Using practice based research methodologies this thesis, Seeing & Saying: Visual imaginings for disease causing genetic mutations, explores the visual and linguistic narratives that emerge from the explanation of complex genetic diagnosis. The research, funded by the Arts & Humanities Research Council (AHRC), is being carried out in collaboration with the European Network of Excellence for rare inherited neuromuscular diseases (TREAT-NMD), coordinated by the Institute of Genetic Medicine at Newcastle University. TREAT-NMD is an international initiative funded by the European Commission linking leading clinicians, scientists, industrial partners and patient organisations in eleven countries. Located in this complex field of study, between the disciplines of art and science, this research project explores the contextual framework of the social and cultural histories that influence and give agency to the visual and text based metaphors that are used to depict and diagnose the specific genetic disease of Duchenne muscular dystrophy (DMD). The use of linguistic metaphors and visual imagery is commonplace when interpreting the how, what, why and where of DNA and it is these types of metaphorical communications that will form the basis of this investigation. This thesis interrogates and extends research methods and processes that develop from studio practice, scientific laboratories and text-based analysis thus creating a synergy between the scientific laboratory and the artist’s studio. This written thesis and the artworks produced are therefore both the narrative and the output of this collaborative relationship that represents a synthesis of the methodologies of art and science. By examining the communication between the network stakeholders of TREAT-NMD and studying how linguistic, visual and artefactual metaphors impact on the construction of technical explanations within this network, this thesis proposes that we can come closer to answering how we see and how we say genetic disease.

The overarching purpose of this research was to find out about life with Parkinson's disease and to use that knowledge to inform physiotherapy management. The project aimed to explore current and alternative ways in which professionals could seek to understand the experience of life with Parkinson's disease; to explore the implications of resultant new knowledge; and to investigate how physiotherapy relationships should take account of new ways of understanding and new knowledge. A spiral of research activity was undertaken comprising three successive cycles. The first two cycles were undertaken using case study methodology, focusing on the experience of life with Parkinson's disease from a group and an individual perspective. A wide range of qualitative and quantitative methods for both data collection (including interviews, disability and quality of life scales and activity monitoring) and data analysis were employed. The level and complexity of personal work undertaken by individuals to manage their condition was the principal theme to emerge from initial cycles. This insight led to the development of a tool — strategy mapping — to enable professionals to capture and use information about self- management in their interactions with individuals. The third cycle employed action research methodology to develop and evaluate the strategy mapping framework - centred on identifying strategies related to Self, Routines, Support and Involvement - in physiotherapy practice. A number of perspectives were developed in relation to the project's aims. The methodological perspective highlighted the need for commitment to listening to the experiential narrative and hearing the story of self-management. The ontological perspective offered the potential for practice and research to build on existing self- management solutions. The epistemological perspective pointed to addressing power differentials between knowledge bases to promote collaborative therapy relationships. The full potential of a paradigm shift which attempts to increase the degree of alignment between the everyday lives of individuals with Parkinson's disease and physiotherapy practice, education and research remains to be uncovered.

In total knee replacement (TKR) surgery, mobile bearing (MB) total knee prostheses were designed to more closely mimic the function of the normal knee than traditional fixed bearing (FB) designs by allowing axial mobility between the polyethylene insert and tibial tray. Despite the hypothetical benefits of the MB design, few studies have objectively analysed knee biomechanics during activities of daily living (ADLs) in the laboratory compared to FB designs. This thesis aimed to substantiate the theoretical advantages of MB implantation during ADLs in the laboratory as well as during free living conditions, in addition to investigating previous claims of instability in MB knees. Sixteen patients undergoing primary unilateral total knee replacement (TKR) surgery were randomised to receive either a FB (n=8) or MB (n=8) total knee prosthesis and were tested at pre-surgery, three months post-surgery, and nine months post-surgery using three dimensional motion analysis in the laboratory and electrogoniometry and accelerometry during free living conditions. No differences were found between FB and MB groups during walking at post-surgery that could not be explained by differences at pre-surgery. There were also no differences between FB and MB groups during the more biomechanically demanding activities of stair negotiation and sit to stand and stand to sit activities, as well as no differences during free living conditions away from the laboratory. There appears to be no evidence based rationale for the widespread use of MBs with regards to optimising knee function during ADLs. This thesis was the first to compare FB and MB designs using the same implant range, posterior cruciate ligament (PCL) scenario, posterior stabilising strategy, and patella strategy over a range of ADLs, as well as being the first to combine testing in the laboratory with testing during free living conditions away from the laboratory.

