Barriers to knowledge sharing in Chinese healthcare referral services: an emergent theoretical model

This paper reports on a research study that aims to identify barriers to knowledge sharing (KS) in Chinese healthcare referral services. An inductive case study approach was employed, in which 24 healthcare professionals and workers from four healthcare organisations in Hubei Province, Central China were interviewed using semi-structured scripts. Through data analysis, 14 KS barriers emerged in four main themes: interpersonal trust barriers, communication barriers, management and leadership barriers, and inter-institutional barriers. A cause-consequence analysis of the identified barriers revealed that three barriers are at the core of the majority of problems, namely, the absence of national and local policies for inter-hospital KS, lack of a specific hospital KS requirement, and lack of mutual acquaintance. Thus, to resolve KS problems, it is important that healthcare governance agencies, both at the national and regional levels, take leadership in the process of KS implementation by establishing specific and strong policies for inter-institutional KS in the referral process

Improvement of the mine fire simulation program MFIRE

Fire represents one of the most severe hazards to underground mines. A good understanding of the interaction between a mine fire and the mine ventilation network would be very crucial for fire emergency planning and hazard control. MFIRE, an underground mine fire simulation program developed in 1980\u27s, is a tool that can be used to simulate the impacts of a mine fire event to a mine ventilation network. However, the lack of the abilities to simulate some of the important mine fire phenomena realistically hindered its wide applications. This research has been carried out to improve the MFIRE program. The new program, named as MFIRE 2.30, incorporated the following improvements to make is more useful in mine fire simulation: (1) A time-dependent fire model, a t-squared fire, is introduced and incorporated into MFIRE. The t-squared fire model was validated with a fuel fire test conducted in 1990. It has been shown that predicted temperatures of the t-squared fire model agreed well with the measured temperatures. (2) Smoke rollback is a phenomenon in underground mine fire and it could hinder the firefighting efforts and endanger the fire fighters. A semi-empirical model based on a large-scale experiment conducted in a real coal mine entry has been selected to identify the smoke rollback in MFIRE 2.30. The distance of smoke rollback is also estimated and output as an important result of MFIRE 2.30. (3) A moving fire source model to represent a conveyor belt fire has been proposed based on experimental studies on belt fires. The model predicts the flame spread rate along the conveyor belt based on the airflow velocity and the thermal properties of the conveyor belt. Two types of moving fire, a constant spread rate moving fire and non-constant spread rate moving fire were defined. The proposed model has been incorporated into the MFIRE 2.30 program. In addition, a fire can start at any location in a branch, not only at the starting junction of a branch as prescribed in the original MFIRE program.;In order to facilitate the continued support and development of the MFIRE program, the program is recoded using an object-oriented programming (OOP) language, Visual C++ (Note: the original MFIRE was coded in FORTRAN 77). A public database interface has been created for the flexible data access. Graphical user interfaces were also provided for easy data input and display of the program outputs

Bioactivities of Milk Polar Lipids in Influencing Intestinal Barrier Integrity, Systemic Inflammation, and Lipid Metabolism

The purpose of lactation is for nutrient provision and also importantly for protection from various environmental stressors. Milk polar lipids reduce cholesterol, protect against bacterial infection, reduce inflammation and help maintain gut integrity. Dynamic interactions within dietary fat, lipid metabolism, gut permeability and inflammatory cytokines remain unclear in the context of obesity and systemic inflammation. A rat model and three mouse models were developed to test the hypotheses that dietary milk polar lipids may affect lipid metabolism and intestinal integrity and may protect against systemic inflammation in the context of stressful diet, systemic inflammation, and obesity. The milk polar lipids isolates had complex effects on lipid metabolism and associated gene expression in the rat model. There were complex dynamics in lipid metabolism, gut permeability and systemic inflammation at different time points in all mouse models. The milk phospholipids increased gut permeability in genetic and diet-induced obesity and during the lipopolysaccharide (LPS) -induced inflammation. The phospholipids increased the plasma LPS level in genetic obesity and during the LPS stress. The phospholipids reduced liver mass and liver lipids in genetic obesity and during the LPS-induced inflammation. The phospholipids increased the body fat in the diet-induced obesity model. The milk gangliosides did not significantly affect gut permeability, systemic inflammation, and lipid metabolism in all three mouse models. Current estimate by the Centers for Disease Control is that about 1/3 Americans are obese (body mass index, BMI ≥ 30) and 1/3 Americans are overweight (25 ≤ BMI \u3c 30). More than 25% of Americans today have a fatty liver which could lead to further health problems. The data from this dissertation shed light on the complicated interrelationships between gut permeability, systemic inflammation, and lipid metabolism in obesity. The results contribute to our understanding of the bioactivities of milk polar lipids and provide scientific evidence for the role of milk polar lipids rich materials in affecting biological functions. The study of the influence of milk polar lipids on gut barrier integrity adds new information on understanding the mechanisms of gut leakiness and recovery. The investigation of the impact of milk polar lipids on lipid metabolism reveals new perspectives for the development of diet-induced obesity