East Midlands Region Research Articles

Using tacit knowledge in training and accident prevention

Tacit knowledge plays an invaluable role in construction and has been labelled as the ‘most strategically important resource’ in organisations. Microconstruction firms rely heavily on the tacit knowledge acquired by their workers when managing site safety. Unfortunately, the importance of this knowledge is sometimes overlooked due to its inexpressible and informal nature. This paper investigates how microconstruction firms use tacit knowledge to prevent accidents on site, thereby improving overall site safety. An ethnographic approach was used to gather rich in-depth qualitative data on the practices of these ‘hard-to-reach’ microconstruction firms. Five case studies were conducted in the East Midlands region of the UK. Findings from the case studies suggest that workers of microconstruction firms use tacit knowledge in areas such as training newcomers and also identifying and managing imminent risks and dangers on site. Additionally, tacit knowledge plays an important role in safety communications among the workers of these microfirms; it helps establish shared understanding and a common sense of achieving their goals. This research sheds light on an underexplored area of the construction industry, which is arguably crucial in preventing accidents and ensuring the well-being of site workers.

Using tacit knowledge in training and accident prevention

Tacit knowledge plays an invaluable role in construction and has been labelled as the ‘most strategically important resource’ in organisations. Microconstruction firms rely heavily on the tacit knowledge acquired by their workers when managing site safety. Unfortunately, the importance of this knowledge is sometimes overlooked due to its inexpressible and informal nature. This paper investigates how microconstruction firms use tacit knowledge to prevent accidents on site, thereby improving overall site safety. An ethnographic approach was used to gather rich in-depth qualitative data on the practices of these ‘hard-to-reach’ microconstruction firms. Five case studies were conducted in the East Midlands region of the UK. Findings from the case studies suggest that workers of microconstruction firms use tacit knowledge in areas such as training newcomers and also identifying and managing imminent risks and dangers on site. Additionally, tacit knowledge plays an important role in safety communications among the workers of these microfirms; it helps establish shared understanding and a common sense of achieving their goals. This research sheds light on an underexplored area of the construction industry, which is arguably crucial in preventing accidents and ensuring the well-being of site workers.

NORM in the East Midlands' oil and gas producing region of the UK

Naturally occurring radioactive material (NORM) is a common feature in North Sea oil and gas production offshore but, to date, has been reported from only one production site onshore in the United Kingdom. The latter, Wytch Farm on the Dorset coast, revealed high activity concentrations of 210Pb in metallic form but little evidence of radium accumulation. NORM has now been discovered at two further onshore sites in the East Midlands region of the UK. The material has been characterized in terms of its mineralogy, bulk composition and disequilibrium in the natural uranium and thorium series decay chains. In contrast to Wytch Farm, scale and sludge samples from the East Midlands were found to contain elevated levels of radium and radioactive progeny associated with crystalline strontiobarite. The highest 226Ra and 228Ra activity concentrations found in scale samples were 132 and 60 Bq/g, with mean values of 86 and 40 Bq/g respectively; somewhat higher than the mean for the North Sea and well above national exemption levels for landfill disposal. The two East Midlands sites exhibited similar levels of radioactivity. Scanning electron microscope imaging shows the presence of tabular, idiomorphic and acicular strontiobarite crystals with elemental mapping confirming that barium and strontium are co-located throughout the scale. Bulk compositional data show a corresponding correlation between barium-strontium concentrations and radium activity. Scales and sludge were dated using the 226Ra/210Pb method giving mean ages of 2.2 and 3.7 years, respectively. The results demonstrate clearly that these NORM deposits, with significant radium activity, can form over a very short period of time. Although the production sites studied here are involved in conventional oil recovery, the findings have direct relevance should hydraulic fracturing for shale gas be pursued in the East Midlands oilfield.

