制度变迁视角下的公立医院编制制度改革的历史演进

分析历史发展脉络是推进制度创新的重要基础,公立医院编制制度改革是公立医院改革的重要内容之一。本研究基于制度变迁的理论和视角,对我国公立医院编制制度改革的历史发展沿革进行梳理,分析制度发展脉络,总结变迁规律,为下一阶段的公立医院编制制度改革提供政策建议。     

公立医院实施国家基本药物制度的可行性分析

在新医改的进程中,国家基本药物制度已在基层医疗卫生机构得到了很好的应用,而在公立医院改革过程中,国家基本药物制度的实施是否应该同步成为一个普遍关注的问题。文章通过对公立医院实施国家基本药物制度可行性的分析,阐明公立医院在改革的过程中应该切实推进国家基本药物制度,并提出了相应的制度保障措施。     

公立医院引入社会资本中的政府责任分析

中国长期以来沿袭计划经济时期对公立医院采取的国有治理方式,随着市场经济的发展,公立医院的资金短缺与低效运作成为一个难题。作为公立医院的所有者,公立医院引入社会资本相关制度的实施,本身就是政府职能所在。以政府责任为分析视角,重点阐述了政府在公立医院社会融资中承担职责的理论依据、现状及存在的问题,介绍了国外公立医院引入社会资本中的政府责任体现,并对如何强化政府责任,以促进公立医院社会融资制度持续推行,提出相关建议。     

我国公立医院的“公立”障碍及解决思路

通过了解公立医院公益淡化的过程，分析公立医院所遭遇的“公立”障碍，试图从制度设计、医院治理模式、政府监管部门、配套制度等角度提出相应的解决思路。     

试析新医改背景下医院文化的重建

新医改明确了公立医院改革的方向,这必然会对公立医院文化产生重要影响。公立医院必须对医院文化进行转型重建,重塑医院和医生的伦理价值观,才能不断适应医改的新变化、新要求。本文从新医改给公立医院文化带来的影响与变化入手,论述了重建医院文化的重要意义,并指出了公立医院文化重建的路径与措施,即重塑医院精神文化,树立正确的价值取向;重塑制度文化,完善各项制度;加强物质文化重建,改善就医环境。     

县级公立医院的治理型市场化改革模式创构

模式的选择关系到县级公立医院改革结果的成败。依据公益性和积极性的关系和权重,县级公立医院主要存在两种改革模式,第一种是绩效性行政化改革模式：公益性和积极性均衡化改革模式;第二种是治理型市场化改革模式：积极性和公益性均衡化改革模式。治理型市场化改革模式是县级公立医院综合改革的必然选择。县级公立医院治理型市场化改革模式,以医药卫生费用虚高为基本假设,以医疗保险补偿机制为后续制度,以医疗保险控费机制为关键制度。医疗保险预付费方式是县级公立医院治理型市场化改革模式的支点,预付费方式不仅可以撬动公立医院管理体制创新,也可以撬动公立医院运行机制重构。     

公立医院法人治理结构与改革

随着国务院医改近期重点实施方案的出台,公立医院法人治理结构的改革模式也渐渐明朗。公立医院法人治理结构改革是创新公立医院体制机制的关键任务之一,是维护公立医院公益性的重要制度保障。针对公立医院法人治理结构的内涵作了阐述,从公立医院的多层委托代理关系、产权制度等多角度分析了我国公立医院法人治理结构的现状和问题,提出了我国公立医院法人治理结构改革的具体措施。     

公立医院治理公法人化刍议

公立医院公法人是一项重要的组织手段与法律制度,其目的在于通过法人的身份独立与行为自主,实现公立医院的自治与绩效,使公立医院由官僚化的单位治理模式向自主化的法人治理模式的演变;使公立医院在以法人化的方式应对行政科层制的弊端的同时,须强化对公立医院的监督,实现公益性。介绍了公立医院事业法人的弊端、公立医院治理公法人化的时代背景及意义,构建了我国公立医院公法人化的基本框架。     

我国公立医院院科两级核算制度的历史与现状分析

运用文献检索、专家咨询等方法,分析了我国公立医院院科两级核算制度的历史、成绩、问题以及发展前景。研究结果表明：20世纪80年代以来,公立医院院科两级核算制度主要是经济效益导向,极大地推动了公立医院的建设发展,成绩巨大。其弊端也十分突出,主要是刺激公立医院逐利,促使医疗费用过快、不合理增长。其解决路径为：分地域、分阶段推进以服务导向的院科两级核算制度;在技术上还需要研究服务量换算方法等。     

