以“立德树人”为核心的医学微生物学思政教学设计

为了促进医学生的全面发展,为社会输送更多的德才兼备的高素质医学人才,我们医学微生物学课程组在贯彻“爱国敬业、救死扶伤、甘于奉献、仁心仁术、善于沟通”等根本性培养目标的基础上,进一步结合学科特点及医学科学家的培养需求,着重从“生物安全责任意识”“科普宣传、社会责任”及“科学精神”这3个方面对医学微生物学思政教学进行了“有意识”地规划和设计。另一方面,利用钟南山、陈薇等榜样的力量对医学生进行立体、多方位的素质培养。实施手段包括数据、图片、主题讨论、案例分析、科普宣传材料制备等。在学生中进行的问卷调查结果显示教学效果良好。     

German law on circumcision and its debate: How an ethical and legal issue turned political

The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent should be carried out for non‐medical reasons. To this end, the potential benefits and harms of circumcision for non‐medical reasons are compared. We argue that circumcision does not provide any benefits for the ‘child as a child’ and poses only risks to boys. We then set out to clarify and analyse political (rather than ethical) justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany's unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues – as in the case of religious circumcision.     

Rawlsian Justice and Palliative Care

Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare. We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because of a central feature in Daniels' account, namely that care should be provided to restore people's opportunities. Daniels' view is both unable to provide pain relief to those who need it as a supplement to treatment and, without justice‐based reasons to provide palliative care to those whose opportunities cannot be restored. We conclude that this makes Daniels' framework much less attractive.     

When does optional participation allow the evolution of cooperation?

Altruistic punishment has been shown to invade when rare if individuals are allowed to opt out of cooperative ventures. Individuals that opt out do not contribute to the common enterprise or derive benefits from it. This result is potentially significant because it offers an explanation for the origin of large-scale cooperation in one-shot interactions among unrelated individuals. Here, we show that this result is not a general consequence of optional participation in cooperative activities, but depends on special assumptions about cooperative pay-offs. We extend the pay-off structure of optional participation models to consider the effects of economies and diseconomies of scale in public-goods production, rival and non-rival consumption of goods, and different orderings of the pay-offs of freeriding and opting out. This more general model highlights the kinds of pay-offs for which optional participation favours cooperation, and those in which it does not.     

患者参与决策与医学新技术使用行为的关联分析

目的 研究我国医学新技术临床应用中的患者参与决策，分析患者参与决策对患者医学新技术使用行为的关联性及影响。方法 采用横断面设计和分层整群抽样方法，选取上海市、福建省、四川省18家医院临床科室的患者进行调研，调查问卷为自主设计，借鉴国外SDM-Q-9量表，应用LIKERT五分量表赋值进行logistic回归分析等。结果 共调查了来自18家医院临床科室的554名患者，患者SDM-Q-9量表总得分为(34.66±7.314) 分，单条目得分为3.74～3.95分，聚类分析显示，310名（占64.32%）患者的量表得分为“较高”；患者SDM-Q-9得分对患者是否使用医学新技术有统计学意义（P＜0.05），对患者决策满意度有统计学意义（P＜0.05），患者满意度对患者是否使用新技术也有统计学意义（P＜0.05），此三者间两两相关。结论 医学新技术临床应用中患者参与决策的实际有效性仍有待研究；患者参与决策正向影响患者决策满意度，并影响患者是否使用医学新技术。建议加强合理的患者参与，适度把握新技术监管，以提高患者满意度，促进医学技术创新发展与适宜推广。     

Mangrove reforestation: greening or grabbing coastal zones and deltas? Case studies in Senegal§

Besides their important contribution to global biodiversity, mangroves provide many services. Nevertheless, due to an increase of human activities and to climate change, in less than 20 years these ecosystems have lost one fifth of their global surface area. In response to this decrease, mangrove reforestation incentives have spread throughout the world. The scientific and societal legitimacy of reforestation actions still remain in question. Focusing on two case studies, the Saloum Delta and Lower Casamance, Senegal, our methodology was mainly based on the analysis of environmental narratives and discourses between 2009 and 2013, and on reforestation campaigns conducted by NGOs. We highlight the complexity of the system of values associated with the mangroves, as well as the positive and negative interactions between the services. Even although the reforestation campaigns were generally successful in terms of reforested surfaces and international visibility, they were poor in terms of biological and cultural diversities and led to spatial injustice. Moreover, the extensive reforestation with a unique mangrove species, Rhizophora mangle, was perceived as means of ‘green grabbing’, and the simultaneous buying of carbon tax by industrial conglomerates induced disempowerment of the local communities. More integrated research programmes must be developed towards the extensive knowledge of the mangroves.     

Female productivity and mortality in early-20th-century Taiwan

In late-Qing-dynasty Taiwan (1870-1895), female infanticide and general neglect killed over 15% of young girls. During the early years of Japanese rule (1895-1915), female infanticide was almost completely eliminated and the treatment of girls improved. This paper argues that the increase in the willingness to raise daughters was due to an increase in adult female productivity. Under Japanese rule, female seclusion decreased, female labor market participation greatly increased and the custom of foot-binding was ended. These changes increased the expected value of raising a daughter relative to raising a son.     

A proposed process for applying a structured decision‐making framework to restoration planning in the Atchafalaya River Basin,Louisiana, U.S.A.

Environmental decision‐making issues in the Atchafalaya River Basin (ARB), Louisiana require innovative approaches that combine scientific understanding and local stakeholder values. Management of the ARB has evolved from strong federal control to establish the ARB as a primary floodway of the Mississippi River and Tributaries Project to a state and federal collaboration to accommodate fish and wildlife resource promotion, recreational opportunities, and economic development. The management policy has expanded to include a growing number of stakeholders, but the decision‐making process has not kept pace. Current conflicts among many local stakeholder groups, due in part to their lack of involvement in the decision‐making process, impede restoration efforts. The absence of a long‐term collective vision for the ARB by both local stakeholder groups and management agencies further confounds these efforts. This paper proposes a process to apply a structured decision‐making framework, a values‐based approach that explicitly defines objectives, to promote stakeholder‐driven restoration efforts in the ARB and to better prepare for and manage long‐term environmental issues. The goals of this approach are: (1) to create a process founded on stakeholder values and supported by rigorous scientific assessment to meet management agency mandates and (2) to establish a transparent process for restoration planning in the ARB that incorporates current and future non‐governmental stakeholders into the decision‐making process. Similar frameworks have been successful in other river basins; we feel the structure of current restoration efforts in the ARB is well‐suited to adopt a values‐focused management framework.     

Integrated climate sensitive restoration framework for transformative changes to sustainable land restoration

Sustainable land restoration is the key to restore degraded land, halt biodiversity loss, and reinstate ecosystem services for human well‐being. Restoration needs to be planned and conducted with due recognition to growing climate uncertainty with an evolved understanding of the future restoration targets. The present opinion article attempts to provide an overview on an integrated climate sensitive restoration framework that recognizes the local participation in mapping degraded lands, identification of species for supporting species modeling to better understand climate uncertainty. Involvement of citizen science‐based restoration monitoring tools can contribute to big data analytics for ecological monitoring and policy support. The Framework potentially helps in sustainable land restoration by transformative changes for achieving the UN Decade on Ecosystem Restoration (2021–2030), Sustainable Development Goals 15, and addressing the post‐2020 Global Biodiversity Framework. However, to realize success, climate finance mechanisms to drive restoration should be seriously considered for reducing bias and enhancing opportunities of equitable sharing in the era of corruption, authoritarianism, and regulatory capture.