What attributions do Australian high-performing general practices make for their success? Applying the clinical microsystems framework: a qualitative study

No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Objectives To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them. Design Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems. Setting Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations. Participants Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses. Results Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support. Conclusions Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision.The research reported in this article was funded by a grant from the Australian Government Department of Health

Genetic fine mapping and genomic annotation defines causal mechanisms at type 2 diabetes susceptibility loci.

We performed fine mapping of 39 established type 2 diabetes (T2D) loci in 27,206 cases and 57,574 controls of European ancestry. We identified 49 distinct association signals at these loci, including five mapping in or near KCNQ1. 'Credible sets' of the variants most likely to drive each distinct signal mapped predominantly to noncoding sequence, implying that association with T2D is mediated through gene regulation. Credible set variants were enriched for overlap with FOXA2 chromatin immunoprecipitation binding sites in human islet and liver cells, including at MTNR1B, where fine mapping implicated rs10830963 as driving T2D association. We confirmed that the T2D risk allele for this SNP increases FOXA2-bound enhancer activity in islet- and liver-derived cells. We observed allele-specific differences in NEUROD1 binding in islet-derived cells, consistent with evidence that the T2D risk allele increases islet MTNR1B expression. Our study demonstrates how integration of genetic and genomic information can define molecular mechanisms through which variants underlying association signals exert their effects on disease

Mentoring and the transfer of organizational memory within the context of an aging workforce : cultural implications for competitive advantage

Organizational memory, the knowledge gained from organizational experience, has significant potential for competitive advantage. Many authors in the knowledge management and human resource management literatures consider mentoring to be a particularly effective method of transferring organizational memory. In addition, older workers are often considered ideal mentors in organizations because of their experience and alleged willingness to pass on their knowledge to less experienced employees. There is an associated assumption that these workers also anticipate and experience positive outcomes when mentoring others. This chapter considers whether these assumptions hold up in the workplaces of the 21st century, particularly within Western countries. Individualistic cultural norms and some discriminatory practices towards older workers, along with a changing career contract that no longer guarantees employment in one organization for life, may discourage knowledge sharing in organizations. This chapter discusses the constraints and motivations that may operate when older experienced workers consider mentoring others. It considers relevant global and organizational cultural characteristics that may influence mentoring to transfer knowledge, and accordingly suggests strategies for those eager to capitalise on the knowledge experienced employees possess

Organizational memory and empowerment

Purpose – The aim of this paper is to test a model of the relationship between organizational memory and empowerment. The model posited that organizational memory would be related to requests to share knowledge, psychological empowerment in the workplace (meaning, competence, self-determination and impact), and organization-based self-esteem. Design/methodology/approach – The model was tested with 134 employees representing six companies using hierarchical regression analysis. Findings – Significant relationships were found between organizational memory and requests to share knowledge, empowerment, and organization-based self-esteem. Findings indicated that a positive stereotype may exist towards older workers and the frequency they are requested to share knowledge, and that a halo-type effect may operate, where knowledge of an organization\u27s history is generalized to other knowledge domains. Research limitations/implications – Causal implications cannot be made as this was correlational research. Some of the research measures while achieving acceptable to good reliability were in an early development stage. The study utilized a convenience sample that may limit how the results can be generalized. Practical implications – The paper indicates that organizations can emphasize positive outcomes for those who are knowledge repositories and mentors. It is also important to consider possible “positive stereotypes” which may be operating when organizational members evaluate older workers as knowledge repositories and mentors. Originality/value – The paper addresses the assumptions in the human resources literature concerning the role of older workers as repositories of organizational memory and suitable mentors. The study introduces the “requests to share knowledge scale”

The major genetic determinants of HIV-1 control affect HLA class I peptide presentation.

Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection

Genetic analysis of over 1 million people identifies 535 new loci associated with blood pressure traits

High blood pressure is a highly heritable and modifiable risk factor for cardiovascular disease. We report the largest genetic association study of blood pressure traits (systolic, diastolic and pulse pressure) to date in over 1 million people of European ancestry. We identify 535 novel blood pressure loci that not only offer new biological insights into blood pressure regulation but also highlight shared genetic architecture between blood pressure and lifestyle exposures. Our findings identify new biological pathways for blood pressure regulation with potential for improved cardiovascular disease prevention in the future

Rare Variant Analysis of Human and Rodent Obesity Genes in Individuals with Severe Childhood Obesity

Obesity is a genetically heterogeneous disorder. Using targeted and whole-exome sequencing, we studied 32 human and 87 rodent obesity genes in 2,548 severely obese children and 1,117 controls. We identified 52 variants contributing to obesity in 2% of cases including multiple novel variants in GNAS, which were sometimes found with accelerated growth rather than short stature as describedw previously. Nominally significant associations were found for rare functional variants in BBS1, BBS9, GNAS, MKKS, CLOCK and ANGPTL6. The p.S284X variant in ANGPTL6 drives the association signal (rs201622589, MAF∼0.1%, odds ratio = 10.13, p-value = 0.042) and results in complete loss of secretion in cells. Further analysis including additional case-control studies and population controls (N = 260,642) did not support association of this variant with obesity (odds ratio = 2.34, p-value = 2.59 × 10-3), highlighting the challenges of testing rare variant associations and the need for very large sample sizes. Further validation in cohorts with severe obesity and engineering the variants in model organisms will be needed to explore whether human variants in ANGPTL6 and other genes that lead to obesity when deleted in mice, do contribute to obesity. Such studies may yield druggable targets for weight loss therapies