From transformative learning to social change? Using action research to explore and improve informal complaints management in an NHS trust

Background: The number of complaints concerning aspects of care from patients and/or carers have increased over time. Yet, in spite of a growing body of national and international literature on health care complaints there is a lack of knowledge around how nurses and midwives manage informal complaints at ward level, or staff needs in relation to this. Aim: Using an Action research (AR) approach with mixed methods, four phases and four cycles, the aim was to explore informal complaints management by nurses and midwives at ward level. We discuss the AR process primarily in connection with learning and service change, drawing from the qualitative data in this paper. Findings: The analysis of the collected qualitative data resulted in three main themes related to the complexities of complaints and complaints management, staff support needs and the existing ambiguous complaints systems which are hard for both staff and servicer users to negotiate. The AR approach facilitated learning and change in participants in relation to views on complaints management, and the main issues around complaints management in the collaborating trust. Conclusions: The extant body of research on complaints does not sufficiently recognise the complexity of complaints and informal complaints management or the complaints systems in place. Needs based staff training can help support staff to manage informal complaints more effectively

Development of large scale inland flood scenarios for disaster response planning based on spatial/temporal conditional probability analysis

Extreme event scenarios are useful for civil emergency services to help in developing contingency plans for responding effectively to major flooding incidents. In the UK, the official national risk register includes a scenario for inland flooding (from rivers and other sources), which is described in terms of a probability of occurrence over a five year period of between 1 in 200 and 1 in 20. This scenario was previously based on recent extreme floods, in conjunction with maps produced to aid in development planning on floodplains. At the time it was constructed, it was not feasible to assess scientifically the combined probability of a nationally-significant flood event of this type, therefore the scenario probability assessment was ambiguous. Recent developments in multivariate extreme value statistics now allow the probability of large scale flood events to be assessed with reference to hydrological summary statistics or impact metrics. Building on theory and pilot studies by Heffernan and Tawn [1], Lamb et al. [2] and Keef et al. [3], we describe the development of a set of national-scale scenarios based on a high-dimensional (ca. 1,100 locations) conditional probability analysis of extreme river flows and rainfall. The methodology provides a theoretically justified basis for extrapolation into the joint tail of the distribution of these variables, which is then used to simulate extreme events with associated probabilities. The probabilistic events are compared with current understanding of meteorological scenarios associated with significant, large-scale flooding in the UK, and with historical flooding, in order to identify plausible events that can inform national risk scenarios. Additionally, we combined scenarios of inland and coastal extremes that have been considered by linking the analysis discussed in this paper with methods presented in a companion paper by Wyncoll et al

From transformative learning to social change? Using action research to explore and improve informal complaints management in an NHS trust

Background: The number of complaints from patients and/or carers concerning aspects of care has increased over time. Yet, in spite of a growing body of national and international literature on healthcare complaints, there is a lack of knowledge around how nurses and midwives manage informal complaints at ward level, or staff needs in relation to this. Aim: Using an action research approach with mixed methods, four phases and four cycles, the aim was to explore informal complaints management by nurses and midwives at ward level. We discuss the action research process primarily in connection with learning and service change, drawing from the qualitative data in this paper. Findings: The analysis of the collected qualitative data resulted in three main themes, related to the complexities of complaints and complaints management, staff support needs and the existing ambiguous complaints systems, which are hard for staff and service users to negotiate. The action research approach facilitated learning and change in participants in relation to complaints management, in the collaborating trust. Conclusions: The extant body of research on complaints does not sufficiently recognise the complexity of complaints and informal complaints management, or the complaints systems that are in place. Needs-based staff training can help support staff to manage informal complaints more effectively. Implications for practice: • There needs to be recognition of the complexities involved in complaints management • Complaints systems need to be clearer for the benefit of service users and staff • Staff need training and support that is tailored to their needs to improve their response to complaints, leading to a better patient experience • Limited interventions, informed by staff needs, can lead to change and act as a catalyst for a wider change in informal complaints managemen

The Contribution of a Layman to the Restoration Movement

The name of Tomas Wharton Phillips, (1835-1912), occurs quite frequently in the history of the Disciples of Christ. Probably his family name is best known by its association with Phillips University, Enid, Oklahoma. There has also been a renewed interest in him through the recent completion of the T.W. Phillips Memorial Library in Nashville, Tennessee, now the headquarters of the Disciples of Christ Historical Society. This general interst generated into a special interst, when, during the lectures on the history of the Disciples of Christ, a remark was made to the effect that there was a need for a more adequte understanding of the place of T.W. Phillips in the Brotherhood of Disciples of Christ. This promoted the undertaking of a study of this layman

Evaluation of drug-loaded gold nanoparticle cytotoxicity as a function of tumor tissue heterogeneity.

