the elite members of the Mongolian People’s Revolutionary Party, who are in charge of working on the first democratic election pledges. Those with a relatively high level of education and strong reform tendencies drew up pledges to meet the domestic situation and the people’s needs at the time. This is one of the reasons why the Mongolian People’s Revolutionary Party won a landslide victory in the first democratic election in history held after regime transformation. The Mongolian People’s Revolutionary Party also had such a high level of popular support that it has been positioned as the ruling party of Mongolia even after the regime transformation.

Adaptive Humanism

We believe that while humanity is experiencing a time of transition and transformation, it is “stuck” within limiting narratives. Those narratives prevent individuals and societies from exploring new options and from acting upon those alternatives; that is, from co-creating a future. We propose the concept of Adaptive Humanism, a process of moving from limiting to quantum narratives: a process of conscious (that is, self-aware) and continuous adaptation to a new situation, as well as critical examination of both challenges and opportunities offered by that new environment. We present real-life examples, compiled during interviews conducted by the authors, of limiting narratives, as well as a brief exploration of limiting narratives from the perspectives of psychology, philosophy, and sociology. Further, we propose that the theoretical framework and practices of Theory U create a non-judgmental open space to get “unstuck” and to move from limiting to quantum narratives, meaning self-correcting narratives oriented to and emerging from the future.

Post-Immune Tolerance Induction Prophylactic FVIII Infusions May Not be Necessary for Tolerized Hemophilia a Patients on Emicizumab

Background: Hemophilia A is a hereditary bleeding disorder characterized by low factor VIII (FVIII) activity. Patients with severe bleeding phenotypes are at risk for significant bleeding-related morbidity and mortality including the development of hemophilic arthropathy. In recent years, prophylaxis with emicizumab, a bispecific monoclonal antibody, has supplanted prophylactic FVIII infusions due to its ease of self-administration, long half-life, and low annual bleeding rate (ABR), independent of tolerization status to alloantibodies against FVIII (inhibitors). However, it is unclear if emicizumab FVIII-mimic activity is sufficient to achieve hemostasis in moderate-severe bleeds, and therefore, FVIII replacement may still be necessary. Despite its well-established benefits, the use of emicizumab in previously untreated patients (PUPs), and patients with under 20 exposures to FVIII is still not well understood due to a lack of long-term experience and understanding of its impact on the pathophysiology of FVIII inhibitors. Further investigation is also needed regarding the risk of inhibitor recurrence in patients with previous inhibitors and the concomitant use of emicizumab. At our institution, patients on emicizumab with a history of inhibitors do not continue post-immune tolerance induction prophylactic FVIII infusions. We also initiate emicizumab before 20 exposures to FVIII, and sometimes before immune tolerance induction (ITI). We explored our patient population to understand inhibitor incidence and recurrence amidst emicizumab prophylaxis. Methods: We performed a single center retrospective analysis of patients served by the Hemophilia Center of Western Pennsylvania. We identified patients with Hemophilia A on emicizumab prophylaxis. Relevant data was collected including demographics, inhibitor status at time of transition to emicizumab and in the available follow-up period, bleeding events after transition, and number of FVIII exposures before and after transition. Inhibitor recurrence was defined as laboratory evidence of inhibitor using chromogenic Bethesda assay and/or unexplained breakthrough bleeding events despite on-demand FVIII infusions. Results: Data was reviewed for 36 patients on emicizumab prophylaxis. Three patients were lost to follow-up. Median age was 15.3 years (range 1.2 - 82). Median follow-up time on emicizumab was 3.5 years (range 0.5 - 5). Two patients had &amp;lt; 20 FVIII exposures prior to emicizumab, and one of those had an inhibitor before emicizumab. In total, 15 patients (45%) were diagnosed with an inhibitor prior to emicizumab. Of these, 8 patients (53%) were tolerized prior to emicizumab, and 7 patients (47%) were not tolerized prior to emicizumab. Median peak inhibitor titer was 4.2 Bethesda units (range 0.7 - 281 Bethesda units). After transition to emicizumab, no tolerized patients for which inhibitor status was tested during the follow-up period had inhibitor recurrence, and 1 non-tolerized patient's inhibitor became undetectable after 4 years of emicizumab therapy (the same patient who had developed an inhibitor with &amp;lt; 20 FVIII exposures prior to emicizumab). Mean ABR was 0.33 events/year for tolerized patients (median 0, range 0 - 3); 0.17 events/year for non-tolerized patients (median 0, range 0 - 1); and 0.60 events/year for patients with no history of inhibitor (median 0, range 0 - 4). Mean number of FVIII exposures per year was 0.09 for tolerized patients (median 0, range 0 - 1); 0.07 for non-tolerized patients (median 0, range 0 - 1); and 1.2 for patients with no history of inhibitor (median 0, range 0 - 20). Conclusion: In our small cohort, no patient who was tolerized prior to emicizumab had recurrence of clinical or laboratory evidence of inhibitor while on emicizumab therapy, despite infrequent exposure to FVIII infusion. We did not have enough power to determine whether patients with &amp;lt; 20 FVIII exposures before emicizumab developed inhibitors, though one such patient had inhibitor resolution on emicizumab without ITI. Consistent with other works, overall ABRs in all patients on emicizumab therapy were low. These findings add to other studies on the safety of emicizumab and its impact on the natural history of FVIII inhibitors. Our study also suggests that continuing post-ITI prophylactic FVIII infusions in tolerized patients on emicizumab may not be necessary. Larger-scale studies are required to substantiate our findings.

