Bringing genetics into primary care: findings from a national evaluation of pilots in England

Objectives: Developments in genetic knowledge and clinical applications are seen as rendering traditional modes of organizing genetics provision increasingly inappropriate. In common with a number of developed world countries the UK has sought to increase the role of primary care in delivering such services. However, efforts to reconfigure service delivery face multiple challenges associated with divergent policy objectives, organizational boundaries and professional cultures. This paper presents findings from an evaluation of an English initiative to integrate genetics into 'mainstream' clinical provision in the National Health Service. Methods: Qualitative research in 11 case-study sites focusing on attempts by pilots funded by the initiative to embed knowledge and provision within primary care illustrating barriers faced and the ways in which these were surmounted. Results: Lack of intrinsic interest in clinical genetics among primary care staff was compounded by national targets that focused their attention elsewhere and by service structures that rendered genetics a peripheral concern demanding minimal engagement. Established divisions between the commissioning of mainstream and specialist services, along with the pressures of shorter-term targets, impeded ongoing funding. Conclusions: More wide-ranging policy and organizational support is required if the aim of entrenching genetics knowledge and practice across the Health Service is to be realized

National evaluation of NHS genetics service investments: emerging issues from the cancer genetics pilots

In seeking to fulfil the ambition of the 2003 genetics white paper, Our Inheritance, Our Future, to ‘mainstream’ genetic knowledge and practices, the Department of Health provided start-up funding for pilot services in various clinical areas, including seven cancer genetics projects. To help to understand the challenges encountered by such an attempt at reconfiguring the organization and delivery of services in this field, a programme-level evaluation of the genetics projects was commissioned to consider the organizational issues faced. Using a qualitative approach, this research has involved comparative case-study work in 11 of the pilot sites, including four of the seven cancer genetics pilots. In this paper, the researchers present early findings from their work, focusing in particular on the cancer genetics pilots. They consider some of the factors that have influenced how the pilots have sought to address pre-existing sector, organizational and professional boundaries to these new ways of working. The article examines the relationship between these factors and the extent to which pilots have succeeded in setting up boundary-spanning services, dealing with human-resource issues and creating sustainable, ‘mainstreamed’ provision which attracts ongoing funding in a volatile NHS commissioning environment where funding priorities do not always favour preventive, risk-assessment services

Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’ of the medical workforce

Efforts to ‘modernize’ the clinical workforce of the English National Health Service have sought to reconfigure the responsibilities of professional groups in pursuit of more effective, joined-up service provision. Such efforts have met resistance from professions eager to protect their jurisdictions, deploying legitimacy claims familiar from the insights of the sociology of professions. Yet to date few studies of professional boundaries have grounded these insights in the specific context of policy challenges to the inter- and intra-professional division of labour, in relation the medical profession and other health-related occupations. In this paper we address this gap by considering the experience of newly instituted general practitioners (family physicians) with a special interest (GPSIs) in genetics, introduced to improve genetics knowledge and practice in primary care. Using qualitative data from four comparative case studies, we discuss how an established intra-professional division of labour within medicine—between clinical geneticists and GPs—was opened, negotiated and reclosed in these sites. We discuss the contrasting attitudes towards the nature of genetics knowledge and its application of GPSIs and geneticists, and how these were used to advance conflicting visions of what the nascent GPSI role should involve. In particular, we show how the claims to knowledge of geneticists and GPSIs interacted with wider policy pressures to produce a rather more conservative redistribution of power and responsibility across the intra-professional boundary than the rhetoric of modernization might suggest

Observatory/data centre partnerships and the VO-centric archive: The JCMT Science Archive experience

We present, as a case study, a description of the partnership between an observatory (JCMT) and a data centre (CADC) that led to the development of the JCMT Science Archive (JSA). The JSA is a successful example of a service designed to use Virtual Observatory (VO) technologies from the start. We describe the motivation, process and lessons learned from this approach.Comment: Accepted for publication in the second Astronomy & Computing Special Issue on the Virtual Observatory; 10 pages, 5 figure

In Defence of Modest Doxasticism About Delusions

Here I reply to the main points raised by the commentators on the arguments put forward in my Delusions and Other Irrational Beliefs (OUP, 2009). My response is aimed at defending a modest doxastic account of clinical delusions, and is articulated in three sections. First, I consider the view that delusions are in-between perceptual and doxastic states, defended by Jacob Hohwy and Vivek Rajan, and the view that delusions are failed attempts at believing or not-quite-beliefs, proposed by Eric Schwitzgebel and Maura Tumulty. Then, I address the relationship between the doxastic account of delusions and the role, nature, and prospects of folk psychology, which is discussed by Dominic Murphy, Keith Frankish, and Maura Tumulty in their contributions. In the final remarks, I turn to the continuity thesis and suggest that, although there are important differences between clinical delusions and non-pathological beliefs, these differences cannot be characterised satisfactorily in epistemic terms. \u

True play attitudes and behaviors in intercollegiate athletes : a thesis ...

