No / Objectives: A review of the literature reveals little description of the advisory role of the health visitor in the child health clinic. This paper describes a study which examined content, clients' recall and value to the client of their discussion with the health visitor. Design: Descriptive study; non-participant observation; semi-structured interviews. Setting: One predominantly urban community Trust involving seven volunteer health visitors from seven different child health clinics. A total of 24 clinics were observed. Participants: One hundred clients attending seven child health clinics. Findings: Most mothers reported that speaking with the health visitor had been fairly or very important. Clients' discussion with the health visitors covered a wide range of child-centred issues and concerns. Mothers recalled 79% of all topics discussed during the clinic visit and initiated nearly 59%. Although weighing was considered an important reason for attending clinic by most mothers it did not preclude wanting to speak with the health visitor. However, some mothers did not wish to speak to the health visitor. Conclusion: The health visitor provided an advisory and support service for many of the attending mothers. Most clients reported valuing this intervention. This study support the notion that mothers do not attend the clinic simply for medical services or screening. Attention should be focused on research and development of services which reflect this consumer agenda. Consideration should be given to the appropriateness of health visitors weighing children.

Yes / Exercise classes provide a range of benefits for older adults, but adherence levels are poor. We know little of instructors’ experiences of delivering exercise classes to older adults. Semi-structured interviews, informed by the Theory of Planned Behaviour (TPB), were conducted with instructors (n=19) delivering multi-component exercise classes to establish their perspectives on older adults’ uptake and adherence to exercise classes. Analysis revealed ‘barriers’ related to identity, choice/control, cost, venue and ‘solutions’ including providing choice, relating exercise to identity, a personal touch and social support. ‘Barriers’ to adherence included unrealistic expectations and social influences and ‘solutions’ identified were encouraging commitment, creating social cohesion and an emphasis on achieving outcomes. Older adults’ attitudes were an underlying theme, which related to all barriers and solutions. The instructor plays an important, but not isolated, role in older adults’ uptake and adherence to classes. Instructors’ perspectives help us to further understand how we can design successful exercise classes.

Yes / Neighbouring Trusts have implemented open access (walk-in) services to shorten waiting times in x-ray. Despite this, staff perceptions of their effectiveness have not yet been studied. This study forms the initial baseline evaluation phase of wider participatory action research investigating the implementation of an open access service for general practitioner musculoskeletal x-ray referrals. Staff perceptions regarding effectiveness of the current service were gathered, including their opinions regarding the effectiveness of open access services. Qualitative data were obtained via three semi-structured interviews with radiology management and two (cross-site) staff focus groups over a 2 month period. Template analysis was used to interpret the data with the aid of NVIVO 11 to facilitate analysis. Template analysis uncovered several drivers for changing the current service including waiting times, external pressures, patient choice and administrative delays. ‘Flexibility’ was the key theme to arise during discussion regarding the effectiveness of the current service. Potential for improved access was highlighted as a major benefit to the implementation of open access, however ‘workload’, ‘staffing’ and ‘communication’ were all identified as potential barriers to its implementation. Although several staff members were satisfied with current service several drivers for change were identified that need to be addressed in order to truly deliver a service that fulfils the patients' needs. Results will inform the wider participatory action research that will investigate the barriers to implementing an open access service and identify whether this is indeed a suitable method of addressing the drivers for change.

Yes / Rationale and Perceptions of frailty can influence how families cope, quality of life and access to support services. Yet little is known of how lay members of the UK general public perceive frailty. This scoping review aimed to explore how frailty is perceived among the lay public in the United Kingdom. Methods: The established scoping review methodology by Arksey and O’Malley was followed and searches were conducted across eight electronic databases and grey literature websites for articles published between 1990 and August 2022. In total, 6,705 articles were identified, of which six were included in the review. Data were analysed using Braun and Clarke’s thematic analysis framework. Results: Three key themes were identified; frailty as a normal part of ageing, perceived consequences of frailty and coping with frailty. Overall, frailty has negative connotations and is perceived as linked to a natural part of the ageing process, increased dependency, loss of identity and social exclusion and stigma. However, it is unclear whether these perceptions have a direct bearing on access to support services for communities. Conclusion and implications: This review identifies that it is imperative for health and social care service providers to consider the individual meaning of frailty for older people and families, to understand and integrate their particular needs and preferences when planning and delivering person centred frailty care and support. There is also a need for development of interventions that focus on increasing education and reducing stigma around frailty in order to change frailty perceptions in the UK. / This report is independent research funded by the National Institute for Health and Care Research, Yorkshire and Humber Applied Research Collaborations NIHR200166.

