Health and the Transition from Employment to Retirement

The relationship between employment and retirement is changing dramatically. In contrast to an earlier pattern of relatively stable career employment leading to retirement around age 65, increasing numbers of men and women are leaving their major employment situation earlier. The process of retirement therefore takes on new meaning and duration. The segment of a person's life between stable career employment and permanent retirement at pensionable age can be quite disruptive, involving difficult job searches, employment at lower levels than before, lower wages and repeated job displacement. There is virtually no research about the effects of life course instability in mid- to late-life on health, but limited research on instability early in the working life shows that instability leads to increased mortality. The possibility that labour force instability later in life has adverse health consequences is great and merits further investigation.health; employment; retirement

The Effect of Macrodiversity on the Performance of Maximal Ratio Combining in Flat Rayleigh Fading

The performance of maximal ratio combining (MRC) in Rayleigh channels with co-channel interference (CCI) is well-known for receive arrays which are co-located. Recent work in network MIMO, edge-excited cells and base station collaboration is increasing interest in macrodiversity systems. Hence, in this paper we consider the effect of macrodiversity on MRC performance in Rayleigh fading channels with CCI. We consider the uncoded symbol error rate (SER) as our performance measure of interest and investigate how different macrodiversity power profiles affect SER performance. This is the first analytical work in this area. We derive approximate and exact symbol error rate results for M-QAM/BPSK modulations and use the analysis to provide a simple power metric. Numerical results, verified by simulations, are used in conjunction with the analysis to gain insight into the effects of the link powers on performance.Comment: 10 pages, 5 figures; IEEE Transaction of Communication, 2012 Corrected typo

Performance Analysis of Dual-User Macrodiversity MIMO Systems with Linear Receivers in Flat Rayleigh Fading

The performance of linear receivers in the presence of co-channel interference in Rayleigh channels is a fundamental problem in wireless communications. Performance evaluation for these systems is well-known for receive arrays where the antennas are close enough to experience equal average SNRs from a source. In contrast, almost no analytical results are available for macrodiversity systems where both the sources and receive antennas are widely separated. Here, receive antennas experience unequal average SNRs from a source and a single receive antenna receives a different average SNR from each source. Although this is an extremely difficult problem, progress is possible for the two-user scenario. In this paper, we derive closed form results for the probability density function (pdf) and cumulative distribution function (cdf) of the output signal to interference plus noise ratio (SINR) and signal to noise ratio (SNR) of minimum mean squared error (MMSE) and zero forcing (ZF) receivers in independent Rayleigh channels with arbitrary numbers of receive antennas. The results are verified by Monte Carlo simulations and high SNR approximations are also derived. The results enable further system analysis such as the evaluation of outage probability, bit error rate (BER) and capacity.Comment: 24 pages, 7 figures; IEEE Transaction of Wireless Communication 2012 Corrected typo

Immune cells and preterm labour:do invariant NKT cells hold the key?

We have developed our original made-to-measure (M2M) algorithm, PRIMAL, with the aim of modelling the Galactic disc from upcoming Gaia data. From a Milky Way like N-body disc galaxy simulation, we have created mock Gaia data using M0III stars as tracers, taking into account extinction and the expected Gaia errors. In PRIMAL, observables calculated from the N-body model are compared with the target stars, at the position of the target stars. Using PRIMAL, the masses of the N-body model particles are changed to reproduce the target mock data, and the gravitational potential is automatically adjusted by the changing mass of the model particles. We have also adopted a new resampling scheme for the model particles to keep the mass resolution of the N-body model relatively constant. We have applied PRIMAL to this mock Gaia data and we show that PRIMAL can recover the structure and kinematics of a Milky Way like barred spiral disc, along with the apparent bar structure and pattern speed of the bar despite the galactic extinction and the observational errors

Antinociceptive actions of descending catecholaminergic tracts on dorsal horn somatosensory neurones

Ionophoretically-applied dopamine and noradrenaline selectively inhibited the nociceptive responses of multireceptive somatosensory dorsal horn neurones, whilst non-nociceptive responses, spontaneous activity and activity evoked by an ionophoretically-applied excitatory amino acid, DL-homocysteic acid were unaffected. Many of the neurones tested had long ascending projections, capable of transmitting nociceptive information to supraspinal sites; in the rat (spinothalamic tract neurones) and in the cat (spinocervical tract neurones).The use of ionophoretically-applied receptor-specific agonists and antagonists demonstrated that the actions of noradrenaline and dopamine were pharmacologically distinct. The selective antinociceptive action produced by noradrenaline was mediated by an 06,-adrenoreceptor, whilst the selective antinociceptive effect of dopamine was mediated by a dopamine receptor.A glyoxylic-acid histofluorescence study was undertaken to ascertain the optimal stereotaxic placement of stimulating electrodes, in the regions of those dopamine cell groups (A9 and All) that have been considered to provide a spinal projection.Focal electrical stimulation in the region of the All dopamine cell group evoked a selective antinociceptive effect on multireceptive dorsal horn neurones in the rat. This stimulus-evoked effect was rapidly and consistently reversed by ionophoresis of the D₂ dopamine-receptor antagonist, sulpiride, in the vicinity of the dorsal horn neurone being tested, whilst an opiate antagonist (naloxone) and an α₂-antagonist (RX781094) had no effect. Using the same parameters, focal electrical stimulation in the region of the A9 dopamine cell group did not affect the evoked responses of any multireceptive neurones tested.The results of this study present data supporting selective antinociceptive roles for dopamine and noradrenaline at the spinal level. The All dopamine cell group was demonstrated as a supraspinal source of a selective antinociceptive effect, mediated by dopamine at the level of the dorsal horn

