How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

Development of an Asset Value Map for Disaster Risk Assessment in China by Spatial Disaggregation Using Ancillary Remote Sensing Data

The extent of economic losses due to a natural hazard and disaster depends largely on the spatial distribution of asset values in relation to the hazard intensity distribution within the affected area. Given that statistical data on asset value are collected by administrative units in China, generating spatially explicit asset exposure maps remains a key challenge for rapid postdisaster economic loss assessment. The goal of this study is to introduce a top‐down (or downscaling) approach to disaggregate administrative‐unit level asset value to grid‐cell level. To do so, finding the highly correlated “surrogate” indicators is the key. A combination of three data sets—nighttime light grid, LandScan population grid, and road density grid, is used as ancillary asset density distribution information for spatializing the asset value. As a result, a high spatial resolution asset value map of China for 2015 is generated. The spatial data set contains aggregated economic value at risk at 30 arc‐second spatial resolution. Accuracy of the spatial disaggregation reflects redistribution errors introduced by the disaggregation process as well as errors from the original ancillary data sets. The overall accuracy of the results proves to be promising. The example of using the developed disaggregated asset value map in exposure assessment of watersheds demonstrates that the data set offers immense analytical flexibility for overlay analysis according to the hazard extent. This product will help current efforts to analyze spatial characteristics of exposure and to uncover the contributions of both physical and social drivers of natural hazard and disaster across space and time.     

唐代御史厅壁记写作的文学与文献学价值——以李华､柳宗元厅壁记写作为例

“厅壁记”是镌刻在古代衙门的墙壁上,记述历代职官沿革、制度得失、官员迁转等,具有警示教育意义的一种文体.唐代御史的厅壁记写作重视“法”的作用,有些甚至上升为国家意志,与粉饰太平的馆阁文学大不相同,是中国法制史上浓墨重彩的一笔.唐代御史的厅壁记写作有着独特的文学价值:(1)李华、柳宗元的诸多厅壁记均用散体文写就,简洁真切,议论精警,已开中唐古文运动的先声.(2)唐代御史在厅壁记创作中注入鲜明的主体意识,语言辛辣,发人深思.唐代御史厅壁记的文献学价值表现在:一是订补现存史志文献之阙,促进唐史研究的深入;二是有助于对唐代文学发生背景的了解.唐代御史厅壁记因观览人数较多,其公众宣传、社会传播、舆论导向之作用亦不可忽视.     

人化自然背景下自然的目的性新论

自然有没有目的性，如果有的话，是在什么意义上讲的，自然的目的性是否具有层次性，我们应该如何对待这些不同形态的自然及其目的性，等等。这个问题，不同的价值观和思维方式的回答是不同的。一般来说，机械论和传统唯物主义是否定自然的目的性的，西方传统中占主导地位的理性主义往往形成自然与社会、物质和精神、理性与非理性等等二元因素的对立。而儒家、马克思的实践哲学明确主张，或从现代现象学可以推断出，自然界不但存在着目的性、主体性，而且存在着它们的差异性，如马克思强调在实践活动的基础上自然与历史的一体化，而儒家的仁爱是有差等的爱，不是墨家所说的具有绝对主义倾向的“兼爱”。也就是说，自然界中的一切生命，按照从高到低的价值顺序，微生物、植物、普通动物、人，都是具有独立的意志和价值的生命体。在道德的理想性、超越性上，它们是平等的，都是爱和尊重的对象，而在现实性上，它们对人的价值是不同的，人们对待它们的态度也应该是不同的，即是有差等的。     

Perceptions of participants and staff of implementing a physical activity program in rural primary care

Addressing the lack of physical activity (PA) in rural adults is vital because of the role it plays in the risk for many chronic diseases. The purpose of the study was to explore the feasibility of conducting a 12-week intervention utilizing a Fitbit to increase PA behavior in inactive rural adults recruited from a primary care clinic. Semi-structured interviews were conducted with study participants (n=10) and a focus group was held with nurses (n=7) from the primary care clinic. Data were analyzed using the process of immersion/crystallization. Participants and nurses both felt the program had a positive impact on PA and that the program was needed in the community. Study participants most often reported their favorite part of the study was being able to track their activity as well as the goal setting. However, study participants reported barriers to continued participation in PA related to a lack of time and ability to be active in cold weather. Further, nursing staff reported barriers in regard to a lack of resources (staffing and money) These barriers need to be examined further and addressed in order to implement a sustainable PA program that can be maintained through a primary care clinic.     

