New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

A local view of factors influencing patient choice

This report aims to deliver a local view on factors likely to influence Patient Choice. The findings represent coverage in selected parts of the Bedfordshire and the immediate surrounding counties. There were 22 GP practices and 29 GPs interviewed using quantitative and qualitative research methods. In addition, 11 patients falling under Bedfordshire and Heartlands PCT completed a questionnaire enabling a like-for-like comparison against the completed GP surveys. Variations existed in the quantitative findings between GP and patient expectations, with a pragmatic approach taken by GPs, believing waiting times and locality would be the key driving forces influencing Patient Choice of provider for elective surgery. In contrast, patients considered reputation or expertise to be far more important along with a clean and comfortable environment. Interviews with GPs highlighted further key points: • 78% of GPs refer 90% or more patients to the local hospital in the same county. The main reasons attributed to this is local hospital/close proximity followed by offering specialty and PCT contract. • If provided with greater choice, 68% of GPs said they were happy with the existing providers and would continue supporting local services. When probed on what criteria will be used to choose between future providers, reputation/specialty was the most commonly mentioned factor at 32% followed by local services at 29% and waiting list at 19%. Moreover, supporting comments demonstrated; i) A reluctance to use alternative trusts for specialties when little information existed. A few GPs commented on the relationship which had been established over many years and would be difficult to replicate under Patient Choice. ii) Many patients were perceived to be inadequate at making sense of such data on specialties and consultants; it was commented that disseminating such data would lead to confusion, incorrect decision making and ultimately a waste of time with the end approval returning to GPs. • The results of GP authority on patients was reaffirmed with many considering the desired empowering effect of giving choice to patients will fail to materialise. Just under half the GPs surveyed said Patient Choice will have no impact with under a third stating it will have a negative impact on patients. There was a consensus amongst GPs and patients alike on the potential influencing power of GPs on Patient Choice. However, the patient results revealed that hospital performance report, reputation of hospital/media reports and recommendation of GP or other health professional were of equal importance, ranking at third place. This may due to a biased sample coming from an Expert Patient group. Impact on GPs was assessed with 57% of practices believing Patient Choice will have negative repercussions with the booking system seen as extra work, taking time away from the allotted 10 minute consultation and once again returning to not knowing who the patient is being referred too. Overall, marketing in the NHS was seen as a good idea providing it served an informative purpose. It was interesting to observe the initial responses being negative followed by conditional positives. The idea around marketing serving to disseminate knowledge were supported with suggestions such as providing information on trusts, specialist units and consultants along with information on spare capacity and waiting times. Only 5% of practices surveyed said that marketing material would have a negative effect. The majority, 57% commented it would have a positive effect by raising awareness. GPs are happy to use local services with comparably short waiting times where good specialties are offered. If a trust has these offerings now and is able to continue with these offerings once Patient Choice has been launched in December 2005, minimal changes can be ex

A review of patient choice in the NHS

By December 2005 National Health Service (NHS) patients who may require elective surgery will be offered a choice of four to five hospitals at the referral stage, as part of the government’s vision for a responsive, patient-centric health service. The Healthcare Management Research Group of Cranfield Postgraduate Medical School has been working with Bedford Hospital NHS Trust to evaluate the possible implications of patient choice, and this document provides an overview of the current situation and predicted changes. During February and March 2004 a number of meetings were held with key NHS stakeholders, including Strategic Health Authorities (SHAs), Primary Care Trusts (PCTs) and General Practitioners (GPs) in Bedfordshire, Hertfordshire, Cambridgeshire, Huntingdonshire and Northamptonshire, and also the Department of Health in London. Conclusions from these interviews form the core of the research and are reinforced by a literature review of academic papers, news articles, books, government guidelines and opinion surveys. In particular, the process by which PCTs commission secondary care providers is assessed and the nine pilot schemes are evaluated. The Department of Health’s report on pilots also provides a valuable insight into the practicalities of offering choice. Lessons learned from healthcare systems around the world are compared with current policy in the NHS, and finally there is critique of the challenges to the implementation of ch

