患者的道德权利在医患纠纷中的重要性

近年来医患冲突不断发生,一系列由伦理道德而引发的医疗纠纷事件反映了我国医院管理存在的问题。患者及家属的观念偏移、医患双方信息不对等、医务人员态度不佳以及医疗资源分配不均等问题均是医患冲突的影响因素。我们通过分析患者的道德权利在医患关系中重要地位,认为医务人员应当树立"以人为本"的服务理念,重视患者及家属的社会心理需求,促进医学道德的发展,构建和谐的医患关系。     

医患纠纷的处理意愿调查与分析

医患纠纷是医患矛盾的一种表现形式。近年来,全国各地因医患纠纷而引起的冲突越来越多,医患双方都从自己的角度出发,希望实现利益的最大化。现行的医患纠纷处理方案主要有民事诉讼、医患协商解决和行政处理3种。通过调查医患双方的处理意愿,分析这三种处理方案存在的积极意义和局限性,提出医院在引入医疗社会工作的基础上,通过开展社会、心理服务,加强医患沟通等途径,建立新的医患纠纷调解机制的设想。     

集体行为理论视角下暴力伤医现象诱发因素的研究

暴力伤医现象是我国医患矛盾尖锐的具体表现,不仅严重干扰了医院正常诊疗秩序,更对医疗人员的人身安全造成威胁。探讨其诱发因素并进一步提出抑制策略对减少暴力伤医事件、构建和谐的医患关系具有重要的理论意义。文章以集体行为理论框架为视角,阐释暴力伤医事件的诱发因素并提出相应的抑制策略。     

关于建立医疗风险管理机制的研究

医疗纠纷及其引发的“医闹”、群体性事件已经成为影响我国医疗卫生事业发展和社会稳定的一个突出问题。通过分析医疗纠纷产生的原因,提出建立集医疗风险预警、医疗风险处置和医疗风险社会分担为一体的医疗风险管理机制的框架。     

论医疗暴力的预防和处理对策

医疗暴力是一种违法行为,已得到了越来越多的人关注。目前医疗暴力事件的频繁发生,不断降低医患相互的信任感,而且引发了恶性的医患暴力冲突事件,影响医疗行业正常发展,成为影响社会稳定的问题之一。本文从整体的角度出发,分析我国目前医疗暴力现状、诱因及对策。深度剖析医患矛盾的缘由,在社会大环境下,就如何缓解医患矛盾的问题也提出了几点建设性的对策。     

从对某三甲医院信访工作分析看医院信访的发展方向

结合对某三甲医院近500例信访事件综合统计分析的结果,阐述了医院信访的构成类别、原因及影响因素,并由此推断今后医院信访工作的发展方向,对现今医院处理信访事件,缓解逾趋恶化的医患矛盾有着重要的指导意义。

     

以利益均衡构筑权利保障——浅析侵权责任法立法价值取向及其对医疗机构的几点启示

利益均衡旨在于利益关系主体之间寻找平衡点,尽可能将内部矛盾冲突降低到最低限度,保持利益体系和利益格局的稳定,其最终目的是实现权利保障,而法律制度的确立则是最有公信力的长效调整机制和保障机制。从侵权责任法医疗损害侵权行为构成要件和归责原则的确认、“举证责任倒置”的改变、医用产品连带责任和不必要检查侵权的规定等几个方面,体现出其以医患双方利益均衡为前提、确保双方权利充分保障的立法价值取向。立足于此,医疗机构应树立对医方权利和患方权利给予同等重视、理解患者合法权利内容、界定合理的医患双方权利义务界限、增强权利自我维护意识的发展观念。     

社交媒体环境下医患话语权的博弈及医方媒介策略 ——从“北医三院产妇事件”的网络信息传播切入

以被广为关注的“北医三院产妇事件”为例，可以发现，为争取医患冲突中的话语优势和有利结果，医患双方开始利用社交媒体传播进行话语权博弈：其发展搭建了医患互动与联系的桥梁，有助于重建医方专业权威，增加信息传播的客观性；而经传播产生的新博弈也易使医方自省能力下降、事件真相淡化，甚至有道德伦理受考验的风险。应从建立社交媒体矩阵平台、减少社交媒体传播损耗来规范和健全社交媒体环境下医患话语权的博弈。     

