BACKGROUND:The Affordable Care Act of 2010 proposed maximum penalty equal to 1% of regular Medicare reimbursements which prompted change in how hospitals regard 30-day readmissions. While several hospital to home transitional care models demonstrated a reduction in readmissions and cost savings, programs adapted to population needs and existing resources was essential.METHODS:Focusing on process and outcomes evaluation, a retrospective analysis of a modified community based care transitions program was conducted.RESULTS:In addition to high levels of patient satisfaction with the care transitions program, participants' confidence with self care was significantly improved. Further, the program evaluation demonstrated a 73% reduction in readmissions and an actual Medicare cost savings during the 9-month study period of $214,192, excluding the cost to administer the program.CONCLUSIONS:While there are several transitional care programs in existence, a customized approach is desirable and often required as the most cost effective way to manage care transitions and employ evidence based policy making. This study established some of the pitfalls when implementing a community-based transitional care program and demonstrated encouraging outcomes.

Youth with disabilities are amongst the poorest and most marginalised of young people worldwide. Approximately 80 per cent of disabled young people live in countries of the Global South. Despite a growing body of research problematising youth transitions in situations of poverty and increasing interest in disability issues beyond the Global North, little is known about how youth with disabilities in the Global South make their transitions to adulthood. This thesis addresses this gap by reporting on a qualitative study on the transitions to adulthood of young people with different impairments living primarily in Accra, Ghana. Using innovative, participatory methods, it explores young people s individual narratives within the areas of education, employment, and social and community life, and the ways in which these shape their life trajectories. The study shows that the transitions to adulthood of youth with disabilities in Accra are substantially influenced by disability-related factors and processes that are socio-spatially embedded and intricately intertwined. Disabling social and physical environments restrict disabled young people s participation in education, employment, and social and community life, which increases their vulnerability to marginalisation and exclusion in society. As a consequence, their transitions to adulthood are even more complex, protracted, and uncertain than for their non-disabled peers. Youth with disabilities, however, use a variety of coping strategies to navigate the challenges they face associated with school, work, and social life in their attempts to achieve adulthood. Foregrounding the voices of young people with differing categories of social difference challenges the hitherto existing homogenisation of the lives of youth with disabilities in the Global South highlighting their agency and capabilities as well as the complex ways in which they negotiate transitions during the life-course.

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: We present a theoretical approach that allows for the description of trapped Bose-Fermi mixtures with a tunable interspecies interaction in the vicinity of a Feshbach resonance magnetic field.The many-body physics of the system is treated at equilibrium using the well-established mean-field and local density approximations. This reduces the physics locally to that of a homogeneous system. We observe a rich local phase structure exhibiting both first and second order phase transitions between the normal and BEC phases. We also consider the global properties of the mixture at a fixed number of particles and investigate how the density profiles and the populations of the various particle species depend on the detuning and trap profile. / AFRIKAANSE OPSOMMING: Ons beskou ’n teoretiese beskrywing van gevangde Bose-Fermi mengsels met ’n verstelbare interspesie wisselwerking in die teenwoordigheid van ’n magneties-geïnduseerde Feshbach resonansie. Die veeldeeltjiefisika van die sisteem word by ekwilibrium binne die welbekende gemiddelde-veld en lokale-digtheid benaderings hanteer. Sodoende word die fisika lokaal tot die van ’n homogene sisteem gereduseer. Ons neem ’n ryk fase-struktuur waar met beide eerste- en tweede-orde fase-oorgange tussen die normale en BEK fases. Ons beskou ook die globale eienskappe van die mengsel by ’n vaste totale aantal deeltjies en ondersoek hoe die digtheidsprofiele en deeltjiegetalle van die afstemming en die profiel van die val afhang.

