Mass Collaboration in Earthquake Risk Management

The mechanism of mass collaboration in risk management was studied during the Sichuan earthquake under a Web-based “PeopleFinder” project, where information is contributed and shared among mass contributors. The case study is provided by a great earthquake that happened in Wenchuan County, Sichuan Province, of southwestern China at 2:28 p.m. on May 12, 2008. We witnessed and experienced the rescue and relief efforts for the great earthquake. In this article, two fundamental frameworks are developed to study the mechanism of mass collaboration. Mass collaboration is proven to be effective in a big public crisis such as the Sichuan earthquake.     

Earthquakes and Risk Management in China

Natural hazards such as floods, tsunamis, wildfire res, droughts, landslides, volcanic eruptions, windstorms, and earthquakes exist everywhere in the world. Earthquakes can pose the greatest threat to human lives, property, and economic development in our society. We review tools that have been developed to assist the earthquake risk management process. We also propose two mechanisms for earthquake risk management: one to possibly better predict earthquake damage magnitude (prediction markets), the other to prepare response team performance (recognition primed decision-making). In conjunction with broader use of information system technology, it may be possible to improve preparedness and response.     

Trends in the Development of Ecological Risk Assessment and Management Frameworks

Ecological risk assessment and management have grown from a long history of assessment and management activities aimed at improving the everyday lives of humans. The background against which ecological risk assessment and management has developed is discussed and recent trends in the development of risk assessment and management frameworks documented. Seven frameworks from five different countries are examined. All maintain an important role for science, suggest adaptive approaches to decision-making and have well-defined analytical steps. Differences in approaches toward the separation of policy and science, the preference for management over assessment, the inclusion of stakeholders, the iterative nature of the analytical cycle, the use of decision criteria and economic information suggest considerable evolution in framework design over time. Despite the changes, no consensus on the design of a framework is apparent and work remains to be done on refining an integrative framework that effectively incorporates both policy and science considerations for environmental management purposes.     

医疗保险费用支付方式改革对医院管理的影响

医疗保险支付方式是医疗保险制度的核心内容之一，它涉及医、患、保三方，是医疗保险过程中涉及各方经济利益的最直接、最敏感的环节。随着医疗保险制度的普及、医疗费用的快速增长，改革医疗保险支付方式已势在必行。疾病诊断相关组预付法是医疗保险支付方式改革的趋势，其实施将对医院的经营管理有重大影响，涉及到医院管理的重点、医保支付相关科室的结构与职能的调整以及相关人员的培训等方面。     

Ecological Risk Assessment and the Precautionary Principle

The Precautionary Principle, generated during the late 1980s as a unifying principle for regulating discharge of hazardous material into the North Sea, has been broadened to include a shifting of the burden of proof to the proponent of a proposed activity, adoption of a more holistic assessment process, and encompassing all environmental management decisions, not just pollution prevention activities. We argue that the Precautionary Principle remains a management philosophy, not a substitute for risk assessment. Risk assessment is a tool for organizing information used in environmental management decisions. However, increasing attention to reducing the Type II error of risk assessment studies would significantly reduce the skepticism with which many view the risk assessment process. A critical review of default assumptions used in risk assessments, inclusion of indirect effects within an ecologically relevant spatial/temporal framework, and better communication between risk assessors and risk managers also would enhance the acceptability of the process. Risk assessment can provide a sound basis for management decisions regardless of the underlying philosophies of environmental conservation or utilitarianism, but only if the inherent biases in the risk assessment assumptions are acknowledged explicitly throughout the assessment and management processes.     

An Integrated Framework for Risk Management and Population Health

The traditional medical model of health and health policy development has focused on individuals and the role of medical care in preventing and treating disease and injury. Recent attention to health inequities and social determinants of health has raised the profile of population heath and evidence-based strategies for improving the health of whole populations. At the same time, risk science has emerged as an important new discipline for the assessment and management of risks to health. This article reviews historical developments in the fields of risk management and population health and proposes a joint population health risk management framework that integrates the key elements of both fields. Applying this integrated approach to managing population health risks will facilitate the development of evidence-based health policy. It will encourage a more systematic and comprehensive evaluation of population health issues and promote the use of a broader suite of interventions to reduce health risks and enhance population health status.     

