Browsing by Subject "Transition"
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Item Open Access Disease Knowledge and Readiness for Transition in Adolescents with Sickle Cell Disease in Jamaica: A Mixed-Methods Study(2018) Aly, MarwaIntroduction: Sickle cell disease (SCD) is a genetically inherited recessive blood disorder that affects millions of people worldwide. The management of SCD should and can be considered a collaborative team effort, and requires the comprehensive and coordinated support of several medical professionals. The rising number of adults living with SCD creates a need for long term therapeutic and management strategies as well as a better understanding of the transition from pediatric to adult care. The research goal for this project is to compare the two systems that exist for treatment of adolescents with SCD in Jamaica and the United States by assessing differences and similarities in patients’ readiness for adult treatment and their understanding of SCD and its management. Methods: This study was conducted in the Sickle Cell Unit at the University of West Indies (UWI) hospital in Kingston, Jamaica. Eligibility for this study was defined as patients with SCD, between the ages of 13-19, seeking treatment at the health facility in the University of the West Indies, who have no acute illness at the time of study. After a verbal and written consent process during check-in, each participant completed a demographic survey, disease knowledge questionnaire, the ASH Transition Readiness Assessment Questionnaire, and had the opportunity to participate in in-depth interviews. Following data collection, results subsequently with similar previously completed surveys from patients at the Duke University Sickle Cell Center. Results: Gender and socioeconomic factors were not associated with differences in assessment scores in Jamaica. Total scores for disease knowledge questionnaires increased with age, however mean scores for the 17-19 age group were 62.17% lower than Duke University patients of the same age. Self-evaluation with the ASH Transition Readiness Assessment also showed an increase in scores with age, and significant increases in disease knowledge and appointments sections in both the 13-14 and 17-19 age groups, estimated by a p-value of 0.023 and 0.006, respectively. The results, however, were also generally lower than similar Transition Readiness Assessment measures at Duke. In-depth interviews revealed patient insight into disease knowledge, treatment involvement and experiences with doctors, family, and in the clinic. Answers align with both questionnaires used in this study.
Item Open Access Emotion and Identity in the Transition to Parenthood(2018) Weed, Emi-LouThough families come in all shapes and sizes, many people recognize the birth of their first child as the start of their new family. The transition to parenthood that expectant parents experience has important implications for their future health and the health of their children. This dissertation investigates the experiences of new and expectant parents as they develop their new roles. The findings draw on publicly-available conversations from parenting forums. Investigative phenomenology, descriptive phenomenology, and quantitative analysis are used to explore three research questions: 1) How do people experience perinatal loss? 2) What are parents’ experiences of working with nurses when their infant is in a neonatal critical care unit? 3) What emotions do men experience on their journey to fatherhood? The findings of this dissertation indicate that the transition to parenthood is a time of ambiguity, stress, and potentially, great joy for new parents. During this transition, people take on new identities, perform new roles, experience a broad range of emotions, and develop new relationships. The impacts of this transition are lifelong, so support is vital to promoting the formation of healthy, well-adjusted families. For healthcare providers and researchers, there is a great deal that can be done to help new and expectant parents feel supported and respected. A few of the many potential tools providers and researchers can use include mindfulness, non-judgement, and therapeutic communication.
Item Open Access Examination of Health Care Transition, Health Status, and Functional Outcomes Among Adolescents and Young Adults with Intellectual Disability(2020) Franklin, Michelle ScottonAdolescence is a period marked by tremendous social, emotional and physical changes; however, adolescents and young adults (AYAs) with intellectual disability (ID), who must navigate this period with limitations in intellectual and adaptive functioning, face additional difficulties. Much remains unknown about their health care transition (HCT) experiences and their health and well-being as they transition into adulthood; therefore, this study examined the HCT, health status, and functional outcomes of AYAs with ID.