The Chinese group is the fastest growing ethnic group in the UK; this group is ageing fast, with the number of older Chinese doubling in 8 years. The majority of older Chinese immigrants in the UK have low education levels and limited English proficiency, and were reported to have low service use rate, lack of social support, and poor emotional status. This suggests that they may have difficult ageing experiences. This research set out to understand the UK older Chinese immigrants’ ageing experiences and coping strategies with the challenges of ageing, with a focus on the formal service use in their later life. The research adopted grounded theory as methodology, and used semi-structured interviews for data collection. The research had two phases. The first phase was exploratory using, mainly, focus groups to investigate perceptions of ageing, and for orientation to the field. Based on the contextual data provided by the phase one study, the phase two study was more focused on the support network and its influences on services use. Here individual interviews with follow-ups were used to gain in-depth understanding. Together, 58 participants, including older Chinese immigrants (n=44), family members of older Chinese (n=9), staff from organizations that work with Chinese people (n=3), and acquaintance who provided support for older Chinese (n=2), were interviewed. During phase two of the study, a group of key support providers who facilitated access to formal services for older Chinese were identified, and named as Bridge People. The outcomes of this research revealed that older Chinese immigrants used Bridge People, consisting of people from family, public sectors, Chinese community, and personal social network, to communicate with formal service providers. Older Chinese immigrants also rely on Bridge People to bridge other gaps in service delivery, such as lack of transportation, informational support, emotional support, and other cultural issues. In return, Bridge People gained trust and incurred power with older Chinese immigrants. Properties of Bridge People were identified as bilingual, bicultural, accessible, costless, and no social debt. Within the concept of Bridge People, each category provides a different combination of support, and older Chinese immigrants used this range of support in different combinations. In this study new theory and knowledge were generated about older Chinese and their key support providers. The Bridge People network model highlights the importance of interactions between Bridge People and older Chinese immigrants in accessing and using formal services. As many factors, including limited information resources, availability, role, emotional attachment, confined the performance of Bridge People, there are implications for policy makers; namely the role and importance of Bridge People should be recognized across health, social care and housing provision for older people. To promote engagement and optimise service use by older Chinese, relevant support should also be provided to Bridge People.

The study takes ideological domination in the field of the media as a point of departure, concentrating on current affairs as one of the most keenly debated issues in the field of mass media since the emergence of news agencies and up to the present age of satellite television channels. The study deals in particular with monopolies of news coverage by the major news agencies, including Reuters, Associated Press (AP), United Press International (UP), and Agence France Press (AFP). The study focuses on the cultural dimensions of news stories and the controversies over their content which have spurred regional and international efforts to establish alternatives to the one-way flow of news and information from core countries to the rest of the world. The study also focuses on American domination in the field of news and the establishment of CNN, which has itself become a symbol of American influence as well as a significant influence on the live news coverage of events. The impact of CNN has also triggered many reactions, including efforts in various countries to compete with it in order to cover the news from perspectives within these countries. The study goes on to focus on the Arab region, which has its own characteristics but also shares many features with other peripheral countries, particularly in the field of the mass media and the reliance of Arab audiences on news sources in core countries. This study deals with various issues concerning the mass media and news coverage in the Arab region, providing a historical framework for the development of its mass media; the political atmosphere and other factors which have affected their performance. The study also examines attempts by Arab countries to work collectively in order to establish alternatives to the core countries’ news outlets. By focusing on the Arab region this study aims to examine in particular the significance of the Arab satellite news channels and their success in competing with the news outlets of core countries. The competitiveness of the Arab satellite channels is evaluated, considering Al-Jazeera as a particularly important example. The study finally focuses on Libya as an example both of an Arab county and as a representative of peripheral countries. This section of the work involves an empirical study into perception and evaluation of regional and international news. This provides ideal opportunities to assess the theoretical framework of the study with references to the features and difficulties of peripheral countries. Libya’s efforts in the field of mass media, and particularly its news outlets, are also evaluated. In addition the study examines the attitudes of the Libyan people towards domestic, regional and international news outlets and their significance in terms of news coverage. This provides a thorough understanding of the perceived weaknesses and strengths of these news outlets, and such information may help in the development of a new strategy for the Libyan mass media in order to make them more competitive.

