ADR-based Workplace Conflict Management Systems: A Case of American Exceptionalism

[Excerpt] The diffusion of ADR-based conflict management systems is a development increasingly highlighted in the literature. Organizations are seen as putting in place multiple procedures and practices so that different varieties of workplace conflict can be effectively addressed. Just why organizations are electing to introduce these integrated bundles of innovative conflict management practices is a matter of debate, but many view the development as transforming the manner in which workplace problems are managed in modern organizations, with some even pronouncing that it amounts to the rewriting of the social contract at work (Lipsky and Seeber 2006). This paper argues that to the extent to which conflict management systems are being diffused, it is occurring mainly in the USA became the institutional context for the management of the employment relationship creates considerable incentives for the adoption of ADR-inspired conflict management innovations. Other Anglo-American countries, where it might be thought reasonable to expect a similar pattern of ADR innovation at the workplace to emerge, are not experiencing any discernible shift towards conflict management systems inside organizations. It is suggested that in the absence of institutional incentives to adopt workplace management systems, organizations are unlikely to opt for radical conflict management innovations. At the same time, drawing on research in the Irish context, it is argued that tried-and-tested conflict management practices do change over time, with an incremental and evolutionary approach adopted by some organizations to upgrade practices considered the most interesting development. The paper is organized as follows. The first section assesses why the emergence of integrated conflict management systems in organizations is considered to be a significant new development in the USA. The next section evaluates evidence and suggests that a similar pattern of workplace conflict management innovation is not occurring in other Anglo-American countries. After this evaluation, it is suggested that the institutional context in the USA creates uniquely strong incentives for organizations to adopt integrated bundles of ADR practices at the workplace - causing the emergence of conflict management systems to be a case of ‘American exceptionalism’. The following section argues that in the absence of strong institutional incentives to do so, organizations are unlikely to move radically away from established conflict management systems. The penultimate section explains that even in the presence of organizational inertia, conflict management practices seldom stay the same and uses research in the Irish context to suggest that organizations sometimes use an evolutionary approach to upgrade conflict management practices in an incremental yet continuous manner. The final section presents a number of case studies of this evolutionary approach to conflict management innovation. The conclusions bring together the arguments of the paper

An update on oral cavity cancer:epidemiological trends, prevention strategies and novel approaches in diagnosis and prognosis

In the UK, the incidence of oral cavity cancer continues to rise, with an increase of around 60% over the past 10 years. Many patients still present with advanced disease, often resulting in locoregional recurrence and poor outcomes, which has not changed significantly for over four decades. Changes in aetiology may also be emerging, given the decline of smoking in developed countries. Therefore, new methods to better target prevention, improve screening and detect recurrence are needed. High-throughput ‘omics’ technologies appear promising for future individual-level diagnosis and prognosis. However, given this is a relatively rare cancer with significant intra-tumour heterogeneity and variation in patient response, reliable biomarkers have been difficult to elucidate. From a public health perspective, implementing these novel technologies into current services would require substantial practical, financial and ethical considerations. This may be difficult to justify and implement at present, therefore focus remains on early detection using new patient-led follow-up strategies. This paper reviews the latest evidence on epidemiological trends in oral cavity cancer to help identify at risk groups, population-based approaches for prevention, in addition to potential cutting-edge approaches in the diagnosis and prognosis of this disease. Keywords: Epidemiology, Oral Cancer, Survival, Risk Factors, Squamous Cell Carcinoma, Mouth Neoplasm

Decentralised Collective Bargaining in Ireland - National Report

The institutional framework for collective bargaining in Ireland is underpinned by the principle of voluntarism. Employers and trade unions voluntarily engage in collective bargaining, and their agreed terms and conditions of employment are not legally binding. Workers have the right to form and join a trade union. However, unions cannot force employers to enter collective bargaining, meaning that there is no legal right to bargaining in Ireland. There is only one trade union confederation, the Irish Congress of Trade Unions. Equally, there is one major cross-sectoral employers’ association, the Irish Business and Employers Confederation. These two organisations played a very significant role in the regulation of the economy during the national social partnership in Ireland between 1987 and 2009, negotiating wage rates for all unionised workers. Since the collapse of the national social partnership in 2009, the main levels at which collective bargaining takes place are the company and the workplace levels. Sectoral bargaining still occurs in a number of low-paid and weakly unionised sectors and in construction and allied sectors. Sectoral bargaining also takes place in public services. Recently, employers and unions have called for a deepening of tripartite social dialogue, and this has occurred in several areas central to Ireland’s response to the COVID-19 pandemic. However, this emerging forum cannot be considered as a precursor to a new form of national social partnership. Neither unions nor employers favour the alignment of social dialogue directly with pay bargaining in a renewal of the social partnership-type centralised pay agreements of the 1987–2009 era. The main actors involved in decentralised bargaining are, on the side of the union, full-time trade union officials, organising workers at the sector level alongside shop stewards working in companies, and, on the side of the employer, Human Resource (HR) Directors and their delegation of managers, variously composed of the HR Manager(s), Head of Finance, and Operations Manager(s). In the largest companies, which are considered to be pattern setters in collective bargaining, the employers’ association also takes part in the negotiations. There are no works councils within companies in Ireland, and only trade unions with a licence are authorised to sign a collective agreement with their management counterpart. In some companies, particular industrial relations arrangements, whereby trade unions and management collaborate in various areas, such as information sharing, training, and work organisation, can be found. These are called workplace partnerships and are supported by formal workplace participation forums that are used by both management and shop stewards to voice their concerns as well as to discuss any issue that is relevant to the workers and the company. These forums, however, are never the locus of collective negotiations

