Stressed, depressed and exhausted: Six years as a teacher in UK state education

This article foregrounds the experiences of a newly qualified teacher – ‘Daniel’ – in the state education sector in the United Kingdom. It provides an insight into the under-explored realities of teaching work and an empirical connection with a segment of the UK public sector that successive governments have positioned as central to economic and social prosperity. It centres on why nine out of ten teachers who participated in the 2017 National Skills and Employment Survey reported that they ‘often’ or ‘always’ come home from work exhausted. In doing so, it also helps to explain why 33% of newly qualified teachers leave within five years of qualifying. Through Daniel’s story, 40 years of neoliberal reform to the UK education system is contextualised and shown to have intensified latent contradictions by stripping teachers of time and the freedom to operate and innovate

Rhetorical technique and governance? Aphorisms and leaders? Political persuasion

Drawing on a previous paper (Morrell, 2006), this chapter looks at the work aphorisms do in leaders’ speeches. Aphorisms are a highly flexible, powerful rhetorical format that can support claims based on logos, ethos and pathos. We begin by describing the rhetorical formats (techniques) speakers use to create an impact on their audience, then identify ten examples of aphorisms by renowned writers. Insights from Conversation Analysis (CA) (Heritage and Greatbatch, 1986; Sacks, 1992; Schegloff, 2007) help us to analyse these and to derive a framework that allows aphorisms to be mapped on two continua: convergent ... divergent; and creative ... destructive. We apply this to two famous speeches: Marcus Antonius’ funeral address in Julius Caesar, and Churchill’s first speech as prime minister. Rather than treating aphorisms in these speeches as isolated fragments, we emphasise the importance of context and consider two features influencing their impact: setting and sequence

Bloody suffering and durability: How chefs forge embodied identities in elite kitchens

In this article, we elaborate on the significance of suffering in processes of embodied identity construction. Drawing on interviews with 62 chefs employed in elite kitchens around the world, we make two main contributions. First, we extend our understanding of suffering as a traumatic, alienating experience by theorizing it as a distinctive form of embodied identity work. We show how suffering can function as a mechanism through which people forge an understanding of who they are. Our second contribution extends the first by elaborating on what we call the aesthetics of suffering. We show how suffering can be perversely appreciable, distinguishing and endured in culturally significant, identity-implicative ways. Via this theorization, we progress our understanding of how identities are forged through (and read from) suffering bodies, and add an additional layer of interpretation to research in which matters of embodied identity and suffering are nascent but largely neglected

Stress, anxiety, and the erosion of trust: Maternity staff experiences of incident management

Background Adverse incidents in maternity care and other healthcare systems continues to be a major cause of morbidity and mortality with significant financial cost to healthcare organisations, patients, and their families. Over the last decades healthcare organisations have focused their attention on improving the quality of patient care, safety, and experience. However, very little attention has been given to understanding and improving staff experience. This is despite the high probability that healthcare professionals who experience their workplace positively will deliver higher quality care, report incidents more commonly, and actively engage in incident investigation and learning processes. Objective The purpose of the study is to explore maternity staffs’ experiences of the incident reporting and investigation process, with specific reference to its impact on trust in local risk management leadership and organizational process. Design Semi-structured in-depth qualitative interviews analyzed using a methodological procedure that reveals the human experience of complex social phenomena (Interpretive Phenomenological Analysis). Setting Tertiary university maternity teaching hospital in England (UK) with approximately 6000 deliveries per annum. Subjects A purposive sample of 10 staff (2 consultants, 3 specialist registrars and 5 midwives) all involved in incidents requiring formal investigation during the preceding 12 months. Main outcome measures The lived experiences, personal feelings, and perceptions of how the incident reporting and investigation process impacts on their trust in the risk management leadership and organizational process. Results Incident reporting and investigation were found to be perceived by staff as very stressful events with no structured feedback and support system in place for staff. We found that this lead to diminished trust in the risk management leadership and organizational process with staff relying on colleagues for support and validation of their practice. Conclusion The study showed that poorly managed processes of incident reporting and investigation result in diminished trust in risk management leadership and organizational processes. It also reinforces understanding that adverse incidents have a profound impact on the mental health and wellbeing of healthcare professionals. Factors that will likely mitigate these experiences and effects include: (1) timely updates and feedback from incident investigation; (2) high levels of leadership visibility; and (3) structured support for staff during and after incident reporting and investigations

The function of fear in institutional maintenance: Feeling frightened as an essential ingredient in haute cuisine

Fear is a common and powerful emotion that can regulate behaviour. Yet institutional scholars have paid limited attention to the function of fear in processes of institutional reproduction and stability. Drawing on an empirical study of elite chefs within the institution of haute cuisine, this article finds that the multifaceted emotion of fear characterised their experiences and served to sustain their institution. Chefs’ individual feelings of fear prompted conformity and a cognitive constriction, which narrowed their focus on to the precise reproduction of traditional practices whilst also limiting challenges to the norms underpinning the institution. Through fear work, chefs used threats and violence to connect individual experiences of fear to the violation of institutionalized rules, sustaining the conditions in which fear-driven maintenance work thrived. The study also suggests that fear is a normative element of haute cuisine in its own right, where the very experience and eliciting of fear preserved an essential institutional ingredient. In this way, emotions such as fear do not just accompany processes of institutionalization but can be intimately involved in the maintenance of institutions

Outcomes of cerebral venous thrombosis due to vaccine-induced immune thrombotic thrombocytopenia after the acute phase

© 2022 American Heart Association, Inc.Background: Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization. Methods: We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0–2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization). Results: Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94–194). Two patients died during follow-up (3% [95% CI, 1%–11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%–94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed). Conclusions: In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw, grant number 10430072110005), the Dr. C.J. Vaillant Foundation, and Hospital District of Helsinki and Uusimaa (grant TYH2022223).info:eu-repo/semantics/publishedVersio

Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination

Objective Cerebral venous thrombosis (CVT) caused by vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus-based severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. Methods We used data from an international prospective registry of patients with CVT after the adenovirus-based SARS-CoV-2 vaccination. We analyzed possible, probable, or definite VITT-CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. Results Ninety-nine patients with VITT-CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in-line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16-1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06-0.58). Treatment with non-heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24-2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74-6.54). Conclusions In patients with VITT-CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT-CVT. ANN NEUROL 2022Peer reviewe

Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19

Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28–54) vs 45 (28–56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28–79) vs 68 (30–125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19–62) vs 53 (20–92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.</p

Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19

Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28–54) vs 45 (28–56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28–79) vs 68 (30–125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19–62) vs 53 (20–92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.</p