Health professionals' attitudes and practices in relation to Functional Capacity Evaluations

Functional Capacity Evaluations (FCE's) are part of practice in work injury prevention and rehabilitation, and are designed to define an individual's functional abilities or limitations in the context of safe, productive work tasks. Qualitative research methodology was used to investigate the attitudes and behaviours of health professionals in relation to FCE use. The study aimed to identify why health professionals chose a particular FCE, and to identify what factors influence health professionals' clinical judgements when providing results and recommendations for the individual being assessed. Five health professionals from the Hunter Region of New South Wales, Australia, participated in semi-structured, individual interviews using a phenomenological approach. Following inductive analysis of the data, four themes reflecting participants' attitudes and behaviours of FCE use emerged: i) referrals and expectations, including why and when the assessment is completed ii) outcomes, -- what the results aim to provide iii) workplace/practice/usage issues and iv) skills of the assessor. The results indicate the need for further research on the clinical utility of FCE's. A large scale quantitative study would allow results to be generalised to a wider community of FCE users.     

Loss and grief: The experience of transition to residential aged care

There is growing recognition of the experience of non-death-related loss and grief. One unexplored area of non-death-related loss and grief is associated with older people’s transition from home to residential aged care (RAC). This paper reports findings from a qualitative study that explored the experiences of people living in RAC, carer-relatives of people living in RAC and RAC staff. Using theories of loss and grief, the paper identifies features of the transition to RAC that are associated with unresolved loss and maladaptation to changed circumstances, and the types of support that would mitigate these. Using a series of focus groups with both residents and carer-relatives, as well as staff, the study found that residents and their families need more support to negotiate the multiple, often necessarily hasty decisions and bureaucratic requirements associated with transitioning to RAC, while simultaneously experiencing loss and grief. The types of support that families would welcome from service providers include facilitating shared decision making, valuing family and community carer expertise and providing practical information and assistance to fulfil administrative obligations.     

Girlz II women: Age‐grading,language change and stylistic variation

Informed by abstract models of language change or stability over time, we present a longitudinal study of two African American females, first interviewed as teenagers, and re‐recorded twenty years later. As teenagers, they used morpho‐syntactic features of AAVE voraciously. But as working adults, these women distance themselves from their teenage activities and social networks, and display a considerably reduced vernacular usage that accords with their articulated concern to get ahead. The diachronic interpretation that best characterizes their transformation is age‐grading rather than generational change, since change at the individual level is accompanied by stability at the community level. The picture is complicated by intermediate recordings showing that one of the speakers is a stylistic chameleon, capable since her teenage years of varying copula absence rates depending on addressee, topic, and projected persona. But the age‐grading interpretation of change at the individual level remains valid based on the evidence of her reduced use of habitual be2, and third singular present tense –s absence. The case highlights the importance of paying more attention to stylistic variation and including more than two time points in sociolinguistic studies of change in real and apparent time.     

Women's Accounts of Organizational Politics as a Gendering Process

Organizational politics is implicated in all levels of organizational functioning, from power structures and informal interaction to individual identity. This study argues that organizational politics provides an approach to examining professional women's experiences of organizations as gendered. Women graduates in male‐dominated organizations claimed not to be limited by explicit discrimination, but they construct organizational politics as being masculine in character and as a barrier to their careers. These women represent organizational politics as irrational, aggressive, competitive and instrumental, leading to individual, not organizational, success. Their accounts undermine the stereotypical dichotomy of masculine rationality and feminine emotion by claiming that women behave reasonably and by focusing on emotion in men's political game playing. However, claiming to be rational and rejecting politics, while acknowledging its role in career success, is uncomfortable for ambitious women. They risk sabotaging their own position by appearing too sensitive to engage in the less savoury aspects of organizational life. Organizational political processes are seen as fundamental to gender in organizations, first, because political activity is seen as gendered and masculine and contrary to female identity; secondly, because politics is part of the informal system which constructs organization from which outsiders are excluded; and finally, because political activity is linked to the performance, achievement and maintenance of power.     