This study incorporated both an individual and population approach to understand needs of AYAs with ID. First, within Chapter 1, a qualitative descriptive design study with semi-structured individual interviews with 16 parent participants was used. We utilized purposive sampling of parents with variation on race/ethnicity and AYA age, stage in transition, and condition; and we utilized content analysis. In Chapter 2, we developed a new method for identifying individuals with ID within large, population-level studies not targeted on ID. We used a secondary analysis of the de-identified, restricted-use National Longitudinal Study of Adolescent to Adult Health (Add Health) database representing 20,745 adolescents to develop a method for identifying individuals who meet criteria of ID. The Add Health ID Indicator was developed from the variables indicative of intellectual and adaptive functioning limitations available within the Add Health database. Through this method, we identified 441 AYAs with ID. Lastly, in Chapter, a descriptive, correlative study utilized the Add Health database and Add Health Indicator to examine the health status and functional outcomes among 254 AYAs with ID.
Our study illuminates the need for (a) improved infrastructure to provide effective HCT and (b) partnerships to help integrate HCT support within other life course systems. Our results support the rationale for a noncategorical HCT-focused approach as well as a parent-peer, coach-facilitated intervention for bridging the gap between systems and meeting family needs. By examining the Add Health ID sample, we identified a decline in health status from adolescence to adulthood among the AYAs with ID, demonstrating that their transition to adulthood is a period during which prevention of obesity and interventions to improve health status should be targeted. The disability-, adolescent-, and family-related factors associated with health status and functional outcomes among AYAs with ID can inform further research, tailoring of interventions, and policies. Researchers can utilize the data-driven method we developed with commonly available data elements in nationally representative datasets to leverage existing rich data sets in order to identify individuals with ID. These data sets, including Add Health, hold significant potential for answering research questions, guiding policy, and informing interventions to improve the health of the ID population.
Item Open Access Foreign Direct Investors as Agents of Economic Transition: An Instrumental Variables Analysis(Quarterly Journal of Political Science, 2009-03-19) Malesky, EJPrevious empirical analysis has noted a correlation between Foreign Direct Investment (FDI) and economic reformin Eastern Europe and the Former Soviet Union, but has attributed the relationship to investors rewarding countries after reform decisions. Little attention has been paid to the fact that investors' lobbying efforts may actually influence reform choices. This paper finds a positive effect of FDI on reform progress through apanel analysis of investor influence in 27 transition states (1991-2004). To address endogeneity bias, the exogenous portion of a country's exchange rate movement is used as an instrument in a two-stage procedure. The underlying counterfactual comparison that results from this approach is between two similarly situated countries, but where one country experienced a large shift in the share of FDI in its economy as a result of changes in the international economy and the other did not. Further analysis reveals that the relationship is particularly strong in the manufacturing and service sectors, but does not hold for construction, utilities, or natural resource based projects. © 2009 E. J. Malesky.Item Embargo Gendering Anti-Francoism: Cantautoras in Spain (1952-1986)(2023) Romera Figueroa, EliaGendering Anti-Francoism reinterprets Spain’s tradition of protest music, offering the first monographic study of Iberian female singer-songwriters (cantautoras). Implementing an interdisciplinary methodology—based on the combination of textual and sonic close readings, oral history interviews, criminal records, and extensive archival research—this dissertation demonstrates that cantautoras played a major role both in the anti-Franco struggle and in the second-wave feminist movement, between 1952 and 1986. Songs were crucial for community-building, for bearing witness to different forms of violence, and for steering feminist progress. They soon became instrumental in raising individual and collective consciousness. Existing scholarship has mainly examined the lives and work of white, heterosexual, male singer-songwriters, from Paco Ibáñez’s first recordings (1956) until Franco’s death in 1975; and it has also organized cantautores by territories, e.g., studying all Catalan singers together, in isolation from their counterparts elsewhere. My periodization foregrounds a new-found group of over 70 female performers playing since the ‘50s; it extends through 1986 to include a decade of feminist activism previously overlooked. Furthermore, my analyses offer a new Iberian multilingual, multicultural, and intersectional approach, placing minoritized languages among other interconnected identity struggles involving gender, sexuality, and class. Adopting a cultural-historical perspective, I demonstrate how cantautoras confronted together the status quo, i.e., the far-reaching effects of the ultra-Catholic, sexist, and nationalist ideology of Francoism. I track how performers endured state repression and music censorship in several multi-artist tours in the 1970s. Meanwhile, concert-goers protested concert cancellations, as well as fines, arrests, and incarcerations that targeted singers. I further argue that most cantautoras put forward a feminist way of thinking that qualified and sought to inflect the priorities of left-wing political parties during the years of clandestine activism, and later, during Spain’s Transition to democracy. Thus, cantautoras performed for the left-leaning political parties and the feminist movement, pushing forward multiple struggles. During the Transition, many cantautoras sang to denounce all discrimination against women remaining from Francoist legislation. I also investigate collaborations between cantautoras, writers, and other female artists; the potential of ambiguous love songs for the LGTBIQ+ community; and the political ideas that cantautoras conveyed through children’s music.
