You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (MP12)1 May 2024MP12-18 SUPPORTING DECISION-MAKING FOR PATIENTS WITH CLINICAL T1 RENAL MASSES: COMMUNICATION NEEDS AND PREFERENCES Katherine E. Poulos, Allison Lazard, Lixin Song, Kathryn H. Gessner, Amir Feinberg, Deborah Usinger, Randall Teal, Debra Gottsleben, Marc Bjurlin, Eric Wallen, David Johnson, Mathew C. Raynor, and Hung-Jui Tan Katherine E. PoulosKatherine E. Poulos , Allison LazardAllison Lazard , Lixin SongLixin Song , Kathryn H. GessnerKathryn H. Gessner , Amir FeinbergAmir Feinberg , Deborah UsingerDeborah Usinger , Randall TealRandall Teal , Debra GottslebenDebra Gottsleben , Marc BjurlinMarc Bjurlin , Eric WallenEric Wallen , David JohnsonDavid Johnson , Mathew C. RaynorMathew C. Raynor , and Hung-Jui TanHung-Jui Tan View All Author Informationhttps://doi.org/10.1097/01.JU.0001009376.16371.fb.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Decision-making for patients with clinical T1 renal masses has become increasingly nuanced and complex, with most patients experiencing decisional conflict at some point in their decision-making process. Given the emerging link between communication and decisional conflict, we sought to explore patient communication needs and preferences to better support patient decision-making for clinical T1 renal masses. METHODS: We recruited patients previously enrolled in GRADE-SRM, a prospective clinical trial investigating decision-making and cancer genomics, to participate in a follow-up study on decision-making and communication. Participants were sampled based on high (21) vs. low (19) decisional conflict. Trained qualitative researchers performed semi-structured interviews on the decision-making experience then conducted a coding-based analysis to define themes on communication needs and preferences that impact decision-making. RESULTS: Among 40 participants, mean age was 65.1, 58% were male and 27.5% were non-White. Patient communication needs and preferences fell into three thematic domains: content, delivery, and context (Figure 1). For content, participants desired mass-specific information, risks and benefits of treatment options (both recommended and not recommended), and clarifying treatment details, including approach, logistics, acute course, and recovery. Preferences for delivery varied greatly among patients, but overall, participants emphasized the importance of building trust with their surgeon, establishing rapport, and receiving tailored information. Overwhelmingly, patients desired to feel included in the process, which was facilitated by the surgeon encouraging patient questions, gauging patient values and priorities, and showing appreciation for their lived experiences. These two domains appeared influenced by the conditions surrounding communication (i.e., context), with participants valuing consistency of information across sources and time with their surgeon. CONCLUSIONS: Beyond content, the delivery and context in which information is communicated appear to weigh heavily on decision-making for clinical T1 masses. Efforts to improve decision-making may consider these aspects of communication in their developmental process. Download PPT Source of Funding: This work was supported by funding from the Department of Defense © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e208 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Katherine E. Poulos More articles by this author Allison Lazard More articles by this author Lixin Song More articles by this author Kathryn H. Gessner More articles by this author Amir Feinberg More articles by this author Deborah Usinger More articles by this author Randall Teal More articles by this author Debra Gottsleben More articles by this author Marc Bjurlin More articles by this author Eric Wallen More articles by this author David Johnson More articles by this author Mathew C. Raynor More articles by this author Hung-Jui Tan More articles by this author Expand All Advertisement PDF downloadLoading ...

The purpose of this study was to examine factors associated with expectations regarding postsecondary education of students with autism spectrum disorder between the ages of 16 and 21 years. We conducted logistic regressions using variables at the student, family, and school levels using the National Longitudinal Transition Study 2012. Logistic regression results showed that parental expectations for attending college was the only significant predictor of students' own educational expectations. Students' adaptive functioning, autonomy levels, demographic and family variables, parent involvement, and prior roles in Individualized Education Program/transition planning were not significant predictors. Future research needs to examine how schools can develop effective ways to increase both students' and parents' expectations toward postsecondary education.

