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1.
摘要 目的:探讨血清铁蛋白(SF)、抗苗勒管激素(AMH)、脂联素(APN)、核因子-κB(NF-κB)与肥胖型多囊卵巢综合征(PCOS)不孕患者胰岛素抵抗(IR)和体外受精-胚胎移植(IVF-ET)助孕妊娠结局的关系。方法:选取2019年1月~2021年1月广西医科大学第一附属医院收治的120例PCOS不孕症患者,根据体重指数(BMI)分为肥胖组(BMI≥28 kg/m2,79例)和非肥胖组(BMI<28 kg/m2,41例),肥胖组患者根据IVF-ET妊娠结局分为妊娠失败组47例和妊娠成功组32例。酶联免疫吸附法检测血清AMH、APN、NF-κB、SF水平,计算稳态模型胰岛素抵抗指数(HOMA-IR),采用Pearson相关系数分析肥胖型PCOS不孕症患者血清AMH、APN、NF-κB、SF水平与HOMA-IR的相关性,采用多因素Logistic回归分析IVF-ET助孕妊娠结局的影响因素。结果:肥胖组血清AMH、NF-κB、SF水平和HOMA-IR高于非肥胖组,APN水平低于非肥胖组(P<0.05)。Pearson相关性分析显示,肥胖型PCOS不孕症患者的HOMA-IR与血清AMH、NF-κB、SF水平呈正相关(r=0.663、0.734、0.687,均P<0.05),与APN水平呈负相关(r=-0.683,P<0.05)。妊娠失败组黄体生成素(LH)、LH/促卵泡生成素(FSH)比值、HOMA-IR、血清AMH、NF-κB、SF水平均高于妊娠成功组,受精率、优胚率、FSH、APN水平均低于妊娠成功组(P<0.05)。多因素Logistic回归分析显示,LH、LH/FSH、HOMA-IR、SF、AMH、NF-κB水平升高是肥胖型PCOS不孕症患者IVF-ET妊娠失败的危险因素,APN水平升高是IVF-ET妊娠失败的保护因素(P<0.05)。结论:肥胖型PCOS不孕症患者血清AMH、NF-κB、SF水平升高,APN水平降低,且与IR和IVF-ET助孕妊娠结局有关。  相似文献   

2.
摘要 目的:血清25-羟维生素D[25(OH)D]、抗苗勒管激素(AMH)和抑制素B(INHB)联合检测在卵巢储备功能低下(DOR)患者体外受精-胚胎移植(IVR-ET)妊娠结局中的应用价值。方法:选择2019年8月~2021年10月我院行IVR-ET助孕的DOR患者292例,根据助孕后的妊娠结局分为妊娠组(n=158)和未妊娠组(n=134),比较两组临床资料及血清25(OH)D、AMH和INHB水平,应用受试者工作特征(ROC)曲线评价血清25(OH)D、AMH和INHB单独及联合检测对妊娠失败的预测价值。应用单因素、多因素Logisitic回归分析妊娠失败的影响因素。结果:妊娠组血清25(OH)D、AMH、INHB水平显著高于未妊娠组(P<0.05)。ROC曲线分析显示,血清25(OH)D、AMH、INHB及三者联合检验对DOR患者IVR-ET妊娠失败的预测的曲线下面积(AUC)分别为0.714(0.631~0.802)、0.801(0.731~0.852)、0.634(0.578~0.741)、0.853(0.806~0.913),三者联合检验对DOR患者IVR-ET妊娠失败预测AUC高于单独检验。单因素分析显示未妊娠组窦卵泡个数<5、获卵个数<8、卵泡刺激素(FSH)/黄体生成激素(LH)≥1.8、血清25(OH)D≤25.05 μg/L、血清AMH≤1.08 ng/mL、血清INHB≤84.28 pg/mL比例显著高于妊娠组(P<0.05)。多因素Logistic回归分析显示FSH/LH≥1.8、血清25(OH)D≤25.05 μg/L、血清AMH≤1.08 ng/mL、血清INHB≤84.28 pg/mL是DOR患者IVR-ET妊娠失败的危险因素(P<0.05)。结论:血清25(OH)D、AMH和INHB 水平较低与DOR患者IVR-ET妊娠失败有关,且联合检测上述指标水平对患者IVR-ET妊娠失败有较高的辅助预测价值。  相似文献   

