以服务导向临床科室绩效考核与薪酬分配制度设计

公立医院科室的薪酬分配及绩效考核工作是加强医疗质量安全和经济运行监管、完善满意度工作、转变公立医院管理机制的一项重要工作。从医院管理者的立场出发,提出了以服务为导向的公立医院薪酬分配及绩效考核的重点内容和思路设计,宏观统筹服务效率、服务质量、服务态度、成本控制、科研教学可持续发展等因素,系统化建构新医改大背景下院科两级的薪酬分配新模式,期望在现有大环境下医务人员、医院管理者、社会等多方能达到一种共赢的稳态发展状态。     

公立医院临床医生薪酬体系结构研究

临床医生是医疗服务的提供者，其行为直接影响医院医疗服务的质量和水平。文章在分析公立医院临床医生薪酬体系现状及问题的基础上，构建了基于闭环控制的动态薪酬体系，使薪酬体系更加科学地服务于临床医生，可以有效激励临床医生的医疗服务行为，更好地提高公立医院的医疗服务质量。     

基于云式薪酬的公立医院薪酬体系优化研究

介绍了云式薪酬理论及其优化层次。通过云式薪酬理论对公立医院的薪酬体系进行优化,使得薪酬体系能够覆盖到医院内每一名员工,并将医疗服务和对医院的战略性贡献进行量化,使其与薪酬有机切合,实现薪酬的柔性化,对于医疗行业的薪酬激励制度创新具有一定的借鉴意义。     

临床医师薪酬分配与绩效实证研究

目的 研究基于绩效的临床医师薪酬分配办法和适当拉开薪酬差距是否能有效提升医院的绩效水平。方法 采用变异系数衡量临床医师的薪酬差距,采用对照研究的方法评估医院的绩效提升水平。结果 外科医师薪酬差距拉开幅度最大,其余依次为儿科、内科和医技科,2006—2010年医院绩效优于对照医院。结论 通过薪酬分配制度改革的实践,基于绩效适当拉开薪酬差距,激发临床医师的积极性,增强医疗团队活力,提高绩效水平,提升医院综合实力。     

医疗职业风险要素分析及在薪酬分配中的应用

目的 分析职业风险要素并应用于医师薪酬分配体系中，合理补偿因承担医疗风险带来的健康及经济损失。方法 采用文献法和Delphi法对以往研究进行文献分析提炼要素并征询意见，专家评分法对试点医院各科室职业风险进行评价。结果 职业风险三个要素分别是职业暴露、医疗纠纷及医疗暴力，Delphi专家意见一致。各科室职业风险评价结果中，风险最高的部门是PICU、骨科急诊、外科急诊，最低的是皮肤科门诊、康复科门诊、成人门诊、中医门诊及儿童保健门诊。结论 评分结果与以往职业风险相关的定量研究结果基本一致，职业风险系数可以适度调整科室之间奖金分配。     

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。     

医院内部绩效改革对转变运行机制的影响分析

目的 探讨医院内部绩效考核与分配制度改革对医院内部运行机制的影响。方法 建立实施以工作量为基础,以加强质量控制、强化服务对象满意,重视成本控制,同时兼顾管理效率和持续发展能力的绩效考核体系绩效薪酬分配方案。结果 医院各项运行指标及质量指标同比明显提高。结论 内部绩效改革对医院医疗综合质量及服务能力的提升产生了积极的影响。     

RBRVS评估系统在医务人员绩效分配中的应用研究

构建科学、合理的绩效考核与薪酬分配制度,符合公立医院改革和医院内部精细化管理的需要。介绍了以资源消耗为基础的相对价值比率（Resource based relative value scale,RBRVS）评估系统及其在医院绩效考核分配中的应用,分析了我国现有医务人员考核分配存在的问题,并提出了相应的建议和对策。     

医疗卫生行业特点与医院内部分配问题与对策研究

目的 梳理医疗卫生行业特点,分析医院内部分配问题,并提出对策建议。方法 基于个人深访和选题小组访谈的访谈法、专家咨询法。结果 医疗卫生行业具有公益性且劳动价值高,社会和政府预期高,高风险,高强度,周期长（高投入）,专业性强,压力大,不计付出,对个人、家庭及周边人员影响大,待遇低等特点。医院内部分配存在薪酬与收入挂钩、内部分配系数差异大、岗位间不平衡等问题。结论 行业宏观政策宜确定医院员工工资和社会平均工资的倍差关系,增设专门津补贴;医院微观制度宜推行岗位评价,落实岗位绩效薪酬制,明确评价指标,增加透明度,调整薪酬系数,提高职工参与度。     

县级公立医院薪酬激励制度改革的理论与实践探讨

改革县级公立医院的运行机制,提升县级公立医院服务能力,发挥县级公立医院的区域基本医疗中心的作用,是体现公立医疗机构的公益性,解决基层群众就医需要的关键措施。文章结合传统薪酬分配制度的缺陷和县级公立医院的经营管理实践,阐述和分析了县级医院实施绩效薪酬制度、有效激励医务人员的必要性和实施路径。     