Vegetation cover and grasslands in the vicinity accelerate development of carabid beetle assemblages on restored landfill sites

There is an increasing evidence that rare and scarce carabid species of conservation importance are frequent in brownfield sites such as restored landfills. However, this potential has largely been unexplored. The present study was undertaken to examine carabid species composition, richness and abundance in relation to habitat quality and landscape structure on landfill sites in comparison with paired reference sites of existing wildlife value. Sampling was conducted by collecting carabids in ten pitfall traps set along two 100 m transects on each of nine restored landfill sites and their paired reference sites in the East Midlands region of the UK. A total of 1014 individuals representing 37 carabid species were found during April–September of 2007 and 2008. On the surveyed landfill sites, generalist species were common, while no nationally rare or scarce species were found. Neither species richness nor diversity of carabid species was found to be different from that of the reference sites. Seeding durin...

Cooling water for Britain's future electricity supply

Trends in the locations and technologies of UK electricity generation plant suggest that demand for cooling water abstractions from rivers will decrease in the coming decades, unless there is widespread uptake of carbon dioxide capture and storage (CCS). CCS may prove to be essential if the UK is to achieve its carbon dioxide and greenhouse gas emission targets. ‘Decarbonisation’ strategies that rely on CCS are therefore potentially at risk of not having sufficient cooling water in periods of low river flows. In this paper, regional freshwater demands for cooling water are assessed against regional freshwater availability at low flows in a scenario of medium climate change. In the strategy with high CCS, demands for water greatly exceed current and future availability in the north-west (NW) England, Humber, East (E) Midlands and Thames regions. These risks can be mitigated by increasing the penetration of hybrid cooling systems or shifting generating capacity to estuaries or the coast. The former could reduce national water use by up to 35%, whereas applying the latter in the NW England, Humber and E Midlands regions offers nationwide reductions from 30 to 50%.

PWE-281 Are patients with cancers ‘missed’ on faecal occult blood (FOB) testing truly asymptomatic? – a multicentre analysis

Introduction We aimed to identify the symptomatology of patients who develop interval cancers (cancers diagnosed within 2 years of a negative FOBT screening) in the eligible population of the East Midlands region. Method Data from the National Bowel Cancer Audit Programme from three tertiary colorectal centres (Queens Medical Centre, Nottingham; Royal Derby Hospital and Sherwood Forest Hospitals ll) in the FOB testing age group (60–74 years) over 2 years (August 2011 to August 2013) were analysed and linked to the regional FOB hub to identify patients who had developed colorectal cancer after a negative FOBT in the screening interval (2 years) status. Tumours from and distal to the splenic flexure were classed as left sided tumours. Dukes C/D tumours were classed as advanced tumours. All three centres were in incident rounds of screening. Results The study covered a population of 2 million of which 200,000 were eligible for screening. 521 colorectal cancers were diagnosed in the above population (0.11%). Of these, 231 cancers (44%) were in patients who had declined screening,162 (31%) were picked up following on from a positive FOBT and 128 (25%) were picked up in patients who had a negative FOBT. Of these 128 patients (M: F; 84:44),median age 67 years (SD:3.8) the commonest presenting symptoms for these patients were change in bowel habits in 50(39%). Other presentations included bleeding per-rectum in 44 patients (34%), abdominal pain in 38 (30%) patients, anaemia in 36(28%) patients, loss of weight in14 (11%)patients, bowel obstruction in 13 (10%) patients, bowel perforation in 3(2%) patients. Only two patients were truly asymptomatic from the bowel cancer with this being identified in one patient during surgery for an ovarian cyst and during a trauma laparotomy in the other patient. In the 28% patients who had anaemia the blood picture included a Hb (mean)of 10.3gm;MCV of 82.4 and;MCH of 26.3. In 61% of anaemic patients, the cancer was located on the right side of the colon with an equal percentage being of advanced Duke’s stage. The median interval between the negative FOB test and the diagnosis of cancer in these patients was 15 months (range 0.5–24 months). Conclusion Our findings suggest that the majority of patients with ‘missed’ interval cancers were symptomatic with ‘red flag symptoms’ inspite of the negative FOB test. We also raise the possibility of a natural bias of subjects volunteering for the FOB test in that some who opt for the test may not be ‘truly’ asymptomatic but may have bowel symptoms not yet discussed with their general practitioner. We highlight the need for improved awareness to reduce delays in symptomatic patients seeking medical advice against a background of a negative FOBT. Disclosure of interest None Declared.