This study used data from the National Longitudinal Transition Study 2012 (NLTS 2012) to explore the future goal aspirations of students with extensive support needs who participate in alternate assessments, compared to other students with extensive support needs and to students with other disabilities. We examined students' individualized education program (IEP)/transition planning meeting experiences and postschool goals in relation to their functional, communication, and self-advocacy skills, as well as their school/community support. Students with other disabilities held higher expectations than all students with extensive support needs for future participation in postsecondary education, employment, independent living, and financial independence. All students had higher postschool goal expectations than their parents. Implications for supporting students with extensive support needs and directions for future research and practice are discussed.

Using National Longitudinal Transition Study 2012 data, this study explored parent and youth expectations in the areas of postsecondary education, employment, independent living, and financial independence. Compared to youth with other disabilities, youth with intellectual and developmental disabilities and their parents had much lower expectations for the four postschool goals, and parent expectations were much lower than youth's own expectations. Also, youth's race, along with their daily living skills and functional abilities, were positively associated with parent and youth expectations in several future goal areas. Our discussion highlights implications for improving the transition experiences of youth with intellectual and developmental disabilities.

Vaccination in pregnancy using a tetanus toxoid, reduced dose diphtheria toxoid, and reduced dose acellular pertussis (Tdap) vaccine is important for prevention of severe pertussis disease in young infants. The objectives of this systematic literature review were to search for original research studies evaluating the vaccine effectiveness, immunogenicity, and safety of Adacel®/Adacel-Polio® used during pregnancy to prevent pertussis disease in young infants. Medical databases used included EMBASE, BIOSIS Previews, and Chemical Abstracts, with search terms related to pregnancy, vaccines/immunization, safety, pertussis, effectiveness/efficacy, and immune response; other potentially eligible reports were included where applicable. Search results were restricted to literature published from 1 January 1995 to 26 July 2021. A total of 2021 articles and 4 other reports were identified for primary review. A total of 49 publications qualified for inclusion after primary and secondary reviews. Effectiveness studies of Adacel or Adacel-Polio given in pregnancy consistently showed high levels of protection from pertussis disease in the newborn (vaccine effectiveness: 91–93%). In immunogenicity studies, the response in pregnant women was consistent with that of non-pregnant women. Infants of mothers vaccinated with Adacel or Adacel-Polio in pregnancy had higher anti-pertussis antibody levels at birth and at 2 months of age compared to infants born to women vaccinated with comparator vaccines, placebo, or those not vaccinated during pregnancy. There was evidence of a slightly decreased response to primary pertussis vaccination in infants of mothers vaccinated with Adacel or Adacel-Polio, but this was not thought to be clinically significant. In safety studies, Adacel or Adacel-Polio vaccination was well tolerated by pregnant woman and not associated with pregnancy, postpartum, or neonatal complications. In conclusion, Adacel or Adacel-Polio vaccination in pregnancy is highly effective in protecting young infants from pertussis disease, with a favorable safety profile for both pregnant women and their infants.

What we know about transition-age ELs with disabilities comes from a limited number of studies and reports. These students face multiple obstacles to achieving the benchmarks of post-school success, including coming from disadvantaged socioeconomic backgrounds and having lower academic achievement than other students with disabilities. This study analyzed National Longitudinal Transition Study 2012 data to explore parents' expectations for their child's future goal aspirations, including postsecondary education, independent living, and financial independence for English learners (ELs) with disabilities and compared results with non-ELs with disabilities. Results showed parent expectations varied by disability category and post-school goals. Also, parents of ELs with disabilities, compared to non-ELs with disabilities, had higher expectations for their child to be financially independent by age 30. The analysis also identified several individual and family predictors of these post-school goals for both parent groups. Implications for research and practice are discussed.

