An investigation into the causes, characteristics and consequences of anger in the workplace

The main aim of this research is to investigate the causes, characteristics and consequences of workplace anger and in particular to identify the factors associated with expression and suppression of anger. The research was conducted in two stages. Stage one of this exploratory study involved in-depth, semi-structured interviews with 24 participants in management and non-management positions, working within four different employment sectors: education, health, retail and wholesale. Participants were asked general questions about their experiences of anger at work, followed by more specific questions. Analysis of the data resulted in several sub-categories, sub-subcategories and themes being identified within the categories of causes, characteristics, short and long consequences of anger incidents. In addition, the analysis resulted in the development of a theoretical model on workplace anger, which acted as the starting point for the development of items for an event contingent anger diary for the second stage of the research. In stage two of the research, participants (n=187) from management and non-management positions, working within the four different employment sectors completed the event-contingent anger diary over a period of four working weeks. The context, source and gender of anger incidents were also explored. Participants also completed the self-report measures on trait anger and job satisfaction. Results show the distribution of the causes and characteristics of anger of incidents in relation to the context, source and employment sector. Furthermore, results show that working in the retail and wholesale sector were significant predictors of expressing anger, and being angered by a student/pupil was a significant predictor of expression of anger. Also, causes of anger which involved disrespect, unjust treatment, unprofessional behaviour, powerlessness, humiliation/jealousy and job incompetence were incidents which were significant predictors of expressing anger. The results also showed, that the more stressed an individual was before an anger incident, the larger the odds of expression. Also, the more an individual was satisfied with their work the more likely they were to express their anger, and the more satisfied an individual was with their coworkers the more likely they were to suppress their anger. Finally, the current research is discussed in terms of its implications for the preventions and reduction of anger at work, and suggestions for future research are proposed

Effects of Adverse Childhood Experiences on High Risk Inpatients Criminal Behavior

Adverse childhood experiences (ACEs) play a role in the development of chronic mental and physical diseases in adulthood. These experiences include adversities such as: emotional/verbal abuse, sexual abuse, physical abuse, and household dysfunction. In this study, we hypothesize that forensic mental health offenders will have higher ACE scores than community participants. Secondly, we hypothesize that these participants will show higher rates of and earlier incidences of offending, arrest, incarceration, and hospitalization as a result of their ACE scores. Further, we hypothesize that males and females will be affected by ACEs differently. Using archival data from a secure forensic psychiatric facility in the Midwestern US, data were collected from 211 participants, of which 80% were males and 18% females. The ages of the participants ranged from 23 to 72 with a median age of 43. Using SPSS software, we were able to determine frequency of the ten categories of abuse, maltreatment, and familial dysfunction as included in the original ACE research. Correlations were run to determine the relationship between ACEs and criminal behavior. Statistical comparisons were also run to examine the differences between males and females. ACE score significantly correlated with age at first psychiatric admission. Males and females were significantly different with regard to ACE score. However, other variables were not significant and suggest that future research need to more deeply examine these differences, and additional variables that may determine criminal outcomes in high-risk samples

Aerosol and physical atmosphere model parameters are both important sources of uncertainty in aerosol ERF

