Violence on the frontline : a qualitative study of how service workers cope

Drawing on extensive empirical evidence, taken from a regional Employment Service, this PhD explores in depth, how frontliners cope with the experience of customers' violence on the frontline. Analysis of empirical data led to the finding that frontliners cope in a number of ways which were both collective and individual. The coping mechanisms used were influenced by the different organisational constructions of customer violence. This PhD has brought the emotional labour and the organisational violence literature together using insights from both to inform the other and aid understanding of not only organisational violence in general, but specifically the way that frontliners cope with the experience of customer violence. This is an aspect somewhat neglected in both the emotional labour literature and the organisational violence literature to differing extents. Although the emotional labour literature does examine ways that frontliners cope with the difficulties of customer service, it frequently fails to examine the interplay of the formal and informal organisation in influencing the means of coping used by frontliners and it has yet to consider the way that frontliners cope specifically with customer violence. The organisational violence literature tends to take the concept of violence as an unproblematic, objective term and ignores the fact that violence is a constructed subjective concept. I see this as problematic. The more interpretevist literature, which does recognise the polysemic nature of violence, only considers customer violence in passing. This literature completely fails to consider the part that the customer sovereignty plays in this violence, a significant omission, which I believe, has implications for our understanding of organisational violence. A number of theoretical points from this study have wider implications that are applicable to more than just the regional Employment Service explored. It was found that the customer sovereignty ideology played an important role in not only the ways that frontliners cope, but also in customer violence in general. Customer sovereignty underpinned the invisibility of violence and the concern for customers' well-being over those of frontliners. Both these findings were applicable to other frontline organisations. This study also found that the customer service ideology contributed towards conditions which fostered customer violence. This PhD also found that those with hierarchical power will be able, to some extent; to impose their construction of what is violent on those with less hierarchical power. However, this study emphasises the importance of human agency in arguing that those with less hierarchical power will still be able to contribute to creating organisational reality. Workers were not taken to be passive recipients of the dominant approach, but were helped shaped the construction of violence. This finding has implications for not only the construction of customer violence within organisations, but for the nature of power and the construction of organisational reality. This study has outlined many areas that need further consideration. The relationship between the customer service ideology and customer violence is currently under-researchedM. ore studies are needed examining this in different frontline settings, including both public and private sectors. Specifically, research is needed to consider the extent to which this ideology is used to justify customer violence and difficult frontline conditions in general. In examining the ways that frontliners cope with the experience of customer violence; this study integrated both the emotional labour and organisational violence literature. It is hoped that in using insights from both to inform the other, together with my own empirical research, this PhD has deepened understanding of not only the coping devices used by frontliners, but also customer violence in general.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Spinal cord injury: known and possible influences on the immune response to exercise

A spinal cord injury (SCI) can increase the risk of infection by impacting on many aspects of immune function; one particularly well-documented observation is a reduction in lymphocyte numbers. The vast majority of lymphoid cells express adrenergic receptors. Therefore, autonomic function loss and concomitant alterations in resting and post-exercise catecholamine concentrations, particularly so in individuals with a tetraplegia, may impact directly on immune cells and depress immunity. Other factors are further likely to contribute, examples including altered muscular, endocrine and cardiovascular function following SCI. However, some alterations, such as increases in natural killer cell cytotoxicity following exercise in those with a tetraplegia, are unrelated to the catecholamine response. Likewise, mucosal immunity in individuals with a tetraplegia appears to be similarly influenced by exercise as in the able-bodied population. Indeed, rehabilitation therapy and exercise can increase some measures of immunity and autonomic function in those with an SCI. It is therefore possible that compensatory mechanisms offset disability-related detriments. This may be by way of sympathetic reflex activity, receptor hypersensitivity, or parasympathetic and neuroendocrine adjustments. Future work needs to explore these mechanisms further to clarify the implications of an SCI on the immune response to exercise and susceptibility to infection. In this article, we review the impacts of an SCI on immune, and specifically, exercise immune function. The relevant anatomical and physiological foundations of the immune system are first briefly laid out in order to understand the potential impacts of neural and neuroendocrine dysfunction on the immune system. With the limited number of human studies available, we have then aimed specifically to gather all relevant existing literature on exercise immunology in individuals with an SCI in patient, recreationally active and athlete populations. We believe that an understanding of the impacts of exercise can provide a tool to help maintain or improve health in individuals with an SCI