Challenges and coping with COVID-19: perspectives of emerging adults and their mothers

ABSTRACT Emerging adulthood (spanning ages 18–25 years old) is a critical time of developmental transition. Although the COVID-19 pandemic led to multiple disruptions in the lives of emerging adults (EAs), little research examined the impacts from the perspectives of both EAs and their parents, who were spending increasing amounts of time together, particularly during the early pandemic stages. From May to July 2020, we interviewed 27 EAs and 12 mothers who were recruited from an ongoing longitudinal study. Themes were derived using conventional qualitative content analysis. Mothers and EAs described challenges and impediments of COVID-19 that fell under three larger categories: Challenges related to COVID-19, Coping Resources and Strategies, and Parental Support. Both mothers and EAs recognized that COVID-19 had led to disruptions in the developmental trajectories of EAs, requiring significant adjustment and coping. They reflected on the increased time together as both an impediment (i.e. to physical and mental health, unhealthy coping) and an opportunity (i.e. for bonding, healthy coping). Our findings highlight the need to address the significant challenges faced by EAs as a result of the pandemic, as well as the role of parents as important sources of support for their EA children during times of stress and crisis.

Parental Involvement in the Transition from Paediatric to Adult Care for Youth with Chronic Illness: A Scoping Review of the North American Literature.

With medical advancements and improvements in medical technology, an increasing number of children with chronic conditions survive into adulthood. There is accordant growing interest toward supporting adolescents throughout the transition from paediatric to adult care. However, there is currently a paucity of research focusing on the role that these patients' parents should play during and after the transition to adult care and if maintained parental involvement is beneficial during this transition within a North American context. Accordingly, this scoping review utilized Arksey and O'Malley's five-step framework to consider parental roles during chronically ill children's transition to adult care. APA PsycInfo, CINAHL, EMBASE, MEDLINE, ProQuest, and Scopus were searched alongside advanced Google searches. Thematic content analysis was conducted on 30 articles meeting the following inclusion criteria: (1) published in English between 2010 and 2022, (2) conducted in Canada or the United States, (3) considered adolescents with chronic conditions transitioning to adult care, (4) family being noted in the title or abstract, and (5) patient populations of study not being defined by delays in cognitive development, nor mental illness. Three themes emerged from the literature: the impacts of maintaining parental involvement during transition to adult care for patients, parents experiencing feeling loss of stability and support surrounding the transition of their child's care, and significant nonmedical life events occurring for youths at the time of transition of care. Parents assuming supportive roles which change alongside their maturing child's needs were reported as being beneficial to young peoples' transition processes, while parents who hover over or micromanage their children during this time were found to hinder successful transitions. Ultimately, the majority of reviewed articles emphasized maintained parental involvement as having a net positive impact on adolescents' transitions to adult care. As such, practice and policies should be structured to engage parents throughout the transition process to best support their chronically ill children during this time of change.

