Derivation and Validation of a General Predictive Model for Long Term Risks for Mortality and Invasive Cardiovascular Interventions in Congenital Heart Disease

Introduction. Accurate assessment of prognosis is a key driver of clinical decision making in congenital heart disease (CHD), but is complicated because CHD represents such a diverse collection of conditions. The aim of this investigation is to derive, validate, and calibrate multivariable predictive models for time to surgical or catheter-mediated intervention (INT) in CHD and for time to death in CHD. Methods. 4108 unique subjects were prospectively and consecutively enrolled, and randomized to derivation and validation cohorts. Total follow up was 26,578 patient-years, with 102 deaths and 868 INTs. Accelerated failure time multivariable predictive models for the outcomes, based on primary and secondary diagnoses, pathophysiologic severity, age, gender, genetic comorbidities, and prior interventional history, were derived using piecewise exponential methodology. The model predictions were validated, calibrated, and evaluated for sensitivity to changes in the independent variables. Results. Model validity was excellent for prediction of both mortality and INT at 4 months, 1 year, 5 years, 10 years, and 22 years (areas under receiver operating characteristic curves ranged from 0.809 to 0.919), and predictions calibrated well with observed outcomes. Although age, gender, secondary diagnoses, and genetic comorbidities were significant independent contributors to the survival and/or freedom from intervention models, predicted outcomes were most sensitive to variations in a composite predictor incorporating primary diagnosis, pathophysiologic severity, and history of prior intervention. An active cohort effect is identified in which predicted mortality and intervention both increased throughout the 22 years of study. Conclusions. Time to INT and time to death in CHD can be predicted with accuracy based on clinical variables. The objective predictions available through these models could educate both patient and provider, and inform clinical decision making in CHD

Profiles of union workplace representatives : evidence from three unions in SW England

As part of a larger research project the authors are examining union responses to workplace and corporate organisational change in the South West of England. This study has concentrated on three unions, the MSF, GMB and AEEU, and has comprised over 100 interviews of workplace representatives from the three unions conducted between 1998 and 2000 throughout the region across a representative range of industrial sectors. A complement to this qualitative research has been analysis of 356 questionnaire returns, concentrating on workplace union changes as well as profiles of the representatives and stewards themselves. Of particular interest have been the personal profiles of workplace representatives and their interaction with members. It is this data which is presented with some commentary in this Research Note

Employee representation and partnership in the non-union sector: a paradox of intention?

Non-union forms of employee representation have become increasingly prominent in UK workplaces in the last 15 years. In addition, partnership working has been encouraged by New Labour, the Chartered Institute of Personnel and Development, the Confederation of British Industry and the TUC as a route to higher commitment and higher individual and organisational performance. These trends have been further encouraged by recent European Union legislation. This article seeks to examine the implied linkages between non-union employee representative mechanisms and partnership working and their influence on the effectiveness of employee voice as a conduit of high performance. The article is based on a case study organisation from within the UK finance sector, and data are drawn from semistructured interviews with managers and staff and a survey of employee attitudes. The article concludes that employers’ attempts to utilise a non-union partnership framework for organisational gain are severely constrained by structural limitations on effective employee voice

Partnership with and without trade unions in the UK financial services: filling or fuelling the representation gap?

Partnership theory proposes that an appropriate integration of direct and indirect employee participation mutually benefits workers and company. This study explores the putative employee voice gains and the risks for union effectiveness by comparing employees' evaluation of partnership practices at two financial service companies with nonunion and union employee representation respectively

Partnership, high performance work systems and quality of working life

The paper measures the effects of workplace partnership and selected high performance work practices on four different dimensions of employee experience. Whilst the partnership– high performance work systems nexus seems to have little impact on employees’ job satisfaction or sense of attachment, it does, however, have a negative impact on both workplace stress and employee evaluations of union performance. The analysis thus questions common assumptions about the inevitability of ‘mutual gain’ and the necessity of employer/union partnership

Best value and workplace partnership in local government

Purpose – This paper explores employee experiences concerning job security/insecurity, workload, job satisfaction and employee involvement in the aftermath of Best Value reviews in a local authority. Design/methodology/approach – Using a mix of quantitative and qualitative data collection techniques employees’ experiences of Best Value reviews in a local authority are compared and contrasted with council staff employed elsewhere in the authority to establish the extent to which workplace partnership principles have taken hold under a Best Value regime. Findings – Little evidence of positive outcomes was found from partnership at work under a Best Value regime. The constraints imposed by central government, under which managers in the public sector operate, contributed significantly to partnership at work remaining little more than a hollow shell. Originality/value – This paper provides a recent in-depth case study of the experience of workplace partnership, which was developed not discrete from but as part of the Best Value modernisation programme in a local authority

Innate Chemical Resistance of Virginia Big-eared Bats (Corynorhinus townsendii virginianus) to White-Nose Syndrome

White-nose Syndrome (WNS) is an emergent epidemic disease of bats in North America. Caused by the novel fungal pathogen Pseudogymnoascus destructans, with a mortality rate of \u3e75%, in the last decade WNS has led to the local extinction of numerous bat species. Despite this high mortality, one species, the Virginia big-eared bat (Corynorhinus townsendii virginianus) remains unaffected. Virginia big-eared bats (VBEs) are commonly found covered in a yellow, oily substance, with a pelage commensal population dominated by the yeast, Debaryomyces udenii. As D. udenii is an oleaginous yeast that produces yellow colonies, the fungus may be responsible for the production of this oily substance on bats. In order to test this, 54 swab samples from the pelage of various bat species, including VBEs, were collected, along with cultures of D. udenii and the control yeast Saccharomyces cerevisiae. These samples were extracted using the Bligh and Dyer lipid extraction method and reversed-phase lipid chromatography to identify shared lipid metabolites. The data demonstrated that only a handful of lipids were unique to D. udenii (compared to S. cerevisae), and only seven of these lipid candidates were found on VBE pelage extracts. Instead of indicating that D. udenii was responsible for the production of the yellow material, our data suggests that the yellow material on bats is selecting for the presence of this yeast, possibly over filamentous fungi. VBEs have large pararhinal glands, our hypothesis is that the material produced by these glands might be anti-fungal, selecting against the growth of filamentous fungi

Teamworking and Lean revisited: a reply to Carter et al

This paper is a reply to Carter et al.’s response to an earlier paper of ours in this journal on the subject of teamworking under Lean in the UK public services . Our reply covers the following issues which Carter et al. have raised: the literature we used to structure our findings; the way in which we used concepts such as autonomy and teamworking; our research methods and approach; how Carter et al.’s newly available data on teamworking might be interpreted; and how data drawn from an official employee attitude survey might best be understood. On the basis of this, we conclude that Carter et al.’s paper fails to meet its objectives. On some things, the authors are simply wrong; on others, they grossly misrepresent our position; on still others, their interpretations are, at best, highly questionable