3.
摘要 目的:研究血清瘦素、鸢尾素、性激素结合球蛋白(SHBG)、水通道蛋白8(AQP8)与多囊卵巢综合征(PCOS)不孕症接受体外受精-胚胎移植(IVF-ET)患者性激素水平和妊娠结局的关系。方法:选取2020年1月~2022年1月我院收治的293例接受IVF-ET的PCOS不孕症患者,根据是否临床妊娠成功将其分为临床妊娠失败组(n=118)和临床妊娠成功组(n=175)。收集患者临床资料,检测血清瘦素、鸢尾素、SHBG、AQP8水平。Pearson相关系数分析PCOS患者不孕症血清瘦素、鸢尾素、SHBG、AQP8水平与性激素水平的相关性,多因素Logistic回归分析PCOS不孕症接受IVF-ET患者妊娠结局影响因素,受试者工作特征(ROC)曲线分析血清瘦素、鸢尾素、SHBG、AQP8水平单独及联合预测PCOS不孕症接受IVF-ET患者临床妊娠失败的价值。结果:与临床妊娠成功组比较,临床妊娠失败组促卵泡生成素(FSH)、促性腺激素(Gn)用量、获卵数、受精率、优胚率、SHBG水平降低,黄体生成素(LH)、LH/FSH、睾酮(T)、胰岛素抵抗指数(HOMA-IR)、瘦素、鸢尾素、AQP8水平升高。Pearson相关系数显示,PCOS不孕症患者血清瘦素、鸢尾素、AQP8与FSH水平呈负相关,与LH、LH/FSH、T水平呈正相关(P均<0.05);SHBG与FSH水平呈正相关,与LH、LH/FSH、T水平呈负相关(P均<0.05)。多因素Logistic回归分析显示,LH/FSH、T、HOMA-IR、瘦素、鸢尾素、AQP8为PCOS不孕症接受IVF-ET患者临床妊娠失败的危险因素,优胚率、SHBG为保护因素(P均<0.05)。ROC曲线显示,血清瘦素、鸢尾素、SHBG、AQP8水平联合预测PCOS不孕症接受IVF-ET患者临床妊娠失败的曲线下面积(AUC)大于各指标单独预测。结论:血清瘦素、鸢尾素、SHBG、AQP8水平与PCOS不孕症接受IVF-ET患者FSH、LH、LH/FSH、T水平和临床妊娠失败相关,有助于预测PCOS不孕症患者妊娠结局。  相似文献   

4.
摘要 目的:探讨游离睾酮指数(FAI)联合血清促性腺激素平抑因子(GnSAF)、性激素结合球蛋白(SHBG)对多囊卵巢综合征(PCOS)不孕患者体外受精-胚胎移植(IVF-ET)治疗妊娠结局的预测价值。方法:选取2020年1月~2022年6月湖南省妇幼保健院生殖医学中心收治的197例PCOS不孕患者为PCOS组,根据IVF-ET治疗妊娠结局分为妊娠失败组和妊娠成功组,另选取同期68名体检健康妇女为对照组。收集PCOS不孕患者临床资料,计算FAI并检测血清GnSAF、SHBG水平。采用单因素和多因素Logistic回归分析PCOS不孕患者IVF-ET治疗妊娠结局的影响因素,采用受试者工作特征(ROC)曲线分析FAI和血清GnSAF、SHBG对PCOS不孕患者IVF-ET治疗妊娠结局的预测价值。结果:PCOS组FAI和血清GnSAF水平高于对照组,SHBG水平低于对照组(P<0.05)。197例PCOS不孕患者IVF-ET治疗妊娠成功率为51.27%(101/197)。单因素分析显示,妊娠失败组体质指数、黄体生成素(LH)、LH/促卵泡生成素(FSH)、睾酮、抗苗勒管激素(AMH)、FAI、GnSAF高于妊娠成功组,FSH、受精率、优胚率、SHBG低于妊娠成功组(P<0.05)。多因素Logistic回归分析显示,体质指数增加和LH、LH/FSH、AMH、FAI、GnSAF升高为PCOS不孕患者IVF-ET治疗妊娠失败的独立危险因素,SHBG升高为其独立保护因素(P<0.05)。ROC曲线分析显示,FAI和血清GnSAF、SHBG联合预测PCOS不孕患者IVF-ET治疗妊娠结局的曲线下面积大于FAI、GnSAF、SHBG单独预测。结论:FAI和血清GnSAF、SHBG水平联合预测PCOS不孕患者IVF-ET治疗妊娠结局的价值较高。  相似文献   

