Transition Program Research Articles

Cell states and neighborhoods in distinct clinical stages of primary and metastatic esophageal adenocarcinoma.

Esophageal adenocarcinoma (EAC) is a highly lethal cancer of the upper gastrointestinal tract with rising incidence in western populations. To decipher EAC disease progression and therapeutic response, we performed multiomic analyses of a cohort of primary and metastatic EAC tumors, incorporating single-nuclei transcriptomic and chromatin accessibility sequencing, along with spatial profiling. We identified tumor microenvironmental features previously described to associate with therapy response. We identified five malignant cell programs, including undifferentiated, intermediate, differentiated, epithelial-to-mesenchymal transition, and cycling programs, which were associated with differential epigenetic plasticity and clinical outcomes, and for which we inferred candidate transcription factor regulons. Furthermore, we revealed diverse spatial localizations of malignant cells expressing their associated transcriptional programs and predicted their significant interactions with microenvironmental cell types. We validated our findings in three external single-cell RNA-seq and three bulk RNA-seq studies. Altogether, our findings advance the understanding of EAC heterogeneity, disease progression, and therapeutic response.

The Role of Certified Community Behavioral Health Centers in Improving Access to Peer-Supported Services.

Peer support workers (PSW) improve outcomes for people with behavioral health needs, but integrating PSWs into routine behavioral healthcare has been challenging. Certified Community Health Centers (CCBHC), a new comprehensive care model, provides new opportunities to increase access to PSWs. The present study examines whether PSW utilization changed following one organization's transition to a CCBHC. Administrative data from a large behavioral health organization was used to examine changes in peer delivered services before and after CCBHC implementation. Chi-square analyses examined changes in the number of visits delivered by peers. Logistic regression examined differences in the likelihood of accessing PSW services during pre and post timepoints. Following CCHC implementation, the overall number of PSW visits delivered within substance use and transition age youth programs increased. In contrast, the number of PSW visits in community-based intensive case management program decreased. Clients with opioid use disorders were more likely to have accessed PSW services following CCBHC implementation. Results reflect that CCBHC designation generally increased the number of PSW visits within this organization; however, changes in peer service utilization were primarily concentrated among individuals with opioid use disorders and within substance use and transitional aged youth programs. This study provides novel insight into how PSWers are being integrated into the CCBHC model.

Backcasting supports cross-sectoral collaboration and social-technical innovation bundling: case studies in agri-food systems

There is a clear and urgent call to transform our food systems as a critical nexus to tackle ongoing global climate, biodiversity, equity, and nutrition crises. Many food and agricultural innovations are being developed and scaled but these innovations often target sector-specific problems and remain disconnected from the more complex demand for transformative change at scale. To bridge this demand for systemic change within the innovation ecosystem, initiatives are applying various approaches such as visioning, holistic assessments, innovation portfolio management and multistakeholder co-creation. Here we report on insights from applying a food systems tailored backcasting approach in a diversity of settings since 2021, including a national food system dialogue, a youth business innovation challenge, a landscape multi-stakeholder platform, a public-private sector co-learning session, an agroecological transitions program, and a hybrid food systems university course for graduate students and global professionals. We thereby build on existing literature and case studies of how change happens (or does not happen) and aim to use those insights to support food systems change makers. Across these settings, the backcasting approach asks participants to connect innovations with broader systems-change visions, to anticipate tradeoffs for multiple food system outcomes and population groups, and to cross sectoral boundaries. The use cases demonstrate that the backcasting process contributes to changes in views, practices and structures that participants work with. Specifically, it supports moving beyond “silver bullet” innovation approaches, the bundling of social and technical innovations, and building action-oriented cross-sectoral bridges. Food systems change is complex and innovations alone are insufficient to address its complexity. But innovations can play a positive role if connected to more holistic systems-change processes and goals. Considering strengths and limitations of the backcasting approach, the diversity of practical applications supports its potential to connect innovations to holistic food systems visions, to strengthen cross-sectoral collaboration and to bundle social and technical innovations for desirable food systems change.

