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

Spin Dynamics in the Magnetic Chains Arrays of Sr14Cu24O41: a Neutron Inelastic scattering Investigation

Below about 150 K, the spin arrangement in the chain arrays of Sr14Cu24O41 is shown to develop in two dimensions (2D). Both the correlations and the dispersion of the observed elementary excitations agree well with a model of interacting dimers. Along the chains, the intra- and inter-dimer distances are equal to 2 and about 3 times the distance (c) between neighboring Cu ions. While the intra-dimer coupling is J about 10 meV, the inter-dimer couplings along and between the chains are of comparable strenght, J// about -1.1 meV and Jperp about 1.7 meV, respectively. This remarkable 2D arrangement satisfies the formal Cu valence of the undoped compound. Our data suggest also that it is associated with a relative sliding of one chain with respect to the next one, which, as T decreases, develops in the chain direction. A qualitative analysis shows that nearest inter-dimer spin correlations are ferromagnetic, which, in such a 2D structure, could well result from frustration effects.Comment: 4 pages, 5 figures, submitted to Phys.Rev.B, date of receipt 29 June 199

Dynamic Spin Response for Heisenberg Ladders

We employ the recently proposed plaquette basis to investigate static and dynamic properties of isotropic 2-leg Heisenberg spin ladders. Simple non-interacting multi-plaquette states provide a remarkably accurate picture of the energy/site and dynamic spin response of these systems. Insights afforded by this simple picture suggest a very efficient truncation scheme for more precise calculations. When the small truncation errors are accounted for using recently developed Contractor Renormalization techniques, very accurate results requiring a small fraction of the computational effort of exact calculations are obtained. These methods allow us to determine the energy/site, gap, and spin response of 2x16 ladders. The former two values are in good agreement with density matrix renormalization group results. The spin response calculations show that nearly all the strength is concentrated in the lowest triplet level and that coherent many-body effects enhance the response/site by nearly a factor of 1.6 over that found for 2x2 systems.Comment: 9 pages with two enclosed postscript figure

Phases of two coupled Luttinger liquids

A model of two interacting one--dimensional fermion systems (``Luttinger liquids'') coupled by single--particle hopping is investigated. Bosonization allows a number of exact statements to be made. In particular, for forward scattering only, the model contains two massless boson sectors and an Ising type critical sector. For general interactions, there is a spin excitation gap and either s-- or d--type pairing fluctuations dominate. It is shown that the same behavior is also found for strong interactions. A possible scenario for the crossover to a Fermi liquid in a many chain system is discussed.Comment: revised version, some changes, 11 pages, no figures, RexTeX3.

Electron transport in coupled chains of interacting fermions with impurities

We study the low-temperature transport of a doped two-chain ladder system of interacting fermions in the presence of a barrier or of a low concentration of impurities. Above a certain value of the interaction, the conductance is suppressed, like for a single chain, despite the presence of dominant superconducting correlations. There is, however, a region of repulsive interaction where perfect transmission across the barrier occurs unlike the single-chain case. We provide a possible explanation for the temperature maximum of the resistivity in the normal state of \srca.Comment: 4 pages, 2 figures, to be published in Phys. Rev. Let

Dynamical Spin Response Functions for Heisenberg Ladders

We present the results of a numerical study of the 2 by L spin 1/2 Heisenberg ladder. Ground state energies and the singlet-triplet energy gaps for L = (4-14) and equal rung and leg interaction strengths were obtained in a Lanczos calculation and checked against earlier calculations by Barnes et al. (even L up to 12). A related moments technique is then employed to evaluate the dynamical spin response for L=12 and a range of rung to leg interaction strength ratios (0 - 5). We comment on two issues, the need for reorthogonalization and the rate of convergence, that affect the numerical utility of the moments treatment of response functions.Comment: Revtex, 3 figure

Excitation Spectrum and Superexchange Pathways in the Spin Dimer VODPO_4 . 1/2 D_2O