As the population of people in the UK, over 65, increases and the welfare system moves from a collectivist, towards a consumerist system, involving older people in their rehabilitation and care becomes more important. It is recognised that the effectiveness of practices to increase involvement varies. The reasons for this include the lack of clarity about the meaning of involvement in health care. The aims of this research were to develop a substantive theory, which explains the meaning of involvement for older people in their rehabilitation after acute illness and facilitates recommendations for health care practice development. Grounded theory was employed to collect longitudinal data from four older people, their practitioners and support staff, during the participants’ rehabilitation stay of around six weeks in an Intermediate Care unit in the UK and at home. Data were collected using recorded, semi-structured interviews and conversations, from December 2008 to November 2009 and were analysed qualitatively. The findings suggest that involvement in rehabilitation operates through an Involvement Attribute set consisting of two interdependent groups of Involvement Attributes (the psychologically-based and the action-based). Collectively, the Involvement Attributes are: the possession of a Vision, Incentive and Goals, a positive Disposition; a propensity for Cognitive Development; Goal planning, setting and achievement; and Risk Management. To be maximally involved the Involvement Attribute set has to be strong, balanced and with alignment between the two groups. Involvement in rehabilitation is also related to the type of relationships developed with the health care staff and relatives. Improvements in Involvement Attribute sets require a move away from paternalistic relationships towards the collaborative, partnerships suggested within relationship-centred care. In this way, involvement of older people in rehabilitation is: “A joint commitment within therapeutic relationships to determine and be determined in the pursuit of an Involvement Attribute set that is strong, balanced and aligned”.

This research focuses on designing with indigenous communities. The use of design raises concerns in this context. Because of the aim to ‘improve’ lives and the emphasis on innovation, design approaches have the probability to colonise. As designers, we have to find ways to deal with such concerns. Approaches that do this within the context of indigenous communities are Sheehan’s respectful design and Tunstall’s culture-based innovation. Both approaches acknowledge that the community should benefit from projects. In this, the role of the designer becomes to spark the resourcefulness of the community members to find such benefit. However, neither approach states in pragmatic terms how such a space can be reached. Therefore, this research aims to: explore the dynamics of a respectful design space in co-creative and co-reflective encounters with indigenous communities; and to provide recommendations to reach such a space. The explorations were performed by introducing co-creative design methods during a case study with three indigenous communities. Some co-creative processes led to respectful design spaces, others did not. All processes were analytically studied by combining annotated portfolios and content analysis in timelines. The aim was to find patterns of dynamics essential for respectful design. The dynamics that arose were: 1) ownership through the type of design participation, 2) indicators of ownership, 3) the type of novel expressions made and 4) the type of material culture introduced. This led to contributions of this research being, firstly, a framework of a respectful design space and recommendations of how to reach such a space. Secondly, the concept of constellations of design initiatives, to understand respectful design in situ. Thirdly, the importance of inclusion of the community’s own material culture to facilitate dialogical spaces, and, finally, the analytical approach used to find the dynamics.

While there is significant interest in the lives of looked-after young people, little attention has been given to the way these young people are depicted onscreen. The aim of this study is to explore looked-after young people's perceptions of these fictional depictions and the impact these depictions have on them. Drawing on Freire’s seminal text, Pedagogy of the Oppressed, I adopt a participatory approach throughout. Research methods involved viewing and discussing TV and film content depicting looked-after characters with a group of young people in care, followed by semi-structured interviews with group members. The data is analysed using a modified Interpretative Phenomenological Analysis protocol. My research highlights that these young people perceive onscreen fictional depictions to be “unrealistic” and negative. These depictions have significant impact, particularly in terms of “presumed media influence”, on how these young people perceive negative depictions to influence others. The young people offer a range of suggestions in terms of better depicting looked-after characters, drawing on their own experiences of care. My research also highlights the benefit of utilising a Freirean empowerment model, in terms of raising critical consciousness, for a group of looked-after young people.