PWE-280 Faecal occult blood testing (FOBT) and interval bowel cancers-results of a multicentre study

<h3>Introduction</h3> We aimed to assess the incidence and demographics of interval cancers (cancers diagnosed within 2 years of a negative FOBT screening) in the eligible population of the East Midlands region. <h3>Method</h3> The National Bowel Cancer Audit Programme data from three centres (Queens Medical Centre, Nottingham; Royal Derby Hospital and Sherwood Forest Hospitals) for all colorectal cancers in the screening age group (60–74 years)over a 2-year period (August 2011–August 2013) were linked for their FOBT screening status (BCSP database/Eastern Hub). Three cancer groups were identified: interval cancers, screen detected (positive FOBT) and those in the non-uptake group (eligible patients who declined screening). Tumours at and distal to the splenic flexure were classed as left sided tumours. Dukes C and D tumours were classed as advanced tumours. All three centres were in incident rounds of screening. <h3>Results</h3> Of the 521 colorectal cancers identified, 128 (25%) were interval cancers, 162(31%) were screen detected and 231 (44%) were from the non-uptake group. Gender, ethnicity and Deprivation index were comparable between the three groups. The mean age in the interval cancer group was greater (67 yrs) compared to the screen detected (66 yrs) (<i>p = 0.005</i>). The interval cancer group had a higher incidence of right sided cancers (38% vs. 25% and 29%; <i>X</i>²=6.59; p = 0.033) compared to the screen-detected and non-uptake groups. Cancers detected in the interval cancer group were of a more advanced stage (Dukes C/D) (70% vs. 34% and 54%; <i>X</i>²=37.2;<i>p &lt; 0.005</i>) in comparison to screen-detected and non-uptake groups. The one year mortality in the interval cancer group (16%) was higher than the non-uptake group (12%) and the screen detected group (3%) (16%vs12% and 3%; X2=13.8;<i>p &lt; 0.005</i>). <h3>Conclusion</h3> A quarter of colorectal cancers identified in our screening-eligible population were interval cancers. We highlight the probability that these cancers were ‘missed’ by the guaiac-based FOBT screening tests. The interval cancer group also had poorer outcomes when compared to the screen-detected group. We highlight the need for a test with a lower false negative rate for population based FOBT screening. <h3>Disclosure of interest</h3> None Declared.

Unintended outcomes of the London 2012 Olympic Games: local voices of resistance and the challenge for sport participation leverage in England

This study was undertaken with five families before, during and after the London 2012 Olympics to examine and explore everyday reactions to the Games on families in the East Midlands region of England. The aim of the research was to build localised accounts of the multiple interpretations, potential impacts and reactions to the Olympics in everyday family household settings. The views, perceptions and interpretations of the Games were gathered through qualitative research methods, using video diaries and, pre- and post-event, group interviews. Findings from the study illustrated diverse reactions to the legacy messages, resistance to policy interpretations surrounding this mega event and a strong sense of regional and financial exclusion from the event. Lessons can be learnt for both policy-makers and event managers in the design of future events that encompass the localised perspectives of those communities and individuals who consume the event beyond direct physical participation. In particular, themes from the data included the importance of regional community involvement of national showcase events, limitations of existing media and web-based information sources, and the everyday resistance to policy messages assumed as taken for granted. It is also hoped that the study will provide lessons for the Rio 2016 Olympics from a local delivery perspective.

The Tradition of Anaesthetic Rooms: Best Practice or Patient Risk?

