The acquisition of conscience and Developmental Systems Theory

Summary Proponents of Developmental Systems Theory (DST) argue that it offers an alternative to current research programs in biology that are built on the historic disjunction between evolutionary and developmental biology. In this paper I illustrate how DST can be used to account for the acquisition of an important component of moral agency, conscience. Susan Oyama, a major proponent of DST, has set moral issues outside the compass of DST. Thus, I examine her reasons for restricting DST to non-moral matters, and argue that they are not decisive. On the positive side, I argue that DST not only is compatible with attempts to describe and explain moral agency but also aids us in understanding it. In particular, I show how DST can provide a fruitful perspective for viewing some significant current findings and theories in moral developmental psychology about the acquisition of conscience. The familiar dichotomies resisted by DST, those between genes and environment, inherited and acquired, innate and learned, and biological and cultural, have also plagued human developmental psychology, including moral development. By bringing a DST perspective to the study of moral development, I illustrate how a DST perspective might offer a promising way to reconceive that phenomenon, and provide some insights into how further work in understanding the development of moral agency might proceed. Thus, I hope to contribute to the current efforts of proponents of DST to integrate developmental and evolutionary considerations.     

医疗保险总额预付试点三级医院患者就医感受调查

目的 调查上海市实行医疗保险总额预付的三级医院中患者的就医感受。方法 经培训的调查员应用结构式调查问卷对上海市10家实行医疗保险总额预付的三级医院的699名患者进行面对面访谈，数据分析主要采用描述性统计。结果 城保患者对门诊医生明显减少处方金额（或处方天数）的感受强于非城保患者，城保和非城保患者的住院就医感受差异无显著统计学意义。结论 医疗保险总额预付对上海三级医院患者就医感受的总体效应似偏弱，而且有限的影响主要集中于门诊而非住院环节。     

Neotypification of the genusTrichosporon

The currently accepted type species of the genusTrichosporon Behrend isT. beigelii. This species has formerly been regarded as identical toT. cutaneum. However, these fungi are now known to represent separate species with different ecology. The first species described inTrichosporon wasT. ovoides, an agent of human white piedra. A neotype strain is designated for this species, while a lectotype strain is indicated forT. cutaneum. The nameT. beigelii is considered as doubtful and consequently cannot be maintained.     

Changing household financial strategies: Canadian couples today

In Canada, there has been a marked increase in the relative frequency of dual earner families, and especially of dual career families, compared to breadwinner/homemaker families. Effects of this change on the handling of incomes inside the household are examined here. In this paper, quantitative survey data and qualitative data on strategies of financial management are described and analyzed for co-resident couples in Winnipeg. Findings are presented on control over income, financial possession, and access to household money. These findings are interpreted as evidence of a shift in the form of companionate marriage toward greater equality of economic agency. It is suggested that the most common household financial strategy among Canadian couples today is that of flexible shares.     

Ethical obligation and legal requirements: On informed consent practices in Bangladesh

Informed consent to medical intervention is fundamental in both ethics and law. But in practice it is often not taken seriously in developing countries. This paper provides an appraisal of informed consent practices in Bangladesh. Following a review of the ethical and legal principles of informed consent, it assesses the degree to which doctors adhere to it in Bangladesh. Based on findings of non-compliance, it then investigates the reasons for such non-compliance through an appraisal of informed consent practices in Bangladesh and provides recommendations aimed at improving such practices. The significance of this paper lies in unveiling the interdependence between the ethical and legal traits of informed consent and their ramifications on strengthening the patient-oriented approach of duty to care.     

Effects of ligand binding on the stability of aldo–keto reductases: Implications for stabilizer or destabilizer chaperones

Ligands such as enzyme inhibitors stabilize the native conformation of a protein upon binding to the native state, but some compounds destabilize the native conformation upon binding to the non‐native state. The former ligands are termed “stabilizer chaperones” and the latter ones “destabilizer chaperones.” Because the stabilization effects are essential for the medical chaperone (MC) hypothesis, here we have formulated a thermodynamic system consisting of a ligand and a protein in its native‐ and non‐native state. Using the differential scanning fluorimetry and the circular dichroism varying the urea concentration and temperature, we found that when the coenzyme NADP⁺ was absent, inhibitors such as isolithocholic acid stabilized the aldo–keto reductase AKR1A1 upon binding, which showed actually the three‐state folding, but destabilized AKR1B10. In contrast, in the presence of NADP⁺, they destabilized AKR1A1 and stabilized AKR1B10. To explain these phenomena, we decomposed the free energy of stabilization (ΔΔG) into its enthalpy (ΔΔH) and entropy (ΔΔS) components. Then we found that in a relatively unstable protein showing the three‐state folding, native conformation was stabilized by the negative ΔΔH in association with the negative ΔΔS, suggesting that the stabilizer chaperon decreases the conformational fluctuation of the target protein or increase its hydration. However, in other cases, ΔΔG was essentially determined by the delicate balance between ΔΔH and ΔΔS. The proposed thermodynamic formalism is applicable to the system including multiple ligands with allosteric interactions. These findings would promote the development of screening strategies for MCs to regulate the target conformations.     

新农合支付方式改革对患者住院均次费用的影响研究

目的 通过多种形式的新农合支付方式改革,提高参保人群的受益程度,有效控制患者住院均次费用的不合理增长,促进医疗机构内部运行机制的转变,提高医保资金的使用效率。方法 采集不同类别的医疗机构,不同支付方式的住院均次费用的增幅数据,进行改革前后的数据分析。结果 改革前后各级各类医院住院均次费用的逐年增幅差距很大,利用支付方式综合改革后的各级各类医疗机构患者住院均次费用得到控制。结论 多种形式的支付方式改革是影响医疗机构内部运行机制、降低住院均次费用增幅的有效手段。     

医德视域下医学生医学精神的建构

近些年来,我国十分重视医学生职业道德教育,然而,在医德教学实践中仍存在着观念落后、内容失衡和方法单一等多方面问题。同时,随着我国多元结构社会的形成,医学生的思想状况和价值观趋于复杂化,从业时职业道德水平出现滑坡。针对目前医学生医德教育存在的种种问题,试图从加强和改进医学生医德教育的角度,探索医学生医德教育改革,增强医学生医德教育的实效性。     

加强多院区大型医院门诊工作的实践与探讨

针对医院门诊工作现状,扩大项目、夯实基础、细化流程、建立机制,实现多院区医院门诊工作专家及专病专业化、各院区门诊资源均衡化、门诊诊疗模式多样化、门诊服务流程标准精细化、门诊诊疗全程信息化、社会不同人群及层次门诊服务需求特需化。     

数字化技术在大型医院病案管理中的应用

目的 探讨医院病案管理数字化实现的技术和方案。方法 采用了病案数字化管理方式,使用高速扫描仪,进行病案资料的数字化采集;同时配合大型数据库技术和大容量硬盘资料缓存技术,实现病案资料的网络检索、查询和打印输出。结果 病案数字化改变了医院传统病案管理模式,提高了病案的使用率,提高了工作效率。结论 在电子病案实现之前,病案数字化管理是解决当前病案资料在保存与利用、信息安全、数据共享等诸多方面问题的一种实用、有效的管理方式。