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抚顺哪个医院能割包皮好医大全抚顺第五医院在哪

来源:问医乐园    发布时间:2019年09月19日 21:37:30    编辑:admin         

Wealthy countries are channelling around bn a year to help poorer nations deal with global warming, according to new findings on one of the most contentious issues in UN climate talks.对联合国(UN)气候谈判中最具争议的问题之一所做的新研究发现,富裕国家目前每年输出约570亿美元用于帮助较贫穷国家应对全球变暖的问题。The figure, from a study by the OECD group of developed nations, comes two months before delegates from nearly 200 countries head to Paris to broker a climate change accord that will lower greenhouse gas emissions.该数据来自经合组织(OECD)所做的一项研究,该组织由发达国家组成。再过两个月,来自近200个国家的代表将前往巴黎参加气候变化大会,以期达成一项旨在减少温室气体排放的气候变化协议。The sum is likely to be seized on by diplomats from wealthy nations to argue that their governments are well on the way to fulfilling a 2010 pledge to raise 0bn a year in public and private climate finance for poorer countries by 2020.富裕国家的外交官们很可能会抓住该数字不放,以此辩称他们的政府正在朝着兑现2010年一项承诺的方向前进。这项承诺是到2020年每年从公共和私人来源为较贫穷国家筹集1000亿美元应对气候变化资金。But it will be scrutinised in minute detail by envoys from poorer countries who say they cannot sign up to a deal in Paris if it lacks the funding they need to shift to greener energy systems and deal with the floods and heatwaves that scientists say are likely to increase as the climate changes.但是,该数字将受到来自较贫穷国家的代表们的严密审视,他们称,如果协议中没有列明他们转向更清洁能源体系以及应对洪水和热浪所需资金的来源,他们将不会在巴黎签署协议。科学家称,随着气候变化,洪水和酷热天气很可能会日益增加。French president, Fran Hollande, warned last month that efforts to seal a successful accord in December could fail unless wealthy countries make a serious commitment on climate finance.法国总统弗朗索瓦攠朗德(Fran Hollande)上个月警告称,在12月签订气候协议的努力或将失败,除非富裕国家就气候融资作出郑重承诺。But figuring out what should and should not be counted as climate funding from the complex web of foreign aid budgets, multilateral bank lending and other sources of money has proved extremely difficult.但是,从外国援助预算、多边贷款以及其他资金来源构成的复杂资金网中判断哪些资金应该被算作气候融资,已经实是极为困难的。Studies since 2010 suggest the figure could be anything from bn to 5bn a year.自2010年以来的研究表明,该数字可能介于每年400亿至1750亿美元之间。In an attempt to get a clearer picture before the Paris meeting, the French government and its Peruvian counterpart, which hosted last year’s UN climate talks, asked the OECD to do a more detailed analysis on how close countries were to meeting the 0bn a year goal.为了在巴黎气候大会前得到一个较清晰的概念,法国政府以及去年主办联合国气候谈判大会的秘鲁政府,要求经合组织进行一项更详细的分析,以了解各国距离每年提供总计1000亿美元气候融资的目标还有多远。The result is a 61-page report that concludes wealthy countries mobilised .8bn in 2014, up from .2bn in 2013, making an average of bn a year for those two years, mostly from public rather than private sources.结果是一份61页的报告,结论是2014年富裕国家调动了618亿美元,较2013年的522亿美元有所增加,使这两年的平均数字达到570亿美元,大部分资金来自公共部门而非私人来源。“We take that as quite an encouraging picture of progress,” said the leader of the research, Simon Buckle, head of the OECD’s climate, biodiversity and water division.“我们认为这是相当鼓舞人心的进展,”该研究的带头人——经合组织气候、生物多样性及水资源部门的负责人西蒙巴克尔(Simon Buckle)称。“This is clearly not a perfect estimate,” he told reporters, explaining that the task confronting his team was so large he had not been confident that it would be possible to arrive at any firm figure.“很明显这并非一项令人非常满意的估计,”他向记者表示,解释称其团队面临的任务非常艰巨,他原本甚至没有信心能够得到确切的数字。