Disaster resilience in tertiary hospitals : a cross-sectional survey in Shandong Province, China

Background: Hospital disaster resilience can be defined as a hospital’s ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China. Methods: A stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies. Results: A response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a ‘portable hospital’ function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%. Conclusions: This study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas.

The development of an intervention to promote the capacity to wait in children with intellectual disability

Aim: Individuals with intellectual disability (ID) often have difficulty with waiting, an important aspect of everyday life. Successful waiting require cognitive, emotional and behavioural self-regulation, and is an essential element in the capacity to delay gratification. Method: We developed an intervention to provide parents with the knowledge and strategies to promote their child’s capacity to wait. The intervention was grounded in previous work about the skills underpinning successful waiting, such as goal-setting, understanding time, and managing frustration. Eleven parents of children with ID (mean CA 9.4 years; mean MA 47 months) participated in an intervention trial. Following pre-testing of their child’s capacity to wait and delay gratification, parents attended a 1 day workshop that was followed by monthly phone discussions with the researchers to monitor progress and provide advice. Post-testing was undertaken 1 year later. Results: Compared with a wait-listed control group, children whose parents had completed the intervention displayed significant improvements in their capacity to wait on a delay of gratification task. Parents reported that their child had become more successful in everyday waiting situations. Conclusion: The results of this pilot study are promising and pave the way for larger-scale interventions to improve self-regulatory skills in people with ID.

Carbon nanotube membranes with ultrahigh specific adsorption capacity for water desalination and purification

Development of technologies for water desalination and purification is critical to meet the global challenges of insufficient water supply and inadequate sanitation, especially for point-of-use applications. Conventional desalination methods are energy and operationally intensive, whereas adsorption-based techniques are simple and easy to use for point-of-use water purification, yet their capacity to remove salts is limited. Here we report that plasma-modified ultralong carbon nanotubes exhibit ultrahigh specific adsorption capacity for salt (exceeding 400% by weight) that is two orders of magnitude higher than that found in the current state-of-the-art activated carbon-based water treatment systems. We exploit this adsorption capacity in ultralong carbon nanotube-based membranes that can remove salt, as well as organic and metal contaminants. These ultralong carbon nanotube-based membranes may lead to next-generation rechargeable, point-of-use potable water purification appliances with superior desalination, disinfection and filtration properties. © 2013 Macmillan Publishers Limited.

“Best interests” and withholding and withdrawing life-sustaining treatment from an adult who lacks capacity in the parens patriae jurisdiction

Disputes about withholding and withdrawing life-sustaining treatment are increasingly coming before Australian Supreme Courts. Such cases are generally heard in the parens patriae jurisdiction where the test applied is what is in the patient’s “best interests”. However, the application of the “best interests” test, and its meaning, remains unclear in this context. To shed light on this emerging body of jurisprudence, this article analyses the Australian superior court decisions that consider an adult’s best interests in the context of decisions about life-sustaining treatment. We identify a number of themes from the current body of cases and consider how these themes may guide future decision-making. After then considering the law in the United Kingdom, we suggest an approach for assessing best interests that could be adopted by Australian Supreme Courts. We argue that the suggested approach will lead to a more structured and systematic decision-making process that better promotes the best interests of the patient.

Effect of hydrophilicity of carbon nanotube arrays on the release rate and activity of recombinant human bone morphogenetic protein-2

Novel nanostructures such as vertically aligned carbon nanotube (CNT) arrays have received increasing interest as drug delivery carriers. In the present study, two CNT arrays with extreme surface wettabilities are fabricated and their effects on the release of recombinant human bone morphogenetic protein-2 (rhBMP-2) are investigated. It is found that the superhydrophilic arrays retained a larger amount of rhBMP-2 than the superhydrophobic ones. Further use of a poloxamer diffusion layer delayed the initial burst and resulted in a greater total amount of rhBMP-2 released from both surfaces. In addition, rhBMP-2 bound to the superhydrophilic CNT arrays remained bioactive while they denatured on the superhydrophobic surfaces. These results are related to the combined effects of rhBMP-2 molecules interacting with poloxamer and the surface, which could be essential in the development of advanced carriers with tailored surface functionalities.

