Growing Up and Moving On — Transition of Care for Patients with Childhood-onset Rheumatic Disease
Bibliographic record
Abstract
Transition, as defined by the Society of Adolescent Health and Medicine, is the “purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented healthcare systems”1. Included in this group is the growing population of adolescents and young adults with childhood-onset rheumatic conditions, such as juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE), as well as several other less common chronic inflammatory conditions. Recent longterm outcome studies have demonstrated that the majority of children with JIA continue to have active disease into adulthood, dispelling the notion that children can “outgrow” JIA2,3. Similarly, newer literature suggests that patients with childhood-onset SLE are likely to require treatment into adulthood, and are at significant risk for early morbidity and mortality in young adulthood4,5,6. These findings highlight the importance of ensuring that our patients transition successfully from pediatric to adult care, and that this transition is seamless without disruptions in treatment or planned followup. Fractured transition has the potential to lead to poor healthcare outcomes and increased healthcare system costs7,8,9. Studies examining transition in pediatric rheumatology and other chronic childhood diseases suggest that significant barriers exist with the current healthcare transition process. Using data from the National Survey of Children with Special Health Care Needs, Scal, et al reported on the proportion of adolescents with arthritis who received transition counseling. They determined that only half of young people had had a discussion with their provider about how their … Address correspondence to Dr. Hersh, Department of Pediatrics, University of Utah’s Primary Children’s Medical Center, 295 Chipeta Way, Salt Lake City, Utah 84103, USA. E-mail: aimee.hersh{at}hsc.utah.edu
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".