我院开展岗位设置的做法与思考

现今，医院人事制度改革正在稳步地推行中，岗位设置的管理实施是人事制度改革的一项重要的基础性工作，对促进医院人事管理向医院人力资源管理转变具有重要意义。从工作实际出发介绍了医院实施岗位设置的重要性，包括其是医院人事制度改革的要求，是医院收入分配制度改革的要求，是提高医院人才素质的必然结果。同时，对医院在实施岗位设置工作过程中存在的问题、做法进行了有益思考。     

基于三阶段DEA的浙江省三级公立医院运行效率分析

目的 测算2015年浙江省68家三级公立医院的运行效率，分析不同类型医院之间效率差异的原因，并提出相应的政策建议。方法 采用三阶段DEA分析模型，在过滤掉外部影响因素和随机误差影响的基础上，定量评价医院的综合技术效率、纯技术效率、规模效益及规模收益趋势。结果 经三阶段DEA分析，医院综合效率平均值比之前提高了0.1。不同类型医院效率不尽相同，省属医院高于非省属医院，西医医院高于中医医院及专科医院。结论 专科医院资源利用多，中医类医院相对较少；省属医院相对效率较高，但面临过度扩张风险；多数非省属有一定的效率改进空间。未来的政策应引导医院转变管理理念，控制医院规模，推进精细管理，实现可持续发展，适度支持中医医院发展。     

浅谈医院内部信息电子化共享的实现

医院内部信息是医院管理和决策的基础和依据，应加快实现医院内部信息的电子化和信息化管理，促使医院的内部信息资源得到有效的利用与共享，从而提高工作效率，提升医院医疗、教学、科研的整体水平，为增强现代医院的核心竞争力奠定基础。医院信息化建设是一项任重而道远的、投入巨大的复杂工程，作为卫生领域的医务工作者，有责任也有义务按照国家医药卫生体制改革的相关要求，搞好医院的信息化建设。     

大型公立医院资源整合与运行发展的实践与思考

无锡市第一人民医院（儿童医院）和无锡市第五人民医院2007年12月开始实施资源整合战略，资源整合前，2家医院围绕筹建、整合和运行3大工作任务，科学统筹,稳步推进，确保了新医院的启用开诊。资源整合后，医院稳步实施三级目标责任制，做活激励机制，做实约束机制，并对重点工作实施项目化、规范化和精益化管理，通过2年运行，医院综合服务能力明显提升，医院资产实现增值保值，形成了一整套医院内部管理的工作经验和举措，促进了医院良性运行和健康发展。     

新媒体在医院文化建设中的应用探讨

新媒体的出现契合了公众生活方式转变的需求，为医院文化建设与发展带来新的契机与平台。探索应用新媒体能够丰富医院文化内涵，塑造良好的医院形象，提升医院竞争力，进而推进医院发展。     

借鉴Z计分法模型监测医院财务风险的实践

随着卫生事业的改革和发展，医院的经营环境不断变化，财务风险对医院的生存和发展起到至关重要的作用。医院的管理者必须充分了解医院面临的财务风险，通过借鉴Z计分法模型建立财务风险预警体系，防范和化解医院发展中的各种财务风险，使医院走向合理、可持续的发展轨道。     

借助ISO 建设 提升医院财务服务水平

在医院为病人提供服务的主题是医护人员，但财务人员也在为病人提供各种相关服务，医院财务人员的服务水平与工作质量需要提升。医院服务水平与ISO认证之间存在关联，医院通过引入ISO认证，建立ISO质量管理体系，可以改善财务工作质量，提升医院财务人员的服务水平。     

医院成本谱编制方法和意义

医院成本管理将成为医院经济管理中最主要的环节，而医院成本谱是医院成本管理的重要工具之一。文章重点阐述了医院成本谱的编制方法与运用，从而了解和分析医疗成本现状，为寻求控制医疗费用增长方法提供研究方向和依据，同时也为医院经营管理决策提供参考依据。     

医院战略薪酬管理体系构建分析

医院的薪酬体系应将医院的战略转化为行动并支持医院战略实施的管理流程。通过借鉴战略及薪酬管理理论，将医院战略与薪酬体系有效连接，构建了公立医院战略薪酬管理模型及医院战略薪酬框架体系，并分析了战略薪酬体系对医院战略实施的作用机理。     

探讨实现医院公益性的保障机制及其基本框架

结合当前卫生体制改革思路，明确医院公益性的定位与职能， 探讨保障医院公益性的制度安排与机制设计原则，研究保障医院公益性运行机制的基本框架，为进一步建立医院公益性保障机制模型奠定基础，为政府有关决策部门制定医院改革与发展的政策与法规提供理论支撑和决策依据。     

Ectogenesis and the case against the right to the death of the foetus

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.     

On the diversity of the Cladocera in the tropics

The mythical concept of an impoverished tropical cladoceran fauna is refuted. On a planetary scale, around half of the cladoceran species presently known occur exclusively in the tropics-subtropics, often with considerable restriction to particular geographical subzones. On a regional (political) scale, the situation is often unclear because of the continued fragmentary nature of studies, and because political units are not a good basis for biogeographical comparisons. At the finest level of resolution (lake-perlake comparisons), there appears to be an upper limit of c. 50 cladoceran species per individual lake. No significant difference between lakes in the temperate zone and in the tropics could be established here. Daphnia is largely absent from the tropics, but is replaced by more Sidids, Moinids, and Bosminids, such that the average cladoceran community in the limnetic zone of a tropical lake is not characterized by less species but rather by lower population densities. This, in turn, is considered a consequence of higher prevalent predation levels in the tropics.     