The inherent heterogeneity of tumor tissue presents a major challenge to nanoparticle-medicated drug delivery. This heterogeneity spans from the molecular to the cellular (cell types) and to the tissue (vasculature, extra-cellular matrix) scales. Here we employ computational modeling to evaluate therapeutic response as a function of vascular-induced tumor tissue heterogeneity. Using data with three-layered gold nanoparticles loaded with cisplatin, nanotherapy is simulated with different levels of tissue heterogeneity, and the treatment response is measured in terms of tumor regression. The results show that tumor vascular density non-trivially influences the nanoparticle uptake and washout, and the associated tissue response. The drug strength affects the proportion of proliferating, hypoxic, and necrotic tissue fractions, which in turn dynamically affect and are affected by the vascular density. This study establishes a first step towards a more systematic methodology to assess the effect of vascular-induced tumor tissue heterogeneity on the response to nanotherapy

A modeling platform to predict cancer survival and therapy outcomes using tumor tissue derived metabolomics data.

Cancer is a complex and broad disease that is challenging to treat, partially due to the vast molecular heterogeneity among patients even within the same subtype. Currently, no reliable method exists to determine which potential first-line therapy would be most effective for a specific patient, as randomized clinical trials have concluded that no single regimen may be significantly more effective than others. One ongoing challenge in the field of oncology is the search for personalization of cancer treatment based on patient data. With an interdisciplinary approach, we show that tumor-tissue derived metabolomics data is capable of predicting clinical response to systemic therapy classified as disease control vs. progressive disease and pathological stage classified as stage I/II/III vs. stage IV via data analysis with machine-learning techniques (AUROC = 0.970; AUROC=0.902). Patient survival was also analyzed via statistical methods and machine-learning, both of which show that tumor-tissue derived metabolomics data is capable of risk stratifying patients in terms of long vs. short survival (OS AUROC = 0.940TEST; PFS AUROC = 0.875TEST). A set of key metabolites as potential biomarkers and associated metabolic pathways were also found for each outcome, which may lead to insight into biological mechanisms. Additionally, we developed a methodology to calibrate tumor growth related parameters in a well-established mathematical model of cancer to help predict the potential nuances of chemotherapeutic response. The proposed methodology shows results consistent with clinical observations in predicting individual patient response to systemic therapy and helps lay the foundation for further investigation into the calibration of mathematical models of cancer with patient-tissue derived molecular data. Chapters 6 and 8 were published in the Annals of Biomedical Engineering. Chapters 2, 3, and 7 were published in Metabolomics, Lung Cancer, and Pharmaceutical Research, respectively. Chapters 4 has been accepted for publication at the journal Metabolomics (in press) and Chapter 5 is in review at the journal Metabolomics. Chapter 9 is currently undergoing preparation for submission

A Regulatory Comparison of Hydraulic Fracturing Fluid Disclosure Regimes in the United States, Canada, and Australia

Numerous state, provincial, and federal governments in the United States, Canada, and Australia have created guidelines, legislation, and/or regulations (or are in the process of doing so) in response to public concerns about water contamination from hydraulic fracturing. This article will compare and analyze three national regimes in the leading states and provinces in which laws have been amended, proposed, or adopted to address public concerns about the chemicals and additives in hydraulic fracturing fluids used to produce unconventional hydrocarbons. New regulations, recent legislative amendments, and, in some cases, new statutes have been proposed or adopted in the past few years. Most of the state and provincial laws require public disclosure of some information about the contents of hydraulic fracturing fluids. At the same time, governments interested in attracting investment capital to develop their shale oil and gas resources recognize the importance of protecting the intellectual property rights (trade secrets) of those parties that have developed hydraulic fracturing fluids

Workplace Contextual Supports for LGBT Employees: A Review, Meta‐Analysis, and Agenda for future Research

The past decade has witnessed a rise in the visibility of the lesbian, gay, bisexual, and transgender (LGBT) community. This has resulted in some organizational researchers focusing their attention on workplace issues facing LGBT employees. While empirical research has been appropriately focused on examining the impact of workplace factors on the work lives of LGBT individuals, no research has examined these empirical relationships cumulatively. The purpose of this study was to conduct a comprehensive review and meta‐analysis of the outcomes associated with three workplace contextual supports (formal LGBT policies and practices, LGBT‐supportive climate, and supportive workplace relationships) and to compare the relative influence of these workplace supports on outcomes. Outcomes were grouped into four categories: (a) work attitudes, (b) psychological strain, (c) disclosure, and (d) perceived discrimination. Results show that supportive workplace relationships were more strongly related to work attitudes and strain, whereas LGBT supportive climate was more strongly related to disclosure and perceived discrimination compared to the other supports. Our findings also revealed a number of insights concerning the measurement, research design, and sample characteristics of the studies in the present review. Based on these results, we offer an agenda for future research

Four years on: A longitudinal study assessing the impact of membership of a virtual community of practice

This paper explores the long term impact of a virtual learning community (VLC) from the perspective of community members and their employing organization. It argues that membership potentially has a significant impact on individual identities and careers, and that managed communities provide an important means for strategic workforce development. The study evaluates the impact of membership of a VLC over a four year period within the context of the theoretical frameworks of communities of practice and identity theory. The concept of boundary crossing is also explored in relation to VLCs. The paper considers the benefits to host organisations in supporting structured VLCs as a means of enabling workforce development and supporting change and innovation