Freight transport decisions are nowadays affected by the impact of the external environment, particularly within commodity markets like the natural rubber industry. Consequently, shipping managers are confronted with uncertain circumstances such as economic changes causing high price volatility, economic crises and emerging new markets. As China becomes the worlds’ largest rubber consumer and has introduced a mixture of rubber buyers to the market, the level of complexity in transportation has now increased substantially. This study considers freight transport mode choice. Despite the fact that mode choice selection is not exactly a new subject, the majority of existing studies conducted have been based only on surveys or secondary data, that have mainly sought to identify an optimized solution or the prioritisation of operational factors such as cost and transit time. The purpose of this study is to investigate factors influencing decision makers when it comes to choosing the transportation alternatives currently available, or that might be used, by natural rubber exporters in Thailand. This research used a preliminarily conceptual framework derived from the combination of the Organisational Buying Behaviour (OBB) model in terms of contextual factors, with relevant literature in relation to operational factors. These include organisation, business environment, individual perceptions and past experience, and operational factors in order to assess primary qualitative data gathered as part of the research fieldwork. This research has adopted a qualitative approach and methodology based on the interpretivist paradigm. The research was conducted using two methods: questionnaires and follow-up semi-structured interviews. To explore the background of the natural rubber industry, identifying its key demographic characteristics and the current situation with regard to freight transport usage, a questionnaire survey was conducted using a sample of 73 shipping managers. Fifty individuals completed and returned the questionnaires. In support of a substantive study, in-depth interviews of the managers of 21 companies were used to investigate what factors influence the selection of transport modes and how they impact on their decisions. The interviewed transcripts were analysed using template analysis. The conceptual model data gave a clearer picture of linkages and relationships between five dimensions: environmental characteristics, organisational characteristics, customer characteristics, transport decision making in the natural rubber industry and operational factors. This model can provide a deeper understanding of freight transport choice decisions in terms of a combination of operational and behavioural factors. The developed model also enhances the power of explanation of those various factors feeding into the decisions of freight transport mode choice and will be disseminated to shipping managers within the commodity market sector.

Collaboration is central in the transformation and sustainability of future healthcare with a clear place in integrated models of care, but the operationalisation of collaborative working presents challenges in practice. There is a lack of evidence about how collaboration is sustained in the delivery of healthcare, and a deficiency of studies which include patients as part of collaboration. This thesis investigates the meaning and manifestation of collaboration, including the experience of patients and professionals in practice. A social constructionist approach to grounded theory is used to investigate collaboration in an Outpatient Parenteral Antimicrobial Therapy (OPAT) service. The sample consists of staff and patients who have experience of OPAT. Interviews and focus groups are used to generate data, and grounded theory methods are used to progress the study through constant comparative analysis and theoretical sampling to a point of data saturation. Coding, categorising and techniques of situational analysis are used to analyse data and develop theory. The theory of Interactive Navigation conceptualises collaboration as a device used to navigate complex care situations and to direct collaboration with differing consequences for patients and professionals. The factors which influence collaboration are found to be a range of Situational Co-ordinates (Certainty, Uncertainty, Limits, Goals and Power) and interaction takes place through Interactive Mechanisms (Rehearsing, Coordination, Communication and Trust). The Collaboration Compass model is presented as a tool to inform understanding of Developing, Maintaining, Limiting and Disrupting collaboration. Collaboration is differentiated into four distinct areas and is revealed as a social device integral to the situation in which it takes place. This complexity requires recognition if collaborative health and social care developments are to succeed. The theory of Interactive Navigation presents a new way to view collaboration, and the Collaboration Compass offers a tool to navigate situations and map collaboration in practice.