Management of long-term sickness absence: a systematic realist review

Purpose
The increasing impact and costs of long term sickness absence have been well documented. However, the diversity and complexity of interventions and of the contexts in which these take place makes a traditional review problematic. Therefore, we undertook a systematic realist review to identify the dominant programme theories underlying best practice, to assess the evidence for these theories, and to throw light on important enabling or disabling contextual factors.

Method
A search of the scholarly literature from 1950 to 2011 identified 5,576 articles, of which 269 formed the basis of the review.

Results
We found that the dominant programme theories in relation to effective management related to: early intervention or referral by employers; having proactive organisational procedures; good communication and cooperation between stakeholders; and workplace-based occupational rehabilitation. Significant contextual factors were identified as the level of support for interventions from top management, the size and structure of the organisation, the level of financial and organisational investment in the management of long-term sickness absence, and the quality of relationships between managers and staff.

Conclusions
Consequently, those with responsibility for managing absence should bear in mind the contextual factors that are likely to have an impact on interventions, and do what they can to ensure stakeholders have at least a mutual understanding (if not a common purpose) in relation to their perceptions of interventions, goals, culture and practice in the management of long term sickness absence.

Development of liposome gel based formulations for intravaginal delivery of the recombinant HIV-1 envelope protein CN54gp140

Mucosally-administered vaccine strategies are widely investigated as a promising means of preventing HIV infection. This study describes the development of liposomal gel formulations, and novel lyophilised variants, comprising HIV-1 envelope glycoprotein, CN54gp140, encapsulated within neutral, positively charged or negatively charged liposomes. The CN54gp140 liposomes were evaluated for mean vesicle diameter, polydispersity, morphology, zeta potential and antigen encapsulation efficiency before being incorporated into hydroxyethyl cellulose (HEC) aqueous gel and subsequently lyophilised to produce a rod-shaped solid dosage form for practical vaginal application. The lyophilised liposome-HEC rods were evaluated for moisture content and redispersibility in simulated vaginal fluid. Since these rods are designed to revert to gel form following intravaginal application, mucoadhesive, mechanical (compressibility and hardness) and rheological properties of the reformed gels were evaluated. The liposomes exhibited good encapsulation efficiency and the gels demonstrated suitable mucoadhesive strength. The freeze-dried liposome-HEC formulations represent a novel formulation strategy that could offer potential as stable and practical dosage form.

Evaluation of Four Designed Virtual Agent Personalities

Convincing conversational agents require a coherent set of behavioral responses that can be interpreted by a human observer as indicative of a personality. This paper discusses the continued development and subsequent evaluation of virtual agents based on sound psychological principles. We use Eysenck's theoretical basis to explain aspects of the characterization of our agents, and we describe an architecture where personality affects the agent's global behavior quality as well as their back-channel productions. Drawing on psychological research, we evaluate perception of our agents' personalities and credibility by human viewers (N = 187). Our results suggest that we succeeded in validating theoretically grounded indicators of personality in our virtual agents, and that it is feasible to place our characters on Eysenck's scales. A key finding is that the presence of behavioral characteristics reinforces the prescribed personality profiles that are already emerging from the still images. Our long-term goal is to enhance agents' ability to sustain realistic interaction with human users, and we discuss how this preliminary work may be further developed to include more systematic variation of Eysenck's personality scales. © 2012 IEEE.


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Understanding the migratory orientation program of birds: extending laboratory studies to study free flying migrants in a natural setting

For many years, orientation in migratory birds has primarily been studied in the laboratory. Although a laboratory-based setting enables greater control over environmental cues, the laboratory-based findings must be confirmed in the wild in free-flying birds to be able to fully understand how birds orient during migration. Despite the difficulties associated with following free-flying birds over long distances, a number of possibilities currently exist for tracking the long distance, sometimes even globe-spanning, journeys undertaken by migrating birds. Birds fitted with radio transmitters can either be located from the ground or from aircraft (conventional tracking), or from space. Alternatively, positional information obtained by onboard equipment (e.g., GPS units) can be transmitted to receivers in space. Use of these tracking methods has provided a wealth of information on migratory behaviors that are otherwise very difficult to study. Here, we focus on the progress in understanding certain components of the migration-orientation system. Comparably exciting results can be expected in the future from tracking free-flying migrants in the wild. Use of orientation cues has been studied in migrating raptors (satellite telemetry) and thrushes (conventional telemetry), highlighting that findings in the natural setting may not always be as expected on the basis of cage-experiments. Furthermore, field tracking methods combined with experimental approaches have finally allowed for an extension of the paradigmatic displacement experiments performed by Perdeck in 1958 on the short-distance, social migrant, the starling, to long-distance migrating storks and long-distance, non-socially migrating passerines. Results from these studies provide fundamental insights into the nature of the migratory orientation system that enables experienced birds to navigate and guide inexperienced, young birds to their species-specific winter grounds.

