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.     

以江泽民同志"5·31"讲话和"三个代表"重要思想为指导 全面推进普通女子高等教育

学习江泽民同志“5·31”讲话,要牢牢把握“三个代表”这条主线,要紧紧抓住解放思想、实事求是、与时俱进、开拓创新这个精髓,要立足于理论联系实际,全面推进普通女子高等教育,加快中华女子学院的发展。     

严复的能力观及其对当代公共管理创新的启示——对史华兹《寻求富强:严复与西方》的一种解读

对美国著名汉学家史华兹的代表作<寻求富强:严复与西方>进行文本解读发现:该著所反映出的严复能力观对当代公共管理的创新发展具有重要的启示意义.严复认为中西方的关键性差别在于能力,而隐含其中的是以能力为导向的主体意识和公共意识方面的差距."-3代公共管理的创新发展有必要吸收严复能力观中的思想精髓,以国家能力建构为着力点,以公民启蒙为社会基石,以突显公正为其内在灵魂.对正处于社会转型期的国家而言,努力实现国家能力与公民自由问的平衡是达致善治的关键.     

从人道主义向自然主义迈进的福克纳——读《我弥留之际》

美国南方流派的代表作家威廉·福克纳是一位实验性的作家,在他的文学生涯中,他做过多种尝试,他的早期长篇小说《我弥留之际》是其中非常重要的一次。这部作品的创作思想显示福克纳在上世纪30年代从人道主义向自然主义迈进。     

六经注我,我注六经--简述陆九渊的经学思想

南宋心学创始人陆九渊对传统经学采取尊重与怀疑的辩证态度,这是由他立学的宗旨和问学的态度决定的。他主张自立、自得、独立思考、大胆疑问,也因此形成了“六经注我,我注六经”的精神,创立了心学一系。象山经学可说是传统经学的心学化。其心学开一代学风,对推动中国学术的向前发展具有重要意义和价值。     

理查兹的作者心理经验论

理查兹(1893—1981)是本世纪初英国著名的文学批评家。本文旨在考查他的作者心理经验论。理查兹倡导了后来美国的新批评派所极力推崇的“细读”式批评。他认为作品只不过是读者进入作者心灵的窗口。由于读者文学水准的高低不一,所以,读者的看法不能作为评价文学的标准。理查兹把作者的心理经验看成是衡量读者“期待视野”的标尺。理查兹对绝对标准的关注,使其理论带有明显的客观主义和实证主义的色彩;同时他对心理因素的兴趣也使他的理论具有人文主义和心理主义的内涵。     

Accelerated life test sampling plans for the Weibull distribution under Type I progressive interval censoring with random removals

This paper considers the design of accelerated life test (ALT) sampling plans under Type I progressive interval censoring with random removals. We assume that the lifetime of products follows a Weibull distribution. Two levels of constant stress higher than the use condition are used. The sample size and the acceptability constant that satisfy given levels of producer's risk and consumer's risk are found. In particular, the optimal stress level and the allocation proportion are obtained by minimizing the generalized asymptotic variance of the maximum likelihood estimators of the model parameters. Furthermore, for validation purposes, a Monte Carlo simulation is conducted to assess the true probability of acceptance for the derived sampling plans.     

A goodness of fit test for the multilevel proportional odds model

It is essential to test the goodness of fit of the model before making inferences based on it. Multilevel modeling of ordinal categorical responses is not as developed as for continuous responses. Assessing model adequacy in terms of the goodness of fit with ordinal categorical responses is still being developed and no satisfactory tests are available so far. As a consequence of that, this study concentrates on developing such a goodness of fit test for Multilevel Proportional Odds models and to study the properties of the test.     

Comparing diagnostic tests: test of hypothesis for likelihood ratios

Likelihood ratios (LRs) are used to characterize the efficiency of diagnostic tests. In this paper, we use the classical weighted least squares (CWLS) test procedure, which was originally used for testing the homogeneity of relative risks, for comparing the LRs of two or more binary diagnostic tests. We compare the performance of this method with the relative diagnostic likelihood ratio (rDLR) method and the diagnostic likelihood ratio regression (DLRReg) approach in terms of size and power, and we observe that the performances of CWLS and rDLR are the same when used to compare two diagnostic tests, while DLRReg method has higher type I error rates and powers. We also examine the performances of the CWLS and DLRReg methods for comparing three diagnostic tests in various sample size and prevalence combinations. On the basis of Monte Carlo simulations, we conclude that all of the tests are generally conservative and have low power, especially in settings of small sample size and low prevalence.     

Early stopping in seamless phase I/II clinical trials

In recent years, seamless phase I/II clinical trials have drawn much attention, as they consider both toxicity and efficacy endpoints in finding an optimal dose (OD). Engaging an appropriate number of patients in a trial is a challenging task. This paper attempts a dynamic stopping rule to save resources in phase I/II trials. That is, the stopping rule aims to save patients from unnecessary toxic or subtherapeutic doses. We allow a trial to stop early when widths of the confidence intervals for the dose-response parameters become narrower or when the sample size is equal to a predefined size, whichever comes first. The simulation study of dose-response scenarios in various settings demonstrates that the proposed stopping rule can engage an appropriate number of patients. Therefore, we suggest its use in clinical trials.