震后应急医疗救援流程效率评价研究

为了最大程度减少地震灾害造成的人员伤亡，实施快速有效的应急医疗救援，在资源有限情景下，迫切需要提高应急医疗救援效率。通过案例分析方法提出了震后应急医疗救援的一般流程，构建了应急医疗救援流程的模糊随机Petri网模型，根据模糊随机Petri网与马尔科夫链的同构关系，得到系统状态的稳态概率表达式，据此分析震后应急医疗救援流程中的关键环节。在此基础上，考虑医疗资源投入的数量与救援工作效率之间的关系，引入时效性评估函数对关键环节的实施效率进行评价，通过理论推导证明同一资源配比存在最优值。以"汶川地震"为例，通过动态和静态分析，得到各状态下稳态概率变化情况，明确了震后应急医疗救援流程的关键环节。以救援过程中资源的投入量作为自变量，通过算例仿真得出医疗资源确定情况下关键环节的最优资源配比。由此对震后应急医疗救援过程提出相应对策与建议，可以为地震灾害应急医疗救援工作部署提供决策支持，促进灾后医疗救援工作的有序进行，实现应急医疗救援效率的提升。     

Public Support For Earthquake Risk Mitigation In Portland,Oregon

During the 1980s, seismic research suggested that Oregon and the City of Portland had a higher risk of a major earthquake than had previously been assumed. In 1993, the State of Oregon adopted a new version of the Oregon Structural Specialty Code, which changed the designation of western Oregon from seismic zone 2b to seismic zone 3. The City of Portland established a program and a Task Force on Seismic Strengthening of Buildings to recommend actions that would encourage upgrading of city buildings. A survey of adult city residents was conducted in April, 1996 to determine public attitudes and opinions about earthquake risks, management and mitigation of earthquake hazards, priorities for protection by strengthening buildings, evaluations of strategies for informing the public about earthquake risks, and support for specific options the city might take to protect citizens against earthquake events. Social and demographic information on individuals and households was also collected. Respondents provided ratings for a wide range of social and environmental risks, provided information on priorities for strengthening key buildings and infrastructure facilities, and answered hypothetical questions about voting for bond measures to pay for city earthquake-mitigation programs. Respondents recognized significant risk from earthquakes and supported programs to protect people, especially vulnerable residents such as children and the sick. There was strong support for protecting emergency response capabilities. There was much less support for using public funds to reduce the risks associated with privately owned buildings. There were also some strong pockets of resistance to publicly funded mitigation programs in response to the hypothetical bond measures.     

Concern About HIV and AIDS Among Older People in the Slums of Nairobi,Kenya

The article explores the way that social networks and personal experiences affect perceived HIV‐related concerns among people aged 50 years or older living in a low resource neighborhood with high HIV prevalence in Nairobi, Kenya. Multiple logistic regression is used to model the association between the reporting of an HIV‐related concern and individual‐level characteristics, personal experiences, and social interaction. The main concerns regarding HIV reported by older people in the study included caring for orphaned children (65%), caring for people with AIDS (48%), and losing material and social support from adult children (36%). Interestingly, 38% of respondents voiced concerns about HIV infection among older people. Respondents who had been individually affected by HIV and AIDS, who were part of a wide social network, or who participated in community activities were frequently more likely to report a concern. The findings highlight the significance of the role of social interaction and social networks in the diffusion of information and knowledge. These findings have implications for HIV and AIDS policy and programs, highlighting the potential for social networks and community‐level interventions to educate and increase awareness about HIV and AIDS among older people. Community leaders can make good peer educators and communication agents for HIV/AIDS campaigns. Additionally, the recognized high level of personal vulnerability to HIV infection among older people suggests the need for targeted sexual behavior change programs among this often neglected group.     

Improving the Impact and Implementation of Disaster Education: Programs for Children Through Theory‐Based Evaluation

A main weakness in the evaluation of disaster education programs for children is evaluators’ propensity to judge program effectiveness based on changes in children's knowledge. Few studies have articulated an explicit program theory of how children's education would achieve desired outcomes and impacts related to disaster risk reduction in households and communities. This article describes the advantages of constructing program theory models for the purpose of evaluating disaster education programs for children. Following a review of some potential frameworks for program theory development, including the logic model, the program theory matrix, and the stage step model, the article provides working examples of these frameworks. The first example is the development of a program theory matrix used in an evaluation of ShakeOut, an earthquake drill practiced in two Washington State school districts. The model illustrates a theory of action; specifically, the effectiveness of school earthquake drills in preventing injuries and deaths during disasters. The second example is the development of a stage step model used for a process evaluation of What's the Plan Stan?, a voluntary teaching resource distributed to all New Zealand primary schools for curricular integration of disaster education. The model illustrates a theory of use; specifically, expanding the reach of disaster education for children through increased promotion of the resource. The process of developing the program theory models for the purpose of evaluation planning is discussed, as well as the advantages and shortcomings of the theory‐based approaches.     

