The acute adaptations of normal and pathological human Achilles tendons to eccentric and concentric exercise

Eccentric exercise is the conservative treatment of choice for mid-portion Achilles tendinopathy. While there is a growing body of evidence supporting the medium to long term efficacy of eccentric exercise in Achilles tendinopathy treatment, very few studies have investigated the short term response of the tendon to eccentric exercise. Moreover, the mechanisms through which tendinopathy symptom resolution occurs remain to be established. The primary purpose of this thesis was to investigate the acute adaptations of the Achilles tendon to, and the biomechanical characteristics of, the eccentric exercise protocol used for Achilles tendinopathy rehabilitation and a concentric equivalent. The research was conducted with an orientation towards exploring potential mechanisms through which eccentric exercise may bring about a resolution of tendinopathy symptoms. Specifically, the morphology of tendinopathic and normal Achilles tendons was monitored using high resolution sonography prior to and following eccentric and concentric exercise, to facilitate comparison between the treatment of choice and a similar alternative. To date, the only proposed mechanism through which eccentric exercise is thought to result in symptom resolution is the increased variability in motor output force observed during eccentric exercise. This thesis expanded upon prior work by investigating the variability in motor output force recorded during eccentric and concentric exercises, when performed at two different knee joint angles, by limbs with and without symptomatic tendinopathy. The methodological phase of the research focused on establishing the reliability of measures of tendon thickness, tendon echogenicity, electromyography (EMG) of the Triceps Surae and the standard deviation (SD) and power spectral density (PSD) of the vertical ground reaction force (VGRF). These analyses facilitated comparison between the error in the measurements and experimental differences identified as statistically significant, so that the importance and meaning of the experimental differences could be established. One potential limitation of monitoring the morphological response of the Achilles tendon to exercise loading is that the Achilles tendon is continually exposed to additional loading as participants complete the walking required to carry out their necessary daily tasks. The specific purpose of the last experiment in the methodological phase was to evaluate the effect of incidental walking activity on Achilles tendon morphology. The results of this study indicated that walking activity could decrease Achilles tendon thickness (negative diametral strain) and that the decrease in thickness was dependent on both the amount of walking completed and the proximity of walking activity to the sonographic examination. Thus, incidental walking activity was identified as a potentially confounding factor for future experiments which endeavoured to monitor changes in tendon thickness with exercise loading. In the experimental phase of this thesis the thickness of Achilles tendons was monitored prior to and following isolated eccentric and concentric exercise. The initial pilot study demonstrated that eccentric exercise resulted in a greater acute decrease in Achilles tendon thickness (greater diametral strain) compared to an equivalent concentric exercise, in participants with no history of Achilles tendon pain. This experiment was then expanded to incorporate participants with unilateral Achilles tendinopathy. The major finding of this experiment was that the acute decrease in Achilles tendon thickness observed following eccentric exercise was modified by the presence of tendinopathy, with a smaller decrease (less diametral strain) noted for tendinopathic compared to healthy control tendon. Based on in vitro evidence a decrease in tendon thickness is believed to reflect extrusion of fluid from the tendon with loading. This process would appear to be limited by the presence of pathology and is hypothesised to be a result of the changes in tendon structure associated with tendinopathy. Load induced fluid movement may be important to the maintenance of tendon homeostasis and structure as it has the potential to enhance molecular movement and stimulate tendon remodelling. On this basis eccentric exercise may be more beneficial to the tendon than concentric exercise. Finally, EMG and motor output force variability (SD and PSD of VGRF) were investigated while participants with and without tendinopathy performed the eccentric and concentric exercises. Although between condition differences were identified as statistically significant for a number of force variability parameters, the differences were not greater than the limits of agreement for repeated measures. Consequently the meaning and importance of these findings were questioned. Interestingly, the EMG amplitude of all three Triceps Surae muscles did not vary with knee joint angle during the performance of eccentric exercise. This raises questions pertaining to the functional importance of performing the eccentric exercise protocol at each of the two knee joint angles as it is currently prescribed. EMG amplitude was significantly greater during concentric compared to eccentric muscle actions. Differences in the muscle activation patterns may result in different stress distributions within the tendon and be related to the different diametral strain responses observed for eccentric and concentric muscle actions.

Assessing performance capability in the work place

As universities worldwide begin to appreciate the value of authentic learning experiences, so they struggle with methods of assessing the outcomes from such experiences. This chapter describes the application of an assessment matrix developed by Queensland University of Technology(QUT) in Australia, to the assessment requirements and practices relating to work integrated learning at the University of Surrey in the UK. Despite the very different institutional contexts and independent way in which the assessment regimes have developed, it was found that the values and outcomes being assessed and the methods used to assess them were similar. The most important feature of assessing work integrated learning experiences is fitness for purpose, hence the learning objectives and assessment of outcomes for a WIL experience must be explicitly aligned to this objective.As universities worldwide begin to appreciate the value of authentic learning experiences, so they struggle with methods of assessing the outcomes from such experiences. This chapter describes the application of an assessment matrix developed by Queensland University of Technology (QUT) in Australia, to the assessment requirements and practices relating to work integrated learning at the University of Surrey in the UK. Despite the very different institutional contexts and independent way in which the assessment regimes have developed, it was found that the values and outcomes being assessed and the methods used to assess them were similar. The most important feature of assessing work integrated learning experiences is fitness for purpose, hence the learning objectives and assessment of outcomes for a WIL experience must be explicitly aligned to this objective.