PCT commissioning under patient choice: implications for Bedford Hospital

Primary Care Trusts (PCTs) are responsible for commissioning secondary care for their local population, thus when patient choice comes into effect in December 2005 they will play a key role in choice by defining the four or five providers offered to GPs and patients for elective surgery. A broader overview on commissioning can be found in Cranfield University's report 'A Review of Patient Choice in the NHS' but the purpose of this document is to explain changes to the commissioning process under choice and the effect these might have on trusts. The Healthcare Management Research Group of Cranfield Postgraduate Medical School has been working with Bedford Hospital NHS Trust to evaluate the possible implications of patient choice. During February and March 2004 a number of meetings were held with key NHS stakeholders, including Strategic Health Authorities (SHAs), Primary Care Trusts (PCTs) and General Practitioners (GPs) in Bedfordshire, Hertfordshire, Cambridgeshire, Huntingdonshire and Northamptonshire, and also the Department of Health in London. Conclusions from these interviews were supported by a literature review of academic papers, news articles, books, government guidelines and patient surveys. In particular, the process by which PCTs commission secondary care providers is assessed and the nine pilot schemes were evaluated. Department of Health guidelines have only been issued for choice at six months so most PCTs are concentrating on meeting the six month target and have not yet formulated a plan for choice at referral. A dominant theme that emerged was therefore one of uncertainty, hence PCTs' predictions for how they will run choice form the basis of this paper rather than definitive policies

A work breakdown structure that integrates different views in aircraft modification projects

The Work Breakdown Structure (WBS) defines the work scope of a project. The way a WBS is defined depends on the person and his/her viewpoint. The aircraft modification business carries out a great variety of projects. Although the core skills and tasks are similar, there are very few projects that are exact repetition of previous work. The reuse of information is difficult without a good structure to archive and manage project information. This paper presents an integrated WBS approach for managing the work scope in aircraft modification projects. The model is the result of an in-depth study and analysis of the working methods in an aircraft modification industrial company. This WBS is designed to incorporate the information needs and the views of the different functions involved in aircraft modification. It provides the structure for the reuse of information, such as cost and schedules, in the diverse range of aircraft modification projects. In this model, the top tiers of the WBS are configured from a pre-defined industry specific template. The lower tiers are defined with a flexible structure to support the different views of the knowledge users and providers in the project. The information need for all the life stages of the project is fully covered. The integrated WBS is being implemented in an enterprise wide computing solution that is used for cost estimating in the collaborating company. The same approach could be used to enhance knowledge reuse where there is a great diversity in project contracts

Optimising Translational Research Opportunities: A Systematic Review and Narrative Synthesis of Basic and Clinician Scientists' Perspectives of Factors Which Enable or Hinder Translational Research.

INTRODUCTION: Translational research is central to international health policy, research and funding initiatives. Despite increasing use of the term, the translation of basic science discoveries into clinical practice is not straightforward. This systematic search and narrative synthesis aimed to examine factors enabling or hindering translational research from the perspective of basic and clinician scientists, a key stakeholder group in translational research, and to draw policy-relevant implications for organisations seeking to optimise translational research opportunities. METHODS AND RESULTS: We searched SCOPUS and Web of Science from inception until April 2015 for papers reporting scientists' views of the factors they perceive as enabling or hindering the conduct of translational research. We screened 8,295 papers from electronic database searches and 20 papers from hand searches and citation tracking, identifying 26 studies of qualitative, quantitative or mixed method designs. We used a narrative synthesis approach and identified the following themes: 1) differing concepts of translational research 2) research processes as a barrier to translational research; 3) perceived cultural divide between research and clinical care; 4) interdisciplinary collaboration as enabling translation research, but dependent on the quality of prior and current social relationships; 5) translational research as entrepreneurial science. Across all five themes, factors enabling or hindering translational research were largely shaped by wider social, organisational, and structural factors. CONCLUSION: To optimise translational research, policy could consider refining translational research models to better reflect scientists' experiences, fostering greater collaboration and buy in from all types of scientists. Organisations could foster cultural change, ensuring that organisational practices and systems keep pace with the change in knowledge production brought about by the translational research agenda