部分国家和地区公立医院社会医疗保险制度比较

通过对法国、德国、日本、韩国和我国台湾地区5个实行社会保险制度的典型国家或地区公立医院基本情况的梳理,总结以上国家及我国台湾地区公立医院规模、布局、结构和功能等现状。提出公立医院改革的建议：医院规模和布局建设应遵循公平、效率与适应性原则,不断优化公立医院布局,严格控制公立医院成本。     

Optimization-based region-of-interest reconstruction for X-ray computed tomography based on total variation and data derivative

Region-of-interest (ROI) and interior reconstructions for computed tomography (CT) have drawn much attention and can be of practical value for potential applications in reducing radiation dose and hardware cost. The conventional wisdom is that the exact reconstruction of an interior ROI is very difficult to be obtained by only using data associated with lines through the ROI. In this study, we propose and investigate optimization-based methods for ROI and interior reconstructions based on total variation (TV) and data derivative. Objective functions are built by the image TV term plus the data finite difference term. Different data terms in the forms of L1-norm, L2-norm, and Kullback–Leibler divergence are incorporated and investigated in the optimizations. Efficient algorithms are developed using the proximal alternating direction method of multipliers (ADMM) for each program. All sub-problems of ADMM are solved by using closed-form solutions with high efficiency. The customized optimizations and algorithms based on the TV and derivative-based data terms can serve as a powerful tool for interior reconstructions. Simulations and real-data experiments indicate that the proposed methods can be of practical value for CT imaging applications.     

Quantitative variation in monoterpenes in four species of conifers

Eighteen monoterpenes found in bole and foliage volatiles of four sympatric species of conifers, Douglas-fir, Pseudotsuga menziesii (Mirb.) Franco, lodgepole pine, Pinus contorta var. latifolia Engelm., interior spruce, Picea engelmannii×glauca, and interior fir, Abies lasiocarpa×bifolia, in three locations in British Columbia, Canada, were analysed for quantitative variation (N=10 trees per sample) using standard and chiral gas chromatography. There was significant variation in monoterpene composition between bole and foliage in all four species. Principal components analysis revealed that the monoterpene profile of coastal Douglas-fir was significantly different from trees in the interior, supporting the hypothesis that coastal and interior populations represent distinct chemotypes. Although the four species did not differ qualitatively, there were significant differences in their quantitative monoterpene profiles in both bole and foliage. These differences were large enough to suggest that host selection by four species of coniferophagous bark beetles (Coleoptera: Scolytidae), specific to each of the above tree species, may depend in part on perception of, and behavioural response to quantitatively distinct blends of monoterpenes.     

合肥市区城市森林景观格局分析

运用3S技术在分析合肥景观特点的基础上,研究了合肥市区17．6km^2范围内的城市森林景观特点及与其它景观单元间关系。结果表明,主要景观要素分为建筑与硬质铺装表面、城市森林斑块、一般绿地、道路、水面五大类景观背景为建筑及铺装表面,占总面积的73．13％;道路为典型的廊道景观,约占6．89％;研究区城市森林斑块共408块,计161．16hm^2,占总面积的9．8％,平均面积0．396hm^2、最大面积12hm^2,斑块形状复杂、近圆度小,其中48％的班块属于面积<500m^2的小班块,>1hm^2的城市森林班块只占8．6％;水面斑块147块,计149．93hm^2,占总面积的8．54％,平均面积1．02hm^2,最大面积16hm^2;一般绿地斑块255块,计39．74hm^2,占2．26％,最大面积3．86hm^2,平均面积0．1558hm^2．Shanlnon-Weiner景观多样性指数和均匀度均偏低,分别为0．9284和0．5768。另外,城市森林与一般绿地两类景观要素的总优势度达0．39,由于这两类景观斑块的尺度变化范围大,比较破碎,小尺度的斑块所占比例高,又主要集中在西区,分布不均匀,故对环境的影响作用受到限制,文中引用自然森林的内部生境概念,确定合肥城市森林斑块出现内部环境的l临界面积为9800m^2,研究区拥有城市森林的内部生境总面积为31．69hm^2,仅为城市森林面积的19．7％,不利于对物种提供更多的生境,提出应用内部生境的大小来划分城市森林斑块,建立城市森林小班块-中斑块-大斑块-特大斑块的尺度等级体系,据此提出,研究区各尺度的城市森林斑块面积比为2：2：2：3。同时提出合肥东北部应增加城市森林面积,尽可能建设1．5～3．0hm^2的片状城市森林。     

