'Transsexual' people in UK workplaces: an analysis of transsexual men's and transexual women's experiences

This thesis explores transsexual men’s and transsexual women’s experiences of UK workplaces. It investigates the mediation of visible/invisible gender-diversity/atypical gender-history, and the ways in which this influences trans-employees’ experiences of discrimination, protection, support, and inclusion/exclusion. Gender is discussed in terms of individual/interpersonal everyday experiences, and as macro societal institution/organizational regime dependent on the repetition of societally recognizable gendered signifiers and ‘expected’ practices. The study then goes on to examine business approaches to trans-employment equality, and responses to transfocussed/inclusive equality legislation. Poststructuralist and queer theory perspectives provided the theoretical framework for this research in order to interrogate and illuminate the research findings. The research focuses primarily on the self-reported experiences of individuals who identify as the sex-category opposite to the one ascribed at birth, regardless of their transition or employment status at the time of participation. This inclusion criteria was chosen because these individuals are the only gender-diverse sub-group to legally be afforded protection and potential gender-recognition. 106 trans-participants were recruited via a combination of snowball and convenience sampling to maximise the diversity of the sample. Quantitative and qualitative data was then collected via an anonymous asynchronous websurvey, which allowed participants to remain entirely anonymous, and participate at a time safe and convenient for them. Semi-structured interviews were also conducted with eight business representatives selected from lists of organizations reported to have a strong focus on equality and diversity. Businesses were contacted by email and telephone, and informants interviewed face-to-face or via telephone. All of the interviewees were de-identified from their responses to prevent legal and personal repercussions, and to avoid deterring participation. Notions of (in)visibility, visibility, and invisibility, are employed as conceptual tools through which to explore the extent to which one’s gender-diversity, including history, is visible or invisible to the present or absent onlooker (see also Rundall and Vecchietti 2010). (In)visible gender-diversity greatly impacts upon trans-employees’ workplace experiences, and the extent to which their ‘transness’ is perceived to be ‘palatable’ by cisgender onlookers, subsequently influencing the degree to which the trans-individual is othered. ‘Visibly’/‘knowably’ gender-diverse individuals face a significant threat of transphobic discrimination and ostracism, although some do successfully gain acceptance of their gender-identities, and receive support and inclusion. Significant variation was found between the experiences of trans men and trans women, and participants employed in different sectors. Legislation was shown to have impacted upon organizational approaches to trans-equality, particularly in relation to policy-provision. And yet, trans-equality continues to be viewed and constructed as subordinate to other more ‘dominant’/societally ‘valid’ equality-strands, and so is frequently denied investment. Thus, many businesses lack the knowledge and mechanisms needed to implement legislation and policies into day-to-day practices, which perpetuates trans as sous rature (under erasure). Through its focus, this thesis makes a contribution to both theoretical and practical knowledge surrounding: the doings/undoings of gender; identity constructions and related interpersonal and intertextual interactions; and the impact of medical, legal, and other dominant societal frameworks; in the UK employment sphere

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Analysis of small-diameter wood supply in northern Arizona - Final report

Forest management to restore fire-adapted ponderosa pine ecosystems is a central priority of the Southwestern Region of the USDA Forest Service. Appropriately-scaled businesses are apt to play a key role in achieving this goal by harvesting, processing and selling wood products, thereby reducing treatment costs and providing economic opportunities. The manner in which treatments occur across northern Arizona, with its multiple jurisdictions and land management areas, is of vital concern to a diversity of stakeholder groups. To identify a level of forest thinning treatments and potential wood supply from restoration byproducts, a 20-member working group representing environmental non-governmental organizations (NGOs), private forest industries, local government, the Ecological Restoration Institute at Northern Arizona University (NAU), and state and federal land and resource management agencies was assembled. A series of seven workshops supported by Forest Ecosystem Restoration Analysis (ForestERA; NAU) staff were designed to consolidate geographic data and other spatial information and to synthesize potential treatment scenarios for a 2.4 million acre analysis area south of the Grand Canyon and across the Mogollon Plateau. A total of 94% of the analysis area is on National Forest lands. ForestERA developed up-to-date remote sensing-based forest structure data layers to inform the development of treatment scenarios, and to estimate wood volume in three tree diameter classes of 16" diameter at breast height (dbh, 4.5' above base). For the purposes of this report, the group selected a 16" dbh threshold due to its common use within the analysis landscape as a break point differentiating "small" and "large" diameter trees in the ponderosa pine forest type. The focus of this study was on small-diameter trees, although wood supply estimates include some trees >16" dbh where their removal was required to meet desired post-treatment conditions.4 There was no concurrence within the group that trees over 16" dbh should be cut and removed from areas outside community protection management areas (CPMAs)..

