How research ethics' protections can contribute to public policy: the case of community treatment orders

Though community treatment orders (CTOs) were first used in 1986 in Australia, debate about their clinical and ethical merits continues even today. For some, the benefits of reduced frequency and duration of involuntary hospitalizations are believed to adequately outweigh the harms of restricted liberties in community living. For others, however, such benefits are believed to be achievable by simply arranging integrated, devoted community resources sans any threat of forced re-hospitalization. In response to this enduring controversy, this article examines the ethical merits of community orders using a novel approach. “Novel” because the examination is based on research ethics and its foundational principles.When hospital and community clinicians, family members, consumer/survivors, and advocacy groups discussed the idea of amending Ontario's mental health legislation to permit CTOs in the late 1990s, evidence of their effects and efficacy was very limited. Moreover, an order was characterized much like standard pharmacological or medical therapies because the person or an appropriate substitute decision maker's consent was necessary to authorize the order or make it valid. These two factors prompted this retrospective analysis: if CTOs - as a public policy initiative - had been treated like most other promising therapies, would any different ethics-related concerns have been raised that, in turn, would have benefited the public debate and the legislature's decisions? In other words, if respected safeguards that apply to new drugs and medical devices had applied to CTOs, would anything have changed?     

北京市家政服务业从业人员状况的研究分析

本文在认真分析北京家政服务业从业人员的基本状况和从业状况的基础上,从营造良好的就业环境、完善管理体制、加强人员培训、完善相关法律法规、提高从业人员收入和社会地位等方面提出了采取有力措施,多管齐下,提高从业人员素质,促进北京家政服务业健康发展的若干建议。     

A traffic accident caused by fatigue failure of axle

An investigation of a traffic accident involving a tractor-trailer and a passenger car that were traveling at high speed is presented. The cause was the fracture of a trailer axle. The investigation showed that the fracture was because of the fatigue failure. In addition, cracks were found in the remaining three trailer wheels. Hardness measurements showed that, because of inadequate heat treatment of the metal, they were prone to failure.     

A comparison of pulmonary intra-alveolar hemorrhage in cases of sudden infant death due to SIDS in a safe sleep environment or to suffocation

The differentiation of SIDS from accidental or inflicted suffocation may be impossible without corroborating findings from the death scene or autopsy or in the absence of a confession from a perpetrator. Pulmonary intra-alveolar hemorrhage (PH) has been proposed as a potential clue to suffocation, but none of the previous studies on this topic have limited SIDS cases to those who were in a safe sleep environment, in which all were found supine and alone on a firm surface with their heads uncovered. Our aims are to: (1) compare PH in SIDS cases found in a safe sleep environment to a control group comprised of infants whose deaths were attributed to accidental or inflicted suffocation and (2) assess the effect of age, CPR, and postmortem interval (PMI), with regard to the severity of PH in this subset of safe-sleeping SIDS cases. We conducted a retrospective study of all postneonatal cases accessioned by the Office of the Medical Examiner in San Diego County, California who died of SIDS or suffocation between 1999 and 2004. A total of 74 cases of sudden infant death caused by SIDS (34 cases as defined above, comprising 8% of the total SIDS cases), accidental suffocation (37), and inflicted suffocation (3) from the San Diego SIDS/SUDC Research Project database were compared using a semiquantitative measure of pulmonary intra-alveolar hemorrhage. The most severe (grade 3 or 4) PH occurred in 35% of deaths attributed to suffocation, but in only 9% of the SIDS cases. Age, duration of CPR attempts and PMI had no effect on the severity of PH in SIDS. Our results indicate that the severity of PH cannot be used independently to differentiate SIDS from suffocation deaths. Each case must be evaluated on its own merits after thorough review of the medical history, circumstances of death, and postmortem findings.     

以治理理论重塑我国公共服务市场化的进路

以治理理论重塑我国的公共服务市场化,其实质在于培育多元化、多渠道的公共服务主体,从而对服务的"生产职能"与"安排职能"实现相对分离。首先,鉴于公共服务领域存在着严重的"政府失灵,"应该打破政府垄断公共服务的格局,明确政府只是服务的提供者,并非一定是生产者的角色,在市场化进程中应慎用政府机制;其次,市场机制可以促进服务质量的提高、服务成本的降低、提高服务效率,充分发挥市场作用。然而,政府机制和市场机制都存在着固有的缺陷,公民社会在分担服务职能等方面也起到了十分重要的作用,培育公民社会也是市场化不可缺少的环节。     

西部开发应实行真正的国民待遇

我国东南沿海地区的经济建设取得了举世瞩目的巨大成就 ,缩小了我国与发达国家之间的差距。在此过程中 ,我国一直对外资实行的“超国民待遇”起到了重要作用 ,但也留下了包括内外资企业不平等在内的许多教训。就国民待遇而言 ,理论上一直存在着错误。从国民待遇的确切含义讲 ,对我国的外商投资企业是不存在适用国民待遇问题的。本文试图从理论上分析国民待遇的真正涵义 ,并认为西部开发须实行真正意义上的国民待遇 ,逐步取消现行的超国民待遇。     

对外资国民待遇相关问题的研究

国民待遇是WTO成员国应遵守的一项原则,外资国民待遇是其中最重要的原则之一。分析研究外资国民待遇,正确理解外资国民待遇的含义,以及如何正确实施国民待遇,对于我国吸引外资、发展经济起着至关重要的作用。     

中国地方政府公共服务合同外包的发展现状——基于二手数据的分析

近年来,合同外包日益成为地方政府提供公共服务的重要机制。本文基于二手数据,在对地方政府公共服务合同外包发展状况(2000~2009)的概括性分析中发现,2000年以来,地方政府公共服务合同外包发展迅猛,其应用的广泛性和深入性均前所未有,并且逐步迈入法制化轨道。由于影响合同外包成效的因素相当复杂,政府显然缺乏相关操作经验,无论是在合同外包的决策当中还是在实施当中,"审慎"是最明智的策略。     

理想抑或其他？地方政府公共服务均等化研究（2001--2010）

地方政府是公共服务提供的主导者,公共服务的均等化已经成为我国在新世纪的重要战略目标。10年来,地方政府公共服务支出增长速度非常快,一个地区公共服务支出总量和经济发展水平密切相关;公共服务支出占一般预算支出的比例基本变化不大,地方政府间存在模仿性策略行为;国家的转移支付,对西部地区均等化起到很好的作用,但是对于中部和东部来说,作用不明显,甚至有“劫富济贫”的倾向;从区域分析来看,四大区域公共服务均等化进一步加强,东部与东北地区公共服务优势缩小,西部地区得到改善,中部地区一直处于不利地位。因此,迫切需要建设公共服务型政府,加大公共服务投入,优化支出结构;建立以公共服务产出为导向的转移支付制度;增强中央政府公共服务供给责任,以基本需求战略为核心,建立公共服务全国最低标准;整合市场与社会的力量,形成多元化供给的格局。