卫生技术评估研究结果产出方式的偏好分析

目的 比较研究人员和决策人员对卫生技术评估研究结果产出方式的偏好程度的差异,为扩大卫生技术评估研究的决策使用提供依据。方法 采用问卷调查的方法,收集研究人员和决策人员对不同卫生技术评估研究结果产出方式的评价,运用统计描述的方法,对偏好差异进行描述分析。结果 研究人员和决策人员对卫生技术评估研究结果的产出方式偏好有所差异;在不同行政单位、不同行政级别以及不同教育程度的决策者之间,对产出方式的偏好也存在不同;而不同职称、不同教育程度的研究者,所偏好的成果产出方式则较为一致。结论 进一步强化研究方与决策方之间的沟通交流,根据不同决策人员的需求采取合适的产出方式,加强机构对卫生技术评估结果决策转化的支持,逐步完善激励机制,并强化卫生技术评估结果向广大社会公众的传播。     

我国医院评审机构设置之我见

通过对国际医院评审机构的分类和起源的介绍以及对三类医院评审机构的特点分析,结合我国的实际情况,对未来我国的医院评审机构提出初步设想：在政府的大力支持下,行业协会等专业性组织逐步成长为受卫生行政部门委托的“第三方”医院评审机构。     

对构建中国第三方医院评审机构的思考和建议

讨论了中国第三方评审机构、设置方法,以及它与政府和其他有关机构之间的关系。评审机构最佳设置地点是高校。这样的设置不仅可使第三方评审迅速步入轨道,而且也有利于培养中国下一代医院评审专业人员和建立医院评审的长久机制。     

基于赤水河流域生态补偿的政府和社会资本合作项目风险识别与分担

赤水河流域为生态脆弱区域,现行的流域生态补偿机制存在补偿资金来源单一、总量不足且持续性较差、补偿方式较为单一等问题。将政府和社会资本合作（Public-Private Partnership,PPP）模式应用于建立赤水河流域生态补偿机制,有助于拓宽补偿资金来源、增加资金总量、丰富补偿方式,推动各利益相关方收益共享、风险共担。与传统PPP项目相比,基于流域生态补偿的PPP项目具有更为复杂的风险结构,风险因素的正确识别和合理分担是成功运用PPP模式完善赤水河流域生态补偿机制的关键。识别基于赤水河流域生态补偿的PPP项目运作关键环节,甄别各环节面临的主要风险因素;基于云理论建立风险分担模型;将有关风险在政府和社会资本间进行分担。研究结果表明：（1）基于赤水河流域生态补偿的PPP项目运作过程共包括项目准备、项目实施和项目合同终结等三个阶段、共11个关键环节,各环节共面临26个主要风险因素。（2）分析了有关风险因素可能对赤水河流域生态补偿机制或PPP项目产生的不利影响,并指出了风险引致方。（3）在项目准备阶段,政府拥有绝对的资源优势,以政府为主承担主要风险;在项目实施阶段,项目风险总体上由政府承担为主向社会资本承担为主转移,80%的风险主要由社会资本承担;特许经营期满后,社会资本将项目的经营权（或所有权与经营权同时）向政府移交,在项目合同终结阶段,有关风险再次以政府承担为主。     

研究者视角的中国卫生技术评估决策转化现状分析

目的 从研究人员视角描述中国卫生技术评估相关研究向决策转化的现状，并分析其中可能存在的影响因素，为促进我国卫生技术评估向决策转化提供建议。方法 采用问卷调查法和文献检索法，在全国范围内调查研究人员，收集研究人员对我国卫生技术评估现状，以及研究结果的政策转化和利用情况等观点。结果 研究共调查了382名研究人员。调查结果显示，尽管研究人员充分认可研究成果向政策转化的必要性，并且在进行选题时已经对决策转化有所考量，但多数卫生技术评估研究仍停滞在学术阶段，多数研究人员仅提交报告并在学术期刊上发表文章，仍缺乏决策转化的实际行动。此外，部分研究者未能获得充足的研究经费和研究时间，研究机构对卫生技术评估研究所给予的支持也仍显不足，这些也是影响卫生技术评估向决策转化的重要原因。结论 有必要建立卫生技术评估研究必要的规范，以统一并提高研究质量，为决策转化打下坚实的基础；并完善卫生技术评估的研究系统，以保障研究经费、高素质的研究人员，以及多样化的研究成果传播渠道。     

公私合营模式下医疗机构服务外包的发展和规范

医疗机构为集中精力提供高效、专业临床诊疗服务,将其非临床诊疗业务、临床支持业务等外包给第三方专业机构。同时,随着国家鼓励公私合营模式发展的政策不断完善,医疗机构服务外包作为公私合营模式在医疗服务供给领域的实践体现具有巨大发展潜力。文章旨在通过分析我国医疗机构服务外包的现状,为其健康发展提供相应的政策建议。     

基于演化博弈视角的环境正义下重工业区工业碳排放治理机制

探寻生态文明建设背景下重工业区工业碳排放治理机制,对于实现“双碳”目标和环境正义具有重要意义。本研究以辽宁重工业区为例,构建地方政府、工业企业和第三方核查机构三方演化博弈模型,探讨影响工业碳排放策略选择的关键因素,对不同均衡点下三方利益主体的策略选择进行仿真,进而构建工业碳排放治理机制。结果表明: 不同均衡情景下,研究区工业碳排放利益主体策略选择分别符合现实和理想两种情景。在三方利益主体博弈的不同均衡情景中,地方政府和第三方核查机构在不同稳定性均衡情景碳排放策略选择中分别起主导作用。政策补贴、违规行为罚款、减排成本、核查成本和监管成本是研究区工业碳排放三方利益主体演化博弈的关键影响因素。结合工业碳排放的关键影响因素,从创新机制、约束机制、市场机制和倒逼机制4个方面构建研究区工业碳排放治理机制。完善研究区工业碳排放利益均衡分配,促进三方利益主体合作,可实现工业碳排放利益主体博弈下的环境正义。     