This study delves into the integration of children’s literature in English language learning classrooms, aiming to clarify teachers’ motivations, challenges, and methods. Through semi- structured interviews with educators from the United States and Sweden, diverse perspectives and experiences are captured, enriching the understanding of this educational practice. The research identifies key factors influencing the selection process of children’s literature, including relevance, student interest, and language proficiency levels, while exploring various integration methods such as read-aloud sessions, comprehension activities, and writing extensions. Despite facing challenges such as limited access to appropriate children’s literature and district policies, teachers demonstrate a commitment to enhancing language skills, promoting global awareness, and fostering critical thinking among students. By exploring different types of children’s literature, including picture books, chapter books, and culturally diverse texts, educators create immersive learning experiences that engage students in meaningful interactions with children’s literature, ultimately cultivating a deeper appreciation for reading and its broader impact on learning and development. The results show the necessity of providing thorough training and support for teachers to address challenges effectively and fully leverage the advantages of incorporating children's literature into language instruction. The findings illuminate the diverse and significant roles of children’s literature in education, mirroring societal views on raising children and meeting the needs and comprehension levels of readers. Through a qualitative approach that empowers participants to contribute their perspectives, the study offers in-depth insights into the diverse instructional strategies for utilizing children’s literature in English language education. Overall, the results enhance our understanding of the educational benefits of children’s literature in enriching classroom instruction and facilitating language learning, highlighting the necessity of nurturing supportive learning environments conducive to the effective integration of children’s literature into educational practices.

The purpose of this study is to identify how parents perceive dialogic book reading workshops that they participate in, and how cultural backgrounds affect these perspectives. Four native English-speaking mothers, and one Spanish-speaking mother with preschool-age children participated in this study. After two dialogic book reading workshops, parents participated in focus groups to discuss their perceptions. Participants noted three positive themes including motivators like incentives and childcare, positive influences, and effective adaptations in their reading routines with their children, and how the workshops were structured with helpful facilitators, supplemental materials, and content. Participants suggested various ideas for improvement. The Spanish-speaking participant mentioned more familial benefits, while the English-speaking participants focused on individual benefits. Overall, parents perceive dialogic book reading workshops as positive experiences that positively impact their families across cultures.

The objective of this study is to provide cross-cultural comparative observations about students' attitudes and behavior towards globalization and localization, which in turn can help determine students' cosmopolitan attitudes. A major part of this discovery is to find which independent variables influence such a "cosmopolitan" perspective through the use of quantitative research. Using the method of survey research to measure the "globalized" and "localized" viewpoints of students in the U.S., Russia, and Turkey, the focus of this project addresses the subjects of globalization and localization. The topic is significant in research as well as teaching perspectives, especially in a cross cultural context. Therefore, the key purpose of this project is to delve into the study of major concepts known as globalization, localization, and cosmopolitanism as they relate to the social sciences and to discover the similarities and differences between them. This research explores the minds of the generation whom "globalization" will most impact; it is they who will take part in its growth in the future. Ultimately, this study will attempt to uncover the implications of teaching and learning about "globalization" in international relations courses and examine students' perspectives towards these major concepts.