Enhancing Occupational Therapists' Intervention Capabilities With Adolescents With Neurodevelopmental Disorders.

Background. Adolescents with neurodevelopmental disorders (NDDs) have an increased risk of participation limitations. Occupational therapy faces knowledge-to-practice gaps among this population. Purpose. To examine the effectiveness of a continuing-education program for occupational therapists working with adolescents with NDDs. Methods. The study used a mixed-method design, including pre-post comparisons of competence and sense of self-efficacy of occupational therapists to work with adolescents with NDDs. Interviews regarding the program's perceived contribution to practice were conducted. Results. Post-program results showed significantly (p < .001) higher professional competence and self-efficacy for interventions and evaluation skills with NDD's adolescents and transition programs as well as higher knowledge about adolescence and NDDs characteristics. Contrary, there was no change in competence and self-efficacy regarding client-centred interventions with adolescents. Program participants increased their professional confidence and incorporated evidence-based methods into routine practice. Conclusions and Implications. The continuing-education program that was examined expanded the occupational therapy practitioner's knowledge and professional skills, resulting in a change in their capacity to practice with adolescents narrowing the knowledge-to-practice gap. Future studies involving the client perspective, regarding their participation may validate and support continuing-education program for occupational therapists.

A transitional care program in a technologically monitored in‐hospital facility reduces the length of hospital stay and improves multidimensional frailty in older patients: a Randomized Clinical Trial

BackgroundLonger length of hospital stay (LOS) negatively affects the organizational efficiency of public health systems and both clinical and functional aspects of older patients. Data on the effects of transitional care programs based on multicomponent interventions to reduce LOS of older patients are scarce and controversial.AimsThe PRO‐HOME study aimed to assess the efficacy in reducing LOS of a transitional care program involving a multicomponent intervention inside a technologically monitored in‐hospital discharge facility.MethodsThis is a Randomized Clinical Trial on 60 patients (≥65 years), deemed stable and dischargeable from the Acute Geriatrics Unit, equally assigned to the Control Group (CG) or Intervention Group (IG). The latter underwent a multicomponent intervention including lifestyle educational program, cognitive and physical training. At baseline, multidimensional frailty according to the Multidimensional Prognostic Index (MPI), and Health‐Related Quality of Life (HRQOL) were assessed in both groups, along with physical capacities for the IG. Enrolled subjects were evaluated after 6 months of follow‐up to assess multidimensional frailty, HRQOL, and re‐hospitalization, institutionalization, and death rates.ResultsThe IG showed a significant 2‐day reduction in LOS (median days IG = 2 (2–3) vs. CG = 4 (3–6); p < 0.001) and an improvement in multidimensional frailty at 6 months compared to CG (median score IG = 0.25(0.25–0.36) vs. CG = 0.38(0.31–0.45); p = 0.040). No differences were found between the two groups in HRQOL, and re‐hospitalization, institutionalization, and death rates.DiscussionMultidimensional frailty is a reversible condition that can be improved by reduced LOS.ConclusionsThe PRO‐HOME transitional care program reduces LOS and multidimensional frailty in hospitalized older patients.Trial registration: ClinicalTrials.gov n. NCT06227923 (retrospectively registered on 29/01/2024).

PRADOC: A Multicenter Randomized Controlled Trial to Assess the Efficiency of PRADO-IC, a Nationwide Pragmatic Transition Care Management Plan for Hospitalized Patients With Heart Failure in France.