The Making of Good Citizens: Participation Policies, the Internet and Youth Political Identities in Australia and the United Kingdom

Collin, P. (2009) The Making of Good Citizens: Participation policies, the internet and youth political identities in Australia and the United Kingdom. PhD Thesis, University of Sydney. Abstract This thesis examines the relationship between youth participation policies, the internet and young people’s political participation. In recent times youth participation policies have become an increasingly popular solution to a range of perceived ‘issues’ related to young people: either problems of youth disengagement from democracy or their exclusion from democratic processes. At the same time, young people’s lives are increasingly mediated by information communication technologies: identity, social relationships, learning and cultural, political and economic practices are embedded in the internet and mobile usage. Consequently, the internet is being increasingly utilised to promote and implement the aims of these youth participation policies. Despite the need to understand the relationship between policy and practice, research rarely considers the relationship between policy, practice and young people’s views and experiences. This thesis addresses this gap in the literature by looking at what participation means in youth policy, in the practice of non-government organisations and for young people themselves. It engages directly with young people’s experiences and in doing so moves beyond questions of mobilisation and reinforcement. Instead it examines the diversity of ways in which young people conceptualise and practice participation, both online and offline. It also relates their views and actions to broader changes in governance and democracy and draws on contemporary theories of political identity and citizenship to make sense of the way that young people view, and exercise, citizenship. This study draws on original qualitative research generated in a comparative study of Australia and the United Kingdom. The experiences of young people in two national non-government organisations are studied and explored in relation to the policy discourses on youth and participation in each country setting. This study has drawn on participant observation, document analysis and in-depth interviews with twenty four young people and eight executive staff and board members across the two country settings. This thesis provides an in-depth account of how young people conceptualise and practice politics. In doing so, it argues, firstly, that the political identities of young people are shaped by dominant discourses of youth and participation and that youth participation policies are transforming the ways that young people conceptualise participation and engage in participatory activities. Although participation policies are often intended to connect young people to government policy making processes, young people remain cynical about the interest and ability of governments to recognise and respond to their views. They see governments and politicians as remote from their lives and the issues they cared about. Comparatively, they demonstrate a passionate commitment to causes, to personally defined acts incorporated in their everyday lives through local volunteering and contributing to national initiatives. Furthermore, these young people reject traditional hierarchies, show significant commitment to action over ideology and value the cultural and interpersonal dimensions of participation. They often conceptualise participation as everyday acts through networks that transcend traditional models of membership-based organisations, of state-oriented politics, of locally-based action and of formal and informal policy making processes. Secondly, young people use the Internet for a diverse range of participation activities. The internet facilitates activities which bring together the political, cultural, social and economic dimensions of young people’s lives. For instance, participatory activities, friendships, study, hobbies and consumer activities were often interwoven as young people discussed participation. However, the picture that emerged in this thesis is that the agency and autonomy that young people value in online participation contrasts starkly with government policies which favour structured, managed, prescribed processes for youth participation both on and offline. Thirdly, whilst participation policies have opened up new access points to policy-making from which young people have traditionally been excluded, they tend to legitimise managed forms of participation and de-legitimise others. Consequently, participation policies, in their present form, tend to exacerbate, rather than remedy problems of elitism and can further alienate young people from political elites. Furthermore, as discourses of participation are becoming more prevalent in the non-government sector, young people are increasingly oriented away from government towards other actors. This thesis finds that young people are becoming more, not less, alienated from formal politics as they find more resonance in non-government processes and feel more excluded from the processes of government

Adrenal insufficiency due to bilateral adrenal metastases - A systematic review and meta-analysis