医疗风险预警及控制机制探讨

目前我国医疗纠纷及伤医事件频发，医疗风险预警及控制机制的不健全、医患沟通不畅及信任危机是造成这种冲突的主要原因。通过对医疗风险预警及控制机制的研究，为政府和医疗机构在减少医疗风险的发生上提供了干预措施和参考依据。     

从沟通过程模型谈医患沟通障碍

根据沟通过程模型,分别从信息发出者和接受者、编码译码的一致性、系统噪音等沟通环节分析了医患沟通过程存在的障碍因素,并提出对医学生进行人文和职业精神教育、加强医生医患沟通能力培训和考核、消除医患沟通中系统噪音等改善医患沟通的措施建议。     

Added mass in human swimmers: Age and gender differences

In unstationary swimming (changing velocity), some of the water around the swimmer is set in motion. This can be thought of as an added mass (M_a) of water. The purpose of this study was to find added mass on human swimmers and investigate the effect of shape and body size. Thirty subjects were connected to a 2.8 m long bar with handles, attached with springs (stiffness k=318 N/m) and a force cell. By oscillating this system vertically and registering the period of oscillations it was possible to find the added mass of the swimmer, given the known masses of the bar and swimmer. Relative added mass (M_a%) for boys, women and men were, respectively, 26.8±2.9%, 23.6±1.6% and 26.8±2.3% of the subjects total mass. This study reported significantly lower added mass (p<0.001) and relative added mass (p<0.002) for women compared to men, which indicate that the possible body shape differences between genders may be an important factor for determining added mass. Boys had significantly lower (p<0.001) added mass than men. When added mass was scaled for body size there were no significant differences (p=0.996) between boys and men, which indicated that body size is an important factor that influences added mass. The added mass in this study seems to be lower and within a smaller range than previously reported (Klauck, 1999, Eik et al., 2008). It is concluded that the added mass in human swimmers, in extended gliding position, is approximately 1/4 of the subjects’ body mass.     

Spleen mass as a measure of immune strength in mammals

• 1 In studies of birds and their pathogens, spleen size has frequently been used to make inferences about immune system strength. However, the use of spleen size in mammals is more complicated because, in addition to having an immune function, the mammalian spleen is also a reservoir for red blood cells.
• 2 To assess the reliability of mammalian spleen mass as an indicator of immune activity, we quantified the white and red pulp mass by histology of spleens from shot red deer Cervus elaphus. We then analysed the relationships among spleen mass, the amounts of white and red pulp, and the deer's body condition relative to faecal counts of the nematode parasite Elaphostrongylus cervi.
• 3 White and red pulp mass were positively correlated so that an increase in spleen mass was a positive function of both components of the spleen. In male deer, which had significantly lower body condition and higher parasite loads than females, parasite counts were negatively correlated with spleen mass, white pulp mass, and red pulp mass.
• 4 Our findings suggest that (i) spleen mass in shot red deer is a reliable measure of white and red pulp content; and (ii) when looking at the red deer life history, which is greatly influenced by sex of the deer, splenic mass and white pulp mass could be used as reflections of immune system strength.
• 5 Future studies of mammalian spleens can contribute to the understanding of evolved strategies of immune response investment in mammals. However, determination of the white and red pulp spleen components using various sampling methods must be made prior to their application.

     

Latitude, elevation and body mass variation in Andean passerine birds

• 1 Relationships between body mass and latitude, and body mass and elevation are examined in the assemblage of Andean passerine birds.
• 2 Across species, body mass is positively correlated with the mid‐point of the species elevational distribution, but there is no significant relationship between body mass and latitudinal range mid‐point.
• 3 When the assemblage is separated into Andean endemic and non‐endemic species, the former group shows a significant positive relationship between body mass and elevation, and the latter a significant positive relationship between body mass and latitude (‘Bergmann’s rule’). Andean endemic species exhibit Bergmann’s rule once elevation is controlled for using multiple regression.
• 4 These relationships are not a consequence of the phylogenetic non‐independence of species. All the effects shown are very weak, with latitude and elevation explaining only a few per cent of the variation in body mass. Relationships are strongest when phylogenetically controlled analyses are performed just within genera.
• 5 The implications of these results for the mechanistic understanding of Bergmann’s rule are discussed.

