临床医生在产前诊断咨询中面对伦理两难问题态度与选择 ——基于情景案例分析

目的 试图通过情景案例分析法,聚焦产前诊断中的伦理两难事件,探究临床医生的伦理道德抉择及可能的影响因素。 方法 采用分层随机抽样对624名临床医生进行了匿名问卷调查。 结果 针对相应的情景案例,大多数临床医生能够遵循尊重原则,保障孕妇夫妻双方知情权与自主权,但在具体案例的处理上,与其他国家的同类调查相比存在差异。 结论 临床医生的生命伦理意识有显著提升,但仍存在不足,应进一步加大相关法律与伦理理念知识的教育与普及;此外,对基因缺陷严重性的认知,在不同文化背景下也可能有所差异。     

三级公立医院临床医生绩效工资考核指标体系研究 ——基于平衡计分卡和层次分析法视角

医院绩效改革的一个重要命题就是如何通过绩效工资改革使公立医院改变僵化的趋利模式,回归公益性并调动医务人员的积极性。要解决这个问题,就必须以绩效工资考核指标体系为抓手,围绕突出岗位价值、实际贡献、服务质量和患者满意度等方面,构建临床医生绩效工资考核指标体系。通过发挥临床医生绩效工资考核指标体系的导向作用,使公立医院担负起公益性和自身发展的双重责任。     

我国发展医院临床社会工作的意义与对策 ——基于美国临床社会工作的经验

随着医药卫生体制改革的不断深化,发展有效协作的医疗服务供给模式成为新趋势,因而凸显了在医疗机构中致力于提供咨询和协调服务的临床社会工作者的重要性。通过对美国临床社会工作内涵及其职责范围、重要性的分析,认为我国发展临床社会工作有利于改善医患关系、保障客户利益、提高医护人员工作福利和增加医院经济效益,建议我国从转变医疗服务供给理念、培养专业的社会工作者队伍和开展临床社会工作定量研究三个方面消除我国医院发展临床社会工作的障碍。     

心理治疗模式遗传咨询的工作重点及基本程序

心理治疗模式遗传咨询的工作重点及基本程序均有别于以往的遗传咨询模式。在这一模式中, 工作重点不再是单纯解决咨询者所遇到的生理问题, 而是要同时解决其所遇到的心理问题。其中由卡尔·罗杰斯提出的“以当事人为中心的疗法”在这一模式的咨询工作中占有重要的地位。由于工作重点由解决生理问题转移到心理问题, 心理治疗模式遗传咨询的工作程序亦需作相应的调整。这些程序大致可分为7个阶段: (1)首次接触; (2)相互介绍; (3)对咨询议程达成共识; (4)采集家族史; (5)告知并解释医学及遗传学信息; (6)结束咨询; (7)咨询后工作。     

我国器官移植中的伦理困境及解决思路

我国的器官移植近10年来有了发展,无论从技术层面、移植数量和质量、临床管理以及法规建设上都有了长足的进步。然而,由于我们在开展器官移植方面的先天不足,例如从事器官移植的技术队伍主要是来自海外学成归来的专家;技术主要靠引进西方的临床技术,在基础研究和创新方面相对薄弱;在法律和管理制度的建设方面相对滞后,没有建立一个从制度上保证器官移植健康开展的系统,使得在器官供体来源和器官的公正分配上存在许多欠缺。因此有必要对我国的器官移植历史进行回顾和总结,对我国在器官移植中存在的错误观念和伦理困境进行剖析,寻找适合我国开展器官移植的正确途径,促进我国的器官移植事业健康发展。     

Scenario Modelling in Prospective LCA of Transport Systems. Application of Formative Scenario Analysis (11 pp)