Enhancing Simulation: A Roadmap for Integrating the Electronic Health Record into the Nurse Practitioner Curriculum

The electronic health record (EHR) is an important health information technology (IT) used to support efficient clinical workflows, patient safety, and quality of care. The EHR is an individual's medical chart stored in digital format for complete real-time information to reduce medical errors and improve outcomes. EHR technology is complex, and users may struggle with efficiently navigating the system for data retrieval, documentation, and time management. Academic institutions are positioned to collaborate with EHR vendors to offer training playgrounds in the curriculum that simulate the clinical interface and support readiness to practice in relevant technology-rich clinical environments. A strategically selected educational EHR vendor matched to the platforms used by major health care organizations may influence clinical partnerships and employment opportunities. EHR competency may alleviate some of the onboarding burden for health care institutions and new graduates at a time of role transition. This article provides strategies for leveraging health IT in the academic curriculum to prepare a technology-proficient workforce capable of meeting the needs of diverse individuals, populations, and healthcare systems.

Environmental characteristics and type 1 diabetes: students' perspectives on diabetes management in college

IntroductionType 1 diabetes is a chronic illness requiring immense lifestyle changes to reduce the chance of life-threatening complications, which can be especially challenging during the time of transition to college. This study applies a communication design perspective to explore how students with type 1 diabetes interpret their experiences in college and what meanings they attribute to those experiences. Specifically, this study sheds light on physical and social environmental components affecting students' diabetes management.MethodsStudy participants were recruited from the College Diabetes Network (CDN). A total of twenty students with type 1 diabetes participated in the study. A qualitative descriptive study design with an ethnographic interview approach was applied.ResultsFour cultural themes emerged from the analysis: (1) Food environment, (2) Structural environment, (3) Academic life, and (4) Social life. The findings illustrate how food outlets and food accessibility, safe spaces for insulin injections, comfortable living spaces, availability of health support services, and diabetes-friendly classroom regulations constitute a higher-level environmental system affecting students' wellbeing. They also highlight a complex relationship between structural barriers to diabetes management, health disclosure, and public stigma.DiscussionResults from this study advance scholarship on diabetes care in the population of emerging adults by offering insights into how college students with T1D transition to college and manage type 1 diabetes. Overall, students with T1D have specific needs beyond those of the general student population. Thus, necessary modifications in the designs of existing structures should be introduced to facilitate students' assimilation into new organizational environments.

Outpatient encounters, continuity of care, and unplanned hospital care for children and young people with cerebral palsy.

To describe the relationships between outpatient encounters, continuity of care, and unplanned hospital care in children/young people with cerebral palsy (CP). In this population-based data-linkage cohort study we included children/young people with CP identified in the New South Wales/Australian Capital Territory CP Register (birth years 1994-2018). We measured the frequency of outpatient encounters and unplanned hospital care, defined as presentations to emergency departments and/or urgent hospital admissions (2015-2020). Continuity of outpatient care was measured using the Usual Provider of Care Index (UPCI). Of 3267 children/young people with CP, most (n = 2738, 83.8%, 57.6% male) had one or more outpatient encounters (123 463 total encounters, median six outpatient encounters per year during childhood). High UPCI was more common in children/young people with mild CP (Gross Motor Function Classification System levels I-III, with no epilepsy or no intellectual disability), residing in metropolitan and areas of least socioeconomic disadvantage. Low UPCI was associated with four or more emergency department presentations (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.71-3.19) and one or more urgent hospital admissions (aOR 2.02; 95% CI 1.57-2.61). Children/young people with CP require frequent outpatient services. Improving continuity of care, particularly for those residing in regional/remote areas, may decrease need for unplanned hospital care. Many children with cerebral palsy use multiple and frequent outpatient services. Better continuity of care is associated with living in metropolitan and less socioeconomically disadvantaged areas. Outpatient service utilization reduces at the time of transition to adult services. High outpatient utilization is associated with unplanned hospital care. Decreased continuity of care is associated with unplanned hospital care.

