非营利性医院融资现状、关键因素与政策支撑体系研究

在分析我国非营利性医院各种融资方式现状的基础上,对影响融资的关键因素进行了识别,包括非营利性医院产权归属、补偿机制、规模与区域卫生规划三个方面,并从管理模式、治理结构、财政补偿、医疗保险制度、卫生资源配置和社会筹资等方面,构建了促进非营利性医院融资的政策支撑体系。     

基于PEST模型的非营利性医院筹资宏观环境分析

用宏观政策分析、PEST分析方法,对我国非营利性医院筹资相关的政治、经济、社会、技术等方面的影响因素及各利益相关主体的作用进行综合分析;发现政府对民生问题的关注改善了整个医疗卫生体系的发展环境,而新的医疗体制改革方案将带来现有卫生体系利益格局的重大调整,基层医疗服务体系、基本医疗保障体系、基本药物制度的建立都将对医院内部资金积累带来限制,政府主导多元投入体制的建立将为医院多渠道筹资创造更宽松的环境。     

医药卫生体制绩效国际比较

根据居民与筹资的联系方式和卫生费用的补偿机制两个维度，按世界卫生组织和世界银行等众多机构提出的目前最富代表性的分类方法，把医药卫生体制分为市场主导型、国家福利型、公共合同型和公私功能互补型。通过对各种类型医药卫生体制的代表国家在模式与资源结构方面进行分析与比较，以起到“他山之石，可以攻玉”的效果。     

健康老龄化视阈下我国卫生服务体系面临的挑战与机遇

阐述了健康老龄化战略的重要意义，探讨了健康老龄化战略与我国卫生体系建设的关联，并运用SWOT分析法，旨在判断与归纳健康老龄化视域下我国卫生服务体系所面临的挑战与机遇。最后，从制度建设、服务供给模式改革、人才培养等多元视角出发，探究我国卫生服务体系在新战略背景下的改革路径，以期为中国实现健康老龄化提供理论参考。     

基于供给侧视角的我国分级诊疗相关问题思考

自习近平总书记首次提出供给侧改革以来,“供给侧”作为经济改革新词逐渐在医疗领域也引起热议,继续推行分级诊疗制更有现实必要性。从医疗服务提供者和相关配套措施角度详细分析了我国分级诊疗供给侧存在的问题,并提出逐步剥离医院门诊服务、加大对基层的投入力度和加强不同医疗机构的协作的建议。     

新医改模式下区域卫生信息化建设的探讨

对区域卫生信息化的概念、内容进行了介绍,阐述了建设区域卫生信息化的意义,并对我国区域卫生信息化主要存在的问题进行了分析,提出加快我国区域卫生信息化建设步伐的建议。     

芬兰医疗卫生体制经验及对我国的启示

芬兰社会福利和卫生保健系统是基于政府补贴的市政社会福利和卫生保健服务,除了公共部门,许多私人企业和非政府机构也提供服务。2010年芬兰社会支出总额为546.5亿欧元,占GDP的30.4%, 其中养老金支出为191.2亿欧元,占全部社会支出的35%,所占比重最大。芬兰的医疗卫生体系分为初级卫生保健与专业医疗保健。文章通过回顾芬兰国家医疗卫生体系的发展历程,对其发展经验的总结,介绍了芬兰卫生服务体系、医疗卫生筹资、卫生保健服务、医疗卫生服务利用和医疗卫生服务监管制度;并结合我国国情,提出我国可借鉴的发展经验。     

我国城乡卫生一体化改革研究

在分析城乡卫生一体化概念和政策目标的基础上,文章通过剖析我国典型地区城乡卫生一体化改革实践,发现我国当前的城乡卫生一体化改革主要以市或区为单位,形成市、乡、镇纵向一体化管理体系,借助政府的财政投入加强乡镇卫生院建设,在不同层级医疗卫生机构间建立协作关系,通过双向转诊机制形成城乡一体化的卫生服务提供体系,然后文章就我国目前城乡卫生一体化改革中存在的问题进行了分析。     

美国区域卫生信息化及有效使用电子健康档案的启示

通过介绍美国区域卫生信息化发展、有效使用EHR计划、区域卫生信息化组织等，探讨推进区域卫生信息化和电子健康档案应用过程中的问题和挑战，包括公共医学术语和技术标准、电子健康档案及区域卫生信息化潜在经济效益、电子健康档案应用保障机制、区域卫生信息化水平评价及区域卫生信息化组织可持续运营等，以提供借鉴。     

我国公立医院人力资源能力成熟度探析

卫生人才是深入推进医改的重要支撑。运用人力熟度资源能力成理论,针对我国公立医院人力资源管理和发展的实际,分析探讨我国公立医院引入人力资源能力成熟度的必要性,尝试提出关于我国公立医院相应成熟度分级的思考,并对当前公立医院人力资源管理存在的问题加以评述,为逐步改进和完善卫生人力资源管理提供借鉴和参考。     