The increase in English learners (ELs) with disabilities has been reported by others, yet little is known about the transition planning meeting experiences of this population and their post-school expectations. This study explored transition planning experiences and post-school expectations of a nationally representative sample of ELs with disabilities by examining the National Longitudinal Transition Study 2012 dataset. Results showed that ELs with disabilities were more likely to take a passive role in transition planning and less likely to be involved in developing goals during the Individualized Education Program (IEP) transition planning meeting. ELs with disabilities, compared to non-ELs with disabilities, had lower expectations for being financially independent by age 30. These findings underscore the importance of specifically addressing the cultural and linguistic needs of ELs with disabilities during the IEP transition planning process and suggest recommendations for educational policy and practice for this population.

BACKGROUND: Preeclampsia affects between 2% and 5% of preg-nancies and is one of the leading causes of perinatal morbidity and mortal-ity worldwide. Despite strong evidence that the combination of systematic preeclampsia screening based on the Fetal Medicine Foundation pre-eclampsia risk calculation algorithm with treatment of high-risk patients with low-dose aspirin reduces the incidence of preterm preeclampsia more than currently used risk-factor-based screening, real-world imple-mentation studies have not yet been done in Canada.OBJECTIVE: This study aimed to assess the operational feasibility of implementing first-trimester screening and prevention of preterm pre-eclampsia (<37 weeks) alongside a publicly funded first-trimester com-bined screening program for aneuploidies.STUDY DESIGN: This was a prospective implementation study. Consecu-tive pregnant patients referred for first-trimester combined screening (11-13 +6 weeks) were offered screening for preeclampsia based on the Fetal Medi-cine Foundation algorithm concomitantly with their aneuploidy screen. Consent-ing participants were screened using maternal risk factors, mean arterial pressure, uterine artery Doppler pulsatility index, pregnancy-associated plasma protein-A, and placental growth factor. Risk for preterm preeclampsia (<37 weeks) was calculated using the Fetal Medicine Foundation algorithm, and indi-viduals with a risk score >1 per 100 were recommended to use aspirin (162 mg once daily at bedtime, <16-36 weeks). Implementation metrics assessed included: acceptability, operational impact, proportion of aspirin initia-tion, quality and safety measures, and screen performance.RESULTS: Between December 1, 2020 and April 23, 2021, 1124 patients consented to preeclampsia screening (98.3% uptake), and 92 (8.2%) screened positive. Appointments for patients receiving first -trimes-ter combined screening aneuploidy and preeclampsia screening averaged 6 minutes longer than first-trimester combined screening alone, and add-ing uterine artery Doppler pulsatility index averaged 2 minutes. Of the 92 patients who screened as high-risk for preeclampsia, 72 (78.3%) were successfully contacted before 16 weeks' gestation. Of these, 62 (86.1%) initiated aspirin, and 10 (13.9%) did not. Performance audit identified a consistent negative bias with mean arterial pressure measurements (median multiple of the median <1 in 10%); other variables were satisfac-tory. There were 7 cases of preterm preeclampsia (0.69%): 5 and 2 in the high-and low-risk groups, respectively. Screening detected 5 of 7 (71.4 %) preterm preeclampsia cases, with improved performance after adjust-ment for aspirin treatment effect.CONCLUSION: This study confirms the operational feasibility of imple-menting an evidence-based preeclampsia screening and prevention program in a publicly funded Canadian setting. This will facilitate imple-mentation into clinical service and the scaling up of this program at a regional and provincial level.

