医疗信息共享对患者转移数量和服务质量水平影响研究

当前我国医院间存在严重的"信息孤岛"，医院参与医疗信息共享意愿不高，患者的诊疗信息被静态碎片化储存而无法充分有效地利用。考虑到医院进行医疗信息共享将降低患者转移成本，本文构建一个多阶段双寡头动态博弈模型研究医疗信息共享对医院竞争过程中患者转移数量和服务质量水平决策的影响。首先，根据是否存在转移成本，将患者分为新患者和经验性患者，借助Hotelling模型刻画患者的效用函数，分析患者就诊决策。然后，在政府价格规制和不考虑医院利他性情景下，构建了医院累积期望收益目标函数，使用动态规划方法，求解实现医院累积期望收益最大化的服务质量水平，获得了实现患者相互转移且医院在市场中共存的马尔可夫完美均衡。最后，根据医院参与医疗信息共享后患者转移成本降为零，分析与比较信息共享前后患者转移数量和服务质量水平变化。研究发现：在不同医院间本身存在患者转移背景下，医院参与信息共享后，患者转移数量增加但存在一个上限，增加的转移量与患者在医院间的转移成本呈正相关，与初始感知效用的差值范围呈负相关；医院参与信息共享后，均衡状态下的医院服务质量水平高于信息共享前的服务质量水平。因此，在不改变当前医保支付方式下，要加快推进医疗信息共享，政府部门可以根据医院的患者数量和服务质量水平变化对其进行定期补贴，以激励医院积极参与医疗信息共享，本文给出了这个补贴的量化表达。     

从盖恩斯《刑前一课》看小说视点与叙事层面的建构

盖恩斯在《刑前一课》里从零视点与悬念的建构、外视点与悖论的建构、内视点与意识流、多视点聚焦与立体感等方面来研究小说视点与叙事层面的相互关联。他从零视点的角度建构人称悬念、瞬间悬念和期待性悬念，从外视点的角度设置了主题悖论、言辞悖论和语境悖论。为了克服零视点和外视点描述的单调性和乏味性，盖恩斯把内视点与意识流进行了有机结合，从触景生情式意识流、内心独白式意识流和交织式意识流等方面探究人物心理与社会环境的内在关联。他还在人物评述和场景氛围等方面采用了多视点策略，从多层次和多侧面的角度来聚焦于具体的人物、物件或场景，构建了叙事层面的立体感，拓展了现代黑人小说创作的美学认知空间。     

Deliberate acquisition of competence in physiological breech birth: A grounded theory study

Problem

Research suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems.

Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment

British Columbia’s treatment as prevention policy has provided free access to highly active antiretroviral therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a seroadaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n = 556) and HIV-positive (n = 218) serostatus participants. Analyses indicated that both groups reported VLS, and that serostatus and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers’ Diffusion Of Preventative Innovations Model, and they have important implications for HIV research and GBM sexual decision-making.     

Staff and family attitudes to fences as a means of detaining people with dementia in residential aged care settings: The tension between physical and emotional safety

This study investigates staff and family attitudes towards the use of the fences that surround many aged care facilities in Australia, in the context of indefinite detention of people with dementia. This indefinite detention has been described in a report from an Australian Senate Inquiry as “a significant problem within the aged care context”, which “is often informal, unregulated and unlawful”. Five focus groups comprising direct care workers, family members, nurse unit managers and facility managers discussed the reasons for and their attitudes towards fences. The results show a tension between the provision of physical and emotional safety. This is to say that even while it is illegal to detain people with dementia against their will, and even while participants understood the negative impact of fences on the well‐being and emotional safety of people with dementia, they accepted and supported the presence of perimeter fences because they provided the perception that fences kept people with dementia physically safe. This has implications for redressing the balance between physical and emotional safety in policy and practice.     

Value drivers of social businesses: A business model perspective

Hybrid organizational forms that combine commercial and welfare institutional logics play an increasingly important role in addressing the grand societal challenges we face today. Building on the literatures on hybrid organizations and social business models, we explore the characteristics of social businesses from a business model perspective. This study seeks to better understand the particularities and value drivers of hybrid social purpose in contrast to purely commercial business models. We follow a grounded theory approach and our findings are based on interview data from 17 social business firms. Building on social businesses' identified particularities, we propose four value drivers of social business models: 1) responsible efficiency, 2) impact complementarities, 3) shared values, and 4) integration novelties. We link our findings to the literature, contributing new insights into social businesses models and implications for practitioners.     

The Value of a Statistical Life for Risk‐Averse and Risk‐Seeking Individuals

This article estimates the value of a statistical life (VSL) for Chile under the hedonic wage method while accounting for individual risk preferences. Two alternative measures of risk aversion are used. First, risk aversion is directly measured using survey measures of preferences over hypothetical gambles, and second, over observed individual behaviors that may proxy for risk preferences, such as smoking status, are used. I reconcile the results with a theoretical model of economic behavior that predicts how the wage‐risk tradeoff changes as risk aversion differs across individuals. The VSL estimates range between 0.61 and 8.68 million dollars. The results using smoking behavior as a proxy for risk attitudes are consistent with previous findings. However, directly measuring risk aversion corrects the wage‐risk tradeoff estimation bias in the opposite direction. The results are robust to other observed measures of risk aversion such as drinking behavior and stock investments. Results suggest that, consistent with the literature that connects smoking behavior with labor market outcomes, smoking status could be capturing poor health productivity effect in addition to purely risk preferences.     

A user’s guide to Lisbon: mobilities,spatial apprenticeship and migrant urban integration*

This paper engages with the ‘mobility turn’ scholarship in order to provide tools for the study of migrants’ integration to urban space. The analysis of urban mobilities draws attention to the practical know-how that underlies mobility practices. I argue that migrants’ urban apprenticeship – that is, the ways migrants learn (to use) city spaces – shape their access to urban resources and their participation in urban life. Based on fieldwork conducted in Lisbon, Portugal, I explore how migrants’ urban knowledges play out in their everyday practices and resonate with broader concerns over migrant integration.     

挣脱生态牢笼的路径探幽——《共产党宣言》中马克思生态思想解读

《共产党宣言》蕴含着深刻的生态思想,其体系以人、社会、自然整体为背景,其核心观点认为生态问题是由资本主义生产方式引起的.马克思在唯物史观视野下,科学论证了资产阶级的所有制必然灭亡、共产主义必然实现的历史发展逻辑,廓清了人与人、人与自然之间双重和解的演化路径.其中关于科技提升、市场拓展、交通和通信发展等引起世界市场“生态扩张”的思想,对全球化程度日益加深境况下“生态文明”和“人类命运共同体”的构建具有重大的理论和实践指导价值.     

新时期大学生思想政治教育的现状与对策

大学生的思想政治教育在时代背景、社会环境和大学生自身素质等方面都呈现出了与以往不同的特点。大学生思想政治教育亟需深刻的改革和创新。通过分析当前大学生思想政治教育的现状以及存在的问题，提出相应的对策进行研究。