Ecological Risk Assessment of China's Freshwater Ecosystems Applying the Relative Risk Model: Toward an Ecosystem-Based Water Management in China

The relative risk model (RRM) was applied to evaluate the ecological risk characterization of the freshwater ecosystems in China, from both overall and region-specific levels. Ten large-scale river basins (further broken into 15 risk regions) in China were chosen as the study objects; 10 sources, two habitats, and seven endpoints were identified as risk components. The results reveal the status of ecosystem conditions, key ecological risk issues, and the spatial heterogeneity of the freshwater ecosystems in China. The policy implications for the ecosystem-based water management contained in the results are discussed. The results obtained in this article provide a deeper understanding of the ecological risk characterization of the freshwater ecosystems in China, and aid in promoting the applications of the RRM as the tool for ecosystem-based water management.     

总额预付背景下医院医保管理策略的调整与思考

目的 探寻总额预付制度对于三级综合医院医保管理工作的影响,并有针对性的提出改进措施。方法 采用访谈法、比较法等收集信息资料,并对相关数据进行统计处理和实施效果分析。结果 医院对管理策略的合理调整,有助于多种角度控制医疗费用增长,临床医务人员在诊疗行为方面趋于规范化,不合理用药现象减少。结论 总额预付制度的实施有助于医院医疗费用的控制,医保的管理意识得到强化。     

基于信息技术的医院医保闭环式管理

新医改背景下医院面临越来越大的医保拒付风险,借助信息技术推动医保闭环式管理能有效防范医保拒付风险。文章先分析了医院推行医保闭环式管理的必要性,再对医院医保闭环式管理的内涵进行了论述,后以我院基于信息技术的医保闭环式管理进行了案例分析。     

Types of Integration in Risk Assessment and Management,And Why They Are Needed

Risk-based decision making requires that the decision makers and stakeholders are informed of all risks that are potentially significant and relevant to the decision. The International Programme on Chemical Safety of the World Health Organization has developed a framework for integrating the assessment of human health and ecological risks. However, other types of integration are needed to support particular environmental decisions. They are integration of exposure and effects, of multiple chemicals and other hazardous agents, of multiple routes of exposure, of multiple endpoints, multiple receptors, multiple spatial and temporal scales, a product's life cycle, management alternatives, and socioeconomics with risk assessment. Inclusion of all these factors in an integrated assessment could lead to paralysis by analysis. Therefore, it is important that assessors be cognizant of the decision process and that decision makers and those who will influence the decision (stakeholders) be involved in planning the assessment to ensure that the degree of integration is necessary and sufficient.     

Introduction to the Special Section on “Chinese Earthquake Risk Management”

Natural disasters by definition are surprises, causing a great deal of damage and inconvenience. Earthquakes are among the most terrifying and destructive natural disasters threatening humans. Emergency management has been described as the process of coordinating an emergency or its aftermath through communication and organization for deployment and the use of emergency resources. This special section of HERA provides the state of the art studies of risk and emergency management related to the Wenchuan earthquake that occurred in China in May 2008.     

Risk and Decision-Making: A Workshop for Environmental Professionals

In the early 1990s, U.S. Environmental Protection Agency Region 9 developed a training workshop for environmental professionals. It was successfully taught throughout Region 9 in collaboration with the California Department of Toxic Substances Control. We have updated the workshop's manual to incorporate current practices including: vapor intrusion into indoor air, benchmark dose, cancer guidelines, inhalation guidance, ecological and screening risk assessments, conceptual site models, and data quality objectives. We maintained the popular workshop format, with participants evaluating information and drawing conclusions in an interactive hands-on approach. We kept the case study approach to simulate realistic environmental issues. After a case study introduction, participants plan a sampling strategy. Principles of toxicology are introduced, and participants develop toxicity criteria using hypothetical animal study results. Participants then identify exposure pathways, and calculate exposure and risk and hazard estimates. Finally, participants develop remedial alternatives and practice risk communication through role playing exercises. The workshop has been an effective tool for training new employees and providing continuing education for experienced employees from consulting, military, and regulatory agencies. The format provides a dynamic learning environment, fostering exchanges among professionals with a wide range of skills and backgrounds (project managers, toxicologists, geologists, engineers, public participation experts).     

The Concept of Data Utility in Health Risk Assessment: A Multi-Disciplinary Perspective

Human and ecological health risk assessments and the decisions that stem from them require the acquisition and analysis of data. In agencies that are responsible for health risk decision-making, data (and/or opinions/judgments) are obtained from sources such as scientific literature, analytical and process measurements, expert elicitation, inspection findings, and public and private research institutions. Although the particulars of conducting health risk assessments of given disciplines may be dramatically different, a common concern is the subjective nature of judging data utility. Often risk assessors are limited to available data that may not be completely appropriate to address the question being asked. Data utility refers to the ability of available data to support a risk-based decision for a particular risk assessment. This article familiarizes the audience with the concept of data utility and is intended to raise the awareness of data collectors (e.g., researchers), risk assessors, and risk managers to data utility issues in health risk assessments so data collection and use will be improved. In order to emphasize the cross-cutting nature of data utility, the discussion has not been organized into a classical partitioning of risk assessment concerns as being either human health- or ecological health-oriented, as per the U.S. Environmental Protection Agency's Superfund Program.     

