Trial Outcomes & Findings for Transplant Social Worker Support for Live Kidney Donation in African Americans (NCT NCT02369354)

NCT ID: NCT02369354

Last Updated: 2023-07-05

Results Overview

Composite rate of live kidney donor inquiries on behalf of participants, completed live kidney donor transplant evaluations, and live kidney donor transplants in each arm, ascertained via medical records maintained by the Duke Kidney and Pancreas Transplant Program.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

300 participants

Primary outcome timeframe

24 months post randomization

Results posted on

2023-07-05

Participant Flow

Recruitment occurred between September 2015 and May 2017. Participants were recruited from the Duke University Kidney and Pancreas Transplant Center in Durham, North Carolina. Transplant Center electronic health records were used to identify eligible patients.

Family members or friends of potential kidney transplant recipients and potential live kidney donors were not enrolled in the study.

Participant milestones

Participant milestones
Measure
Usual Care
Usual medical care at the Duke Kidney Transplant Clinic
TALKS
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes.
TALKS PLUS
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings plus live donor financial assistance intervention TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes. Financial Assistance Intervention: The financial assistance intervention offers potential donors the ability to draw from a "bank" of $2100 to reimburse their costs related to being evaluated for live kidney donation or for donating a kidney. Costs include, but are not limited to: child care, travel, time off work, and other out of pocket expenses related to being evaluated to become a live kidney donor or to donating.
Overall Study
STARTED
100
100
100
Overall Study
COMPLETED
88
86
86
Overall Study
NOT COMPLETED
12
14
14

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Transplant Social Worker Support for Live Kidney Donation in African Americans