OBJECTIVE:To evaluate the effectiveness of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine containing five pertussis components (Tdap5; Adacel®, Sanofi) when given during pregnancy at preventing pertussis in infants less than 2 months of age. METHODS:The US Centers for Disease Control and Prevention (CDC), in collaboration with the Emerging Infections Program (EIP) Network, undertook a case-control study evaluating the effectiveness of Tdap vaccination in pregnancy against pertussis in infants less than 2 months of age based on data collected by the EIP Network from 2011 through 2014. The dataset from the CDC/EIP Network study was used to conduct this product-specific vaccine effectiveness analysis of Tdap5 vaccination in pregnancy to prevent disease in young infants. The main outcome of interest was vaccine effectiveness in infants whose pregnant parents were vaccinated with Tdap5 between 27 and 36 weeks' gestation, in accordance with the ideal timing for Tdap vaccination in pregnancy recommended by the US Advisory Committee on Immunization Practices. Odd ratios (ORs) and 95 % confidence intervals (CIs) were estimated using conditional logistic regression, and vaccine effectiveness was calculated as (1-OR) × 100 %. RESULTS:There were 160 infant pertussis cases and 302 matched controls included in this Tdap5-specific study. Tdap5 effectiveness in preventing pertussis in infants whose pregnant parents were vaccinated between 27 and 36 weeks' gestation was 92.5 % (95 % CI, 38.5 %-99.1 %). Effectiveness of Tdap5 against pertussis-related hospitalization in infants whose pregnant parents were vaccinated between 27 and 36 weeks' gestation could not be calculated due to lack of discordance among matched cases and controls. Vaccination of the parents after pregnancy or less than 14 days before delivery did not protect infants from pertussis. CONCLUSIONS:Tdap5 vaccination in pregnancy between 27 and 36 weeks' gestation is highly effective at protecting young infants from pertussis. STUDY REGISTRATION:ClinicalTrials.gov, NCT05040802.

Abstract The purpose of this study was to use data from the United States' National Longitudinal Transition Study 2012 (NLTS 2012) to present descriptive information on youth and parent participation and youth's role in required Individualized Education Program (IEP)/transition planning meetings by disability category and age groupings (14-22 year olds, 14-15 year olds, and 16-22 year olds). The study found that youth and parent attendance in IEP/transition planning meetings was high across disability categories, but the extent to which youth and parents met with teachers to discuss transition goals was much lower. Data from NLTS 2012 and a previous U.S. study, the National Longitudinal Transition Study 2 (NLTS2), were compared for youth's participation with school staff in discussing transition goals. A significant decline in participation was found over the past decade. Logistic regression analyses illustrated differences in youth and parent participation and youth's role by disability category.

One important aspect of special education research that makes it complex is the variability of the disability categories being studied. This study used the context of Individualized Education Program (IEP)/transition planning and National Longitudinal Transition Study 2012 (NLTS 2012) student and parent survey items associated with this context to illustrate the challenges of grouping disability categories. We examined how disability groupings are treated similarly with respect to their transition planning experiences across different survey items. Findings illustrate that the 12 transition-related disability categories can be empirically formed into four clusters according to their IEP/transition planning meeting experiences. Results indicate that regardless of the scale used, these groupings are relatively consistent (e.g., autism, multiple disabilities, and orthopedic impairments were always together), but different from groupings based on theory or another set of items (e.g., self-determination). Implications for practice and future research are discussed.

This paper describes the process that the faculty at the University of Minnesota used to redesign its graduate programs in evaluation. We build from the premise that evaluator education programs undergo periodic review to remain consistent with program goals and maintain alignment with competency taxonomies. With the retirement of a senior faculty member and the addition of a new junior faculty member, we decided the time had come to examine closely the existing MA and PhD curriculum. We describe our process for conceptualizing the program’s ultimate goals, examining course content, cross-referencing the courses with the AEA Competencies, and aligning all courses and processes with our revised programmatic goals. The result is a redesigned and streamlined curriculum to support evaluation practice for master’s students and both scholarship and practice for doctoral students.

Prior research has demonstrated that paid work experience while in school is a predictor of postschool employment outcomes for youth with disabilities. For youth with Autism Spectrum Disorder (ASD), early paid work experience in high school can provide a place to learn occupational skills as well as develop communication, problem solving and interpersonal skills and behaviors that are essential for obtaining and maintaining employment. In the present study, we examined the extent to which youth with ASD have engaged in early paid work experiences while in school and factors associated with such experiences, using data from the National Longitudinal Transition Study 2012 . We found that approximately 24.4% of youth with ASD reported having been involved in a paid work experience during high school at some point within the past year. Further, age, social engagement, household income, and parent expectations were significant predictors of early paid work experience. Implications for practice and research are discussed.

