2,290 research outputs found
The social negotiation of fitness for work: tensions in doctor-patient relationships over medical certification of chronic pain
The UK government is promoting the health benefits of work, in order to change doctors' and patients' behaviour and reduce sickness absence. The rationale is that many people 'off sick' would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacement of the 'sick note' with the 'fit note' and a national educational programme are intended to reduce sickness-certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies. Our findings highlight the limitations of naĂŻve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note's focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listin
Adapting structuration theory to understand the role of reflexivity: Problematization, clinical audit and information systems
This paper is an exploratory account of the further development and application of a hybrid framework,
StructurANTion, that is based on Structuration Theory and Actor Network Theory (ANT). The use of social
theories in general and their use in information systems (IS) research in particular is explored leading to
the use of the framework to examine the concept of what are termed humanchine networks in the context
of clinical audit, within a healthcare Primary Care Trust (PCT). A particular focus is on the manner in which
information systems-based reflexivity contributes to both entrenching a networks’ structurated order as
well as contributing to its emancipatory change. The case study compares clinic-centric and patientcentric
audit and seeks to further extend the understanding of the role of information and information
systems within structurated humanchine activity systems. Conclusions indicate that the use of more
socially informed IS methods and approaches can incorporate more emancipatory ideals and lead to
greater adoption and usage of more relevant and useful clinical information systems and practices
Exhaust jet wake and thrust characteristics of several nozzles designed for VTOL DOWNWASH suppression. Tests in and out of ground effect with 70 deg F and 1200 deg F nozzle discharge temperatures
Jet wake degradation and thrust characteristics of exhaust nozzles designed for VTOL downwash suppression and fuselage and ground effect
Asymptotic silence-breaking singularities
We discuss three complementary aspects of scalar curvature singularities:
asymptotic causal properties, asymptotic Ricci and Weyl curvature, and
asymptotic spatial properties. We divide scalar curvature singularities into
two classes: so-called asymptotically silent singularities and non-generic
singularities that break asymptotic silence. The emphasis in this paper is on
the latter class which have not been previously discussed. We illustrate the
above aspects and concepts by describing the singularities of a number of
representative explicit perfect fluid solutions.Comment: 25 pages, 6 figure
Bianchi VIII Empty Futures
Using a qualitative analysis based on the Hamiltonian formalism and the
orthonormal frame representation we investigate whether the chaotic behaviour
which occurs close to the initial singularity is still present in the far
future of Bianchi VIII models. We describe some features of the vacuum Bianchi
VIII models at late times which might be relevant for studying the nature of
the future asymptote of the general vacuum inhomogeneous solution to the
Einstein field equations.Comment: 22 pages, no figures, Latex fil
Dynamics of spatially homogeneous solutions of the Einstein-Vlasov equations which are locally rotationally symmetric
The dynamics of a class of cosmological models with collisionless matter and
four Killing vectors is studied in detail and compared with that of
corresponding perfect fluid models. In many cases it is possible to identify
asymptotic states of the spacetimes near the singularity or in a phase of
unlimited expansion. Bianchi type II models show oscillatory behaviour near the
initial singularity which is, however, simpler than that of the mixmaster
model.Comment: 27 pages, 3 figures, LaTe
An almost isotropic cosmic microwave temperature does not imply an almost isotropic universe
In this letter we will show that, contrary to what is widely believed, an
almost isotropic cosmic microwave background (CMB) temperature does not imply
that the universe is ``close to a Friedmann-Lemaitre universe''. There are two
important manifestations of anisotropy in the geometry of the universe, (i) the
anisotropy in the overall expansion, and (ii) the intrinsic anisotropy of the
gravitational field, described by the Weyl curvature tensor, although the
former usually receives more attention than the latter in the astrophysical
literature. Here we consider a class of spatially homogeneous models for which
the anisotropy of the CMB temperature is within the current observational
limits but whose Weyl curvature is not negligible, i.e. these models are not
close to isotropy even though the CMB temperature is almost isotropic.Comment: 5 pages (AASTeX, aaspp4.sty), submitted to Astrophysical Journal
Letter
Global dynamics of the mixmaster model
The asymptotic behaviour of vacuum Bianchi models of class A near the initial
singularity is studied, in an effort to confirm the standard picture arising
from heuristic and numerical approaches by mathematical proofs. It is shown
that for solutions of types other than VIII and IX the singularity is velocity
dominated and that the Kretschmann scalar is unbounded there, except in the
explicitly known cases where the spacetime can be smoothly extended through a
Cauchy horizon. For types VIII and IX it is shown that there are at most two
possibilities for the evolution. When the first possibility is realized, and if
the spacetime is not one of the explicitly known solutions which can be
smoothly extended through a Cauchy horizon, then there are infinitely many
oscillations near the singularity and the Kretschmann scalar is unbounded
there. The second possibility remains mysterious and it is left open whether it
ever occurs. It is also shown that any finite sequence of distinct points
generated by iterating the Belinskii-Khalatnikov-Lifschitz mapping can be
realized approximately by a solution of the vacuum Einstein equations of
Bianchi type IX.Comment: 16 page
The Asymptotic Behaviour of Tilted Bianchi type VI Universes
We study the asymptotic behaviour of the Bianchi type VI universes with a
tilted -law perfect fluid. The late-time attractors are found for the
full 7-dimensional state space and for several interesting invariant subspaces.
In particular, it is found that for the particular value of the equation of
state parameter, , there exists a bifurcation line which signals a
transition of stability between a non-tilted equilibrium point to an extremely
tilted equilibrium point. The initial singular regime is also discussed and we
argue that the initial behaviour is chaotic for .Comment: 22 pages, 4 figures, to appear in CQ
Spherically symmetric relativistic stellar structures
We investigate relativistic spherically symmetric static perfect fluid models
in the framework of the theory of dynamical systems. The field equations are
recast into a regular dynamical system on a 3-dimensional compact state space,
thereby avoiding the non-regularity problems associated with the
Tolman-Oppenheimer-Volkoff equation. The global picture of the solution space
thus obtained is used to derive qualitative features and to prove theorems
about mass-radius properties. The perfect fluids we discuss are described by
barotropic equations of state that are asymptotically polytropic at low
pressures and, for certain applications, asymptotically linear at high
pressures. We employ dimensionless variables that are asymptotically homology
invariant in the low pressure regime, and thus we generalize standard work on
Newtonian polytropes to a relativistic setting and to a much larger class of
equations of state. Our dynamical systems framework is particularly suited for
numerical computations, as illustrated by several numerical examples, e.g., the
ideal neutron gas and examples that involve phase transitions.Comment: 23 pages, 25 figures (compressed), LaTe
- …