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.

A future dynamically reconfigurable automotive software system

Embedded software systems in vehicles are of rapidly increasing commercial importance for the automotive industry. Current systems employ a static run-time environment; due to the difficulty and cost involved in the development of dynamic systems in a high-integrity embedded control context. A dynamic system, referring to the system configuration, would greatly increase the flexibility of the offered functionality and enable customised software configuration for individual vehicles, adding customer value through plug-and-play capability, and increased quality due to its inherent ability to adjust to changes in hardware and software. We envisage an automotive system containing a variety of components, from a multitude of organizations, not necessarily known at development time. The system dynamically adapts its configuration to suit the run-time system constraints. This paper presents our vision for future automotive control systems that will be regarded in an EU research project, referred to as DySCAS (Dynamically Self-Configuring Automotive Systems). We propose a self-configuring vehicular control system architecture, with capabilities that include automatic discovery and inclusion of new devices, self-optimisation to best-use the processing, storage and communication resources available, self-diagnostics and ultimately self-healing. Such an architecture has benefits extending to reduced development and maintenance costs, improved passenger safety and comfort, and flexible owner customisation. Specifically, this paper addresses the following issues: The state of the art of embedded software systems in vehicles, emphasising the current limitations arising from fixed run-time configurations; and the benefits and challenges of dynamic configuration, giving rise to opportunities for self-healing, self-optimisation, and the automatic inclusion of users’ Consumer Electronic (CE) devices. Our proposal for a dynamically reconfigurable automotive software system platform is outlined and a typical use-case is presented as an example to exemplify the benefits of the envisioned dynamic capabilities.

Future Selves: Career choices of young disabled people

There is growing recognition that gaining the views of young people is crucial for understanding issues that affect their lives. However, to date, very little is known about the way in which disabled children, make sense of their identities, and create a sense of their past and their imagined futures over time. This three year study, funded by the European Social Fund, and conducted by Dr Sonali Shah and colleagues at the University of Nottingham, used various methods to explore how physically disabled students, in full-time special or mainstream education, make choices concerning their occupational futures. It identified the factors that shape their educational and career related choices and chances, and explored how social relations, social processes, and social policies influenced the extent to which their aspirations were achieved. This study presents disabled children and young people as critical social actors who are telling their own stories of how social structures and processes shape their choices and aspirations for their future selves. It illustrates the importance of consulting children and young people about issues concerning their lives, and not rely solely on adults’ conceptions of childhood. The young disabled people’s experiences and views can be used to develop a new flexible system which offers the benefits of mainstream and special education, and facilitates young disabled people’s self-determination to make choices to participate in and contribute to their independent futures.

Reproductive decisions of couples living with HIV in Malawi: What can we learn for future policy and research studies?

Background The rapid scale-up of free antiretroviral therapy has lead to decline in adult mortality at the population level and reduction of vertical transmission. Consequently, some couples living with HIV are maintaining their reproductive decisions; marrying and having children. This paper analyses policies and guidelines on HIV, AIDS and sexual and reproductive health in Malawi for content on marriage and childbearing for couples living with HIV. Methods A qualitative study using interpretive policy analysis approach was conducted from July to December 2010 in two phases. First, data on access to HIV, AIDS and sexual and reproductive health services were collected using in-depth interviews with twenty couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa communities. Secondly, data were collected from Malawi policies and guidelines on HIV, AIDS and sexual and reproductive health. The documents were reviewed for content on marriage and childbearing for couples living with HIV. Data were analysed using framework approach for applied policy analysis. Results Four categories emerged from each phase. From the study, we extracted health workers attitudes, weak linkage between HIV, AIDS and sexual and reproductive health services, contradictory messages between media and the hospitals and lack of information as factors directly related to guidelines and policies. Analysis of guidelines and policies showed nonprescriptiveness on issues of HIV, AIDS and reproduction: they do not reflect the social cultural experiences of couples living with HIV. In addition, there is; lack of clinical guidelines, external influence on adoption of the policies and guidelines and weak linkages between HIV and AIDS and sexual and reproductive health services. Conclusion This synthesis along with more detailed findings which are reported in other published articles, provide a strong basis for updating the policies and development of easy-to-follow guidelines in order to effectively provide services to couples living with HIV in Malawi.