Objective: Bilateral adrenal metastases may cause adrenal insufficiency (AI) but it is unclear if screening for AI in patients with bilateral adrenal metastases is justified, despite the potential for adrenal crises. Method: A search using PubMed/Medline, ScienceDirect and Cochrane Reviews was performed to collect all original research articles and all case reports from the past 50 years that describe AI in bilateral adrenal metastases. Results: Twenty studies were included with 6 original research articles, 13 case reports and one case series. The quality was generally poor. The prevalence of AI was 3–8%. Of all cases of AI (n ¼ 25) the mean pooled baseline cortisol was 318 237 nmol/L and stimulated 423 238 nmol/L. Hypotension was present in 69%, hyponatremia in 9% and hyperkalemia in 100%. Lung cancer was the cause in 35%, colorectal 20%, breast cancer 15% and lymphoma 10%. The size of the adrenal metastases was 5.5 2.8 cm (left) and 5.5 3.1 cm (right), respectively. There was no correlation between basal cortisol, stimulated cortisol concentration or ACTH with the size of adrenal metastases. The median time to death was 5.0 months (IQR 0.6–6.5). However, two cases were alive after 12–24 months. Conclusion: The prevalence of AI in patients with bilateral adrenal metastases was low. Prognosis was very poor. Due to the low prevalence of AI, screening is likely only indicated in patients with symptoms and signs suggestive of hypocortisolism

Use of Medicines by Community Dwelling Elderly in Ontario

OBJECTIVE: Prescription medicine use by the elderly is of growing concern as indicated by a large literature focused on rising costs, patient compliance and the appropriateness of use. However, prescriptions account for only a portion of medicines used by the elderly, who have increasing access to non-prescription medicines and natural health products. The objective of this paper is to describe overall medicine use among the elderly in Ontario. METHODS: Using the National Population Health Survey (1996/97), we describe self-reported use of prescription, non-prescription and alternative medicines among elderly Ontarians aged 65+, and we compare use among four age sub-groups and by gender. Analysis is focused on the prevalence of, and the relative balance of use of different types of medicines. RESULTS: About one quarter of the respondents reported using no prescription or non-prescription medicines in the two days prior to being surveyed; a large majority reported using two or fewer medicines only, and use of non- prescription medicines was reported more often than prescription medicines (56% vs 48%). Use of natural health products by seniors is relatively low, but we observe a trend toward increased use in younger age groups. DISCUSSION: The findings place the consumption of prescription medicines by the elderly into a broader context that reveals that much of medicine use by the elderly involves non-prescribed products. We highlight the need to better understand seniors' decision-making regarding the different types of medicines available, and the financial costs and health risks of the medicine regimes of elderly persons.elderly, medicine-use, prescription medicines, over-the-counter medicines, natural health products, NPHS

The VOICE Study: Valuing Opinions, Individual Communication and Experience: Building the evidence base for undertaking patient-centred family meetings in palliative care - a mixed methods study

Background: Despite family meetings being widely used to facilitate discussion among patients, families, and clinicians in palliative care, there is limited evidence to support their use. This study aims to assess the acceptability and feasibility of Patient-Centred Family Meetings in specialist inpatient palliative care units for patients, families, and clinicians and determine the suitability and feasibility of validated outcome measures from the patient and family perspectives. Methods: The study is a mixed-methods quasi-experimental design with pre-planned Patient-Centred Family Meetings at the intervention site. The patient will set the meeting agenda a priori allowing an opportunity for their issues to be prioritised and addressed. At the control site, usual care will be maintained which may include a family meeting. Each site will recruit 20 dyads comprising a terminally ill inpatient and their nominated family member. Pre- and post-test administration of the Distress Thermometer, QUAL-EC, QUAL-E, and Patient Health Questionnaire-4 will assess patient and family distress and satisfaction with quality of life. Patient, family, and clinician interviews post-meeting will provide insights into the meeting feasibility and outcome measures. Recruitment percentages and outcome measure completion will also inform feasibility. Descriptive statistics will summarise pre- and post-meeting data generated by the outcome measures. SPSS will analyse the quantitative data. Grounded theory will guide the qualitative data analysis. Discussion: This study will determine whether planned Patient-Centred Family Meetings are feasible and acceptable and assess the suitability and feasibility of the outcome measures. It will inform a future phase III randomised controlled trial. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12616001083482 on 11 August 201

Assessing housing quality and its impact on health, safety and sustainability

Background The adverse health and environmental effects of poor housing quality are well established. A central requirement for evidence-based policies and programmes to improve housing standards is a valid, reliable and practical way of measuring housing quality that is supported by policy agencies, the housing sector, researchers and the public. Methods This paper provides guidance on the development of housing quality-assessment tools that link practical measures of housing conditions to their effects on health, safety and sustainability, with particular reference to tools developed in New Zealand and England. Results The authors describe how information on housing quality can support individuals, agencies and the private sector to make worthwhile improvements to the health, safety and sustainability of housing. The information gathered and the resultant tools developed should be guided by the multiple purposes and end users of this information. Other important issues outlined include deciding on the scope, detailed content, practical administration issues and how the information will be analysed and summarised for its intended end users. There are likely to be considerable benefits from increased international collaboration and standardisation of approaches to measuring housing hazards. At the same time, these assessment approaches need to consider local factors such as climate, geography, culture, predominating building practices, important housing-related health issues and existing building codes. Conclusions An effective housing quality-assessment tool has a central role in supporting improvements to housing. The issues discussed in this paper are designed to motivate and assist the development of such tools