Social tariffs and democratic choice—Do population‐based health state values reflect the will of the people?

In economic evaluations of health technologies, health outcomes are commonly measured in terms of quality‐adjusted life years (QALYs). QALYs are the product of time and health‐related quality of life. Health‐related quality of life, in turn, is determined by a social tariff, which is supposed to reflect the public's preference over health states. This study argues that, because of the tariff's role in the societal decision‐making process, it should not be understood as merely an operational (statistical) definition of health, but as a major instrument of democratic participation. I outline what implications this might have for both the method used to aggregate individual preferences, and the set of individuals whose preferences should count. Alternative tariff specifications and decision rules are explored, and future research directions are proposed.     

临床营养专科护士培训实践与成效

目的 探讨临床营养专科护士培训实践方法,为国内临床营养专科护士的培养提供参考.方法 基于临床营养专科护士核心能力构建培训体系,对115名学员采用理论授课(4周)与临床实践(8周)相结合方式分阶段进行培训.结果 学员总成绩(90.69±2.28)分;学员对培训的总体满意度为98.26％.结论 临床营养专科护士培训可提高专科护士营养相关知识和技能,促进专科护士持续成长.     

Development of a composite indicator to prioritize districts for implementation of human immunodeficiency virus programmes in Maharashtra,India

A key recommendation of the National AIDS Control Programme‐IV of India was to develop new strategies for geo‐prioritization of the human immunodeficiency virus (HIV) epidemic. We conducted this study to categorize the districts in Maharashtra (India) based on a multidimensional framework for geo‐prioritization of services. Programmatic data on trends of HIV prevalence, coverage of marginalized populations and vulnerability factors were included. A composite indicator based on these was developed, and the cumulative score was calculated for each district. HIV prevalence among general population has declined steadily from 0.60% in 2007 to 0.33% in 2017. The programme coverage was stable but inadequate for men who have sex with men (MSM). The coverage for female sex workers (FSWs) was inadequate and reduced over time. Nine districts were categorized as high priority, 13 as moderate priority and 11 were classified as low‐priority districts based on burden and vulnerability for HIV. The high‐priority districts were Pune, Solapur and Yavatmal for FSW interventions and Pune, Thane and Latur for MSM interventions. This multidimensional indicator is based on existing programmatic data, dynamic and can be made state‐specific. It is useful to categorize and prioritize districts for allocation of resources and geo‐prioritization of services in resource limited settings.     

A spectral framework for sperm shape characterization

A novel methodology for characterization of animal sperm shape involving the use of a spectral approach to multiscale curvature estimation is proposed. By using the derivative property of the Fourier transform, allied to Gaussian smoothing, accurate estimates of the curvature along the sperm contour can be obtained in such a way that the curvature peaks corresponding to the sperm head vertices can be effectively identified. The measurements derived from such a processing, namely the width of the basal region of the head, the centralization of tail implantation, and the multiscale bending energy, provide valuable resources for fertility and phylogenetic studies.     

医院管理公司对中国医疗产业发展影响探讨

医院管理公司是继国有医院集团以后新兴的医院联合的模式,这种模式可以充分利用医疗产业现有的机会,通过产业集中和完善医院的治理结构,对当前的产业总体结构进行调整.医疗产业经过调整后,会产生新的产业分工,并通过市场调节机制发挥卫生资源重新配置的职能.     

数据库规范设计

数据库设计既是一项涉及多学科的综合性技术,又是一项庞大的工程项目。人们努力探索,利用数据库规范设计方法设计出符合需要的数据库系统。     

Micro-Imaging by Interference Microscopy: A Case Study of Orientation-Dependent Guest Diffusion in MFI-Type Zeolite Host Crystals

Because of the small particle size, orientation-dependent diffusion measurements in microporous materials remains a challenging task. We highlight here the potential of micro-imaging by interference microscopy in a case study with MFI-type crystals in which, although with different accuracies, transient concentration profiles in all three directions can be observed. The measurements, which were performed with “rounded-boat” shaped crystals, reproduce the evolution patterns of the guest profiles recorded in previous studies with the more common “coffin-shaped” MFI crystals. The uptake and release patterns through the four principal faces (which in the coffin-shaped crystals extend in the longitudinal direction) are essentially coincident and there is no perceptible mass transfer in the direction of the long axis. The surface resistances of the four crystal faces through which mass transfer occurs are relatively small and have only a minor effect on the mass transfer rate. As a result of the pore structure, diffusion in the crystallographic c direction (which corresponds to the direction of the long axis) is expected to be much slower than in the transverse directions. This could explain the very low rate of mass transfer observed in the direction of the long axis, but it is also possible that the small end faces of the crystal may have high surface resistance. It is not possible to distinguish unequivocally between these two possibilities. All guest molecules studied (methyl-butane, benzene and 4-methyl-2-pentyne) show the same orientation dependence of mass transfer. The long 4-methyl-2-pentyne molecules would be expected to propagate at very different rates through the straight and sinusoidal channels. The coinciding patterns for uptake through the mutually perpendicular crystal faces therefore provide clear evidence that both the coffin shaped crystals and the rounded-boat-shaped crystals considered in this study, must be intergrowths rather than pure single crystals.     

Defining a Bobath clinical framework – A modified e-Delphi study

Objective: To gain consensus within the expert International Bobath Instructors Training Association (IBITA) on a Bobath clinical framework on which future efficacy studies can be based. Methods: A three-round modified e-Delphi approach was used with 204 full members of the IBITA. Twenty-one initial statements were generated from the literature. Consensus was defined a priori as at least 80% of the respondents with a level of agreement on a Likert scale of 4 or 5. The Delphi questionnaire for each round was available online for two weeks. Summary reports and subsequent questionnaires were posted within four weeks. Results: Ninety-four IBITA members responded, forming the Delphi panel, of which 68 and 66 responded to Rounds Two and Three, respectively. The 21 initial statements were revised to 17 statements and five new statements in Round Two in which eight statements were accepted and two statements were eliminated. Round Three presented 12 revised statements, all reaching consensus. Conclusion: The Delphi was successful in gaining consensus on a Bobath clinical framework in a geographically diverse expert association, identifying the unique components of Bobath clinical practice. Discussion throughout all three Rounds revolved primarily around the terminology of atypical and compensatory motor behavior and balance.