Nearly a third of all emergency department (ED) visits are for non-emergent conditions. Several factors contribute to non-emergent ED use, though the relative importance of these factors and how non-emergent ED users differ from those seeking similar care in primary care (PC) settings are less clear. Surveys were administered to adult, English-speaking, primary care patients seeking same-day, non-emergent care in the ED and PC clinic at an urban, safety-net hospital during normal clinic hours. ED patients were eligible if they had a primary care physician (PCP) located at the hospital and thus the ability to seek same-day care in the PC clinic. Surveys assessed sociodemographics and six major care-seeking factors (perceived urgency, cost, convenience, beliefs about alternative sites, access, and referral). Patient characteristics were compared between sites using t-tests and Fisher’s exact test, and multivariable logistic regression identified predictors of ED use. Compared to PC patients (n=61), ED patients (n=59) were significantly more likely to be male, middle-aged, homeless, Medicaid-insured, and unmarried with a trend toward being non-White and less educated. ED patients were significantly more likely to perceive the cost of an ED and PC visit to be the same/free (69.1% vs. 37.1%; p<0.01) and to believe the ED would provide higher quality care (24.6% vs. 3.6%; p<0.001). PC patients were more likely to consider their doctor’s office as their usual source of care (83.1% vs. 37.9%; p<0.0001) and believe it is easy to make PCP appointments on short notice (74.5% vs. 54.2%; p=0.04). In the adjusted model, patients whose usual source of care was not the doctor’s office had the highest odds of non-emergent ED use (aOR 4.25, 95% CI 1.28–15.20), and patients reporting ease of scheduling PCP appointments on short notice had significantly lower odds of ED use (aOR 0.19, 95% CI 0.04–0.67). Non-emergent patients in the ED and primary care clinic differed by sociodemographics, usual source of care, and perceptions of cost, care quality, and ease of scheduling appointments. Opportunities exist to reduce unnecessary ED use in similar populations by promoting the primary care clinic as a routine and easily accessible source of high-quality care. / 2019-11-08T00:00:00Z

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South Africa (SA) is home to 11 official named languages; its Language in Education Policy (LIEP) identifies multilingualism as one of the defining characteristics of its citizenry (DOE, 1997). Moreover, English is the official Language of Learning and Teaching (LOLT) in most ex-Model C schools nationwide. It is the language that is reported to be valued by the middleclass, people who are known for placing a high premium on education (Soudien, 2004; Alexander, 2005). The aim of this ethnographic Language Socialisation study is to explore the language socialisation experiences of a Grade R child in a Black middle-class multilingual family residing in a Cape Town suburb. The study is framed by the question: What are the language socialisation experiences of a child from a Black middle-class multilingual family? It uses a socio-cultural approach, drawing from linguistic anthropology, applied linguistics and sociolinguistics to critically analyse the language ideologies, language practices and linguistic repertoires evident in both the home and school domains across which the young child traverses. Concepts such as multilingualism, Family Language Policy and ‘mother tongue’ identity are reviewed and used to gain insight into the lived language experiences of the Grade R child. The concepts of assimilation (Soudien, 2004) and anglonormativity (Christie &amp; McKinney, 2017) are reflected on as markers of school language practices and ideologies. Findings reveal that the Grade R child is an emergent multilingual who participates meaningfully in multilingual conversations with her family but only produces English. Despite the evident heteroglossia (Bhaktin, 1991) of the family’s language practices through translanguaging (Garcia, 2009; Creese and Blackledge, 2010) and drawing from the range of resources in their linguistic repertoires (Busch, 2012), the parents continue to use their Tswana and Xhosa ethnicity as markers of their language identities. The parents want their children to speak their heritage languages for identity reasons. They also want them to speak English to ‘fit in’ with their peers and to access learning. They see the teaching of Tswana and Xhosa as their sole responsibility thereby absolving the school. Their view enables the schools’ status quo of anglonormativity to go unchallenged. The child, thus, experiences heritage languages as identity markers and languages reserved for home, and English as a valuable language resource that gives access to learning. The notion of a single language identity remains complex for a child who is expected to be multilingual at home but monolingual at school.

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Agency and desire are interdependent. Agency is not a given, but an achievement of ordered desiring. We want to control our desires rather than be controlled by them, but the dilemma is that our selves are separate neither from our desires nor our control. John Dewey articulates this dynamic and proposes a solution; we can control desire and thereby ourselves by an immanent and reflective reconstruction of the meaning and object of desire. However, Dewey over-estimates the cognitive control of meaning and desire, because he presumes that desire is always ideational, rather than explaining how desire comes into cognitive awareness and control to be available for reflective manipulation. This work will extend Dewey's theory of experience and habit by explaining the structural habitual conditions necessary for the cognitive control of desire, e.g., how desire becomes ideational and subsequently an ideal. It offers a constructive criticism and a new heterodox phenomenological method based on the works of John Dewey, Thomas Alexander, and Victor Kestenbaum.

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Thesis (Ed.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The purpose of the present study is to investigate the relationship between parent-child interaction during shared book reading and emergent reading behaviors of 4 and 5 year old bilingual children at an international preschool in Japan. More specifically, this study examines: 1) Parental beliefs held about education and literacy learning. 2) The parental structuring of time, material, and experiences in the child's home environment. 3) Emergent reading behaviors of bilingual children during storybook reading. 4) The different types of support parents provide for their children during reading that contribute to the level of reading achievement attained by preschoolers. Qualitative case study methods were used to investigate common features of the parent-child interaction during the storybook reading and the literacy environments the child experiences. The data analysis revealed the following: The Japanese mothers in the current study supported the principle of direct teaching of literacy skills and did not support the interdependency of reading and writing even though they are highly-educated and from middle and upper class families. The mediating styles and strategies they employed during the storybook reading are reflective of their beliefs. The findings reveal that the method of literacy learning is valued differently by sociocultural context, where diverse contexts adhere different values to the educational process, its immediate and long-range goals, and the kind of adults a community hopes these children will become. The results of this study indicated that storybook reading could be fostered through a most routine of family activities. Parental involvement relates the text and its background knowledge to a child's personal experience of the world since reading skills, here, are developed in the course of the reading itself, assistance from the mother by means of 'scaffolding' and through connecting the story's elements to a child's own life events. The bilingual preschoolers also developed emergent literacy strategies as a result of being immersed in a print-rich environment where they can interact with print in meaningful and purposeful ways. The results may offer suggestions for presenting a developmentally and culturally appropriate literacy-learning environment for preschoolers who are learning English outside of English-speaking countries. / 2999-01-01

The Survival games genre is infamous for its lack of narrative. In this paper we look at thepossibility of emerging narrative in open world survival sandbox games. The survival aspectof a game is heavily tied to specific survival-centric mechanics that are frequently occurringin the genre. These mechanics and systems can in and of themselves give way to an unwrittennarrative for each individual player. By working with the concept of Narrative gamemechanics, we interviewed a pool of people about their stories and narrative experiences insurvival games. After analysing the results we found recurring patterns to indicate how certaintypes of survival-mechanics can lead to certain types of narrative situations.