Exercise intensity and its impact on relationships between salivary immunoglobulin A, saliva flow rate and plasma cortisol concentration

Introduction Salivary secretory immunoglobulin A (sIgA), saliva flow rate and plasma cortisol concentrations have been shown to be influenced by exercise, particularly the intensity exercise is performed at, and circadian variation. The autonomic nervous system partly regulates salivary secretion, but it is not yet known whether cortisol also explains some variation in salivary parameters. Methods Twelve moderately trained male individuals (V̇ O2peak legs: 46.2±6.8 mL·kg−1·min−1) performed three 45-min constant load exercise trials in the morning: arm cranking exercise at 60%V̇ O2peak arms; moderate cycling at 60%V̇ O2peak legs; and easy cycling at 60%V̇ O2peak arms. Timed saliva samples and blood samples for plasma cortisol concentration determination were obtained before, post, 2 h post, and 4 h post-exercise. Saliva was collected in an additional resting trial at the same time points. Results At each time point for each exercise trial, negative correlations between cortisol and saliva flow rate (explaining 25±17% of the variance, R2=0.002–0.46) and positive correlations between cortisol and sIgA concentration (explaining 8±8% of the variance R2=0.002–0.24) were found. Saliva flow rate increased over time, whereas sIgA concentration and cortisol decreased over time for all trials (P<0.05), there was no effect of time for sIgA secretion rate (P=0.16). Conclusion These results show a relationship between cortisol and saliva flow rate, which directly impacts on the concentration of salivary analytes. This study further confirms circadian variations in salivary parameters which must be acknowledged when standardising salivary data collection

Plasma cytokine and exertional responses in relation to exercise intensity and volume of exercising muscle mass during arm-crank ergometry

Plasma cytokine and exertional responses in relation to exercise intensity and volume of exercising muscle mass during arm-crank ergometr

Salivary alpha amylase not chromogranin A reflects sympathetic activity: exercise responses in elite male wheelchair athletes with or without cervical spinal cord injury

Background: Salivary alpha-amylase (sAA) and chromogranin A (sCgA) have both been suggested as non-invasive markers for sympathetic nervous system (SNS) activity. A complete cervical spinal cord injury leading to tetraplegia is accompanied with sympathetic dysfunction; the aim of this study was to establish the exercise response of these markers in this in vivo model. Methods: Twenty-six elite male wheelchair athletes (C6-C7 tetraplegia: N=8, T6-L1 paraplegia: N=10 and non spinal cord injured controls: N=8) performed treadmill exercise to exhaustion. Saliva and blood samples were taken pre, post, and 30 min post exercise and analysed for sAA, sCgA and plasma adrenaline concentration, respectively. Results: In all three subgroups, sAA and sCgA were elevated post exercise (P<0.05). Whilst sCgA was not different between subgroups, a group x time interaction for sAA explained the reduced post exercise sAA activity in tetraplegia (162±127 vs 313±99 (paraplegia) and 328±131 U∙mL-1 (controls), P=0.005). The post exercise increase in adrenaline was not apparent in tetraplegia (P=0.74). A significant correlation was found between adrenaline and sAA (r=0.60, P=0.01), but not between adrenaline and sCgA (r=0.06, P=0.79). Conclusions: The blunted post-exercise rise in sAA and adrenaline in tetraplegia implies that both reflect SNS activity to some degree. It is questionable whether sCgA should be used as a marker for SNS activity, both due to the exercise response which is not different between the subgroups and its non-significant relationship with adrenaline

