Return-to-Work Coordinators' Perceptions of Their Roles Relative to Workers: A Discourse Analysis.

PURPOSE: This paper describes how Canadian Return to Work coordinators (RTWC) framed their job roles relative to workers in ways that went beyond the usual professional norms of helping worker recovery. METHODS: In-depth interviews were conducted with 47 RTWCs across Canada in 2018-2019. We used critical discourse analysis to analyze the way coordinators viewed workers in the complex, multi-stakeholder system of RTW. RESULTS: We identified four ways that RTWCs positioned themselves relative to workers: as trust builders, experts, detectives and motivators. These roles reflected RTWCs position within the system; however, their discourse also contributed to the construction of a moral hierarchy that valued worker motivation and framed some workers as attempting to exploit the RTW system. CONCLUSIONS: RTWCs' positions of power in the coordination process warrant further investigation of how they exercise judgement and discretion, particularly when the process depends on their ability to weigh evidence and manage cases in what might be seen as an objective and fair manner.

BF3-Catalyzed Intramolecular Fluorocarbamoylation of Alkynes via Halide Recycling.

A BF3-catalyzed atom-economical fluorocarbamoylation reaction of alkyne-tethered carbamoyl fluorides is reported. The catalyst acts as both a fluoride source and Lewis acid activator, thereby enabling the formal insertion of alkynes into strong C-F bonds through a halide recycling mechanism. The developed method provides access to 3-(fluoromethylene) oxindoles and γ-lactams with excellent stereoselectivity, including fluorinated derivatives of known protein kinase inhibitors. Experimental and computational studies support a stepwise mechanism for the fluorocarbamoylation reaction involving a turnover-limiting cyclization step, followed by internal fluoride transfer from a BF3-coordinated carbamoyl adduct. For methylene oxindoles, a thermodynamically driven Z-E isomerization is facilitated by a transition state with aromatic character. In contrast, this aromatic stabilization is not relevant for γ-lactams, which results in a higher barrier for isomerization and the exclusive formation of the Z-isomer.

The feasibility and impact of implementing a computer-guided consultation to target health inequality in Asthma.

Greater Manchester has a greater prevalence and worse asthma outcomes than the national average. This study aims to evaluate a digital approach to primary care asthma management and in particular the initial impact of implementing Clinical Decision Support System software in the form of a computer-guided consultation (CGC) in the setting of primary care asthma reviews in deprived areas of Greater Manchester. The CGC (LungHealth Ltd) is an intelligent decision support system ensuring accurate guideline-based staging of asthma and assessment of asthma control with the software subsequently prompting guideline-standard management. Patients on asthma registers in Greater Manchester Primary Care Networks were identified and underwent remote review by nursing staff using the CGC linked directly to the GP clinical system. Three-hundred thirty-eight patients (mean age 59 (SD 17) years; 60% Female) were reviewed. The CGC reported the patient's asthma control to be "Good" in 22%, "Partial" in 6% and "Poor" in 72%. ACT scores were significantly higher in those patients exhibiting "Good" and "Partial" control when compared to those with "Poor" control. The number of steroid courses and hospital admissions in the previous 12 months was significantly lower in those patients exhibiting "Good" and "Partial" control when compared to those with "Poor" control. Nineteen percent were found not to have a personalised asthma management plan during CGC review, which was alerted by the CGC and subsequently, all but 3 patients had this created on review completion (McNemar's test; p < 0.001). 5% were found not to have been prescribed regular inhaled steroid therapy resulting in the operator being alerted by the CGC in all cases. Overall, 44% underwent alteration in asthma therapy following the CGC review with 82% of these representing treatment escalation. An end-to-end digital service solution is feasible for Asthma within primary care and the utilisation of a CGC when conducting primary care asthma reviews increases implementation of guideline-level management thus addressing healthcare inequality while enabling identification of "high risk" asthma patients and guiding appropriate therapy escalation and de-escalation.

Systematic Review of the Impact on Return to Work of Return-to-Work Coordinators.

Purpose We conducted a systematic review to understand the impact that return-to-work coordinators (RTWCs) have on return to work (RTW) outcomes for sick/injured workers. Methods MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and ABI Inform were searched from January 1, 2000 to September 16, 2020. Of 2,927 retrieved and screened citations, 14 quantitative articles fulfilled the eligibility and quality criteria. Quality assessment, data extraction, and evidence synthesis followed article screening. Results We focused on the impact of RTWCs for outcomes of work absence, RTW rates, quality of life, and cost-benefit. Our final synthesis included 14 articles. We found strong evidence that work absence duration was reduced when workers had face-to-face contact with a RTWC. As well, there was strong evidence linking face-to-face RTWC interventions with higher RTW rates and moderate evidence that this reduced intervention costs. RTWC interventions involving the identification of barriers and facilitators to RTW also showed promising results. However, only limited evidence was found that RTWCs improved quality of life for workers. Conclusions Our synthesis identifies key features of RTW interventions that improve RTW outcomes. Future high-quality research should measure long-term outcomes of RTWC interventions to evaluate sustainability and consider the nature of work. They should also focus on RTWC impact on worker quality of life assessments and for older workers and workers with chronic health conditions.

Return to Work for Mental Ill-Health: A Scoping Review Exploring the Impact and Role of Return-to-Work Coordinators.

