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This thesis explores how the discourse of complexity thinking can be used to foster emergence in curriculum and practice-based research. The curriculum-related exploration focused specifically on games of chase as one facet of early childhood curriculum. It investigated using complexity thinking firstly, to occasion emergence (that is, create a new phenomenon) in children’s games of chase at an early childhood centre and secondly, to describe this emergence. The research-related exploration focused on creating an emergent methodology which is underpinned by complexity thinking. In this thesis report, I present a series of emergent curriculum-related phenomena that arose during the explorations, that is, an emergent game, a local curriculum theory for games of chase, the concepts of local curriculum theory, curriculum design and curriculum dynamics, and a curriculum vision. I also present an understanding of emergent methodology and two methodological innovations in the form of the Research Data Management System and the Visual Summary. This research involved taking the role of a volunteer teacher-researcher-curriculum designer at an early childhood centre to play games of chase with children. This role was informed by and contributed to a curriculum design that focused on designing the teaching and learning environment to occasion emergence in learning and curriculum. The games of chase curriculum contributed to children’s learning, my own learning and the general rhythm of life at the centre. The children learnt to distinguish between children who were playing and those who were not. They also learnt different ways to tag people in a game. In addition, the children and I developed a game playing routine before playing each game. This routine involved putting on tag belts, discussing what game we were playing and how we were going to play it. We played three different games of chase, starting with tag, followed by What is the time Mr(s) Wolf?, and finally the emergent game Big A, Little A. The stories of emergence are described in visual, descriptive and narrative texts organised into curriculum stories, teaching stories and children’s learning stories. Curriculum stories describe the activities that unfolded. Teaching stories present stories of teaching while learning stories are stories of children’s learning. These stories represent views of the enacted curriculum as activity, teaching and learning respectively. Taken together, the stories present a description of the curriculum dynamics that unfolded at the centre in relation to games of chase. This thesis shows that a local curriculum theory for games of chase at the centre emerged from the complex interactions of curriculum design and curriculum dynamics that unfolded at the centre. It also articulates the emergent concepts of local curriculum theory, curriculum design and curriculum dynamics using the language of complexity. This thesis also presents the local curriculum theory as a curriculum vision. This vision involves a shift in thinking about curriculum as either a set “course to be run” or the “path created in the running” (currere) to embracing curriculum as both “the space for running” and currere. It is a vision that values both children’s and teachers’ interests, focuses on teachers and children exploring depth and breadth of a curriculum domain together, enables teachers to follow, generate and sustain children’s interest in the explorations, and is generative, flexible and future-focused. This thesis conceptualises an emergent methodology as a methodology for emergence which (1) involves the researcher actively striving to foster emergence in research, (2) is brought forth in the interactions between the designed and enacted facets of methodology, (3) is local to a particular research project, and (4) emerges from the interactions of several related strategies. This thesis can be seen as an attempt to change the language game of curriculum by using the language of complexity throughout the thesis. In so doing, it not only enables the reader to talk about the discourse of complexity thinking, it also enables the reader to experience the discourse and the emergence of the curriculum-related phenomena and the methodological innovations that are the focus of this thesis. Finally, this thesis argues that using the discourse of complexity thinking in teaching and research can be enabling. It can enable the teacher and/or researcher to be creative, flexible and ethical within the constraints of his/her professional and personal life.

BACKGROUND: Complementary and alternative medicine (CAM) use has steadily increased globally over the past two decades and is increasingly playing a role in the healthcare system in the United States. CAM practice-based effectiveness research requires an understanding of the settings in which CAM practitioners provide services. This paper describes and quantifies practice environment characteristics for a cross-sectional sample of doctors of chiropractic (DCs), licensed acupuncturists (LAcs), and licensed massage therapists (LMTs) in the United States. METHODS: Using a cross-sectional telephone survey of DCs (n = 32), LAcs (n = 70), and LMTs (n = 184) in the Tucson, AZ metropolitan area, we collected data about each location where practitioners work, as well as measures on practitioner and practice characteristics including: patient volume, number of locations where practitioners worked, CAM practitioner types working at each location, and business models of practice. RESULTS: The majority of practitioners reported having one practice location (93.8% of DCs, 80% of LAcs and 59.8% of LMTs) where they treat patients. Patient volume/week was related to practitioner type; DCs saw 83.13 (SD = 49.29) patients/week, LAcs saw 22.29 (SD = 16.88) patients/week, and LMTs saw 14.21 (SD =10.25) patients per week. Practitioners completed surveys for N = 388 practice locations. Many CAM practices were found to be multidisciplinary and/or have more than one practitioner: 9/35 (25.7%) chiropractic practices, 24/87 (27.6%) acupuncture practices, and 141/266 (53.0%) massage practices. Practice business models across CAM practitioner types were heterogeneous, e.g. sole proprietor, employee, partner, and independent contractor. CONCLUSIONS: CAM practices vary across and within disciplines in ways that can significantly impact design and implementation of practice-based research. CAM research and intervention programs need to be mindful of the heterogeneity of CAM practices in order to create appropriate interventions, study designs, and implementation plans.

