Gestational diabetes mellitus and retinal microvasculature.

BACKGROUND: Small-vessel dysfunction may be an important consequence of chronic hyperglycemia. We examined the association between gestational diabetes mellitus (GDM), a state of transient hyperglycemia during pregnancy, and retinal microvascular changes in pregnant women at 26-28 weeks of pregnancy. METHODS: A total of 1136 pregnant women with singleton pregnancies were recruited during their first trimester at two major Singapore maternity hospitals in an on-going birth cohort study. Participants underwent an oral glucose tolerance test and retinal imaging at 26-28 weeks gestation (n = 542). We used the 1999 World Health Organization (WHO) criteria to define GDM: ≥7.0 mmol/L for fasting glucose and/or ≥7.8 mmol/L for 2-h post-glucose. Retinal microvasculature was measured using computer software (Singapore I Vessel Analyzer, SIVA version 3.0, Singapore Eye Research Institute, Singapore) from the retinal photographs. RESULTS: In a multiple linear regression model adjusting for age, ethnicity and maternal education, mothers with GDM had narrower arteriolar caliber (-1.6 μm; 95% Confidence Interval [CI]: -3.1 μm, -0.2 μm), reduced arteriolar fractal dimension (-0.01 Df; 95% CI: -0.02 Df, -0.001 Df;), and larger arteriolar branching angle (1.8°; 95% CI: 0.3°, 3.3°) than mothers without GDM. After further adjusting for traditional risks of GDM, arteriolar branching angle remained significantly larger in mothers with GDM than those without GDM (2.0°; 95% CI: 0.5°, 3.6°). CONCLUSIONS: GDM was associated with a series of retinal arteriolar abnormalities, including narrower caliber, reduced fractal dimension and larger branching angle, suggesting that transient hyperglycemia during pregnancy may cause small-vessel dysfunction

Shifting paradigms in human resource management while striving for service excellence in the tourism industry

Globalization has led the tourism industry to undergo radical changes, with an ideological shift toward embracing the customer-centric approach and discarding the traditional focus on profits. Tourism organizations need to fulfill the demands and expectations of customers by training staff to maintain service excellence. A strategic approach must ensure employees are engaged, recognized, innovative, trustworthy, and loyal, exhibiting innovation and enhanced performance. This conceptual study explores the paradigm shifts in tourism human-resource management, and highlights a strategic approach of integrating operational and cultural elements for achieving service excellence. The proposed Operational Integration and Cultural Integration (OICI) elucidates effective management of human resources to achieve service excellence. It highlights that the customers' power to choose has increased, as the quality of the overall experience is wholly based on perception and acts as a main differentiator in the competitive world. Hence there is a need for constantly innovative ways to enhance services' effectiveness through efficient utilization of human resources (employees). To achieve high performance and service excellence, organizations must constantly encourage and inspire their employees, and acknowledge their contribution. The OICI model's implementation can achieve organizational goals and lead to satisfied, delighted, and loyal customers

Experimental Results on a 1.5??MW, 110??GHz Gyrotron with a Smooth Mirror Mode Converter

We present an internal mode converter (IMC) design for a 1.5 MW, 110 GHz gyrotron operating in the TE(22,6) mode. The launcher, designed using the codes Surf3d and LOT, converts the cavity waveguide mode into a nearly pure Gaussian beam. The Gaussian beam output from the launcher is shaped by a series of 4 smooth, curved mirrors to provide a circular output beam with a flat phase front at the gyrotron window. By employing smooth mirrors rather than mirrors with phase correcting surfaces, such an IMC is less sensitive to alignment issues and can more reliably operate with high efficiency. The IMC performance was verified by both cold test and hot test experiments. Beam pattern measurements in each case were in good agreement with theoretical predictions. The output beam was of high quality with calculations showing that the Gaussian Beam content was 95.8 +/- 0.5% in both hot and cold test