In the United Kingdom (UK), anaesthetic rooms (ARs) are the standard site for induction of anaesthesia. Although advocates of ARs argue that they provide a quiet and comfortable place for patients to be anaesthetised, the competing argument is that ARs create a risk to those patients by transferring them whist they are unconscious and unmonitored. This study focuses on the current use of ARs and the rationale for their inclusion in new theatre design. It investigates decision-making and prioritisation of competing factors in clinical choice. Mixed methods were used to explore perspectives of anaesthetic clinicians and perioperative managers. Two hundred and two consultant anaesthetists from National Health Service Trusts across the East Midlands region of the UK completed an online survey, and 17 perioperative managers were interviewed regarding the incorporation of ARs in theatre design and changing practice. The majority of anaesthetists preferred to induce all types of patients in the AR, except high risk and obese patients. The most important reasons for choosing to induce in the AR were the ‘quiet environment’ and “patient experience’, whereas the least important reasons included ‘patient safety’ and ‘efficiency’. For the respondents who preferred to induce in the theatre the primary reason was ‘patient safety’. Manager interviews revealed their belief that the benefit of ARs is based on perception –not evidence. The research findings question the motives for using the AR for standard anaesthesia provision, as both the daily use of, and design considerations for ARs, seem driven by perception and experience, rather than clear and compelling evidence. Anaesthetic practice in the UK may be operating under the pretences of safety and performance, while carrying on with a traditional way of working which may one-day prove to be an unacceptable risk and investment.

A new model of knowledge and innovative capability development for small born-global bio-tech firms: evidence from the East Midlands, UK

In the last two decades, the rapid transformation in information and communication technologies together with the adoption of more liberal structures governing trade as well as the modularisation of production and services has resulted in the proliferation of small born–global bio–tech firms. The firms have an international flair and they rapidly globalise their operations. Their strategic intent is to develop unique innovative capabilities through networking. In science–based industries such as the biotechnology sector the ability to innovate can only occur if a firm is able to both generate and integrate knowledge from inside and outside its boundaries. In that respect, this article employs a multi–case approach to construct a frame of reference for developing innovative capabilities that complement firm–based competences. The main focus is on small born–global bio–tech firms in the East Midlands region of the UK. The newly developed framework is invaluable to researchers, small born–global bio–tech and large bio–pharmaceutical firms. More so, it contributes to the concepts of dynamic capabilities and networking.

Access to medicines by child refugees in the East Midlands region of England: a cross-sectional study

ObjectivesTo explore access to primary healthcare and drug therapy by refugee children in the East Midlands region of England.DesignInterviews with refugees with children and a control group of British parents...

Doing Fence Sitting

A growing body of research indicates that the way health care professionals conceptualize mental health might have important clinical implications. We adopted a discursive psychology approach to explore clinical psychologists' accounts of mental health and its effects. Semistructured interviews were conducted with 11 clinical psychologists in the East Midlands region of the United Kingdom. The participants constructed mental health through building up biological factors and psychosocial aspects as opposite ends of the same spectrum, and then positioned themselves as distant from these extremes to manage issues of stake and accountability. A discourse of moral concern for service users was used to negotiate the implications of having different views of mental health from service users, enabling clinicians to manage issues of accountability and demonstrate their ability to be helpful. This suggests that clinicians should be mindful of the effects of their use of language and make the contingent nature of their knowledge explicit.

Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study.

There is clinical uncertainty of the benefits and costs of different treatment options for children with Down syndrome who have glue ear. This study was designed to assess the extent of this lack of knowledge and determine if pursuing further information would be practical, beneficial and cost-effective. To assess the level and practical effect of current uncertainty around treatment options for children with Down syndrome and glue ear. To assess the feasibility of studying the options for management of glue ear in children with Down syndrome via a randomised controlled trial (RCT) or multicentre prospective cohort study by evaluating the willingness of (1) parents to agree to randomisation for their children and (2) clinicians to recruit participants to a definitive study. To undertake value of information analyses to demonstrate the potential economic benefit from undertaking further research. A feasibility study exploring the views of parents of children with Down syndrome and professionals who have responsibility for the health and education of children with Down syndrome, on the participation in, and value of, future research into interventions for glue ear. Data were collected from parents via self-completed questionnaires, face-to-face interviews and focus groups and from professionals via online questionnaires and a Delphi review exercise. Development of economic models to represent clinical pathways of care and a RCT informed a value of information (VOI) analysis. UK (professionals); East Midlands region of the UK (parents). Parents of children aged 1-11 years with Down syndrome (n = 156). Professionals including audiologists, ear, nose and throat surgeons, audiological physicians, speech and language therapists, and teachers of the deaf (n = 128). Quantitative and qualitative data on parental views and experiences of glue ear and its effects; interventions and treatment received; taking part in research and factors that would encourage or discourage participation; and the importance of various outcome domains to them and for their children. For professionals: information on caseloads; approaches to clinical management; opinions on frequency and significance of the consequences of glue ear for this population; importance of different outcome measures; opinions of interventions and their role in future research; views on health research; facilitators and barriers to recruitment, and participation in research involving RCTs. The complexity of the experience and individual characteristics of children with Down syndrome poses challenges for the design of any future research but these challenges were not considered by professionals to raise sufficient barriers to prevent it being undertaken. Parents were generally supportive of the need for, and value of, research but identified practical and emotional issues that would need addressing. Glue ear was considered to impact more on speech, language and communication than on hearing. Outcome measures for future research would need to evaluate these elements but measures should be designed specifically for the population. Parents and professionals identified randomisation as a significant barrier to participation. The VOI analyses identified lack of data as problematic but concluded that a future trial involving surgical intervention would be feasible at costs of < £650,000. Future research into the benefits of interventions for glue ear in children with Down syndrome would be feasible and could be cost-effective but should be carefully designed to facilitate and maximise participation from parents and professionals responsible for recruitment. The National Institute for Health Research Health Technology Assessment programme.