5.
摘要 目的:探讨多囊卵巢综合征(PCOS)患者血清缺血修饰白蛋白(IMA)、缺氧诱导因子1α(HIF1α)、内脏脂肪特异性丝氨酸蛋白酶抑制剂(Vaspin)、胰岛素样生长因子-1(IGF-1)水平与性激素、糖脂代谢及胰岛素抵抗的相关性。方法:选择2017年1月至2019年12月我院收治的268例PCOS患者(PCOS组),根据体质量指数(BMI)将PCOS患者分为超重/肥胖组(BMI≥24 kg/m2,161例)和正常体重组(18.5 kg/m2≤BMI<24 kg/m2,107例),另选择135例于妇科门诊体检的健康女性志愿者为对照组。检测血清IMA、HIF1α、Vaspin、IGF-1水平以及性激素、糖脂代谢、胰岛素抵抗指标,Pearson相关性分析其相关性。结果:PCOS组血清IMA、HIF1α、Vaspin、IGF-1、睾酮(T)、促黄体生成素(LH)、促卵泡激素(FSH)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、餐后2小时血糖(2hPG)、空腹胰岛素(FINS)水平,胰岛素抵抗指数(HOMA-IR)均高于对照组(P<0.001)。PCOS患者超重/肥胖组血清IMA、HIF1α、Vaspin、IGF-1、T、TC、LDL-C、FPG、FINS、2hPG水平,HOMA-IR均高于正常体重组(P<0.001)。PCOS患者血清IMA、HIF1α水平与T、HOMA-IR呈正相关(P<0.05),血清Vaspin、IGF-1水平与TC、LDL-C、FPG、FINS、2hPG 、HOMA-IR呈正相关(P<0.05)。结论:PCOS患者血清IMA、HIF-1α、Vaspin、IGF-1水平均升高,IMA、HIF-1α、Vaspin、IGF-1均与PCOS胰岛素抵抗有关。  相似文献   

6.
摘要 目的:分析脐带间充质干细胞对卵巢早衰家兔的治疗效果及机制研究。方法:经腹腔连续注射 2 d 环磷酰胺50 mg/(kg?d)建立卵巢早衰家兔模型。将建模成功的10只家兔随机分成模型组和治疗组,每组5只。建模一周后,治疗组家兔每天经耳缘静脉注射5×106/mL脐带间充质干细胞混悬液2 mL,连续注射3 d。模型组家兔经耳缘静脉注射等量无菌生理盐水。于治疗后 0 d、7 d、14 d和28 d,取家兔静脉血检查血清激素表达水平。于治疗后28 d,检测家兔卵巢中生长卵泡数、封闭卵泡数、黄体数、富半胱氨酸蛋白61(CYR61)和结缔组织生长因子(CTGF)mRNA及蛋白质相对表达量。结果:治疗前,模型组和治疗组家兔血清雌二醇(E2)、促卵泡生成素(FSH)、FSH/黄体生成素(LH)、抑制素B(INHB)和抗苗勒管激素(AMH)、均无显著差异(P>0.05)。与模型组相比,治疗后治疗组家兔血清E2和INHB水平显著上升(P<0.05),FSH水平显著下降(P<0.05),FSH/LH均无显著差异(P>0.05)。随着治疗时间延长,治疗组家兔血清E2和FSH水平周期性波动。治疗28 d后,与模型组相比,治疗组家兔血清AMH水平显著升高(P<0.05);卵巢组织中CYR61和CTGF mRNA及蛋白质相对表达量均显著升高(P<0.05);生长卵泡数显著升高(P<0.05);封闭卵泡数和黄体数均显著降低(P<0.05)。结论:静脉注射脐带间充质干细胞可通过上调CYR61和CTGF的表达,促进卵泡生成,恢复卵巢功能,达到治疗卵巢早衰的临床效应。  相似文献   