“But we really think it’s a robust, up to date estimate that will be useful,” he said.“但是我们的确认为这是一个站得住脚的最新估算,它将是有用的,”他称。Mr Buckle said one of the report’s biggest contributions was its attempt to clarify how climate financing can be measured and defined.巴克尔称,该报告最大的贡献之一是它试图明确对气候融资进行衡量和定义的方式。The study does not, for example, include money relating to coal projects, even though Japan and Australia say funding for more efficient coal plants should be considered as a form of climate finance.例如,该研究并未将与煤炭项目相关的资金包括在内,尽管日本和澳大利亚方面认为,为更高效的燃煤发电厂提供资金应该被视为气候融资的一种形式。Japan has provided up to .2bn for such projects over 2013-14.2013-14年间,日本为这类项目提供了多达32亿美元的资金。The bn figure also excludes pledges wealthy countries have made totalling just over bn to a newly-established Green Climate Fund set up as a result of past UN talks.570亿美元的数字也未计入富裕国家承诺向新成立的绿色气候基金(Green Climate Fund)提供的总计逾100亿美元资金。该基金的成立是联合国气候谈判的成果之一。Several countries have made significant commitments of more funding in recent weeks, including the UK and China, which has offered .1bn over an unspecified time period.最近几周,一些国家做出了提供更多资金的重大承诺,其中包括英国和中国,后者在未指明的时间段内已经提供了31亿美元的资金。But poverty campaigners say a new draft of a negotiating text for a Paris accord released on Monday is still short on detail about how much money wealthy countries are willing to offer poorer nations in future.但是,代表较贫穷国家的活动人士称,周一公布的为巴黎协议所拟的谈判文本的新草案,在富裕国家愿意在未来向较贫穷国家提供的资金额的问题上仍然缺少细节。The text has an option for scaling up the 0bn a year pledge “from 2020”. But that is not good enough for an agreement that is supposed to be an enduring global response to climate change, said Tim Gore, climate change policy adviser at Oxfam.该文本中有一项是“从2020年起”在每年1000亿美元资金的基础上逐步增加金额。但是,乐施会(Oxfam)气候变化政策顾问蒂姆戈尔(Tim Gore)称,对于一项应该作为全球应对气候变化的长期协议来说,该条款不够理想。“To have nothing to say about the cost of achieving all this just seems barely credible,” he said.“对实现这一切的成本只字不谈,似乎是不可信的,”他称。 /201510/402453。

BETSY came to Dr. Martin for a second — or rather, a sixth — opinion. Over a year, she had seen five other physicians for a “rapid heartbeat” and “feeling stressed.” After extensive testing, she had finally been referred for psychological counseling for an anxiety disorder.贝蒂来找马丁医生是想问问第二个大夫的意见——实际上是第六个。在过去一年里,因为“心动过速”和“受迫感”的问题,她咨询过五位医生。在经过大量的检查后,医生最终建议她去做焦虑症方面的心理咨询。The careful history Dr. Martin took revealed that Betsy was taking an over-the-counter weight loss product that contained ephedrine. (I have changed their names for privacy’s sake.) When she stopped taking the remedy, her symptoms also stopped. Asked why she hadn’t mentioned this information before, she said she’d “never been asked.” Until then, her providers would sooner order tests than take the time to talk with her about the problem.马丁医生仔细地询问病史,终于得知贝蒂当时正在用一种减肥用的非处方药,其中含有麻黄碱。(为了保护隐私,文中用了化名。)停止用这种药物后,她的症状也就消失了。在被问到过去为什么没有提过这件事时,她说,“从来没人问过。”在那以前,她的医生都会很快让她去做检查,而不是花时间和她谈病情。Betsy’s case was fortunate; poor communication often has much worse consequences. A review of reports by the Joint Commission, a nonprofit that provides accreditation to health care organizations, found that communication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.贝蒂的情况还算幸运,沟通不畅常常会导致更恶劣的后果。非营利组织“医疗机构认联合委员会”(Joint Commission)发布的一份报告指出,医院中发生的严重不良健康后果中,有逾70%的根源在于沟通不畅(而不是医护人员欠缺专业技能)。