Management of a high grade pan stage schedule to reduce the steam consumption

MOST PAN stages in Australian factories use only five or six batch pans for the high grade massecuite production and operate these in a fairly rigid repeating production schedule. It is common that some of the pans are of large dropping capacity e.g. 150 to 240 t. Because of the relatively small number and large sizes of the pans, steam consumption varies widely through the schedule, often by ±30% about the mean value. Large fluctuations in steam consumption have implications for the steam generation/condensate management of the factory and the evaporators when bleed vapour is used. One of the objectives of a project to develop a supervisory control system for a pan stage is to (a) reduce the average steam consumption and (b) reduce the variation in the steam consumption. The operation of each of the high grade pans within the schedule at Macknade Mill was analysed to determine the idle (or buffer) time, time allocations for essential but unproductive operations (e.g. pan turn round, charging, slow ramping up of steam rates on pan start etc.), and productive time i.e. the time during boil-on of liquor and molasses feed. Empirical models were developed for each high grade pan on the stage to define the interdependence of the production rate and the evaporation rate for the different phases of each pan’s cycle. The data were analysed in a spreadsheet model to try to reduce and smooth the total steam consumption. This paper reports on the methodology developed in the model and the results of the investigations for the pan stage at Macknade Mill. It was found that the operation of the schedule severely restricted the ability to reduce the average steam consumption and smooth the steam flows. While longer cycle times provide increased flexibility the steam consumption profile was changed only slightly. The ability to cut massecuite on the run among pans, or the use of a high grade seed vessel, would assist in reducing the average steam consumption and the magnitude of the variations in steam flow.

High-rate, room temperature plasma-enhanced deposition of aluminum-doped zinc oxide nanofilms for solar cell applications

A custom-designed inductively coupled plasma (ICP)-assisted radio-frequency magnetron sputtering deposition system has been employed to synthesize aluminium-doped zinc oxide (ZnO:Al) nanofilms on glass substrates at room temperature. The effects of film thickness and ZnO target (partially covered by Al chips) power on the structural, electrical and optical properties of the ZnO:Al nanofilms are studied. A high growth rate (∼41 nm/min), low electrical sheet resistance (as low as 30 Ω/□) and high optical transparency (>80%) over the visible spectrum has been achieved at a film thickness of ∼615 nm and ZnO target power of 150 W. The synthesis of ZnO:Al nanofilms at room temperature and with high growth rates is attributed to the unique features of the ICP-assisted radio-frequency magnetron sputtering deposition approach. The results are relevant to the development of photovoltaic thin-film solar cells and flat panel displays.

High-rate, low-temperature synthesis of composition controlled hydrogenated amorphous silicon carbide films in low-frequency inductively coupled plasmas

It is commonly believed that in order to synthesize high-quality hydrogenated amorphous silicon carbide (a-Si1-xCx : H) films at competitive deposition rates it is necessary to operate plasma discharges at high power regimes and with heavy hydrogen dilution. Here we report on the fabrication of hydrogenated amorphous silicon carbide films with different carbon contents x (ranging from 0.09 to 0.71) at high deposition rates using inductively coupled plasma (ICP) chemical vapour deposition with no hydrogen dilution and at relatively low power densities (∼0.025 W cm -3) as compared with existing reports. The film growth rate R d peaks at x = 0.09 and x = 0.71, and equals 18 nm min-1 and 17 nm min-1, respectively, which is higher than other existing reports on the fabrication of a-Si1-xCx : H films. The extra carbon atoms for carbon-rich a-Si1-xCx : H samples are incorporated via diamond-like sp3 C-C bonding as deduced by Fourier transform infrared absorption and Raman spectroscopy analyses. The specimens feature a large optical band gap, with the maximum of 3.74 eV obtained at x = 0.71. All the a-Si1-xCx : H samples exhibit low-temperature (77 K) photoluminescence (PL), whereas only the carbon-rich a-Si1-xCx : H samples (x ≥ 0.55) exhibit room-temperature (300 K) PL. Such behaviour is explained by the static disorder model. High film quality in our work can be attributed to the high efficiency of the custom-designed ICP reactor to create reactive radical species required for the film growth. This technique can be used for a broader range of material systems where precise compositional control is required. © 2008 IOP Publishing Ltd.

Minimum cost of transport in human running is not ubiquitous

Purpose This study explores recent claims that humans exhibit a minimum cost of transport (CoTmin) for running which occurs at an intermediate speed, and assesses individual physiological, gait and training characteristics. Methods Twelve healthy participants with varying levels of fitness and running experience ran on a treadmill at six self-selected speeds in a discontinuous protocol over three sessions. Running speed (km[middle dot]hr-1), V[spacing dot above]O2 (mL[middle dot]kg-1[middle dot]km-1), CoT (kcal[middle dot]km-1), heart rate (beats[middle dot]min-1) and cadence (steps[middle dot]min-1) were continuously measured. V[spacing dot above]O2 max was measured on a fourth testing session. The occurrence of a CoTmin was investigated and its presence or absence examined with respect to fitness, gait and training characteristics. Results Five participants showed a clear CoTmin at an intermediate speed and a statistically significant (p < 0.05) quadratic CoT-speed function, while the other participants did not show such evidence. Participants were then categorized and compared with respect to the strength of evidence for a CoTmin (ClearCoTmin and NoCoTmin). The ClearCoTmin group displayed significantly higher correlation between speed and cadence; more endurance training and exercise sessions per week; than the NoCoTmin group; and a marginally non-significant but higher aerobic capacity. Some runners still showed a CoTmin at an intermediate speed even after subtraction of resting energy expenditure. Conclusion The findings confirm the existence of an optimal speed for human running, in some but not all participants. Those exhibiting a COTmin undertook a higher volume of running, ran with a cadence that was more consistently modulated with speed, and tended to be aerobically fitter. The ability to minimise the energetic cost of transport appears not to be ubiquitous feature of human running but may emerge in some individuals with extensive running experience.