7.
摘要 目的:探讨血清同型半胱氨酸(Hcy)、胰腺衍生因子(PANDER)、肥胖抑制素(Obestatin)与妊娠期糖尿病(GDM)患者血糖控制情况和妊娠结局的关系。方法:选择2021年1月至2022年1月于我院就诊的286例GDM患者,根据分娩前糖化血红蛋白(HbA1c)水平分为血糖控制达标组(HbA1c<7%,173例)和血糖控制不达标组(HbA1c≥7%,113例),检测并比较两组患者入组时血清Hcy、PANDER、Obestatin、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗(HOMA-IR)水平,采用Pearson相关分析Hcy、PANDER、Obestatin与FPG、FINS、HOMA-IR的相关性。根据妊娠结局分为妊娠结局不良组(90例)和妊娠结局良好组(196例),采用多因素Logistic回归分析GDM患者妊娠结局的影响因素。结果:血糖控制不达标组血清Hcy、PANDER、FPG、FINS、HOMA-IR水平均高于血糖控制达标组,而Obestatin水平低于血糖控制达标组(P<0.05)。血清Hcy、PANDER水平与FPG、FINS、HOMA-IR水平均呈正相关,Obestatin水平与FPG、FINS、HOMA-IR水平均呈负相关(P<0.05)。妊娠结局不良组年龄、入组时体质量指数(BMI)、糖尿病家族史、血糖控制不达标比例以及血清Hcy、PANDER、FPG、FINS、HOMA-IR水平均高于妊娠结局良好组,Obestatin水平则低于妊娠结局良好组(P<0.05)。血糖控制不达标、血清Hcy、PANDER水平是GDM患者妊娠结局不良的危险因素,而Obestatin水平是保护因素(P<0.05)。结论:GDM血糖控制不达标患者血清Hcy、PANDER水平增高,Obestatin水平降低,且与胰岛素抵抗和妊娠结局不良有关。  相似文献   

8.
摘要 目的:探讨血清血管内皮生长因子(VEGF)、可溶性Fms样酪氨酸激酶-1(sFlt-1)、白细胞介素-4(IL-4)水平与妊娠期高血压疾病(HDP)患者分类及妊娠结局的关系。方法:选取2019年7月~2021年1月我院收治的204例HDP患者(HDP组),根据指南分类原则分为妊娠期高血压组(n=88)、子痫前期组(n=66)、子痫组(n=50),根据妊娠结局分为结局不良组和结局良好组,另选取同期100名于我院产检健康孕产妇为对照组。采用单因素及多因素Logistic回归和受试者工作特征(ROC)曲线分析HDP患者妊娠结局不良的影响因素及血清VEGF、sFlt-1、IL-4水平对妊娠结局不良的预测价值。结果: 与对照组比较,HDP组血清VEGF、IL-4水平降低,sFlt-1水平升高(P<0.05)。妊娠期高血压组、子痫前期组、子痫组血清VEGF、IL-4水平依次降低,sFlt-1水平依次升高(P<0.05)。204例HDP患者妊娠结局不良发生率为29.90%(61/204)。单因素分析显示,妊娠结局不良与年龄、不同疾病分类、SBP、DBP、尿蛋白、VEGF、sFlt-1、IL-4有关(P<0.05)。多因素Logistic回归分析显示,HDP患者妊娠结局不良的独立危险因素与独立保护因素分别为子痫、sFlt-1升高与VEGF、IL-4升高(P<0.05)。血清VEGF、sFlt-1、IL-4水平单独与联合预测HDP患者妊娠结局不良的曲线下面积(AUC)分别为0.766、0.774、0.770、0.905,VEGF、sFlt-1、IL-4联合预测HDP患者妊娠结局不良的AUC最大。结论:HDP患者血清VEGF、IL-4水平降低,sFlt-1水平升高,与HDP分类和妊娠结局不良有关,VEGF、sFlt-1、IL-4联合对HDP患者妊娠结局不良的预测价值较高。  相似文献   

