A comparative case study of appreciative inquiries in one organization: implications for practice

Eight different sites in a large, Canadian urban school district engaged in an appreciative inquiry into “what do we know about learning”. Data collected over the following year indicate that four of the sites experienced transformational changes, two sites had incremental changes and two showed little or no change. This paper describes the AI intervention in detail and then explores differences in each site that may explain differences in level of change. The level of positive affect and ratings of success of the AI Summits at each site showed no meaningful relationship to change outcomes. Level of change did appear to be related to how generative the inquiries were, how well the Discovery phase was managed and the quality of Design statements that came out of the summits. Other factors exogenous to the design of the AI also appeared to play a role. These included relations between teachers and principals, credibility of local change agents, passionate and engaged leadership, and linkage to pre-existing, shared concerns. Recommendations for AI practice are given.Appreciative Inquiry Summit; Collective Dream; Transformation; Case Study

Small-scale Interaction of Turbulence with Thermonuclear Flames in Type Ia Supernovae

Microscopic turbulence-flame interactions of thermonuclear fusion flames occuring in Type Ia Supernovae were studied by means of incompressible direct numerical simulations with a highly simplified flame description. The flame is treated as a single diffusive scalar field with a nonlinear source term. It is characterized by its Prandtl number, Pr << 1, and laminar flame speed, S_L. We find that if S_L ~ u', where u' is the rms amplitude of turbulent velocity fluctuations, the local flame propagation speed does not significantly deviate from S_L even in the presence of velocity fluctuations on scales below the laminar flame thickness. This result is interpreted in the context of subgrid-scale modeling of supernova explosions and the mechanism for deflagration-detonation-transitions.Comment: 8 pages, 6 figures, accepted by Astrophys.

Can positive inquiry strengthen obstetric referral systems in Cambodia?

Maternal death remains high in low resource settings. Current literature on obstetric referral that sets out to tackle maternal death tends to focus on problematization. We took an alternative approach and rather asked what works in contemporary obstetric referral in a low income setting to find out if positive inquiry could generate original insights on referral that could be transformative. We documented and analysed instances of successful referral in a rural province of Cambodia that took place within the last year. Thirty women, their families, healthcare staff and community volunteers were purposively sampled for in‐depth interviews, conducted using an appreciative inquiry lens. We found that referral at its best is an active partnership between families, community and clinicians that co‐constructs care for labouring women during referral and delivery. Given the short time frame of the project we cannot conclude if this new understanding was transformative. However, we can show that acknowledging positive resources within contemporary referral systems enables health system stakeholders to widen their understanding of the kinds of resources that are available to them to direct and implement constructive change for maternal health

Appreciative inquiry as a method of transforming identity and power in Pakistani women

This paper describes a three-year action research project that used Appreciative Inquiry to work with marginalised Pakistani women living in Sheffield. The research encountered many of the difficulties and dilemmas that have been previously identified in the theory and practice of Appreciative Inquiry. However, it also empowered the participants to develop critical thinking, particularly around issues of power and identity. Through generating authentic and untold stories, Appreciative Inquiry enabled participants to discuss, subvert and challenge the identities that had been constructed for them by sources of power within their community and culture. The paper describes the innovative application of Appreciative Inquiry, offers a theoretical response to criticisms of Appreciative Inquiry and suggests how it may be effective in enabling marginalised people to critically address issues of powe

Altered metabolic parameters in association with antipsychotic medication use in diabetes:A population based case-control study

Aims: This study assess differences in clinical variables in diabetes patients prescribed antipsychotic medication and determines relative schizophrenia prevalence in the diabetes population. Methods: This population-based case-control study utilizing Scotland's national diabetes registry (SCI-diabetes) and linked psychiatric hospital discharge data (SMR04) established diabetes phenotypes in a patient cohort prescribed long term antipsychotic medication (n = 2362) (cases). Cases were matched 1:10 to diabetes patients not prescribed antipsychotic medication (controls) for BMI, gender; diabetes type; birth year; diagnosis date; smoking status. Sub-groups with defined schizophrenia (n = 196) or bipolar disorder (n = 190) were further examined. Schizophrenia prevalence in the diabetes versus general population was compared. Results: During follow up, antipsychotic prescription was associated with lower HbA1c (55.1 (95% CI 54.5-55.8) or 7.2 (95% CI 7.1-7.3)% vs 58.2 (58.0-58.4) mmol or 7.5 (95% CI 7.5-7.5)% p &lt;0.001) lower serum total cholesterol, 4.2 (4.1-4.2) vs 4.3 (4.2-4.3) mmol/l, p &lt;0.001, lower blood pressure (systolic 130 (130.17-131.29) vs 134 (134.3-134.7) mmHg, p &lt;0.001), higher prescription of oral hypoglycaemic medication (42% (40-45) vs 38% (37-39) p &lt;0.001), similar statin prescriptions (85% (81-89) vs 85% (84-86), p = 0.55), and lower retinopathy rates (28% (25.6-30.5) vs 32% (31.5-33.1), p &lt;0.001). HbA1c at diagnosis was similar (p = 0.27). Schizophrenia prevalence was higher in the diabetes versus general population with differences across age groups (Scottish population versus diabetic population rate of 522.2 (522.1-522.3) versus 717.4 (703.4-731.9) per 100,000). Conclusions: We confirm higher diabetes rates in schizophrenia up to age 70, similar attendance rates and clinical measurements that are not worse in a large well-matched population-based Scottish sample prescribed antipsychotic medication versus matched general diabetes patients.</p

Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice

Background Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study

Excess mortality from chronic physical disease in psychiatric patients - The forgotten problem

The article discusses various reports published within the issue, including one by David Lawrence and Joanne Pais on the mortality rate of mentally ill, another by Chris J. Busche and Richard Hodgson on cancer complexities, and on the incidence of chronic disorders among Canadians