Search

OBJECTIVE: Sick leave is a major negative economic effect of the COVID-19 pandemic. In April 2021, the Integrated Benefits Institute reported that employers spent a total of US $50.5 billion for workers absent due to the COVID-19 pandemic. While vaccination programs lowered the number of severe illness and hospitalizations worldwide, the number of side effects following vaccination against COVID-19 were high. The present study aimed to evaluate the effect of vaccination on the probability of taking sick leave in the week following vaccination. SUBJECTS AND METHODS: The study population was comprised of all personnel serving in the Israel Defense Forces (IDF) between October 7, 2020, and October 3, 2021, (a total of 52 weeks) who were vaccinated with at least one dose of the BNT162b2 vaccine. Data on Israel Defense Forces (IDF) personnel sick leaves were retrieved and the probability of a “post-vaccination week sick leave” and a “regular (not post-vaccination week) sick leave” were analyzed. An additional analysis was performed to determine whether winter-related diseases or the sex of the personnel affected the probability of taking sick leave. RESULTS: The probability of taking sick leave in a post-vaccination week was significantly higher than the probability of taking sick leave in a regular week (8.45% vs. 4.3%, respectively, p < 0.01). The increased probability remained unchanged after analysis of sex-related and winter disease-related variables. CONCLUSIONS: Given the major effect of vaccination against COVID-19 by BNT162b2 vaccine on the probability of taking sick leave, when medically feasible, the timing of the vaccination should be considered by medical, military, and industrial authorities with the intent to minimize the effect on overall national economy and safety. [ABSTRACT FROM AUTHOR]

On December 5th, 2022, controlled fusion ignition was demonstrated for the first time at the National Ignition Facility (NIF), a major achievement in the field of Inertial Confinement Fusion (ICF) requiring a multi-decadal effort involving broad national and international collaborations. To drive the fusion ignition reaction with the compressed fuel capsule, that yielded 3.15 MJ of nuclear energy [ 1 ], the NIF laser delivered a high-precision pulse shape with 2.05 MJ of ultra-violet (UV) laser energy and a peak power of 440 TW. This laser energy was an increase of ∼8 % compared to that delivered on the previous "threshold of ignition" record yield experiment (1.37 MJ of yield for 1.89 MJ of laser energy) on August 8th, 2021 [ 2 ]. We explain how the results of our extensive research in laser technology and UV optics damage mitigation led to major improvements in the NIF laser, enabling this energy increase along with additional accuracy, precision, and power balance enhancements. Furthermore, we will discuss on-going efforts that have enabled operations at 2.2 MJ of UV energy as well as potential new initiatives to push the laser performance –accuracy and delivered energy– to even higher levels in the future as previously demonstrated on a small subset of NIF beams [ 3 ]. [ABSTRACT FROM AUTHOR]

The risk of cancer in adults with congenital heart disease (ACHD) is 23% higher than in the general population. The objective of our study was to assess cancer screening coverage in ACHD. This was a prospective, observational, bicentric study of ACHD patients. Data were collected through a self-questionnaire proposed to all consecutive patients over 25 years from September 2022 to March 2023. Information on cervical, breast and colorectal cancer screening was collected and compared with screening data provided by Santé Publique France. A total of 263 patients were included. The mean age was 44 years (range, 25–78), 122 (46%) patients were male, and 99 (38%) patients had a complex CHD. Eleven (4%) patients had a history of cancer. The screening participation rate for breast cancer was higher in ACHD patients (72%) compared to the general population from Ile de France region (39%, p < 0.001) and from the whole French population (51%, p = 0.002). For colorectal and cervical cancers, the screening participation rate were 36% and 65%, compared to 31% and 51% in Île de France region and 34% and 59% in the whole French population, respectively with no statistically significant difference (Figure 1). Cancer screening coverage in ACHD patients was greater than non-congenital patients for breast cancer, but comparable for colorectal and cervical cancers. The screening participation rate remained however lower than European objectives for all cancers. Our data call for specific actions to better screen this aging population at high risk for cancer. [ABSTRACT FROM AUTHOR]