Purpose This scoping review was completed to explore the role and impact of having a return-to-work (RTW) coordinator when dealing with individuals with common mental ill-health conditions. Methods Peer reviewed articles published in English between 2000 and 2018 were considered. Our research team reviewed all articles to determine if an analytic focus on RTW coordinator and mental ill-health was present; consensus on inclusion was reached for all articles. Data were extracted for all relevant articles and synthesized for outcomes of interest. Results Our search of six databases yielded 1798 unique articles; 5 articles were found to be relevant. The searched yielded only quantitative studies. Of those, we found that studies grouped mental ill-health conditions together, did not consider quality of life, and used different titles to describe RTW coordinators. Included articles described roles of RTW coordinators but did not include information on their strategies and actions. Included articles suggest that RTW interventions for mental ill-health that utilize a RTW coordinator may result in delayed time to RTW. Conclusions Our limited findings suggest that interventions for mental ill-health that employ RTW coordinators may be more time consuming than conventional approaches and may not increase RTW rate or worker's self-efficacy for RTW. Research on this topic with long-term outcomes and varied research designs (including qualitative) is needed, as well as studies that clearly define RTW coordinator roles and strategies, delineate results by mental health condition, and address the impact of RTW coordinators on workers' quality of life.

2.7 years of beta-decay-rate ratio measurements in a controlled environment.

We report nearly continuous beta-decay-rate measurements of Na-22, Cl-36, Co-60, Sr-90, and Cs-137 over a period of 2.7 years using four Geiger-Müller tubes. We carefully control the ambient pressure and temperature for the detectors, sources, and electronics in order to minimize environmentally-dependent systematic drifts in the measurement chains. We show that the amplitudes of an annual oscillation in the decay rates are consistent with zero to within 0.004%.

Consistency of patellar spin, tilt and lateral translation side-to-side and over a 1 year period in healthy young males.

The purpose of this study was to determine the consistency and symmetry of in vivo measures of patellar spin, tilt, and medial/lateral translation in healthy knees. Patellofemoral joint kinematics were measured bilaterally through a range of loaded knee flexion in 10 active males (aged 19.0 (0.57) years) at baseline, 6, and 12 months using a validated magnetic resonance imaging method. Effects due to time and limb were determined using ANOVA. Variation over 12 months and from side-to-side was summarized as the average of the mean absolute deviations of the measures at 1 degrees increments of knee flexion for corresponding loading cycles for each knee. The measures did not differ over time (p>0.52) or side-to-side (p>0.17). The mean intrasubject variability over the three time points was < or = 1.17 (0.3) degrees for spin and tilt and < or = 0.83 (0.61) mm for lateral translation. The mean intrasubject variability between limbs was 2.14 (1.29) degrees for spin, 0.46 (1.96) degrees for tilt and 1.29 (1.28)mm for lateral translation. The consistency of measures of normal patellar motion over a 1 year period supports application of this methodology to evaluate changes in patellar motion in longitudinal studies involving patient populations.

Does considering severity of illness improve interpretation of patient satisfaction data?

With the emergence of new, relatively low-cost code-based severity indexes, this question arises: Do complex descriptions of patient population in terms of severity yield a clearer picture of patients' opinions about hospital care and service? Consumers and third-party payers of healthcare are using patient satisfaction data with increasing frequency to evaluate the quality of care that hospitals provide. Insurers also use satisfaction data, when they are available, for contracting and ensuring provider accountability. The study described here examines whether the all patient refined-diagnosis related groups (APR-DRG) severity-of-illness rating system, in particular, can explain the variability in inpatient satisfaction ratings independently of patient demographics and clinical events. Multiple logistic regression was used on a data set of 3,720 patient records from one tertiary care facility, and model terms were fitted on the basis of reason for admission, year, gender, length of stay, age, and severity. The findings were that age and reason for admission were consistent predictors of high satisfaction on 14 survey items. APR-DRG severity was not a significant factor. Length of stay made a small but significant contribution on three items related to clinical quality.

Racial differences in cancer of the male breast--15 year experience in the Detroit metropolitan area.

Characteristics of cancer of the male breast were evaluated in a population based review of 244 cases identified retrospectively through the Metropolitan Detroit Cancer Surveillance System (MDCSS) between 1973 and 1987. The mean age at diagnosis was 65 years and median survival time, 44 months. There were no apparent time trends in incidence for either white or black men from 1973 through 1987. Modified radical mastectomy was the most common surgical procedure, while simple and radical mastectomy declined in popularity over time. Cox's proportional hazards regression model was used to test the simultaneous effects of age, race, stage, and treatment on survival. Men older than 65 at diagnosis had a greater risk of dying than men under 65 (RR 1.52, 95% confidence interval, 1.01-2.28). Survival was significantly worse for men who presented at a more advanced stage; regional versus localized (RR 2.19, 95% confidence interval, 1.39-3.45) and remote versus localized (RR 4.31, 95% confidence interval 2.26-8.23). Race had no significant effect on survival in men with breast cancer in the Detroit Metropolitan Area.

Acetylcysteine for treatment of acetaminophen toxicosis in the cat.

Acute acetaminophen intoxication in the cat was studied to characterize the antidotal profile of acetylcysteine. Toxicosis was associated with cyanosis, hyperventilation, depression, and facial edema. Abnormal laboratory findings were methemoglobinemia and elevated serum glutamic-pyruvic transaminase activity. In one trial, each of ten cats was given a 325-mg tablet of acetaminophen, then another after 4 hours. Five of the cats were given antidotal treatment with acetylcysteine (140 mg/kg, per os) at the time of the second dosing with acetaminophen and at 8-hour intervals thereafter for a total of three treatments. All treated cats survived. Two of the untreated cats died. In another trial, doubling each dose of acetaminophen (650 mg) proved fatal in all of four untreated cats. When antidotal therapy was initiated at the time of the second dosing with acetaminophen and repeated at 8- or 4-hour intervals for three treatments, two of four cats in each treatment group survived. Although antidotal therapy was associated with a return of serum glutamic-pyruvic transaminase and methemoglobinemia values toward normal, only the methemoglobin value was a reliable prognostic indicator.