3,118 research outputs found

    The social negotiation of fitness for work: tensions in doctor-patient relationships over medical certification of chronic pain

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    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

    Seasonal priority effects: Implications for invasion and restoration in California coastal sage scrub

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    Competition from exotic annual grasses (EAGs) threatens native plant communities in California. Coastal sage scrub communities have substantially diminished in area over the last century, in some instances by greater than 90%, while EAGs continue to proliferate. Several mechanisms may explain the success of EAGs, including the suppression of native seedlings by accumulated litter, exhaustion of soil moisture, and low seed production or dispersal of natives. 
The timing and magnitude of rainfall plays a significant role in determining the survival and reproduction of plant species in Mediterranean ecosystems. Populations of annuals fluctuate greatly from year to year, corresponding with variability in autumn precipitation. EAGs in California germinate quickly following small threshold rain events, whereas native species have more complex germination cues, such that exotic annual grasses become active earlier in the growing season. In this way, EAGs may exhibit a priority effect over native plant species with respect to establishment; however, they may have reduced success if their germination is induced at a time followed by a substantial drought (for instance, in the summer) so that they will not persist. 
The goal of this investigation is 1) to evaluate whether seasonal priority effects contribute to community-level patterns of abundance, and 2) whether late summer watering could be a feasible restoration technique for suppression of exotic annual grasses and weeds in Mediterranean ecosystems

    Measurements of the short-term stability of quartz crystal resonators: A window on future developments in crystal oscillators

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    Recent measurements of the inherent short-term stability of quartz crystal resonators are presented. These measurements show that quartz resonators are much more stable for times less than 1s than the best available commercial quartz oscillators. A simple model appears to explain the noise mechanism in crystal controlled oscillators and points the way to design changes which should permit more than 2 orders of magnitude improvement in their short-term stability. Calculations show that a reference signal at 1 THz, derived from frequency multiplying a 5 MHz source with the above measured crystal stability, should have an instantaneous or fast linewidth of order 1 Hz. These calculations explicitly include the noise contribution of our present multiplier chains and are briefly outlined

    Outside edge

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    In this article, we discuss the contribution that Geographers make to academic, policy, debate and practice through working in University non-Geography departments and disciplines

    How does 'banter' influence trainee doctors' choice of career? A qualitative study

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    Following publication of the original article, the authors reported an error in the first paragraph of the 'Results' section. The correction details are available at https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-019-1707-7Peer reviewedPublisher PD
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