Thanks to the progresses made in the management of congenital heart diseases (CHD), life expectancy of these patients has greatly improved, including those of patients with complex CHD. Epidemiology of this growing population is rapidly evolving. French data are needed to prepare each regional healthcare plan. We aim to analyse national PMSI database to assess trends and projections. We investigated the number of hospitalizations stay of children and adults with CHD over 10 years from 2013 to 2022 in France. Complexity of CHD was defined according to M3C classification. Number of hospital stays of patients with CHD varied from 37,339 to 45,310 in total and from 9,320 to 11,006 for patients with complex CHD. Over 10 years, the latter represent 26.2% of all hospitalizations. In children, it varied from 19,787 to 23,023 in total and from 5,714 to 6,987 for children with complex CHD. Over 10 years, the latter represent 30.6% of all hospitalizations. The number of neonates with CHD hospitalized is very stable over time ranging from 1380 to 1596. A similar trend is observed for children. In adults with CHD, it increased continuously by 55.9% from 15,056 to 23,475 and from 3,564 to 4,294 for adults with complex CHD. Over 10 years, the latter represent 21.0% of all hospitalizations. There is an increase in hospitalizations in adults with CHD with a 5-year projection suggesting an increase up to 35%. In particular number of ACHD hospitalized for management of arrhythmia or for catheterization has almost doubled over 10 years (Figure 1). Number of children with complex CHD seems to be very stable over time. On the other hand, there is a growing number of hospitalizations in adults with CHD. Next healthcare plan should contribute to develop facilities for the specific management of adults with CHD in these centres. [ABSTRACT FROM AUTHOR]

A typical olive (Olea europaea L.) inflorescence consists of about 20 flowers. However, in many cultivars, only one fruit develops. This is due to massive abscission of flowers and fruitlets, which occurs during the first month after anthesis. In this study, we used the olive cultivar 'Barnea' to characterize the abscission mechanism and to try to increase fruit set by increasing the number of developed fruit per inflorescence. Removing the lateral flowers 3 weeks before anthesis increased fruit set by more than 50%. Removing all inflorescences but one from a branch increased the number of developed fruits from 0.93 to 2.8 during 2017 and from 0.91 to 3.34 fruits per inflorescence in 2018. Sugar quantification in the pistil revealed that starch level is high on the day of anthesis and low 25 days later in abscised as well as in developed fruit. Soluble carbohydrates are low on the day of anthesis, low in abscised flowers/fruitlets 25 days after anthesis and high in developed fruit. Screening the natural variation found in the Israeli germplasm collection revealed that in most cultivars less than one fruit per inflorescence has developed. However, there are unique cultivars with a higher fruit set. [ABSTRACT FROM AUTHOR]

The risk of cancer in adults with congenital heart disease (ACHD) is 23% higher than in the general population. The objective of our study was to assess cancer screening coverage in ACHD. This was a prospective, observational, bicentric study of ACHD patients. Data were collected through a self-questionnaire proposed to all consecutive patients over 25 years from September 2022 to March 2023. Information on cervical, breast and colorectal cancer screening was collected and compared with screening data provided by Santé Publique France. A total of 263 patients were included. The mean age was 44 years (range, 25–78), 122 (46%) patients were male, and 99 (38%) patients had a complex CHD. Eleven (4%) patients had a history of cancer. The screening participation rate for breast cancer was higher in ACHD patients (72%) compared to the general population from Ile de France region (39%, P < 0.001) and from the whole French population (51%, P = 0.002). For colorectal and cervical cancers, the screening participation rate were 36% and 65%, compared to 31% and 51% in Île de France region and 34% and 59% in the whole French population, respectively with no statistically significant difference (Figure 1). Cancer screening coverage in ACHD patients was greater than non-congenital patients for breast cancer, but comparable for colorectal and cervical cancers. The screening participation rate remained however lower than European objectives for all cancers. Our data call for specific actions to better screen this aging population at high risk for cancer. [ABSTRACT FROM AUTHOR]