Perception of Earthquake Risk in Taiwan: Effects of Gender and Past Earthquake Experience

This study explored how individuals in Taiwan perceive the risk of earthquake and the relationship of past earthquake experience and gender to risk perception. Participants (n= 1,405), including earthquake survivors and those in the general population without prior direct earthquake exposure, were selected and interviewed through a computer‐assisted telephone interviewing procedure using a random sampling and stratification method covering all 24 regions of Taiwan. A factor analysis of the interview data yielded a two‐factor structure of risk perception in regard to earthquake. The first factor, “personal impact,” encompassed perception of threat and fear related to earthquakes. The second factor, “controllability,” encompassed a sense of efficacy of self‐protection in regard to earthquakes. The findings indicated prior earthquake survivors and females reported higher scores on the personal impact factor than males and those with no prior direct earthquake experience, although there were no group differences on the controllability factor. The findings support that risk perception has multiple components, and suggest that past experience (survivor status) and gender (female) affect the perception of risk. Exploration of potential contributions of other demographic factors such as age, education, and marital status to personal impact, especially for females and survivors, is discussed. Future research on and intervention program with regard to risk perception are suggested accordingly.     

Residents’ information seeking behavior and protective action for earthquake hazards in The Portland Oregon Metropolitan Area

Though significant research exists on earthquake hazard adjustment adoption more generally, research focused on how information seeking influences planned or actual preparedness behavior is rare, limiting our understanding of how information seeking translates into preparedness. To address this gap, our study tests a proposed model of household seismic hazard adjustment using questionnaire responses of roughly 400 households living in the Portland, OR metropolitan region. The proposed model includes components of the Protective Action Decision Model (PADM) with specific emphasis on past information seeking behavior, preparedness behavior, intentions to seek information, and intentions to take protective action. Other components include risk perception, earthquake experience, affective response, seismic risk zone residency, and demographics. Consistent with previous research, this study finds information seeking behavior to be the strongest influence on preparedness with other important influences being risk perception, affective response, and intentions to prepare. We find weak ties between risk zone residency and earthquake risk perception, though this may be because our sample has little experience with earthquakes and the majority live in the same earthquake risk zones. Importantly, longitudinal studies are needed to determine whether information seeking and intentions to prepare eventually result in household protective action.     

Does Medical Risk Perception and Risk Taking Change with Age?

Across adulthood, people face increasingly more risky medical problems and decisions. However, little is known about changes in medical risk taking across adulthood. Therefore, the current cross‐sectional study investigated age‐related differences in medical risk taking with N = 317 adults aged 20–77 years using newly developed scenarios to assess medical risk taking, and additional measures designed to evaluate risk‐taking behavior in the medical domain. Greater expected benefits on the Domain‐Specific Risk‐Taking Scale—Medical (DOSPERT‐M) predicted more active risk taking, whereas higher perceived risk predicted less active risk taking. Next, we examined differences in active and passive risk taking, where passive risk taking refers to risk taking that is associated with inaction. Age was associated with less passive risk taking, but not with active risk taking, risk perception, or expected benefits on the DOSPERT‐M. Participants were overall more likely to opt for taking medical action than not, even more so for a scenario about a vaccine for a deadly flu than for a scenario about a chemotherapy treatment for cancer. Overall, participants were more likely to accept medication (vaccine or chemotherapy) for their child than for themselves. Increasing age was associated with a lower likelihood of accepting the treatment or vaccine for oneself. Taken together, our study provides important insights about changes in medical risk taking across adulthood when people face an increasing number of complex and risky medical decisions.     

People's Preferences for Safety Control: Why Does Baseline Risk Matter?

