我国自然保护区资金机制改革创新的几点思考

目前国际上自然保护地的资金投入规模远远低于实际需求, 未来融资机制需要创新, 包括吸引和利用外部资金、鼓励自行经营创收、基于保护地产品或服务的市场交易收费等, 其中鼓励创收主要指的是财政手段(例如生态税)、收益共享机制、管理成本共担机制、金融交易(例如碳排放交易)等。政治领域的制度规范、经济领域的市场、价格政策等都会影响保护地的融资机制, 保护地未来的融资机制将更多地依赖于财政、金融、市场、贸易相互结合的多元化融资手段。我国自然保护区目前存在资金来源结构不合理、资金规模太小, 支出结构不合理、缺乏周边社区补偿和收益共享机制等问题。为此, 作者提出以下建议: (1)确保中央财政承担国家级自然保护区的主要管理经费; (2)在充分发挥生态旅游服务付费、资源使用付费等传统产品(服务)收费型融资手段的基础上, 建立和完善生态系统服务付费、森林碳汇交易和保护区绿色产品认证等新的市场交易型融资渠道; (3)利用境外资金提升我国自然保护区的能力建设; (4)积极争取国内不同社会团体的资金支持, 条件允许的保护区可通过多方联合治理模式建立管理成本共担机制以及与周边社区的收益共享机制。(5)在资金使用方面, 在保障保护区工作人员基本薪酬福利的前提下, 将剩余资金包括经营收入优先用于核心保护业务的投资上, 同时加强资金的监管。     

Issues in determining financial competence in the elderly.

With the ever-increasing numbers and relative proportion of elderly in the population, physicians are now frequently facing the difficult task of determining the financial competence of vulnerable individuals. The determination of financial competence in the elderly is still a very poorly defined issue. In this paper an attempt is made to clarify the existing law and the physician''s legal obligations. The Mental Health Act, Powers of Attorney Act and Mental Incompetency Act, as they relate to a patient''s financial competence, are reviewed. The difficulties in the clinical application of these laws are illustrated by two reports of patients referred to the geriatric psychiatry service of Sunnybrook Medical Centre, University of Toronto. Some general principles and practical guidelines are proposed to help physicians deal more effectively with this issue.     

国家重点功能区转移支付对生态系统格局变化的县域对比分析

国家财政部于2009年印发了《国家重点生态功能区转移支付(试点)办法》,中央财政开始以转移支付的方式对国家重点生态功能区进行生态补偿，截止到2020年国家已累计下达转移支付资金6035.5亿元。评估国家重点功能区财政转移支付的生态保护成效对国家生态环境保护与修复决策具有重要意义，以国家重点生态功能区转移支付县域为调查和评估对象，基于多期遥感解译的土地利用/土地覆被数据，对正式实施财政转移支付政策以来国家重点生态功能区生态系统格局及其变化进行了评估，并对是否接受财政转移支付县域生态系统格局变化进行了对比分析。研究结果表明：国家重点生态功能区生态质量状况整体好转，2011—2019年土地覆被转类指数为3.85%,生态质量整体上好转主要与水域增加有关。享受国家财政转移支付政策后各县域生态质量改善明显，从2011—2016年的空间横向比较来看，享受财政转移支付县域土地覆被转类指数为2.28%,未享受县域为-3.36%;从2011—2019年的时间纵向比较来看，享受财政转移支付前土地覆被转类指数为-3.35%,而享受后为1.70%。然而，国家重点生态功能区人为活动干扰仍然较为强烈，研究时段内城乡...     

Who cares about equity in the NHS?

The concept of equity in relation to the National Health Service in Britain encompasses not one but at least eight distinct principles. Until the 1980s the NHS had a good record of incorporating these principles into practice. Throughout the 1980s, however, there has been a pronounced change, with the gradual introduction of business values into the service, culminating in the market based reforms of the 1990s. Several recent policies seem to be taking the NHS away from the goal of an equitable system--for example, the new arrangements for community care and the incentives within contracting to select patients on financial grounds. To restore equity as a value demands priority for ethical values, monitoring of policies for their effects on equity, some national planning, and a new debate about the entitlement to services such as continuing care.     