This study examined the long-term thermal perception and adaptation to a hot and arid climate of immigrants from cold regions as compared to native-born residents. The study was conducted in the desert city of Beer Sheva, Israel, population 220,000 inhabitants, including 50,000 immigrants from cold climates of Eastern Europe and Central Asia. Climatic measurements were made in winter and summer during 2010–2015 in various outdoor environments in the city, accompanied by questionnaire surveys including 2863 valid responses. Results showed that female immigrants were the most tolerant to the winter cold thermal conditions and their lower limit of neutral temperature was 3–4.5 °C PET lower than the other groups. During the summer, the difference in thermal sensation between genders and origins became negligible above 35 °C PET. The 90% Thermal Acceptability Range (TAR) for the winter was 13–22 °C PET for female immigrants and 17–24 °C PET for male native-born. In summer, the TAR upper limit for all groups was similar. Clothing insulation played an important role, where female immigrants usually used higher clothing insulation than natives. Immigrants from cold climatic backgrounds achieved long-term thermal adaption to the cold arid thermal conditions, and to the hot, arid climatic conditions by adapting behavioral thermal adjustment. [Display omitted] • We examined long-term thermal perception of a hot and arid climate by immigrants from cold zones. • Immigrants from cold zones cope better with arid zone winter conditions than native-born. • Immigrants and native-born thermal sensitivity to hot conditions is similar. • Female immigrants had the best thermal adaption in our study. • Immigrants from cold zones cope with hot, arid climate mainly by adapting behavioral adjustment. [ABSTRACT FROM AUTHOR]

Truncus arteriosus (TA) is a rare lesion, defined by a single great vessel from which the pulmonary arteries, aorta, and coronary arteries arise. Operative correction has dramatically reduced mortality. However, the adult life of these patients is still affected by the burden of reinterventions. Quality of life (QoL) has become an important issue in patients with congenital heart disease (CHD). Accordingly, the focus has shifted from mere survival to a better QoL. Despite a good understanding of the longterm surgical outcomes, there are no data on the health-related quality of life following TA repair in those who reach adulthood. This study aimed to explore QOL and physical activity in a cohort of adults with TA. QOL was assessed using the 5-level EQ-5D version (EQ-5D-5L). Physical activity was assessed using the Ricci-Gagnon self-questionnaire. Ninety-three adult patients (age > 16 years on 31 December 2019) with TA were identified in our centre for this study. Of these, 64 (69%) participated and completed the questionnaires. Medical records were reviewed. Associations of QOL with patient's characteristics were assessed. Mean age was 24 years (±6.5) and 27 (41.5%) were male. Three of them did not undergo repair and were in Eisenmenger status. Age at repair was 136 days (±418). All repaired patients underwent reinterventions in childhood either by surgery or catheterism (from 1 to 10 reinterventions/patient) whereas 17 (26%) underwent reinterventions in adulthood. Overall, they reported a good QOL comparable to French population norms with a mean EQ-5D Index of 0.84 (±0.21). 41% patients reported to be active. Reinterventions in adulthood was the only variable associated with better QOL (P < 0.01). The distribution of the index values (QOL) according to of the number of reinterventions in adulthood is shown in Fig. 1. TA patients experience a generally good QOL with a positive association of QOL with reinterventions in adulthood. [ABSTRACT FROM AUTHOR]

Limited data are available on the prognostic value of haemodynamic parameters in pulmonary arterial hypertension associated to congenital heart disease (PAH-CHD). The benefit of repeated invasive hemodynamic measurements in PAH-CHD patients remains controversial. The main objective of this study was to assess the prognostic value of haemodynamic variables in PAH-CHD. This bi-centre retrospective study included 109 patients with a median age of 47 [36-38] year-old with PAH-CHD (female, 69%). A multiparametric evaluation was performed, including clinical, hemodynamical, using a robust standardized approach based on Fick principle and oxygen consumption measurement, and cardiac magnetic resonance parameters (n = 44). Sixty-four (59%) patients had a pre-tricuspid defect. Eisenmenger syndrome was presented in 66 patients (60%). Fifty-three (49%) patients were in WHO/NYHA function class III or IV, heart rate was 80 beats.min [73–88], six-minutes walking-distance was 406 m [355–470] and oxygen saturation at rest was 91% [84–96]. Pulmonary vascular resistance (PVR) was 10 Wood Units (WU) |5–16] and mean pulmonary artery pressure (mPAP) 53 mmHg [41–69]. Eighty-four (77%) patients received PAH-specific drug therapy. Median follow-up was 17 months [10–32]. Primary outcome (death or transplantation) occurred in 29 (26%) (16 deaths, 8 underwent double-lung transplant, two cases with later atrial septal defect percutaneous closure, and 5 underwent heart-lung transplant). In multivariate analysis, right ventricular (RV) failure signs (HR 3.1; CI 95% 1.2–7.7; P = 0.01), heart rate (HR 1.1; CI 95% 1.01–1.1; P < 0.001), tricuspid annular plane excursion (TAPSE) (HR 0.84; IC 95% 0.73–0.96; P = 0.01) and PVR (HR 1.1; CI 95% 1.1–1.2; P < 0.001) remained significant predictors of death or transplantation (Fig. 1). Invasive assessment of haemodynamics in patients with PAH-CHD remains the cornerstone of their prognostic assessment. PVR seems to be a strong and independent predictor of mortality and transplant in PAH-CHD patients. [ABSTRACT FROM AUTHOR]

