The Day of the Rally:An ethnographic study of 'ceremony as resistance' and 'resistance as ceremony'

The literature on organisational culture suggests that ceremonies or rituals reinforce control. By contrast, this article contributes to the literature on resistance, culture and ceremony by arguing that ceremony can also be understood as a form of resistance. It does so through drawing on ethnographic research, first, to explore how a ceremonial 1-day rally during an academic dispute was productive for frontline employee resistance (ceremony as resistance). Second, it considers how such resistance can also be productive in generating consent, for it is infused with and reproduces established norms, subjectivities and power relations (resistance as ceremony). Finally, it is asserted that resistance can be productive in fostering a subjectivity characterised by stability and instability and so practices such as a rally are necessary to try to stabilise both the organisation and the subjectivity of resistance. The article therefore illustrates the ambiguity of productive resistance which has been neglected to date. These insights and arguments indicate that all forms of workplace resistance are decaf, for they are imbued with the context and norms through which they arise. Nevertheless, resistance remains dangerous for those in positions of authority because it means that power is never totalising and so outcomes continue to be uncertain

‘The costumes don’t do it for me’: Obstacles to the translation of ‘new’ management ideas

It has been argued that management support is important to successfully translate new management ideas into practice. Through focusing on the obstacles to the translation of a management guru text in a manufacturing organisation, we point towards a far more uncertain situation. First, we explore the paradoxical situation of engaged managers undermining the implementation of new ideas. Second, we consider how attempts to use humour to aid translation may generate a variety of unintended employee translations. Third, we examine how the objects that management enlist to support translation can thwart change. It has been argued that ‘technological’ and ‘textual’ objects exercise agency through making humans act in intended ways. Into this mix, we add ‘cultural’ objects (in our case costumes) and argue that while they exercise agency, the outcomes they produce may hinder managerial designs

‘It’s just a job’:understanding emotion work, de-animalization and the compartmentalization of organized animal slaughter

This article contributes to an understanding of the nexus between humans and animals by drawing on ethnographic research conducted in a British chicken factory and, more particularly, by exploring the emotional subjectivity of Meat Inspectors employed by the Food Standards Agency to oversee quality, hygiene and consumer safety within this plant. We argue that these Inspectors displayed a complex range of often contradictory emotions from the ‘mechanized’ to the ‘humanized’ and link this, in part, to the technocratic organization of factory work that compartmentalizes and sanitizes slaughter. This serves to de-animalize and commodify certain animals, which fosters an emotional detachment from them. In contrast to research which suggests that emotions switch off and on in a dialectic between violence and non-violence, or that we are living in a post-emotional society, we elucidate the co-existence, fluidity and range of emotions that surface and submerge at work. While contributing to the extant literature on ‘emotionologies’, we add new insights by considering how emotions play out in relation to animals

Sensory training system for use at home by people with complex regional pain syndrome in England: Protocol for a proof-of-concept study

Introduction: Complex regional pain syndrome (CRPS) is a disabling and distressing chronic pain condition characterised by a range of sensory, motor, autonomic and trophic symptoms. UK guidelines recommend therapy interventions to help normalise touch perception through self-administered tactile and thermal desensitisation activities. Interventions have been developed, aiming to help individuals broaden their sensory experience, thereby relieving chronic pain. However, therapy-led interventions often experience practical constraints and poor adherence. In response, a sensory training system (STS) device has been designed for unsupervised independent home-use.Methods: This proof-of-concept study aims to explore whether people with CRPS use the device at home for 30 minutes a day for 30 days. Secondary aims are to determine whether the STS device will change tactile acuity and perceived levels of pain intensity, pain interference, sensitivity or feelings towards the affected limb. We will seek to recruit 20 eligible participants. Participants will be asked to measure tactile acuity using a two-point discrimination assessment, complete an online questionnaire before and after use of the device and complete a daily diary. On completion of the 30-day use, participants will be invited to take part in a semi-structured interview to explore their experiences of using the device.Analysis: Pain intensity and pain interference will be scored using the online Assessment Center Scoring Service or using the look-up table in the PROMIS scoring manual. The remaining questionnaire data, including tactile acuity results, and device-use data, including frequency and duration of use, will be analysed using descriptive statistics. Qualitative data will be thematically analysed.Ethics and dissemination: London-Stanmore Research Ethics Committee provided a favourable opinion on 19 April 2021 (ref 21/LO/0200). The NHS Health Research Authority, UK, approved this study on 7 June 2021. Dissemination will include peer-reviewed publications, presentations at conferences, social media and reports to the funder and patient charities

Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England::a discrete event simulation

