面对死亡，医学仍有责任

1998年,李嘉诚先生捐建了中国大陆第一家宁养院,为贫困的晚期癌症病人提供免费的疼痛控制,心理辅导和生命伦理的关怀。三年后,李嘉诚基金会将这一项目推向全国,创立“全国宁养医疗服务计划”,提出了“以人为本,全人服务”的服务宗旨,给国内的医疗工作开启了一个新的视野。宁养疗护以“五全照顾”充分体现了以人为本,尊重生命的医学本质。医学不仅仅是科学,它更应该是研究人的“仁”学;面对迈向死亡的末期病人,协助病人坦然面对,减少身、心、灵的痛苦,协助其放下万缘,安详往生也是我们医者的责任。     

Labour discipline in a Christian Orthodox sisterhood in Russia*

This article discusses the issue of labour discipline in a Christian Orthodox organisation in Russia. The sisterhood which I analyse is the meeting point of two types of ‘work’: the ‘secular work’ of employed workers is embedded into the ‘religious work’ of the sisters who live a monastic life. I argue that the religious–economic mix of the sisterhood suggests that three employment models are evident: ‘work more, get less’, ‘work less, get more’ and ‘work for free’. Religious and economic spheres are mediated by labour which takes different forms, creating distinct, but related disciplinary labour spaces. I thread the concept of discipline through religious and economic discourses in the monastic workplace, the conflicts between the religious and economic motivations to work and the role of ‘emotional work’. The analysis is based on the participant observation, conducted over a period of four months while I was a staff member of the sisterhood.     

Effects of daily maladaptive coping on nightly sleep in mothers

Objective: We examined effects of daily rumination and suppression in response to stressors on objective and subjective sleep among mothers.

Design: Participants were 183 mothers, including chronically stressed mothers of children with an autism spectrum disorder (M-ASD; n = 92) and age-matched mothers of neurotypical children (M-NT; n = 91). In an intensive longitudinal design, participants provided reports of daily rumination and suppression, nightly objective actigraphy-defined sleep and nightly subjective sleep quality for seven consecutive days at baseline, 9 months and 18 months.

Main Outcome Measures: Total sleep time, sleep fragmentation, sleep onset latency, and subjective sleep quality.

Results: Among M-NT with above average depressive symptoms, higher daily rumination was associated with shorter total sleep time. Rumination was associated with more sleep fragmentation among M-NT at the trend level. Rumination was not associated with sleep onset latency among M-NT, or with any sleep outcomes among M-ASD. Suppression was not associated with any sleep outcomes.

Conclusion: We provide novel evidence of the effect of rumination on objectively measured sleep duration among M-NT. Coping was not related to sleep among M-ASD. Given the prevalence of poor sleep among mothers, future work should examine modifiable factors perpetuating sleep disturbance.     

What do targeting positive views on ageing add to a physical activity intervention in older adults? Results from a randomised controlled trial

Objective: Physical activity is a key factor for healthy ageing, yet many older people lead a sedentary lifestyle. Traditional physical activity interventions do not consider the specific needs and views of older adults. As views on ageing are known to be related to health behaviours, the current study evaluates the effectiveness of prompting positive views on ageing within a physical activity intervention.

Design: Randomised controlled trial with three groups aged 65+: Intervention for physical activity with ‘views-on-ageing’-component (n?=?101; IGVoA), and without ‘views-on-ageing’-component (n?=?30; IG), and active control intervention for volunteering (n?=?103; CG).

Main outcome measures: Attitudes towards older adults and physical activity were assessed five weeks before intervention, two weeks, six weeks and 8.5?months after the intervention.

Results: Compared to the IG and CG, positive attitudes towards older adults increased in the IGVoA after the intervention. For IGVoA, the indirect intervention effect on change in activity via change in attitudes towards older adults was reliable.

Conclusion: A ‘views-on-ageing’-component within a physical activity intervention affects change in physical activity via change in views on ageing. Views on ageing are a promising intervention technique to be incorporated into future physical activity interventions for older adults.     

