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The ecological consequences of precipitation change and increased atmospheric nitrogen (N) deposition have profound impacts on ecosystem CO2 exchange in grassland ecosystems. Water and N can largely influence grassland productivity, community composition and ecosystem functions. However, the influences of water and N addition on the ecosystem CO2 exchange of alpine grassland ecosystems remain unclear. A field manipulative experiment with water and N additions was conducted in an alpine meadow on the Tibetan Plateau over 4 years with contrasting precipitation patterns. There were four treatments: control (Ctrl), N addition (N), water addition (W) and N and water addition (NW), each replicated three times. N addition, but not water addition, increased gross ecosystem productivity (GEP), plant biomass, community cover and community-weighted mean height. The responses of ecosystem CO2 exchange to water and N addition varied between the wet and dry years. Water addition had a positive effect on net ecosystem carbon exchange (NEE) due to a larger increase in GEP than in ecosystem respiration (ER) only in the dry year. On the contrary, N addition significantly enhanced ecosystem CO2 exchange only in the wet year. The increased GEP in N addition was attributed to the larger increase in NEE than ER. Moreover, N addition stimulated NEE mainly through increasing the cover of dominant species. Our observations highlight the important roles of precipitation and dominant species in regulating ecosystem CO2 exchange response to global environmental change in alpine grasslands.

ObjectivesTo establish a training programme to cultivate trainee mediation skills through time investment, skill incorporation and formation of in-house mediation services.DesignA four-round consensus conference was conducted by a number of seasoned experts selected in the manner of purposive sampling to determine core competences and relevant curricula through the modified Delphi process.SettingResponses collected from enrolled experts through four rounds of the Delphi process from 11 November 2018 to 17 May 2019.ParticipantsOnboard seasoned mediators with different specialties.Outcome measuresItems with a median rating of 4 or more on a Likert scale of 1–7 points and 70% or more in agreement were identified as core competence and curricula.ResultsEleven enrolled experts reached the consensus about the training syllabus based on the 4-round agreement with four pillars of core competence, including ‘knowledge base of law’, ‘internalisation of the denotative and connotative meanings of care’, ‘effective, smooth and timely communication’ and ‘conflict resolution’. To grasp the dynamics and diversity of medical disputes on target, it is necessary to have sufficient knowledge and skills. We arrange our course in the order of teaching materials with pure didactics in the former two and with mixed contents comprising lectures and field exercises in the rest two.ConclusionsThe sample developed a syllabus to train apprentices to take intermediate responses to medical disputes through the skills of conflict resolution and establishment of effective communication to improve the relationship between patients/relatives and medical staff, as a result of eventually reducing the conversion rate from dispute into litigation or alternative pathway. Policy-makers in healthcare and top management in healthcare institutions can use this syllabus to guide their future education and training programme.