Detection of magnetic dipole lines of Fe XII in the ultraviolet spectrum of the dwarf star ε Eri

We report observations of the dwarf star e Eri (K2V) made with the Space Telescope Imaging Spectrograph (STIS) on the Hubble Space Telescope. The high sensitivity of the STIS instrument has allowed us to detect the magnetic dipole transitions of Fe XII at 1242.00 and 1349 38 Å for the first time in a star other than the Sun. The width of the stronger line at 1242.00 Å has also been measured; such measurements are not possible for the permitted lines of Fe XII in the extreme-ultraviolet. To within the accuracy of the measurements the N v and the Fe XII lines occur at their rest wavelengths. Electron densities and linewidths have been measured from other transition region lines. Together, these can be used to investigate the non-thermal energy flux in the lower and upper transition regions, which is useful in constraining possible heating processes. The Fe XII lines are also present in archival STIS spectra of other G/K-type dwarfs.

From non-porous crystalline to amorphous microporous metal(IV) bisphosphonates

Porous layered hybrid materials have been prepared by the reaction of organo-bisphosphonate ligands, 4-(4'-phosphonophenoxy)phenylphosphonic, 4,4'-biphenylenbisphosphonic and phenylphosphonic acids, with metal(IV) cations (Zr and Sn). Crystalline Zr(IV) and Sn(IV) layered bisphosphonates were also prepared, which were non-porous. The amorphous M(IV) bisphosphonates showed variable compositions and textural properties ranging from mainly mesoporous to highly microporous solids with BET surface areas varying from 300 to 480 m(2) g(-1), micropore volumes ranging 0.10-0.20 cm(3)/g, and narrow porous size distributions for some materials. N-2 isotherms suggest that Sn(IV) derivatives show a comparatively higher micropore contribution than the Zr(IV) analogous at least for the ether-bisphosphonate hybrids. Sn(IV) bisphosphonates exhibit high microporosities without the need of using harmful DMSO as solvent. If ether-bisphosphonic acid is partially replaced by less expensive phenylphosphonic ligand, porous products are also obtained. P-31 and F-17 MAS NMR and XPS data revealed the presence of hydrogen-phosphonate groups and small (F-, Cl- and OH-) anions, which act as spacer ligands within the inorganic layers, in these hybrid materials. The complexity of the inorganic layers is higher for the Sn(IV) bisphosphonates likely due to the larger amount of small bridging anions including fluorides. It is suggested that the presence of these small inorganic ligands may be a key factor influencing both, the interaction of the inorganic layer with the bisphosphonate groups, which bridge the inorganic layers, and the generation of internal voids within a given inorganic layer. Preliminary studies of gases adsorption (H-2 and NO) have been carried out for selected Sn(IV) bisphosphonates. The H-2 adsorption capacity at 77 K and 1 bar was low, 0.26 wt%, but the NO adsorption capacity at similar to 1 bar and 298 K was relatively high, 4.2 wt%. Moreover, the hysteresis in the NO isotherms is indicative of partial strong irreversible adsorption of NO. (C) 2008 Elsevier Inc. All rights reserved.

Community identity as resource and context: A mixed method investigation of coping and collective action in a disadvantaged community

Community identities enhance well-being through the provision of social support and feelings of collective efficacy as well as by acting as a basis for collective action and social change. However, the precise mechanisms through which community identity acts to enhance well-being are complicated by stigmatisation which potentially undermines solidarity and collective action. The present research examines a real-world stigmatised community group in order to investigate: (1) the community identity factors that act to enhance well-being, and (2) the consequences of community identity for community action. Study 1 consisted of a household survey conducted in disadvantaged areas of Limerick city in Ireland. Participants (n=322) completed measures of community identification, social support, collective efficacy, community action, and psychological well-being. Mediation analysis indicated that perceptions of collective efficacy mediated the relationship between identification and well-being. However, levels of self-reported community action were low and unrelated to community identification. In Study 2, twelve follow–up multiple-participant interviews with residents and community group workers were thematically analysed, revealing high levels of stigmatisation and opposition to identity-related collective action. These findings suggest the potential for stigma to reduce collective action through undermining solidarity and social support.