汶川地震转运与震区住院患者回顾性对比分析

目的:探讨汶川地震转运与震区住院伤病员的特点和疾病谱.方法:采用“军卫一号“医院信息系统,收集整理三所军队医院收治汶川地震伤病员的诊疗信息.对比转运与震区住院伤病员的入院时间、基本情况和诊疗信息的差异.结果:震后第2日震区住院伤病员入院人数最多,为394人;前4日占震后10日内入院人数的80.6％.全部住院伤病员男性730人,占56.5％,女性562人,占43.5％;汉族占95％,羌族、藏族及其他民族占5％;已婚占76.4％;手术率为36.5％;住院天数的中位数为12天;治愈好转率为96.5％,病死率为1％.转运与震区住院伤病员的性别、年龄组、民族、手术与否和治疗结果构成差异具有统计学意义(P＜0.05);震区住院伤病员组的住院天数中位数低于转运住院伤病员组(P＜0.00l).按照出院第一诊断,损伤或中毒住院伤病员占81.5％;其他疾病前五位为消化系统疾病、呼吸系统疾病、肌肉骨骼和结缔组织疾病、循环系统疾病、症状和体征.结论:地震等灾害后应尽早(灾后3-5天)转运伤病员.震区一线医院和接收转运伤病员医院应科学、合理设置床位、安排陪护人员、招募志愿者.地震第一阶段医疗救援完成后,救援重点应转向内科和慢性疾病,并提前做好应医疗准备.     

转基因生物及其产品的风险与管理

转基因生物及其新产品已经进入国际贸易,关于其风险性的争论甚为激烈。上前所知的风险主要是基于理论上的推测。本文介绍了世界各国对转基因生物及其产品的管理模式和一些国际组织的有关活动和规则,并对当前形势下我国应采取的对策提出了建议。     

地震灾害对四川省区域生态系统危害及损失评价

地震是自然灾害中最为严重的一种,其带来的生态破坏灾难巨大,区域生态系统损害估算是目前研究中的难点问题之一。对我国西部地震的生态损失特点进行了研究,系统总结国内外地震灾害的生态系统损失评估成果,提出了西部地震生态损失评估模型：Eq=Ep＋ERC＋ERL,利用指数分析法和机会成本法等构建了地震研究的基本计算模型和理论,提出用地震生态损失量和地震生态损失灾害度相结合的办法来研究具体区域生态系统的地震灾害损失。利用模型计算,四川省在本次地震中森林碳汇储备能力每年损失78．1万t,损失价值2．5×10^8元,森林释放氧气能力降低67．38万t,损失价值2．7×10^8元。直接生态系统损失（％）647．58×10^8元,生态系统恢复费用（ERC）1158．31×10^8元,全省森林生态系统生态服务价值损失达1055．88×10^8元,综合生态损失在3527．31×10^8元,灾度0．38,属于明显灾害破坏。灾害损失和灾害度的快速评估对于指导灾后生态系统重建工作和生态系统工程的防灾都具有重要的积极作用。     

Addressing Susceptibility in Microbial Pathogen Risk Assessment

As concern for vulnerable subpopulations has grown, susceptibility has become a more important element in risk assessment and management processes. However, there is little consensus on how to incorporate or model the concept effectively in microbial pathogen risk assessment (MRA). Susceptibility is fundamentally a complex concept. There are many different definitions for it, reflecting the principles and viewpoints of the fields that contribute to risk assessment. Although susceptibility needs to be addressed in every step of the risk management paradigm, it has not yet been fully integrated into risk assessment, one step within the paradigm. Many factors are involved in characterizing and modeling susceptibility, but little is known about the relationships of many of the factors and many cannot be reliably measured. Recent MRA frameworks and case studies were reviewed for their approaches to susceptibility. Themes identified included limited or no explicit conceptualization of susceptibility in the problem formulation, limited data to assess susceptibility, heavy or exclusive emphasis on susceptibility in the health effects portion of the model, primary focus on host characteristics, and little consideration of susceptibility in risk characterization. Recommendations to improve approaches to susceptibility in MRA are presented.