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The reform of the healthcare system in China opened room for the creation of the position of the attending physician, being entrusted with critical clinical functions. This position is crucial, but traditional hospital human resource evaluation in China mostly focuses on qualifications rather than competencies to select and evaluate attending physicians. However, a competency-based management offers better guarantees for high professional level. Therefore, there is a need to build a competency-based management of attending physicians and research is lacking in China. This study is set to fill this research gap. To achieve this, three empirical studies were conducted. The first, qualitative, identified a list of primary competencies for the attending physicians through interviews, reaching consensus via Delphi technique. Based on a sample of 406 healthcare professionals as well as patients, study 2 report findings from a conjoint analysis and questionnaire survey on rankings of the framework of competencies and other aspects generated by the first study. This produced a weighted evaluation index for attending physicians. The last study tested the predictive validity of such competency framework with a sample of 183 director-physician dyads, testing a moderated mediation model that linked competency and performance via work engagement while testing for the interaction effect with perceived organizational support. Findings supported the conceptual model thus indicating the competency framework proposed for attending physicians is robust in grasping their primary competencies, and that it can be used to conduct further research as well as to manage and improve professionalism throughout the healthcare system. A reforma do sistema de saúde na China abriu espaço para a criação do cargo de médico assistente, sendo-lhe confiadas funções clínicas críticas. Esta posição é crucial, mas a avaliação tradicional dos recursos humanos hospitalares na China centra-se sobretudo nas qualificações e não nas competências para seleccionar e avaliar os médicos assistentes. Contudo, uma gestão baseada nas competências oferece melhores garantias para um elevado nível profissional. Assim, afigura-se necessário promover uma gestão dos médicos assistentes, baseada nas competências e falta investigação na China. Este estudo destina-se a preencher esta lacuna de investigação. Para o efeito, foram realizados três estudos empíricos. O primeiro, qualitativo, identificou uma lista de competências primárias dos médicos assistentes através de entrevistas, chegando a consenso através da técnica Delphi. Com base numa amostra de 406 profissionais de saúde, bem como pacientes, o estudo 2 relatou os resultados de uma análise conjoint sobre rankings do quadro de competências e outros aspetos gerados pelo primeiro estudo. Isto produziu um índice de avaliação ponderada para os médicos assistentes. O último estudo testou a validade preditiva desse quadro de competências com uma amostra de 183 díades director-médico assistente, testando um modelo de mediação moderada que liga competência e desempenho através do envolvimento no trabalho enquanto testou o efeito de interacção com o apoio organizacional percebido. Os resultados apoiam o modelo conceptual, indicando assim que o quadro de competências proposto para os médicos assistentes é robusto para retratar as suas competências primárias, e que pode ser utilizado para conduzir mais investigação, bem como para gerir e melhorar o profissionalismo em todo o sistema de saúde.

Hydraulic fracturing (HF) is indispensable in shale gas, but there are also problems existed in high ratio of energy consumption and low ratio of energy utilization. Based on hydraulic fracturing and pulsating jet, pulse hydraulic fracturing (PHF) has been widely used and achieved good results in the coal-bed methane. This paper attempts to study the mechanism of pulse wave propagation and attenuation during PHF in shale reservoirs, which provides theoretical support for application. On the basis of the motion equation and continuity equation, the two-dimensional propagation and attenuation equation with damping and fissure width during PHF is established and fracture network is simulated based on DFN discrete random model. The mathematical and physical model is verified by laboratory experiment The study of PHF superiority, PHF waveform effect, PHF propagation and attenuation characters are also performed. Results indicate that PHF propagation has two stages: The first is the pressure fluctuation is sharp in the process of the initial fracturing. The second is a stable state is appeared after a period of time. Compared with HF, PHF can pressurize obviously the pressure gradient of pulse waveform, which is an important parameter of affecting pulse pressure: the greater pressure gradient, the more obvious water hammer and supercharging effect. In the process of PHF propagation, pressure distribution complicates under the supercharging. Pressure wave has different attenuation characteristics in two steps. These research results will provide guidance for optimizing technical parameters for using PHF technology in shale reservoirs.