     

Predator size and the suitability of a common prey

 Although a predator’s mass should influence the suitability of its prey, this subject has received little direct attention. We studied the capture and processing of an abundant syrphid fly Toxomerus marginatus (c. 4 mg) by 0.6- to 40-mg juvenile crab spiders Misumena vatia (Thomisidae) to determine how profitability, relative profitability (profitability/predator mass), overall gain in mass, and relative gain in mass differed with predator mass, and whether foraging changed concurrently. In multi-prey experiments, the smallest successful spiders (0.6–3.0 mg) extracted less mass from flies, and did so more slowly, than large spiders. This gain was proportionately similar to that of 10- to 40-mg spiders with access to many Toxomerus. However, many small spiders failed to capture flies. When we gave spiders only a single Toxomerus, the smallest ones again extracted mass more slowly than the large ones and increased in mass less than the large ones, but increased in mass proportionately more than large ones. Relative gain in mass from a single prey decreased with increasing spider mass. Spiders larger than 10 mg all extracted similar amounts of mass from a single Toxomerus at similar rates, but varied in time spent between captures. Thus, Toxomerus changes with spider mass from a large, hard-to-capture bonanza to a small, easy-to-capture item of low per capita value. However, Toxomerus is common enough that large spiders can capture it en masse, thereby compensating for its decline in per capita value. Received: 7 May 1996 / Accepted: 23 September 1996     

Response of Sphagnum fuscum to water levels and CO2 concentration

Abstract

Sphagnum fuscum samples collected from an ombrotrophic bog were grown in a greenhouse at six water levels (0, 5, 10, 15, 25 and 30 cm) below the capitulum level and in four concentrations of CO₂ (350, 700, 1000 and 2000 ppm). The cores of S. fuscum were treated for 87 days and length increment was measured by the plastic strip method and by innate time markers. Water content of the shoot, dry mass of the capitulum, dry mass per unit length of stem and production of dry mass were measured at the end of the experiment.

The water content, capitulum dry mass, dry mass per unit length of stem, length increment and dry mass production differed markedly for S. fuscum grown in different water levels. With lower water levels, the water content of the shoot decreased and the dry mass of both the capitulum and unit length of stem increased. The total length increment was highest when the water level was at or near the capitulum level (0–10 cm). No clear trend in dry mass production on an areal basis could be found due to uncoupled responses in length increment and stem dry mass at the experimental water levels.

Neither capitulum dry mass nor dry mass per unit length of stem showed distinct trends in S. fuscum grown at different ambient CO₂ concentrations. Some increase in length increment and in dry mass production was detected at CO₂ concentrations above 350 ppm, but this effect appeared only at high water levels. It is suggested that the low response in length increment and production to CO₂ concentration resulted in part from insufficient moisture for photosynthesis at the lower water levels. Also, the possibility of increased nonstructural production is discussed.     

Abundance–body mass relationships in size-structured food webs

In communities sharing a common energy source, the energetic equivalence hypothesis predicts that numerical abundance (N) scales with body mass (M) as M^?0.75. However, in size‐structured food webs all individuals do not share a common energy source, and the energy available (E) to larger individuals is constrained by inefficient energy transfer through the food chains that support them. This is expected to lead to steeper scalings of N with M. Here, we formalize and test an existing model for predicting abundance–body mass scaling, where the decline in E with M is calculated from the mean predator–prey body mass ratio (from size‐based nitrogen stable isotope analysis) and trophic transfer efficiency. We show that the steep predicted scalings of abundance and body mass (N scales as M^?1.2, B scales as M^?0.2) in a marine food web are consistent with empirical estimates and can be attributed to the small predator–prey body mass ratio (106 : 1). As a previous study has shown that environmental stability may favour low predator–prey mass ratios and long food chains, we predict that steeper abundance–body mass relationships will be found in more stable environments.     

Geographical and land-use effects on seed-mass variation in common grassland plants

Seed mass is one of the most important plant traits. It is strongly related to plant fitness and life-history strategy, and is one of the key determinants of the ability of plants to spread and thus to respond to changing environments. While substantial empirical work has been devoted to understanding seed-mass variation across species, we know less about seed-mass variation within species, its geographical and ecological differentiation, and the degree to which it is influenced by environmental change. Here, we studied intraspecific variability in seed mass of six common grassland plants (Arrhenatherum elatius, Bromus hordeaceus, Cerastium holosteoides, Heracleum sphondylium, Trifolium repens and Veronica chamaedrys) across three regions in Germany and a broad range of land-use types and intensities. We found substantial seed-mass variation among regions, populations, and individuals within all of the studied species. In five species, seed mass had a strong and consistent geographic component, and in three species we found significant effects of land use – fertilisation, grazing intensity or mowing frequency – on seed mass. In several species, land use and geographic region not only affected mean seed mass, but also the variability of seed mass within populations. Our study demonstrates that seed mass is geographically and ecologically differentiated in common grassland species. It is likely that both phenotypic plasticity and genetic factors contribute to this differentiation. Our results also show that seed mass is a highly variable trait with typically around 10-fold variation within species.     