Magnetic excitations have been investigated in the spin dimer material VODPO_4 \cdot 1/2 D_2O using inelastic neutron scattering. A dispersionless magnetic mode was observed at an energy of 7.81(4) meV. The wavevector dependence of the scattering intensityfrom this mode is consistent with the excitation of isolated V^{4+} spin dimers with a V-V separation of 4.43(7) \AA. This result is unexpected since the V-V pair previously thought to constitute themagnetic dimer has a separation of 3.09 \AA. We identify an alternative V-V pair as the likely magnetic dimer, which involves superexchange pathways through a covalently bonded PO_4 group. This surprising result casts doubt on the interpretation of (VO)_2P_2O_7 as a spin ladder.Comment: 4 pages, 4 postscript figures - identical to previous paper but figure 2 and 3 hopefully more compatible .p

The Mid-Infrared Instrument for the James Webb Space Telescope, VIII: The MIRI Focal Plane System

We describe the layout and unique features of the focal plane system for MIRI. We begin with the detector array and its readout integrated circuit (combining the amplifier unit cells and the multiplexer), the electronics, and the steps by which the data collection is controlled and the output signals are digitized and delivered to the JWST spacecraft electronics system. We then discuss the operation of this MIRI data system, including detector readout patterns, operation of subarrays, and data formats. Finally, we summarize the performance of the system, including remaining anomalies that need to be corrected in the data pipeline

Quasi-two-dimensional hole ordering and dimerized state in the CuO2-chain layers in Sr14Cu24O41

Neutron scattering experiments have been performed on Sr$_{14}$Cu$_{24}$O$_{41}$ which consists of both chains and ladders of copper ions. We observed that the magnetic excitations from the CuO$_2$ chain have two branches and that both branches are weakly dispersive along the $a$ and $c$ axes. The $\omega$-$Q$ dispersion relation as well as the intensities can be reasonably described by a random phase approximation with intradimer coupling between next-nearest-neighbor copper spins $J$=11 meV, interdimer coupling along the c axis $J_c$=0.75 meV, and interdimer coupling along the a axis $J_a$=0.75 meV. The dimer configuration indicates a quasi-two-dimensional hole ordering, resulting in an ordering of magnetic Cu$^{2+}$ with spin-1/2 and nonmagnetic Cu, which forms the Zhang-Rice singlet. We have also studied the effect of Ca substitution for Sr on the dimer and the hole ordering.Comment: 7 pages, Revtex, 10 figures, Submitted to Phys. Rev.

Long term durability of protected silver coating for the mirrors of Ariel mission telescope

Ariel (Atmospheric Remote-sensing Infrared Exoplanet Large survey) is the fourth medium-size mission in ESA “Cosmic Vision” program. It is scheduled to launch in 2029. Ariel will conduct spectroscopic and photometric observations of a large sample of known exoplanets to survey their atmospheres with the transit method. Ariel is based on a 1 m class telescope designed for the visible and near infrared spectrum, but optimized specifically for spectroscopy in the waveband between 1.95 and 7.8 μm. Telescope and instruments will be operating in cryogenic conditions in the range 40-50 K. The telescope mirrors will be manufactured in aluminum 6061, with a protected silver coating deposited onto the optical surface to enhance reflectivity and prevent oxidation and corrosion. During the preliminary definition phase of the development work, leading to mission adoption, a silver coating with space heritage was selected and underwent a qualification process on disc-shaped samples of the mirrors substrate material. The samples were deposited through magnetron sputtering and then subjected to a battery of tests, including environmental durability tests, accelerated aging, cryogenic tests and mechanical resistance tests. Further to the qualification, the samples have been stored in cleanroom conditions and periodically re-examined and measured to detect any sign of coating degradation. The test program, still ongoing at the time of writing this article, consists of visual inspection with a high intensity lamp, spectral reflectance measurements and Atomic Force Microscopy (AFM) evaluation of nanometric surface features. The goal is to ensure stability of the optical performance, in terms of coating reflectance, during a time span comparable to the period that the actual mirrors of the telescope will spend in average cleanroom conditions. This study presents the interim results after three years of storage