Anthropology and genetics of the caucasus peoples and the problem of the origin of the caucasoids

The electrophoretical polymorphisms of some blood proteins were studied in the Talysh population of Pirasora situated in South-East Azerbaidjan. We calculated the gene frequencies of these polymorphisms and determined the genetic distances between the Talyshes and some Iranian populations of North, Central and South Iran, Afghans, and three populations of Azerbaijan. The Talyshes are very close to Iranians of Shiraz, whereas they are distant from the Azerbaijanians. Anthropological investigations showed that the Caucasoids and Mongoloids lived in the Aragvi Basin since the Eneolithic period. This was stated by Alexeev (1974), who emphasized the mixture of the Caucasus populations from ancient times on. We calculated the genetic distances between the Caucasus populations and numerous populations of other geographic regions, considering 28 alleles of 12 loci of blood group, serum protein and red cell enzyme polymorphisms and constructed the dendrogram of these populations. The position of the Caucasus populations in the dendrogram corresponds on principle to the earlier anthropological observations. The clustering of the Caucasoid populations corresponds completely with anthropological and historical data, and supports our earlier hypothesis (Nazarova 1999) concerning the differentiation of Caucasoids, Northern Mongoloids and Amerinds from the populations, which inhabitated Asia in palaeolithic times.     

On the structure and dynamics of the complex of the nucleosome and the linker histone

Several different models of the linker histone (LH)–nucleosome complex have been proposed, but none of them has unambiguously revealed the position and binding sites of the LH on the nucleosome. Using Brownian dynamics-based docking together with normal mode analysis of the nucleosome to account for the flexibility of two flanking 10 bp long linker DNAs (L-DNA), we identified binding modes of the H5-LH globular domain (GH5) to the nucleosome. For a wide range of nucleosomal conformations with the L-DNA ends less than 65 Å apart, one dominant binding mode was identified for GH5 and found to be consistent with fluorescence recovery after photobleaching (FRAP) experiments. GH5 binds asymmetrically with respect to the nucleosomal dyad axis, fitting between the nucleosomal DNA and one of the L-DNAs. For greater distances between L-DNA ends, docking of GH5 to the L-DNA that is more restrained and less open becomes favored. These results suggest a selection mechanism by which GH5 preferentially binds one of the L-DNAs and thereby affects DNA dynamics and accessibility and contributes to formation of a particular chromatin fiber structure. The two binding modes identified would, respectively, favor a tight zigzag chromatin structure or a loose solenoid chromatin fiber.     

Kinematics and dynamics of the temporomandibular joint and of the movements of the mandible

In order to analyze the complicated movements of the mandible as the open-closing movement and the protrusio are, it is useful to evaluate the basic kinematic principles and reduce them to simple technical constructions. Both the open-closing movement and the protrusio could be reduced to 4-bar links, which were used to simulate the movements with help of a computer. Besides, the polodes and the curves of points in the muscular attachments could be constructed. The 2 entirely different 4-bar links have 3 things in common: The resting system - cranium, the moving system - mandibula, and 1 of the 2 arms connecting these 2 systems - the ligamentum laterale. As this ligament is taut during movements it can be considered a "guiding ligament" representing 1 of the 3 determining components of the mandibular movements. The other of the 2 arms has no anatomical equivalent; this arm, however, is "replaced" by the 2 other determining components of the mandibular movements: the joint and the muscles. The curves, which the Caput mandibulae describes, are practically identical for the open-closing movement and the protrusio despite of the different 4-bar links and these curves exactly correspond to the Discus articularis, taut by the upper part of the M. pterygoideus lateralis. The muscles do not only just move the mandibula, but they are also the component, which can choose between the different mandibular movements. By means of the curves, which points in the muscular attachments describe, the function of the masticatory muscles could be analyzed exactly.     

