Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

文化与河流

文化与河流的关系十分特殊，文化既源于河流，又反过来改造河流。文章重点阐述了文化如何由源于河流到改造河流，如何由被动地改造河流到主动地改造河流的过程。     

What to Do at Low Doses: A Bounding Approach for Economic Analysis

To quantify the health benefits of environmental policies, economists generally require estimates of the reduced probability of illness or death. For policies that reduce exposure to carcinogenic substances, these estimates traditionally have been obtained through the linear extrapolation of experimental dose-response data to low-exposure scenarios as described in the U.S. Environmental Protection Agency's Guidelines for Carcinogen Risk Assessment (1986). In response to evolving scientific knowledge, EPA proposed revisions to the guidelines in 1996. Under the proposed revisions, dose-response relationships would not be estimated for carcinogens thought to exhibit nonlinear modes of action. Such a change in cancer-risk assessment methods and outputs will likely have serious consequences for how benefit-cost analyses of policies aimed at reducing cancer risks are conducted. Any tendency for reduced quantification of effects in environmental risk assessments, such as those contemplated in the revisions to EPA's cancer-risk assessment guidelines, impedes the ability of economic analysts to respond to increasing calls for benefit-cost analysis. This article examines the implications for benefit-cost analysis of carcinogenic exposures of the proposed changes to the 1986 Guidelines and proposes an approach for bounding dose-response relationships when no biologically based models are available. In spite of the more limited quantitative information provided in a carcinogen risk assessment under the proposed revisions to the guidelines, we argue that reasonable bounds on dose-response relationships can be estimated for low-level exposures to nonlinear carcinogens. This approach yields estimates of reduced illness for use in a benefit-cost analysis while incorporating evidence of nonlinearities in the dose-response relationship. As an illustration, the bounding approach is applied to the case of chloroform exposure.     

乐教与儒者的宗教情怀

乐教是理解儒家精神不可忽视的重要方面。乐教扎根于“亲亲”之情,具体体现为与“忧患意识”有别,而与“安”“乐”相协调一致的“怛”和“哀”“悲”之情。此情实质上是超越的天道内化为人的心性而落实下来的生命意义与价值得以呈现的方式。儒者虽深知人生之哀、悲,但以乐入手,解悟和转化现实的人生与宇宙,是一大特色。如此,宗教情怀转化为现实的人生关怀,成为特有的礼乐文明的核心内涵。     

思想政治教育的文化本性与文化选择

思想政治教育具有其特殊的文化本性。从教育内容上看 ,思想政治教育是一种特殊的文化传播 ;从教育的主客体属性及其运作过程看 ,它主要是文化原理的运作 ,是一个文化过程 ;从其作为社会统治和控制手段看 ,它是一种人文力。这种文化本性要求思想政治教育必须遵循文化的逻辑 ,进行正确的文化选择。一是要弘扬中国传统文化精华 ,抵御西方文化中的消极因素 ,二是要严格按照教育目的进行文化选择 ,三是要提高教育者的文化素质 ,强化文化选择 ,四是要加强亚文化建设 ,引导受教育者的文化选择。这既有助于实现思想政治教育的目的 ,而且达到了文化价值的展现     

Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders

Musculoskeletal diagnoses account for the majority of cases of reduced work capacity. This article investigates lay persons' strategies in relation to work and musculoskeletal disorders. Twenty interviews were conducted and analysed using grounded theory. A typology of self-presentations was developed. The interviewees' self-presentations revealed a strong sense of a 'duty to work'. This sense of duty took four different forms, leading us to categorise persons expressing particular forms as workaholics, work manics, workhorses or relaxed workers. Relaxed workers seem to have the best prognosis for recovery as they had a confident self-agency and worked to fulfil their own needs rather than those of others. This was in contrast to work manics, with an uncertain self-agency and driven to work by others' needs. In conclusion, awareness of such linguistic forms as self-attributions and idiomatic phrases provides an opportunity to identify and talk about individual's self-agency and driving forces in the recovery process.     

论工艺的观念和审美属性

工艺不仅是一种现象 ,而且还是一种精神。对工艺内涵的界定 ,如果仅凭直观 ,是不可能满足定义要求的。为了正确地把握工艺的本质 ,需要运用辩证的思维和发展的眼光 ,在精神层面展开研究。同时 ,将其纳入人类审美文化发展的广阔的视野 ,才能进一步看清工艺的审美属性 ,了解它的价值和意义     

The Boston Area Diary Study and the Moral Citizenship of Care

This paper describes the theoretical foundations, empirical findings, and practical and philosophical implications of the Boston Area Diary Study (BADS), a study of the caring behavior of 44 participants over one calendar year. In particular, the paper presents an identification theory of care and discusses how it shaped the conceptualization, collection, and analysis of the data in a year-long diary study of daily voluntary assistance. The findings from the BADS (1) theoretically confirm the identification theory of care; (2) methodologically capture how individuals perceive and carry out caring behavior as a unity; and (3rpar; empirically document the existence of a moral citizenship in America that is substantially more vigorous than is implied by the usual indicators of civic and political citizenship.     

我国区域刑事法律冲突初探

我国各民族之间的差异、民族区域自治制度及其自治权的存在是我国区域刑事法律冲突产生的基本原因,而通过制定顾全大局、兼顾特别的变通性、补充性刑法规范,可缓解这一冲突;通过加快少数民族地区的发展步伐,逐步消除民族之间的政治、经济、文化上的差距,进而达到彻底消除这一冲突,实现法制统一的良好局面。