Forest species in an agricultural landscape in the Netherlands: Effects of habitat fragmentation

Abstract. For 312 forest patches on sandy soils in the Netherlands, effects of fragmentation are studied of forest habitat in the past on the present occurrence of forest plant species. Using regression techniques, the numbers of forest edge, interior, zoochorous and anemochorous species, as well as occurrence of 24 individual species were related to patch area and connectivity measures. Connectivity was defined as the amount of forest habitat around patches within three zones up to 1000 m. Plant categories were distinguished by habitat type and dispersal mechanism. The results showed that number of total species and number of species of all habitat and dispersal categories increased with area. The occurrence of ten individually studied species were also positively related to area. Most of them were interior species. The number of zoochorous species increased with increasing connectivity. Also occurrence of ten individually studied species were affected by connectivity. Interior zoochorous species showed the highest percentage of affected species. The relationship of interior, animal-dispersed plants to connectivity can be explained by the limited distances covered by their dispersal agents (forest birds and ants) in a non-forest habitat. Also, some anemochorous plants appeared to be affected by connectivity, especially those with heavy seeds and potentially short distance dispersal. As not all species within a certain dispersal or habitat category react similar to area or isolation, it is suggested that differences in underlying processes of fragmentation such as local extinction and colonization need more focus.     

3D打印股骨远端内侧个性化解剖型接骨板的研究进展

目前,比较复杂的股骨远端C3型骨折和膝外翻的矫形手术都需要应用到独立的股骨内侧接骨板。以往术者都是将对侧股骨的外侧接骨板进行预弯曲,以达到贴近骨骼自然形态的目的,而这种冷变形会改变接骨板的金相结构,进而破坏接骨板的生物力学,接骨板螺钉孔的位置有时也会影响到骨折的愈合情况。与传统制造技术相对比,3D打印技术作为"第三次工业革命"的核心技术,不必事先制造模具,不必在制造过程中去除大量的材料,也不必通过复杂的锻造工艺就可以得到最终产品,更适合于难加工材料的制造、外形设计检查、装配检验和快速反求工程等。本文将股骨远端内侧接骨板的个性化设计与3D打印技术相结合,从接骨板的应用、3D打印技术的现况及其应用于制作股骨远端内侧个性化解剖型接骨板的前景等方面进行了综述。     

Ecological subregions of the Interior Columbia Basin,USA

Abstract. Land evaluations are not always conducted with adequate understanding of the relevant geologic and climatic contexts and their appropriate scales. This understanding is essential for developing representative sampling, monitoring, and conservation designs, and for pooling results of landscape analysis. To provide context for several regions of the interior northwestern United States, we conducted an ecoregion classification of the interior Columbia River Basin and vicinity (‘the Basin’). We grouped land units that are influenced by the same higher order geology and landform features, and share similar areal composition of potential vegetation and climate attributes. We used the TWINSPAN procedure to group 7496 watersheds of the Basin into 53 ecological subregions. We evaluated the contribution of attributes to group separation by discriminant analysis, and evaluated subregion robustness to prediction by cross‐validation. Classification accuracy ranged from 80‐97% across the subregions. All watersheds were classified to a subregion, and there were strong resemblances between members of adjacent subregions. Subregions with strong resemblances shared a similar composition of attributes, but differed in relative abundance and attribute combinations. We evaluated the geologic and climatic context of each subregion considering four levels in a nested land unit hierarchy. Most subregions nested at one of at least four scales, but some overlapped. Our results suggest that observation levels for a given ecological phenomenon need not be nested within their appropriate context levels, and across broad geographic areas context of the same phenomenon occurs at different scales.     

Climate and the effectiveness of Psyllaephagus bliteus as a parasitoid of the red gum lerp psyllid

The encyrtid parasitoid Psyllaephagus bliteus Riek was introduced to California in 2000 to control the red gum lerp psyllid, Glycaspis brimblecombei Moore. Field experiments were conducted to determine the effect of regional summer climate (California coastal vs. interior valleys) on P. bliteus performance. Measurements of parasitoid performance, including reproduction and longevity, showed that P. bliteus was adversely affected by the extreme summer heat in the interior valley sites. The results suggest that regional climatic differences can contribute to the lower parasitism rates observed in California's warmer interior valleys. The results are discussed with respect to biological control of G. brimblecombei and the potential limitations of the parasitoid P. bliteus, as well as the possible impact of climate and intraguild predation as alternative hypotheses for the observed variable geographic performance of P. bliteus.     