Generally speaking depictive theories attempt to explain the experience of looking at paintings and drawings, in particular they describe the process by which a viewer makes sense of a surface that has been intentionally marked in such a way as to describe some thing in the world. Depictive theories have generally been developed with reference to figurative work where the viewer is able to recognize the depicted object(s). The aim of this thesis is to determine the extent to which they apply to non-figurative work, what is commonly referred to as abstract art, and to identify what factors can influence the understanding and interpretation of such work. The method used is a combination of theory and practice. An analysis of theories of depiction and of contemporary scholarship on the subject is undertaken. Using the results of this work and by reference to the key concepts of these theories an analysis of specific artworks is carried out in a series of case studies. The purpose of the case studies is to identify, in the first instance, how certain theories of depiction can be seen to apply. In other words how they explain the experience of looking at a figurative artwork. The case study approach is an essential element of the methodology of the project. It is used, initially, to interrogate a work by Titian that is, arguably, readily explained by ‘traditional’ depictive theories. The procedure evolved for this analysis is then applied to the less figurative works of Auerbach and Twombly and from this process a non-iconographic approach to depiction is developed which is tested by application to my own work and to that of two contemporary artists. The thesis concludes that a comprehensive theory of depiction must allow for such factors as material and facture and that, as a result of this research, the meaning of the term ‘depiction’ can, under certain conditions, be extended to include for non-figurative work. It suggests that some theories may usefully be modified to accommodate the findings of this research. Dominic Lopes argues that ‘a complete account of pictures should explain abstract pictures as well as figurative ones.’ This thesis is seen as making a contribution to the development of any such account.

By situating ecology as an ontological position, this dissertation adapts Jan Zwicky’s notion of resonance to probe imagining as a complex collaborative process involving diverse emergent variables. As a practicing artist, writer, teacher and researcher, I combine theoretical research and (visual arts) practice-based research to posit a sense of imagining that is unsituatable. The structure of this dissertation is grounded in the form of the essay (as a “try” or an “attempt”) which adapts explanatory text, metaphorical text and visual elements as a way to expand qualitative practices that have engaged critically with the politics of accepted forms and structures of academic writing. The project is intended for an off-line format, as a series of six distinct yet interdependent hand-made books that focus on: (1) An Emergent Methodology; (2) Ontology, Form and a Reconstitution of the Individual; (3) Zwicky, Thisness, Ecology & Ontological Ethics; (4) Zwicky, Imagination and the Image; (5) An Envisioning of Imagining as a Resonant Ecological Process and lastly, (6) Moments of Engaging Eco-Imagining in the Post-Secondary Classroom. The research-writing expands a body of work, through visual-textual, theoretical-metaphorical form, to enact imagining as a resonant ecological process that unfolds through the emergence of a complex co-mingling of a deluge of variables. / Graduate

This research illustrates the performer-researcher's artistic process of reaching an understanding of music through performance, and explores how an effort to understand music at the instrument and in the context of music-making could influence our critical evaluation of the music. ​Engaged in the process of learning music, I seek to document my artistic practices as a reflective practitioner: to open up the performer-researcher's workspace, communicate the performativity of the music, and reveal my embodied doing-thinking as a performer. By involving in the performer-researcher's physical and intellectual trajectory, the focus of musicological research could be shifted from the study of music as writing to a practice-based study that communicates and values music as performance. ​This shift provides a chance to rethink musical works at the piano and place the music in a context in which music can be understood, communicated, and valued through performance. This has the potential to shed light on the performative value of music, and may challenge the existing critique of musical works by emphasising the centrality of musical performance in the realm of music research, perhaps revealing what has been neglected by the text and outcome-focused approaches to music. I believe this could lead us to assess musical works in a different value system by considering the music in and as performance.

Purpose: Practice-based research networks (PBRN) seek to shorten the gap between research and application in primary patient care settings. Inclusion of community pharmacies in primary care PBRNs is relatively unexplored. Such a PBRN model could improve care coordination and community-based research, especially in rural and underserved areas. The objectives of this study were to: 1) evaluate rural Appalachian community pharmacy key informants’ perceptions of PBRNs and practice-based research; 2) explore key informants’ perceptions of perceived applicability of practice-based research domains; and 3) explore pharmacy key informant interest in PBRN participation. Methods: The sample consisted of community pharmacies within city limits of all Appalachian Research Network (AppNET) PBRN communities in South Central Appalachia. A descriptive, cross-sectional, questionnaire-based study was conducted from November 2013 to February 2014. Bivariate and multivariate analyses were conducted to examine associations between key informant and practice characteristics, and PBRN interest and perceptions. Findings: A 47.8% response rate was obtained. Most key informants (88%) were very or somewhat interested in participating in AppNET. Enrichment of patient care (82.8%), improved relationships with providers in the community (75.9%), and professional development opportunities (69.0%) were perceived by more than two-thirds of respondents to be very beneficial outcomes of PBRN participation. Respondents ranked time constraints (63%) and workflow disruptions (20%) as the biggest barriers to PBRN participation. Conclusion: Key informants in rural Appalachian community pharmacies indicated interest in PBRN participation. Integration of community pharmacies into existing rural PBRNs could advance community level care coordination and promote improved health outcomes in rural and underserved areas. Type: Original Research