经济增加值指标在医院经营管理评价中的应用

2010年,国家国有资产管理委员会引入经济增加值,作为对央企高管绩效考核的重要指标。借鉴央企改革,论述经济增加值指标较传统指标在管理中的优胜之处,并讨论经济增加值指标在医院价值评价、财务管理和绩效管理方面的应用可能。     

EVA dosimetry in manned spacecraft

Extra Vehicular Activity (EVA) will become a large part of the astronaut's work on board the International Space Station (ISS). It is already well known that long duration space missions inside a spacecraft lead to radiation doses which are high enough to be a significant health risk to the crew. The doses received during EVA, however, have not been quantified to the same degree. This paper reviews the space radiation environment and the current dose limits to critical organs. Results of preliminary radiation dosimetry experiments on the external surface of the BION series of satellites indicate that EVA doses will vary considerably due to a number of factors such as EVA suit shielding, temporal fluctuations and spacecraft orbit and shielding. It is concluded that measurement of doses to crew members who engage in EVA should be done on board the spacecraft. An experiment is described which will lead the way to implementing this plan on the ISS. It is expected that results of this experiment will help future crew mitigate the risks of ionising radiation in space.     

EVA regulates thymic stromal organisation and early thymocyte development

Epithelial V-like antigen (EVA) is an immunoglobulin-like adhesion molecule identified in a screen for molecules developmentally regulated at the DN to DP progression in thymocyte development. We show that EVA is expressed during the early stages of thymus organogenesis in both fetal thymic epithelia and T cell precursors, and is progressively downregulated from day 16.5 of embryonic development. In the postnatal thymus, EVA expression is restricted to epithelial cells and is distributed throughout both cortical and medullary thymic regions. Transgenic overexpression of EVA in the thymus cortex resulted in a modified stromal environment, which elicited an increase in organ size and absolute cell number. Although peripheral T lymphocyte numbers are augmented throughout life, no imbalance either in the repertoire, or in the different T cell subsets was detected. Collectively, these data suggest a role for EVA in structural organisation of the thymus and early lymphocyte development.     

The effects of elk velvet antler consumption on the rat: development, behavior, toxicity and the activity of liver gamma-glutamyltranspeptidase

The effect of exposure to, followed by consumption of, a diet containing 10% powdered elk velvet antler (EVA) from the 18th day of gestation to the 88th day after birth was examined in male and female Fischer 344 rats. There were no teratogenic effects of EVA exposure in utero or differences in birth outcomes between pups born to regular chow fed and EVA chow fed dams. Growth curves of the EVA fed rats were identical to those of regular chow fed rats, as were developmental milestones of pinna development and eye-opening. Acoustical startle and righting reflexes, developmental and behavioral indices, were identical. Blood glucose levels were comparable in EVA chow fed and regular chow fed rats, indicating that EVA is without effect on glucose balance. There were no signs of toxicity in the EVA chow fed compared to regular chow fed rats as judged from plasma enzyme markers of liver damage: plasma levels of alanine aminotransferase were 50% lower in EVA chow fed rats compared to regular chow fed rats; and plasma levels of gamma-glutamyltranspeptidase (gammaGT) were the same. The activity of gammaGT displayed a decrease in the livers of EVA chow fed rats, more so in the male (22%) than in the female (14%), suggestive of an androgenic effect. A possible hepatobeneficial effect of the EVA induced decrease in liver gammaGT is discussed. In summary, dietary10% EVA chow is without long term effect on growth, development and behavior is non-toxic and may be hepatobeneficial.     

石油降解细菌的表型特性和系统发育分析

从3种不同土壤中分离和纯化得到10个石油降解细菌菌株,分离菌株均为好氧菌、革兰氏阴性菌、不形成芽孢的杆菌,10个菌株均能利用中等链长的烷烃、柴油和原油作为碳源,而不能以单环芳烃和多环芳烃为碳源。根据其生理生化性状和16SrDNA序列分析结果表明,分离菌株EVA5,EVA6,EVA7,EVA8和EVA9为假单胞菌（Pseudomonas spp.）,EVA10、EVA11、EVA12、EVA13和EVA14为不动杆菌（Acinetobacter spp.）,均属于Proteobac-teria的γ亚群。     

Identifying and targeting the molecular signature of smooth muscle cells undergoing early vascular ageing

Early vascular ageing (EVA) is a pathological phenomenon whereby the vascular system ages more quickly than chronological age. This underpins many cardiovascular diseases including the complications of type 2 diabetes, aneurysm formation and hypertension. Smooth muscle cells (SMC) are the principal cell type in the vascular wall and maintain vascular tone. EVA-related phenotypic switching of these cells contributes towards disease progression. EVA is distinct from chronological ageing, and research is ongoing to identify a definitive molecular signature of EVA. This will facilitate the discovery of new clinical tests for early detection of EVA and identify therapeutic targets to halt (or prevent) EVA in SMC, thus reducing macrovascular morbidity and mortality.     