基于成本核算的医院内部服务价格的制定

随着医院内部成本核算基础工作的日益加强和成本核算体系的日趋成熟,为了使单位内部责任的划分更加清晰明确,把责任成本作为成本控制的重要内容纳入总体绩效考核评价体系中,实行内部服务价格势在必行。以成本核算为基础,探讨医院内部服务价格制定的作用、原则和方法,并以某大型三甲医院机电维修内部服务价格的制定为例,研究内部服务价格的制定步骤和实施环节。     

Ultrastructure and differentiation of ascidian muscle

Summary The larval caudal musculature of the compound ascidian Diplosoma macdonaldi consists of two longitudinal bands of somatic striated muscle. Approximately 800 mononucleate cells, lying in rows between the epidermis and the notochord, constitute each muscle band. Unlike the caudal muscle cells of most other ascidian larvae, the myofibrils and apposed sarcoplasmic reticulum occupy both the cortical and the medullary sarcoplasm.The cross-striated myofibrils converge near the tapered ends of the caudal muscle cell and integrate into a field of myofilaments. The field originates and terminates at intermediate junctions at the transverse cellular boundaries. Close junctions and longitudinal and transverse segments of nonjunctional sarcolemmata flank the intermediate junctions, creating a transverse myomuscular (TMM) complex which superficially resembles the intercalated disk of the vertebrate heart.A perforated sheet of sarcoplasmic reticulum (SR) invests each myofibril. The sheet of SR spans between sarcomeres and is locally undifferentiated in relation to the cross-striations. Two to four saccular cisternae of SR near each sarcomeric Z-line establish interior (dyadic) couplings with an axial analogue of the vertebrate transverse tubular system. The axial tubules are invaginations of the sarcolemma within and adjacent to the intermediate junctions of the TMM complex.The caudal muscle cells of larval ascidians and the somatic striated muscle fibers of lower vertebrates bear similar relationships to the skeletal organs and share similar locomotor functions. At the cellular level, however, the larval ascidian caudal musculature more closely resembles the vertebrate myocardium.This investigation was supported by Developmental Biology Training Grant No. 5-T01-HD00266 from the National Institute of Child Health and Human Development, National Institutes of Health, by National Research Service Award No. 1-F32-GM05259 (M.J.C.) from the National Institute of General Medical Sciences, National Institutes of Health, and by Research Grant No. BMS 7507689 (R.A.C.) from the National Science Foundation. A portion of this study was carried out at the Friday Harbor Laboratories of the University of Washington, and the authors gratefully acknowledge the cooperation and advice extended by the former Director, Dr. Robert L. FernaldResearch facilities were provided in part by Douglas E. Kelly, Professor and Chairman, Department of Anatomy, University of Southern California School of Medicine, Los Angeles, California 90033, USA. The provisions and counsel are warmly acknowledged     

A mitochondrial-DNA-based phylogeny for some evolutionary-genetic model species of Colias butterflies (Lepidoptera, Pieridae)

We study the phylogenetic relationships among some North American Colias ("sulfur") butterflies, using mitochondrial gene sequences (ribosomal RNA, cytochrome oxidase I+II) totaling about 20% of the mitochondrial genome. We find that (1) the lowland species complex shows a branching order different from earlier views; (2) several montane and northern taxa may be more distinct than in earlier views; (3) one morphologically conservative Holarctic assemblage, C. hecla, is differentiated at the molecular-genetic level into at least three taxa which occupy distinct positions in the phylogeny and are sisters to diverse other taxa. These conclusions, constituting phylogenetic hypotheses, are supported by parsimony, maximum-likelihood, and Bayesian reconstruction algorithms. They are tested formally, by interior branch tests and paired-site tests, against alternative hypotheses derived from conventional species and subspecies naming combinations. In all cases our hypotheses are supported by these tests and the conventional alternatives are rejected. The "barcoding" subset of cytochrome oxidase I sequence identifies only some of the taxa supported by our full data set. Comparison of genetic divergence values among Colias taxa with those among related Pierid butterflies suggests that species radiations within Colias are comparatively younger. This emerging Colias phylogeny facilitates comparisons of genetic polymorphism and other adaptive mechanisms among taxa, thereby connecting micro- and macro-evolutionary processes.