Pulmonary autograft reinforcement to prevent dilatation and subsequent neo-aortic valve regurgitation was reported. However, the late functional outcome of the native pulmonary valve inside a rigid Dacron conduit requires to be documented. We aimed to assess the results of modified Ross procedure associated with autograft reinforcement reimplantation technique. Outcomes of 61 consecutive patients who underwent Ross procedure with reinforcement between 2009 and 2021 were analyzed. Majority of cases has presented with mono or bicuspid aortic valve (n = 52; 85%), predominant aortic valve regurgitation (n = 47; 77%) and dilatation (> 30 mm) of the ascending aorta (n = 33; 54%). Forty-seven patients (77%) had prior aortic valve procedure including 38 surgical repair (62%) and 9 balloon dilatation (15%). Pulmonary autograft was reimplanted in a Dacron conduit of a median diameter = 25.6 mm (ranges: 20–30) using Tirone David's valve sparing aortic root replacement technique. No death occurred. Median age at procedure was 16.8 years (range: 6–38). Two patients (3%) required early neo-Aortic root revision, one other was reoperated later on resulting in neo-aortic valve replacement in 3 (4.9% IC 95% [0.34%; 12.7%]) because of respectively infective endocarditis, left ventricular false aneurysm and leaflet perforation. Six patients required right ventricular outflow conduit replacement including one percutaneous replacement. At mean 66 ± 50.5 months postoperatively, the survival rate with freedom from reintervention was 83% [71.9; 93.5] and the deterioration of the initial neo-Aortic valve function (regurgitation or stenosis) was not observed (Fig. 1). Autograft reinforcement by means of reimplantation technique allowed to extend the indications for Ross procedure to all patients requiring Aortic valve replacement and prevented neo-Aortic root dilatation. Failures were early and rare, and late controls confirmed the stability of the neo-aortic valve function in follow-up. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Biology is the property of Instituto Internacional de Ecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Adults with Autism Spectrum Conditions (ASC) experience marked difficulties in recognising the emotions of others and responding appropriately. The clinical characteristics of ASC mean that face to face or group interventions may not be appropriate for this clinical group. This article explores the potential of a new interactive technology, converting text to emotionally expressive speech, to improve emotion processing ability and attention to faces in adults with ASC. We demonstrate a method for generating a near-videorealistic avatar (XpressiveTalk), which can produce a video of a face uttering inputted text, in a large variety of emotional tones. We then demonstrate that general population adults can correctly recognize the emotions portrayed by XpressiveTalk. Adults with ASC are significantly less accurate than controls, but still above chance levels for inferring emotions from XpressiveTalk. Both groups are significantly more accurate when inferring sad emotions from XpressiveTalk compared to the original actress, and rate these expressions as significantly more preferred and realistic. The potential applications for XpressiveTalk as an assistive technology for adults with ASC is discussed. [ABSTRACT FROM AUTHOR]

