Factors associated with a positive childbirth experience in Brazilian women: A cross-sectional study

BackgroundHaving a positive childbirth experience is an increasingly valued outcome. Few studies evaluated the women’s satisfaction with childbirth through face-to-face interviews out of the health service environment. The objective of this study was to identify factors associated with a higher level of satisfaction with the childbirth experience among Brazilian women.MethodsThis cross-sectional study involved 287 women giving birth in two hospitals in southern Brazil. Women who gave birth to healthy newborns at term were randomly selected. Face-to-face interviews were conducted 31–37 days after delivery, at the mothers’ homes, using a structured questionnaire. Satisfaction with the childbirth experience was measured using a Likert-type scale ranging from very satisfied to very dissatisfied. Prevalence ratios (PR) were estimated using Poisson regression with robust variance.ResultsFollowing hierarchical multivariate analysis, the following factors remained associated with a higher level of satisfaction with the childbirth experience: being satisfied with antenatal care (PR = 1.30; 95% confidence interval [95%CI] = 1.06−1.59), understanding the information provided by health professionals during labor and delivery (PR = 1.40; 95%CI = 1.01−1.95), not having reported disrespect and abuse (PR = 1.53; 95%CI = 1.01−2.31), and having had the baby put to the breast within the first hour of life (PR = 1.63; 95%CI = 1.26−2.11). No association was observed with type of delivery or hospital status (public or private).ConclusionsA higher level of satisfaction with the childbirth experience is related to satisfactory antenatal care, a non-abusive, respectful, and informative environment during childbirth, and to the opportunity to breastfeed the baby within the first hour of life. In clinical practice, greater attention to these basic principles of care during pregnancy and delivery could provide more positive experiences during birth.     

民办幼儿园教师专业素养培训方式实验研究

随着现代教育的发展，提升幼儿园教师专业素养已成为促进学前教育发展的必然要求。以探究民办幼儿园教师专业素养为视角，提出通过干预行为提升教师专业素养水平的构想。实验随机选取成都市某民办幼儿园的20名教师为实验组，再选取与其办园环境、办园背景相似的另一所民办幼儿园的20名教师为对照组，对实验园教师的专业理念与师德、专业知识、专业能力3个维度进行干预。实验结果表明：与对照园相比，实验园教师的专业能力提升显著；与实验园实验前后相比，教师在专业知识、专业能力维度及专业素养总体水平方面均有提升。对教师培训的具体建议为：（1）单一与混合相结合的培训方式对提升民办幼儿园教师专业素养总体水平有现实意义；（2）民办幼儿园教师专业知识的提升需理论培训与自主学习相结合；（3）专家"现场诊断-指导式"培训方式对提升民办幼儿园教师专业能力有显著作用。综上，建议民办幼儿园在了解本园教师专业素养水平的基础上，针对教师专业素养的不同方面，分别采取不同的有效培训方式。     

新时代大学生担当精神及其培育体系的构建

新时代培育民族复兴大任的时代新人，必须提升大学生的担当精神，以建设一支有担当、敢担当的时代新人队伍，这是应对时代诉求与历史使命的必由之路。然而，大学生的担当精神培育既面对着认知新的历史方位、奋力托举中国梦与应对新“忧患”的时代诉求；又要面对围观的看客心态、非科学的失衡心理、认知偏颇的冲击。因此，把担当精神摆在育人的重要位置，从升级育人内容、优化育人环境等几个关键教育环节着手，营造崇德向善、力争担当的社会风尚，将担当精神培育生活化、长效化，进而不断增强大学生的担当意识与担当力。     

Mentorship experiences during registrar training: reflections of Black African specialists in the Western Cape

In order to meet the significant staffing challenges to health care provision in South Africa, the need to support the training and retention of Black medical specialists has been identified. This small qualitative study aimed to explore experiences of mentorship among a group of Black medical specialists in hopes of understanding the value and potential challenges that these relationships raise. Ten Black medical specialists were interviewed about their experiences of being mentored during their registrar training. The interview data was analysed using discourse analysis, and the results comprise of three main themes, namely: Difficulty accessing mentorship, a lack of Black and/or female role models and finally, experiences of feeling excluded from soft networks. The experiences explored in this study indicate the need for open dialogue within the mentorship dyad regarding certain taken-for-granted assumptions surrounding race, so as to aid the provision of more effective and satisfying mentorship outcomes.     

Engaging leader – Engaged employees? A cross-lagged study on employee engagement

The goal of this study is to provide a cross-lagged examination of the relationships between engaging leadership, job resources and employee work engagement. We propose a mediation model and we postulate that engaging leadership can increase perceptions of three specific job resources (i.e. autonomy, support from colleagues and opportunities for learning and development) which theoretically correspond to the three facets of engaging leadership (i.e., inspiring, connecting and strengthening, respectively). Subsequently, in keeping with the extant body of Job Demands-Resources (JD-R) research, we link job resources to employee work engagement. Our hypotheses were tested on data collected at two time-points – T1 (N = 759) and T2 (N = 273) –from employees working for a hotel chain in the Netherlands. In line with our expectations, engaging leadership showed a significant cross-lagged relationship with autonomy and support from colleagues, but did not predict learning opportunities and work engagement across time. While we formulated specific hypotheses, we also tested reversed causation relationships. We found no direct effect from engaging leadership on employee work engagement, however, the reversed effect was significant; employee perceptions of engaging leadership were shaped by their own engagement experiences. Importantly, engaged employees at T1 reported more job resources at T2. By providing a cross-lagged examination of our model, we showed that engaging leaders as well as employees’ positive affective state of being engaged, are essential to shaping a resourceful work context. A comprehensive view on the triggers and outcomes of work engagement and engaging leadership is needed, as the traditional unidirectional cause-effect rationale fails to explain how these concepts relate to one another and to employee experiences of job resources.     