Predictors of Improvement in Parental Stress After the First Three Months at Home with a Medically Fragile Infant.

Little is known about the early stress experiences of parents of infants with serious life-limiting/life-threatening conditions during the initial months after discharge from hospital. The aim of the study was to measure change, and predictors of change, in parenting stress at the time of transition from hospital to home (T1) with a medically fragile infant, and after a 3-month period (T2). Parents of infants identified as meeting ≥ 1 palliative care referral criterion were recruited in a Midwestern United States tertiary pediatric hospital (2012-2014) within 2 weeks of hospital discharge. A repeated measures design was used to assess change on a validated parenting stress inventory over the two timepoints (T1 and T2). Fifty-two parents (61 infants) participated at T1 and 44 (85%) at T2. On discharge (T1) stress was moderately high 3 months post discharge (T2) overall and domain-specific stress scores improved, except stress related to parent role functioning and participation in their child's medical care. Independent predictors of improvement in overall parenting stress scores (T2-T1) were being a younger parent and having experienced prior pregnancy-related loss. The time of discharge from hospital to home is often stressful for parents of medically fragile infants. Improvements were found during the first 3 months at home, but improvement was minimal for stress related to role function and providing medical care. Past experience with pregnancy-related loss and being younger were associated with improvement in stress across theoretical domains. Screening for stress should be included as part of routine pre- and post-neonatal intensive care unit discharge psychosocial assessments of parents caring for infants with serious illness to ensure their unique support needs continue to be met over time.

Decision aid and patient engagement in breast surgical consults: A treatment-compliant analysis of Alliance A231701CD.

314 Background: In a recent trial, we observed no statistically significant increase in engagement after a web-based decision aid (DA) was delivered to breast cancer patients prior to a surgical consult. However, a minority of the intervention group (44%) reviewed the DA. The objective is to assess the effect of the DA on engagement for the cohort of patients who reviewed it. Methods: A stepped wedge trial was conducted with 10 NCI Community Oncology Research Program clinics that care for a high proportion of socioeconomically disadvantaged patients (6/2019-12/2021). Clinics were randomized to time of transition from usual care (UC) to delivery of a DA. Patients with stage 0-3 breast cancer eligible for surgery provided consent prior to a surgical consult. Engagement was measured from audio-recorded surgical consults (Active Patient Behaviors, Street protocol). For this analysis, we identified a cohort of treatment compliant (TC) patients who reviewed the DA. Intervention effects comparing TC and UC groups were tested with linear mixed-effects models, accounting for time, enrollment post-COVID, and patient age, race, education, and socioeconomic disadvantage (assessed with Area Deprivation Index and dichotomized). Exploratory models were generated using Active Patient Behavior subcomponents (asking questions, assertive responses, expressions of concern) as the outcome. Results: The cohort includes 407 patients (UC 264; TC 143). TC patients were more likely to be white (TC 73%, UC 64%, p=0.03), have a college degree (TC 65%, UC 55%, p=0.05), and not be disadvantaged (TC 89%, UC 72%, p=0.001). TC was associated with increased engagement (8.2 [0.08, 16.2], p=0.048, Table). A college degree was associated with higher, while black race and socioeconomic disadvantage lower, engagement. On exploratory analyses, TC had a stronger association with higher levels of assertive responses (2.9 [-0.3, 6.1], p=0.07) compared with asking questions (5.2 [-1.4, 11.9], p=0.12) or expressions of concern (0.08 [-0.60, 0.76], p=0.82). Conclusions: We observed increased engagement in breast cancer patients who reviewed a DA prior to a surgical consult. However, we also observed differences based on race, education, and socioeconomic disadvantage. Further research will identify adjunct interventions to combine with the DA to improve cancer care delivery for diverse populations. Support: UG1 CA189823; AHRQ R01HS025194; https://acknowledgments.alliancefound.org. Clinical trial information: NCT03766009 .[Table: see text]

Increasing Cardiovascular Burden Among Young Adults with Pediatric CKD at Time of Transition to Adult Care

Increasing Cardiovascular Burden Among Young Adults with Pediatric CKD at Time of Transition to Adult Care