Previous tests of how people's valuations of safety vary with the level of baseline risk have left policymakers with a rather mixed message. Some data support the conventional hypothesis derived from economic theory that marginal valuations of risk changes increase with the baseline level, but other data reject it. With these indeterminate findings in mind, the present study adopted an in-depth quantitative-qualitative methodology to explore the preferences of a general population sample (N = 147) for safety programs targeted at hazards with different age groups at risk and numbers of deaths per year. The data clearly showed that self- or household interest mattered to people (e.g., programs in which the respondent or their household members were in the at-risk age group were evaluated more positively). The number of deaths also mattered, although not always for reasons strictly consistent with the conventional hypothesis. Rather, the qualitative findings suggested that evaluations may be driven by auxiliary assumptions about aspects of the programs induced by this information (e.g., people believe that a higher number of deaths is an indicator that more people are likely to be exposed to that hazard). These findings bring into question the extent to which quantitative responses from stated preference surveys can be taken at face value to form a reliable basis for public policy.     

Communicating Earthquake Preparedness: The Influence of Induced Mood,Perceived Risk,and Gain or Loss Frames on Homeowners’ Attitudes Toward General Precautionary Measures for Earthquakes

Despite global efforts to reduce seismic risk, actual preparedness levels remain universally low. Although earthquake‐resistant building design is the most efficient way to decrease potential losses, its application is not a legal requirement across all earthquake‐prone countries and even if, often not strictly enforced. Risk communication encouraging homeowners to take precautionary measures is therefore an important means to enhance a country's earthquake resilience. Our study illustrates that specific interactions of mood, perceived risk, and frame type significantly affect homeowners’ attitudes toward general precautionary measures for earthquakes. The interdependencies of the variables mood, risk information, and frame type were tested in an experimental 2 × 2 × 2 design (N = 156). Only in combination and not on their own, these variables effectively influence attitudes toward general precautionary measures for earthquakes. The control variables gender, “trait anxiety” index, and alteration of perceived risk adjust the effect. Overall, the group with the strongest attitudes toward general precautionary actions for earthquakes are homeowners with induced negative mood who process high‐risk information and gain‐framed messages. However, the conditions comprising induced negative mood, low‐risk information and loss‐frame and induced positive mood, low‐risk information and gain‐framed messages both also significantly influence homeowners’ attitudes toward general precautionary measures for earthquakes. These results mostly confirm previous findings in the field of health communication. For practitioners, our study emphasizes that carefully compiled communication measures are a powerful means to encourage precautionary attitudes among homeowners, especially for those with an elevated perceived risk.     

Risk Perception,Experience, and Objective Risk: A Cross‐National Study with European Emergency Survivors

Understanding public risk perceptions and their underlying processes is important in order to learn more about the way people interpret and respond to hazardous emergency events. Direct experience with an involuntary hazard has been found to heighten the perceived risk of experiencing the same hazard and its consequences in the future, but it remains unclear if cross‐over effects are possible (i.e., experience with one hazard influencing perceived risk for other hazards also). Furthermore, the impact of objective risk and country of residence on perceived risk is not well understood. As part of the BeSeCu (Behavior, Security, and Culture) Project, a sample of 1,045 survivors of emergencies from seven European countries (i.e., Germany, the Czech Republic, Poland, Sweden, Spain, Turkey, and Italy) was drawn. Results revealed heightened perceived risk for emergency events (i.e., domestic and public fires, earthquakes, floods, and terrorist attacks) when the event had been experienced previously plus some evidence of cross‐over effects, although these effects were not so strong. The largest country differences in perceived risk were observed for earthquakes, but this effect was significantly reduced by taking into account the objective earthquake risk. For fires, floods, terrorist attacks, and traffic accidents, only small country differences in perceived risk were found. Further studies including a larger number of countries are welcomed.     

Adolescents’ and Young Adults’ Online Risk Taking: The Role of Gist and Verbatim Representations

Young people are exposed to and engage in online risky activities, such as disclosing personal information and making unknown friends online. Little research has examined the psychological mechanisms underlying young people's online risk taking. Drawing on fuzzy trace theory, we examined developmental differences in adolescents’ and young adults’ online risk taking and assessed whether differential reliance on gist representations (based on vague, intuitive knowledge) or verbatim representations (based on specific, factual knowledge) could explain online risk taking. One hundred and twenty two adolescents (ages 13–17) and 172 young adults (ages 18–24) were asked about their past online risk‐taking behavior, intentions to engage in future risky online behavior, and gist and verbatim representations. Adolescents had significantly higher intentions to take online risks than young adults. Past risky online behaviors were positively associated with future intentions to take online risks for adolescents and negatively for young adults. Gist representations about risk negatively correlated with intentions to take risks online in both age groups, while verbatim representations positively correlated with online risk intentions, particularly among adolescents. Our results provide novel insights about the underlying mechanisms involved in adolescent and young adults’ online risk taking, suggesting the need to tailor the representation of online risk information to different age groups.     