Changes in aerosols cause a change in net top-of-the-atmosphere (ToA) short-wave and long-wave radiative fluxes, rapid adjustments in clouds, water vapour and temperature, and cause an effective radiative forcing (ERF) of the planetary energy budget. The diverse sources of model uncertainty and the computational cost of running climate models make it difficult to isolate the main causes of aerosol ERF uncertainty and to understand how observations can be used to constrain it. We explore the aerosol ERF uncertainty by using fast model emulators to generate a very large set of aerosol-climate model variants that span the model uncertainty due to twenty-seven parameters related to atmospheric and aerosol processes. Sensitivity analyses shows that the uncertainty in the ToA flux is dominated (around 80 %) by uncertainties in the physical atmosphere model, particularly parameters that affect cloud reflectivity. However, uncertainty in the change in ToA flux caused by aerosol emissions over the industrial period (the aerosol ERF) is controlled by a combination of uncertainties in aerosol (around 60 %) and physical atmosphere (around 40 %) parameters. Four of the atmospheric and aerosol parameters that cause uncertainty in short-wave ToA flux (mostly parameters that directly scale cloud reflectivity, cloud water content or cloud droplet concentrations) also account for around 60% of the aerosol ERF uncertainty. The common causes of uncertainty mean that constraining the modelled planetary brightness to tightly match satellite observations changes the lower 95 % credible aerosol ERF value from −2.65 Wm−2 to −2.37 Wm−2. This suggests the strongest forcings (below around −2.4 Wm−2) are inconsistent with observations. These results show that, regardless of the fact that the ToA flux is an order of magnitude larger than the aerosol ERF, the observed flux can constrain the uncertainty in ERF because their values are connected by constrainable process parameters. The key to reducing the aerosol ERF uncertainty further will be to identify observations that can additionally constrain individual parameter ranges and/or combined parameter effects, which can be achieved through sensitivity analysis of perturbed parameter ensembles

Gratitude, resignation and the desire for dignity: lived experience of food charity recipients and their recommendations for improvement, Perth, Western Australia

ObjectiveThe present study explored recipients’ perceptions of food charity and their suggested improvements in inner-city Perth, Western Australia.DesignIn-depth interviews were conducted with charitable food service (CFS) recipients. Transcripts were thematically analysed using a phenomenological approach.SettingInterviews were conducted at two CFS in inner-city Perth.SubjectsFourteen adults.ResultsThe recipients’ journeys to a reliance on CFS were varied and multifactorial, with poverty, medical issues and homelessness common. The length of time recipients had relied on food charity ranged from 8 months to over 40 years. Most were ‘grateful yet resigned’, appreciative of any food and resigned to the poor quality, monotony and their unmet individual preferences. They wanted healthier food, more variety and better quality. Accessing services was described as a ‘full-time job’ fraught with unreliable information and transport difficulties. They called for improved information and assistance with transport. ‘Eroded dignity’ resulted from being fed without any choice and queuing for food in public places, often in a volatile environment. ‘Food memories and inclusion’ reflected a desire for commensality. Recipients suggested services offer choice and promote independence, focusing on their needs both physical and social.ConclusionsAlthough grateful, long-term CFS recipients described what constitutes a voluntary failure. Their service improvement recommendations can help meet their nutritional and social needs. A successful CFS provides a food service that prioritises nutritious, good-quality food and individual need, while promoting dignity and social inclusion, challenging in the current Australian context

Anger expression and suppression at work: causes, characteristics and predictors

Purpose: The current study aims to explore the causes, characteristics and consequences of workplace anger expression and suppression, with an additional aim of testing the emotional dimension of Affective Events Theory. Design/methodology/approach: Participants (n=187) from management and non-management positions completed an event-contingent anger diary over a period of four working weeks, alongside measures on trait anger and job satisfaction. Findings: Over fifty per cent of the sample disclosed anger causing events. In keeping with Affective Events Theory disposition was important, with trait anger higher in those disclosing anger causing events. There appeared a range of factors predicting the expression of anger, with these focused primarily on individual issues and pre-existing emotion rather than work characteristics. Practical implications: Originality/value: Through consideration of management and non-management workers and by using a longitudinal design, the study highlights the importance of individual factors in understanding workplace anger. It notes the value in focusing on discrete emotion. The findings offers clear direction for future research that could assist with enhancing models of workplace emotion, particularly if the aim is to account for discrete emotions

Supporting shared decision-making and people’s understanding of medicines : An exploration of the acceptability and comprehensibility of patient information

ACKNOWLEDGEMENTS The research team would like to thank the community pharmacy management and staff for all their assistance in facilitating recruitment. Thanks also to our colleague Alyson Brown, Robert Gordon University, for her help with recruitment and to Linda Collins, Healthcare Improvement Scotland, for assisting with project materials. We are incredibly grateful to all participants who gave up their time to participate in the research and who provided such valuable feedback.Peer reviewedPublisher PD