Item Open Access Sustained: Exploring Pastoral Leadership Transitions in Light of Old Testament Succession Narratives(2020) McClendon, Lesley FranciscoPastoral succession is a necessary topic for non-denominational churches. According to the Barna research group, clergy are aging, candidate pools are shrinking and the North American Church as a whole is rapidly approaching a mass pastoral succession. One of the primary issues, however, is that there are not many models that are readily available for leaders to follow to transition well, meaning there is no plan in place before the actual transition occurs. Although transition may be difficult, it is in fact inevitable since one leader cannot stay in position forever. One of the more pressing issues facing our congregations is not the ability to address the what, but the failure to implement the how and when. The objective of this research is to convey the need for succession specifically in independent churches, encourage fellow pastors to think “with” the biblical narratives that highlight leadership transitions and consider what happens when these stories are read in light of contemporary questions about pastoral leadership and transitions. Finally, the goal is to help leaders and their congregations to see transition as an intentional, ongoing process instead of a one-time event and to provide the necessary tools to begin implementing the process of transition. The key ingredients of a healthy pastoral transition involve locating someone chosen by God and affirmed by the predecessor, who earns the trust of the congregation and leads with confidence.
Item Open Access Transition in Post-soviet Art: "Collective Actions" before and after 1989(2009) Esanu, OctavianFor more than three decades the Moscow-based conceptual artist group "Collective Actions" has been organizing actions. Each action, typically taking place at the outskirts of Moscow, is regarded as a trigger for a series of intellectual activities, such as analysis, interpretation, narration, and description. The artists have systematically recorded and transcribed these activities, collecting and assembling texts, diagrams, and photographs in a ten-volume publication entitled "Journeys Outside the City." Five volumes of this publication concern the activities of the group before, and five after, 1989. Over the years the "Journeys Outside the City" became an idiosyncratic, self-sufficient aesthetic discourse arrayed along a constellation of concepts developed by those engaged in "Collective Actions." In its elusive hermeticism and self-referentiality the aesthetic framework constructed by these artists formed a closed system, gathering bundles of signs that seldom referred to anything concrete outside the horizon of Moscow Conceptualism. It is in this regard that the early volumes of the "Journeys Outside the City" can be compared to the similarly closed ideological discourse of the Soviet Politburo. After 1989, however, with the transition from socialism to capitalism, the aesthetic and artistic language of this group began to change as its text-based self-sufficient system began to open up under pressure from new socioeconomic conditions introduced by the processes of democratization and liberalization.
My dissertation "Transition in Post-Soviet Art: `Collective Actions' Before and After 1989" is neither a history of nor a monographical work on "Collective Actions," but rather an analytical exploration of aesthetic, artistic and institutional changes that have transpired in the "Journeys Outside the City" during the transition from socialism to capitalism. As the artists migrated from one art historical category into another (from the status of "unofficial artists" to that of "contemporary artists"), their aesthetics and art revealed a series of stylistic, technical, formal, textual, and aesthetical transformations and metamorphoses that paralleled broader cultural conversions taking place in post-Soviet and Eastern European art during the transition to capitalism.