Part-time job design : symptom and solution for a changing work environment

Part-time work presents a conundrum. Across industrialised countries, there has been significant growth in part-time work as a solution to resolving the diverse interests of employers, workers and families in managing time and resources. However, there are intrinsic disadvantages associated with part-time work; notably with pay and career prospects, which impact the same stakeholders it is intended to benefit. These disadvantages are particularly evident in professional services organisations, due to strong cultural norms of long work hours, single-focused commitment to work and 24x7 availability. There are indications, both in research and practice, that the design of part-time work arrangements could be improved to address some of the disadvantages associated with part-time work, and to challenge norms and dated assumptions that influence the structure of professional work. This study explored the changes made when professional service workers move from a full-time to part-time arrangement. The study drew on a recently proposed framework for work design, which extended previous models to reflect substantial changes in the contemporary work environment. The framework proved to be a useful perspective from which to explore the design of part-time work, principally because it integrated previously disconnected areas of literature and practice through a broader focus on the context of work. Exploration of the differences between part-time and full-time roles, and comparisons between part-time roles in similar types of work, provided insights into the design of professional part-time work. Analysis revealed that having a better understanding of design characteristics may help explain disadvantages associated with professional part-time work, and that some full-time roles can be more easily adapted to part-time arrangements than others. Importantly, comparisons revealed that even roles that are considered difficult to undertake on a part-time basis can potentially be re-designed to be more effective. Through empirical testing of the framework, a contextualised work design model is presented that may guide further research and the practice of crafting part-time arrangements. The findings also suggest that poor work design may lead to the symptoms associated with professional part-time work, and that improved work design may be a potential solution to these structural constraints.

Methods used in cross-cultural comparisons of psychological symptoms and their determinants

This paper is the second in a series of reviews of cross-cultural studies of menopausal symptoms. The goal of this review is to compare and contrast methods which have been previously utilized in Cross-Cultural Midlife Women's Health Studies with a view to (1) identifying the challenges in measurement across cultures in psychological symptoms and (2) suggesting a set of unified questions and tools that can be used in future research in this area. This review also aims to examine the determinants of psychological symptoms and how those determinants were measured. The review included eight studies that explicitly compared symptoms in different countries or different ethnic groups in the same country and included: Australian/Japanese Midlife Women's Health Study (AJMWHS), Decisions At Menopause Study (DAMeS), Four Major Ethnic Groups (FMEG), Hilo Women's Health Survey (HWHS), Penn Ovarian Aging Study (POAS), Study of Women's Health Across the Nation (SWAN), Women's Health in Midlife National Study (WHiMNS), and the Women's International Study of Health and Sexuality (WISHeS). This review concludes that mental morbidity does affect vasomotor symptom prevalence across cultures and therefore should be measured. Based on the review of these eight studies it is recommended that the following items be included when measuring psychological symptoms across cultures, feeling tense or nervous, sleeping difficulty, difficulty in concentrating, depressed and irritability along with the CES-D Scale, and the Perceived Stress Scale. The measurement of these symptoms will provide an evidence based approach when forming any future menopause symptom list and allow for comparisons across studies.

Methods used in cross-cultural comparisons of vasomotor symptoms and their determinants

Methodological differences among studies of vasomotor symptoms limit rigorous comparison or systematic review. Vasomotor symptoms generally include hot flushes and night sweats although other associated symptoms exist. Prevalence rates vary between and within populations, but different studies collect data on frequency, bothersomeness, and/or severity using different outcome measures and scales, making comparisons difficult. We reviewed only cross-cultural studies of menopausal symptoms that explicitly examined symptoms in general populations of women in different countries or different ethnic groups in the same country. This resulted in the inclusion of nine studies: Australian/Japanese Midlife Women's Health Study (AJMWHS), Decisions At Menopause Study (DAMeS), Four Major Ethnic Groups (FMEG), Hilo Women's Health Survey (HWHS), Mid-Aged Health in Women from the Indian Subcontinent (MAHWIS), Penn Ovarian Aging Study (POAS), Study of Women's Health Across the Nation (SWAN), Women's Health in Midlife National Study (WHiMNS), and Women's International Study of Health and Sexuality (WISHeS). These studies highlight the methodological challenges involved in conducting multi-population studies, particularly when languages differ, but also highlight the importance of performing multivariate and factor analyses. Significant cultural differences in one or more vasomotor symptoms were observed in 8 of 9 studies, and symptoms were influenced by the following determinants: menopausal status, hormones (and variance), age (or actually, the square of age, age2), BMI, depression, anxiety, poor physical health, perceived stress, lifestyle factors (hormone therapy use, smoking and exposure to passive smoke), and acculturation (in immigrant populations). Recommendations are made to improve methodological rigor and facilitate comparisons in future cross-cultural menopause studies.

Livable housing design: Is it likely to work?