Tubular networks in the terminal endings of the visual receptor cells in the human,the monkey,the cat and the dog

Summary A tubular network was found in the terminal endings of the visual receptor cells in the human, the monkey (Macaca mulatta), the cat and the dog. These tubules are arranged in close groups in the vicinity of the synaptic lamellae and the invaginated dendrites. According to the form, diameter, density of the tubules and to the consistence of the network formed by them one can distinguish at these places an initial type (type I), a transitory (type II) and a vesicular one (type III). In the the type III branching, bizarre forms are frequent. The diameter of all the tubules reaches 500–600 Å, their density and walls being the same as in the synaptic vesicles.Similar networks also occur in the axons of the visual receptor cells of the monkey.

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Zusammenfassung In den Endigungen der Photorezeptorzellen von Mensch, Affe (Macaca mulatta), Katze und Hund kommen aus Tubuli bestehende Komplexe vor. Organellenartig in geschlossenen Gruppen angeordnet, liegen sie in Nähe der synaptischen Lamellen und der invaginierten Dendriten. An diesen Stellen kann man nach Form, Durchmesser, Dichte und Konsistenz der von den Tubuli gebildeten Komplexe drei Typen unterscheiden: 1. einen initialen (Typus I), 2. einen Übergangstypus (Typus II) und 3. einen vesiculären Typus (Typus III). In letzterem kommen häufig verzweigte, bizarre Formen vor. Der Durchmesser sämtlicher Tubuli erreicht 500–600 Å. Ihre Dichte und ihre Wand gleicht denen der synaptischen Vesikel.Ähnliche Komplexe fanden wir auch in den Axonen der Photorezeptorzellen vom Affen.

     

Assessing the Physiological State of the Fucoids from the Barents Sea Littoral by the End of the Polar Night

Methods of amperometry and potentiometric titration were used to follow dark respiration (DR) and apparent photosynthesis (AP) in the fucoids Ascophyllum nodosum (L.) Le Jol, Fucus vesiculosus L., and F. serratus L. from the Barents Sea littoral by the end of the 40-day-long polar night. The macroalgae were shown to manifest species-specific low rates of photosynthesis and respiration. However, in spite of their low photosynthetic status due to the effects of subzero temperature and prolonged low or zero illumination, the macroalgae have been able to restore DR and AP to the initial level already by the day 9; the ability to restore AP depended on the level of illumination. The study of the changes in the carbonate–bicarbonate system in the light and darkness demonstrated that the macroalgae grown in darkness, in contrast to those grown in twilight, could absorb bicarbonate in darkness; however, they lost this capacity after two-day-long illumination at an irradiance of 7 mol/(m² s). Bicarbonate uptake in darkness and the capacity to restore the systems of photosynthesis and respiration in fucoid cells are discussed in the context of algal energy metabolism under the polar night conditions.     

Arranging the elements of the potassium channel: the T1 domain occludes the cytoplasmic face of the channel

The voltage-gated potassium channel is currently one of the few membrane proteins where functional roles have been mapped onto specific segments of sequence. Although high-resolution structures of the transmembrane portions of three bacterial potassium channels, the tetramerization domain and the cytoplasmic ball are available, their relative spatial arrangement in mammalian channels remains a matter of ongoing debate. Cryo-electron microscopic images of the six transmembrane voltage-gated Kv channel have been reconstructed at up to 18 Å resolution, revealing that the T1 domain tetramerizes and is suspended below the transmembrane segments. However, the resolution of these images is insufficient to reveal the location of the third piece of the puzzle, the inactivating ball domain. We have used the aberrant interactions observed in a series of chimæric channels to establish that an assembled T1 domain restricts access to the cytoplasmic face of the channel, suggesting that the N-terminal ball and chain may be confined in the space between the T1 domain and the transmembrane portion of the channel.     

Feeding the vertebrate retina from the Cambrian to the Tertiary

The retina of the vertebrate eye is metabolically active and requires nutritive support. During the last 540 million years it has evolved into forms as complicated and nutritionally demanding as those found in avian or primate eyes. Diffusion from the choroid is generally able to supply the metabolic needs of thin retinae. However, when the thickness exceeds the limits of diffusion, structures are needed to supplement the vascular supply from the choroid. These supplemental nutritive devices include the choroidal gland, the falciform process and preretinal vascular plexus of fish, the conus papillaris of lizards, the pecten oculi of birds, the intraretinal vessels of mammals and a few novel systems that remain difficult to classify. These vascular systems are among the most variable features of the vertebrate eye. Here, we review classical and recent findings regarding such retinal nutrition systems, propose a three category classification for them based on histologic origins and speculate on the evolutionary forces which drove their development.     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418     

Separation of the pineal vesicle from the wall of the third ventricle during the post-hatching development of the chicken

Summary According to light- and electron-microscopic observations the pineal organ of the 3-day-old chicken consists of a prominent end vesicle and a tapering parenchymal stalk. During this stage the pineal lumen is in open communication with the third ventricle. However, in the 40-day-old chicken, which still possesses a well-developed end vesicle, the proximal portion of the pineal stalk displays regressive changes leading to local fragmentation. At this stage the pineal stalk is reduced, and the pineal lumen is missing. In 1-year-old chickens the parenchyma of the proximal portion of the stalk is further diminished, and in 3-year-old domestic fowl is completely displaced by bundles of collagenous fibers, only some nerve fibers being present. This post-hatching pineal development may reflect the sequence of changes leading from pineal sense organs to pineal glands.This work was supported by a grant-in-aid for Scientific Research from the Ministry of Education, Science and Culture of Japan