CLCA2 Interactor EVA1 Is Required for Mammary Epithelial Cell Differentiation

CLCA2 is a p53-, p63-inducible transmembrane protein that is frequently downregulated in breast cancer. It is induced during differentiation of human mammary epithelial cells, and its knockdown causes epithelial-to-mesenchymal transition (EMT). To determine how CLCA2 promotes epithelial differentiation, we searched for interactors using membrane dihybrid screening. We discovered a strong interaction with the cell junctional protein EVA1 (Epithelial V-like Antigen 1) and confirmed it by co-immunoprecipitation. Like CLCA2, EVA1 is a type I transmembrane protein that is regulated by p53 and p63. It is thought to mediate homophilic cell-cell adhesion in diverse epithelial tissues. We found that EVA1 is frequently downregulated in breast tumors and breast cancer cell lines, especially those of mesenchymal phenotype. Moreover, knockdown of EVA1 in immortalized human mammary epithelial cells (HMEC) caused EMT, implying that EVA1 is essential for epithelial differentiation. Both EVA1 and CLCA2 co-localized with E-cadherin at cell-cell junctions. The interacting domains were delimited by deletion analysis, revealing the site of interaction to be the transmembrane segment (TMS). The primary sequence of the CLCA2 TMS was found to be conserved in CLCA2 orthologs throughout mammals, suggesting that its interaction with EVA1 co-evolved with the mammary gland. A screen for other junctional interactors revealed that CLCA2 was involved in two different complexes, one with EVA1 and ZO-1, the other with beta catenin. Overexpression of CLCA2 caused downregulation of beta catenin and beta catenin-activated genes. Thus, CLCA2 links a junctional adhesion molecule to cytosolic signaling proteins that modulate proliferation and differentiation. These results may explain how attenuation of CLCA2 causes EMT and why CLCA2 and EVA1 are frequently downregulated in metastatic breast cancer cell lines.     

Applications of a rapid endospore viability assay for monitoring UV inactivation and characterizing arctic ice cores

We have developed a rapid endospore viability assay (EVA) in which endospore germination serves as an indicator for viability and applied it to (i) monitor UV inactivation of endospores as a function of dose and (ii) determine the proportion of viable endospores in arctic ice cores (Greenland Ice Sheet Project 2 [GISP2] cores; 94 m). EVA is based on the detection of dipicolinic acid (DPA), which is released from endospores during germination. DPA concentrations were determined using the terbium ion (Tb3+)-DPA luminescence assay, and germination was induced by L-alanine addition. The concentrations of germinable endospores were determined by comparison to a standard curve. Parallel EVA and phase-contrast microscopy experiments to determine the percentage of germinable spores yielded comparable results (54.3% +/- 3.8% and 48.9% +/- 4.5%, respectively), while only 27.8% +/- 7.6% of spores produced CFU. EVA was applied to monitor the inactivation of spore suspensions as a function of UV dose, yielding reproducible correlations between EVA and CFU inactivation data. The 90% inactivation doses were 2,773 J/m2, 3,947 J/m2, and 1,322 J/m2 for EVA, phase-contrast microscopy, and CFU reduction, respectively. Finally, EVA was applied to quantify germinable and total endospore concentrations in two GISP2 ice cores. The first ice core contained 295 +/- 19 germinable spores/ml and 369 +/- 36 total spores/ml (i.e., the percentage of germinable endospores was 79.9% +/- 9.3%), and the second core contained 131 +/- 4 germinable spores/ml and 162 +/- 17 total spores/ml (i.e., the percentage of germinable endospores was 80.9% +/- 8.8%), whereas only 2 CFU/ml were detected by culturing.     

Epithelial V-like antigen regulates permeability of the blood-CSF barrier

Epithelial V-like antigen (EVA), a CD3-binding immunoglobulin-like protein, regulates embryonic thymic development. Here we demonstrate that EVA is expressed in choroid plexus from mature immune competent and lymphocyte-deficient (RAG−/−) mice. Choroid plexus epithelial cells from RAG−/− mice demonstrated reduced junctional integrity and enhanced permeability that was associated with decreased expression of E-cadherin and EVA mRNA as compared to wild-type mice. Following iv infusion of an anti-CD3 antibody (145-2C11) that also binds EVA, expression of E-cadherin and EVA mRNA approached levels seen in wild-type mice. Immuno-fluorescent staining for cadherin also revealed decreased expression in untreated RAG−/− mice that could be increased by 145-2C11 treatment. Expression of mouse EVA in HEK-293 cells followed by challenge with 145-2C11 resulted in increased cytosolic calcium that was not seen in control cells. These results suggest that EVA expressed in choroid plexus cells may regulate the permeability of the blood-CSF barrier.