The PRADO-IC (Programme de Retour à Domicile après une Insuffisance Cardiaque) is a transition care program designed to improve the coordination of care between hospital and home that was generalized in France in 2014. The PRADO-IC consists of an administrative assistant who visits patients during hospitalization to schedule follow-up visits. The aim of the present study was to evaluate the PRADO-IC program based on the hypotheses provided by health authorities. The PRADOC study is a multicenter, controlled, randomized, open-label, mixed-method trial of the transition program PRADO-IC versus usual management in patients hospitalized with heart failure (standard of care group; NCT03396081). A total of 404 patients were recruited between April 2018 and May 2021. The mean patient age was 75 years (±12 years) in both groups. The 2 groups were well balanced regarding severity indices. At discharge, patients homogeneously received the recommended drugs. There was no difference between groups regarding hospitalizations for acute heart failure at 1 year, with 24.60% in the standard of care group and 25.40% in the PRADO-IC group during the year following the index hospitalization (hazard ratio, 1.04 [95% CI, 0.69-1.56]; P=0.85) or cardiovascular mortality (hazard ratio, 0.67 [95% CI, 0.34-1.31]; P=0.24). The PRADO-IC has not significantly improved clinical outcomes, though a trend toward reduced cardiovascular mortality is evident. These results will help in understanding how transitional care programs remain to be integrated in pathways of current patients, including telemonitoring, and to better tailor individualized approaches. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03396081.

Occupational Therapists perceptions of a school-to-work transition programme at a special educations needs school

Occupational Therapists perceptions of a school-to-work transition programme at a special educations needs school

Impact of globalization and energy consumption on CO2 emissions in China: Implications for energy transition

Despite the importance of understanding the impact of economic globalization on CO2 emissions through renewable and non-renewable energy consumption, previous studies have yielded contradictory results. This study addresses this gap by examining the relationship between trade openness, foreign direct investment, renewable energy consumption, non-renewable energy consumption, and CO2 emissions in China using wavelet analysis. The methodology allows for simultaneous evaluation of the commonality between variables in both time and frequency domains. The results reveal that the causality between variables varies with frequency, with notable reversals in lead-lag relationships. Economic globalization affects CO2 emissions differently through renewable and non-renewable energy consumption, with distinct short-term and long-term dynamics. The findings highlight the need for credible energy transition programs, increased renewable energy utilization, and strengthened global cooperation to balance economic globalization and environmental quality in China. Future research could explore heterogeneity among provinces, nonlinear and asymmetric effects, and expand the scope to other developing economies.

IBA Section on Energy, Environment, Natural Resources and Infrastructure Presentation: ‘Net Zero and Natural Resources Law: Sovereignty, Security and Solidarity in the Clean Energy Transition’ (Oxford University Press, 2024)

The IBA’s Section on Energy, Environment, Natural Resources and Infrastructure Law is advised by the Academic Advisory Group (AAG), a group of leading academics from around the world. Every two years, the AAG publishes a book about a key topic of interest to the entire Section. This year’s book focuses on the legal issues involved with the clean energy transition. In response to the climate emergency, several countries, corporations and other actors worldwide have announced programmes aimed at reducing global emissions of greenhouse gases that contribute to climate change to net zero by the year 2060 or earlier. While the need for a clean energy transition is clear, incoherently designed transition programmes could produce complex environmental, social and governance risks, including legal liability and protracted disputes. At the same time, the growing rush for minerals needed to manufacture clean energy technologies raises fundamental questions. Most crucial is how to ensure the exploration and development of energy transition minerals in a manner that does not exacerbate resource conflicts, resource nationalism, human rights violations, protectionism, energy insecurity, social exclusions and inequity, especially in conflict-affected and high-risk regions. These scenarios raise the need for net-zero and climate-aligned natural resource contracts, legislation and investment agreements to drive a just and inclusive energy transition. With presentations from some of the expert contributors to the latest AAG book, Net Zero and Natural Resources Law, this panel session 1 reflected upon innovative legal drafting, contract negotiation and policymaking approaches needed to address the wide range of resource sovereignty, security and solidarity questions posed by the net zero transition.

Healthcare transition in pediatric neurosurgery: lessons learned from a pilot program for patients with hydrocephalus and spina bifida.

