长期护理需求评估体系建设研究——基于地方试点与德国实践

长期护理需求评估是长期护理保险筹资与给付的联结点,直接决定了保险给付,并对长期护理保险筹资有重要影响.当前我国试点地方在长期护理需求评估制度的设计上分歧较大,虽积累了差异化的经验与案例,但地区分割不利于社会公平与社会流动.应立足于长期护理保险的社会保险属性,结合社会实际与试点效果,适当借鉴德国经验,统筹设计长期护理需求评估体系,通过"法律+行政法规+部门规章"的规范形式,精准定位评估对象,明确独立的评估主体、科学设计评估指标与评估工具、严格规范评估程序等确保评估结果的科学、客观与公正,并根据评估结果进行分级分类给付,实现长期护理保险资源流向精准.     

The importance of cross‐disciplinary scientific engagement in the development of quantitative procedures for aggregate safety assessments

Recent guidance on safety monitoring during drug development, issued by regulatory authorities in the United States and European Union, indicate a shift in focus towards aggregate safety monitoring and scientific evaluation of integrated safety data. The call for program‐level reviews of accumulating safety data, including from ongoing studies, provides an opportunity to leverage the scientific expertise and medical judgment of safety management teams with (a) a multidisciplinary approach, (b) quantitative frameworks to measure level of evidence, and (c) assessments that are product‐specific and driven by medical judgment. A multidisciplinary team, regularly reviewing aggregate safety data throughout the development program, is vital not only for early signal detection but also for generating a better understanding of the accumulating data and context needed for decreasing false alarms.     

Probabilistic frontier regression models for binary type output data

This paper proposes a probabilistic frontier regression model for binary type output data in a production process setup. We consider one of the two categories of outputs as ‘selected’ category and the reduction in probability of falling in this category is attributed to the reduction in technical efficiency (TE) of the decision-making unit. An efficiency measure is proposed to determine the deviations of individual units from the probabilistic frontier. Simulation results show that the average estimated TE component is close to its true value. An application of the proposed method to the data related to the Indian public sector banking system is provided where the output variable is the indicator of level of non-performing assets. Individual TE is obtained for each of the banks under consideration. Among the public sector banks, Andhra bank is found to be the most efficient, whereas the United Bank of India is the least.     

Validation of the Australian Midwifery Standards Assessment Tool (AMSAT): A tool to assess midwifery competence

Background

There is no current validated clinical assessment tool to measure the attainment of midwifery student competence in the midwifery practice setting. The lack of a valid assessment tool has led to a proliferation of tools and inconsistency in assessment of, and feedback on student learning.

新时代教师安全素质培养体系的构建

在倡导"生命至上、安全第一"的新时代，安全素质已然成为教师专业素质结构中的重要组成部分。但目前我国中小学教师安全素质水平较低，其主要原因在于校内安全教育的低效与共性化、职后安全培训的不足以及自主学习途径的缺乏。针对当前存在的主要问题，教师安全素质培养路径的优化和培养体系的构建可以从三个方面展开：首先，在职前修订师范教育人才培养标准，重建教师专业素质结构，同时调整安全教育的课程设置，协同第二课堂提升教师安全素质；其次，在职后扩大教师安全培训对象，建立"分层进阶"新模式，对安全考试合格者发放教师安全培训合格证书，调整和完善中小学校岗位安全工作指南；第三，在日常工作期间，逐步改善教师自主学习条件，积极开展安全专题类校本课程研究。     

Recognizing Structural Nonidentifiability: When Experiments Do Not Provide Information About Important Parameters and Misleading Models Can Still Have Great Fit

