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

Cosmic No Hair for Collapsing Universes

It is shown that all contracting, spatially homogeneous, orthogonal Bianchi cosmologies that are sourced by an ultra-stiff fluid with an arbitrary and, in general, varying equation of state asymptote to the spatially flat and isotropic universe in the neighbourhood of the big crunch singularity. This result is employed to investigate the asymptotic dynamics of a collapsing Bianchi type IX universe sourced by a scalar field rolling down a steep, negative exponential potential. A toroidally compactified version of M*-theory that leads to such a potential is discussed and it is shown that the isotropic attractor solution for a collapsing Bianchi type IX universe is supersymmetric when interpreted in an eleven-dimensional context.Comment: Extended discussion to include Kantowski-Sachs universe. In press, Classical and Quantum Gravit

The theoretical capacity of the Parity Source Coder

The Parity Source Coder is a protocol for data compression which is based on a set of parity checks organized in a sparse random network. We consider here the case of memoryless unbiased binary sources. We show that the theoretical capacity saturate the Shannon limit at large K. We also find that the first corrections to the leading behavior are exponentially small, so that the behavior at finite K is very close to the optimal one.Comment: Added references, minor change

Dynamics of a self--gravitating magnetized source

We consider a magnetized degenerate gas of fermions as the matter source of a homogeneous but anisotropic Bianchi I spacetime with a Kasner--like metric. We examine the dynamics of this system by means of a qualitative and numerical study of Einstein-Maxwell field equations which reduce to a non--linear autonomous system. For all initial conditions and combinations of free parameters the gas evolves from an initial anisotropic singularity into an asymptotic state that is completely determined by a stable attractor. Depending on the initial conditions the anisotropic singularity is of the ``cigar'' or ``plate'' types.Comment: 7 pages, 1 figur

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

Evolution of Upper Jaw Protrusion Mechanisms in Elasmobranchs

Upper jaw protrusion is a prominent component of the feeding mechanism in most elasmobranchs and has received considerable attention over the years. In this paper, we review what is known of muscle activity during prey capture in elasmobranchs, particularly that of upper jaw protrusion, and evaluate the extent to which functional modifications have evolved through changes in anatomy or patterns of muscle activity. To date, motor activity during feeding has been documented in only four species of elasmobranchs, although they represent the three major elasmobranch groups: Galea (typical sharks); Squalea (dogfish sharks); and Batoidea (skates and rays). Our efforts show that while muscles involved in cranial elevation and lower jaw depression and elevation show a conserved pattern of motor activity and function across species, other muscles show a more variable history. Our observations of elasmobranch upper jaw protrusion mechanisms suggest a mosaic of character changes over the course of evolution that involve anatomical changes in all cases and modifications of muscle activation patterns in some cases. During the evolution of feeding mechanisms of elasmobranchs, there have been two structural changes incorporating a pre-existing motor pattern to yield an unmodified kinematic profile, the original preorbitalis and the descendent preorbitalis. One additional instance of structural modification is accompanied by an alteration in the motor pattern leading to a change in movement pattern, the levator palatoquadrati

Homogeneous cosmologies with cosmological constant

Spatially homogeneous cosmological models with a positive cosmological constant are investigated, using dynamical systems methods. We focus on the future evolution of these models. In particular, we address the question whether there are models within this class that are de Sitter-like in the future, but are tilted.Comment: 10 pages, 13 eps-figures. Submitted to Phys. Rev.

Does evolutionary innovation in pharyngeal jaws lead to rapid lineage diversification in labrid fishes?

<p>Abstract</p> <p>Background</p> <p>Major modifications to the pharyngeal jaw apparatus are widely regarded as a recurring evolutionary key innovation that has enabled adaptive radiation in many species-rich clades of percomorph fishes. However one of the central predictions of this hypothesis, that the acquisition of a modified pharyngeal jaw apparatus will be positively correlated with explosive lineage diversification, has never been tested. We applied comparative methods to a new time-calibrated phylogeny of labrid fishes to test whether diversification rates shifted at two scales where major pharyngeal jaw innovations have evolved: across all of Labridae and within the subclade of parrotfishes.</p> <p>Results</p> <p>Diversification patterns within early labrids did not reflect rapid initial radiation. Much of modern labrid diversity stems from two recent rapid diversification events; one within julidine fishes and the other with the origin of the most species-rich clade of reef-associated parrotfishes. A secondary pharyngeal jaw innovation was correlated with rapid diversification within the parrotfishes. However diversification rate shifts within parrotfishes are more strongly correlated with the evolution of extreme dichromatism than with pharyngeal jaw modifications.</p> <p>Conclusion</p> <p>The temporal lag between pharyngeal jaw modifications and changes in diversification rates casts doubt on the key innovation hypothesis as a simple explanation for much of the richness seen in labrids and scarines. Although the possession of a secondarily modified PJA was correlated with increased diversification rates, this pattern is better explained by the evolution of extreme dichromatism (and other social and behavioral characters relating to sexual selection) within <it>Scarus </it>and <it>Chlorurus</it>. The PJA-innovation hypothesis also fails to explain the most dominant aspect of labrid lineage diversification, the radiation of the julidines. We suggest that pharyngeal jaws might have played a more important role in enabling morphological evolution of the feeding apparatus in labrids and scarines rather than in accelerating lineage diversification.</p

Asymptotic analysis of spatially inhomogeneous stiff and ultra-stiff cosmologies

We calculate analytically the past asymptotic decay rates close to an initial singularity in general G_0 spatially inhomogeneous perfect fluid models with an effective equation of state which is stiff or ultra-stiff (i.e., $\gamma \ge 2$). These results are then supported by numerical simulations in a special class of G_2 cosmological models. Our analysis confirms and extends the BKL conjectures and lends support to recent isotropization results in cosmological models of current interest (with $\gamma > 2$).Comment: Accepted by CQ