The pediatric neurosurgical community has increasingly recognized the importance of healthcare transition, the process of moving a patient from a pediatric to an adult model of care. However, surveys of pediatric neurosurgeons have revealed that few institutions have formal transition programs. Here, the authors share their preliminary experience with the development of a formal transition pilot program for patients with spina bifida and/or hydrocephalus. Patients 18 years of age or older with a diagnosis of spina bifida and/or hydrocephalus who were followed by a pediatric neurosurgeon at Connecticut Children's from January 2017 to December 2023 and were recommended to transition to an adult neurosurgeon were retrospectively reviewed. Patients in the informal transition program (ITP) cohort (i.e., the recommendation to transition was made before the formal transition program [FTP] was developed in early 2020) were compared with those in the FTP cohort. Twenty-two patients met inclusion criteria with 7 (31.8%) in the ITP cohort and 15 (68.2%) in the FTP cohort. The median age at the time of the recommendation to transition was similar in both ITP and FTP cohorts (24 [IQR 20-35] years vs 25 [IQR 24-27] years, respectively). Four (57.1%) patients in the ITP cohort had a confirmed visit with an adult neurosurgeon, compared with 13 (86.7%) patients in the FTP cohort (p = 0.274). One patient in the ITP cohort with a failed transition returned to pediatric neurosurgical care, and 1 patient in the FTP cohort required a shunt revision by an adult neurosurgeon within 1 year of the recommendation to transition. Healthcare transition is recognized as a priority within pediatric neurosurgery, but structured, formal transition programs remain underdeveloped. The authors' preliminary experience with a pilot transition program demonstrated that patients who underwent a formal transition were more likely to successfully establish care with an adult neurosurgeon and trended toward less resource utilization.

Health care transition models in spina bifida care: evidence-based lessons in support of neurosurgical practice.

The purpose of this study was to conduct a literature review on transition programs from pediatric to adult care and the role of neurosurgery as individuals with spina bifida (SB) transition, and to provide a framework for neurosurgical providers to assist in the transition to adult-centered care. A comprehensive literature review was conducted according to the PRISMA statement, with a search in Medline and Embase to identify US clinical programs reporting on their experiences establishing a transition program for adolescents and young adults with SB. Data were collected for authors, year, transition clinic location, model of care for transition clinic, ages served, and specialty clinical team. The literature search yielded 698 articles, 5 of which met the inclusion criteria. These 5 studies included 4 transition programs for which models of care and approach to transition, clinical services involved, establishment of goals, and age of initiation and transition were identified. All programs described setting transition goals, ranging from community services, to self-management, to health care navigation, to patient-driven goals, with 1 program reporting a quality-of-life measurement component to their model. Robust SB transition programs can be established by applying the expanded chronic care model, reviewing lessons learned by other programs, advocating at the institutional level, and seeking support via professional organizations. While the comprehensive role of neurosurgical providers in these programs is still being defined, a shared vision of enhancing the health and quality of life for individuals with SB and their families is needed by all subspecialists involved.

Transition Services &amp; Young Adults With Autism Spectrum Disorder

Abstract Date Presented 03/23/24 The purpose of this research is to explore the experience of young adults with autism spectrum disorder (ASD), considering social skills at transition programs. OT involvement may aid in the mission of these programs by increasing independent living skills. Primary Author and Speaker: Cristina Rivas

Navigating the transition: the crucial shift from pediatric to adult care for individuals living with spina bifida.