Dilatation of the pulmonary autograft resulting in aortic valve regurgitation represents a common issue following Ross procedure with root replacement, in particular when performed beyond childhood. We present our early experience with modified Ross procedure associated with autograft reinforcement using reimplantation technique. Records of 59 consecutive patients who underwent Ross procedure with reinforcement between 2009 and 2021were analysed. Pulmonary autograft was reimplanted in a Dacron conduit of a median diameter = 26 mm (range: 20–30) using Tirone David's technique of valve sparing aortic root replacement (VSRR). Median age was 17 years (range: 6–38). Majority of cases has presented with mono or bicuspid aortic valve (n = 50; 85%), predominant aortic valve regurgitation (n = 38; 64%) and dilatation (> 30 mm) of the ascending aorta (n = 32; 54%). Forty-six (78%) had at least one prior aortic valve procedure. No death occurred. Three patients required early procedure-related reoperation 8 others were reoperated on later resulting in 3 neo-aortic valve replacement all-over (5%). The mean duration of follow-up was 46 ± 12 months. Neither more than mild autograft regurgitation nor stenosis was observed. Mean diameters of the autograft annulus and sinotubular junction were respectively 24.8 ± 2.6 mm and 25.3 ± 2.1 mm at discharge and 25.3 ± 2.1 mm and 25.4 ± 2.7 mm at the last visit (P = 0.06 and 0.08). Autograft reinforcement by means of reimplantation technique prevented neo-aortic root dilatation and allowed to extend the indications for Ross procedure to patients for whom the conventional Ross technique was qualified to be unsuitable. Early failure was rare (5%) and mid-term outcomes confirmed the stability of the neo-aortic valve function in follow-up. [ABSTRACT FROM AUTHOR]

Although perinatal complications during pregnancy in women with Congenital Heart Disease (ACHD) are well known, the pathophysiological mechanisms are still to be elucidated. As the placenta is the interface between mother and fetus, its analysis might help to better understand their interactions and identify risk factors for complications. We hypothesize that abnormal findings would be more frequent in placentas of women with CHD than in those without cardiac disease. The main objective of this study is to compare the incidence of placental abnormalities (PA) in ACHD versus controls women. The present proposal is to conduct a prospective, multicentric, national, 2-years (2023–2024) cohort study (research involving human type III), in order to analyze Doppler imaging and histological placentas, and compare findings in a group of women with ACHD versus a group without. The secondary objectives of the study are to assess the association between PA and the occurrence of maternal cardiovascular, fetal and/or perinatal complications, and to assess risk factors for PA or maternal/fetal events (Fig. 1). Placentas of ACHD would have significantly (P < 0.05) more abnormalities and these would correlate with the occurrence of complications. Description of PA could help to elucidate the pathophysiological mechanisms and eventually propose preventive therapeutic strategies of fetal and/or neonatal complications. Risk factors could be stratified according to the type of heart disease (as the mWHO score) and could allow to propose a novel risk-score of pregnancy in women with CHD. [ABSTRACT FROM AUTHOR]

Cardiac ultrasound has remained the primary tool for diagnostic and surgical decision-making for congenital heart disease (CHD). With recent developments in fusion imaging especially between CT and 3D echocardiography, previously described in percutaneous tricuspid annuloplasty and left atrial appendage closure, we obtain more information from combined images. Our aim is to study the feasibility and the added preoperative input and educational value of CT/3D-US fusion in prospective cohort of CHD patients more specifically in double outlet right ventricle, where a biventricular repair approach may need delicate preoperative analysis in order to achieve the best result. We prospectively included 25 patients (median age: 5 years) with mild to complex CHD, who underwent cardiac CT and 3D transthoracic echocardiography as part of their pre-operative or follow-up evaluation at our centre. We included three complete atrioventricular canal, three transposition of the great arteries, two congenitally corrected transposition of the great arteries with VSD and pulmonary stenosis, seven double outlet right ventricle, three truncus arteriosus, two tetralogy of Fallot, three Sinus Venosus ASD, one multiple VSD and one congenitally abnormal aortic valve. Time for completing fusion process and the quality of fusion between CT and 3D-US were noted. Educational value was evaluated by fellows. Fusion was successful in all patients with median fusion quality scored 4/5. The median time to complete the fusion process was 735 seconds [628–1163] regardless of the cardiopathy complexity. Landmarks were significantly modified in complex congenital heart disease. Educational value was scored by fellows (C: No-Little value; B: Intermediate value; A: Major value) (Fig. 1). Using Fusion modatily is feasible for everyone with little knowledge. The simultaneous visualization of intracardiac structures with fusion helps better understand anatomical relations of atrioventricular valves with outlets and helps young fellows in pediatric cardiology better visualize intracardiac repair and familiarize with congenital heart disease. Fusion technique can be routinely applied to patients regardless of their age and weight. [ABSTRACT FROM AUTHOR]