How a Nonprofitness Orientation Influences Collective Civic Action: The Effects of Civic Engagement and Political Participation

VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations - This research addresses the question of how the institutional frame of “nonprofitness” shapes the civic...     

Marginal and hazard ratio specific random data generation: Applications to semi-parametric bootstrapping

Cox's partial likelihood for censored time-to-event data can be interpreted as a permutation probability, whereby covariate values are permuted to the observed times-to-event and censoring times. This interpretation facilitates a simple method for jointly generating times-to-event and covariate tuples with considerable flexibility, including time dependence of the hazard ratio and specification of both the marginal time-to-event and covariate distributions. This interpretation also facilitates a method for semi-parametric bootstrapping of hazard ratio estimators.     

Using categorical markers as auxiliary variables in log‐rank tests and hazard ratio estimation

Markers, which are prognostic longitudinal variables, can be used to replace some of the information lost due to right censoring. They may also be used to remove or reduce bias due to informative censoring. In this paper, the authors propose novel methods for using markers to increase the efficiency of log‐rank tests and hazard ratio estimation, as well as parametric estimation. They propose a «plug‐in» methodology that consists of writing the test statistic or estimate of interest as a functional of Kaplan–Meier estimators. The latter are then replaced by an efficient estimator of the survival curve that incorporates information from markers. Using simulations, the authors show that the resulting estimators and tests can be up to 30% more efficient than the usual procedures, provided that the marker is highly prognostic and that the frequency of censoring is high.     

Let's Call it Quits: Break‐Even Effects in the Decision to Stop Taking Risks

“Chasing” behavior, whereby individuals, driven by a desire to break even, continue a risky activity (RA) despite incurring large losses, is a commonly observed phenomenon. We examine whether the desire to break even plays a wider role in decisions to stop engaging in financially motivated RA in a naturalistic setting. We test hypotheses, motivated by this research question, using a large data set: 707,152 transactions of 5,379 individual financial market spread traders between September 2004 and April 2013. The results indicate strong effects of changes in wealth around the break‐even point on the decision to cease an RA. An important mediating factor was the individual's historical long‐term performance. Those with a more profitable trading history were less affected by a fall in cash balance below the break‐even point compared to those who had been less profitable. We observe that break‐even points play an important role in the decision of nonpathological risk takers to stop RAs. It is possible, therefore, that these nonpathological cognitive processes, when occurring in extrema, may result in pathological gambling behavior such as “chasing.” Our data set focuses on RAs in financial markets and, consequently, we discuss the implications for institutions and regulators in the effective management of risk taking in markets. We also suggest that there may be a need to consider carefully the nature and role of “break‐even points” associated with a broader range of nonfinancially‐focused risk‐taking activities, such as smoking and substance abuse.     

What might Normalisation Process Theory bring to policy implementation studies? Learning lessons and uncovering questions through a case study of the profound implementation failure of a new policing policy

Normalisation Process Theory (NPT), used nationally and internationally to explore implementation within health services research, is used for the first time within policing to understand profound policy implementation failure and to generate broader discussion of policy implementation theory. The policy in question (Police to Primary Care [P2PC]) was an intervention designed to notify GPs when women are assessed by police as at high risk of future domestic abuse. Designed to improve interagency communication, it took place amidst radical organisational change. Using qualitative interviews with domestic abuse specialist and frontline officers, this paper addresses how NPT helps to explain the (non)implementation of P2PC, how such an analysis differs from other policy implementation approaches, and what this means for our understandings of policy implementation more broadly. NPT proved useful in understanding mechanisms leading to (non)implementation of the intervention: fuzzy alignment with existing practice, faulty communication of purpose, and inattention to discretionary implementation spaces. It helped us understand why the intervention came to be invisible. Dwarfed by its organisational context, made institutionally hard to read by a lack of formal protocols, and given restricted view to police officers, it was compromised by a failure to instigate systems of organisational learning. More broadly, NPT helped reveal practices intersecting top‐down and bottom‐up implementation theory. The paper concludes by asking how NPT and theories of street‐level bureaucracy might be better used in tandem and, particularly, how this might help explorations of policy implementation where human actors are joined by technological actors in interpreting and making policy in vivo.