马克思关于人类社会阶段“跨越”发展的辩证法

马克思曾设想俄国农村公社有可能跨越资本主义制度“卡夫丁峡谷”而直接进入共产主义社会。本文运用马克思主义理论辩证地阐述了人类社会实现跨越发展所必备的条件内在因素、外在条件、动力以及跨越的内容。     

医疗机构产权制度改革及其监管

本文从产权的角度出发,对当前的医疗机构改革进行了分析,并对医疗机构自主经营、企业化经营过程中可能出现的一些问题,提出了政府作为财产的最终所有者应加强对医疗机构经营状况的监管。     

The Effect of Residential Aged Care Size,Ownership Model,and Multichain Affiliation on Resident Comfort and Symptom Management at the End of Life

Context

In most resource-rich countries, a large and growing proportion of older adults with complex needs will die while in a residential aged care (RAC) facility.

Perceptual Embodiment of Prosthetic Limbs by Transcutaneous Electrical Nerve Stimulation

Objectives: In able‐bodied participants, it is possible to induce a sense of perceptual embodiment in an artificial hand using a visual‐tactile illusion. In amputee patients, electrical stimulation of sensory afferents using transcutaneous electrical nerve stimulation (TENS) has been shown to generate somatic sensations in an amputee's phantom limb(s). However, the effects of TENS on the perceptual embodiment of an artificial limb are not known. Our objective was to investigate the effects of TENS on the perceptual embodiment of an artificial limb in fully intact able‐bodied participants. Materials and Methods: We used a modified version of the rubber hand illusion presented to 30 able‐bodied participants (16 women, 14 men) to convey TENS paresthesia to an artificial hand. TENS electrodes were located over superficial radial nerve on the lateral aspect of the right forearm (1 cm proximal to the wrist), which was hidden from view. TENS intensity was increased to a strong non‐painful TENS sensation (electrical paresthesia) was felt beneath the electrodes and projecting into the fingers of the hand. The electrical characteristics of TENS were asymmetric biphasic electrical pulsed waves, continuous pulse pattern, 120 Hz pulse frequency (rate), and 80 µs pulse duration (width). Results: Participants reported significantly higher intensities of the rubber hand illusion during the two TENS conditions (mean = 5.8, standard deviation = 1.9) compared with the two non‐TENS conditions (mean = 4.9, standard deviation = 1.7), p < 0.0005. Conclusions: Our findings provide initial evidence that TENS paresthesia can be projected into an artificial limb, and this can enhance the sense of perceptual embodiment of an artificial hand. Further exploratory studies involving an amputee population are warranted.     

The nutritive adequacy of some Nigerian peasant diets

The nutritive values of six traditional diets of the people of South‐Eastern Nigeria have been evaluated. A bioassay procedure was used; it involved the measurement of Biological Value, True Digestibility of the dietary nitrogen, Net Protein Utilization (operative) and Net Dietary Protein Calories Percent (NDpCals%). The procedures were applied to diets cooked as for human consumption, then dried and fed unmodified to male weaning albino rats. The results showed that in all cases the digestibility of the dietary nitrogen was high but the nutritive value was significantly low. These results are discussed and compared with the FAO recommended practical allowances for NDpCals% for various physiological ages and states.     

Association Between Pet Ownership and the Sensitization to Pet Allergens in Adults With Various Allergic Diseases

Purpose

As pet ownership increases, sensitization to animal allergens due to domestic exposure is a concern. Sensitization to animal allergens may occur from indirect exposure, as well as direct ownership of animals. However, there have been conflicting results regarding the association between pet ownership and sensitization to animal allergens in adults.

Methods

In total, 401 patients with various allergic diseases were enrolled in this study. We performed skin prick tests with 55 common inhalant and food allergens, including dog, cat, and rabbit allergens. A mean wheal diameter of 3 mm or greater was considered a positive reaction. The exposure modality to each animal allergen was investigated using a questionnaire and included present ownership, past ownership, occupational exposure, occasional exposure, contact with pet owner, and no contact. Present ownership, past ownership, occupational, and occasional exposure were regarded as direct exposure.