To study isolated fallopian torsion (IFTT) in a large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). A retrospective cohort study. A tertiary, university affiliated medical center. We included women with surgically confirmed ovarian and/or fallopian tube torsion between March 2011 and June 2020. We compared women with IFTT to those with NIAT during the same period. Diagnostic and operative laparoscopy. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Edematous and enlarged ovaries were less common in the IFTT group. In a multivariate regression analysis, the following factors were independently positively associated with IFTT; vaginal discharge [adjusted Odds Ratio (aOR) 95% CI 8.16, 1.98-33.55], and cervical motion tenderness (aOR 95% CI 2.71, 1.01-7.29). The following factors were independently negatively associated with IFTT; fertility treatments (aOR 95% CI 0.26, 0.70-0.77), previous abdominal surgery (aOR 95% CI 0.46, 0.22-0.96), vomiting (aOR 95% CI 0.38, 0.19-0.76) and enlarged ovary (aOR 95% CI 0.34, 0.18-0.65). We have identified preoperative factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion. [ABSTRACT FROM AUTHOR]

Congenital heart disease (CHD) represents a predisposing condition for the development of infective endocarditis (IE). In recent years, the reduction in the incidence of rheumatic heart disease, advances in cardiac surgery and the increased use of long-term central venous catheters in subjects without CHD have changed significantly the epidemiology of the disease. We sought to evaluate the epidemiology of EI in children in the north of France. We retrospectively included all children < 18 years hospitalized for EI in 2008–2018 in 4 tertiary centres. Demographic, underlying conditions, echocardiography, microbiology and outcomes were collected. We identified 64 episodes of IE in 60 children. Incidence was 3.07 cases for 10,000 paediatric hospitalisations (Table 1). Median age was 8 years [0–13] and distribution was bimodal with peaks in infancy and adolescence. An organism pathogen was isolated in 87.5% of cases. The most common was Staphylococcus aureus (34%), then streptococcus (25%). At echocardiography, anomalies were vegetations (n = 32), new valvular regurgitations (n = 10), peri-valvular abscesses (n = 2). Among cohort, 45 had a CHD (70%), 7 were preterm birth (11%), 2 had long-term central venous catheters and 10 no predisposition. No CHD group was significatively younger than CHD group. Among CHD patients, 38 (84%) had previous heart surgery and 10 presented an IE < 2 months after surgery. Pulmonary bioprosthetic valve were involved in 22 cases and mechanical valve in 3. Cardiac surgery was needed in 26 cases (41%) including valve replacement in half of them and were significatively higher in CHD group (P < 0.05). Complications of IE occurred in 35 (58%) including emboli, mycotic aneurysm, cerebral haemorrhage and myocardial abscess. IE mostly occurred in predisposed children. Morbidity is important with neurological impairment and valvular replacement in this young population at risk for recurrence. [ABSTRACT FROM AUTHOR]

Introduction The Self-Management and Transition to Adulthood with Rx = Treatment (STAR x ) Questionnaire was developed to collect information on self-management and health care transition (HCT) skills, via self-report, in a broad population of adolescents and young adults (AYAs) with chronic conditions. Methods Over several iterations, the STAR x questionnaire was created with AYA, family, and health provider input. The development and pilot testing of the STAR x Questionnaire took place with the assistance of 1219 AYAs with different chronic health conditions, in multiple institutions and settings over three phases: item development, pilot testing, reliability and factor structuring. Results The three development phases resulted in a final version of the STAR x Questionnaire. The exploratory factor analysis of the third version of the 18-item STAR x identified six factors that accounted for about 65% of the variance: Medication management, Provider communication, Engagement during appointments, Disease knowledge, Adult health responsibilities, and Resource utilization. Reliability estimates revealed good internal consistency and temporal stability, with the alpha coefficient for the overall scale being .80. The STAR x was developmentally sensitive, with older patients scoring significantly higher on nearly every factor than younger patients. Conclusion The STAR x Questionnaire is a reliable, self-report tool with adequate internal consistency, temporal stability, and a strong, multidimensional factor structure. It provides another assessment strategy to measure self-management and transition skills in AYAs with chronic conditions. [ABSTRACT FROM AUTHOR]