Changing patient safety culture in China: a case study of an experimental Chinese hospital from a comparative perspective.

BACKGROUND: The World Health Organization highlights that patient safety interventions are not lacking but that the local context affects their successful implementation. Increasing attention is being paid to patient safety in Mainland China, yet few studies focus on patient safety in organizations with mixed cultures. This paper evaluates the current patient safety culture in an experimental Chinese hospital with a Hong Kong hospital management culture, and it aims to explore the application of Hong Kong's patient safety strategies in the context of Mainland China. METHODS: A quantitative survey of 307 hospital staff members was conducted using the Hospital Survey on Patient Safety Culture questionnaire. The findings were compared with a similar study on general Chinese hospitals and were appraised with reference to the Manchester Patient Safety Framework. RESULTS: Lower scores were observed among participants with the following characteristics: males, doctors, those with more work experience, those with higher education, and those from the general practice and otolaryngology departments. However, the case study hospital achieved better scores in management expectations, actions and support for patient safety, incident reporting and communication, and teamwork within units. Its weaknesses were related to non-punitive responses to errors, teamwork across units, and staffing. CONCLUSIONS: The case study hospital contributes to a changing patient safety culture in Mainland China, yet its patient safety culture remains mostly bureaucratic. Further efforts could be made to deepen the staff's patient safety culture mind-set, to realize a "bottom-up" approach to cultural change, to build up a comprehensive and integrated incident management system, and to improve team building and staffing for patient safety.

Andrographolide sensitizes prostate cancer cells to TRAIL-induced apoptosis.

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a promising agent for anticancer therapy. The identification of small molecules that can establish the sensitivity of prostate cancer (PCa) cells to TRAIL-induced apoptosis is crucial for the targeted treatment of PCa. PC3, DU145, JAC-1, TsuPr1, and LNCaP cells were treated with Andrographolide (Andro) and TRAIL, and the apoptosis was measured using the Annexin V/PI double staining method. Real time-polymerase chain reaction (PCR) and Western blot analysis were performed to measure the expression levels of target molecules. RNA interference technique was used to down-regulate the expression of the target protein. We established a nude mouse xenograft model of PCa, which was used to measure the caspase-3 activity in the tumor cells using flow cytometry. In this research study, our results demonstrated that Andro preferentially increased the sensitivity of PCa cells to TRAIL-induced apoptosis at subtoxic concentrations, and the regulation mechanism was related to the up-regulation of DR4. In addition, it also increased the p53 expression and led to the generation of reactive oxygen species (ROS) in the cells. Further research revealed that the DR4 inhibition, p53 expression, and ROS generation can significantly reduce the apoptosis induced by the combination of TRAIL and Andro in PCa cells. In conclusion, Andro increases the sensitivity of PCa cells to TRAIL-induced apoptosis through the generation of ROS and up-regulation of p53 and then promotes PCa cell apoptosis associated with the activation of DR4.

Comparative metabolism of tussilagone in rat and human liver microsomes using ultra-high-performance liquid chromatography coupled with high-resolution LTQ-Orbitrap mass spectrometry.

RATIONALE: Tussilagone is a major component in Tussilago farfara that has been widely used as an anti-tussive herbal medicine for the treatment of bronchitis, cough and asthmatic disorders in the clinic. However, its metabolism has been poorly investigated. In order to clarify its in vitro metabolism, a comparative analysis of its metabolic profile in rat liver microsomes (RLMs) and human liver microsomes (HLMs) was carried out. Further, the cytochrome P450 isoforms (CYPs) involved in the metabolism were investigated. METHODS: In this work, the biotransformation of tussilagone in RLMs and HLMs was compared using ultra-high-performance liquid chromatography coupled with high-resolution LTQ-Orbitrap mass spectrometry (UHPLC/HRMS) and the CYPs involved in the metabolism were further investigated by recombinant human CYP enzymes. RESULTS: Totally, nine metabolites of tussilagone were identified in RLMs and HLMs based on the proposed MS/MS fragmentation pathways of tussilagone and the accurate MS/MS spectra. Among them, one metabolite (M9) was detected in both RLMs and HLMs while the other eight metabolites were only detected in HLMs. Three hydroxylation metabolites (M6, M7 and M8) were detected in the assay with individual recombinant P450s incubation. M6 was detected in all CYPs except CYP2A6 while M7 and M8 were only observed in CYP3A4. CONCLUSIONS: The HR-ESI-MS/MS fragmentation behavior of tussilagone and its metabolic profile in RLMs and HLMs were investigated for the first time. The results demonstrated that the biotransformation of tussilagone involved hydrolysis of ester bonds at C-14 and hydroxylation in the side chains at C-12, C-5' or C-6'. Among the CYPs, CYP3A4 played an important role in the hydroxylation reaction of tussilagone in vitro. Furthermore, the results indicated a species-related difference in the metabolism of tussilagone between RLMs and HLMs. This work provided basic information for the metabolism of tussilagone in RLMs and HLMs, which would help to better understand the pharmacological activities of tussilagone.