卫生技术评估认知与需求现况调查

??????? 目的 了解浙江省卫生技术及管理人员对卫生技术评估（HTA）的认知和需求,为进一步开展HTA工作提供建议。方法 采用问卷调查与访谈相结合的方法对3家医院,1家公共卫生机构,8家卫生行政机构的102位运用HTA结果的潜在使用者和22位决策者进行了调查。结果 被调查者认为卫生技术相关政策法规在卫生技术信息来源最为重要,卫生技术临床疗效在用于决策的卫生技术相关信息中最为重要,相关研究质量太差是影响卫生技术评估的最大障碍。结论 浙江省卫生技术及管理人员对于HTA有一定的认知与需求,但关注度不够,针对遇到的障碍提出了HTA进一步发展的建议。     

基于人口老龄化的社区护理教学改革的重要环节

目的建立适合我国国情的老年人社区护理模式。方法采用理论分析、文献研究和比较分析法,总结我国目前社区护理教学现状以及社区护理服务机构现状。结果我国老年人保健体制的构建和实践起步比较晚,相对于西方发达国家,中国老年人社区护理模式仍处于不断的完善之中,仍需要实践的探索。结论我国老年人社区护理模式,需要从创新护理教学法、制定护理教学方案、确保方案的实施、引入第三方合作、普及学生护理知识教育等几个方面健全和完善。     

基于第三方支付机构的居民健康卡应用研究

文章引入了第三方支付公司来发行居民健康卡,设计了第三方支付公司发行居民健康卡的总体规划,研究了政府管理机构、第三方支付公司和应用受理机构在整个解决方案中的角色,设计了居民健康卡发行体系和支付体系,实现了快捷地办理居民健康卡,方便、安全地进行账户充值以及高效、便捷地完成诊疗支付。     

Characteristics of the membranes of the pellicle of the ciliatePseudomicrothorax dubius

Summary The membranes of the pellicle of the ciliatePseudomicrothorax dubius are investigated using thin section electron microscopy and freeze-fracture replicas. The plasma membrane is covered by a surface coat and is connected to the outer alveolar membrane by short, sometimes branched, bridges. The inner alveolar membrane is coated on both sides. The epiplasm lies in intimate contact with the cytoplasmic surface of this membrane, and there is a corresponding deposit on the other surface. This deposit is regularly striated.The epiplasmic layer and the alveoli are interrupted at sites of cytotic activity,e.g., the attachment sites of trichocysts, the cytoproct, and the parasomal sacs. The striated deposit ends where the epiplasm ends, indicating a direct relationship between these two epimembranous layers.There is a deposit along the sides of the first part of the tip of the trichocysts, and in this region the trichocyst membrane is free of intramembranous particles.The membrane of the parasomal sacs has a coat on both surfaces. That on the extraplasmic surface is similar to the surface coat of the plasma membrane. The origin of the cytoplasmic coat is unknown. The cytotic activity of these sacs is indicated by their highly irregular profiles.     

The early development of the tail and the transformation of the shape of the nucleus of the spermatid of the domestic fowl,Gallus gallus

Summary The differentiation of the spermatid, especially in reference to the formation of the flagellum, and transformation of the shape of the nucleus was investigated in the domestic fowl.In the early stage of the spermatid, a prominent Golgi apparatus appears around the centrioles. The Golgi vesicles then surround the axial-filament complex which develops from the distal centriole. These vesicles fuse to form continuous membrane at the earliest stage of flagellar formation, and in the succeeding stage Golgi lamellae are attached to the plasma membrane of the developing flagellum. From these observations, it is assumed that Golgi apparatus may be a source of the membrane system of the flagellum.The microtubules distributed around the nucleus form the circular manchette. The anterior region of the nucleus with the manchette is cylindrical in shape and the posterior region without it remains irregular in shape. When the circular manchette has been completed, the whole nucleus acquires a slender cylindrical shape. The circular manchette then changes into the longitudinal manchette. The nuclei of spermatids without a longitudinal manchette are abnormal in shape. In view of these observations it is assumed that the nuclear shaping of the spermatid may be accomplished by circular manchette and the maintenance of shape of the elongated nucleus by longitudinal manchette.The authors wish to thank Mr. Takayuki Mori for his helpful suggestions and technical advices     

Characterization of the composition of the aqueous humor and the vitreous body of the eye of the frog Rana temporaria L

This study aimed to analyze the aqueous humor (AH) and the vitreous body (VB) of the eye of the adult frog Rana temporaria L. as a representative species of amphibians, which lead a semi-terrestrial life. The presence of collagen, albumin, uric acid and electron donors was shown in both media; however, there are slight differences in their concentrations. To determine collagen, a spectral-fluorescent probe, cyanine dye, was used. The presence of collagen in AH of the frog was found at the first time. The total content of electron donors (ascorbic and uric acids, tryptophan, and tyrosine) in VB and HA was roughly estimated at ~ 1.5 × 10^− 4 mol/L. Both VB and AH absorb light in similar UV regions. The total protein and albumin contents in AH were found to be somewhat higher than those in VB. The uric acid content was at an equally low level in both intraocular media. It is supposed that the similarity of VB and AH compositions shown in this work is due to some exchange between VB and AH contents in the course of accommodation. The role of intraocular fluids in physiological functions of the eye and in protecting the retina against UV light is discussed.     

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