Results

The sensitization rate for animal allergens was 20.4% for dog, 15.0% for cat, and 9.0% for rabbit. Direct exposure to dogs (72.0%) was significantly higher than that of other animals (18.4% for cats and 16.7% for rabbits), whereas ''no contact'' with cats (78.3%) and rabbits (83.3%) was significantly higher than with dogs (26.8%; P<0.0001). Independent risk factors for sensitization to animal allergens were sensitization to Dermatophagoides pteronyssinus (OR=2.4, P=0.052), Dermatophagoides farinae (OR=5.1, P<0.001), cat (OR=4.4, P<0.0001), and direct exposure to dogs (OR=1.5, P=0.029) for dog, and sensitization to dog (OR=4.4, P<0.0001) and rabbit (OR=2.6, P=0.036) for cats. Finally, for rabbits, the independent risk factor was sensitization to Alternaria (OR=6.0, P<0.002).

Conclusions

These results suggest that direct exposure to dogs contributes to the sensitization to dog allergens in patients with allergic diseases, whereas indirect exposure to cats and rabbits may induce sensitization to each animal''s allergen.     

Multisensory integration across exteroceptive and interoceptive domains modulates self-experience in the rubber-hand illusion

Identifying with a body is central to being a conscious self. The now classic “rubber hand illusion” demonstrates that the experience of body-ownership can be modulated by manipulating the timing of exteroceptive (visual and tactile) body-related feedback. Moreover, the strength of this modulation is related to individual differences in sensitivity to internal bodily signals (interoception). However the interaction of exteroceptive and interoceptive signals in determining the experience of body-ownership within an individual remains poorly understood. Here, we demonstrate that this depends on the online integration of exteroceptive and interoceptive signals by implementing an innovative “cardiac rubber hand illusion” that combined computer-generated augmented-reality with feedback of interoceptive (cardiac) information. We show that both subjective and objective measures of virtual-hand ownership are enhanced by cardio-visual feedback in-time with the actual heartbeat, as compared to asynchronous feedback. We further show that these measures correlate with individual differences in interoceptive sensitivity, and are also modulated by the integration of proprioceptive signals instantiated using real-time visual remapping of finger movements to the virtual hand. Our results demonstrate that interoceptive signals directly influence the experience of body ownership via multisensory integration, and they lend support to models of conscious selfhood based on interoceptive predictive coding.     

The principal–agent problem and owner‐managers: An instrumental variables application to nursing home quality

The literature on provider ownership has primarily focused broadly on for‐profits compared with nonprofits and chains versus nonchains. However, the understanding of more nuanced ownership arrangements within individual facilities is limited. Utilizing the principal–agent and managerial control frameworks, we study the role of managerial ownership and its relationship to quality among for‐profit nursing homes (NHs). We identify NH administrators with more than 5% ownership (owner‐manager) from Ohio Medicaid Cost Reports (2005–2010) and link these data to long‐stay resident records in the Minimum Data Set. Using differential distance to the nearest NHs with a salaried manager relative to an owner‐manager, we address the differential selection into these two types of NHs. After instrumenting for admissions to owner‐managed NHs, quality among long‐stay residents at owner‐managed NHs is generally better than NHs with salaried managers. We find suggestive evidence that the magnitudes of quality difference are larger when the principal–agent problem is likely more pronounced, such as when NHs that are part of a multifacility chain and located in more concentrated markets.     

Does hospital ownership influence hospital referral region health rankings in the United States

Extensive evidence demonstrates that a hospital's organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value‐Based Purchasing dataset are utilized to conduct a cross‐sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures—access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives—and performance as measured by value‐based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals' organizational structures. Hospital referral regions with a greater number of not‐for‐profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for‐profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community's resources of health care delivery entities and their structure.