(Study-Specific definition of 'Culture') For the purpose of this study, cultures will be defined by broad rather than specific categorization. The cultures of race and biological sex are material and thus more frequently observed and studied by educational researchers. However, the obvious debate about the concrete identity of one individual as belonging to only one race and one sex make the borders of these terms fluid and mutable. Unless the terms 'race' and 'sex' signify a self-identified choice by the individuals, they are just as limiting and possibly offense as the outside identification of 'gender' and 'ethnicity'. Assumption is therefore a cautious ground for educators, and a broader idea of personal identity is necessary. This study will thus refer to 'cultures' in terms of typically practiced beliefs. Since some of the beliefs discussed may overlap and apply to multiple cultures, the term will apply to the group in discussion. Teachers and educators may then avoid inappropriate judgments as they see students individually demonstrate the beliefs described and act accordingly. (Study-Specific definition of 'Reading Motivational Methodologies') Reading motivational methodologies will be defined as the actions and ideas presented by teachers, reading coaches, and tutors meant to stimulate and encourage the practice and mastery of reading. These methods may be tangible, observable, and repeatable. They may also be ideological or perceptual. (Study-Specific Areas of Exploration and Discussion) Communication is a tool. Whether verbal or written, it is created and carried out with purpose. Reading is a form of communication performed in almost every major global culture, yet utilized in different ways according to a number of factors. The values of a culture entirely define the usage of verbal and written messages. If reading is performed for different reasons by different groups of people, wouldn't it naturally follow that our purposes for becoming literate vary as well? What motivational tools will then help all students to develop a desire a read? This is a multi-dimensional question which includes many factors. One of the more complicated, qualitative factors of the answer is that of cultural perception and thought. As previously stated, communication is a tool. Tools are utilized for different purposes, and consequently different ways of thinking, of knowing, and of questioning arise within the classroom. According to Vacca and Vacca, "different cultures may place different emphasis and value on various cognitive activities"1 This implies that certain activities may intellectually stimulate familiar cognitive processes, building on student schema activation, while other activities require students to build newer processing skills. For example, "some societies ... emphasize memorization and analytical thinking over the ability to experiment or make predictions"2 Students from such societies might be able to do extremely well at language arts activities like spelling or literary essays, but have a harder time making a mind-map of the themes a story represents. In my study, I plan to explore different perceptions of important cognitive practices among groups through use of the Schwartz Model of classroom group interaction. This entails: 1) Emphasis on individual and group performance 2) Emphasis on assertiveness and a desire for group accord 3) Emphasis on reasons for acting in the interest of others 4) Emphasis on individual thought and success These differences in the reception of information create a need for different literal classroom practices. One of the most practical areas to explore and measure is that of literal classroom practices. Some areas investigated in relation to the Schwartz Model are: 1) Group setting preferences. Does the student prefer to work alone, in small groups, or as a class? 2) Auditory preferences. Does the student prefer to read aloud to the class, be read to by the teacher, be read to by a peer, be read to be an audio device, or read alone silently? 3) Visual preferences. Does the student like being provided with relevant pictures, charts and graphs, or will this make the student feel overwhelmed and inundated with information? 4) Literary analyzation group setting preferences. Does the student prefer to read and analyze literature alone, in small groups, or as a class? 5) Personal choice preferences. Does the student prefer to choose their own literature, or have literature selected for them? 6) Extrinsic reward preferences. Does the student prefer tangible rewards, or some form of teacher/peer praise? 7) Goal setting preferences. Does the student prefer specific, small goals or general, larger goals? 8) Creative options preferences. Does the student prefer to be given specific directions, or creative freedom? Other factors include technology available and content covered. The last factor which I plan to explore is that of cognitive dissonance as an affective and moral factor. According to the National Assessment of Educational Progress (NAEP), African American high school seniors scored lower on the NAEP reading exam in 2002 than any other ethnic group. One factor clearly influenced test performance among the group: the amount of time spent reading for enjoyment outside of school. The NEAP test is graded on a scale of 1-3. 10% of African American seniors who read for pleasure scored a 3 on the test; only 6% of students with the same demographic who did not read for pleasure scored a 3. According to these statistics, the impact of the ability to find joy in reading is obvious. These statistics on are not atypical and not limited to one ethnic group, and many similar studies are also often transcendental of race. Affective topics such as this tend to be ignored, namely in later grades and at higher levels of achievement due to the fact that "research funding for adolescent literacy ... is minuscule in relation to the big bucks federal and state agencies spend on early literacy and early intervention research"3 Yet it is this aspect of literacy development which entirely influences the ability to move onto cognitive factors. 6) Extrinsic reward preferences. Does the student prefer tangible rewards, or some form of teacher/peer praise? 7) Goal setting preferences. Does the student prefer specific, small goals or general, larger goals? 8) Creative options preferences. Does the student prefer to be given specific directions, or creative freedom? Other factors include technology available and content covered. The last factor which I plan to explore is that of cognitive dissonance as an affective • and moral factor. According to the National Assessment of Educational Progress (NAEP), African American high school seniors scored lower on the NAEP reading exam in 2002 than any other ethnic group. One factor clearly influenced test performance among the group: the amount of time spent reading for enjoyment outside of school. The NEAP test is graded on a scale of 1-3. 10% of African American seniors who read for pleasure scored a 3 on the test; only 6% of students with the same demographic who did not read for pleasure scored a 3. According to these statistics, the impact of the ability to find joy in reading is obvious. These statistics on are not atypical and not limited to one ethnic group, and many similar studies are also often transcendental of race. Affective topics such as this tend to be ignored, namely in later grades and at higher levels of achievement due to the fact that "research funding for adolescent literacy ... is minuscule in relation to the big bucks federal and state agencies spend on early literacy and early intervention research"3 Yet it is this aspect of literacy development which entirely influences the ability to move onto cognitive factors. All three factors are intrinsically linked: affective factors inspire students to read, cognitive factors grant students the ability to read, and classroom practices allow for the effective and appropriate growth of readers. The final section aims to express the extreme complexity of cross-cultural communication and the factors which can influence the positive or negative outcome of such contact while covering the multitude of options available to different forms of educators who are faced with a multicultural classroom.