Background Tools and methods able to cope with uncertainties are essential for improving the credibility of Life Cycle Assessment (LCA) as a decision support tool. Previous approaches have focussed predominately upon data quality. Objective and Scope. An epistemological approach is presented conceptualising uncertainties in a comparative, prospective, attributional LCA. This is achieved by considering a set of cornerstone scenarios representing future developments of an entire Life Cycle Inventory (LCI) product system. We illustrate the method using a comparison of future transport systems. Method Scenario modelling is organized by means of Formative Scenario Analysis (FSA), which provides a set of possible and consistent scenarios of those unit processes of an LCI product system which are time dependent and of environmental importance. Scenarios are combinations of levels of socio-economic or technological impact variables. Two core elements of FSA are applied in LCI scenario modelling. So-called impact matrix analysis is applied to determine the relationship between unit process specific socio-economic variables and technology variables. Consistency Analysis is employed to integrate unit process scenarios, based on pair-wise ratings of the consistency of the levels of socio-economic impact variables of all unit processes. Two software applications are employed which are available from the authors. Results and Discussion The study reveals that each possible level or development of a technology variable is best conceived of as the impact of a specific socio-economic (sub-) scenario. This allows for linking possible future technology options within the socio-economic context of the future development of various background processes. In an illustrative case study, the climate change scores and nitrogen dioxide scores per seat kilometre for six technology options of regional rail transport are compared. Similar scores are calculated for a future bus alternative and an average Swiss car. The scenarios are deliberately chosen to maximise diversity. That is, they represent the entire range of future possible developments. Reference data and the unit process structure are taken from the Swiss LCA database 'ecoinvent 2000'. The results reveal that rail transport remains the best option for future regional transport in Switzerland. In all four assessed scenarios, four technology options of future rail transport perform considerably better than regional bus transport and car transport. Conclusions and Recommendations. The case study demonstrates the general feasibility of the developed approach for attributional prospective LCA. It allows for a focussed and in-depth analysis of the future development of each single unit process, while still accounting for the requirements of the final scenario integration. Due to its high transparency, the procedure supports the validation of LCI results. Furthermore, it is well-suited for incorporation into participatory methods so as to increase their credibility. Outlook and Future Work. Thus far, the proposed approach is only applied on a vehicle level not taking into account alterations in demand and use of different transport modes. Future projects will enhance the approach by tackling uncertainties in technology assessment of future transport systems. For instance, environmental interventions involving future maglev technology will be assessed so as to account for induced traffic generated by the introduction of a new transport system.     

基于LEAP的厦门市节能与温室气体减排潜力情景分析

城市是人类社会经济活动的中心,聚集了世界一半以上的人口。在城市发生的温室气体排放量占全球排放总量的75%左右,因此在城市这个尺度上研究温室气体减排意义重大。从城市这个尺度出发,以厦门市为实际研究案例,应用LEAP模型进行节能减排政策情景分析,定量分析评价城市节能减排潜力,并详细分析各种控制情景和各部门的节能减排贡献率。研究结果显示:在综合控制情景下,厦门能源消费总量年均增长率、万元地区生产总值能耗和温室气体排放总量年均增长率都有所下降;清洁燃料替代措施节能减排效果最好,工业部门节能减排潜力最大;优化能源使用结构蕴藏巨大减排潜力。     

猪窝产仔数的遗传分析

对二花脸猪,大白猪及其杂交一代3个群体共计1686窝仔猪数的资料进行了遗传分析,结果表明猪总产仔数,活产仔数,20日龄仔猪数和45日龄仔猪数的遗传力分别为0．081,0．156,0．402和0．419。主效基因指数分析表明二花脸猪这4个性状均存在主效基因遗传。     

基于SSR标记的彩色马铃薯亲缘关系分析及指纹图谱构建

为了探究彩色马铃薯种质资源的遗传背景,该试验共选用22对SSR标记引物,对33份彩色马铃薯品种(系)进行遗传多样性分析以及指纹图谱构建。结果表明:(1)22对引物可扩增得到95个等位位点,其中82个为多态性位点,多态性比率达到86.31%;多态信息量(PIC)从0.168 7(STM1053)到0.991 9(STI033),平均为0.8411。(2)UPGMA聚类分析表明,在相似系数0.71处,33份供试材料分为4个主要聚类群,不同聚类群之间具有较大的遗传差异。(3)利用STM0031、STM0030、STI014、STM1029、STI001共5对SSR标记引物构建了33份彩色马铃薯材料的分子标记指纹图谱。该研究结果为彩色马铃薯育种亲本组配奠定了理论基础,有助于彩色马铃薯种质资源的快速鉴定。     

Ethical Implications of Case‐Based Payment in China: A Systematic Analysis

How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee‐for‐service to case‐based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case‐based payment in the Chinese health care system and applied a systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case‐based payment. Some ethical problems of case‐based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high‐income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient‐physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case‐based payment is currently more ethically acceptable than fee‐for‐service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case‐based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications.     

