医院全成本核算奖金制度和工作量奖金制度的比较研究

????? 主要对全成本核算以及基于萧庆伦教授提出的以资源投入为基础的相对价值比率的工作量奖金制度进行比较研究,有助于分析全成本核算在施行过程中存在的问题。阐述以资源投入为基础的相对价值比率的工作量奖金制度的施行方法,并提出基于以资源投入为基础的相对价值比率的工作量奖金制度将是未来医院改革的方向。

     

Unexpected Home Confinement

An analysis of 100 consecutive cases of unattended home confinements has shown that, while precipitate labour is an important factor, inadequate preparation and instruction of the patient are the commonest causes.     

Unexpected massive myocardial calcification

A 62-year-old female with a history of hypertension, atrial fibrillation and pulmonary embolism was admitted for dyspnoea.     

Unexpected metabolites produced from clomethiazole

The heterocyclic drug clomethiazole is metabolized by body passage partly to small aliphatic molecules. The occurrence of such unexpected metabolites is usually overlooked. An appropriate method for their detection is the comparison of urine profiles during drug intake and after withdrawal of the drug.     

Unexpected applications of secondary metabolites

Secondary metabolites have been found to have interesting applications over and above their well-known medical uses, e.g., as antimicrobials, etc. These alternative applications include antitumor, cholesterol-lowering, immunosuppressant, antiprotozoal, antihelminth, antiviral and anti-ageing activities. Polyene antibiotics, such as amphotericin B, are of use as antiprion agents, antitumor drugs and against leishmaniasis. Other microbial natural products that show antibiotic activity are used against cancer e.g., doxorubicin, neomycin, β-lactams, bleomycin and rapamycin. Macrolide antibiotics, such as erythromycin, clarithromycin and azithromycin, improve pulmonary function in patients suffering from panbion cholitis. Pigments like prodigiosin and shikonin have antitumor activity, while violacein has anti-ulcer and antitumor activity and also acts as an antiprotozoal agent. Statins, in addition to lowering cholesterol and LDL levels, also decrease elevated C-reactive protein (CRP) levels independent of their cholesterol effects. Immunosppressants have many alternative effects: (i) Cyclosporin is proving useful in treatment of inflammatory disease such as asthma and muscular dystrophy. (ii) Rapamycin is extremely useful in preventing restenosis of stents grafted in balloon angioplasty. (iii) Tacrolimus and ascomycin help in treating inflammatory skin disease such as allergic contact dermatitis and psoriasis. Artemisinin, an antimalarial agent, is also showing antitumor activity. Other natural products, including those from plants (betulinic acid and shikonin), animals (bryostatins) and microbes (squalestatin and sophorolipids) have a multiplicity of potentially useful actions. Unexpected functions of known secondary metabolites are continuously being unraveled, and are fulfilling some of the needs of present day medicine and show great promise for the future.     

Unexpected variation in lignin.

Recent studies on mutant and transgenic plants indicate that lignification may be far more flexible than previously realized. Pines with a mutation affecting the biosynthesis of the major lignin precursor, coniferyl alcohol, show a high level of an unusual subunit, dihydroconiferyl alcohol. These results argue in favor of an increased potential for genetic modification of lignin and indicate that our knowledge of the biosynthesis of lignin is far from complete.     

Retirement and Unexpected Health Shocks

Is retirement good for your health? We complement previous studies by exploring the effect of retirement on unexpected health evolution. Using panel data from the Household, Income and Labour Dynamics in Australia survey (2001-2014), we construct measures of the mismatch between individual expected and actual health evolution (hereafter “health shocks”). In our approach, reverse causation running from health shocks to retirement is highly unlikely, because we look at shocks that happen after retirement, and those shocks are, by definition, unanticipated. We find that retirement decreases the probability of negative shocks (by approximately 16% to 24% for men and 14% to 23% for women) while increasing the likelihood of positive shocks (by 9% to 14% for men and 10% to 13% for women). This result is robust to the use of different lead-lag structures and of alternative measures of health change. Our findings are thus consistent with a positive impact of retirement on health.     

Unexpected coherence and conservation.

The effects of migration in a network of patch populations, or metapopulation, are extremely important for predicting the possibility of extinctions both at a local and a global scale. Migration between patches synchronizes local populations and bestows upon them identical dynamics (coherent or synchronous oscillations), a feature that is understood to enhance the risk of global extinctions. This is one of the central theoretical arguments in the literature associated with conservation ecology. Here, rather than restricting ourselves to the study of coherent oscillations, we examine other types of synchronization phenomena that we consider to be equally important. Intermittent and out-of-phase synchronization are but two examples that force us to reinterpret some classical results of the metapopulation theory. In addition, we discuss how asynchronous processes (for example, random timing of dispersal) can paradoxically generate metapopulation synchronization, another non-intuitive result that cannot easily be explained by the standard theory.     