Differentiated perceived exertion and self-regulated wheelchair exercise

OBJECTIVE. To investigate the utility of the differentiated rating of perceived exertion (RPE) for the self-regulation of submaximal wheelchair propulsion in novice users. DESIGN. Each participant completed a submaximal incremental test and a graded test to exhaustion to determine peak oxygen consumption (Vo2peak) on a wheelchair ergometer. On a separate day, two 12-minute intermittent bouts consisting of three 4-minute stages were completed at individualized imposed power outputs equating to light (40% Vo 2peak) and moderate (60% Vo2peak) intensity exercise. On a third occasion, participants were assigned to either the overall group or the peripheral group and were required to self-regulate 12-minute intermittent exercise according to either overall RPE or peripheral RPE reported during the corresponding imposed intensity trial. SETTING. Laboratory facilities at a university. PARTICIPANTS. Preliminary population of able-bodied participants with no prior experience of wheelchair propulsion (N=18). INTERVENTIONS. Not applicable. MAIN OUTCOME MEASURES. Differences in oxygen consumption (V̇o2), heart rate, blood lactate concentration, and power output between the imposed and self-regulated exercise trials. RESULTS. No difference was found in physiological responses between the moderate-intensity imposed and RPE-regulated trials in the peripheral group, whereas a significant (P<.05) underproduction in V̇o2 (1.76±.31 vs 1.59±.25L/min) and blood lactate concentration (2.8±0.90 vs 2.21±.83mmol/L) was seen in the overall group. In contrast, a significant (P<.05) overproduction was seen in the peripheral group at a light exercise intensity, whereas no difference was found between all variables during the light-intensity imposed and RPE-regulated trials in the overall group. CONCLUSIONS. Peripheral RPE enabled a more precise self-regulation during moderate-intensity wheelchair exercise in novice users. In contrast, overall RPE provided a more accurate stimulus when performing light-intensity propulsion

Arm and intensity-matched leg exercise induce similar inflammatory responses

Introduction: The amount of active muscle mass can influence the acute inflammatory response to exercise, associated with reduced risk for chronic disease. This may affect those restricted to upper body exercise, for example due to injury or disability. The purpose of this study was to compare the inflammatory responses for arm exercise and intensity-matched leg exercise. Methods: Twelve male individuals performed three 45-min constant load exercise trials following determination of peak oxygen uptake for arm exercise (V[Combining Dot Above]O2peak A) and cycling (V[Combining Dot Above]O2peak C): (1) arm cranking exercise at 60%V[Combining Dot Above]O2peak A; (2) moderate cycling at 60%V[Combining Dot Above]O2peak C; and (3) easy cycling at 60%V[Combining Dot Above]O2peak A. Cytokine, adrenaline and flow cytometric analysis of monocyte subsets were performed before and up to 4h post exercise. Results: Plasma IL-6 increased from resting concentrations in all trials, however, post exercise concentrations were higher for arm exercise (1.73+/-1.04pg[BULLET OPERATOR]mL-1) and moderate cycling (1.73+/-0.95pg[BULLET OPERATOR]mL-1) compared with easy cycling (0.87+/-0.41pg[BULLET OPERATOR]mL-1,P<0.04). Similarly, the plasma IL-1ra concentration in the recovery period was higher for arm exercise (325+/-139pg[BULLET OPERATOR]mL-1) and moderate cycling (316+/-128pg[BULLET OPERATOR]mL-1) when compared with easy cycling (245+/-77pg[BULLET OPERATOR]mL-1,P<0.04). Arm exercise and moderate cycling induced larger increases in monocyte numbers and larger increases of the classical monocyte subset in the recovery period than easy cycling (P<0.05). The post-exercise adrenaline concentration was lowest for easy cycling (P=0.04). Conclusions: Arm exercise and cycling at the same relative exercise intensity induces a comparable acute inflammatory response; however, cycling at the same absolute oxygen uptake as arm exercise results in a blunted cytokine, monocyte and adrenaline response. Relative exercise intensity appears to be more important to the acute inflammatory response than modality, which is of major relevance for populations restricted to upper body exercise

Salivary immunoglobulin A and upper respiratory symptoms during 5 months of training in elite tetraplegic athletes

Purpose: Altered autonomic innervation in tetraplegic individuals has been shown to depress certain immune parameters at rest and alter exercise-related salivary immunoglobulin A (sIgA) responses. The purpose of this study was to examine resting sIgA responses as a function of training load and episodes of upper respiratory symptoms (URS) in elite tetraplegic athletes. Methods: Resting saliva samples were obtained from 14 tetraplegic athletes at 12 predefined time points over 5 months and analyzed for sIgA. Occurrence of self-reported URS and training load was recorded throughout the study’s duration. Regression analyses were performed to investigate the relationship between sIgA responses and training load. Furthermore, the relationships between sIgA responses and URS occurrence were examined. Results: sIgA secretion rate was negatively correlated with training load (P = .04), which only accounted for 8% of the variance. No significant relationships were found between sIgA responses and subsequent URS occurrence. Finally, sIgA responses did not differ between athletes with and without recorded URS during the study period. Conclusions: In line with findings in ablebodied athletes, negative relationships between sIgA secretion rate and training load were found in tetraplegic athletes. This may explain some of the higher infection risk in wheelchair athletes with a high training load, which has been previously observed in paraplegic athletes. However, the nonsignificant relationship between sIgA responses and URS occurrence brings into question the use of sIgA as a prognostic tool for the early detection of URS episodes in the studied population

