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In paediatric wards, establishing therapeutic rapport with children requires employing friendly gestures or an understanding gaze, an aspect inhibited when clinicians wear facial personal protective equipment (PPE). In this case study we explore how interactions in three scenarios of a paediatric ward might inform the design of child-friendly PPE. We show how our research methods involved healthcare professionals, parents, and children to identify problems and solution pathways. Our findings indicate that PPE for paediatric wards need to be a system design solution considering emotions, engagement, communication, education, and sustainability factors. We discuss three aspects of conducting design research in healthcare contexts: working within high-risk environments, ethics in design for healthcare projects, and the translation of findings within the regulatory landscape.
This study explores how the introduction of the carbon emissions trading scheme (ETS) affects investors’ reactions to corporate earnings surprises. We propose two non-exclusive explanations, namely, the preference-based view and the uncertainty-based view, and suggest that the implementation of ETS may influence the magnitude of investor responses to corporate unexpected earnings. Consistent with the preference-based view, by utilizing China’s introduction of ETS as a quasi-natural experiment, we observe a reduction in the earnings response coefficients (ERCs) following the implementation of ETS. We validate this result by showing that the introduction of ETS prompts investors to focus on corporate carbon risk. Cross-sectional tests find that the effect of ETS on ERCs is more pronounced in firms with higher corporate carbon risk exposure, in firms whose investors exhibit greater environmental awareness, in better-developed carbon pilot markets, and in firms with greater exposure to international capital markets, while this impact is mitigated by firms’ non-financial performance. These findings highlight the importance of environmental regulation and market liberalization in influencing investors’ resource allocation.
Objective Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.
Design, setting, and participants This is a registry-embedded observational cohort study. Patients were included if they were enrolled in the binational ECMO registry (EXCEL). The exclusion criteria included patients on ECMO for heart/lung transplants. Data included demographics, clinical information on their first ECMO run, and six-month outcomes obtained by telephone interview. The primary outcome was death or new disability at six months. A multivariable analysis was conducted using hospitals' annual ECMO volume. High-volume centres were defined as having >30 ECMO cases annually, and analyses were run on ECMO subgroups of veno-venous (VV), veno-arterial (VA), and extracorporeal cardiopulmonary resuscitation (ECPR).
Results Of 1232 patients, 663 patients were cared for on ECMO at high-volume centres and 569 patients at low-volume centres. There was no difference in six-month death or new disability between high- and low-volume ECMO centres in VV-ECMO [OR: 1.09 (0.65–1.83), p = 0.744], VA-ECMO [OR: 1.10 (0.66–1.84), p = 0.708], and ECPR-ECMO [OR: 1.38 (0.37–5.08), p = 0.629]. This finding was persistent in all sensitivity analyses, including exclusion of patients who were transferred between high- and low-volume centres.
Conclusion There was no difference in death or disability at six months between high- and low-volume centres in Australia and New Zealand, possibly due to the current model of coordinated care that includes patient transfers and training between high- and low-volume ECMO centres in our region.
Background Neonatal palliative care is an essential component of comprehensive neonatal care; however, its implementation remains challenging worldwide, particularly in low- and middle-income countries due to limited resources, cultural barriers, and lack of training.
Objectives The aim of this study was to investigate the structural characteristics of neonatal nurses' attitudes towards neonatal palliative care and their intention to provide such care using network analysis to identify key influencing factors and interrelationships.
Design A multi-center cross-sectional study.
Setting The setting was 92 hospitals across 28 provinces in mainland China.
Participants A convenience sampling method was employed to recruit 893 neonatal nurses from October 2023 to February 2024.
Methods The web-based survey included a sociodemographic questionnaire, the simplified Chinese version of the Neonatal Palliative Care Attitude Scale (NiPCAS), and a single question gauging participants' intention to provide neonatal palliative care. Network analysis techniques were used to examine the structural characteristics of the attitude network.
Results A total of 767 valid questionnaires were received. The estimated network comprised 26 nodes representing individual NiPCAS items, with 150 non-zero edges out of a possible 325 connections. In-service education experience emerged as the most central and influential node, demonstrating the highest centrality (strength = 2.511; bridge strength = 3.144) and predictability (R2 = 0.475). This was followed by the ideal palliative care environment and staff support for palliative care. On average, 29.3 % of each item's variance could be accounted for by surrounding items. The strongest associations with the intention to provide neonatal palliative care were observed with beliefs about the necessity of palliative care in neonatal nurse education (edge weight = 0.29).
Conclusions The findings highlight the pivotal role of in-service education experience in shaping nurses' attitudes towards neonatal palliative care, suggesting that educational interventions may significantly influence overall attitudinal structures. The strong associations between the intention to provide neonatal palliative care, and beliefs about the necessity of palliative care in neonatal nurse education, further reinforce the critical role of education in fostering positive attitudes and intentions. The significance of organizational and resource-related factors suggests that efforts to improve neonatal palliative care should focus on enhancing staff support and creating supportive work environments.
The history of developing supercapacitors with increased performance is inextricably linked to the exploration and design of suitable electrode materials. Metal-organic frameworks (MOFs) have attracted intensive attention for use in high-performance supercapacitors thanks to their large specific surface area, tuneable pore sizes and crystal structure. Understanding the influence of MOF structures and properties on the performance of supercapacitors is critical to enhancing their performance. However, so far researchers have been keen on exploring metal atoms in MOFs and have ignored the effects of organic ligands, especially the functional groups thereon, on supercapacitors. In this work, we have studied the impact of organic linkers’ functional groups on the properties of MOFs and how this influences their performance as supercapacitor electrode materials. We synthesized four MOFs with different functional groups, including hydroxyl, nitride and thiol groups and characterised their physicochemical properties and their performance as supercapacitor electrode materials. Characterisation of the specific surface area shows that the BET area decreases from 980.3 m2 g−1 for the original MOF to 12.2 m2 g−1 when the thiol group is incorporated. Furthermore the –OH, –NH, and −SH functionalities reduced the charge transfer resistance (< 1 Ω) and induced more pseudocapacitance, whereas the –OH group dramatically increased the hydrophilicity of the electrode and rate performance of supercapacitors. Although the MOFs without extra function group showed the highest specific capacitance of 1495F g−1, analysis of the normalized areal specific capacitance only shows 1.5 F m−2. The MOFs with the −SH group showed the highest normalized areal specific capacitance of 26F m−2 as well as stable cycling performance of 80 % retention after 10,000 cycles.