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

Generic Subsequence Matching Framework: Modularity, Flexibility, Efficiency

Subsequence matching has appeared to be an ideal approach for solving many problems related to the fields of data mining and similarity retrieval. It has been shown that almost any data class (audio, image, biometrics, signals) is or can be represented by some kind of time series or string of symbols, which can be seen as an input for various subsequence matching approaches. The variety of data types, specific tasks and their partial or full solutions is so wide that the choice, implementation and parametrization of a suitable solution for a given task might be complicated and time-consuming; a possibly fruitful combination of fragments from different research areas may not be obvious nor easy to realize. The leading authors of this field also mention the implementation bias that makes difficult a proper comparison of competing approaches. Therefore we present a new generic Subsequence Matching Framework (SMF) that tries to overcome the aforementioned problems by a uniform frame that simplifies and speeds up the design, development and evaluation of subsequence matching related systems. We identify several relatively separate subtasks solved differently over the literature and SMF enables to combine them in straightforward manner achieving new quality and efficiency. This framework can be used in many application domains and its components can be reused effectively. Its strictly modular architecture and openness enables also involvement of efficient solutions from different fields, for instance efficient metric-based indexes. This is an extended version of a paper published on DEXA 2012.Comment: This is an extended version of a paper published on DEXA 201

Assessing the variation in the load that produces maximal upper-body power

Substantial variation in the load that produces maximal power has been reported. It has been suggested that the variation observed may be due to differences in subject physical characteristics. Therefore the aim of this study was to determine the extent in which anthropometric measures correlate to the load that produces maximal power. Anthropometric measures (upper-arm length, forearm length, total arm length, upper-arm girth) and bench press strength were assessed in 26 professional rugby union players. Peak power was then determined in the bench press throw exercise using loads of 20 to 60% of one repetition maximum (1RM) in the bench press exercise. Maximal power occurred at 30 +/- 14 %1RM (mean +/- SD). Upper-arm length had the highest correlation with the load maximizing power: -0.61 (90% confidence limits -0.35 to -0.78), implying loads of 22 vs. 38 %1RM maximize power for players with typically long vs. short upper-arm length. Correlations for forearm length, total arm length and upper-arm girth to the load that maximized power were -0.29 (0.04 to -0.57), -0.56 (-0.28 to -0.75), and -0.29 (0.04 to -0.57), respectively. The relationship between 1RM and the load that produced maximal power was r = -0.23 (0.10 to -0.52). The between-subject variation in the load that maximised power observed (SD= +/- 14 %1RM) may have been due to differences in anthropometric characteristics, and absolute strength and power outputs. Indeed, athletes with longer limbs and larger girths, and greater maximal strength and power outputs utilised a lower percentage of 1RM loads to achieve maximum power. Therefore, we recommend individual assessment of the load that maximizes power output

Weekend hospitalization and additional risk of death: An analysis of inpatient data

Objective To assess whether weekend admissions to hospital and/or already being an inpatient on weekend days were associated with any additional mortality risk.Design Retrospective observational survivorship study. We analysed all admissions to the English National Health Service (NHS) during the financial year 2009/10, following up all patients for 30 days after admission and accounting for risk of death associated with diagnosis, co-morbidities, admission history, age, sex, ethnicity, deprivation, seasonality, day of admission and hospital trust, including day of death as a time dependent covariate. The principal analysis was based on time to in-hospital death.Participants National Health Service Hospitals in England.Main Outcome Measures 30 day mortality (in or out of hospital).Results There were 14,217,640 admissions included in the principal analysis, with 187,337 in-hospital deaths reported within 30 days of admission. Admission on weekend days was associated with a considerable increase in risk of subsequent death compared with admission on weekdays, hazard ratio for Sunday versus Wednesday 1.16 (95% CI 1.14 to 1.18; P < .0001), and for Saturday versus Wednesday 1.11 (95% CI 1.09 to 1.13; P < .0001). Hospital stays on weekend days were associated with a lower risk of death than midweek days, hazard ratio for being in hospital on Sunday versus Wednesday 0.92 (95% CI 0.91 to 0.94; P < .0001), and for Saturday versus Wednesday 0.95 (95% CI 0.93 to 0.96; P < .0001). Similar findings were observed on a smaller US data set.Conclusions Admission at the weekend is associated with increased risk of subsequent death within 30 days of admission. The likelihood of death actually occurring is less on a weekend day than on a mid-week day