Pressure management in water distribution systems: current status, proposals, and future trends

Pressure management (PM) is commonly used in water distribution systems (WDSs). In the last decade, a strategic objective in the field has been the development of new scientific and technical methods for its implementation. However, due to a lack of systematic analysis of the results obtained in practical cases, progress has not always been reflected in practical actions. To address this problem, this paper provides a comprehensive analysis of the most innovative issues related to PM. The methodology proposed is based on a case-study comparison of qualitative concepts that involves published work from 140 sources. The results include a qualitative analysis covering four aspects: (1) the objectives yielded by PM; (2) types of regulation, including advanced control systems through electronic controllers; (3) new methods for designing districts; and (4) development of optimization models associated with PM. The evolution of the aforementioned four aspects is examined and discussed. Conclusions regarding the current status of each factor are drawn and proposals for future research outlined

Irish state infrastructural investment: an analysis of past patterns, and an outline of a future integrated systems of systems evaluation methodology

The literature clearly links the quality and capacity of a country’s infrastructure to its economic growth and competitiveness. This thesis analyses the historic national and spatial distribution of investment by the Irish state in its physical networks (water, wastewater and roads) across the 34 local authorities and examines how Ireland is perceived internationally relative to its economic counterparts. An appraisal of the current status and shortcomings of Ireland’s infrastructure is undertaken using key stakeholders from foreign direct investment companies and national policymakers to identify Ireland's infrastructural gaps, along with current challenges in how the country is delivering infrastructure. The output of these interviews identified many issues with how infrastructure decision-making is currently undertaken. This led to an evaluation of how other countries are informing decision-making, and thus this thesis presents a framework of how and why Ireland should embrace a Systems of Systems (SoS) methodology approach to infrastructure decision-making going forward. In undertaking this study a number of other infrastructure challenges were identified: significant political interference in infrastructure decision-making and delivery the need for a national agency to remove the existing ‘silo’ type of mentality to infrastructure delivery how tax incentives can interfere with the market; and their significance. The two key infrastructure gaps identified during the interview process were: the need for government intervention in the rollout of sufficient communication capacity and at a competitive cost outside of Dublin; and the urgent need to address water quality and capacity with approximately 25% of the population currently being served by water of unacceptable quality. Despite considerable investment in its national infrastructure, Ireland’s infrastructure performance continues to trail behind its economic partners in the Eurozone and OECD. Ireland is projected to have the highest growth rate in the euro zone region in 2015 and 2016, albeit that it required a bailout in 2010, and, at the time of writing, is beginning to invest in its infrastructure networks again. This thesis proposes the development and implementation of a SoS approach for infrastructure decision-making which would be based on: existing spatial and capacity data of each of the constituent infrastructure networks; and scenario computation and analysis of alternative drivers eg. Demographic change, economic variability and demand/capacity constraints. The output from such an analysis would provide valuable evidence upon which policy makers and decision makers alike could rely, which has been lacking in historic investment decisions.

Privacy matters: issues within mechatronics

As mechatronic devices and components become increasingly integrated with and within wider systems concepts such as Cyber-Physical Systems and the Internet of Things, designer engineers are faced with new sets of challenges in areas such as privacy. The paper looks at the current, and potential future, of privacy legislation, regulations and standards and considers how these are likely to impact on the way in which mechatronics is perceived and viewed. The emphasis is not therefore on technical issues, though these are brought into consideration where relevant, but on the soft, or human centred, issues associated with achieving user privacy.

FROM CONTAGION TO ISOLATION: THE INSISTENT DYSTOPIAN FUTURE IN THE RAG DOLL PLAGUES AND SLEEP DEALER

This essay proposes a discussion on the insistence of a dystopian future and the attempt to get away from it in the novel The Rag Doll Plagues, by Alejandro Morales, and in the movie Sleep Dealer, by Alex Rivera. Through the union of the nationalities that constitute the NAFTA in Morales’s novel, and through the isolation proposed in Rivera’s movie, both works depict a time that faces serious inequality issues. Discussions about science fiction, posthumanism and alternative modernities will be taken into account to analyze the need of thinking about other ways of transgression in order to change our present.