Background: Patients in the emergency department are not always satisfied with the care received and the nursing care in the emergency department is sometimes described as instrumental and non-holistic. Structured quality improvement work and evidence-based practice are needed. Aim: The overall aim was to emphasize general patients in the emergency department to enhance the knowledge on how they perceive the quality of care and how the care could be improved through collaboration with the healthcare professionals. Methods: Four studies, with quantitative and qualitative designs, were conducted in a Swedish emergency department. Two hundred patients answered a questionnaire, after which 22 healthcare professionals comprising five focus groups were interviewed, and finally 200 patients were included in an intervention study. Results: The following five areas for improvement were identified: “information, respect and empathy”, “pain relief”, “nutrition”, “waiting time” and “general atmosphere”. Of these areas, the healthcare professionals prioritized “information, respect and empathy”, “waiting time” and “pain relief” to be highlighted in the quality improvement work. Although goals and suggestions for changes were stated, barriers to quality improvement at different levels in the health care were detected. The results of the intervention study showed that structured nursing assessment of the patients’ abdominal status and nurse-initiated intravenous opioid analgesic could increase frequency of analgesic and reduce time to analgesic in the emergency department. Patients perceived lower pain intensity and improved quality of care in pain management. Conclusions: An uncomplicated nursing intervention, related to pain management, based on the results from a patient questionnaire and interviews with healthcare professionals, can improve the care process and pain management in the emergency department, as well as patients’ perceptions of the quality of care in pain management. To succeed with continuous quality improvement work, barriers to change should be addressed.

En raison du peu d’écrits sur la musique destinée aux marionnettes du symbolisme à la naissance de la musique concrète, l’objet de notre thèse porte sur une mise en perspective de la musique de sept compositeurs écrite pour marionnettes et jouée à Paris entre le symbolisme et la naissance officielle de la musique concrète. Longtemps considérée comme un divertissement, la marionnette acquiert à l’aube du XXe siècle une image d’égérie des avant-gardes et devient le foyer d’expérimentations. Face à l’émergence d’écritures originales sur les plans théâtral ou plastique, nous étudierons à quels moyens expressifs la musique écrite pour marionnettes a recours, dans un langage renouvelé ou non, et comment elle peut ainsi nous éclairer sur la dimension et la nature de son rôle. Notre étude, située à la croisée de plusieurs langages, s’appuie sur l’analyse de signes communs et distinctifs dans une volonté tout d’abord de restitution diachronique à l’aide de supports d’époque, puis d’analyse synchronique à travers des recréations contemporaines. / There being few texts on music composed for puppet-shows between the time of the symbolists and the beginnings of music concrete, our thesis aims to put into perspective the music of seven composers, written for puppets and performed in Paris between 1886 and 1948. Having been regarded for a long time as mere entertainment puppet-shows are seen at the dawning of the 20th century as the driving force of the avant-garde, and the locus of experimentation. In the face of the emergence of original writing in the fields of theatre and the plastic arts, we shall study the means of expression to which music written for puppet-shows turns, either or not this is in a renewed language, and thus how it might enlighten us on the breadth and nature of its role. Our study, set where several languages meet, is based on the analysis of signs both common and distinctive with the desire first of all to create a diachronic reconstruction with the help of documents of the area, and then a synchronic analysis based on modern recreations.