A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care. Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms. Evidently, we have a long way to go.医生能否解释、倾听、与患者产生共鸣,对于病人的诊疗有着深远的影响。然而一项调查发现,有三分之二的病人在不知道诊断结果的情况下,就被要求出院了。另一项研究发现,在超过60%的病例中,患者在问诊后误解了医生的指示。医生平均只会等18秒,就会打断患者对症状的陈述。显然,我们有很长的路要走。Three years ago, my colleagues and I started a program in Harrisburg designed to improve doctors’ communication with their patients. This large urban hospital system serves a city with a population of about 50,000, together with the surrounding metropolitan area of more than 550,000 people.三年前,我和同事在宾夕法尼亚州哈里斯堡启动了一个旨在改善医患沟通的项目。这个规模庞大的城市医院系统,为本市大约5万人口提供务,同时也面向周边城市群共计超过55万的居民。The hospital faces particular challenges: The city has a high poverty rate (32 percent, compared with the state average of 13 percent), and the metro area has a high rate of childhood obesity. Over all, nearly a third of people around Harrisburg are uninsured, compared with about one in 10 for the rest of Pennsylvania.医院面临着一些特殊的挑战:这座城市贫困率极高(达32%,与之相对比,全州平均水平为13%),所在城区的儿童肥胖率也很高。总体而言,哈里斯堡及周边人口中,有近三分之一没有医疗保险,而宾夕法尼亚州其他地区的这一比例则约为十分之一。Our project started with a simple baseline assessment of how we as doctors communicated with our patients. Observation soon revealed that physicians introduced themselves on only about one in four occasions. And without an introduction, it’s no surprise that patients could correctly identify their physician only about a quarter of the time.项目开始时,我们对医生与患者的沟通状况做了一个简单的基准评估。通过观察,我们很快就发现,只有大约四分之一的情况,医生会向患者做自我介绍。既然没有做自我介绍,另一个现象也就不奇怪了:仅有大约四分之一的情况,患者能正确指出给自己诊断的医生是谁。Brief, rushed physician encounters were common, with limited opportunity for questions. A lack of empathy was often apparent: In one instance, after a tearful patient had related the recent death of a loved one, the physician’s next sentence was: “How is your abdominal pain?”与医生会面时简短、仓促的情况十分普遍,提问的机会也很有限。对患者缺乏理解的情况往往很明显:在一个案例中,患者痛哭流涕地倾诉,最近一位亲人去世了,但医生接下来问的却是,“你的腹痛是什么情况?”We developed a physician-training program, which involved mock patient interviews and assessment from the actor role-playing the patient. Over 250 physicians were trained using this technique. We also arranged for a “physician coach” to sit in on real patient interviews and provide feedback.我们推出了一项医生培训计划,其中包括由演员扮演的患者参与的模拟问诊和评估。有超过250名医生接受了运用这个技巧进行的培训。我们还安排了“医生辅导员”在实际接诊时坐在旁边,进而提供反馈。Over the next two years, patient satisfaction with doctors, as measured by a standard questionnaire, moved the hospital’s predicted score up in national rankings by a remarkable 40 percentile points. Several studies have found a correlation between higher patient satisfaction scores and better health outcomes. In one, published in The New England Journal of Medicine, Harvard health policy researchers reported that higher patient satisfaction was associated with improved outcomes for several diseases, including heart attacks, heart failure and pneumonia.在接下来的两年里,通过一项标准化问卷的衡量,患者对医生的满意度提高了,而这所医院的预期得分,在全美排名中也出现了40个百分点的可观提升。有若干项研究发现,患者满意度指标的提高,与治疗效果的改善存在正相关性。在一篇发表在《新英格兰医学杂志》(The New England Journal of Medicine)上的研究论文中,哈佛大学的医疗政策研究人员写道,患者满意度提高,与若干种疾病治疗效果的改善存在相关性,包括心肌梗死、心脏衰竭和肺炎。