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: A qualitative study of Kaiser Permanente

Background: Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited. Methods

Gravitating global monopoles in extra dimensions and the brane world concept

Multidimensional configurations with Minkowski external space-time and a spherical global monopole in extra dimensions are discussed in the context of the brane world concept. The monopole is formed with a hedgehog-like set of scalar fields \phi^i with a symmetry-breaking potential V depending on the magnitude \phi^2 = \phi^i \phi^i. All possible kinds of globally regular configurations are singled out without specifying the shape of V(\phi). These variants are governed by the maximum value \phi_m of the scalar field, characterizing the energy scale of symmetry breaking. If \phi_m < \phi_cr (where \phi_cr is a critical value of \phi related to the multidimensional Planck scale), the monopole reaches infinite radii while in the ``strong field regime'', when \phi_m\geq \phi_cr, the monopole may end with a cylinder of finite radius or possess two regular centers. The warp factors of monopoles with both infinite and finite radii may either exponentially grow or tend to finite constant values far from the center. All such configurations are shown to be able to trap test scalar matter, in striking contrast to RS2 type 5D models. The monopole structures obtained analytically are also found numerically for the Mexican hat potential with an additional parameter acting as a cosmological constant.Comment: 21 pages, 6 figures, latex, gc styl

Community capacity to acquire, assess, adapt, and apply research evidence: a survey of Ontario's HIV/AIDS sector

<p>Abstract</p> <p>Background</p> <p>Community-based organizations (CBOs) are important stakeholders in health systems and are increasingly called upon to use research evidence to inform their advocacy, program planning, and service delivery. To better support CBOs to find and use research evidence, we sought to assess the capacity of CBOs in the HIV/AIDS sector to acquire, assess, adapt, and apply research evidence in their work.</p> <p>Methods</p> <p>We invited executive directors of HIV/AIDS CBOs in Ontario, Canada (n = 51) to complete the Canadian Health Services Research Foundation's "Is Research Working for You?" survey.</p> <p>Findings</p> <p>Based on responses from 25 organizations that collectively provide services to approximately 32,000 clients per year with 290 full-time equivalent staff, we found organizational capacity to acquire, assess, adapt, and apply research evidence to be low. CBO strengths include supporting a culture that rewards flexibility and quality improvement, exchanging information within their organization, and ensuring that their decision-making processes have a place for research. However, CBO Executive Directors indicated that they lacked the skills, time, resources, incentives, and links with experts to acquire research, assess its quality and reliability, and summarize it in a user-friendly way.</p> <p>Conclusion</p> <p>Given the limited capacity to find and use research evidence, we recommend a capacity-building strategy for HIV/AIDS CBOs that focuses on providing the tools, resources, and skills needed to more consistently acquire, assess, adapt, and apply research evidence. Such a strategy may be appropriate in other sectors and jurisdictions as well given that CBO Executive Directors in the HIV/AIDS sector in Ontario report low capacity despite being in the enviable position of having stable government infrastructure in place to support them, benefiting from long-standing investment in capacity building, and being part of an active provincial network. CBOs in other sectors and jurisdictions that have fewer supports may have comparable or lower capacity. Future research should examine a larger sample of CBO Executive Directors from a range of sectors and jurisdictions.</p

Effects of an evidence service on community-based AIDS service organizations' use of research evidence: A protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>To support the use of research evidence by community-based organizations (CBOs) we have developed 'Synthesized HIV/AIDS Research Evidence' (SHARE), which is an evidence service for those working in the HIV sector. SHARE consists of several components: an online searchable database of HIV-relevant systematic reviews (retrievable based on a taxonomy of topics related to HIV/AIDS and open text search); periodic email updates; access to user-friendly summaries; and peer relevance assessments. Our objective is to evaluate whether this 'full serve' evidence service increases the use of research evidence by CBOs as compared to a 'self-serve' evidence service.</p> <p>Methods/design</p> <p>We will conduct a two-arm randomized controlled trial (RCT), along with a follow-up qualitative process study to explore the findings in greater depth. All CBOs affiliated with Canadian AIDS Society (n = 120) will be invited to participate and will be randomized to receive either the 'full-serve' version of SHARE or the 'self-serve' version (a listing of relevant systematic reviews with links to records on PubMed and worksheets that help CBOs find and use research evidence) using a simple randomized design. All management and staff from each organization will be provided access to the version of SHARE that their organization is allocated to. The trial duration will be 10 months (two-month baseline period, six-month intervention period, and two month crossover period), the primary outcome measure will be the mean number of logins/month/organization (averaged across the number of users from each organization) between baseline and the end of the intervention period. The secondary outcome will be intention to use research evidence as measured by a survey administered to one key decision maker from each organization. For the qualitative study, one key organizational decision maker from 15 organizations in each trial arm (n = 30) will be purposively sampled. One-on-one semi-structured interviews will be conducted by telephone on their views about and their experiences with the evidence service they received, how helpful it was in their work, why it was helpful (or not helpful), what aspects were most and least helpful and why, and recommendations for next steps.</p> <p>Discussion</p> <p>To our knowledge, this will be the first RCT to evaluate the effects of an evidence service specifically designed to support CBOs in finding and using research evidence.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01257724">NCT01257724</a></p