The Australian Baby Bonus Maternity Payment and Birth Characteristics in Western Australia

Background

The Australian baby bonus maternity payment introduced in 2004 has been reported to have successfully increased fertility rates in Australia. We aimed to investigate the influence of the baby bonus on maternal demographics and birth characteristics in Western Australia (WA).

Methods and Findings

This study included 200,659 birth admissions from WA during 2001–2008, identified from administrative birth and hospital data-systems held by the WA Department of Health. We estimated average quarterly birth rates after the baby bonus introduction and compared them with expected rates had the policy not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately by maternal demographics and birth characteristics. WA birth rates increased by 12.8% following the baby bonus implementation with the greatest increase being in mothers aged 20–24 years (26.3%, 95%CI = 22.0,30.6), mothers having their third (1.6%, 95%CI = 0.9,2.4) or fourth child (2.2%, 95%CI = 2.1,2.4), mothers living in outer regional and remote areas (32.4%, 95%CI = 30.2,34.6), mothers giving birth as public patients (1.5%, 95%CI = 1.3,1.8), and mothers giving birth in public hospitals (3.5%, 95%CI = 2.6,4.5). Interestingly, births to private patients (−4.3%, 95%CI = −4.8,−3.7) and births in private hospitals (−6.3%, 95%CI = −6.8,−5.8) decreased following the policy implementation.

Conclusions

The introduction of the baby bonus maternity payment may have served as an incentive for women in their early twenties and mothers having their third or fourth child and may have contributed to the ongoing pressure and staff shortages in Australian public hospitals, particularly those in outer regional and remote areas.     

Unexpected reductions of glycosyl spacer-armed phthalimides

An unusual reductive ring-opening reaction in the title compounds, of the phthalimide group with sodium hydride in anhydrous DMF is observed for the first time and the presumed mechanism is described in detail. An unexpected hydrogenation of the phthalimide group was also observed.     

Unexpected encounter of the parasitic kind

Both parasitology and stem cell research are important disciplines in their own right. Parasites are a real threat to human health causing a broad spectrum of diseases and significant annual rates morbidity and mortality globally. Stem cell research, on the other hand, focuses on the potential for regenerative medicine for a range of diseases including cancer and regenerative therapies. Though these two topics might appear distant, there are some "unexpected encounters". In this review, we summarise the various links between parasites and stem cells. First,we discuss how parasites' own stem cells represent interesting models of regeneration that can be translated to human stem cell regeneration. Second, we explore the interactions between parasites and host stem cells during the course of infection. Third, we investigate from a clinical perspective, how stem cell regeneration can be exploited to help circumvent the damage induced by parasitic infection and its potential to serve as treatment options for parasitic diseases in the future. Finally, we discuss the importance of screening for pathogens during organ transplantation by presenting some clinical cases of parasitic infection following stem cell therapy.     

Unexpected anthropophagic behaviour in Anopheles quadriannulatus

The strongly anthropophilic behaviour of Anopheles gambiae Giles sensu stricto (Diptera: Culicidae), the most important malaria vector in Africa, has been demonstrated by field and laboratory studies. Other members of the An. gambiae complex express varied degrees of anthropophily. Anopheles quadriannulatus (Theobald) species A and B are more zoophilic members of the complex and hence are considered to be of no medical importance. Olfactometer experiments with An. quadriannulatus species A have demonstrated attraction to both human and cow odour. To extend these olfactometer observations a choice experiment was conducted in an outdoor cage with a human and a calf as baits, using laboratory-reared mosquitoes. Anopheles gambiae s.s. (from Liberia) and two strains of An. quadriannulatus species A (SKUQUA from South Africa, SANGQUA from Zimbabwe), marked with different coloured fluorescent powders for identification purposes, were released simultaneously and given an equal opportunity to feed on either host. The experiment was repeated six times. Bloodmeals were identified using the precipitin technique. Anopheles gambiae s.s. showed highly anthropophagic behaviour, taking 88% of bloodmeals from the human host. In contrast, both strains of An. quadriannulatus fed with equal frequency on the human or the calf; the response to either host was not significantly different. These results confirm the olfactometer findings and demonstrate anthropophagic behaviour not previously recorded in this species. This finding has implications for prospective manipulation of host preference for genetic control purposes.     

Unexpected Hedgehog-Wnt interactions in epithelial differentiation

Wnt and Hedgehog (Hh) signalling regulate stem-cell self-renewal and differentiation in a range of epithelia and the inappropriate activation of these pathways contributes to epithelial cancers. Recently, it was reported that Indian Hedgehog (Ihh) antagonises Wnt signalling in colonic epithelium. This observation contrasts with other reports of positive synergy between the pathways and challenges the view that systemically administered Hedgehog antagonists could be beneficial for the treatment of intestinal tumours. The work is discussed in the broader context of Ihh expression and function in epithelia and the different ways in which the Hh and Wnt pathways interact.