Clarifying the role of belief-motive explanations in multi-stakeholder realist evaluation

In realist evaluation, where researchers aim to make program theories explicit, they can encounter competing explanations as to how programs work. Managing explanatory tensions from different sources of evidence in multi-stakeholder projects can challenge external evaluators, especially when access to pertinent data, like client records, is mediated by program stakeholders. In this article, we consider two central questions: how can program stakeholder motives shape a realist evaluation project; and how might realist evaluators respond to stakeholders’ belief-motive explanations, including those about program effectiveness, based on factors such as supererogatory commitment or trying together in good faith? Drawing on our realist evaluation of a service reform initiative involving multiple agencies, we describe stakeholder motives at key phases, highlighting a need for tactics and skills that help to manage explanatory tensions. In conclusion, the relevance of stakeholders’ belief-motive explanations (‘we believe the program works’) in realist evaluation is clarified and discussed.     

The role of leadership in shared value creation from the public’s perspective: A multi-continental study

Porter and Kramer’s concept of creating shared value (CSV) has been welcomed as an approach to corporate social responsibility (CSR) among corporations that also provides a practical opportunity for dialogue in public relations, but it has been little examined from the general population’s (i.e., the public’s) perspective. Such scrutiny is important because its findings enable public relations to contribute to the debate and development of CSV from both the public’s and the organization’s viewpoints. Additionally, if public relations professionals understand how the public perceives CSV, they can give a strategic perspective to top management for maximizing moral capabilities of the business and formulate effective communication to promote CSV initiatives. This study investigates whether the public prefers corporations to practice CSV as opposed to intrinsic CSR as a separate pursuit from business interests. It also explores the role of leadership as an influential and ethical construct in implementing effective CSV as perceived by the public. The public’s preference for CSV over intrinsic CSR was revealed in a survey of 1784 participants in the United States (US), Germany, and China. Factor analysis results further suggested that effective CSV competencies of CEOs were construed as a unidimensional concept in the US, but German and Chinese participants viewed it as two-dimensional. The public perceived that leaders’ moral character played a more important, core role in effective CSV than did altruistic and behavioral attributes, across nations. Network analysis of the perceived effective CSV-characteristics provides further implications for CSV communication.     

属性集容量确定的夹挤式测度模式及其推算模型

迄今，为解决多属性偏好关联决策属性集容量判断指数复杂性难题所提出的λ模糊测度模式与k-可加模糊测度模式，以及建构在它们之上的属性集容量确定的推算模型，尚存在着适用性差的技术不足。为此，以平衡容量判断的可操作性和容量推算的准确性为视角，提出了一种新容量测度模式，即关于容量判断与推算的夹挤式测度模式，并在此基础上通过引入决策者较易判断给出的容量序信息构建了相应的容量推算模型。基于数值模拟的对比分析表明：新模式不仅在应用可行性上高于k-可加模糊测度模式，而且从容量推算的准确性上看也明显优于λ模糊测度模式和k-可加模糊测度模式，因而对实际决策具有更强的适用性。     

制造系统生产单元碳排放核算模型

制造业是我国国民经济的支柱产业，但也是环境污染物排放的主要来源、能源消耗主体和温室气体排放大户。制造系统高能耗、高物耗、高碳排放的加工过程是造成制造业碳排放量大的重要原因。生产单元作为制造系统的加工的主体，其碳排放量的核算是确定整个制造系统乃至制造业碳排放总量的关键。本文首先对生产单元的原材料、电能、辅助物料及废屑处理所引起的碳排放进行分析，确定生产单元的碳排放源；其次，产品合格率的不同会造成生产单元输入及输出的成品/半成品数量的差异，进而影响生产单元单位产品的碳排放量，在此基础上，综合考虑了原材料、电能、辅助物料及废屑处理的碳排放情况，构建了给定工艺流程下生产单元碳排放核算模型。最后，结合一汽车排气装置加工实例，分别核算加工过程中九个生产单元的碳排放量，验证了模型的可行性。     

Integrating risk and performance management in quality management systems for the development of complex bespoke systems (CBSs)

Abstract

Risk and performance management are at the core of complex bespoke systems (CBSs). CBSs are developed to customer–specified requirements in terms of structure, functionality and conformance. This article examines how risk and performance management are integrated as essential systems in the successful development of projects across multi-organizational functions in complex bespoke system (CBS) organizations. The article argues for the development of a quality management system that consists of two sub-processes: quality control and quality development. Using three case studies from engineering companies, we provide evidence and insights of the way change control, quality development and quality performance are developed in innovating business solutions.