Baseline Morbidity in 2,990 Adult African Volunteers Recruited to Characterize Laboratory Reference Intervals for Future HIV Vaccine Clinical Trials

BACKGROUND: An understanding of the health of potential volunteers in Africa is essential for the safe and efficient conduct of clinical trials, particularly for trials of preventive technologies such as vaccines that enroll healthy individuals. Clinical safety laboratory values used for screening, enrolment and follow-up of African clinical trial volunteers have largely been based on values derived from industrialized countries in Europe and North America. This report describes baseline morbidity during recruitment for a multi-center, African laboratory reference intervals study. METHODS: Asymptomatic persons, aged 18-60 years, were invited to participate in a cross-sectional study at seven sites (Kigali, Rwanda; Masaka and Entebbe, Uganda; Kangemi, Kenyatta National Hospital and Kilifi, Kenya; and Lusaka, Zambia). Gender equivalency was by design. Individuals who were acutely ill, pregnant, menstruating, or had significant clinical findings were not enrolled. Each volunteer provided blood for hematology, immunology, and biochemistry parameters and urine for urinalysis. Enrolled volunteers were excluded if found to be positive for HIV, syphilis or Hepatitis B and C. Laboratory assays were conducted under Good Clinical Laboratory Practices (GCLP). RESULTS AND CONCLUSIONS: Of the 2990 volunteers who were screened, 2387 (80%) were enrolled, and 2107 (71%) were included in the analysis (52% men, 48% women). Major reasons for screening out volunteers included abnormal findings on physical examination (228/603, 38%), significant medical history (76, 13%) and inability to complete the informed consent process (73, 13%). Once enrolled, principle reasons for exclusion from analysis included detection of Hepatitis B surface antigen (106/280, 38%) and antibodies against Hepatitis C (95, 34%). This is the first large scale, multi-site study conducted to the standards of GCLP to describe African laboratory reference intervals applicable to potential volunteers in clinical trials. Approximately one-third of all potential volunteers screened were not eligible for analysis; the majority were excluded for medical reasons

Efficacy of customised foot orthoses in the treatment of achilles tendinopathy : study protocol for a randomised trial

BACKGROUND: Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy. Foot orthoses have also been advocated as a treatment for Achilles tendinopathy, but the long-term efficacy of foot orthoses for this condition is unknown. This manuscript describes the design of a randomised trial to evaluate the efficacy of customised foot orthoses to reduce pain and improve function in people with Achilles tendinopathy. METHODS: One hundred and forty community-dwelling men and women aged 18 to 55 years with Achilles tendinopathy (who satisfy inclusion and exclusion criteria) will be recruited. Participants will be randomised, using a computer-generated random number sequence, to either a control group (sham foot orthoses made from compressible ethylene vinyl acetate foam) or an experimental group (customised foot orthoses made from semi-rigid polypropylene). Both groups will be prescribed a calf muscle eccentric exercise program, however, the primary difference between the groups will be that the experimental group receive customised foot orthoses, while the control group receive sham foot orthoses. The participants will be instructed to perform eccentric exercises 2 times per day, 7 days per week, for 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire. The secondary outcome measures will be participant perception of treatment effect, comfort of the foot orthoses, use of co-interventions, frequency and severity of adverse events, level of physical activity and health-related quality of life (assessed using the Short-Form-36 questionnaire - Version two). Data will be collected at baseline, then at 1, 3, 6 and 12 months. Data will be analysed using the intention to treat principle. DISCUSSION: This study is the first randomised trial to evaluate the long-term efficacy of customised foot orthoses for the treatment of Achilles tendinopathy. The study has been pragmatically designed to ensure that the study findings are generalisable to clinical practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number: ACTRN12609000829213

Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial.

BACKGROUND: Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. METHODS: In this multicentre, open-label, randomised controlled trial, we recruited women aged 18-40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527. FINDINGS: Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference -0·19%; 95% CI -0·34 to -0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy). INTERPRETATION: Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use. FUNDING: Juvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research