An index to represent lateral variation of the confidence of experts in a 3-D geological model

A Confidence Index is proposed that expresses the confidence of experts in the quality of a 3-D model as a representation of the subsurface at particular locations. The Confidence Index is based on the notion that the variation of the height of a particular geological surface represents general geological variability and local variability. The general variability comprises simple trends which allow the modeller to project surface structure at locations remote from direct observations. The local variability limits the extent to which borehole observations constrain inferences which the modeller can make concerning local fluctuations around the broad trends. The general and local geological variability of particular contacts are modelled in terms of simple trend surfaces and variogram models. These are then used to extend measures of confidence that reflect expert opinion so as to assign a confidence value to any location where a particular contact is represented in a model. The index is illustrated with an example from the East Midlands region of the United Kingdom.

Context, control and the spillover of energy use behaviours between office and home settings

This paper examines how office-based lighting and computer use behaviours relate to similar behaviours performed by the same individuals in a household setting. It contributes to the understanding of energy use behaviour in both household and organisational settings, and investigates the potential for the ‘spillover’ of behaviour from one context to another. A questionnaire survey was administered to office-based employees of two adjacent local government organisations (‘City Council’ and ‘County Council’) in the East Midlands region of the UK. The analysis demonstrates that the organisational or home setting is an important defining feature of the energy use behaviour. It also reveals that, while there were weak relationships across settings between behaviours sharing other taxonomic categories, such as equipment used and trigger for the behaviour, there was no evidence to support the existence of spillover effects across settings.

Mixed embeddedness and new migrant enterprise in the UK

How can the phenomenon of new migrant enterprise be explained? The arrival of new migrants to the UK in significant numbers is prompting a new wave of business activity. This expression of ‘super-diversity’ poses challenges for existing modes of theorizing, or so it seems. We venture outside the cosmopolitan metropolis of London to examine the experiences of 165 new migrant business owners in the East Midlands region of the UK. Mixed embeddedness theory is used to illuminate the business activities of these new arrivals. We find that new migrants are indeed ‘diverse’ in many respects; but importantly, the onerous nature of structural constraints limit the scope of new migrant enterprise. There is more than a faint of echo of predecessor ethnic minority communities; and racism continues to cast influence on the business activities of new migrants.

Scientific data and its limits: rethinking the use of evidence in local climate change policy

Climate policy is typically seen as informed by scientific evidence that anthropogenic carbon emissions require reducing in order to avoid dangerous consequences. However, agreement on these matters has not translated into effective policy. Using interviews with local authority officials in the UK’s East Midlands region, this paper argues that the ideas, arguments and data informing local climate policy have been grounded in evidence from the natural sciences. Focusing on carbon emissions data demonstrated a consensus around scientific knowledge, not local policy responses to this knowledge. Acknowledging this ‘mistaken consensus’ provides the potential to utilise evidence more attentive to local contexts.

