Background: Frequent ED users are generally over the age of 65 years, Medicare beneficiaries, sicker and have more health issues than non-frequent users. Elderly patients suffer a 20% mortality rate upon admission and a 30% decrease in activities of daily living (ADL) after discharge. Transitional care programs (TCP) decrease ED visits and readmission rates, improves ADLs, and increases event-free survival. Purpose: To evaluate the need of an ED TCP in the ED. Aims are to assess ED providers’, nurses’ and managers’ perceptions of elderly frequent ED users’ discharge needs, resources, and potential role of a TCP. Methods: Conducted within one community based ED in Tucson, Arizona. Survey content determined by a review of the literature focused upon elderly transitional care. Recruitment of nurses, providers, and managers following verbal consent. Inclusion criteria: willingness to participate in a 10-minute survey and work two shifts a month minimum within the ED. The survey is comprised of 19 questions focused on patient needs, current resources and the role of a TCP. Surveys were followed by a 5-minute post-survey session to review questions regarding content. Questions structured using a Likert scale format and categorical answers. Data analyzed using descriptive statistics. A needs assessment (NA) executive summary was presented to the ED staff and management. Results: One hundred providers, nurses, and managers completed the survey of which 79% were female, 73% registered nurses, 14% physicians, and 10% advanced practice providers. The majority of respondents believed elderly patients are discharged unsafely, additional resources were needed, more time was spend caring for elderly patients, and TCPs were a viable supportive option. “What is a transitional care team (TCT)?” was the most asked question during question and answer session. Implications: This NA revealed providers’, nurses’, and managers’ perceptions of elderly frequent ED user needs and the role of a TCP. Concerns identified are consistent with the literature. This NA provided information about ED staff perceptions of elderly frequent users and addressed transitional care while laying the groundwork for the potential future implementation of a TCP initiated in the ED.

This dissertation project develops a theoretical understanding of how truth commissions achieve legitimacy and thus contribute to peace and stability in the aftermath of major traumatic events (e.g. civil war, mass killings, regime changes). I identify three components of truth commission legitimacy---authority, fairness, and transparency---that facilitate beneficial outcomes for societies emerging from a period of severe human rights repression or civil war. I theorize and test how institutions with these legitimacy characteristics contribute to an increase in respect for human rights and decrease political violence in transitioning societies, thus contributing to peace and stability. In order to test the hypothesized relationships, I create a truth commission characteristic dataset that provides greater detail than existing datasets. This project is a contribution to our understanding of the relationships between human rights, institutions, conflict, and international law. It provides one explanation for the inconsistent findings of extant work concerning the impact of transitional justice, generally and truth commissions, specifically. I provide evidence that there are identifiable "best practices" that truth commissions should consider adopting. This information can assist states, intergovernmental organizations, and nongovernmental organizations alike in making difficult decisions regarding the transitional justice process, which is expensive and time consuming further necessitating an understanding of what practices are most crucial for achieving peace and stability.

Transitional care represents a critical juncture in the continuing care of patients with chronic conditions, particularly for adolescent patients. It also represents a significant point of failure in that process for adolescents, with many patients experiencing difficulties during the transition between adolescent and adult medicine that lead to negative long-term impact on health and wellbeing. This thesis aims at addressing adolescent transitional care processes and its obstacles through a broad medical humanities inquiry in a multidisciplinary dialogue between philosophy, social sciences, and medicine. The social, anthropological, and medical concepts of adolescence and autonomy were derived from a literature review and used to identify and philosophically analyze obstacles to adolescent transitional care. Studies were used to illuminate those obstacles. For a first person-perspective analysis, an autoethnography was developed to provide patient testimony, towards improving the reflection on transitional care. This analysis tested the alignment of the author’s experiences in interacting with a healthcare transition as part of the patient population with those recorded in the literature. This study has found barriers and facilitators concerning autonomy and communication at many levels and among many parties involved in the transition, such as patients, caregivers, healthcare providers, and healthcare systems operations, particularly regarding insurance management. This study recommends a focused coordination of primary care and/or transitional care specialists with the participation of adolescent patients’ voices and testimony to develop and manage challenges to autonomy in transitional care.

This study addresses young children's involvement with comfort objects, including why children have them, how they are used, when attachments to such objects are cause for concern and how teachers and parents can respond to promote the young child's development. The child's becoming and development is examined in this study. The researcher also reviews major transitional object theories in terms of origin, development and psychological meaning. This study aims to explore this phenomenon from a psychological - educational perspective and to formulate a set of guidelines for parents and professionals whose children use comfort behaviour. Information was collated from case studies, a questionnaire and a detailed study of literature. / Psychology of Education / M. Ed. (Guidance and Counselling)

This study addresses young children's involvement with comfort objects, including why children have them, how they are used, when attachments to such objects are cause for concern and how teachers and parents can respond to promote the young child's development. The child's becoming and development is examined in this study. The researcher also reviews major transitional object theories in terms of origin, development and psychological meaning. This study aims to explore this phenomenon from a psychological - educational perspective and to formulate a set of guidelines for parents and professionals whose children use comfort behaviour. Information was collated from case studies, a questionnaire and a detailed study of literature. / Psychology of Education / M. Ed. (Guidance and Counselling)

Heart failure (HF) is a chronic condition affecting older adults. It is estimated over 5.8 million Americans are currently diagnosed with HF, with an anticipated increase to seven million by 2030. HF patients are faced not only with the physical symptoms, but also with emotional tolls, and socioeconomic burdens related to HF. Low income and rural facilities, which lack financial resources, are at greater risk for closure if there are concerns of loss of reimbursement. Hospitals are now challenged to prevent readmissions and to avoid penalties associated with HF admission within the 30-day window. Incorporating various interventions have shown improvements in readmission rates. Nurse practitioners and registered nurses can serve as patient educators regarding topics such as diagnoses, procedures, disease monitoring, medications, and medication side effects. In most hospitals, RNs at patients' bedside are at the forefront of providing HF patients discharge instructions and education, which should include symptom recognition and management. The aim of this project inquiry was to assess the knowledge of HF education and perceived barriers to providing HF education by nurses and nurse practitioners, such that improved transition of care for patients in the rural health setting can occur.

