Prognostic implications of surrogate markers of atherosclerosis in low to intermediate risk patients with type 2 diabetes.

published_or_final_versio

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe

GENDER, WORK AND ETHNICITY : AN ETHNOGRAPHY OF FEMALE FACTORY WORKERS IN SINGAPORE

Ph.DDOCTOR OF PHILOSOPH

Timing, Trust and Transparency: Wage Restructuring at Glaxosmithkline

The economic ups and downs since the eruption of the Asian crisis in 1997 had prompted a wave of restructurings and job losses in Singapore and several other Asian countries. As a response, policy-makers in the Singapore government had urged companies to undertake wage reforms and to adopt more flexible wages. The wage restructuring exercise undertaken by the Singapore office of Glaxo Smithkline, one of the largest pharmaceutical companies in the world, in 2002 is studied in this case. Since the merger of Glaxo Welcome and SmithKline Beecham two years earlier, there had been consolidation with the less efficient plants in the system closing down. Although the Singapore plants were performing well, the impetus to restructure wages came primarily from a more competitive internal and external environment. Management believed that the introduction of Performance Bonus (PB) would lead to improved metrics and was essential for the company to compete in the changed environment. While the Union leadership was in broad agreement that the plant needed to remain competitive, it had some initial misgivings about the proposals put forth by management. This case charts the process of the wage restructuring exercise, illustrating some of the challenges that companies may face in implementing wage restructuring initiatives. We also examine the impact of different factors, as well as the process of implementation, on the success of such initiatives.

Laparoscopic Cholecystectomy for Acute Cholecystitis: The Evolving Trend in an Institution

Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic cholecystolithiasis. Technical maturation and advances in instrumentation have enabled the application of this procedure for acute cholecystitis (AC). We review the evolving role of LC for AC in our institution. Methods: A retrospective study was conducted of patients who received LC for AC between January 1994 and June 2001. Patients' demographics, clinical findings and perioperative outcomes were evaluated. Results: There were 140 men and 141 women with a mean age of 56.9 years (range, 23-89 years). Two hundred and eighteen of these patients underwent successful LC. There were 63 conversions (22.4%) for uncertain anatomy and difficult dissection (41), gangrenous or perforated gallbladder (16) and bleeding (6). The conversion rates as stratified to surgeon's seniority were 25.1%, 22.8% and 9.7% for registrar, senior registrar and consultant, respectively. The mean operative time was 84.3 minutes (range, 30-255 minutes) and the mean postoperative stay was 5.8 days (range, 1-35 days). The overall complication rate was 11.6%, including two bile duct injuries and two perioperative deaths. Conclusion: LC for AC is safe and effective and associated with a low incidence of complications when routinely applied by surgical residents. The conversion rate is related to operators' surgical experience

The impact of the psychological contract, justice and individual differences: nurses take it personally when employers break promises

Aim: to explore affective and attitudinal outcomes of aspects of the psychological contract, organizational justice and negative affectivity in nursing. Background Job satisfaction, mental health and commitment to organizations and the nursing profession is important for nurse retention. The psychological contract and organizational justice are related constructs that have been linked to these outcomes, as has the characteristic of negative affectivity. Rarely have the relationships between these concepts and outcomes been examined. Design Cross-sectional data were collected during November, 2007. Method Survey data collected on Registered Nurses and midwives from a large metropolitan hospital in Australia (n = 193, after removing missing cases and outliers) were analysed using structural equation modelling. The model used self-report measures of psychological contract obligations, fulfilment and breach, organizational justice and negative affectivity as predictors of job satisfaction, organizational commitment, career commitment and psychological distress. Results Goodness-of-fit statistics confirmed a well-fitting model. The model explained 49%, 29%, 60% and 47% of the variance in psychological distress, job satisfaction, organizational commitment and career commitment respectively. Conclusion Findings support the influence of the psychological contract, fairness and individual differences on outcomes important to nurse retention. Keeping promises is more important than making promises that cannot be kept. The results support a discrepancy mechanism underlying fulfilment and breach. The impact of breach suggests that nurses take breach personally, whereas fulfilment may represent a global evaluation of discrepancies. Ultimately, fulfilling, rather than making promises, keeps nurses happy