A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes

Background The transition of health care from Pediatric to Adult providers for adolescents and young adults with chronic disease is associated with poor outcomes. Despite the importance of this transition, over 80% of these patients do not receive the services necessary to transition to Adult health care. In 2018, we initiated a transition clinic structure, integrating an Internal Medicine - Pediatrics trained Adult Rheumatologist in a Pediatric Rheumatology clinic to guide this transition. Our goal was to improve transition outcomes. We report the methods of this clinic and its preliminary outcomes. Methods For patients referred to the transition clinic, the Adult Rheumatologist assumed medical management and implemented a six-part modular transition curriculum. This curriculum included a Transition Policy, Transition Readiness Assessment, medication review and education, diagnosis review and education, and counseling on differences between Pediatric and Adult-oriented care. Eligible patients and their families were enrolled in a prospective observational outcomes research registry. Initial data from this transition clinic is reported including adherence with certain aspects of the transition curriculum and clinic utilization. Results The transition clinic Adult Rheumatologist saw 177 patients in 2 years, and 57 patients were eligible for, approached, and successfully enrolled in the registry. From this registry, all patients reviewed the Transition Policy with the Adult Rheumatologist and 45 (78.9%) completed at least one Transition Readiness Assessment. Of the 22 patients for whom transition was indicated, all were successfully transitioned to an Adult Rheumatologist. 17 (77.3%) continued care post-transition with the transition clinic Adult Rheumatologist, and 5 (22.7%) continued care post-transition with a different Adult Rheumatologist. The median time between the last transition clinic visit and first Adult clinic visit was 5.1 months. Conclusions Our experience demonstrated the success of our clinic model regarding participation in the transition curriculum and improved clinic utilization data. Our results are an improvement over transition rates reported elsewhere that did not implement our model. We believe that this structure could be applied to other primary care and subspecialty clinics. Trial registration This research was approved by the University of Utah Institutional Review Board (IRB) in January 2019 (IRB_00115964). Patients were retrospectively registered if involved prior to this date.

Public Discourses on (Sectoral) Energy Policy in Switzerland

Energy transitions are based upon policy choices of sovereign nation states. Hence, politics plays a role in determining which policies governments implement and which sectors are targeted. Our chapter looks at the evolution of public discourse on energy policy as one important factor reflecting policy discussion and contestation within the political arena. Our descriptive and explorative analysis of the early public discourse in Swiss energy policy between 1997 and 2011 contributes to three main issues. First, it makes a case for the disaggregation of energy policy and its public perception to add to our understanding of energy transition pathways. We argue that looking at sectoral discourses as well as sectoral policy outputs allows for a more comprehensive understanding of the idiosyncrasies of Swiss energy policy regarding temporal as well as sectoral variation. Second, an increased politicization of energy policy may affect future policy choice, and thus any account on energy transition policy needs to scrutinize potential feedback effects from policies that manifest via policy discourse. Third, and on a more methodological stance, we argue that our approach to use news media as a representation of the public discourse via structural topic models can help to explore and explain the evolving national policy priorities regarding energy transition.

A Survey of Stakeholders’ Views and Practices

Along with policy proposers and individual voters, key stakeholders play a crucial role in shaping the socio-political acceptance of energy policy. Understanding a broad landscape of energy stakeholders’ views and practices thus should be a central theme in energy transition research. The Energy Strategy 2050 (ES2050), a sweeping energy transition policy package in Switzerland, was adopted in 2017. Concrete policy goals implied by ES2050 are yet to be implemented. Although there is a large body of social acceptance studies focusing on individual voters, we have a relatively scant empirical understanding of how stakeholders in this domain perceive the policy goals and how perceptions are linked to their organizational characteristics. To elucidate Swiss energy stakeholders’ perceptions on key action targets implied by recent energy policies in Switzerland, we analyzed data from our original survey with 364 organizations. We examined their views on concrete policy goals related to electric mobility, deep geothermal energy, wind energy, hydropower, and planned phase-outs of renewable energy subsidies. When asked to rate how realistic these goals appear to them, the majority of the stakeholders responded negatively. Furthermore, our findings indicate that, despite the considerable diversity and the overall pessimism in their feasibility perceptions, those that consider goals to be realistic are more likely to be active in the media. This is a concerning finding as the public might receive a biased impression via the media about the level of consensus among the stakeholders, who could, at times, be seen by the public as experts on the topic.

Assessment of Energy Transition Policy in Taiwan—A View of Sustainable Development Perspectives

Energy transition has become a priority for adaptive policy and measures taken in response to climate change around the world. This is an opportunity and a challenge for the Taiwan government to establish a climate-resilient power generation mixed to ensure electricity security as well as climate change mitigation. This study adopted a sustainable development perspective and applied optimal control theory to establish a cost-effective model to evaluate a long-term (2050), climate-resilient power generation mix for Taiwan. Furthermore, this study applies the STIRPAT approach to predict the demand of electricity by 2050 for the demand side management. The results not only showed the share of various power generation mixed, but also recommended the trajectory of electricity saving by 2050.