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In the context of an ageing population and longer working lives, the impact of increasing rates of early exit from the labour force on quality of life is a particularly current concern. However, relatively little is known about the impact on quality of life of later-life labour force transitions and various forms of early exit from the labour force, compared to remaining in employment. This paper examines lifecourse labour force trajectories and transitions in relation to change in quality of life prior to the State Pension Age. Lifecourse data on early life circumstances, labour force trajectories and labour force transitions from 3,894 women and 3,528 men in the National Child Development Study (1958 British Birth Cohort) were examined in relation to change in quality of life, measured by a short-form version of CASP, between the ages of 50 and 55. Women and men differed in the types of labour force transition associated with positive change in quality of life, with men more frequent beneficiaries. For both men and women, labour force exit due to being sick or disabled was associated with a negative change in quality of life, whereas joining the labour force was associated with a positive change in quality of life. Moving into retirement was associated with a positive change in men's quality of life, but not women's. Moving from full-time to part-time employment was associated with a positive change in women's quality of life but not men's. The findings that stand out for their policy relevance are: the threat to the quality of life of both women and men from early labour force exit due to limiting longstanding illness; and women are less likely to experience beneficial labour force exit in the later years of their working life, but are more likely to benefit from a reduction in working hours.
This volume, the first collection of essays devoted to Hoccleve since 1996, both confirms his importance in shaping the English poetic tradition after Chaucer's death and demonstrates the depth of ongoing critical interest in Hoccleve's work in its own right.
In the scenes of day-to-day life which the government clerk Thomas Hoccleve presents in his poetry, he is often approached by other people. Often those whom he encounters know something of him in advance, whether from prior experience or hearsay. In the Male Regle, the innkeepers, cooks and taxi-boatmen recognise him as a generous customer who pays promptly and well (177–84, 195–8). The old man who walks alongside Hoccleve and introduces himself in the Regiment’s prologue has also heard of the poet and of his literary connection with Chaucer (who had died a decade earlier). When Hoccleve tells him his name, the old man responds with recognition: ‘Sone, I have herd or this men speke of thee’ (1866). Hoccleve is someone known to others and discussed in his absence. Even in the ‘Complaint’, when he describes how some in the Westminster crowd sought to avoid him, such bystanders nonetheless reveal that they both know who he is and some part of what has happened to him (C 43–5, 64–93, 120–35). Hoccleve’s reputation often precedes him, inviting many kinds of approaches even as it discourages others.
This collection of essays likewise approaches Hoccleve and his works, bringing both prior reputation and fresh eyes to bear on this most engaging of poets. Since an earlier collection of four essays on Hoccleve edited by Catherine Batt was published in 1996, Hoccleve’s star has continued to rise, and he is now among the most frequently taught of fifteenth-century authors as well as the subject of many journal articles and chapters, and a growing number of monographs. Many readers, not least the students who increasingly read Hoccleve’s verse as part of their university degrees, find him very accessible. Students often respond with enthusiastic recognition to the confessional elements of Hoccleve’s poetry, those passages in which he acknowledges his own failings and self-sabotage, his anxiety about the future, his frustrated career hopes or his precarious finances. Most particularly in an age where mental health difficulties are acknowledged more readily, many of us engage very directly not only with Hoccleve’s accounts of what it is to worry gloomily about the future but also his descriptions of a more acute mental health crisis and the social stigma which can result from such a temporary loss of sanity.
Rapid whole genome sequencing (rapid WGS) is a powerful diagnostic tool that is becoming increasingly practical for widespread clinical use. However, protocols for its use are challenging to implement. A significant obstacle to clinical adoption is that laboratory certification requires an initial research development phase, which is constrained by regulations from returning results. Regulations preventing return of results have ethical implications in cases which might impact patient outcomes. Here, we describe our experience with the development of a rapid WGS research protocol, that balanced the requirements for laboratory-validated test development with the ethical needs of clinically relevant return of results.
Medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS) are debilitating to patients. As many specific PPS syndromes share common behavioural, cognitive, and affective influences, transdiagnostic treatments might be effective for this patient group. We evaluated the clinical efficacy and cost-effectiveness of a therapist-delivered, transdiagnostic cognitive behavioural intervention (TDT-CBT) plus (+) standard medical care (SMC) v. SMC alone for the treatment of patients with PPS in secondary medical care.
Methods
A two-arm randomised controlled trial, with measurements taken at baseline and at 9, 20, 40- and 52-weeks post randomisation. The primary outcome measure was the Work and Social Adjustment Scale (WSAS) at 52 weeks. Secondary outcomes included mood (PHQ-9 and GAD-7), symptom severity (PHQ-15), global measure of change (CGI), and the Persistent Physical Symptoms Questionnaire (PPSQ).
Results
We randomised 324 patients and 74% were followed up at 52 weeks. The difference between groups was not statistically significant for the primary outcome (WSAS at 52 weeks: estimated difference −1.48 points, 95% confidence interval from −3.44 to 0.48, p = 0.139). However, the results indicated that some secondary outcomes had a treatment effect in favour of TDT-CBT + SMC with three outcomes showing a statistically significant difference between groups. These were WSAS at 20 weeks (p = 0.016) at the end of treatment and the PHQ-15 (p = 0.013) and CGI at 52 weeks (p = 0.011).
Conclusion
We have preliminary evidence that TDT-CBT + SMC may be helpful for people with a range of PPS. However, further study is required to maximise or maintain effects seen at end of treatment.
Implementation of clinically useful research discoveries in the academic environment is challenged by limited funding for early phase proof-of-concept studies and inadequate expertise in product development and commercialization. To address these limitations, the National Institutes of Health (NIH) established the National Centers for Accelerated Innovations (NCAI) program in 2013. Three centers competed successfully for awards through this mechanism. Here, we present the experience of one such center, the Boston Biomedical Innovation Center (B-BIC), and demonstrate its remarkable success at the translation of innovations to clinical application and commercialization, as well as skills development and education.