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Usual Care
n=100 Participants
Usual medical care at the Duke Kidney Transplant Clinic
TALKS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes.
TALKS PLUS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings plus live donor financial assistance intervention TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes. Financial Assistance Intervention: The financial assistance intervention offers potential donors the ability to draw from a "bank" of $2100 to reimburse their costs related to being evaluated for live kidney donation or for donating a kidney. Costs include, but are not limited to: child care, travel, time off work, and other out of pocket expenses related to being evaluated to become a live kidney donor or to donating.
Total
n=300 Participants
Total of all reporting groups
Age, Categorical
<=18 years
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=157 Participants
Age, Categorical
Between 18 and 65 years
89 Participants
n=99 Participants
83 Participants
n=107 Participants
87 Participants
n=206 Participants
259 Participants
n=157 Participants
Age, Categorical
>=65 years
11 Participants
n=99 Participants
17 Participants
n=107 Participants
13 Participants
n=206 Participants
41 Participants
n=157 Participants
Age, Continuous
51.7 years
n=99 Participants
52.3 years
n=107 Participants
52.4 years
n=206 Participants
52.3 years
n=157 Participants
Sex: Female, Male
Female
41 Participants
n=99 Participants
46 Participants
n=107 Participants
46 Participants
n=206 Participants
133 Participants
n=157 Participants
Sex: Female, Male
Male
59 Participants
n=99 Participants
54 Participants
n=107 Participants
54 Participants
n=206 Participants
167 Participants
n=157 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=157 Participants
Race (NIH/OMB)
Asian
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=157 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=157 Participants
Race (NIH/OMB)
Black or African American
100 Participants
n=99 Participants
100 Participants
n=107 Participants
100 Participants
n=206 Participants
300 Participants
n=157 Participants
Race (NIH/OMB)
White
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=157 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=157 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=157 Participants
Region of Enrollment
United States
100 Participants
n=99 Participants
100 Participants
n=107 Participants
100 Participants
n=206 Participants
300 Participants
n=157 Participants
Education
Intermediate or middle school (6-8)
1 Participants
n=99 Participants
2 Participants
n=107 Participants
1 Participants
n=206 Participants
4 Participants
n=157 Participants
Education
High school (9-12) or GED
37 Participants
n=99 Participants
38 Participants
n=107 Participants
38 Participants
n=206 Participants
113 Participants
n=157 Participants
Education
Two years of college
30 Participants
n=99 Participants
30 Participants
n=107 Participants
33 Participants
n=206 Participants
93 Participants
n=157 Participants
Education
College
22 Participants
n=99 Participants
25 Participants
n=107 Participants
18 Participants
n=206 Participants
65 Participants
n=157 Participants
Education
Graduate or professional school
10 Participants
n=99 Participants
5 Participants
n=107 Participants
10 Participants
n=206 Participants
25 Participants
n=157 Participants
Employment
Full-time employee
18 Participants
n=99 Participants
19 Participants
n=107 Participants
22 Participants
n=206 Participants
59 Participants
n=157 Participants
Employment
Part-time employee
6 Participants
n=99 Participants
10 Participants
n=107 Participants
5 Participants
n=206 Participants
21 Participants
n=157 Participants
Employment
Student
3 Participants
n=99 Participants
1 Participants
n=107 Participants
1 Participants
n=206 Participants
5 Participants
n=157 Participants
Employment
Retired
9 Participants
n=99 Participants
14 Participants
n=107 Participants
10 Participants
n=206 Participants
33 Participants
n=157 Participants
Employment
Homemaker
1 Participants
n=99 Participants
3 Participants
n=107 Participants
4 Participants
n=206 Participants
8 Participants
n=157 Participants
Employment
Retired due to disability
56 Participants
n=99 Participants
47 Participants
n=107 Participants
48 Participants
n=206 Participants
151 Participants
n=157 Participants
Employment
Unemployed/looking for work
6 Participants
n=99 Participants
6 Participants
n=107 Participants
10 Participants
n=206 Participants
22 Participants
n=157 Participants
Employment
Refused
1 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
1 Participants
n=157 Participants
Income
Under $20,000
18 Participants
n=99 Participants
18 Participants
n=107 Participants
22 Participants
n=206 Participants
58 Participants
n=157 Participants
Income
$20,000 - $39,999
21 Participants
n=99 Participants
24 Participants
n=107 Participants
25 Participants
n=206 Participants
70 Participants
n=157 Participants
Income
$40,000 - $59,999
26 Participants
n=99 Participants
14 Participants
n=107 Participants
20 Participants
n=206 Participants
60 Participants
n=157 Participants
Income
$60,000 or more
22 Participants
n=99 Participants
26 Participants
n=107 Participants
19 Participants
n=206 Participants
67 Participants
n=157 Participants
Income
Refused/Don't know
13 Participants
n=99 Participants
18 Participants
n=107 Participants
14 Participants
n=206 Participants
45 Participants
n=157 Participants
Poverty
Not in poverty
70 Participants
n=99 Participants
65 Participants
n=107 Participants
67 Participants
n=206 Participants
202 Participants
n=157 Participants
Poverty
Near poverty
7 Participants
n=99 Participants
9 Participants
n=107 Participants
8 Participants
n=206 Participants
24 Participants
n=157 Participants
Poverty
Poverty
10 Participants
n=99 Participants
8 Participants
n=107 Participants
11 Participants
n=206 Participants
29 Participants
n=157 Participants
Poverty
Missing
13 Participants
n=99 Participants
18 Participants
n=107 Participants
14 Participants
n=206 Participants
45 Participants
n=157 Participants
Medical Insurance
Private
22 Participants
n=99 Participants
23 Participants
n=107 Participants
23 Participants
n=206 Participants
68 Participants
n=157 Participants
Medical Insurance
Medicaid Only
5 Participants
n=99 Participants
2 Participants
n=107 Participants
6 Participants
n=206 Participants
13 Participants
n=157 Participants
Medical Insurance
Medicare Only
57 Participants
n=99 Participants
53 Participants
n=107 Participants
48 Participants
n=206 Participants
158 Participants
n=157 Participants
Medical Insurance
Medicare/Medicaid
14 Participants
n=99 Participants
21 Participants
n=107 Participants
22 Participants
n=206 Participants
57 Participants
n=157 Participants
Medical Insurance
Other
2 Participants
n=99 Participants
1 Participants
n=107 Participants
1 Participants
n=206 Participants
4 Participants
n=157 Participants
Marital status
Married/living with partner
48 Participants
n=99 Participants
44 Participants
n=107 Participants
44 Participants
n=206 Participants
136 Participants
n=157 Participants
Marital status
Separated
3 Participants
n=99 Participants
7 Participants
n=107 Participants
8 Participants
n=206 Participants
18 Participants
n=157 Participants
Marital status
Divorced
18 Participants
n=99 Participants
8 Participants
n=107 Participants
14 Participants
n=206 Participants
40 Participants
n=157 Participants
Marital status
Single, never married
27 Participants
n=99 Participants
29 Participants
n=107 Participants
33 Participants
n=206 Participants
89 Participants
n=157 Participants
Marital status
Widowed
4 Participants
n=99 Participants
12 Participants
n=107 Participants
1 Participants
n=206 Participants
17 Participants
n=157 Participants
Family members
Has child(ren) · Yes
77 Participants
n=99 Participants
85 Participants
n=107 Participants
78 Participants
n=206 Participants
240 Participants
n=157 Participants
Family members
Has child(ren) · No
23 Participants
n=99 Participants
15 Participants
n=107 Participants
22 Participants
n=206 Participants
60 Participants
n=157 Participants
Family members
Has sibling(s) · Yes
86 Participants
n=99 Participants
91 Participants
n=107 Participants
91 Participants
n=206 Participants
268 Participants
n=157 Participants
Family members
Has sibling(s) · No
14 Participants
n=99 Participants
9 Participants
n=107 Participants
9 Participants
n=206 Participants
32 Participants
n=157 Participants
Family members
Mother living · Yes
43 Participants
n=99 Participants
50 Participants
n=107 Participants
55 Participants
n=206 Participants
148 Participants
n=157 Participants
Family members
Mother living · No
57 Participants
n=99 Participants
50 Participants
n=107 Participants
45 Participants
n=206 Participants
152 Participants
n=157 Participants
Family members
Father living · Yes
35 Participants
n=99 Participants
23 Participants
n=107 Participants
31 Participants
n=206 Participants
89 Participants
n=157 Participants
Family members
Father living · No
65 Participants
n=99 Participants
77 Participants
n=107 Participants
69 Participants
n=206 Participants
211 Participants
n=157 Participants
Total potential immediate family donors
6 potential immediate family donors
n=99 Participants
6 potential immediate family donors
n=107 Participants
5.5 potential immediate family donors
n=206 Participants
6 potential immediate family donors
n=157 Participants
Family history of kidney disease
52 Participants
n=99 Participants
49 Participants
n=107 Participants
51 Participants
n=206 Participants
152 Participants
n=157 Participants
Health literacy
≤3rd grade
3 Participants
n=99 Participants
3 Participants
n=107 Participants
4 Participants
n=206 Participants
10 Participants
n=157 Participants
Health literacy
4th-6th grade
5 Participants
n=99 Participants
4 Participants
n=107 Participants
4 Participants
n=206 Participants
13 Participants
n=157 Participants
Health literacy
7th-8th grade
27 Participants
n=99 Participants
29 Participants
n=107 Participants
33 Participants
n=206 Participants
89 Participants
n=157 Participants
Health literacy
≥9th grade
64 Participants
n=99 Participants
58 Participants
n=107 Participants
55 Participants
n=206 Participants
177 Participants
n=157 Participants
Health literacy
Missing
1 Participants
n=99 Participants
6 Participants
n=107 Participants
4 Participants
n=206 Participants
11 Participants
n=157 Participants
Years on the waiting list
0.5 years
n=99 Participants
0.8 years
n=107 Participants
0.9 years
n=206 Participants
0.8 years
n=157 Participants
Current end-stage (ESRD) renal disease treatment
No kidney replacement treatment yet
15 Participants
n=99 Participants
16 Participants
n=107 Participants
22 Participants
n=206 Participants
53 Participants
n=157 Participants
Current end-stage (ESRD) renal disease treatment
In-center hemodialysis
63 Participants
n=99 Participants
63 Participants
n=107 Participants
63 Participants
n=206 Participants
189 Participants
n=157 Participants
Current end-stage (ESRD) renal disease treatment
Home hemodialysis
6 Participants
n=99 Participants
3 Participants
n=107 Participants
3 Participants
n=206 Participants
12 Participants
n=157 Participants
Current end-stage (ESRD) renal disease treatment
Peritoneal dialysis
16 Participants
n=99 Participants
18 Participants
n=107 Participants
12 Participants
n=206 Participants
46 Participants
n=157 Participants