Research suggests that bullying victimization occurs at higher rates among students with autism spectrum disorder (ASD) than among their typically-developing peers. This study used data from the National Longitudinal Transition Study 2012 to explore differences in student and family characteristics between students with ASD and students with all other special education disability categories. The study also examined characteristics serve as predictors of bullying and victimization. Students with ASD were found to have greater difficulties with communication and social skills, as well as less-robust sense of themselves and their abilities than students with all other disabilities. Race, household income, social and communication skills, and self-concept were found to be associated with higher rates of bullying and victimization.

Objectives: The goal of this study was to investigate diversity in stakeholders' perspectives on how best to maximize older adults' well-being when they use long-term services and supports (LTSS). Methods: We used Q methodology, an exploratory method, to investigate preference patterns among a purposive sample of older adults, family members, and leadership professionals (n = 57). Participants categorized 52 items related to 9 domains of LTSS quality relevant to well-being into categories of importance. We used factors analysis and qualitative methods to identify groups of individuals who identified similar priorities. Results: The analysis identified four shared viewpoints, each prioritizing different aspects of well-being: 1) physical health and safety; 2) independence; 3) emotional well-being; and 4) social engagement. Individual and contextual factors, including stakeholder role, care needs, and expectations for LTSS, appeared to influence participants' perspectives. Conclusions: Distinct viewpoints on how to maximize well-being when older adults use LTSS exist. Our results affirm the importance of person-centered care yet demonstrate that shared preference patterns LTSS exist. Clinical Implications: Engaging with older adults' values and preferences is critical to improving their experiences with LTSS. Better understanding common preference patterns could help providers deliver person-centered care more efficiently and effectively.

This study used data from the National Longitudinal Transition Study 2012 (NLTS 2012) to explore the individualized education program (IEP)/transition planning participation and role of students with the most significant cognitive disabilities, compared to students with other disabilities. We viewed students with the most significant cognitive disabilities as those included in three disability categories—autism, intellectual disability, and multiple disabilities—who took an alternate assessment. The study also included an analysis of student’s participation in relation to their functional, communication, and self-advocacy skills, and student–teacher relationships. Although students with the most significant cognitive disabilities experienced greater limitations overall, students with other disabilities were experiencing similar challenges. Implications for practice were discussed from the lens of student engagement, self-determination, and student’s leadership role.

The addition of boron to steel alloys results in an increase in both hardenability and casting defects. The casting difficulties are predicted to stem from a metatectic reaction, delta + gamma -> L + gamma, where a fully solidified material begins to locally remelt as the temperature decreases. Another possible source of casting defects is a boride-rich phase that is predicted to remain liquid at low temperatures. To experimentally determine which reaction is the likely source of the casting defects, the predicted reactions and the effect of solute elements on those reactions are investigated. Levitation zone melting is used to control segregation in a ternary Fe-C-B alloy and a commercial 22MnB5 alloy. Carbon segregation and a peritectic reaction result in a peritectic jump during directional solidification where the first directionally solidified (DS) zone undergoes delta-bcc solidification followed by a peritectic jump to steady state planar solidification of gamma-fcc in the second DS zone. The presence of other solute elements in the zone melted 22MnB5 alloy lead to a breakdown in the planar solidification front before steady state solidification could be achieved in the second DS zone. With a cellular solid/liquid interface, boron-rich intercellular liquid formed low melting iron boro-carbide particles. The controlled solidification conditions in a levitation zone melter were unable to prevent similar to 0.003 wt% boron from segregating to high enough levels to form boride particles. Therefore, it is likely that during commercial casting, the formation of the low melting boride phase from interdendritic segregation is a key source of the casting issues.