Detection of visual-field deterioration by Glaucoma Progression Analysis and Threshold Noiseless Trend programs

BACKGROUND: To compare the ability of Glaucoma Progression Analysis (GPA) and Threshold Noiseless Trend (TNT) programs to detect visual-field deterioration.

METHODS: Patients with open-angle glaucoma followed for a minimum of 2 years and a minimum of seven reliable visual fields were included. Progression was assessed subjectively by four masked glaucoma experts, and compared with GPA and TNT results. Each case was judged to be stable, deteriorated or suspicious of deterioration

RESULTS: A total of 56 eyes of 42 patients were followed with a mean of 7.8 (SD 1.0) tests over an average of 5.5 (1.04) years. Interobserver agreement to detect progression was good (mean kappa = 0.57). Progression was detected in 10-19 eyes by the experts, in six by GPA and in 24 by TNT. Using the consensus expert opinion as the gold standard (four clinicians detected progression), the GPA sensitivity and specificity were 75% and 83%, respectively, while the TNT sensitivity and specificity was 100% and 77%, respectively.

CONCLUSION: TNT showed greater concordance with the experts than GPA in the detection of visual-field deterioration. GPA showed a high specificity but lower sensitivity, mainly detecting cases of high focality and pronounced mean defect slopes.

A qualitative enquiry into the appropriation of mobile telephony at the bottom of the pyramid

Purpose: The paper aims to analyse Bottom of the Pyramid (BoP) customers’ (e.g. Bangladeshi farmers) use and appropriation of mobile telephony and to critically identify a suitable research strategy for such investigation.

Design/methodology/approach: Concentrated ethnographic immersion was combined with both methodological and investigator triangulation during a four-month period of fieldwork conducted in Bangladeshi villages to obtain more robust findings. Concentrated immersion was required to achieve relatively speedier engagement owing to the difficulty in engaging with respondents on a long-term basis.

Findings: The farmers’ use of mobile telephony went beyond the initial adoption, as they appropriated it through social and institutional support, inventive means and/or changes in their own lifestyle. The paper argues that technology appropriation, being a result of the mutual shaping of technology, human skills and abilities and macro-environmental factors, enables users to achieve desired outcomes which may not always be the ones envisaged by the original designers.

Research limitations/implications: The paper contributes to two major areas: first, it identifies technology appropriation as an important and emerging concept in international marketing research; second, it suggests a concentrated form of ethnographic engagement for studying technology appropriation in a developing country context.

Practical implications: A good understanding of the dynamic interplay between users’ skills and abilities, social contexts and technological artefacts/applications is required in order for businesses to serve BoP customers profitably.

Originality/value: The paper presents a dynamic model of technology appropriation based on findings collected through a pragmatic approach by combining concentrated ethnographic immersion with methodological and investigator triangulation

Corneal toxicity and inflammation secondary to retained perfluorodecalin

PURPOSE: To describe a case with bullous keratopathy and anterior segment inflammation associated with heavy liquids. DESIGN: Observational case report. METHODS: Review of clinical and histopathologic changes. RESULTS: A 65-year-old patient underwent a pars plana vitrectomy for a rhegmatogenous retinal detachment. Perfluorodecalin was used as a temporary retinal tamponade. After surgery, bubbles of heavy liquid were noted in the anterior chamber. Fifteen months later, severe corneal edema developed, associated with corneal vascularization and keratic precipitates. Removal of heavy liquid through a paracentesis was attempted but the cornea remained edematous, and a penetrating keratoplasty was performed. In the histopathologic examination inflammatory changes from retention of perfluorodecalin were observed. There was a decompensated cornea with florid bullous keratopathy, inflammatory infiltration with vascularization, and deposition of perfluorodecalin within keratocytes and perivascular macrophages. CONCLUSION: Presence of heavy liquids in the anterior chamber may be associated with an intense inflammatory response and corneal decompensation. © 2005 by Elsevier Inc. All rights reserved.