Spina bifida (SB) is a complex congenital condition characterized by incomplete closure of the neural tube, resulting in varying degrees of physical and neurological impairment. Although commonly managed by multidisciplinary pediatric clinics, a substantial proportion of SB patients are now living into adulthood, necessitating the transition from pediatric to adult healthcare. This transition introduces a myriad of challenges for individuals living with SB and their families. Prior research on SB transition programs has demonstrated anecdotal success; however, minimal research has been published on early posttransition health outcomes and compliance with medical recommendations. This quality improvement study assessed early posttransition compliance with medical recommendations, adverse health events, access to medical supplies/equipment, and patient-reported health outcome and confidence in medical providers. Adult participants in the Spina Bifida Transition Clinic at the authors' pediatric institution were invited to complete a telephone survey after transition to adult care. The mean (SEM) elapsed time since transition was 1.21 (0.11) years. The survey evaluated adult provider utilization, accessibility of medical supplies and equipment, adverse medical events, compliance with sleep study acquisition, patient-reported health status, and satisfaction with providers. Of 52 eligible participants, 49 (94%) completed a telephone survey. Within the cohort, 82% had open SB (myelomeningocele), with the remaining having occult SB (lipomyelomeningocele). The mean age at transition was 26.0 years. Since transition, 78% have attended at least one primary care visit, with 76% seeking care from at least one adult care specialist (69% sought care with urologists). Forty-five percent reported an adverse medical event: 31% required an emergency department visit, 22% were hospitalized, 18% underwent surgery, and 24% had skin breakdown. Access to medical supplies varied, with patients experiencing the most difficulty obtaining wheelchairs and assistive walking devices. Patients rated pediatric provider engagement and knowledge of SB significantly higher than adult providers (mean 3.92 vs 3.32, p < 0.001). This quality improvement study evaluated the effectiveness of our Spina Bifida Transition Clinic in the early post transition period. While patients have used primary and specialty care (urology), they have experienced many adverse events and low compliance with sleep study acquisition. Continued evaluation of transition programs is required to optimize the outcome of those living with SB.

Can we do better supporting young adults with cerebral palsy as they navigate adulthood? A review of current and future transitional practices.

Patients with cerebral palsy (CP) face lifelong consequences of their condition, and their healthcare needs evolve as they age. Transitional care for these patients is not universally available and various models have been described. In this article, the authors review the current literature surrounding transitional care for patients with CP, focusing predominantly on the neurosurgical aspects of transitional care, and they describe current approaches adopted by programs in North America. They further describe their own experience developing a transitional care clinic for patients with CP, as well as the integration of this program with a multidisciplinary clinic to address the specific challenges that growing patients face in our region. The authors performed a literature review to identify models, barriers, and assessments of effective transitional care for CP patients. They also reviewed the recommendations of various professional societies regarding transitional care practices. They performed qualitative analysis of the relevant literature. Transitional care has been broadly categorized into transitional care clinics with multidisciplinary teams and facilitator-led transitional care. CP patients have to overcome a variety of barriers, including those from within the healthcare system as well as environmental and personal, during the period of their transition. These challenges are all interconnected, and navigation requires healthcare professionals to work closely with patients and their caregivers. Multiple instruments are described to measure successful transition, which is likely a reflection of the unique needs that a patient may require. Current guidelines recommend that neurosurgeons select a suitable model of care based on their own local practice and available services, develop a well-defined transition plan, and identify a primary transition facilitator or care coordinator. Providing effective transitional care to CP patients remains challenging given the different models of care and the barriers faced by them during the period of transition. In developing a transitional care program for these patients, attention must be given to the resources that are available regionally, with an effort to incorporate the best practices from successful transitional care programs.

The role of a dedicated transition process from pediatric to adult interdisciplinary care for persons with spina bifida.

Interdisciplinary care and pediatric to adult transitional programs have consistently shown medical and social value for individuals with complex medical conditions such as spina bifida (SB). Such interdisciplinary clinics are common in pediatrics but are rarely offered for adults. This survey-based study reports information related to transition, daily pain burden, and satisfaction with care delivery in an adult SB clinic. A 23-question survey that was based on empirical observations from the adult SB clinic was formulated, IRB approved, and distributed to adult patients. Many respondents had previously received care at the institution's pediatric SB clinic and completed transition to the adult program. Responses were de-identified, categorized, stored in a secure database, and statistically analyzed using SPSS. Of 245 patients approached, 116 (47%) surveys were completed and analyzed. Those who had a direct transition (defined as a less than 24-month gap in care) from the pediatric to the adult clinic comprised 44% (n = 51) of responders. The alternative group of 56% (n = 65) had a longer gap, disorganized or absent transition, or had pediatric care elsewhere. The study population had an average age of 36 years, had mostly received childhood care at the authors' institution, regardless of whether they made a direct transition or had a gap in care (68%), and held the diagnosis of open myelomeningocele (78%). Overall satisfaction with the clinic experience was high (mean score 9.04 on a 10-point subjective scale). Differences regarding independence in activities of daily living based on transition status were not significant, but on multivariate analysis, those who reported independence in activities of daily living had an almost 4-fold higher odds of daily pain (p = 0.024; OR 3.86, 95% CI 1.19-12.5). The most frequently identified areas for improvement included improved access to care and pain control. Pediatric transitional processes and interdisciplinary clinics may contribute to improved patient-perceived outcomes and satisfaction with their SB care in comprehensive settings. Further elucidation of barriers to pain control is warranted, in addition to ways in which comprehensive and longitudinal care can improve them.