Biophysics and Structure of the Patch and the Gigaseal

Interpreting channel behavior in patches requires an understanding of patch structure and dynamics, especially in studies of mechanosensitive channels. High resolution optical studies show that patch formation occurs via blebbing that disrupts normal membrane structure and redistributes in situ components including ion channels. There is a 1-2 μm region of the seal below the patch where proteins are excluded and this may consist of extracted lipids that form the gigaseal. Patch domes often have complex geometries with inhomogeneous stresses due to the membrane-glass adhesion energy (E_a), cytoskeletal forces, and possible lipid subdomains. The resting tension in the patch dome ranges from 1-4 mN/m, a significant fraction of the lytic tension of a bilayer (∼10 mN/m). Thus, all patch experiments are conducted under substantial, and uneven, resting tension that may alter the kinetics of many channels. E_a seems dominated by van der Waals attraction overlaid with a normally repulsive Coulombic force. High ionic strength pipette saline increased E_a and, surprisingly, increased cytoskeletal rigidity in cell-attached patches. Low pH pipette saline also increased E_a and reduced the seal selectivity for cations, presumably by neutralizing the membrane surface charge. The seal is a negatively charged, cation selective, space with a resistance of ∼7 gigohm/μm in 100 mM KCl, and the high resistivity of the space may result from the presence of high viscosity glycoproteins. Patches creep up the pipette over time with voltage independent and voltage dependent components. Voltage-independent creep is expected from the capillary attraction of E_a and the flow of fresh lipids from the cell. Voltage-dependent creep seems to arise from electroosmosis in the seal. Neutralization of negative charges on the seal membrane with low pH decreased the creep rate and reversed the direction of creep at positive pipette potentials.     

Serology and systematics of the Ebenales and the Theales

The systematic position ofthe Ebenaceae, Sapotaceae, Styracaceae, Ochnaceae, Stachyuraceae, Dipterocarpaceae, Clusiaceae and Hypericaceae has been investigated using serological comparisons of sets of antigenic determinants. The results show that the Sytracaceae and Sapotaceae are undoubtedly more closely associated with the Actinidiaeceae and Theaceae, respectively, than with each other. We found no corresponding determinants betnween antigen systems from the Ebenaceae and systems from any other family whose relations to this family have been proposed. As discovered previously, investigations of antigen systems from the Ochnaceae, Dipterocarpaceae, Stachyuraceae, Clusiaceae and Hypericaceae are against the idea of a natural order “Theales” in which these families, or at least some of them, are combined with the Theaceae and Actinidiaceae. This paper completes our previous investigations which largely support a superorder Ericanae sensu Ehrendorfer and Takhtajan. We propose to include the Actinidiaceae and Theaceae in this superorder, assigning them a central position laong with the Sapotaceae and Sytracaeae on one side and the Primulales and Ericales on the other. Another most interesting finding is that there are corresponding determinants between antigen systems from the members of the Ericanae and representatives of the Polemoniaceae and Loasaceae.     

人类基因组及后基因组研究进展及其应用与开发研究现状

人类对自身基因组的研究,随着人类基因组工作草图的绘制完成和对基因功能研究的深入已加快进入了实质性、关键性的开发利用阶段。本文概述了人类基因组及后基因组的研究进展及依此开展基因治疗及基因（组）药物研制等应用开发研究的现状。     

Comparison of the Effects of Flexion and Extension of the Thumb and Fingers on the Position and Cross-Sectional Area of the Median Nerve

Objective

To assess the separate effects of thumb and finger extension/flexion on median nerve position and cross-sectional area.

Methods

Ultrasonography was used to assess median nerve transverse position and cross-sectional area within the carpal tunnel at rest and its movement during volitional flexion of the individual digits of the hand. Both wrists of 165 normal subjects (11 men, 4 women, mean age, 28.6, range, 22 to 38) were studied.

Results

Thumb flexion resulted in transverse movement of the median nerve in radial direction (1.2±0.6 mm), whereas flexion of the fingers produced transverse movement in ulnar direction, which was most pronounced during flexion of the index and middle fingers (3.2±0.9 and 3.1±1.0 mm, respectively). Lesser but still statistically significant movements were noted with flexion of the ring finger (2.0±0.8 mm) and little finger (1.2±0.5 mm). Flexion of the thumb or individual fingers did not change median nerve cross-sectional area (8.5±1.1 mm²).

Conclusions

Volitional flexion of the thumb and individual fingers, particularly the index and middle fingers, produced significant transverse movement of the median nerve within the carpal tunnel but did not alter the cross-sectional area of the nerve. The importance of these findings on the understanding of the pathogenesis of the carpal tunnel syndrome and its treatment remains to be investigated.     

On the Microanatomy of the Brain and the Innervation and Homologues of the Cephalic Appendages of Hesionidae and Syllidae (Polychaeta)

Abstract Earlier papers dealing with the anatomy of the hesionids and syllids were studied. Thereby it was found that information about the structure of the central nervous system was meagre. As a result, the anterior end appendages, especially the large, laterloventral ones of the Syllidae, have been differently interpreted. This prompted a re-investigation. The circum-oesophageal connectives, the brain commissures and the innervation of the alimentary canal and the cephalic appendages of a number of hesionid and syllid species were studied. The results, summarized in schematic diagrams, were compared with corresponding observations in other polychaete families. Among other things, it was concluded that not only the latero-ventral cephalic appendages of the hesionids but also those of the syllids are homologous with the palps of the nereids and of many other “errant” and “sedentary” families.