Becoming a company person.

Physicians face a management challenge in adjusting to being part of a larger organization. By nature, physicians are not "company people." For physician executives, whose instincts can still lean toward being ferociously independent and individualistic--therein lies the struggle. Here are a few suggestions to help physician executives make the adjustments that are required of a "company person": (1) Be in the right place; (2) abandon critical/negative thinking; (3) focus on the issues; (4) maintain solidarity; and (5) make your boss look good.     

New Product Development Decision‐Making Effectiveness: Comparing Individuals,Face‐To‐Face Teams,and Virtual Teams*

A total of 411 subjects participated in two decision‐making experiments in order to examine the effectiveness of new product development project continuation decisions. Using escalation of commitment theory, in Study 1, individual versus face‐to‐face team decision‐making effectiveness was compared. Study 2, an extension of Study 1, compared the new product development decision‐making effectiveness of individuals, face‐to‐face teams, and virtual teams. A virtual team is a geographically and temporally dispersed and electronically communicating work group. In Study 2, the virtual teams communicated asynchronously via groupware technology. Our findings suggest that teams make more effective decisions than individuals, and virtual teams make the most effective decisions.     

Multiple Health Risk Perception and Information Processing Among African Americans and Whites Living in Poverty

We investigated the risk‐information‐processing behaviors of people living at or near the poverty line. Because significant gaps in health and communication exist among high‐ and low‐income groups, increasing the information seeking and knowledge of poor individuals may help them better understand risks to their health and increase their engagement in health‐protective behaviors. Most earlier studies assessed only a single health risk selected by the researcher, whereas we listed 10 health risks and allowed the respondents to identify the one that they worried about most but took little action to prevent. Using this risk, we tested one pathway inspired by the risk information seeking and processing model to examine predictors of information insufficiency and of systematic processing and extended this pathway to include health‐protective action. A phone survey was conducted of African Americans and whites living in the southern United States with an annual income of ≤$35,000 (N= 431). The results supported the model pathway: worry partially mediated the relationship between perceived risk and information insufficiency, which, in turn, increased systematic processing. In addition, systematic processing increased health‐protective action. Compared with whites and better educated respondents, African Americans and respondents with little education had significantly higher levels of information insufficiency but higher levels of systematic processing and health‐protective action. That systematic processing and knowledge influenced health behavior suggests a potential strategy for reducing health disparities.     

Catastrophe Risk Models for Evaluating Disaster Risk Reduction Investments in Developing Countries

Major natural disasters in recent years have had high human and economic costs, and triggered record high postdisaster relief from governments and international donors. Given the current economic situation worldwide, selecting the most effective disaster risk reduction (DRR) measures is critical. This is especially the case for low‐ and middle‐income countries, which have suffered disproportionally more economic and human losses from disasters. This article discusses a methodology that makes use of advanced probabilistic catastrophe models to estimate benefits of DRR measures. We apply such newly developed models to generate estimates for hurricane risk on residential structures on the island of St. Lucia, and earthquake risk on residential structures in Istanbul, Turkey, as two illustrative case studies. The costs and economic benefits for selected risk reduction measures are estimated taking account of hazard, exposure, and vulnerability. We conclude by emphasizing the advantages and challenges of catastrophe model‐based cost‐benefit analyses for DRR in developing countries.     

Property Loss Estimation for Wind and Earthquake Perils

This article describes the development of a generic loss assessment methodology, which is applicable to earthquake and windstorm perils worldwide. The latest information regarding hazard estimation is first integrated with the parameters that best describe the intensity of the action of both windstorms and earthquakes on building structures, for events with defined average return periods or recurrence intervals. The subsequent evaluation of building vulnerability (damageability) under the action of both earthquake and windstorm loadings utilizes information on damage and loss from past events, along with an assessment of the key building properties (including age and quality of design and construction), to assess information about the ability of buildings to withstand such loadings and hence to assign a building type to the particular risk or portfolio of risks. This predicted damage information is then translated into risk-specific mathematical vulnerability functions, which enable numerical evaluation of the probability of building damage arising at various defined levels. By assigning cost factors to the defined damage levels, the associated computation of total loss at a given level of hazard may be achieved. This developed methodology is universal in the sense that it may be applied successfully to buildings situated in a variety of earthquake and windstorm environments, ranging from very low to extreme levels of hazard. As a loss prediction tool, it enables accurate estimation of losses from potential scenario events linked to defined return periods and, hence, can greatly assist risk assessment and planning.     