9.
摘要 目的:探讨血清环磷腺苷效应元件结合蛋白(CREB)、叉头框蛋白O1(FoxO1)、NOD样受体热蛋白结构域相关蛋白3(NLRP3)与妊娠期糖尿病(GDM)患者胰岛素抵抗(IR)的相关性分析及对妊娠结局的影响。方法:选取2019年12月~2022年8月邵阳学院附属第一医院收治的136例GDM患者为GDM组,根据妊娠结局分为结局不良组(42例)和结局良好组(94例),另选取55名健康孕妇为对照组。收集GDM患者临床资料,检测血清CREB、FoxO1、NLRP3水平并计算稳态模型评估-胰岛素抵抗(HOMA-IR)。采用Pearson相关性分析GDM患者血清CREB、FoxO1、NLRP3水平与HOMA-IR的相关性,多因素Logistic回归分析GDM患者妊娠结局不良的影响因素,受试者工作特征(ROC)曲线分析血清CREB、FoxO1、NLRP3水平对GDM患者妊娠结局不良的预测价值。结果:与对照组比较,GDM组血清CREB、FoxO1、NLRP3水平和HOMA-IR升高(P<0.05)。Pearson相关性分析显示,GDM患者血清CREB、FoxO1、NLRP3水平与HOMA-IR呈正相关(P均<0.001)。136例GDM患者妊娠结局不良发生率为30.88%。多因素Logistic回归分析显示,HOMA-IR、CREB、FoxO1、NLRP3升高为GDM患者妊娠结局不良的危险因素(P<0.05)。ROC曲线分析显示,血清CREB、FoxO1、NLRP3水平联合预测GDM患者妊娠结局不良的曲线下面积大于CREB、FoxO1、NLRP3单独预测。结论:血清CREB、FoxO1、NLRP3水平升高与GDM患者IR和妊娠结局不良密切相关,可能成为GDM患者妊娠结局不良的辅助预测指标。  相似文献   

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摘要 目的:探讨妊娠合并乙肝病毒(HBV)感染患者血清脱氧核糖核酸甲基转移酶1(DNMT1)、T细胞免疫球蛋白粘蛋白-3(TIM-3)与乙型肝炎病毒-脱氧核糖核酸(HBV-DNA)病毒载量和妊娠结局的关系。方法:选取2021年1月~2022年1月南京医科大学第一附属医院收治的186例妊娠合并HBV感染患者为HBV感染组,根据HBV-DNA病毒载量分为阳性组56例和阴性组130例,根据妊娠结局分为结局不良组和结局良好组,另选取同期于南京医科大学第一附属医院进行孕检的150名健康孕妇为对照组。采用酶联免疫吸附法检测血清DNMT1、TIM-3水平。比较HBV感染组与对照组、阳性组与阴性组血清DNMT1、TIM-3水平。采用单因素及多因素Logistic回归分析妊娠合并HBV感染患者妊娠结局不良的影响因素,受试者工作特征(ROC)曲线分析血清DNMT1、TIM-3水平对妊娠合并HBV感染患者妊娠结局不良的预测价值。结果:与对照组比较,HBV感染组血清DNMT1、TIM-3水平升高(P<0.05)。与阴性组比较,阳性组血清DNMT1、TIM-3水平升高(P<0.05)。186例妊娠合并HBV感染患者妊娠结局不良发生率为55.38%(103/186)。单因素分析显示,妊娠结局不良与HBV感染孕周、HBV-DNA病毒载量、谷草转氨酶(AST)、谷丙转氨酶(ALT)、DNMT1、TIM-3有关(P<0.05)。多因素Logistic回归分析显示,HBV-DNA病毒载量阳性和DNMT1>34.94 ng/mL、TIM-3>18.96 pg/mL为妊娠合并HBV感染患者妊娠结局不良的独立危险因素(P<0.05)。ROC曲线分析显示,血清DNMT1、TIM-3水平单独和联合检测预测妊娠合并HBV感染患者妊娠结局不良的曲线下面积分别为0.798、0.791、0.870。结论:妊娠合并HBV感染患者血清DNMT1、TIM-3水平升高与HBV-DNA病毒载量阳性和妊娠结局不良密切相关,血清DNMT1、TIM-3水平联合对妊娠合并HBV感染患者妊娠结局预测价值良好。  相似文献   