Structure of Al–Co–Ni pentagonal quasicrystal studied by HAADF-STEM and ab initio calculations

Using a combination of atomic-resolution high-angle annular dark-field (HAADF) Z-contrast imaging and ab initio calculations, atomic models of clusters 2 nm in diameter and 0.8 nm in height are proposed for the Al–Co–Ni pentagonal quasicrystal. This quasicrystal has 5-fold symmetry (the so-called 5f state) without superstructures, and is one of numerous modifications of the Al–Co–Ni decagonal quasicrystal. HAADF results reveal that the two-dimensional quasi-periodic lattice contains mainly Penrose pentagonal tiling. The centres within the decorated pentagonal tiles, i.e. the so-called pentagonal super-clusters, show structural characteristics having both a satellite-orbit shape and a pentagon-symmetry shape. The proposed atomic models, based directly on the HAADF images, are subjected to ab initio total energy calculations. After relaxation, the calculations demonstrate that the models with 5-fold symmetry are energetically more favourable than those with 10-fold symmetry.     

Group‐analytic network process for balancing stakeholder views on fire protection of steel‐framed buildings

To select appropriate fire protection options for buildings during their design stage, economic, safety, environmental, and societal criteria need to be accounted for. The divergent and sometimes conflictual desires from different fire design stakeholders involved in the process present a multicriteria decision problem. Design decision criteria and fire protection options can be interdependent, and so there is a need to manage these desires with an advanced decision analysis technique, thereby reducing uncertainties in the complex decision‐making process. The aim of this paper is to use the weighted/geometric mean method‐analytic network process (W/GMM‐ANP) to balance the opinions of fire design stakeholders extracted from 42 structured stakeholder interviews on selecting the most suitable fire protection option for buildings constructed of steel frames. Different categories of interdependent decision elements were developed from 22 design decision criteria and 5 proposed fire protection options to produce a network of decision clusters for multicriteria decision analysis. In the synthesis and ranking of fire protection options, the W/GMM‐ANP accounted for the multiple interdependencies of weighted and unweighted stakeholder desires and managed the complexity of the decision‐making problem. The technique is proposed for approaching suitable group decisions in structural fire design of steel‐framed buildings as well as other performance‐based engineering decision making that may involve multidisciplinary stakeholders.     

减少医师自卫医学行为的对策研究

根据自卫医学行为产生的原因,减少自卫医学行为有两个思路,一个是减轻医师的法律责任,另一个是化解医师在法律责任下所面临的风险.根据第二个思路,应该采取下面的措施:建立医师责任保险制度;建立医疗责任保险制度;实施医疗风险管理;提高医师个人的执业素养.     

Encountering Dissimilar Views in Deliberation: Political Knowledge,Attitude Strength,and Opinion Change

Conversing with diverse points of view stands as the central tenet of deliberative democracy, yet empirical evidence has suggested mixed outcomes related to perspective change as a result of deliberative encounters. I propose a difference‐driven model that suggests individual predispositions moderate the processing of dissimilar views when changing policy preferences. My analysis is based on a random sample of over 400 voters at a California‐wide deliberative event, where participants discussed proposals for reforming the state politics. I find that encountering more and different arguments transforms policy attitudes. Yet it is more difficult for people to change their minds on issues about which they hold strong beliefs. Some evidence suggests that different psychologies are at play for people who enter deliberation with substantial or weak political knowledge and for those who deliberate while holding strong or moderate prior opinions. Well‐grounded strong opinions are resistant to change, while well‐grounded moderate opinions are persuadable in deliberative groups. Uninformed positions can become entrenched in like‐minded groups, yet they can be adjusted once participants deliberate with dissimilar views, especially opinions that are held strongly without good informational ground. The findings urge deliberative forums that introduce participants to diverse perspectives to foster a considered public opinion.     

全面的意义结构:总体类型学--解析戈德曼的哲学理论逻辑

戈德曼是20世纪法国重要的西方马克思主义哲学家。他所提出的发生结构主义和科学人学观也是西方马克思主义哲学史中极为重要的一环。本文主要讨论了他试图调和人本主义与科学主义逻辑断裂的理论努力,即总体类型学的观点。在这里,戈德曼想用皮亚杰的发生学的科学结构主义观念为基础,并以主体与结构的接合关系形成他面对世界的全部哲学理念。     

H管理理论探索

H管理理论是我国学者提出的具有中国特色的管理理论。本文针对H管理理论的主要思想、构成内容进行了探索 ,着重考察了H管理理论中的人格学说 ,并对该理论的理论基础和实践基础进行了分析和论证 ,最后指出H管理理论的理论意义和实践意义 ,以及以后需要完善之处。