A national review of environmental education and its contribution to sustainability in Australia: further and higher education

This report is Volume 5 in a five part series that reviews Environmental Education and its contribution to sustainability in Australia. The research which underpins it was undertaken between July and September 2004 by the Australian Research Institute in Education for Sustainability (ARIES) for the Australian Government Department of the Environment and Heritage

A cross-sectional comparison of quality of life between physically active and underactive older men with prostate cancer

Men with prostate cancer experience many side effects and symptoms that may be improved by a physically active lifestyle. It was hypothesized that older men with prostate cancer who were physically active would report significantly higher levels of quality of life (QOL) as assessed by the WHOQOL-BREF and the WHOQOL-OLD. Of the 348 prostate cancer survivors who were invited to participate in the present postal survey, 137 men returned the questionnaires. Those who were physically active had significantly lower prostate specific antigen (PSA) scores and higher social participation than those insufficiently active. These findings offer some support for the benefits of physical activity (PA) within the prostate cancer population in managing the adverse side effects of their treatments on aspects of their QOL. Future research should more closely examine what types of PA best promote improvements in varying aspects of QOL and psychological well-being for prostate cancer survivors

The Effects of Residency and Body Size on Contest Initiation and Outcome in the Territorial Dragon, Ctenophorus decresii

Empirical studies of the determinants of contests have been attempting to unravel the complexity of animal contest behaviour for decades. This complexity requires that experiments incorporate multiple determinants into studies to tease apart their relative effects. In this study we examined the complex contest behaviour of the tawny dragon (Ctenophorus decresii), a territorial agamid lizard, with the specific aim of defining the factors that determine contest outcome. We manipulated the relative size and residency status of lizards in contests to weight their importance in determining contest outcome. We found that size, residency and initiating a fight were all important in determining outcomes of fights. We also tested whether residency or size was important in predicting the status of lizard that initiated a fight. We found that residency was the most important factor in predicting fight initiation. We discuss the effects of size and residency status in context of previous studies on contests in tawny dragons and other animals. Our study provides manipulative behavioural data in support of the overriding effects of residency on initiation fights and winning them.This study was funded by the Australian Research Council (www.arc.gov.au), the School of Botany and Zoology, and ANU (www.anu.edu.au). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Long-term weight maintenance and cardiovascular risk factors are not different following weight loss on carbohydrate-restricted diets high in either monounsaturated fat or protein in obese hyperinsulinaemic men and women

The aim of this study was to determine after 52 weeks whether advice to follow a lower carbohydrate diet, either high in monounsaturated fat or low fat, high in protein had differential effects in a free-living community setting. Following weight loss on either a high monounsaturated fat, standard protein (HMF; 50 % fat, 20 % protein (67 g/d), 30 % carbohydrate) or a high protein, moderate fat (HP) (40 % protein (136 g/d), 30 % fat, 30 % carbohydrate) energy-restricted diet (6000 kJ/d) subjects were asked to maintain the same dietary pattern without intensive dietary counselling for the following 36 weeks. Overall weight loss was 6·2 (sd 7·3) kg (P < 0·01 for time with no diet effect, 7·6 (sd 8·1) kg, HMF v. 4·8 (sd 6·6) kg, HP). In a multivariate regression model predictors of weight loss at the end of the study were sex, age and reported percentage energy from protein (R2 0·22, P < 0·05 for the whole model). Fasting plasma insulin decreased (P < 0·01, with no difference between diets), 13·9 (sd 4·6) to 10·2 (sd 5·2) mIU/l, but fasting plasma glucose was not reduced. Neither total cholesterol nor LDL-cholesterol were different but HDL was higher, 1·19 (sd 0·26) v. 1·04 (sd 0·29) (P < 0·001 for time, no diet effect), while TAG was lower, 1·87 (sd 1·23) v. 2·22 (sd 1·15) mmol/l (P < 0·05 for time, no diet effect). C-reactive protein decreased (3·97 (sd 2·84) to 2·43 (sd 2·29) mg/l, P < 0·01). Food records showed that compliance to the prescribed dietary patterns was poor. After 1 year there remained a clinically significant weight loss and improvement in cardiovascular risk factors with no adverse effects of a high monounsaturated fat diet.Jennifer B. Keogh, Natalie D. Luscombe-Marsh, Manny Noakes, Gary A. Wittert and Peter M. Clifto