Financial Stress and Outcomes after Acute Myocardial Infarction

Background

Little is known about the association between financial stress and health care outcomes. Our objective was to examine the association between self-reported financial stress during initial hospitalization and long-term outcomes after acute myocardial infarction (AMI).

Materials and Methods

We used Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER) data, an observational, multicenter US study of AMI patients discharged between January 2003 and June 2004. Primary outcomes were disease-specific and generic health status outcomes at 1 year (symptoms, function, and quality of life (QoL)), assessed by the Seattle Angina Questionnaire [SAQ] and Short Form [SF]-12. Secondary outcomes included 1-year rehospitalization and 4-year mortality. Hierarchical regression models accounted for patient socio-demographic, clinical, and quality of care characteristics, and access and barriers to care.

Results

Among 2344 AMI patients, 1241 (52.9%) reported no financial stress, 735 (31.4%) reported low financial stress, and 368 (15.7%) reported high financial stress. When comparing individuals reporting low financial stress to no financial stress, there were no significant differences in post-AMI outcomes. In contrast, individuals reporting high financial stress were more likely to have worse physical health (SF-12 PCS mean difference −3.24, 95% Confidence Interval [CI]: −4.82, −1.66), mental health (SF-12 MCS mean difference: −2.44, 95% CI: −3.83, −1.05), disease-specific QoL (SAQ QoL mean difference: −6.99, 95% CI: −9.59, −4.40), and be experiencing angina (SAQ Angina Relative Risk = 1.66, 95%CI: 1.19, 2.32) at 1 year post-AMI. While 1-year readmission rates were increased (Hazard Ratio = 1.50; 95%CI: 1.20, 1.86), 4-year mortality was no different.

Conclusions

High financial stress is common and an important risk factor for worse long-term outcomes post-AMI, independent of access and barriers to care.     

Aesthetic surgery economics: lessons from corporate boardrooms to plastic surgery practices

Healthcare traditionally has been described as not conforming to the laws of economics. Consumers pay for aesthetic surgery directly, thus freeing it from the usual confounding factors and making it more likely to comply with the market forces explained by economics. Recent studies have demonstrated the ability of classic economics to analyze, predict, and optimize the financial environment of aesthetic surgery. This article describes economic principles and how they can be applied to aesthetic surgery. Some of the basic instruments of economics include the study of supply and demand, prices, and price elasticity; capital investments; communication and cooperation; and consumer cognitive limitations. Each of these tools offers plastic surgeons the opportunity to gain improved control of their financial environment.     

公立医院医疗政策性亏损财政补偿方式研究

从区域政府财政投入角度出发,结合理论和实际情况进行分析,确立公立医院医疗政策性亏损补偿的分类测算、相对效率、投入——产出最优及动态性4个原则,并提出融合了相应激励制约机制指标体系在内的测算方法。     

Beyond hectares: four principles to guide reforestation in the context of tropical forest and landscape restoration

New climate change agreements emerging from the 21st Conference of the Parties and ambitious international commitments to implement forest and landscape restoration (FLR) are generating unprecedented political awareness and financial mobilization to restore forests at large scales on deforested or degraded land. Restoration interventions aim to increase functionality and resilience of landscapes, conserve biodiversity, store carbon, and mitigate effects of global climate change. We propose four principles to guide tree planting schemes focused on carbon storage and commercial forestry in the tropics in the context of FLR. These principles support activities and land uses that increase tree cover in human‐modified landscapes, while also achieving positive socioecological outcomes at local scales, in an appropriate contextualization: (1) restoration interventions should enhance and diversify local livelihoods; (2) afforestation should not replace native tropical grasslands or savanna ecosystems; (3) reforestation approaches should promote landscape heterogeneity and biological diversity; and (4) residual carbon stocks should be quantitatively and qualitatively distinguished from newly established carbon stocks. The emerging global restoration movement and its growing international support provide strong momentum for increasing tree and forest cover in mosaic landscapes. The proposed principles help to establish a platform for FLR implementation and monitoring based on a broad set of socioenvironmental benefits including, but not solely restricted, to carbon mitigation and wood production.     

