我国医疗联合体的利益相关者分析

随着医药卫生体制改革的不断深化,组建医疗联合体成为公立医院改革的新趋势。通过对医疗联合体利益相关者分析,组建区域性医疗联合体,对于联合体成员,包括核心医院和其他成员医院,还有政府或者患者都是有利的。因此,政府应在政策上对区域性医疗联合体给予更多支持,充分发挥医疗联合体的优势效应,促进公立医院的发展。     

九江市区域医疗联合体建设的实践与思考

介绍了九江市区域医疗联合体建设的基本情况、联合模式、主要做法以及主要成效,分析了医疗联合体运行过程中存在的一些共性问题。可借鉴国内医疗联合体建设的成功经验,进一步完善运作模式,推动医疗联合体健康发展。     

上海瑞金—卢湾医疗联合体实施现状与对策

在回顾国内外医疗联合体发展状况的基础上,介绍了上海瑞金—卢湾医疗联合体实施现状,结合瑞金—卢湾医疗联合体实施前后的相关数据,分析了瑞金—卢湾医疗联合体发展中面临的根本性问题,特别是在双向转诊、分层就诊方面,都碰到了难以逾越的壁垒,并针对存在的问题提出相应对策。     

医疗联合体国内外研究现状及发展动态

医疗资源配置不均衡,医疗服务“断裂”以及“碎片化”的问题越来越受到国内外专家学者以及卫生政策制定者的关注。构建医疗联合体是医疗资源整合的方式之一。本文对医疗联合体的国内外研究现状及发展动态进行梳理和总结,旨在为我国医疗联合体的构建及发展提供一定的经验和启示。     

医疗联合体发展过程中的阻力分析

伴随医药卫生体制改革,医疗联合体再次应运而生。医疗联合体意欲在一定行政区域范围内通过医疗机构分级管理、利用区域优质医疗资源为广大人民群众服务,但在实施过程存在很多壁垒。文章通过分析相关因素,探讨解决问题的办法,以利于推动医疗联合体的工作进程。     

医疗联合体国内外研究现状及发展动态

医疗资源配置不均衡,医疗服务“断裂”以及“碎片化”的问题越来越受到国内外专家学者以及卫生政策制定者的关注。构建医疗联合体是医疗资源整合的方式之一。文章对医疗联合体的国内外研究现状及发展动态进行梳理和总结,旨在为我国医疗联合体的构建及发展提供一定的经验和启示。     

ROCCIPI框架下区域医疗联合体的问题识别与分析

我国割裂的医疗服务体系和碎片化服务已经严重阻碍了医改成效，区域医疗联合体孕育而生并成为弥合割裂的战略选择。但医疗联合体并非“一联就灵”，也面临着一些困难和问题。文章以ROCCIPI技术为分析框架，系统全面地识别区域医疗联合体发展中存在的问题，并提出改进策略，为区域医疗联合体实践提供参考。     

我国医疗联合体的质量与安全现状及对策探讨

对国内外医疗联合体的质量与安全现状进行比较分析,发现目前医疗联合体的质量与安全问题包括缺乏统一的质量控制标准、统一的双向转诊标准、有效的利益平衡机制以及患者医疗服务流程优化等。欧美等国医联体更加注重医疗质量的同质化管理,并且通过精细化的医疗服务管理手段,使医联体内各成员之间医疗质量控制指标、医疗诊疗规范、医疗信息标准等保持同质化,进而保证医联体内的医疗服务质量与安全。     

新医改背景下医疗联合体类别及功能的理论分析

目的 分析新医改时期医疗联合体的类别、特征及功能。方法 运用文献研究方法,总结归纳新医改时期医疗联合体的分类维度。结果 新医改背景下医疗联合体划分标准归纳为联合行为、区域跨度、合作程度3个维度。结论 依据3个维度,医疗联合体共计可分为8种类型,8种类型医疗联合体特征、功能目标不尽相同。

     