[Study on spatial interpolation of the average temperature in the Yili River Valley based on DEM].

On the basis of the monthly mean temperature data of 19 meteorological stations from 1961 to 2008 in the Yili River Valley, the correlation between mean annual temperature and elevation was analyzed to get access to the temperature lapse rate of 0.564 degrees C/100 m. The main purpose of this study was to apply a spatial interpolation method based on DEM and compare with the traditional ones of inverse distance weight (IDW) and Kriging methods. According to the cross-validation results, it was concluded that the accuracy of interpolation method based on DEM was superior to the other two methods. Combined with DEM data, the mean annual temperature distribution map with 90 m resolution was established and it expressed the main trend of temperature changing with terrain and reflected the spatial variability of temperature.

[Impact of moss soil crust on vegetation indexes interpretation].

Vegetation indexes were the most common and the most important parameters to characterizing large-scale terrestrial ecosystems. It is vital to get precise vegetation indexes for running land surface process models and computation of NPP change, moisture and heat fluxes over surface. Biological soil crusts (BSC) are widely distributed in arid and semi-arid, polar and sub-polar regions. The spectral characteristics of dry and wet BSCs were quite different, which could produce much higher vegetation indexes value for the wet BSC than for the dry BSC as reported. But no research was reported about whether the BSC would impact on regional vegetation indexes and how much dry and wet BSC had impact on regional vegetation indexes. In the present paper, the most common vegetation index NDVI were used to analyze how the moss soil crusts (MSC) dry and wet changes affect regional NDVI values. It was showed that 100% coverage of the wet MSC have a much higher NDVI value (0.657) than the dry MSC NDVI value (0.320), with increased 0.337. Dry and wet MSC NDVI value reached significant difference between the levels of 0.000. In the study area, MSC, which had the average coverage of 12.25%, would have a great contribution to the composition of vegetation index. Linear mixed model was employed to analyze how the NDVI would change in regional scale as wet MSC become dry MSC inversion. The impact of wet moss crust than the dry moss crust in the study area can make the regional NDVI increasing by 0.04 (14.3%). Due to the MSC existence and rainfall variation in arid and semi-arid zones, it was bound to result in NDVI change instability in a short time in the region. For the wet MSC's spectral reflectance curve is similar to those of the higher plants, misinterpretation of the vegetation dynamics could be more severe due to the "maximum value composite" (MVC) technique used to compose the global vegetation maps in the study of vegetation dynamics. The researches would be useful for detecting and mapping MSC from remote sensing imagery. It also is to the advantage to employing vegetation index wisely.

[Progress in spectral characteristics of biological soil crust of arid or semiarid region].

The Biological Soil Crusts (BSC) (also known as organic or microphytic crust) can be formed by different combinations of microphytic communities including mosses, lichens, liverworts, algae, fungi, cyanobacteria (= blue-green algae or Cyanophyta), as well as bacteria. Large areas of sand fields in arid and semi-arid regions are covered by BSC. Remote sensing distinction should be made between physical and biogenical crust formations. It was reviewed the advances of domestic and overseas studies of BSC spectral characteristics, as well as spectral reflectance measurement in situ of our workgruop. When the BSC is wet, it turns green, a notable change in the reflectance curve occurs. The wet BSC's spectral reflectance curve is similar to those of the higher plants and therefore may lead to misinterpretation of the vegetation dynamics and to overestimation of ecosystem productivity. This spectral feature produces a much higher NDVI value for the wet moss BSC than for the dry moss BSC (0.65 vs. 0.30 units, respectively), a higher NDVI value for the wet algae BSC than for the dry algae BSC (0.30 vs. 0.15 units, respectively). The "maximum value composite" (MVC) technique is used to eliminate the effect of clouds and haze from vegetation maps. Misinterpretation of the vegetation dynamics could be more severe due to the MVC technique used to compose the global vegetation maps in the study of vegetation dynamics. But relatively limited research has been conducted to investigate the spectral characteristics of BSC change with different moisture conditions and under different seasons. More research works could be considered in spectral characteristics of BSC. The researches would be useful for detecing and mapping BSC, from remote sensing imagery. It also is to the advantage to employ Vegetation Index wisely.