Scaling body mass and use of space in three species of marsupials in the Atlantic Forest of Brazil

Abstract Body mass is considered a major determinant of home range size, but usually at a large scale of body mass variation. The exact scale where body size becomes more important than particular adaptations of each species is not clear, and uncertainty in the estimate of home range size is a possible cause of weak intraspecific scaling. We determine the scaling to body mass of two alternative movement measurements, daily home range (DHR) and its intensity of use (IU), in three species of didelphid marsupials, Didelphis aurita, Philander frenatus, and Metachirus nudicaudatus (Didelphimorphia, Didelphidae). The expected scaling exponents DHR ≈ M^0.5 and IU ≈ M^?0.25 were derived from the scaling to body mass of home range and daily movement distance. Animals were tracked in Serra dos Órgãos, Rio de Janeiro, Brazil, using a spool‐and‐line device. Individuals of the three species were compared combining intra and interspecific variation in a single analysis, with species, body mass, and thread tracked as covariates. The model best supported included only body mass as the independent variable, with DHR ≈ M^0.435 and IU ≈ M^?0.218, close to the expected values. The second best supported model included species identity, but with a non‐significant effect. It was surprising that body mass was more important than species identity in a comparison involving only three species, and considering the morphological and locomotory adaptations of the three species. Body mass may become more important than species identity when the scale of variation approaches one order of magnitude.     

Rapid characterization of DNA oligomers and genotyping of single nucleotide polymorphism using nucleotide-specific mass tags

Using currently available MS-based methods, accurate mass measurements are essential for the characterization of DNA oligomers. However, there is a lack of specificity in mass peaks when the characterization of individual DNA species in a mass spectrum is dependent solely upon the mass-to-charge ratio (m/z). Here, we utilize nucleotide-specific tagging with stable isotopes to provide internal signatures that quantitatively display the nucleotide content of oligomer peaks in MS spectra. The characteristic mass-split patterns induced by the partially ¹³C/¹⁵N-enriched dNTPs in DNA oligomers indicate the number of labeled precursors and in turn the base substitution in each mass peak, and provide for efficient SNP detection. Signals in mass spectra not only reflect the masses of particular DNA oligomers, but also their specific composition of particular nucleotides. The measurements of mass tags are relative in the mass-split pattern and, hence, the accuracy of the determination of nucleotide substitution is indirectly increased. For high sample throughput, ¹³C/¹⁵N-labeled sequences of interest have been generated, excised in solution and purified for MS analysis in a single-tube format. This method can substantially improve the specificity, accuracy and efficiency of mass spectrometry in the characterization of DNA oligomers and genetic variations.     

Comparison of Communities of Stored Product Mites in Grain Mass and Grain Residues in the Czech Republic

In storage facilities one can find grain either in stored grain mass or in grain residues in the store corners or machinery. Although it is claimed that grain residues are serious pest reservoirs since they harbor numbers of stored product arthropods and are connected via continuous emigration with grain mass, the documentation for this is not convincing. Therefore in 78 selected grain stores, we simultaneously sampled the grain mass and residues in order to compare concurrent mite communities in these two different habitats. We found 30 species in about 614 000 individuals in residues and 23 species in about 20 000 individuals in grain mass. Canonical correspondence analysis (CCA) of transformed abundance data showed differences in the communities of mites in grain mass and residues: (i) species associated to grain residues (e.g. Tyrophagus longior, Tydeus interruptus, Acarus farris and Cheyletus eruditus) and (ii) species associated to both grain mass and grain residues (e.g. Tarsonemus granarius, Acarus siro, Tyrophagus putrescentiae, Lepidoglyphus destructor and Cheyletus malaccensis). Although the residue samples had more mites and higher species diversity than the stored grain mass, no correlation in mite abundance and species numbers between samples from grain residues and grain mass was found, thereby indicating low connectivity of these two habitats.