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A review is presented of issues relevant to the definition, measurement, and classification of stimuli, situations, and environments. Problems such as the lack of adequate definitions of concepts, error and bias in measurement procedures, confusion between measurement of a concept and measurement of its behavioral effects, and the lack of agreement among alternative measures are emphasized. It is suggested that concepts be defined in terms of objective characteristics while allowing for the study of the transactional relationship between organism and environment. The work of the ethologists in defining stimuli while studying their relationship to different organismic states and situational contexts is emphasized in this regard. Following Brunswik, it is also suggested that wherever possible there be a representative sampling of variables in natural settings. Note from the editors: From time to time, Human Ecology will publish a review article. Our first in this series is a review by a psychologist of basic definitional and conceptual problems in environmental studies.This paper was prepared while the author was a Visiting Research Fellow at the Educational Testing Service. The support of ETS and my colleagues in the Division of Psychological Studies is gratefully acknowledged. The review was also supported in part by a grant from the Rutgers University Research Council.  相似文献   

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We compared the cardiovascular effects evoked in conscious dogs by 1) submaximal exercise; 2) infusion of dobutamine (40 micrograms X kg-1 X min-1); and 3) infusion of a combination of atropine (0.15 mg/kg), norepinephrine (0.19 micrograms X kg-1 X min-1), and epinephrine (0.05 micrograms X kg-1 X min-1). Myocardial O2 demand, as estimated by the double product (heart rate X systolic blood pressure), was similar during all three interventions. Cardiac output and heart rate increased significantly (P less than 0.05) during each of the three interventions. Arteriovenous O2 difference and total body O2 consumption, however, increased only during submaximal exercise. Although myocardial blood flow increased similarly during each of the three interventions, blood flow to skeletal muscle and the tongue increased only during exercise. Exercise and the combined infusion of atropine, norepinephrine, and epinephrine produced similar increases in blood flow to the diaphragm and similar decreases in blood flow to the stomach. These changes in blood flow were associated with appropriate changes in vascular resistance. Additionally, blood flow to the brain, kidney, adrenal glands, liver, and intestine did not change during any of the three interventions. Thus, in dogs, submaximal exercise, infusion of dobutamine, and infusion of a combination of atropine, norepinephrine, and epinephrine to evoke a given level of estimated myocardial O2 consumption produce similar increases in cardiac output, heart rate, and myocardial blood flow. In contrast, the changes in total body O2 consumption, arteriovenous O2 difference, regional blood flow, and regional vascular resistance that occur during each of these three interventions are different.  相似文献   

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Indians, Markets, and Rainforests: Theory, Methods, and Analysis. Ricardo A. Godoy. New York: Columbia University Press, 2001. 274 pp.  相似文献   

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2-Dimethylaminomethylene-1-benzosuberone 1 was coupled with diazotized aniline derivatives to afford a series of the hitherto unreported 2-arylazo-1-benzosuberones 3ai. The tautomeric structure and the effect of substituents on the tautomeric form (s) of the products 3ai were discussed. Similar coupling of the enaminone 1 with diazonium salts of heterocyclic amines gave the respective fused azolotriazino-benzosuberones. Some of the newly synthesized compounds showed potent antimicrobial, anti-HCV, antioxidant, antitumor (as topoisomerase I inhibitors), and antimicrobial activities.  相似文献   

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The Precautionary Principle is in sharp political focus today because (1) the nature of scientific uncertainty is changing and (2) there is increasing pressure to base governmental action on more “rational” schemes, such as cost-benefit analysis and quantitative risk assessment, the former being an embodiment of ‘rational choice theory’ promoted by the Chicago school of law and economics. The Precautionary Principle has been criticized as being both too vague and too arbitrary to form a basis for rational decision making. The assumption underlying this criticism is that any scheme not based on cost-benefit analysis and risk assessment is both irrational and without secure foundation in either science or economics. This paper contests that view and makes explicit the rational tenets of the Precautionary Principle within an analytical framework as rigorous as uncertainties permit, and one that mirrors democratic values embodied in regulatory, compensatory, and common law. Unlike other formulations that reject risk assessment, this paper argues that risk assessment can be used within the formalism of tradeoff analysis—a more appropriate alternative to traditional cost-benefit analysis and one that satisfies the need for well-grounded public policy decision making. This paper will argue that the precautionary approach is the most appropriate basis for policy, even when large uncertainties do not exist, especially where the fairness of the distributions of costs and benefits of hazardous activities and products are a concern. Furthermore, it will offer an approach to making decisions within an analytic framework, based on equity and justice, to replace the economic paradigm of utilitarian cost-benefit analysis.  相似文献   

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