[Vulnerability of eco-economy in northern slope region of Tianshan Mountains].

Based on the theoretical meaning of vulnerability, a vulnerability assessment of eco-econom in fifteen counties in the northern slope region of Tianshan Mountains was conducted. The ecosystem services change to land use was regarded as the impact, and based on the fourteen indices from resource holding, society development, and economy development statistic data, the adaptive ability was evaluated by using the methods of analytic hierarchy process (AHP) and fuzzy synthetic evaluation. On the basis of assessment results of impact and adaptive capacity, the fifteen counties were divided into five classes under the assessment principles, and the district with higher-class number was of more vulnerability. The first class included Usu City and Changji City, the second class included Hutubi County, Miquan County, Fukang City, Jimsar County, Qitai County and Mori Kazak Autonomous County, the third class included Karamay City and Urumqi City, the fourth class included Kuitun City and Shawan County, and the fifth class included Jinghe County, Shihezi City and Manas County. The vulnerability reflected the level of eco-environment change and socioeconomic development, and the vulnerability assessment could be a good way to ensure the sustainable development. Aiming to decrease the vulnerability, various districts belonging to different class of vulnerability should establish relevant tactics according to the vulnerability factors to accelerate the region's sustainable development.

[Ecosystem service value and its aplication in evaluation of eco-economic harmonious development].

Based on the data of land use/cover and by using eco-economic harmony index (EEH) this paper studied the spatiotemporal characteristics of ecosystem service value on the northern slope of Tianshan Mountains, and evaluated the harmony degree of eco-economic development in the region. The results showed that the total ecosystem service value on the northern slope of Tianshan Mountains was increased from 319.93 x 10(8) yuan in 1989 to 321.26 x 10(8) yuan in 2000, with a net increment of 0.42%. The regional eco-economic development was overall at a low harmony level, being higher in eastern part than in middle and western parts, among which, eight counties had a positive value of EEH and their eco-economic development was harmonious, while seven counties had a negative value of EEH and their eco-economic development was inharmonic. The eco-economic development in the region was at the margin of harmony, and thus, more attention should be paid to strengthen the protection of eco-environment and promote the harmonious development of eco-economy to have a sustainable development.

Adopting an ecological view of metropolitan landscape: the case of "three circles" system for ecological construction and restoration in Beijing area.

Ecological construction and restoration for sustainable development are now a driving paradigm. It is increasingly recognized that ecological principles, especially landscape ecology theory, are not only necessary but also essential to maintain the long-term sustainability worldwide. Key landscape ecology principles-element, structure and process, dynamics, heterogeneity, hierarchies, connectivity, place and time were reviewed, and use Beijing area as a case study to illustrate how these principles might be applied to ecological construction and restoration, to eventually achieve sustainability. An example to more effectively incorporate the ecological principles in sustainable planning in China was presented.

Agricultural sustainability in a sensitive environment--a case analysis of Loess Plateau in China.

Loess Plateau, an arid and semi-arid region in Northwest China, is well-known for its most serious soil erosion in terms of sediment yield each year. Soil erosion, which is intensified by agricultural activities, is the major factor influencing sustainable agriculture development in this region. It reduces productivity by removing nutrients and especially reducing water availability that is essential for crop production in the area. It also brings about off-site costs by demanding more efforts for maintenance of banks and dams along Yellow River through raising the riverbed with sediment. Climate is capricious and extreme weather conditions occur frequently, which impairs normal agricultural production with erosion and also decrease of water availability. Extensive way of farming still dominates on the Loess Plateau, which cannot produce satisfying economic results and needs to be improved or altered. Conventional agricultural production pattern needs to be reconsidered for husbandry has not been granted its due position. Agriculture is the backbone of economy. Poor agricultural production impedes economic development and vice versa, backward economy also influences the advancement of agriculture. Besides a large population, education status of farmers is another threshold that requires being resolved for a sustainable agriculture. Although conventional agriculture has been practiced there for more than 5000 years, now it cannot meet the demand for food and fiber by the increasing population and some of its farming practices are contributing to environmental degradation directly or indirectly and can sustain no longer. Agriculture on Loess Plateau needs to find its own way of sustainability. To work toward a sustainable agriculture, chances and challenges both indwell on Loess Plateau.