LL.M. (International Law) / The after-effects of the Second World War (WWII) and the Cold War that followed engendered a radical paradigm shift in the collective accountability for international crimes. Indeed, institutions have been established to take stock of the catastrophic effects of wars and enable states to come to terms with their confrontational past. The Nuremberg and Tokyo trials mainly focused on reigning in military leaders who perpetrated mass killings. These trials laid the foundation for a reconfiguration of the international criminal justice. This study argues that the complementarity principle in the classical sense and the prosecutorial strategy of the Office of the Prosecutor (OTP) of only bringing to justice high-level perpetrators effectively creates an impunity gap if states are unwilling and unable to prosecute. Therefore, positive complementarity becomes necessary for the ICC to encourage states to prosecute both high and low-level perpetrators. In an endeavour to achieve this, TJ mechanisms become necessary as they provide a holistic approach, i.e. involvement of victims, provision of reparations and prosecution of offenders. The statute of the International Criminal Court (Rome statute) is said to have a so-called “catalysing effect” on domestic criminal justice systems by some authors mainly because the principal obligation to investigate and prosecute international crimes is entrusted to the domestic criminal justice systems. The ICC may exercise its prerogative over a case only if the states have not genuinely investigated or prosecuted the perpetrator. However, the catalysing effect of the complementarity principle can be discordant with transitional justice (TJ) mechanisms in post-conflict societies where justice might have to be compromised over peace and vice versa. This has been observed where measures such as amnesty, the use of Truth and Reconciliation Commissions (TRCs), and pardons have been solicited by rebels or de facto holders of power, such as military chiefs, as a way of evading accountability.

A mentor is a qualified mental health practitioner, namely in this instance a nurse who facilitates guides and supervises the learning experience and assesses the student’s competences in practice. This longitudinal study examines the perceptions of mentorship in clinical practice from nurses, as they move from students to recognised professionals with authority to advise and assess students’ competence in practice. This ethically approved study mainly uses qualitative methods. Initially it involved interviewing eight completing mental health nursing students, and 270 mainly qualitative questionnaires were sent to qualified mental health nurse mentors in clinical practice. The final data collection of the study involved interviewing six qualified nurses/mentors who were originally the students in this study. Existential phenomenology was a valuable means of interpreting the perceptions of both the students, qualified nurses and the mentors. This ontological perspective explores the consciousness of the self, operating within a collective consciousness of their world. The data analysis initially followed Van Manen’s holistic approach; then extracting essences, identifying themes and then synthesizing essences. This was then followed by an existential processing of the data from the first and second interviews. The results reveal that the students believe that mentoring is an absolute necessity for their practical training; but the mentoring experience is precarious due to the numerous barriers. The results also highlighted incidences where students who experience ineffective mentoring are inspired to become much more effective at mentoring, because they do not want their students to experience the poor mentoring they had received. The participants in this study said students who are not competent are still passing practice, and the craft of mental health caring is not taught to an appropriate standard. However, learning from the experience of the transitional process was also revealed, and how the development of the self affected the perception of mentoring.

Background: Heart failure (HF) is a complex, costly and debilitating chronic health condition. Symptom recognition and self-care are crucial components of heart failure management; however, many HF patients struggle to perform these behaviors and skills at a proficient level. A transitional care program in the Southwest provides services to heart failure patients. A primary program aim is to help facilitate enhanced symptom recognition and self-care among heart failure patients. This project focuses on the assessment of the impact of such a transitional care program on HF patients' ability to perform symptom recognition and self-care. Methods: Demographic questionnaires were distributed to collect socioeconomic data and clinical characteristics of participants. A pre and post SCHFI survey was completed by participants, and analysis of data performed using a paired t-test. Results: The 15 participants were primarily Hispanic, elderly, and male. The majority of participants reported an annual income less than $10,000, lived in close proximity to the transitional care clinic, reported living with family and/or friends, and had at least one additional comorbidity. There was improvement in self-care maintenance scores following the initial transitional care encounter; however, participants did not achieve self-care adequacy in this domain. Participants also did not achieve self-care adequacy in self-management. Self-confidence scores improved to reach adequacy following the initial transitional care encounter; however, results were not statistically significant. Conclusion: With the complexities of HF self-management, it is not alarming that these patients have continued to struggle with symptom recognition and self-care. Recommendations are made for future research and interventions.

How do infants segment objects from the complex visual environment? Investigations of figure-ground perception have been dominated by studies assessing infants' sensitivity to depth and figure cues; few studies have assessed what information infants' use to perceive figures as separate from grounds. Research examining word segmentation suggests that statistical learning might aid segmentation in visual scenes. Despite the numerous studies investigating figure-ground segmentation, none have investigated the role of spatial transitional probabilities as a means for segmentation. To examine this question, we used a habituation/familiarity-preference procedure to assess whether background variability enables 5.5-month-old infants' perception of figures as separate from the background. The results of Experiments 1 and 2 indicated that statistical learning extends to scene segmentation, scene contexts allowed extraction of statistical distribution. Experiment 3 demonstrated that matching the configuration of visual arrays during training and test is essential; mismatched stimuli impede the measurement of segmentation.