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 naïve 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

Biography and vulnerability: Loss, dying and death in the Romantic paintings of JMW Turner (1775-1851)

Copyright@ 2005 Edward Arnold (Publishers) Ltd.Narratives of suffering and vulnerability are an important theme in western art, the humanities and the social sciences. It is argued here that J.M.W. Turner's pictures, like those of many artists, are biographical tales. The central tenet of Turner's romantic art is the arousal of sensation and Turner's pictures include wonderfully evocative `visual poems' on the human experiences of loss, decline, `the fallacies of hope', grief and death. This paper first explores the connections between Turner's biography and his art through a discussion of several of Turner's key paintings. It then moves on to a more in-depth discussion of two pictures painted by Turner in 1842, when he was 67 years old: Peace — Burial at Sea, and War — The Exile and the Rock Limpet. These paintings can be seen as insightful biographical narratives on the embodiment of vulnerability. In conclusion, it is suggested that Turner's paintings of loss and death are valuable exemplars of the capacity of art to meld together biography, narrative, vulnerability, suffering and embodiment

What do others think is the point of design and technology education?

As a result of a national curriculum review in England (Department for Education [DfE], 2011), a new curriculum for design and technology (D&T) is being taught in secondary schools from September 2014 (Department of Education [DoE], 2013a). This curriculum is compulsory for a decreasing number of schools; two potential consequences are the nature of D&T in secondary schools changing to reflect local perceptions of the subject and maybe D&T being removed from the curriculum completely. The pressure on D&T’s curriculum content is likely to come from different stakeholders such as senior school leaders, D&T teachers, and pupils. D&T school departments could respond to this pressure by adapting the curriculum to popularise the subject or produce high exam results with a consequence that much of the subject’s value is lost. This paper reports on a small research project conducted in two secondary schools where stakeholder representatives were interviewed to identify their values of D&T. These different stakeholders were interviewed using the active interview method (Holstein & Gubrium, 1995), coded following Aurebach and Silverstein’s method (2003) and their values compared to Hardy’s values framework (Hardy, 2013b). Analysis shows most stakeholders believe a key value of D&T is to provide ‘practical life skills’ (Hardy, p.226), whilst only one recognizes that learning in D&T involves ‘identifying problems to be solved’. The outcomes from the research are being used to support critically reflective conversations within both D&T departments (Zwozdiak-Myers, 2012) framing their evaluation of their local curriculum and making changes to their curriculum

Endothelin and the ischaemic heart

Soon after its identification as a powerful vasoconstrictor peptide, endothelin (ET-1) was implicated as a detrimental agent involved in determining the outcome of myocardial ischaemia and reperfusion. Early experimental studies demonstrated that ETA selective and mixed ETA/ETB receptor antagonists can reduce infarct size and prevent ischaemiainduced ventricular arrhythmias in models of ischaemia/reperfusion, implying that ET-1 acts through the ETA receptor to contribute to injury and arrhythmogenesis. However, as our understanding of the physiology of ET-1 has expanded, the role of ET-1 in the ischaemic heart appears ever more complex. Recent evidence suggests that ET-1 exerts actions on the heart that are not only detrimental (vasoconstriction, inhibition of NO production, activation of inflammatory cells), but which may also contribute to tissue repair, such as inhibition of cardiomyocyte apoptosis. In addition, ET-1-induced mast cell degranulation has been linked to a homeostatic mechanism that controls endogenous ET-1 levels, which may have important implications for the ischaemic heart. Furthermore the mechanism by which ET-1 promotes arrhythmogenesis remains controversial. Some studies imply a direct electrophysiological effect of ET-1, via ETA receptors, to increase monophasic action potential duration (MAPD) and induce early after-depolarisations (EADs), while other studies support the view that coronary constriction resulting in ischaemia is the basis for the generation of arrhythmias. Moreover, ET-1 can induce cardioprotection (precondition) against infarct size and ventricular arrhythmias, through as yet incompletely understood mechanisms. To enable us to identify the most appropriate means of targeting this system in a therapeutically meaningful way we need to continue to explore the physiology of ET-1, both in the normal and the ischaemic heart

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

Neuroscientists’ everyday experiences of ethics: The interplay of regulatory, professional, personal and tangible ethical spheres

Copyright @ 2013 The Authors. This article has been published using OnlineOpen. Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonline library.com/onlineopen#OnlineOpen_Terms.The ethical issues neuroscience raises are subject to increasing attention, exemplified in the emergence of the discipline neuroethics. While the moral implications of neurotechnological developments are often discussed, less is known about how ethics intersects with everyday work in neuroscience and how scientists themselves perceive the ethics of their research. Drawing on observation and interviews with members of one UK group conducting neuroscience research at both the laboratory bench and in the clinic, this article examines what ethics meant to these researchers and delineates four specific types of ethics that shaped their day-to-day work: regulatory, professional, personal and tangible. While the first three categories are similar to those identified elsewhere in sociological work on scientific and clinical ethics, the notion of ‘tangible ethics’ emerged by attending to everyday practice, in which these scientists’ discursive distinctions between right and wrong were sometimes challenged. The findings shed light on how ethical positions produce and are, in turn, produced by scientific practice. Informing sociological understandings of neuroscience, they also throw the category of neuroscience and its ethical specificity into question, given that members of this group did not experience their work as raising issues that were distinctly neuro-ethical.Wellcome Trus

The Development of Instruments for Assessment of Instructional Practices in Standards-Based Teaching

We provide a description and rationale for the development of two instruments: 1) a classroom observation protocol; and, 2) a teacher interview protocol—designed to document the impact of reform-based professional development with undergraduate mathematics and science faculty, and its impact on the resultant preparation of teachers. Constructed upon review of the research on teaching and standards documents in mathematics and science, these instruments form the basis for data collection in a three-year longitudinal study of teaching practice among early career teachers as well as undergraduate college faculty. In addition, we suggest further applications of the observation protocol beyond the original purpose of our research study