Determination of battery storage capacity in energy buffer for wind farm

Design of a battery energy storage system (BESS) in a buffer scheme is examined for the purpose of attenuating the effects of unsteady input power from wind farms. The design problem is formulated as maximization of an objective function that measures the economic benefit obtainable from the dispatched power from the wind farm against the cost of the BESS. Solution to the problem results in the determination of the capacity of the BESS to ensure constant dispatched power to the connected grid, while the voltage level across the dc-link of the buffer is kept within preset limits. A computational procedure to determine the BESS capacity and the evaluation of the dc voltage is shown. Illustrative examples using the proposed design method are included.

Determination of strain-rate-dependent mechanical behavior of living and fixed osteocytes and chondrocytes using atomic force microscopy and inverse finite element analysis

The aim of this paper is to determine the strain-rate-dependent mechanical behavior of living and fixed osteocytes and chondrocytes, in vitro. Firstly, Atomic Force Microscopy (AFM) was used to obtain the force-indentation curves of these single cells at four different strain-rates. These results were then employed in inverse finite element analysis (FEA) using Modified Standard neo-Hookean Solid (MSnHS) idealization of these cells to determine their mechanical properties. In addition, a FEA model with a newly developed spring element was employed to accurately simulate AFM evaluation in this study. We report that both cytoskeleton (CSK) and intracellular fluid govern the strain-rate-dependent mechanical property of living cells whereas intracellular fluid plays a predominant role on fixed cells’ behavior. In addition, through the comparisons, it can be concluded that osteocytes are stiffer than chondrocytes at all strain-rates tested indicating that the cells could be the biomarker of their tissue origin. Finally, we report that MSnHS is able to capture the strain-rate-dependent mechanical behavior of osteocyte and chondrocyte for both living and fixed cells. Therefore, we concluded that the MSnHS is a good model for exploration of mechanical deformation responses of single osteocytes and chondrocytes. This study could open a new avenue for analysis of mechanical behavior of osteocytes and chondrocytes as well as other similar types of cells.

Adults who lack capacity : substitute decision-making

• Mechanisms to facilitate consent to healthcare for adults who lack capacity are necessary to ensure that these adults can lawfully receive appropriate medical treatment when needed. • In Australia, the common law plays only a limited role in this context, through its recognition of advance directives and through the parens patriae jurisdiction of superior courts. • Substitute decision-making for adults who lack capacity is facilitated primarily by guardianship and other related legislation. This legislation, which has been enacted in all Australian States and Territories, permits a range of decision-makers to make different types of healthcare decisions. • Substitute decision-makers can be appointed by the adult or by a guardianship or other tribunal. Where there is no appointed decision-maker, legislation generally empowers those close to the adult to make the relevant decision. Most Australian jurisdictions have also provided for statutory advance directives. • For the most serious of decisions, such as non-therapeutic sterilisations, consent can only be provided by a tribunal. Other decisions can generally be made by a range of substitute decision-makers. Some treatment, such as very minor treatment or that which is needed in an emergency, can be provided without consent. • Guardianship legislation generally establishes a set of principles and/or other criteria to guide healthcare decisions. Mechanisms have also been established to resolve disputes as to who is the appropriate decision-maker and how a decision should be made.

Enhancing the capacity of kin caregivers and their families to meet the needs of children left behind

Based on qualitative research of the experiences of 23 kin caregivers and five school personnel, this article explores the role of informal kinship care in addressing the needs of school-age children left behind in rural China. The findings of this study suggest that kin caregivers' child-rearing capacity is limited in the rural context, and they are often overwhelmed by children's diverse and complex needs, particularly their emotional ones. In view of the huge population and their vulnerability, it is imperative for the state to take up its responsibilities and develop specific social work services and other support for children left behind and their families. 根据对23位亲属照顾者和5位学校人员的质性研究，文章探讨在处理中国留守学龄儿童的需要时，非正式亲属照料所担当的角色。研究发现，在农村的亲属照料者的抚养儿童能力有限，而且他们时常在面对儿童众多复杂的需求时应接不暇，问题又以情绪需要尤甚。有见于留守儿童的数目众多和易受伤害，政府急切需要承担相关的责任，为留守儿童及其家庭发展专门的社会工作服务和其他支援。

The effect of ß-alanine on buffering capacity and exercise performance during and following high-intensity exercise in healthy males