我国医疗联合体主要运行模式及存在的问题

我国医疗联合体运行模式包括集团化模式、委托代管模式、院办院管模式、医疗协作模式、联合兼并模式、股份制合作模式等。但无论采用哪种模式,目前医疗联合体在实施过程中普遍存在概念不明确、缺乏配套政策及监督管理机制不完善、缺乏协调机制、社会对医疗联合体的认知不足等诸多问题。政府应正确定位角色,建立健全协调、监督、评价机制,并采取加大对基层医疗机构支持力度、建立信息共享平台等措施,确保医疗联合体工作取得切实成效。     

河北省医学重点学科人力资源现状研究

目的 探索重点学科人力资源现状。方法 对重点学科人力资源进行现状分析。结果 重点学科共有4 059人;年龄在25岁及以上、45岁以下的占71.2%;工作年限15年以下的占69.5%;硕士研究生学历的占47.3%,本科学历的占38.4%;高级职称的占45.7%。结论 重点学科汇集了大量优秀人才,学科成员年龄分布合理,工作年限偏低,学历以硕士研究生和本科为主,职称偏高,重点学科与重点发展学科内部学历、职称构成存在差异。     

CSYseq: The first Y-chromosome sequencing tool typing a large number of Y-SNPs and Y-STRs to unravel worldwide human population genetics

Male-specific Y-chromosome (chrY) polymorphisms are interesting components of the DNA for population genetics. While single nucleotide polymorphisms (Y-SNPs) indicate distant evolutionary ancestry, short tandem repeats (Y-STRs) are able to identify close familial kinships. Detailed chrY analysis provides thus both biogeographical background information as paternal lineage identification. The rapid advancement of high-throughput massive parallel sequencing (MPS) technology in the past decade has revolutionized genetic research. Using MPS, single-base information of both Y-SNPs as Y-STRs can be analyzed in a single assay typing multiple samples at once. In this study, we present the first extensive chrY-specific targeted resequencing panel, the ‘CSYseq’, which simultaneously identifies slow mutating Y-SNPs as evolution markers and rapid mutating Y-STRs as patrilineage markers. The panel was validated by paired-end sequencing of 130 males, distributed over 65 deep-rooted pedigrees covering 1,279 generations. The CSYseq successfully targets 15,611 Y-SNPs including 9,014 phylogenetic informative Y-SNPs to identify 1,443 human evolutionary Y-subhaplogroup lineages worldwide. In addition, the CSYseq properly targets 202 Y-STRs, including 81 slow, 68 moderate, 27 fast and 26 rapid mutating Y-STRs to individualize close paternal relatives. The targeted chrY markers cover a high average number of reads (Y-SNP = 717, Y-STR = 150), easy interpretation, powerful discrimination capacity and chrY specificity. The CSYseq is interesting for research on different time scales: to identify evolutionary ancestry, to find distant family and to discriminate closely related males. Therefore, this panel serves as a unique tool valuable for a wide range of genetic-genealogical applications in interdisciplinary research within evolutionary, population, molecular, medical and forensic genetics.     

The cosmobiological balance of the emotional and spiritual worlds: Phenomenological structuralism in traditional Chinese medical thought

This paper points to a convergence of formal and rhetorical features in ancient Chinese cosmobiological theory, within which is developed a view of the inner life of human emotions. Inasmuch as there is an extensive classical tradition considering the emotions in conjunction with music, one can justify a structural analysis of medical texts treating disorder in emotional life, since emotions, musical interpretation and structural analysis all deal with systems interrelated in a transformational space largely independent of objective reference and propositional coordination. Following a section of ethnolinguistic sketches to provide grounds in some phenomenological worlds recognized by Chinese people, there is a textual analysis of a classical medical source for the treatment of emotional distress. Through close examination of the compositional schema of this text, it can be demonstrated that the standard categories of correlative cosmology are arrayed within a more comprehensive structural order.     

Characterization of murine gammaherpesvirus 68 glycoprotein B

Murine gammaherpesvirus 68 (MHV-68) glycoprotein B (gB) was identified in purified virions by immunoblotting, immunoprecipitation, and immunoelectron microscopy. It was synthesized as a 120-kDa precursor in infected cells and cleaved into 65-kDa and 55-kDa disulfide-linked subunits close to the time of virion release. The N-linked glycans on the cleaved, virion gB remained partially endoglycosidase H sensitive. The processing of MHV-68 gB therefore appears similar to that of Kaposi's sarcoma-associated herpesvirus gB and human cytomegalovirus gB.     