Aspirations, Goals, Dreams, and Future Pursuit of Basketball Athletes in the National College Athletics Association (NCAA): A Literature Review

This study offers insightful information about academic support programs for student-athletes, highlighting the necessity of all-encompassing assistance and utilizing technology to cater to their requirements. Aspects of academic support included in the evaluation include study halls, writing centers, technology, job transition, counseling, and bridging programs. It emphasizes how crucial customized solutions and a positive team atmosphere are. The necessity of a more comprehensive strategy to affect student-athletes’ conduct, the significance of specialized library education, and the requirement to ease their transition into the workforce are among the study gaps that have been found. To better meet the special needs of student-athletes and pinpoint best practices for various contexts, the abstract suggests that more research be done on the long-term effects of academic support programs, the efficacy of technology-based interventions, and cross-cultural analysis of academic support programs. In addition to offering suggestions for future research to improve academic assistance programs for student-athletes, the abstract contains insightful information about the difficulties and experiences faced by student-athletes.

“Did ‘Step-Up’ help in stepping up?” Transition programmes as a factor to improve student academic performance

“Did ‘Step-Up’ help in stepping up?” Transition programmes as a factor to improve student academic performance

Evaluation of the transition program at the University Hospital of Reims from 2015 to 2020.

The transition of young type 1 diabetic (T1D) patients from pediatric to adult healthcare is a high-risk period of loss to follow-up. Since 2015, we have implemented a transition program, involving both pediatric and adult clinicians. The main objective was to evaluate the number of patients who had succeeded this transition program at 1 year. We found that 86% of patients underwent the complete transition program. However, adverse outcomes occurred in 19.1% of patients at 1 year but decreased to 2.9% after 3 years. In 63% of patients their HbA1c level had deteriorated 1 year after the transition day and this level stabilized at around 8% in the following 2 and 3 years. In patients who had improved HbA1c levels the body mass index was lower (P = 0.03) and they lived alone (P = 0.04). Although our program seemed to allow a better follow-up than previously described, this study highlights the importance of further supporting this transition period.

“Transience, Disruption, and Unfamiliarity in Refugee Journeys”: How Are Newly Arrived Refugee Families Supported in Their Children’s Transition to School in a Host Country?

ABSTRACT Newly arrived refugee families face cultural and linguistic difficulties when navigating their children’s transition to school in a host country. However, little is known about how families are supported in their child’s transition to school. Therefore, this article aimed to investigate how leaders and facilitators in community hubs and centers support refugee families in their child’s transition to school in Australia. Data gathered from interviews with 32 community hub leaders and center facilitators from three Australian states were analyzed thematically. The support provided to families fell into six themes: promoting children’s early learning; building families’ or mothers’ capital about starting school; promoting connections between school, families, and children; offering cultural and linguistic brokerage; providing soft entry support; and easing children’s and families’ transition to school via school-based transition activities and programs. The implications of this holistic model of support for educators that is built on place and strength-based approaches in facilitating newly arrived refugee children’s and families’ smooth start to school in their new communities are outlined.

Collaboration between Lecturers and Industry in Implementing Career Transition Programs for Students with Disability

Collaboration between Lecturers and Industry in Implementing Career Transition Programs for Students with Disability