Spinal cord injury level and the circulating cytokine response to strenuous exercise

PURPOSE: A complete spinal cord injury (SCI) above the 6th thoracic vertebra (T6) results in the loss of sympathetic innervation of the adrenal medulla. This study examined the effect of a complete SCI above and below T6 on plasma concentrations of epinephrine, circulating interleukin (IL)-6 and other inflammatory cytokines in response to acute strenuous exercise. METHODS: Twenty-six elite male wheelchair athletes (8=C6-C7 tetraplegic (TETRA); 10=T6- L1 paraplegic (PARA); 8=non-spinal cord injured controls (NON-SCI)) performed a submaximal exercise test followed by a graded exercise to exhaustion on a motorised treadmill. Blood samples were taken pre-exercise, post-exercise and 30 min post-exercise (post30) and analysed for concentrations of IL-6, IL-10, IL-1 receptor-antagonist (IL-1ra), tumor necrosis factor-alpha (TNF-α), epinephrine and cortisol. RESULTS: Circulating IL-6 concentration was significantly elevated at post-exercise and post30 (~5-fold) in NON-SCI and PARA (P=0.003) whereas concentrations in TETRA did not change significantly from pre-exercise values. IL-10, IL-1ra and TNF-α were unaffected by exercise in all groups, however both SCI groups presented elevated concentrations of IL-10 compared with NONSCI (P=0.001). At post-exercise, epinephrine concentrations were significantly higher than pre-exercise and post30 concentrations in NON-SCI (~3-fold) and PARA (~2-fold) (P=0.02). Plasma epinephrine concentrations were unchanged in TETRA throughout exercise; concentrations were significantly lower than NON-SCI and PARA at all-time points. Plasma cortisol concentrations were significantly elevated in all groups at post-exercise and post30 compared with pre-exercise (P<0.001). Total exercise time was similar between groups (NON-SCI= 38±6; PARA= 35±5; TETRA= 36±5 min). CONCLUSION: These findings suggest the sympathetic nervous system plays an important regulatory role in the circulating IL-6 response to exercise and has implications for the metabolic and inflammatory responses to exercise in individuals with injuries above T6

Benchmarking good practice in qualitative management research

This report presents an analysis of assessment criteria and training needs for qualitative management research. 45 in-depth interviews were held with members of four panels: academic disseminators; practitioners; doctoral programme leaders; and qualitative researchers. Interviews were transcribed verbatim and interpreted with the aid of template analysis. This report presents six major themes from this analysis concerning qualitative management research: definitions; status and credibility; good practice; assessment criteria; training needs; professional and institutional context. A variety of definitions of qualitative management research were identified ranging from indicating a central concern with the subjectivity of research practice to barely constituting research at all. Such a range of definitions indicates the range of work in the area but also implies that the derivation of a set of universal assessment criteria is problematic. Sources of research credibility also varied widely. To some extent judgements of credibility were seen to depend on aspects of the nature and conduct of the research itself (e.g. methodical, conclusive, technically skilled etc), but also as influenced by symbolism and context. In general definitions of credibility were seen to disadvantage qualitative research. Various elements of good practice in relation to qualitative management research were identified (and sometimes disputed) including flexible research design, epistemologically coherent analysis, reflexivity concerning process and product of research and a persuasive, engaging presentation. Assessing qualitative management research appeared to be more of an intuitive decision-making process than an application of known and agreed criteria (cf quantitative research). Judgements in these areas vary according to the beliefs and commitments of the individual. Reflecting this variety, a summary table of contingent criteria is presented at the end of the report. Provision of qualitative research training was seen to vary but be generally scarce and of poor quality . Specific training needs included: ‘technical’ skills, such as data analysis techniques and writing; knowledge of underlying philosophical issues; reviewing skills; and PhD supervision. Current research practice was seen to be deeply affected by pressures within the current academic context including audit processes and career needs. Such pressures may work against the adoption of qualitative management research. In general all these issues were seen to be highly related and inter-dependent. While some contextual issues cannot be addressed by this research, the report concludes with an overview of the qualitative management research workshops derived from our interpretation of the interviewees’ observations