The need to train and test physicians in “interpersonal and communication skills” was formally recognized only relatively recently, in 1999, when the American Board of Medical Specialties made them one of physicians’ key competencies. Although medical schools and residency programs then began to train and test students on these skills, once physicians have completed training, they are seldom evaluated on them. And doctors trained before the mid-1990s have rarely, if ever, been evaluated at all.对医生在“人际关系和沟通技巧”方面进行培训和检验的需求,直到近年来才正式得到承认。在1999年,美国医疗专科委员会(American Board of Medical Specialties)将这些技巧列为医生的关键能力之一。尽管医学院和住院医项目从那时就开始对学生的这些技巧进行培训和测试,但是医生在完成学业后,极少还会受到这方面的评估。所有在上世纪90年代中期之前接受医学教育的医生,则极少甚至完全没有得到过评估。I realize that many colleagues may see methods like ours as too intrusive on their clinical practice and may say that they don’t have the time. But we need to move away from the perception that social skills and better communication are a kind of optional extra for doctors. A good bedside manner is simply good medicine.我明白很多同行可能会认为,我们这样的方法对临床实践的干扰太强,也可能会说他们没时间。不过,我们需要摒弃那种认为社交技巧和改善沟通对医生来说是一种可有可无的额外素质的念头,因为在临床实践中,良好的态度本身就是一剂良药。A passionate diabetes specialist told me how she sat down with a patient to understand why he was not using his diabetes medications regularly, despite numerous hospital admissions for complications.一位充满热情的糖尿病专科医师给我讲述了她与一名患者坐下来聊天的情形。尽管那名患者因为并发症而多次入院治疗,但是他还是不肯规律地摄入糖尿病药物,她想弄明白这是为什么。“I can’t continue to do this anymore,” he told her, on the verge of tears. “I’ve just given up.”“我不能再这样活了,”他强忍着泪水告诉她。“我干脆放弃了。”She placed a hand on his shoulder and just sat with him. After a pause, she said: “You have a heart that still beats, and legs you can still walk on — many of my patients don’t have that privilege.”她把手放在他的肩膀上,坐在了他身旁。停顿片刻后,她说:“你的心脏还能跳,腿也还能走。许多患者根本没有这样的运气。”Five years later, recalling this episode, her patient credits her with inspiring him to take better care of himself. The entire encounter took less than five minutes.五年之后,这位患者在回顾这一幕时称赞道,是医生的鼓舞让他更好地照顾自己。那次会面只花了不到五分钟。 /201501/352632。

When a pig farmer sued a hot air balloon firm, he needed to prove he wasn’t telling porkies。如果一个养猪的农民想要状告热气球公司,那么他得明自己不是在胡说八道。Luckily for Dan Gilbank, he had maths professor, the laws of trigonometry, a lucky photograph and a golfer’s laser rangefinder to back up his case。丹·吉尔本克就是这样一个幸运的农民,数学教授、三角原理、一张照片还有一个高尔夫球手常用的激光测距仪都帮他赢得了官司。Farm manager Mr Gilbank, 46, and his father Mick, 67, were adamant that a low-flying balloon had caused 250 of their pigs to stampede into a ditch, with disastrous – and costly – consequences。丹是一名农场经理,今年46岁,他和67岁的父亲米克,都坚信,使他们家250头猪受到惊吓逃窜到一条沟里从而造成灾难性后果及巨大经济损失的,是一个低空飞行的热气球。Now the farm’s owners have won nearly £40,000 compensation following a two-year legal battle。官司持续了两年的时间,如今该农场的主人获得了近4万英镑的赔偿。The stampede happened in April 2012 when a hot air balloon carrying a party of sightseers flew over Low Moor Farm, near York。农场的猪受惊事件发生在2012年4月份的一天,当时一个载着一群游客的热气球飞过约克郡附近的低尔庄园。The pigs had been in their pens but were so terrified by the sight of the red-and-white-striped balloon and the noise from its burners they charged through fences, stampeded 200 yards and ended up in a ditch at the end of the field。原本呆在围栏里的猪,因为被红白相间的热气球及其燃烧炉发出的声音吓到,随即越过栅栏四处逃窜了200多码(约183米)最后掉进了一个水沟里。Hot air balloons are banned from flying lower than 1,500ft over it or closer than 1,500ft to it。