玉米耐铝性的遗传分析

以两个耐铝性不同的玉米自交系及它们的杂交和回交世代为材料,采用营养液培养方法,对玉米的耐铝性进行了遗传分析。结果表明,根系相对生物量具有较高的的遗传变异,其广义遗传率高达78.6%。但其狭义遗传率仅为15.4%,说明其遗传方式以显性效应为主。相反,地上部相对生物量具有相对较高的狭义遗传率（43.1%）,其遗传方式以加性效应为主。在0.1m mol/L Al3+ 胁迫条件下,根系总的和活跃的吸收比表面遗传率较低,说明此根系活力性状受环境影响较大。Abstract: The heredity of Al-tolerance was studied in different Al-tolerance of two inbred lines of maize and their F1, F2, B1 and B2 generations by the means of nutritional cultivation. The results indicated that the relative biomass(Al/CK) of root had high hereditary variance, the broad-sense heredity reached 78.6 %, but narrow-sense heredity only had 15.4 %. Its hereditary pattern mainly was dominant effects. On contrast, the relative biomass of shoot had high narrow-sense heredity (43.1%), it means that the hereditary pattern of relative biomass of shoot mainly was additive effects. On the hereditary ground of 0.1 mmol/L Al3+, the broad-sense heredity of total absorbing surface to volume ratio and active absorbing surface to volume ratio were 17.9 % and 36.4 %, and narrow-sense heredity of them were 10.0 % and 18.4 %. It means that the characters of root activity were obviously affected by environment.     

基于全基因组SNP分子标记分析青海云杉遗传结构

以张掖龙渠青海云杉（Picea crassifolia）无性系种子园中的106个青海云杉亲本无性系为研究材料,采用改良CTAB法,提取的青海云杉基因组DNA,构建SLAF文库并进行高通量测序,之后分析SLAF测序数据和筛选SNP位点,基于邻接法分析得到样品的聚类情况。研究得出：将测序的水稻日本晴reads与其参考基因组进行比对,显示本试验双端比对效率为95.33%,说明SLAF建库成功。本研究中所测序列的Q30较高,碱基测 序错误率低,测序质量高;本研究共开发4 058 883个SLAF标签,标签的平均测序深度为21.21×。共开发 12 275 765个青海云杉SNP标记,各青海云杉样本的SNP数量为1 890 934~4 487 841。利用已开发的高质量青海云杉SNP标记,构建了106个青海云杉的系统发育树,发现来自不同种源的青海云杉在各组中分布比较均匀,不同种源的青海云杉多聚为一类。通过SNP标记和主成分分析,这些无性系来源于同一个祖先的可能性较大,表明无性系间亲缘关系相近。为今后遗传多样性的分析、遗传图谱的构建等提供了基础数据,也为青海云杉初级种子园去劣疏伐提供依据,为高世代种子园的营建奠定基础。     

Commercial Genetic Testing in Mainland China: Social, Financial and Ethical Issues

This paper provides an empirical account of commercial genetic predisposition testing in mainland China, based on interviews with company mangers, regulators and clients, and literature research during fieldwork in mainland China from July to September 2006. This research demonstrates that the commercialization of genetic testing and the lack of adequate regulation have created an environment in which dubious advertising practices and misleading and unprofessional medical advice are commonplace. The consequences of these ethically problematic activities for the users of predictive tests are, as yet, unknown. The paper concludes with a bioethical and social science perspective on the social and ethical issues raised by the dissemination and utilization of genetic testing in mainland China.