William Bateson, human genetics and medicine

The importance of human genetics in the work of William Bateson (1861–1926) and in his promotion of Mendelism in the decade following the 1900 rediscovery of Mendel’s work is described. Bateson had close contacts with clinicians interested in inherited disorders, notably Archibald Garrod, to whom he suggested the recessive inheritance of alkaptonuria, and the ophthalmologist Edward Nettleship, and he lectured extensively to medical groups. Bateson’s views on human inheritance were far sighted and cautious. Not only should he be regarded as one of the founders of human genetics, but human genetics itself should be seen as a key element of the foundations of mendelian inheritance, not simply a later development from knowledge gained by study of other species.     

Identification of microRNAs of the herpesvirus family

Epstein-Barr virus (EBV or HHV4), a member of the human herpesvirus (HHV) family, has recently been shown to encode microRNAs (miRNAs). In contrast to most eukaryotic miRNAs, these viral miRNAs do not have close homologs in other viral genomes or in the genome of the human host. To identify other miRNA genes in pathogenic viruses, we combined a new miRNA gene prediction method with small-RNA cloning from several virus-infected cell types. We cloned ten miRNAs in the Kaposi sarcoma-associated virus (KSHV or HHV8), nine miRNAs in the mouse gammaherpesvirus 68 (MHV68) and nine miRNAs in the human cytomegalovirus (HCMV or HHV5). These miRNA genes are expressed individually or in clusters from either polymerase (pol) II or pol III promoters, and share no substantial sequence homology with one another or with the known human miRNAs. Generally, we predicted miRNAs in several large DNA viruses, and we could neither predict nor experimentally identify miRNAs in the genomes of small RNA viruses or retroviruses.     

The emerging medical ecology of the human gut microbiome

It is increasingly clear that the human gut microbiome has great medical importance, and researchers are beginning to investigate its basic biology and to appreciate the challenges that it presents to medical science. Several striking new empirical results in this area are perplexing within the standard conceptual framework of biomedicine, and this highlights the need for new perspectives from ecology and from dynamical systems theory. Here, we discuss recent results concerning sources of individual variation, temporal variation within individuals, long-term changes after transient perturbations and individualized responses to perturbation within the human gut microbiome.     

On the inhibition of histone deacetylase 8

Histone deacetylases are key regulators of gene expression and have recently emerged as important therapeutic targets for cancer and a growing number of non-malignant diseases. Many widely studied inhibitors of HDACs such as SAHA are thought to have low selectivity within or between the human HDAC isoform classes. Using an isoform-selective assay, we have shown that a number of the known inhibitors have in fact a low activity against HDAC8. Based on the wealth of structural information available for human HDAC8, we use a combination of docking and molecular dynamics simulations to determine the structural origin of the experimental results. A close relationship is found between the activity and the high surface malleability of HDAC8. These results provide a rationale for the recently described ‘linkerless’ HDAC8 selective inhibitors and design criteria for HDAC8 selective inhibitors.     

Mammal extinctions and the increasing isolation of humans on the tree of life

A sixth great mass extinction is ongoing due to the direct and indirect effects of human pressures. However, not all lineages are affected equally. From an anthropocentric perspective, it is often purported that humans hold a unique place on Earth. Here, we show that our current impacts on the natural world risk realizing that expectation. We simulated species loss on the mammalian phylogenetic tree, informed by species current extinction risks. We explored how Homo sapiens could become isolated in the tree if species currently threatened with extinction disappeared. We analyzed correlates of mammal extinctions risks that may drive this isolation pattern. We show that, within mammals, and more particularly within primates, extinction risks increase with the number of known threat types, and decrease with geographic range size. Extinctions increase with species body mass, trophic level, and the median longitudinal extent of each species range in mammals but not within primates. The risks of extinction are frequently high among H. sapiens close relatives. Pruning threatened primates, including apes (Hominidae, Hylobatidae), from the tree of life will lead to our species being among those with the fewest close relatives. If no action is taken, we will thus not only lose crucial biodiversity for the preservation of Earth ecosystems, but also a key living reference to what makes us human.