Restoration of ecosystem services and biodiversity: conflicts and opportunities

Ecological restoration is becoming regarded as a major strategy for increasing the provision of ecosystem services as well as reversing biodiversity losses. Here, we show that restoration projects can be effective in enhancing both, but that conflicts can arise, especially if single services are targeted in isolation. Furthermore, recovery of biodiversity and services can be slow and incomplete. Despite this uncertainty, new methods of ecosystem service valuation are suggesting that the economic benefits of restoration can outweigh costs. Payment for Ecosystem Service schemes could therefore provide incentives for restoration, but require development to ensure biodiversity and multiple services are enhanced and the needs of different stakeholders are met. Such approaches must be implemented widely if new global restoration targets are to be achieved.     

The alluring myth of private medicine.

Canada''s medicare system has provided Canadians with high-quality health care for almost three decades. Now Canadian health care appears to be at risk of losing the single-payer system, which is the premise on which medicare is built. As medicare comes under increasing financial pressure, many are calling for the introduction of private care as a means of bolstering our health care system and maintaining its quality. Although it appears alluring to some politicians, physicians and commentators, privatization could very well lead to the demise of the principles and practices of the Canadian health care system as we know it, with little clear benefit to the public or physicians.     

DebtRank: A Microscopic Foundation for Shock Propagation

The DebtRank algorithm has been increasingly investigated as a method to estimate the impact of shocks in financial networks, as it overcomes the limitations of the traditional default-cascade approaches. Here we formulate a dynamical “microscopic” theory of instability for financial networks by iterating balance sheet identities of individual banks and by assuming a simple rule for the transfer of shocks from borrowers to lenders. By doing so, we generalise the DebtRank formulation, both providing an interpretation of the effective dynamics in terms of basic accounting principles and preventing the underestimation of losses on certain network topologies. Depending on the structure of the interbank leverage matrix the dynamics is either stable, in which case the asymptotic state can be computed analytically, or unstable, meaning that at least one bank will default. We apply this framework to a dataset of the top listed European banks in the period 2008–2013. We find that network effects can generate an amplification of exogenous shocks of a factor ranging between three (in normal periods) and six (during the crisis) when we stress the system with a 0.5% shock on external (i.e. non-interbank) assets for all banks.     

Solidarity and justice as guiding principles in genomic research

In genomic research the ideal standard of free, informed, prior and explicit consent is sometimes difficult to apply. This has raised concern that important genomic research will be restricted. Different consent procedures have therefore been proposed. This paper explicitly examines the question how, in genomic research, the principles of solidarity and justice can be used to justify forms of diminished individual control over personal data and bio-samples. After a discussion of the notions of solidarity and justice and how they can be related to health care and genomic research, we examine how and in which situations these notions can form a strong moral basis for demanding certain financial sacrifices. Then we examine when these principles can justify consent procedures which diverge from the ideal standard. Because much genomic research is not expected to lead to immediate (clinical) benefits we also discuss the question of whether we can be obliged to make any sacrifices for future (not yet existing) patients. We conclude with the formulation of a number of conditions that have to be met before autonomy sacrifices can be reasonably demanded in genomic research.     

Alternative funding plans: is there a place in academic medicine?