This thesis investigated the attitudes and the behaviors in the main sport environment of 53 intercollegiate athletes. Two instruments were developed, administered, and combined to give three measures of the true play characteristics of the subjects who were members of the men\u27s golf, men\u27s basketball, men\u27s tennis, women\u27s basketball, women\u27s tennis and women\u27s volleyball teams at the University of the Pacific. Results were determined by using the Statistical Package for the Social Sciences: Update 7-9. ANOVA and Scheffe\u27s post hoc test revealed, at the .05 level, that female athletes scored higher in true play characteristics than did male athletes; that star athletes scored higher in true play characteristics than did regular and substitute athletes; and that the sport of volleyball scored higher in true play characteristics than did the sport of golf

Modelling the causes and consequences of perceptions of personal safety on public transport ridership

Fears about personal safety on public transport can have an important impact on ridership. A range of studies have examined different factors that influence perceptions of crime risk. This study uses structural equation modelling to explore the influences on perceptions of safety on public transport and the impact these perceptions have on ridership using a survey sample from Melbourne, Australia. The largest direct influences on feelings of safety on public transport were trust in others and feeling safe in one’s home or on the street at night. Gender and age are commonly-cited influences in the literature but in this model their influence on feelings of safety was indirect. The total indirect effect of age was larger than the indirect effect of gender. Feelings of safety had a small but significant positive influence on how frequently people used public transport. This was slightly smaller than the negative effect of cars in the household but larger than the negative effect of distance from the city centre

Exploring Priorities in Transit Scheduling Between Small and Large Bus Companies

This research paper explores the relative importance of strategic and tactical objectives during the crew scheduling and rostering process between smaller and larger bus companies via a survey of bus companies in Victoria, Australia. Results indicate that larger bus companies emphasise reduced labour cost through maximising their operational efficiency. They acknowledge the importance of keeping their customers satisfied and to a lesser extent their drivers, however, doing so is not as important as it is to smaller organisations. Whilst reducing labour cost plays an important role to small bus companies their main focus is maximising customer service levels. To a lesser extent keeping their drivers satisfied is also important, however, in both cases smaller companies are willing to sacrifice labour cost and operational efficiencies to ensure these two objectives are met.A modelling exercise was undertaken to determine the impacts of applying large company priorities to small bus operators. The key strategic objective applied during this process was reducing labour cost whilst at an operational level maximising the use of on-road meal break locations and reducing meal breaks during peak periods were the focus. As anticipated in both cases the labour costs were reduced (by between 1.5% and 13.3%). Dead running distances increased in both cases, however, these would have a minor impact on overall operating costs savings.The results of both this survey and subsequent modelling have implications for both research and practice. Research in the area of crew scheduling and rostering for smaller companies has been quite limited. Most literature has focussed primarily on the objectives of larger companies. Implications for future research and practice are identified.1. Introductio

The Relative Priority of Personal Safety Concerns for Young People on Public Transport

This paper presents the results of a survey of young people concerning personal safety and public transport. Previous research suggests concerns amongst public transport users in general with regarding personal safety issues. Young people are highly dependent on public transport and tend to travel at times (evenings) and locations (fringe areas) where personal safety issues are more prevalent. Research on young people shows that young women, migrant teenagers and homosexual youth have more concerns about personal safety then other groups. Concerns about use of rail and waiting at stations is also highlighted in the literature.A web based survey of 239 young people aged 18-25 explored experience of personal safety issues on public transport in Melbourne, Australia. Analysis explored the relative priorities which young people have about personal safety compared to other public transport issues. Results suggest that personal safety issues are not as highly rated as concerns about service levels (frequency and availability). Nevertheless personal safety in general and personal safety at night in particular was considered to be very important to young people but to have only medium to high performance.Using public transport at night and waiting at rail stations was considered to be the most dangerous aspects of public transport use amongst the sample. Interestingly travelling on train was not rated as a significantly high issue which contrasts somewhat with results from previous research. The survey also found high concerns about passengers influenced by alcohol. The highest ratings for measures to address personal safety concerns involved the presence of security guards on stations and trains. Emergency/panic buttons, better lighting and measures to ban intoxicated passengers were also highly rated