热气球在飞行时,与地面的距离被禁止低于低于或接近1500英尺(约457.2米)。On this occasion, Mr Gilbank – who has run the farm with his father for 16 years – suspected the offending balloon had breached these limits as it soared over the North Yorkshire countryside。因此,和父亲一起经营农场有16年之久的丹,怀疑这个在约克郡北部乡村上空飞行的热气球违反了规定。But the balloon’s operators insisted it had come no closer than 2,500ft to the farm。但是当时的热气球操作员坚持说热气球与村庄的距离超过了2500英尺(约762米)。Insurers for the company used GPS data generated during the flight to back their claim that it could not have caused the stampede。热气球公司的保险人员查看了飞行过程中的GPS数据也持了操作员的说法,认为猪受惊事件不是由此导致的。However, the wife of a neighbouring farmer had by chance taken a photograph of the balloon. Low Moor Farm’s owners, Ian Mosey (Livestock) Ltd, called in Chris Fewster, a professor of mathematics at the University of York。但是,丹邻居的妻子当时偶然拍下了一张热气球的照片。低尔庄园的所有者伊恩·莫西有限公司,找来了大学数学教授克里斯·福斯特。Professor Fewster used trigonometry to show that the balloon had been at a height of only about 100ft and had been less than 1,000ft from the pigs when it fired its burner。福斯特教授运用数学中的三角原理明出热气球当时的飞行高度只有100英尺(约30.5米),热气球的燃烧炉距离猪圈不到1000英尺(约304.8米)。He was helped in his calculations by Mr Gilbank, who used his laser rangefinder – a golfer’s tool to measure the distance to the green – to work out the height of the trees。在福斯特教授计算的过程中,丹使用激光测距仪帮助教授测量了树木的高度。激光测距仪是高尔夫球手常用作测量草坪距离的一种工具。As a result, the insurers, who had initially offered £10,000 compensation, have now agreed a settlement of £38,782.最终,起初只提供10万英镑赔偿的保险公司现在同意把赔偿金提高到38782英镑。Professor Fewster said the data he obtained from the photo was vital. ‘Putting all of that together, with fairly elementary mathematics, we got to the answer,’ he said。福斯特教授称他从那张偶然拍摄的照片中得到的数据很关键。“把所有这些综合在一起,使用数学方法计算之后,我们就得出了。”The balloon firm, also known as Cameron Flights Southern Limited, went into liquidation last year。而那家叫做卡米伦南部飞行有限公司的热气球公司在去年已经破产。 /201410/336239。

Petra Diamonds announced its discovery of what may very well be the largest blue diamond to ever be unearthed at the Cullinan mine in South Africa.佩特拉钻石公司近日宣布,他们在南非库利南钻石矿发现了一颗很有可能是迄今为止最大的蓝钻石。It is the size of a strawberry and weighs a bit less than three pound coins.它和一颗草莓差不多大,比3枚一英镑硬币略轻。But if you had this rare blue beauty in your pocket you would be carrying around a diamond that could be worth more than #163;60million.要是你能将这颗蓝色尤物装进自己的口袋,那你等于随身带了一颗价值超过6千万英镑(约为6.3亿人民币)的钻石。Anyone who buys it, however, will be hoping for better luck than the owners of the famous deep blue Hope Diamond. It supposedly puts a curse on those who possess it, as the guillotined Louis XVI and his wife Marie Antoinette discovered.这颗钻石的买家得祈祷自己拥有比著名的“希望蓝钻”的拥有者更好的运气。“希望蓝钻”被认为会为拥有者带来厄运,比如被送上断头台的路易十六夫妇。Blue diamonds get their colour from small amounts of the chemical element boron trapped in their crystal structure. The more ‘blue’ it is, the greater the value. They are the rarest diamonds after red, which are almost never found.蓝钻石的晶体结构中含有的化学元素硼是蓝色的由来。蓝色越深,钻石的价值越高。蓝钻石是第二稀有的钻石,仅次于极难被发现的红钻石。The Cullinan mine is recognised as the most important diamond mine in the world. It is famous for producing the world’s largest white diamond, the 3,106-carat Cullinan Diamond, which was found in 1905.库利南钻石矿被认为是世界上最重要的钻石矿。它因1905年发现的世界最大的白钻石——3106克拉的库利南钻石而声名远播。 /201406/306214。