In the quest to model various phenomena, the foundational importance of parameter identifiability to sound statistical modeling may be less well appreciated than goodness of fit. Identifiability concerns the quality of objective information in data to facilitate estimation of a parameter, while nonidentifiability means there are parameters in a model about which the data provide little or no information. In purely empirical models where parsimonious good fit is the chief concern, nonidentifiability (or parameter redundancy) implies overparameterization of the model. In contrast, nonidentifiability implies underinformativeness of available data in mechanistically derived models where parameters are interpreted as having strong practical meaning. This study explores illustrative examples of structural nonidentifiability and its implications using mechanistically derived models (for repeated presence/absence analyses and dose–response of Escherichia coli O157:H7 and norovirus) drawn from quantitative microbial risk assessment. Following algebraic proof of nonidentifiability in these examples, profile likelihood analysis and Bayesian Markov Chain Monte Carlo with uniform priors are illustrated as tools to help detect model parameters that are not strongly identifiable. It is shown that identifiability should be considered during experimental design and ethics approval to ensure generated data can yield strong objective information about all mechanistic parameters of interest. When Bayesian methods are applied to a nonidentifiable model, the subjective prior effectively fabricates information about any parameters about which the data carry no objective information. Finally, structural nonidentifiability can lead to spurious models that fit data well but can yield severely flawed inferences and predictions when they are interpreted or used inappropriately.     

论环境影响评价与排污许可制度的互动和衔接——从制度逻辑和构造建议的角度

如何将环境影响评价与排污许可等环境治理工具进行互动与衔接是未来环境治理制度改革的关键。两种制度在现时的环境下都存在各自的问题及相应的变革路径。两种不同的变革路径却有着共同的价值需求，即环境影响评价与排污许可的衔接与互动。在衔接的过程中存在的最大的争议就是维持或简化环境影响评价审批，这种衔接思路的差异制造了两种截然相反的制度逻辑:一种以维持环评审批为核心，另一种以简化环评审批为核心。就中国目前的环境影响评价制度改革方向而言，简化环评审批似乎已是不可阻挡之潮流。是否应当以简化环评审批、强调排污许可为目标进行两种制度的衔接。简化环评审批并不等同于弱化环评制度；在环境影响评价与排污许可的衔接构造上，应当遵循的思路:在宏观上，以效益最大化统领全局；在具体操作上，秉持“在简化环境影响评价的大环境中，寻找强化的契机；以排污许可为核心的进程中，夯实衔接的构造”的理念。     

The Child Abuse Risk Evaluation Dutch Version (CARE-NL): A retrospective validation study

Abstract

The Child Abuse Risk Evaluation – Dutch version (CARE-NL) is a structured professional guideline for assessing the risk of all types of child abuse. The CARE-NL comprises 18 risk factors: eight Parental characteristics, three Parent-Child interaction factors, five Family factors, one Child vulnerability factor, and an extra factor for child sexual abuse risk. We examined interrater reliability and predictive accuracy of the instrument in a retrospective study at Advice and Reporting Centers on Child Abuse (ARCCA) in The Netherlands. The ARCCA files contained limited information on Parental risk factors, while parental characteristics, such as mental disorder and substance abuse, are the most important risk factors for (repeated) child abuse. On the other hand, the majority of the files included ample information on child and family characteristics. The CARE-NL could be reliably coded by trained raters and the predictive accuracy for out-of-home placement (AUC = .73) and placement of the child under court supervision (AUC = .78), at two years follow-up, was adequate. Use of the CARE-NL ensures that the assessment of the risk of child abuse focuses on the most important, empirically based risk factors in a structured and coherent way.     

ISO 45001 and controversial transnational private regulation for occupational health and safety

This article analyses the genesis of the ISO 45001 standard on occupational health and safety, a new initiative of transnational private regulation. The authors draw a picture of controversy from interviews with stakeholders involved in its design, approval and initial dissemination, and from a qualitative content analysis of the internal documentation of the committee responsible for its approval. Like its predecessors relating to environmental management – ISO 14001 – and corporate social responsibility – ISO 26000 – this new standard raises serious concerns among stakeholders given that it deals with substantive political, social and legal issues.     

Contribution analysis to analyze the effects of the health impact assessment at the local level: A case of urban revitalization

The health impact assessment (HIA) is a tool used to estimate the potential impact on health of non-health-related proposals prior to implementation. While it is increasingly used in Quebec, Canada, studies have not analyzed its medium-term impacts and potential long-term impacts. We conducted a contribution analysis using in-depth interviews with key stakeholders, as well as documents, observation and images related to HIA in order to analyze its impacts on the revitalization of road infrastructure, parks and green spaces, and residential housing. Our analysis not only reflects on the decision-making process through the adoption and implementation of HIA recommendations, but also on the link between actions implemented in the field and health outcomes.