Introduction Intense exercise induced acidosis occurs from the accumulation of hydrogen ions as by-products of anaerobic metabolism. Oral ingestion of ß-alanine, a limiting precursor of the intracellular physiochemical buffer carnosine in skeletal muscle, may counteract any detrimental effect of acidosis and benefit performance. The aim of this study was to investigate the effect of ß-alanine as an ergogenic aid during high intensity exercise performance in healthy males. Methods Five males ingested either ß-alanine (BAl) (4.8 g.d-1 for 4wk, then 6.4 g.d-1 for 2wk) or placebo (Pl) (CaCO3) in a crossover design with 6 wk washout between. Following supplementation, participants performed two different intense exercise protocols over consecutive days. On the first day a repeated sprint ability (RSA) test of 5 x 6s, with 24s rest periods, was performed. On the second day a cycling capacity test measuring the time to exhaustion (TTE) was performed at 110% of their max workload achieved in a pre supplementation max test (CCT110%). Non-invasive quantification of carnosine, prior to, and following each supplementation, with magnetic resonance spectrometry was performed in the soleus and gastrocnemius. Time to fatigue (CCT110%), peak and mean power (RSA), blood pH, and plasma lactate were measured. Results Muscle carnosine concentration was not different prior to ß-alanine supplementation and increased 18% in the soleus and 26% in the gastrocnemius, respectively with 6 wk supplementation. There was no difference in the measured performance variables during the RSA test (peak and average power output). TTE during the CCT110% was significantly enhanced following the ingestion of BAl (155s ± 19.03) compared to Pl (134s ± 26.16). No changes were observed in blood pH during either exercise protocol and during the recovery from exercise. Plasma lactate in the BAl condition was significantly higher than Pl only from the 15th minute following exercise during the CCT110%. FIG. 1: Changes in carnosine concentration in the gastrocnemius prior and post 6 week chronic supplementation of placebo and β-alanine. Values expressed as mean.* p<0.05 from Pl at 6 weeks, # p<0.05 from pre supplementation. Conclusion/Discussion Greater muscle carnosine content following 6wk supplementation of ß-alanine enhanced the potential for intracellular buffering capacity. However, this only translated into enhanced performance during the CCT110% high intensity cycling exercise protocol, with no change observed during the RSA test. No differences in post exercise and recovery plasma lactates and blood pH, indicates that 6wks ß-alanine supplementation has no effect on anaerobic metabolism during multiple bout high intensity exercise. Changes in plasma lactate during recovery supports that ß-alanine supplementation may affect anaerobic metabolism however during single bout high intensity.

The effect of ß-alanine on buffering capacity and exercise performance during and following high-intensity exercise in healthy males

Intense exercise induced acidosis occurs after accumulation of hydrogen ions as by-products of anaerobic metabolism. Oral ingestion of ß-alanine, a limiting precursor of the intracellular physiochemical buffer carnosine in skeletal muscle, may counteract detrimental effects of acidosis and benefit performance. This study aimed to investigate the effect of ß-alanine as an ergogenic aid during high intensity exercise performance. Five healthy males ingested either ß-alanine or placebo (Pl) (CaCO3) in a crossover design with 6 wk washout between. Participants performed two different intense exercise protocols over consecutive days. On the first day a repeated sprint ability (RSA) test was performed. On the second day a cycling capacity test measuring the time to exhaustion (TTE) was performed at 110% of maximum workload achieved in a pre supplementation max test (CCT110%). Non-invasive quantification of carnosine, prior to, and following each supplementation, with in vivo magnetic resonance spectrometry was performed in the soleus and gastrocnemius muscle. Time to fatigue (CCT110%), peak and mean power (RSA), blood pH, and plasma lactate were measured. Muscle carnosine concentration was not different prior to ß-alanine supplementation and increased 18% in the soleus and 26% in the gastrocnemius, respectively after supplementation. There was no difference in the measured performance variables during the RSA test (peak and average power output). TTE during the CCT110% was significantly enhanced following the ingestion of BAl (155s ± 19.03) compared to Pl (134s ± 26.16). No changes were observed in blood pH during either exercise protocol and during the recovery from exercise. Plasma lactate after BAI was significantly higher than Pl only from the 15th minute following exercise during the CCT110%. Greater muscle carnosine content following 6wk supplementation of ß-alanine enhanced the potential for intracellular buffering capacity. This translated into enhanced performance during the CCT110% high intensity cycling exercise protocol but not during the RSA test. The lack of change in plasma lactate or blood pH indicates that 6wks ß-alanine supplementation has no effect on anaerobic metabolism during multiple-bout high-intensity exercise. Changes measured in plasma lactate during recovery support the hypothesis that ß-alanine supplementation may affect anaerobic metabolism particularly during single bout high intensity.