The purpose of this study was to begin testing of a downward cross-level model for studying the ability of older adults to transition from a nursing home after a Medicare Part A reimbursed stay. Transitions are known to be a weak point in the provision of healthcare to older adults and thus far, research has not identified those factors that influence older adult's transitions i.e., from the nursing home after a post acute stay. The theoretical background for this study was supported by Resource Dependency Theory which is a theory that contends that organizations are externally controlled by activities outside the organization such as the "free-market" economic model that predominates the nursing home industry. It was thought that nursing homes may prioritize their need for resident census above the resident's need for discharge. The hypothesis was that both individual resident characteristics and organizational characteristics might influence the ability of older adults to transfer from the nursing home after a Medicare Part A stay. The method of analysis in this study was contextual regression. Individual and facility characteristics were the independent variables and length of stay was the dependent variable. For this project, emphasis was placed on the development of a methodology for using the MDS in this and future research studies. Selection of variables and methods for variable computation were highlighted. Individual and facility characteristics and discharge disposition (level of care) were reported descriptively. Although facility characteristics did not contribute significantly to the model, individual characteristics explained 28% of the variance in the length of stay. Fifteen percent of individuals in the sample died during their Medicare Part A stay and 18% were readmitted to the hospital. The most prevalent diagnoses of the sample were hypertension (35%), falls (34%) and arthritis (32%). Findings suggest that individual characteristics account for only a portion of the length of stay for post acute nursing home residents. Further model testing is needed and should include a larger facility sample size and market characteristics to determine if those factors significantly influence the ability of older adults to transfer after the Medicare Part A stay ends.

The world, including Sweden, is suffering from a shortage of nurses. The nurse shortage is caused by many factors, including an aging population causing a rise in demand, considerably fewer applicants for high school nursing programs, and a large wave of retirement as the baby boomers are leaving the work force. However, research has found that no single thing is more responsible for the nurse shortage than the inability to keep able nurses in the nurse force as they voluntarily terminate their employment. Research has also found that young nurses and newly graduated nurses are more likely to terminate their employment than nurses who have been working for a long time. One of the explanations for this problem is the special problems nurses face during the transition from student to practicing nurses. This thesis aims to help the health care institutions of Sweden, and the world, by further explaining the problems nurses face in the transition from nursing student to practicing nurse. This is done by examining the expectations nurses have on the profession before they start studying, and before they graduate, and examine how the nurses perceive that their expectations have been confirmed or disconfirmed. Further we examine how the nurses perceive that their confirmed or disconfirmed expectations affect their job satisfaction and in extension, their will to terminate their employment and leave the profession. In order to examine the subject, we conducted a qualitative study. Semistructured interviews were held with eight nurses in order to assess how their expectations had affected their current view on their job and what disappointments and positive surprises would infer. The data we gathered from the interviews were analyzed thematically. The main themes we derived from the data were: Emotions – Driver in Early Expectations, Expectations and Experiences in the Transition Period, Confirmation of Early Expectations, Expectations Role in Job Satisfaction, and Expectations as a Factor in Turnover Intentions. We could conclude that there were certain areas where nurses’ positive expectations were confirmed, e.g. meaningfulness of the job. There were also areas where nurses experienced a reality worse than what they expected, such as stress, work environment, responsibility, feedback, and emotional challenges. From subthemes of these general themes we crafted a conceptual model to illustrate how both early and later expectations affect the job satisfaction, opinions on the profession, and turnover intentions of the nurses.

Contactless electroreflectance (CER), a modulation spectroscopy (MS) technique, has been used to study the A and C exciton transitions in A1xGa1-xN layers for a composition range of 0 ≤ x ≤ 0.48 at room temperature. Taking the entire composition range (0 ≤ x ≤ 1) into account by incorporating a previously reported band gap energy for AlN, the dependence of the A-exciton transition on composition showed a downward bowing from linearity. A bowing parameter of b = 1.7 eV was found. Analysis of the lower composition range 0 ≤ x ≤ 0.48 resulted in a linear fit, as did the trend for the detectable C exciton transitions. The slope of the linear trendlines for the A and C exciton were practically the same.