PRIMARY outcome

Timeframe: 24 months post randomization

Composite rate of live kidney donor inquiries on behalf of participants, completed live kidney donor transplant evaluations, and live kidney donor transplants in each arm, ascertained via medical records maintained by the Duke Kidney and Pancreas Transplant Program.

Outcome measures

Outcome measures
Measure
Usual Care
n=100 Participants
Usual medical care at the Duke Kidney Transplant Clinic
TALKS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes.
TALKS PLUS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings plus live donor financial assistance intervention TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes. Financial Assistance Intervention: The financial assistance intervention offers potential donors the ability to draw from a "bank" of $2100 to reimburse their costs related to being evaluated for live kidney donation or for donating a kidney. Costs include, but are not limited to: child care, travel, time off work, and other out of pocket expenses related to being evaluated to become a live kidney donor or to donating.
Number of Participants With Live Kidney Donor Activation Events
0 Activation events
87 Participants
86 Participants
88 Participants
Number of Participants With Live Kidney Donor Activation Events
1 Activation event
5 Participants
4 Participants
7 Participants
Number of Participants With Live Kidney Donor Activation Events
2 Activation events
3 Participants
7 Participants
2 Participants
Number of Participants With Live Kidney Donor Activation Events
3 Activation events
3 Participants
2 Participants
3 Participants
Number of Participants With Live Kidney Donor Activation Events
4 Activation events
1 Participants
1 Participants
0 Participants
Number of Participants With Live Kidney Donor Activation Events
>=5 Activation events
1 Participants
0 Participants
0 Participants

SECONDARY outcome

Timeframe: 24 months post randomization

Potential kidney recipients' behaviors reflecting their interest and pursuit of live donor kidney transplantation, including: self-reported live donor kidney transplant discussions with physicians, self-reported live donor kidney transplant discussions with family, and identification of a potential live donor.

