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。     

Refinement and validation of a comprehensive scale for measuring HR practices aimed at performance-enhancement and employee-support

The purpose of this paper is to refine and validate a Human Resource practices (HRP) scale to measure employees' perceptions and test a two-tier model structured in eight practices and two bundles. In a sample of 554 employees, an EFA (Exploratory Factor Analysis) offered six factors that explained about 70% of the variance. Then, with 1647 employees (from 41 Spanish organizations), first- and second-order models were tested with Confirmatory Factor Analysis (CFA). The former encompasses eight practices. The latter grouped the practices in two bundles, one on enhancing performance and the other on supporting employees. The Cronbach's alpha, Rho coefficient (Composite Reliability Coefficient), Omega coefficient, and Spearman-Brown split half coefficient showed good reliability. Validity evidence was found for construct, criterion, convergent, content, discriminant, and predictive validity. Moreover, the paper integrates different ways of approaching the study of HR management based on employees' perceptions, using a two-tier approach. The two-bundle model showed better fit, pointing out the importance of paying attention to multiple outcomes for employees and organizations. The study makes a relevant theoretical contribution about the role and aims of HRM practices for organizational success and employees' performance and well-being.     

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。     

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.     

Coalition for a Healthier Community: Lessons learned and implications for future work

The Coalition for a Healthier Community (CHC) initiative was implemented to improve the health and well-being of women and girls. Underpinning CHC is a gender-based focus that uses a network of community partners working collaboratively to generate relevant behavior change and improved health outcomes. Ten programs are trying to determine whether gender-focused system approaches are cost-effective ways to address health disparities in women and girls. Programs implemented through coalitions made up of academic institutions, public health departments, community-based organizations, and local, regional, and national organizations, are addressing health issues such as domestic violence, cardiovascular disease prevention, physical activity, and healthy eating. Although these programs are ongoing, they have made significant progress. Key factors contributing to their early success include a comprehensive needs assessment, robust coalitions, the diversity of populations targeted, programs based on findings of the needs assessments, evaluations taking into consideration the effect of gender, and strong academic–community partnerships. A noteworthy impact of these programs has been their ability to shape and impact public, social, and health policies at the state and local levels. However, there have been challenges associated with the implementation of such a complex program. Lessons learned are discussed in this paper.     

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.