Because of shrinking resources and the resulting threat to its academic vitality the Department of Paediatrics, Hospital for Sick Children, University of Toronto, entered into an agreement on alternative funding with the Ontario Ministry of Health in 1990. The department developed a set of principles that guided the negotiations, which ultimately led to a budget that formed the basis of the agreement. The contract with the ministry provides a global budget to the department; this budget funds faculty members, administrative staff and the educational and research programs formerly supported by fee-for-service billing to the Ontario Health Insurance Plan. The alternative funding plan has provided financial stability to the department and affords an opportunity to develop innovative and cost-effective models of pediatric care.     

Assessing the effect of poisoning programs on the density of non-target fauna: Design and interpretation

To establish whether poisoning programs affect non-target density, the null hypothesis that density does not decline on poisoned sites needs to be tested. However, where no statistically significant reduction in density is found, there is some probability that a biologically significant reduction has been overlooked. The probability that such an error has occurred (a Type 2 error) depends on the effect poisoning has on non-target density, the precision with which the reduction is assessed, and the number of poisoning operations sampled. Prospective power analysis can identify minimum sample sizes that reduce the probability of a Type 2 error to acceptable levels. Equivalence tests require a priori identification of the minimum change in non-target density that can be safely overlooked and the acceptable probability of doing so. As such, they explicitly link the statistical and biological significance of non-target poisoning assessments. We illustrate these principles using an experimental assessment of the effect rabbit poisoning has on the density of large kangaroo populations in Australia. A rule-of-thumb guide was used to estimate appropriate levels of power (0.85) and reductions in kangaroo density (r = -0.12) for the assessment, and a pilot study conducted to estimate the between-sample standard deviation for estimates of change in kangaroo density(s = 0.089). Prospective power analysis based on these estimates indicated that 6 poisoning programs would provide a robust assessment of the effect of poisoning on kangaroos. However, because the between-sample standard deviation was underestimated, a subsequent assessment based on 6 samples had insufficient power to usefully estimate the effect poisoning had on kangaroos. Retrospective power analysis indicated that at 0.85 power, reductions in kangaroo density as high as r=—2.2 may have been overlooked. Using the between-sample standard deviation from this assessment, changes in kangaroo density would have to be estimated for 17-19 poisoning programs if a subsequent experiment was to achieve a biologically as well as statistically robust result.     

MISCONCEPTIONS ABOUT COERCION AND UNDUE INFLUENCE: REFLECTIONS ON THE VIEWS OF IRB MEMBERS

Payment to recruit research subjects is a common practice but raises ethical concerns relating to the potential for coercion or undue influence. We conducted the first national study of IRB members and human subjects protection professionals to explore attitudes as to whether and why payment of research participants constitutes coercion or undue influence. Upon critical evaluation of the cogency of ethical concerns regarding payment, as reflected in our survey results, we found expansive or inconsistent views about coercion and undue influence that may interfere with valuable research. In particular, respondents appear to believe that coercion and undue influence lie on a continuum; by contrast, we argue that they are wholly distinct: whereas undue influence is a cognitive distortion relating to assessment of risks and benefits, coercion is a threat of harm. Because payment is an offer, rather than a threat, payment is never coercive.     

Responsible estuarine finfish stock enhancement: an Australian perspective

The responsible approach to marine stock enhancement is a set of principles aimed at maximising the success and benefits of artificially re‐stocking depleted fisheries. The benefits of such an approach are evident in the 400% increase in survival of stocked striped mullet in Hawaii through refinement of release techniques, however financially or temporally constrained stocking programs in Australia have not adhered to all principles. A pragmatic approach to address these principles is proposed, using international examples and Australian marine finfish pilot stockings of barramundi, mulloway, sand whiting, dusky flathead and black bream. Biological ranking of candidate species by estuarine residency, a low natural‐mortality to growth ratio, a large L _∞ and comparison by recreational value and available rearing technologies, show that mulloway, barramundi and sea mullet are ideal species for stocking in Australia. Australian intermittently closed opening landlocked lagoons and recreational fishing havens, especially near cities, provide experimental opportunities to apply this approach and stock suitable species through small‐scale pilot experiments. This would allow evaluation of production and carrying capacity, and density dependent processes with respect to optimal stocking strategies unconfounded by emigration and commercial fishing practices. Twenty per cent of Australians fish each year, and harvest approximately 27 000 t of finfish. Stocking recreationally important species in Australia should give a greater financial benefit, which is spread across a larger cross‐section of the community, compared to stocking to enhance commercial fisheries. The pragmatic application of the responsible approach, and stocking of fast growing estuarine residents into recreational fishing havens would enhance the benefit from marine stocking.     

