A profile of anaesthesia trainees in Hong Kong

Objectives. To examine the demographics, professional background, progress, and aspirations of anaesthesia trainees in Hong Kong. Design. Anonymous questionnaire consisting of 56 items grouped into the areas of demographics, and anaesthetic and postanaesthetic training. Eight of the items were open questions. Descriptive analyses were undertaken for the closed items. Setting. Hong Kong College of Anaesthesiologists, Hong Kong. Participants. All trainees. Main outcome measures. Demographic data, aspects of training, supervision, working environment, career aspirations, job satisfaction, and morale. Results. The response rate was 77%. The various problems highlighted by respondents included the need for more input and feedback into individual training programmes, the lack of senior support, and the need for more relevant and examination-orientated courses and workshops. Unsatisfactory aspects of the specialty reported were the lack of control over work routines, relationships with surgeons, boredom, and the poor public image of the specialty. Eighty-four percent of respondents reported having reasonable to good job satisfaction. Conclusions. Ongoing benefits could be derived from enhancing communication between trainees and the Hong Kong College of Anaesthesiologists, through appropriate channels for trainee feedback.published_or_final_versio

Structural assessment and seismic vulnerability of earthen historic structures. Application of sophisticated numerical and simple analytical models

Adobe constructions account for a significant portion of the built heritage, associated with early building techniques, material accessibility and low-cost. Nonetheless, adobe buildings, due to their low mechanical properties and overturning resistance, are subject to early structural damage, such as cracking, separation of structural elements and, possibly, collapse in areas of high seismic hazard. The lack of maintenance and absence of adequate retrofitting techniques usually intensifies the loss of historic fabric. The current paper, aims at the structural assessment and seismic safety, in current conditions, of the Church of Kuno Tambo, a religious adobe structure of the 17th century, in Cusco region, in Peru. The inspection and diagnosis involved sonic testing and damage mapping, while ambient vibration tests revealed the modal response of the structure. The assessment of seismic vulnerability, together with the necessity of retrofitting measures were verified through nonlinear static and pushover parametric analyses, complemented with a macro-block limit analysis and a performance based assessment, under local seismic criteria. A more realistic response from dynamically induced ground motions was performed, by a nonlinear time history analysis, according to the Eurocode 8 framework. Through an integrated approach, in situ inspection, testing, numerical and analytical modelling are associated under the scope of reproducing the existing structural damage, the sequence of inelastic behavior and verification of the necessity of retrofitting measures.The current work is part of the Seismic Retrofitting Project, of the Getty Conservation Institute and was partly supported by FCT (Portuguese Foundation for Science and Technology), within the INFRARISK PhD program and ISISE, project UID/ECl/04029/2013.info:eu-repo/semantics/publishedVersio

The importance of providing counselling and financial support to patients receiving treatment for multi-drug resistant TB: Mixed method qualitative and pilot intervention studies

Background: People with multi-drug resistant tuberculosis (MDR-TB) in low-income countries face many problems during treatment, and cure rates are low. The purpose of the study was (a) to identify and document the problems experienced by people receiving care for MDR-TB, and how they cope when support is not provided, to inform development of strategies; (b) to estimate the effectiveness of two resultant strategies, counselling alone, and joint counselling and financial support, of increasing DOTS-plus treatment success under routine programme conditions. Methods. A mixed-method study comprising a formative qualitative study, pilot intervention study and explanatory qualitative study to better understand barriers to completion of treatment for MDR-TB. Participants were all people starting MDR-TB treatment in seven DOTS-plus centres in the Kathmandu Valley, Nepal during January to December 2008. The primary outcome measure was cure, as internationally defined. Results: MDR-TB treatment caused extreme social, financial and employment hardship. Most patients had to move house and leave their job, and reported major stigmatisation. They were concerned about the long-term effects of their disease, and feared infecting others. In the resultant pilot intervention study, the two strategies appeared to improve treatment outcomes: cure rates for those receiving counselling, combined support and no support were 85%, 76% and 67% respectively. Compared with no support, the (adjusted) risk ratios of cure for those receiving counselling and receiving combined support were 1.2 (95% CI 1.0 to 1.6) and 1.2 (95% CI 0.9 to 1.6) respectively. The explanatory study demonstrated that patients valued both forms of support. Conclusions: MDR-TB patients are extremely vulnerable to stigma and extreme financial hardship. Provision of counselling and financial support may not only reduce their vulnerability, but also increase cure rates. National Tuberculosis Programmes should consider incorporating financial support and counselling into MDR-TB care: costs are low, and benefits high, especially since costs to society of incomplete treatment and potential for incurable TB are extremely high