Practice-based research networks (PBRNs) are groups of health care practitioners who engage in translational research and quality improvement activities, with the overarching goal of improving patient care in primary care settings. The Appalachian Research Network (AppNET), a rural primary care PBRN, was created in 2009 and comprises 17 clinics in 16 rural communities in South Central Appalachia. Nationally, only 4 of 152 PBRNs registered with the Agency for Healthcare Research and Quality (AHRQ) place particular emphasis on community pharmacies and pharmacists in research efforts. Researchers at ETSU seek to integrate community pharmacies into AppNET, thereby establishing a novel interprofessional rural PBRN. The objective of this study was to assess pharmacist perceptions regarding practice-based research and interest in participating in AppNET. Barriers to participation in a PBRN, perceived benefits of participation, and practice-specific characteristics were also assessed. Contact information was obtained via telephone calls made to individual pharmacies in AppNET communities. Thereafter, paper-based surveys were mailed to 69 pharmacist contacts, along with a personalized cover letter and a stamped return envelope. A total of two mailings were used to recruit pharmacists to participate in the study. A response rate of 42% was obtained. Respondents were on average 44 years of age and had been licensed as a pharmacist for an average of 19 years. A large majority of respondents (86%) were very or somewhat interested in participating in AppNET. The majority of respondents felt that time constraints and workflow interruptions were the greatest barriers to participation. One hundred percent of respondents indicated that research on prescription drug abuse, medication adherence, and medication safety are very or somewhat applicable to their practice settings. Ninety-two percent felt that research on value-added services (e.g., immunizations, diabetes education) and medication therapy management was somewhat or very applicable to their practice. Overall, pharmacist respondents in AppNET communities indicated interest in research that benefits the care of their patients and interest in AppNET. Researchers are presently conducting a third recruitment attempt and will thereafter develop AppNET enrollment mechanisms that minimize barriers to participation of community pharmacies in practice-based research.

In the modern society, chronic diseases have become the leading causes of death. With early recognition and proper management, however, many of the complications from chronic diseases could be prevented or delayed. Taking such a proactive approach in managing a population often requires the use of team-based approaches and delegation of certain clinical and nonclinical tasks to nonphysician team members. This three-study dissertation used a combination of methods to explore contextual factors that influence primary care teamwork and physician-pharmacist collaboration. The first study quantitatively examined baseline barriers and facilitators of physician-pharmacist collaboration in clinics participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) Trial. Pharmacist expertise and clinic staff support were found to be the most important facilitators for physicians, while insurance reimbursement and task design factors were important for pharmacists. The second study characterized clinic personnel experience participating in the CAPTION trial and explored determinants of disease state control. Higher proportions of indigent and minority populations and higher baseline pharmacy structure scores were found to be associated with lower blood pressure control. The third study qualitatively examined organizational influences on primary care team effectiveness and the roles of pharmacists in a separate sample of primary care clinics. A lack of organizational rewards for teamwork in primary care was identified and pharmacists were integrated into clinic workflow in various degrees. These findings will be informative for practice managers and health care professionals seeking to redesign their practice to meet increasing needs of patients with chronic diseases.

The objectives of this study were to: 1) create a measure of PBRN clinician member individual performance; 2) produce a rich description of PBRN directors' leadership behaviors and styles; and, 3) identify significant relationships between PBRN director leadership-PBRN clinician member performance. A sequential, exploratory mixed methods design was used to interview and survey PBRN directors and non-director participants. In Phase I, a semi-structured interview guide was used to identify PBRN director leadership behaviors, PBRN non-director performance behaviors and expectations, and decision making activities. A clinician member performance measure was created using a validated behavioral item extraction method. A thematic analysis was conducted on all other data. In Phase II, two quantitative surveys were administered to PBRN directors assessing demographics, membership activity, PBRN productivity, and clinician member performance. One survey was administered to PBRN clinician members assessing their demographics, activity level, and their perceptions of PBRN leadership behaviors. Clinician member performance within PBRNs is a multidimensional construct distinct from participation that is comprised of ownership and engagement aspects, although there is some evidence of a further division into leadership, awareness, follow-through, and communication factors. Collaborative leadership was reported as being distributed to all roles in the PBRN, but is primarily inculcated by a collaborative PBRN director. Time and funding were reported as important resources necessary for the completion of PBRN activities, and are increasingly becoming more limited in their availability. PBRNs engage in a variety of projects and other activities carried out and monitored through ongoing collaborative communication and consensus-based decision making efforts. Top-down decision making patterns by PBRNs have negative relationships with measures of productivity. Directive and participative leadership behaviors do not appear to have direct relationship with clinician member performance, but years of involvement in current PBRN does have a positive association. However, further investigation is necessary to replicate these findings in larger samples. Aiding busy clinicians with engagement through use of central staff may be beneficial. PBRN directors should focus on strengthening collaborative culture of their PBRN and minimizing barriers to effective communication and decision making.