Lost circulation is one of the most troublesome and costly problems encountered in drilling. This problem is magnified while drilling in deeper, depleted and complex reservoirs. Based on the nation of preventive treatment, the paper intends to present a novel hydraulic tool with a purpose of lost circulation control while drilling. The hydraulic energy of swirling jet is employed in this tool to push the granules in drilling fluid into the fractures, and “an artificial borehole wall” is formed to enhance the pressure-bearing capacity of leakage formation. Moreover, a computing model for flow rate allocation of the tool is developed. The result of comparison experiment on plugging effectiveness manifests that plugging effectiveness with the use of hydraulic tool is much better than that without the tool. The maximal pressure-bearing capacity of experimental core is increased to 8.3 MPa under the experimental circumstances, which demonstrates that the hydraulic tool can provide an effective preventive treatment for lost circulation. Furthermore, field tests of the hydraulic tool are conducted in deep wells and depleted reservoirs. The statistical results validate that the plugging effectiveness can be improved greatly by employing the tool, and the pressure-bearing capacity of formation in depleted reservoir is increased to 11.6 MPa.

The objective of the current effort was to determine the efficacy of Fe(II)-montmorillonite (Fe(II)-MMT) as an adjuvant for specific targeted adsorption of phosphate. Specifically, Fe(II)-MMT was studied to combat hyperphosphatemia and anemia arising from chronic renal failure. The adsorption of phosphate over time, pH, and initial concentration was studied. The systems were characterized by X-ray diffraction (XRD), Raman, and zeta potential. The experimental results demonstrated the adsorption time was set to 140 min to achieve maximum adsorption efficiency. It was thus found that the maximum adsorption was at pH 3.0. In addition, it reached equilibrium when the initial phosphate concentration was at 60 mg/L while the maximum adsorption capacity was 5.75 mg of phosphate/g of Fe(II)-MMT. On the other hand, adsorption isotherms showed that the Langmuir model was better than the Freundlich model. This means that the adsorption of the phosphate on Fe(II)-montmorillonites was monolayer adsorption, and the phosphate was successfully adsorbed either onto the surface or intercalated within interlayer volume. Live experiments supported the ability of Fe (II)-MMT to control hyperphosphatemia and treat chronic renal failure.

Fe(II)-montmorillonites (Fe(II)-MMTs) were prepared by mixing solutions of Fe(II) and montmorillonite at pH 3.5. Two different Fe(II)-MMTs were prepared and the ferrous iron contents were 40 mg/L and 80 mg/L. All samples were characterized by XRD, FT-IR, TGA, DSC, and nitrogen adsorption. By nitrogen adsorption, the pore size can be obtained in the pore diameter curve with average pore widths of 6.67 nm, 9.96 nm, and 17.07 nm, respectively. The removal rate of phosphate increased rapidly during the first 40 min, in which Fe(II)-MMT (1) and Fe(II)-MMT (2) were stronger adsorption systems than MMT. The maximum adsorption was 48.38 mg/g at pH 2.0. The kinetics of phosphate adsorption were better described using pseudo-second-order models (R$^{2}$: 0.997, 0.999, 1.000) than pseudo-first-order (R$^{2}$: 0.933, 0.900, 0.760). R$^{2}$ is the determinable statistic coefficient that measures the goodness of fit. If the R$^{2}$ value is closer to one, the fitting degree of the regression line is better. By the thermodynamic analyses, we obtained the $\Delta $G$^{\circ}$ and $\Delta $H$^{\circ}$ of samples at 298 $^{\circ}$C, 303 $^{\circ}$C, and 310 $^{\circ}$C. The adsorption isotherms also better fitted a Langmuir model in which the process was nonspontaneous and exothermic.