Effect of Hospital Staff Surge Capacity on Preparedness for a Conventional Mass Casualty Event

OBJECTIVES: To assess current medical staffing levels within the Hospital Referral System in the City of Cape Town Metropolitan Municipality, South Africa, and analyze the surge capacity needs to prepare for the potential of a conventional mass casualty incident during a planned mass gathering.METHODS: Query of all available medical databases of both state employees and private medical personnel within the greater Cape Town area to determine current staffing levels and distribution of personnel across public and private domains. Analysis of the adequacy of available staff to manage a mass casualty incident.RESULTS: There are 594 advanced pre-hospital personnel in Cape Town (17/100,000 population) and 142 basic pre-hospital personnel (4.6/100,000). The total number of hospital and clinic-based medical practitioners is 3097 (88.6/100,000), consisting of 1914 general physicians; 54.7/100,000 and 1183 specialist physicians; 33.8/100,000. Vacancy rates for all medical practitioners range from 23.5% to 25.5%. This includes: nursing post vacancies (26%), basic emergency care practitioners (39.3%), advanced emergency care personnel (66.8%), pharmacy assistants (42.6%), and pharmacists (33.1%).CONCLUSION: There are sufficient numbers and types of personnel to provide the expected ordinary healthcare needs at mass gathering sites in Cape Town; however, qualified staff are likely insufficient to manage a concurrent mass casualty event. Considering that adequate correctly skilled and trained staff form the backbone of disaster surge capacity, it appears that Cape Town is currently under resourced to manage a mass casualty event. With the increasing size and frequency of mass gathering events worldwide, adequate disaster surge capacity is an issue of global relevance. [West J Emerg Med. 2010; 11(2):189-196.

IFN-α enhances poly-IC responses in human keratinocytes by inducing expression of cytosolic innate RNA receptors: Relevance for psoriasis

Keratinocytes play a key role in innate immune responses of the skin to bacterial and viral pathogens. Viral double-stranded RNA and its synthetic analogue polyriboinosinic-polyribocytidylic acid (poly-IC) are recognized via multiple pathways involving the receptors Toll-like receptor 3 (TLR3), protein kinase R (PKR), and the recently described cytosolic RNA helicases retinoic acid-inducible gene-I (RIG-I) and melanoma differentiation-associated gene 5 (MDA5). We show that preincubation of human keratinocytes with IFN-α enhances the proinflammatory responses to poly-IC. Kinetic studies suggest that this is mediated via upregulation of the receptors TLR3, PKR, RIG-I, and MDA5. Interestingly, expression of RIG-I, MDA5, and PKR was significantly increased in lesional skin from patients with psoriasis, a chronic inflammatory skin disease that is characterized by high IFN-α levels. These results suggest that psoriatic keratinocytes show increased sensitivity to viral RNA intermediates, thereby leading to excessive proinflammatory responses and maintenance of the inflammatory skin phenotype. Here, we provide early evidence that point toward a role for the recently described cytosolic innate RNA receptors in non-viral chronic inflammatory diseases

Sustainable Business Models Through Servant Leadership: Theory and Praxis

Abstract Sustainable business models (SBMs) archetypes have been introduced to develop a common language that can be used to accelerate the development of SBMs in research and practice. The way in which SBMs are triggered by managers or entrepreneurs who act as leader of an organization has not yet been deeply investigated. Accordingly, the works aims to inquire the role of entrepreneurial and managerial leadership style—with a particular focus on servant leadership—in influencing the strategies, the organizational culture and the stakeholders engagement of companies, orienting them toward sustainable business models. After having traced the theoretical background, the empirical research in this chapter helps to shed light on corporate sustainability management and sustainable innovation in daily business and to inquire the extent to which servant leadership allows SBMs implementation. The cases-studies are relative to two Italian large-sized companies (Brunello Cucinelli Spa and Geico Spa) belonging to different sectors and geographical areas, led by managers and entrepreneurs with common traits in their servant leadership styles and characterized by the implementation of distinctive sustainable business models. Findings emphasize the role of the values and ethicalbased conducts of the managers/entrepreneurs in forging the sustainable and servant leadership model and affecting the SBMs adopted by the companies