Life cycle assessment and life cycle costing of road infrastructure in residential neighbourhoods

Purpose

The built environment consists of a huge amount of infrastructure, such as roads and utilities. The objective of this paper is to assess the life cycle financial and environmental impact of road infrastructure in residential neighbourhoods and to analyse the relative contribution of road infrastructure in the total impact of neighbourhoods.

Methods

Various road sections are analysed based on an integrated life cycle approach, combining life cycle costing and life cycle assessment. To deal with complexity, a hierarchic assessment structure, using the principles of the “element method for cost control”, is implemented. Four neighbourhood models with diverse built densities are compared to gain insight in the relative impact of road infrastructure in neighbourhoods.

Results and discussion

The results reveal important financial and environmental impact differences between the road sections analysed. Main contributors to the life cycle financial and environmental impact are the surface layer and electrical and piped services. The contribution of road infrastructure to the total neighbourhood impact, ranging from 2 to 9 % of the total cost, is relatively limited, compared to buildings, but not negligible in low built density neighbourhoods.

Conclusions

Good spatial planning of the neighbourhood is recommended to reduce the amount of road infrastructure and the related financial and environmental impact. The priority should be to design denser neighbourhood layouts, before decreasing the financial and environmental impact of the road sections.

     

Do post-menopausal women provide more care to their kin?: evidence of grandparental caregiving from two large-scale national surveys

Drawing on the logical principles of life-history theory, it may be hypothesized that—compared to pre-menopausal women—post-menopausal women will spend more time caring for grandchildren and other kin. This hypothesis was tested in two studies, on results obtained from two large datasets documenting altruistic behaviors of pre-menopausal and post-menopausal women in the United States (n = 7161) and Australia (N = 25,066). Results from both studies revealed that (even when controlling statistically for age, health, financial resources, and other pertinent variables), post-menopausal women devoted more time to grandparental caregiving. This effect was specific to kin care: Menopause status was not as strongly related to a measure of non-kin-directed altruistic behavior (time spent volunteering). These results provide the first empirical support for a previously-untested behavioral implication of menopause.     

A CMA position. Acquired immunodeficiency syndrome.

The following general principles serve as guidelines for various bodies, health care professionals and the general public. Specific aspects of infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) that relate to physicians'' ethical responsibilities as well as society''s moral obligations are discussed. Such matters include the need for education, research and treatment resources; the patient''s right to investigation and treatment and to refusal of either; the need to obtain the patient''s informed consent; the right to privacy and confidentiality; the importance of infection control; and the right to financial compensation in the case of occupational exposure to HIV.     

Selection and Evolution with a Deck of Cards

Imparting a basic understanding of evolutionary principles to students in an active, engaging fashion can be troublesome because the logistics involved in designing experiments where students pose their own questions and use the data to test alternative hypotheses often outstrip time and financial constraints. In recent years, educators have begun publishing exercises that teach evolution using innovative, in-class experiments. This article adds to this growing forum by describing a classroom exercise that introduces the concept of evolution by natural selection in a hypothesis-driven, experimental fashion, using a deck of cards. Our standard exercise is suitable for upper-level high school and introductory biology students at the college level. In this paper, we discuss the exercise in detail and give several examples that illustrate how our games provide accessible bridges to the primary literature. Finally, we discuss how extensions of our basic exercise can be used to effectively teach advanced evolutionary concepts.