Background We have previously modelled that the optimal number of comprehensive stroke centres (CSC) providing endovascular thrombectomy (EVT) in England would be 30 (net 6 new centres). We now estimate the relative effectiveness and cost-effectiveness of increasing the number of centres from 24 to 30. Methods We constructed a discrete event simulation (DES) to estimate the effectiveness and lifetime cost-effectiveness (from a payer perspective) using 1 year’s incidence of stroke in England. 2000 iterations of the simulation were performed comparing baseline 24 centres to 30. Results Of 80,800 patients admitted to hospital with acute stroke/year, 21,740 would be affected by the service reconfiguration. The median time to treatment for eligible early presenters (< 270 min since onset) would reduce from 195 (IQR 155–249) to 165 (IQR 105–224) minutes. Our model predicts reconfiguration would mean an additional 33 independent patients (modified Rankin scale [mRS] 0–1) and 30 fewer dependent/dead patients (mRS 3–6) per year. The net addition of 6 centres generates 190 QALYs (95%CI − 6 to 399) and results in net savings to the healthcare system of £1,864,000/year (95% CI -1,204,000 to £5,017,000). The estimated budget impact was a saving of £980,000 in year 1 and £7.07 million in years 2 to 5. Conclusion Changes in acute stroke service configuration will produce clinical and cost benefits when the time taken for patients to receive treatment is reduced. Benefits are highly likely to be cost saving over 5 years before any capital investment above £8 million is required

Candidate biomarkers of PARP inhibitor sensitivity in ovarian cancer beyond the BRCA genes

BACKGROUND: Olaparib (Lynparza™) is a PARP inhibitor approved for advanced BRCA-mutated (BRCAm) ovarian cancer. PARP inhibitors may benefit patients whose tumours are dysfunctional in DNA repair mechanisms unrelated to BRCA1/2. We report exploratory analyses, including the long-term outcome of candidate biomarkers of sensitivity to olaparib in BRCA wild-type (BRCAwt) tumours. METHODS: Tumour samples from an olaparib maintenance monotherapy trial (Study 19, D0810C00019; NCT00753545) were analysed. Analyses included classification of mutations in genes involved in homologous recombination repair (HRR), BRCA1 promoter methylation status, measurement of BRCA1 protein and Myriad HRD score. RESULTS: Patients with BRCAm tumours gained most benefit from olaparib; a similar treatment benefit was also observed in 21/95 patients whose tumours were BRCAwt but had loss-of-function HRR mutations compared to patients with no detectable HRR mutations (58/95). A higher median Myriad MyChoice® HRD score was observed in BRCAm and BRCAwt tumours with BRCA1 methylation. Patients without BRCAm tumours derived benefit from olaparib treatment vs placebo although to a lesser extent than BRCAm patients.CONCLUSIONS: Ovarian cancer patients with tumours harbouring loss-of-function mutations in HRR genes other than BRCA1/2 may constitute a small, molecularly identifiable and clinically relevant population who derive treatment benefit from olaparib similar to patients with BRCAm

‘Curiouser and curiouser!’:organizations as wonderland – a metaphorical alternative to the rational model

The metaphors in Morgan’s (1986) Images of Organization largely imply order, rationality, stability and manageability. This reflects that the text is concerned with facilitating the design and management of organizations. This article draws on Lewis Carroll’s (1865) novel Alice’s Adventures in Wonderland to propose Wonderland as an alternative metaphor that places at centre stage issues such as absurdity, irrationality, uncertainty and disorder. Rather than a marginal or temporary aberration, it is argued that such conditions need to be understood as an everyday experience for many. This metaphor is important because those who are tasked with managing organizations may find it stressful and puzzling that they are so inept, when they compare their experiences and achievements with the rational model. In this sense, it offers both comfort and perhaps encouragement, but it should also foster humility and caution in terms of what those at the top can achieve. Likewise, those on the receiving end of irrational decisions or who reside in absurd worlds can gain solace from knowing that they are not alone, whilst those concerned with resisting such conditions can find strength in the knowledge that those in positions of authority are not omniscient/omnipotent

Abstracts from the NIHR INVOLVE Conference 2017

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PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Tearing at the Tapestry:An ethnography of solidaristic humour, academic strike action and a new management strategy

This article emerged through ethnographic research into strike action at a UK university. It provides three insights. First, it adds to the literature linking humour to resistance that has largely focused on subterranean, disguised, hidden, camouflaged or decaf opposition. The resistant humour explored in this case is more diverse and challenges extant distinctions because it was overt and covert, individual and collective, decaf and ‘real’. Second, it posits that during strike action the already ambiguous distinction between humour and seriousness becomes even more blurred. Third, it contributes to our understanding of power-resistance relations through introducing the term solidaristic humour which conveys a neglected expression of opposition that reflects and seeks to galvanize solidarity