道冲突与企业间协作：第三方介入的调节作用

以社会平衡理论和营销渠道组织间关系的相关研究为基础，探讨渠道冲突对企业间协作的影响，并检验第三方介入对冲突与企业间协作之间关系的调节作用。收集550份有效调查数据，应用统计方法分析数据和检验假设。结果发现：渠道冲突对制造商和经销商之间的协作有负向影响，会减少双方共同制定计划与共同解决问题的行为；而制造商邀请第三方介入进行调解，则有助于弱化渠道冲突对共同制定计划与共同解决问题的负向作用。另外，我们还发现，第三方介入还能够促进合作双方的共同制定计划与共同解决问题，进而对双方的渠道合作绩效有积极的影响。     

Altruistic Preferences for Life-Saving Public Programs: Do Baseline Risks Matter?

Cost-benefit analyses of life-saving public programs typically focus on the number of expected deaths avoided (statistical lives saved) as the metric for evaluating benefits. Although this measure of population risk is clearly important, it ignores the distribution of underlying individual risks. A similar number of lives can be saved by protecting relatively large populations with relatively low baseline risk as can be saved by protecting smaller populations faced with higher baseline risks. Should the value of saving a statistical life be sensitive to the baseline levels of risk to exposed individuals? This paper addresses this issue by focusing specifically on individuals’ altruistic values with regard to life-saving programs. Using results from a survey, this study finds that when individuals are asked to state their preference for equally costly life-saving programs that will only affect others’ level of risk, they prefer those that save more lives. More importantly, however, controlling for the number of lives saved, they also prefer programs that affect smaller populations facing higher levels of baseline risk. Furthermore, the results suggest that each order-of-magnitude increase in the level of baseline risk to others approximately doubles the altruistic value component of a statistical life saved.     

The Risk Perception Paradox—Implications for Governance and Communication of Natural Hazards

This article reviews the main insights from selected literature on risk perception, particularly in connection with natural hazards. It includes numerous case studies on perception and social behavior dealing with floods, droughts, earthquakes, volcano eruptions, wild fires, and landslides. The review reveals that personal experience of a natural hazard and trust—or lack of trust—in authorities and experts have the most substantial impact on risk perception. Cultural and individual factors such as media coverage, age, gender, education, income, social status, and others do not play such an important role but act as mediators or amplifiers of the main causal connections between experience, trust, perception, and preparedness to take protective actions. When analyzing the factors of experience and trust on risk perception and on the likeliness of individuals to take preparedness action, the review found that a risk perception paradox exists in that it is assumed that high risk perception will lead to personal preparedness and, in the next step, to risk mitigation behavior. However, this is not necessarily true. In fact, the opposite can occur if individuals with high risk perception still choose not to personally prepare themselves in the face of a natural hazard. Therefore, based on the results of the review, this article offers three explanations suggesting why this paradox might occur. These findings have implications for future risk governance and communication as well as for the willingness of individuals to invest in risk preparedness or risk mitigation actions.     

Earthquake Risk Perception in Bucharest, Romania

The Municipality of Bucharest is one of the capitals with the highest seismic risk in the world. Bucharest is particularly vulnerable to seismic hazard due to: the high density of inhabitants, especially within the residential districts with blocks of flats; the old public utility fund; the out-of-date infrastructure; the numerous industrial parks that are undergoing a restructuring process, not to mention the inefficient organization of civil protection and poor education of the population regarding seismic risk. This research was designed to examine the attitudes and perceptions of people living with the risk of an earthquake hazard in Bucharest. We were interested in how attitudes and perceptions differ depending on gender, age, education, residential area and socioeconomic status, characteristics of seismic hazard, degree of risk exposure, degree of danger, and casualty awareness. At the same time, we compare the results of this study with those from a previous and similar enquiry in 1997. The statistical processing has indicated a significant difference between the declared perception of seismic risk and the independent variables of gender, age, level of education, level of attachment to the residential area, and degree to which the subjects consider they may be affected and could retrieve their losses. Due to the continuous decrease of their living standard, the most vulnerable is the aged population. The feelings toward the residential area is another factor of statistical significance for the population's seismic danger perception. A strong affective bond offers a feeling of safety and leads to the neglect and even total denial of the hazard. In the case of independent variables regarding the type of dwelling, its age, and property form, deviations of empiric values from the theoretical distribution are not relevant for the correlation searched for, which indicates that this issue goes beyond the above-mentioned criteria.