A persona-based approach to domestic energy retrofit

In order to improve the efficiency of the housing stock successfully, the offered technical solutions also need to meet occupants' needs and match their aspirations. Owner-occupiers present particular challenges: conflicting demands on their use of time and financial resources and their role as decision-makers for their own domestic renovation. A persona-driven study (based on user-centred design) was undertaken to explore the varying behaviours, attitudes and motivations towards home improvement for owner-occupiers who live in ‘hard to treat’ solid-walled dwellings. Five evidence-based personas are constructed that reflect archetypes, based on the outcomes of a qualitative study involving 33 owner-occupier householders in the East Midlands region of the UK. The adoption of a persona-based approach in response to the socio-technical challenges of energy renovation is important for understanding the specific drivers and appropriate range of policy responses for each persona. The persona development process is described and the success of the approach is evaluated in relation to the needs of policy developers, energy providers and product developers. Tailoring strategies to suit different personas will considerably enhance the diffusion of policy goals for low-energy retrofit and also allow business and technology developers to target an appropriate user.

Teaching musculoskeletal examination skills to UK medical students: A comparative survey of Rheumatology and Orthopaedic education practice

BackgroundSpecialists in Rheumatology and Orthopaedics are frequently involved in undergraduate teaching of musculoskeletal (MSK) examination skills. Students often report that specialty-led teaching is inconsistent, confusing and bears little resemblance to the curricula. The Gait, Arms, Legs and Spine (GALS) is a MSK screening tool that provides a standardised approach to examination despite it being fraught with disapproval and low uptake. Recent studies would appear to support innovative instructional methods of engaging learners such as patient educators and interactive small group teaching.MethodsThis comparative cross-sectional survey evaluates the current state of undergraduate teaching in Rheumatology and Orthopaedics, including preferred teaching methods, attitudes towards GALS, and barriers to effective teaching. An electronic questionnaire was sent to specialist trainees and Consultants in the East and West Midlands region, representing 5 UK medical schools. Descriptive statistical data analysis was performed.ResultsThere were 76 respondents representing 5 medical schools. There was a request for newer teaching methodologies to be used: multi-media computer-assisted learning (35.5%), audio-visual aids (31.6%), role-playing (19.7%), and social media (3.9%). It is evident that GALS is under-utilised with 50% of clinicians not using GALS in their teaching.ConclusionsThere is a genuine desire for clinical educators to improve their teaching ability, collaborate more with curriculum planners, and feel valued by institutions. There remains a call for implementing a standardised approach to MSK clinical teaching to supersede GALS.

Uncovering the values that motivate people in relation to payments for involvement in research

Purpose – The purpose of this paper is to contribute to response to the 2013 health and welfare reform in the UK by looking specifically at how health research stakeholders in the East Midlands perceive reimbursements for their participation in research. Design/methodology/approach – In keeping with the government research agenda, a survey was distributed to patient and public involvement in research volunteers and other stakeholders in the East Midlands region. In total, 251 useful returns were statistically analysed using descriptive and frequency based statistics and factor analysis. Principal Component Analysis and Varimax Rotation with Kaiser Normalisation were used. This was supplemented by thematic analysis of the content of open questions. Findings – 29 per cent of respondents reported experience with payments and/or reimbursement of expenses for participation in research. Three main factors emerged from the exploratory factor analysis indicative of the values that underpin participants motivation to participate in research. These were “as an opportunity for self-development”, “volunteering”, and “work and market forces”. This revealed that local organisations were somewhat out of step with stakeholders motivations. Research limitations/implications – It is a small study, and therefore has limited power to predict. Wider societal factors were not taken into account and may also impinge on the responses given, especially if respondents are dependent on welfare benefits and vulnerable to shifting community attitudes. Practical implications – This study has got practical implications for policy makers, ethics committees, agencies promoting patient and public involvement, and research organisations. It should influence the design of health research, allow systems to be aligned with individual motivation, maximise recruitment to research and enhance the validity of research findings. Social implications – Genuine coproduction will enhance the quality of health and social care research, and will be strengthened by payment systems that respond the ethical position of participants rather than simply organise around welfare benefit regulations. This study also has the potential to influence guidance from major funders of health research. Originality/value – This study offers an unique contribution into a neglected, complex yet significant area of research practice.