Outcome measures

Outcome measures
Measure
Usual Care
n=100 Participants
Usual medical care at the Duke Kidney Transplant Clinic
TALKS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes.
TALKS PLUS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings plus live donor financial assistance intervention TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes. Financial Assistance Intervention: The financial assistance intervention offers potential donors the ability to draw from a "bank" of $2100 to reimburse their costs related to being evaluated for live kidney donation or for donating a kidney. Costs include, but are not limited to: child care, travel, time off work, and other out of pocket expenses related to being evaluated to become a live kidney donor or to donating.
Number of Participants With Potential Recipient Interest and Pursuit of Live Donor Kidney Transplantation
Low pursuit (did not discuss with family)
1 Participants
0 Participants
1 Participants
Number of Participants With Potential Recipient Interest and Pursuit of Live Donor Kidney Transplantation
Moderate (Discussed with family)
12 Participants
10 Participants
8 Participants
Number of Participants With Potential Recipient Interest and Pursuit of Live Donor Kidney Transplantation
High (Identified potential donor)
58 Participants
57 Participants
64 Participants
Number of Participants With Potential Recipient Interest and Pursuit of Live Donor Kidney Transplantation
Data missing
29 Participants
33 Participants
27 Participants

SECONDARY outcome

Timeframe: 24 months post randomization

Passive follow up of participants for 2 years to assess completed live kidney donor transplant evaluations in each arm, ascertained via medical records maintained by the Duke Kidney and Pancreas Transplant Program.

Outcome measures

Outcome measures
Measure
Usual Care
n=100 Participants
Usual medical care at the Duke Kidney Transplant Clinic
TALKS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes.
TALKS PLUS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings plus live donor financial assistance intervention TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes. Financial Assistance Intervention: The financial assistance intervention offers potential donors the ability to draw from a "bank" of $2100 to reimburse their costs related to being evaluated for live kidney donation or for donating a kidney. Costs include, but are not limited to: child care, travel, time off work, and other out of pocket expenses related to being evaluated to become a live kidney donor or to donating.
Number of Participants With Live Donor Evaluations
0 Evaluations
93 Participants
93 Participants
97 Participants
Number of Participants With Live Donor Evaluations
1 Evaluation
5 Participants
7 Participants
3 Participants
Number of Participants With Live Donor Evaluations
2 Evaluations
2 Participants
0 Participants
0 Participants
Number of Participants With Live Donor Evaluations
3 Evaluations
0 Participants
0 Participants
0 Participants
Number of Participants With Live Donor Evaluations
4 Evaluations
0 Participants
0 Participants
0 Participants

SECONDARY outcome

Timeframe: 24 months post randomization

Passive follow up of participants for 2 years to assess live kidney donor transplants in each arm, ascertained via medical records maintained by the Duke Kidney and Pancreas Transplant Program.

Outcome measures

Outcome measures
Measure
Usual Care
n=100 Participants
Usual medical care at the Duke Kidney Transplant Clinic
TALKS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes.
TALKS PLUS
n=100 Participants
Usual Care plus TALKS Social Worker Intervention: Includes video, book, and Social Worker meetings plus live donor financial assistance intervention TALKS Social Worker Intervention: TALKS includes a video and book that describe patient and family experiences with talking about and considering live kidney transplantation. TALKS also includes a social worker meeting. Potential recipients meet with a transplant social worker for up to 60 minutes to identify potential barriers to considering or pursuing live donor kidney transplantation. They also are invited to have a second meeting with family and/or friends with the social worker for up to 60 minutes. Financial Assistance Intervention: The financial assistance intervention offers potential donors the ability to draw from a "bank" of $2100 to reimburse their costs related to being evaluated for live kidney donation or for donating a kidney. Costs include, but are not limited to: child care, travel, time off work, and other out of pocket expenses related to being evaluated to become a live kidney donor or to donating.
Number of Participants With Live Kidney Donor Transplants
2 Participants
1 Participants
2 Participants

Adverse Events

Usual Care

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

TALKS

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

TALKS PLUS

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. L. Ebony Boulware

Duke University School of Medicine

Phone: 919-613-2099

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place