A clinical observational analysis of aerosol emissions from dental procedures

Aerosol generating procedures (AGPs) are defined as any procedure releasing airborne particles <5 μm in size from the respiratory tract. There remains uncertainty about which dental procedures constitute AGPs. We quantified the aerosol number concentration generated during a range of periodontal, oral surgery and orthodontic procedures using an aerodynamic particle sizer, which measures aerosol number concentrations and size distribution across the 0.5–20 μm diameter size range. Measurements were conducted in an environment with a sufficiently low background to detect a patient’s cough, enabling confident identification of aerosol. Phantom head control experiments for each procedure were performed under the same conditions as a comparison. Where aerosol was detected during a patient procedure, we assessed whether the size distribution could be explained by the non-salivary contaminated instrument source in the respective phantom head control procedure using a two-sided unpaired t-test (comparing the mode widths (log(σ)) and peak positions (D(P,C))). The aerosol size distribution provided a robust fingerprint of aerosol emission from a source. 41 patients underwent fifteen different dental procedures. For nine procedures, no aerosol was detected above background. Where aerosol was detected, the percentage of procedure time that aerosol was observed above background ranged from 12.7% for ultrasonic scaling, to 42.9% for 3-in-1 air + water syringe. For ultrasonic scaling, 3-in-1 syringe use and surgical drilling, the aerosol size distribution matched the non-salivary contaminated instrument source, with no unexplained aerosol. High and slow speed drilling produced aerosol from patient procedures with different size distributions to those measured from the phantom head controls (mode widths log(σ)) and peaks (D(P,C), p< 0.002) and, therefore, may pose a greater risk of salivary contamination. This study provides evidence for sources of aerosol generation during common dental procedures, enabling more informed evaluation of risk and appropriate mitigation strategies

A multivariable Mendelian randomization analysis investigating smoking and alcohol consumption in oral and oropharyngeal cancer

The independent effects of smoking and alcohol in head and neck cancer are not clear, given the strong association between these risk factors. Their apparent synergistic effect reported in previous observational studies may also underestimate independent effects. Here we report multivariable Mendelian randomization performed in a two-sample approach using summary data on 6,034 oral/oropharyngeal cases and 6,585 controls from a recent genome-wide association study. Our results demonstrate strong evidence for an independent causal effect of smoking on oral/oropharyngeal cancer (IVW OR 2.6, 95% CI = 1.7, 3.9 per standard deviation increase in lifetime smoking behaviour) and an independent causal effect of alcohol consumption when controlling for smoking (IVW OR 2.1, 95% CI = 1.1, 3.8 per standard deviation increase in drinks consumed per week). This suggests the possibility that the causal effect of alcohol may have been underestimated. However, the extent to which alcohol is modified by smoking requires further investigation

Using genetic variants to evaluate the causal effect of cholesterol lowering on head and neck cancer risk:a Mendelian randomization study

Head and neck squamous cell carcinoma (HNSCC), which includes cancers of the oral cavity and oropharynx, is a cause of substantial global morbidity and mortality. Strategies to reduce disease burden include discovery of novel therapies and repurposing of existing drugs. Statins are commonly prescribed for lowering circulating cholesterol by inhibiting HMG-CoA reductase (HMGCR). Results from some observational studies suggest that statin use may reduce HNSCC risk. We appraised the relationship of genetically-proxied cholesterol-lowering drug targets and other circulating lipid traits with oral (OC) and oropharyngeal (OPC) cancer risk using two-sample Mendelian randomization (MR). For the primary analysis, germline genetic variants in HMGCR, NPC1L1, CETP, PCSK9 and LDLR were used to proxy the effect of low-density lipoprotein cholesterol (LDL-C) lowering therapies. In secondary analyses, variants were used to proxy circulating levels of other lipid traits in a genome-wide association study (GWAS) meta-analysis of 188,578 individuals. Both primary and secondary analyses aimed to estimate the downstream causal effect of cholesterol lowering therapies on OC and OPC risk. The second sample for MR was taken from a GWAS of 6,034 OC and OPC cases and 6,585 controls (GAME-ON). Analyses were replicated in UK Biobank, using 839 OC and OPC cases and 372,016 controls and the results of the GAME-ON and UK Biobank analyses combined in a fixed-effects meta-analysis. We found limited evidence of a causal effect of genetically-proxied LDL-C lowering using HMGCR, NPC1L1, CETP or other circulating lipid traits on either OC or OPC risk. Genetically-proxied PCSK9 inhibition equivalent to a 1 mmol/L (38.7 mg/dL) reduction in LDL-C was associated with an increased risk of OC and OPC combined (OR 1.8 95%CI 1.2, 2.8, p = 9.31 x10-05), with good concordance between GAME-ON and UK Biobank (I2 = 22%). Effects for PCSK9 appeared stronger in relation to OPC (OR 2.6 95%CI 1.4, 4.9) than OC (OR 1.4 95%CI 0.8, 2.4). LDLR variants, resulting in genetically-proxied reduction in LDL-C equivalent to a 1 mmol/L (38.7 mg/dL), reduced the risk of OC and OPC combined (OR 0.7, 95%CI 0.5, 1.0, p = 0.006). A series of pleiotropy-robust and outlier detection methods showed that pleiotropy did not bias our findings. We found limited evidence for a role of cholesterol-lowering in OC and OPC risk, suggesting previous observational results may have been confounded. There was some evidence that genetically-proxied inhibition of PCSK9 increased risk, while lipid-lowering variants in LDLR, reduced risk of combined OC and OPC. This result suggests that the mechanisms of action of PCSK9 on OC and OPC risk may be independent of its cholesterol lowering effects; however, this was not supported uniformly across all sensitivity analyses and further replication of this finding is required