人工智能背景下医疗法律责任的现实困境与完善路径

医疗人工智能利用深度学习和计算机算法等现代化技术，实现辅助诊疗、医学影像、药物发掘、健康诊疗等功能，是人工智能应用最具前景的领域之一。随着人工智能技术发展，具备自主思维和决策能力的智能机器人医生等人工智能将对现有的医疗法律责任制度带来颠覆性影响。在人工智能背景下，医疗人工智能是否具有独立法律主体地位、传统的医疗过错责任归责能否适用、因果关系如何认定等成为现代民事法律责任制度的严峻挑战，也成为实践中的必答之问。因此，在借鉴欧美人工智能领域的探索经验的基础上，在当前阶段通过修正和完善我国民事法律责任制度，提出针对不同的人工智能侵权情形适用差别化归责原则，并尝试建立人工智能强制保险或储备金制度，设置人工智能监管机构及行业标准，以实现既保障患者合法公平权益，又鼓励人工智能技术有效发展之间的平衡。     

历史变局、国家兴衰与发展之路——三次千年变局叠加下的中国特色社会主义发展道路

每当先进的发展制度开始取代落后的发展制度时，整个世界格局就会进入重大的转换阶段。在中国五千年的发展历史中，有两次重大的历史变局完全改变了中国历史发展轨迹并深远地影响了当前中国的发展模式。新时代下的中国作为前两次历史变局影响的客体，曾经既是先进发展制度取代落后发展制度的受益者，也经历过作为落后发展制度主体而被先进发展制度冲击的过程。目前世界正处于第三次先进发展制度与落后发展制度交替的历史变局阶段，作为第三次重大历史变局的主体，在三次千年历史变局叠加的背景下，能否有效地认识、适应并改造利用前两次历史变局的经验与教训，构建系统性、科学性、可行性、领先性的中国特色社会主义制度，将决定中国在本次历史变局中能否顺利成为先进发展制度的主体从而实现民族复兴。     

Statistical testing strategies for assessing treatment efficacy and marker accuracy in phase III trials

When a candidate predictive marker is available, but evidence on its predictive ability is not sufficiently reliable, all‐comers trials with marker stratification are frequently conducted. We propose a framework for planning and evaluating prospective testing strategies in confirmatory, phase III marker‐stratified clinical trials based on a natural assumption on heterogeneity of treatment effects across marker‐defined subpopulations, where weak rather than strong control is permitted for multiple population tests. For phase III marker‐stratified trials, it is expected that treatment efficacy is established in a particular patient population, possibly in a marker‐defined subpopulation, and that the marker accuracy is assessed when the marker is used to restrict the indication or labelling of the treatment to a marker‐based subpopulation, ie, assessment of the clinical validity of the marker. In this paper, we develop statistical testing strategies based on criteria that are explicitly designated to the marker assessment, including those examining treatment effects in marker‐negative patients. As existing and developed statistical testing strategies can assert treatment efficacy for either the overall patient population or the marker‐positive subpopulation, we also develop criteria for evaluating the operating characteristics of the statistical testing strategies based on the probabilities of asserting treatment efficacy across marker subpopulations. Numerical evaluations to compare the statistical testing strategies based on the developed criteria are provided.     

论“莱西会议精神”对新时期全面深化农村基层党组织建设的价值和意义

农村基层党组织是党在农村的神经末梢,也是党的路线、方针、政策的"终端"推动者和实践者。现阶段农村党组织建设面临新兴组织不断涌现与党组织作用削弱的不适应,"权力和资源缺失"与服务刚性增强的不适应,村民自治进一步发展与群众政治参与欠充分的不适应,群众诉求多样化与满足渠道单一的不适应,部分党员党性不强、意识淡化与始终保持先进性的要求不适应等问题。在加强以党支部为核心的农村基层组织建设的"莱西会议精神"指导下,全面深化农村基层党组织建设:思想上高度认识是前提,加强支部建设是核心,坚持法治、完善村民自治是重点,紧扣服务、创新制度是关键,统筹协调、综合配套是保障。     

美国师德问责体系的结构、特点及启示——基于德克萨斯州的经验

美国德克萨斯州历来重视教育工作者的职业道德建设，建立了一系列教育工作者违规行为问责机制，形成了较为完善的师德问责体系。美国德克萨斯州的师德问责体系具有独特的结构与特征。颁布《教育工作者伦理规范》，使问责有法可依；设立专门机构，使问责主体明确；细化教师违规行为，使问责有据可凭；强调证据证词，使问责合理科学；重视结果多样，使问责责罚分明。这些对于促进我国师德问责的规范化、制度化发展有着积极的借鉴意义。