This study examined the perceptions of gifted middle school students who attended one of two middle school gifted service options as they transitioned into high school. Gifted middle school students from either a center-based gifted service option or a school-based gifted service option from middle schools in a suburban district in Central Virginia participated in the study. Participants who had completed three consecutive years within the gifted service option were purposively selected for the study. Students completed a pre-transition survey at the end of their eighth grade year and a post-transition survey early in their ninth grade year. The survey asked students to identify their high school program choice and provide a reason for their choice in order to establish high school program choice trends among the different gifted service options. The surveys also assessed the differences in the students’ perceptions of the transition from middle school into the chosen high school as it pertains to academic, organizational, and social constructs of the high school program. Students from the center-based gifted program were more likely to choose to attend one of the regional Governor’s schools, and chose to do so because of personal interest and the perception of academic rigor. The students from the school-based gifted service options were more likely to choose to attend one of the district’s specialty centers, and chose to do so because of personal interest and parental encouragement. Prior to transitioning into high school, both the center-based gifted and the school based gifted students had high perceptions of the grades they earned. However, after transitioning into high school, only the center-based gifted students continued to have a high perception of grades earned. Prior to the transition into high school the center-based gifted students had higher perceptions of the academic, organizational, and social constructs. Differences were not found among the post-transition perceptions of the academic, organizational, and social constructs between the two gifted middle school groups; however, the extremely small sample size of the post-transition survey may have impacted these results.

The overall aim of the thesis is to examine the institutional conditions for the implementation and emergence of landfill mining. The result shows that  current policy makes it difficult for landfill mining operators to find a market outlet for the exhumed material, which means that landfill mining may result in a waste disposal problem. Regulations also restrict accessibility to the material in landfills. Therefore, it has generally been municipal landfill owners that perform landfill mining operations, which directs learning processes towards solving landfill problems rather than resource recovery. Landfill mining is not, however, necessarily to be perceived as a recycling activity. It could also be understood as a remediation or mining activity. This would result in more favorable institutional conditions for landfill mining in terms of better access to the market and the material in the landfill. The regulatory framework surrounding landfills is based on a perception of landfills as a source of pollution, a problem that should be avoided, capped and closed. Extracting resources from landfills, challenges this perception and therefore results in a mismatch with the regulatory framework. On the other hand, the material in mines is typically regarded in the formal institutions as a positive occurrence. Mining activities are regarded as the backbone of the Swedish economy and therefore receive various forms of political support. This favorable regulatory framework is not available for secondary resource production. Based on the identified institutional conditions, institutional challenges are identified. The core of these challenges is a conflict between the policy goal of increased recycling and a non-toxic environment. Secondary resources are typically punished through strict requirements for marketability, while primary resources are supported through subsidies such as tax exemptions. The authorities lack capacity to manage the emergence of unconventional and complex activities such as landfill mining. The institutional arrangements that are responsible for landfills primarily perceive them as pollution, while the institutions responsible for resources, on the other hand, assume them to be found in the bedrock. The major contribution of the thesis is to go beyond the potential-oriented studies of landfill mining to instead focus on how institutions relate to landfill mining. In order to move towards a resource transition with dominant use of secondary resources a new institutional order is proposed.

O dano produzido por radiação em monocristais de KCl contendo centros U, (íons de H- ou D- substitucionais) mostrou ser dependente tanto da temperatura como da pureza espectral da radiação u.v. utilizada. A interação entre centros F e U2 (átomos de H&#176 ou D&#176 intersticiais), produtos da irradiação, dá origem a novas transições óticas na região do espectro visível, em concordância com as previsões de um modelo proposto. Foi estudado o efeito isotópico sobre os defeitos produzidos pela radiação e sobre a largura das bandas de absorção. Experiências sobre irradiação por u.v. e por raios x em KCl com pares H- H- alinhados são também discutidas / The radiation damage of KCl single crystals containing U centers (substitutional H- ou D- ions) is found to be dependent on the temperature and on the spectral purity of the u.v. radiation used. The interaction between F centers and U centers, (interstitial H&#176 or D&#176 atoms), products of the radiation damage, gives rise to new optical transitions in the visible part of the spectra according to the predictions of a proposed model. The isotope effect on the radiation damage by u.v. and by X-rays on KCl with H- H- aligned pairs are also discussed

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