The need for accessible housing in Australia is acute. Both government and the community service sector recognise the importance of well designed accessible housing to optimise the integration of older people and people with disability, to encourage a prudent use of scarce health and community services and to enhance the liveability of our cities. In 2010, the housing industry, negotiated with the Australian Government and community representatives to adopt a nationally consistent voluntary code (Livable Housing Design) and a strategy to provide minimal level of accessibility in all new housing by 2020. Evidence from the implementation of such programs in the United Kingdom and USA, however, serves to question whether this aspirational goal can be achieved through voluntary codes. Minimal demand at the point of new sale, and problems in the production of housing to the required standards have raised questions regarding the application of program principles in the context of a voluntary code. In addressing the latter issue, this paper presents early findings from the analysis of qualitative interviews conducted with developers, builders and designers in various housing contexts. It identifies their “logics in use” in the production of housing in response to Livable Housing Design’s voluntary code and indicates factors that are likely to assist and impede the attainment of the 2020 aspirational goal.

Things just got really serious : coping in crisis

You have chosen to enter a profession that can afford you a wonderfully rich career. It is a role that has many areas of speciality and many opportunities and challenges in communicating with a vast array of people including patients, families, peers, and management. Inherent in the role are all sorts of potential stressors such as not having the equipment you need at a time you think you crucially need it, working with people you find difficult, shift work, lack of staffing, overcrowding, and the list is sometimes seemingly endless. But there are also obvious advantages to your role such as meeting a large variety of people, helping people to recover, to feel comfortable in your care and supporting families, patients and colleagues. This brings me to the two primary points to this chapter. The first point of this chapter is to understand that sometimes the challenges you may face in the health arena overwhelm your initial understanding of your capacity to cope. That is to say, there will likely be times when you feel overwhelmed or even distraught in the face of a particular situation. The second point is that these same overwhelming experiences can provide a catalyst for you to grow as a human being; to develop beyond the person you perceived yourself to be beforehand. According to Aaron Antonovsky (1985), stress is inherent in the human condition, but further to that, in your role, there is a very high possibility of traumatic experiences as well.

Young People and Work

This edited book brings together empirical studies of young people in paid employment from a variety of disciplinary perspectives and in different national settings. In the context of increasing youth labour market participation rates and debates about the value of early employment, it draws on multi-level analyses to reflect the complexity of the field. Each of the three sections of the book explores a key aspect of young people's employment: their experience of work, intersections between work and education, and the impact of other actors and institutions. The book contributes to broadening and strengthening knowledge about the opportunities and constraints that young people face during their formative experiences in the labour market.

Employee perceived workplace stress : examining core self-evaluations, political skill, coping strategies and support

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Using the web to look for work: Implications for online job seeking and recruiting

Purpose - The web is now a significant component of the recruitment and job search process. However, very little is known about how companies and job seekers use the web, and the ultimate effectiveness of this process. The specific research questions guiding this study are: how do people search for job-related information on the web? How effective are these searches? And how likely are job seekers to find an appropriate job posting or application? Design/methodology/approach - The data used to examine these questions come from job seekers submitting job-related queries to a major web search engine at three points in time over a five-year period. Findings - Results indicate that individuals seeking job information generally submit only one query with several terms and over 45 percent of job-seeking queries contain a specific location reference. Of the documents retrieved, findings suggest that only 52 percent are relevant and only 40 percent of job-specific searches retrieve job postings. Research limitations/implications - This study provides an important contribution to web research and online recruiting literature. The data come from actual web searches, providing a realistic glimpse into how job seekers are actually using the web. Practical implications - The results of this research can assist organizations in seeking to use the web as part of their recruiting efforts, in designing corporate recruiting web sites, and in developing web systems to support job seeking and recruiting. Originality/value - This research is one of the first studies to investigate job searching on the web using longitudinal real world data. © Emerald Group Publishing Limited.

Using the work system method with freshman information systems students

Recent surveys of information technology management professionals show that understanding business domains in terms of business productivity and cost reduction potential, knowledge of different vertical industry segments and their information requirements, understanding of business processes and client-facing skills are more critical for Information Systems personnel than ever before. In an attempt to restrucuture the information systems curriculum accordingly, our view it that information systems students need to develop an appreciation for organizational work systems in order to understand the operation and significance of information systems within such work systems.

Labouring for leisure? Achieving work-life balance through compressed working weeks

Flexible work practices spreading work times across the entire week have reduced the time to engage in leisure activities and for some have compounded the problem of a lack of defined break between work weeks. This study examines time spent outside of the workplace through a multiple case study of working time and leisure in the construction industry. A framework of synchronous leisure is used to examine the interplay of work and non-work arrangements. The effects of changing work arrangements to deliver a longer break between working weeks and the consequent impact on leisure activities are analysed. Interviews and focus groups across four construction sites revealed that while leisure is important to relieve fatigue and overwork, a work schedule allowing a long break between working weeks, specifically on a weekend, enables workers to achieve synchronous time, particularly with family, and improves work-life balance satisfaction. It was found that a well-defined break across a weekend also offers the opportunity to synchronize schedules with others to spend time away on short breaks.