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.     

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。     

Squashed dreams and rare breeds: ableism and the arbiters of life and death

The week beginning 29 June 2015 is not just historic for the closure of the Independent Living Fund in the United Kingdom, but for me was the week they decided that my life is not worth investing in; they being NHS England, NICE and, with them, the Department of Health. They chose not to support the enzyme replacement therapy that has been not only keeping me alive, but giving me a quality of life – enabling me to return to finish my Disability Studies PhD exploring how Christian leaders explain disability, where ethics have become the main topic, and to rebuild my career – or so I thought.     

论贤相伊尹的个人素质及其形成

伊尹作为中国历史上第一位贤相,其突出的个人素质表现在精于至味之理、精通耕作之道、创制治病汤液几方面,即懂得如何吃饭、种地和治病。这正是广大民众最为关心的事情,也是治理内政极其关键的因素,只有这三件事做得好,才可能完成"祀与戎"等国家大事。如此全面素质的形成,与其丰富的人生经历和勤于思索有关。     

Vaginal births after caesarean: What does Google think about it?

AimVaginal birth after caesarean (VBAC) is a relatively safe alternative to repeat caesarean birth in the proper context. This important decision to undergo an elective caesarean versus VBAC is ultimately a decision of the mother. The purpose of our study was to assess the quality of online information in relation to VBAC collected using the most common search engine: Google.MethodsThe 10 most common hit sites for the keywords “VBAC” and “Vaginal birth after caesarean” were evaluated using the search engine Google. The quality of websites was rated based on the Silberg scale for accountability, the modified Abbott's criteria for presentation and the SMOG index for readability. The content of each website was compared to the Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines for VBAC.Findings13 out of 20 identified websites met the adequate criteria for accountability, with 85% of the websites indicating authorship. 11 websites were deemed aesthetically agreeable. The target audience, assessed by the readability score, was notably above the non-medical population with an average SMOG index score of 14.75. Only half of the websites contained recommendations, as detailed by the SOGC guidelines.ConclusionAlmost all sites target a higher academic level, making it beyond the comprehension of the general population. Woman friendly web-assessment tools should be provided to enable pregnant women to take an active role in their decision making.     

国家级教学名师的优秀品质及其养成

通过对5位国家级教学名师的自述报告进行三级编码和主题凝练，研究发现国家级教学名师作为教师队伍的杰出代表，在其专业发展过程中养成了许多优秀品质。例如：教学方面注重实践、考虑周全，师德方面以德施教、追求卓越，科研方面以教带研、实现创新。国家级教学名师优秀品质的养成通常经历了漫长而曲折的过程，不仅需要精神与物质力量的共同推动，还需要家庭、学校和社会各环境要素的相互促进，以及社会取向养成方式和个人取向养成方式的互相配合。深入探究国家级教学名师的优秀品质及其养成之道，可以为教师专业发展提供借鉴与启示。     

Interval estimation for conformance proportions of multiple quality characteristics

A conformance proportion is an important and useful index to assess industrial quality improvement. Statistical confidence limits for a conformance proportion are usually required not only to perform statistical significance tests, but also to provide useful information for determining practical significance. In this article, we propose approaches for constructing statistical confidence limits for a conformance proportion of multiple quality characteristics. Under the assumption that the variables of interest are distributed with a multivariate normal distribution, we develop an approach based on the concept of a fiducial generalized pivotal quantity (FGPQ). Without any distribution assumption on the variables, we apply some confidence interval construction methods for the conformance proportion by treating it as the probability of a success in a binomial distribution. The performance of the proposed methods is evaluated through detailed simulation studies. The results reveal that the simulated coverage probability (cp) for the FGPQ-based method is generally larger than the claimed value. On the other hand, one of the binomial distribution-based methods, that is, the standard method suggested in classical textbooks, appears to have smaller simulated cps than the nominal level. Two alternatives to the standard method are found to maintain their simulated cps sufficiently close to the claimed level, and hence their performances are judged to be satisfactory. In addition, three examples are given to illustrate the application of the proposed methods.     

不同冷链服务模式下生鲜农产品供应链决策

基于单物流服务商、单供应商和单零售商构成的生鲜农产品供应链，构建3种冷链服务模式：承诺模式、提前要求模式与延后要求模式，探讨不同冷链服务模式对定价与冷链服务水平、企业绩效的影响。研究发现：某种冷链服务模式是否有利于消减数量与质量损耗依赖于产品易腐性、冷链服务成本及其分担比例。供应链成员无法在承诺模式与提前要求模式下形成统一的模式偏好。当物流服务商承担的冷链服务成本比例较低时，相比于提前要求模式，供应商偏好承诺模式，否则，偏好提前要求模式。承诺模式比提前要求模式更有利于物流服务商，然而对于零售商，结果正好相反。数值实验表明，虽然供应链成员无法对冷链服务模式形成整体的一致性偏好，但仍可实现局部的一致性偏好。     

A New Methodology for Before–After Safety Assessment Using Survival Analysis and Longitudinal Data

The widely used empirical Bayes (EB) and full Bayes (FB) methods for before–after safety assessment are sometimes limited because of the extensive data needs from additional reference sites. To address this issue, this study proposes a novel before–after safety evaluation methodology based on survival analysis and longitudinal data as an alternative to the EB/FB method. A Bayesian survival analysis (SARE) model with a random effect term to address the unobserved heterogeneity across sites is developed. The proposed survival analysis method is validated through a simulation study before its application. Subsequently, the SARE model is developed in a case study to evaluate the safety effectiveness of a recent red‐light‐running photo enforcement program in New Jersey. As demonstrated in the simulation and the case study, the survival analysis can provide valid estimates using only data from treated sites, and thus its results will not be affected by the selection of defective or insufficient reference sites. In addition, the proposed approach can take into account the censored data generated due to the transition from the before period to the after period, which has not been previously explored in the literature. Using individual crashes as units of analysis, survival analysis can incorporate longitudinal covariates such as the traffic volume and weather variation, and thus can explicitly account for the potential temporal heterogeneity.