The Organization Department of the Central Committee and the Ministry of Human Resources and Social Security issued the Provisions on the Examination of Staff in Institutions.

The full text of the Assessment Provisions:

Provisions on the assessment of staff in public institutions

Chapter I General Principles

Article 1 These Provisions are formulated in accordance with the Regulations on Personnel Management of Public Institutions and relevant laws and regulations in order to accurately evaluate the professional performance and work performance of staff in public institutions, standardize the assessment of staff in public institutions, promote the construction of high-quality professional staff who can shoulder the heavy responsibility of national rejuvenation, be loyal and clean, and implement the standards of good cadres in the new era.

Article 2 Staff assessment in public institutions refers to the understanding, verification and evaluation of the political quality, performance ability, work performance and work style of staff in public institutions by public institutions or competent authorities (departments) in accordance with the authority of cadre and personnel management and the prescribed standards and procedures.

The assessment of the leaders of public institutions shall be carried out in accordance with the relevant provisions.

Article 3 The staff assessment of public institutions shall be guided by the Supreme Leader’s Socialism with Chinese characteristics Thought in the new era, implement the Party’s organizational line and the principles and policies for cadres’ work in the new era, focus on fully mobilizing the enthusiasm, initiative and creativity of the staff of public institutions, promote the high-quality development of public welfare undertakings in the new era, adhere to respect for labor, knowledge, talents and creativity, comprehensively and accurately evaluate the staff of public institutions, clearly establish the orientation of selecting and employing people in the new era, and promote the formation of "those who are competent, those who are superior, and those who are mediocre". At work, we should adhere to the following principles:

(a) the party is in charge of cadres and talents;

(2) Having both ability and political integrity and putting morality first;

(three) the cause is the best, fair and decent;

(four) pay attention to performance, recognized by the masses;

(five) classification, simple and effective;

(six) the combination of examination and use, rewards and punishments.

Article 4 The methods of staff assessment in public institutions are mainly annual assessment and employment period assessment, and peacetime assessment and special assessment are carried out according to the actual work.

Chapter II Assessment Contents

Article 5 The staff of public institutions shall be assessed on the basis of their job responsibilities and tasks, with a comprehensive assessment of morality, ability, diligence, performance and honesty, with emphasis on the assessment of morality and performance.

(1) Germany. Insist on putting political standards first, comprehensively assess political quality and moral conduct, focus on studying and implementing Socialism with Chinese characteristics Thought of the Supreme Leader in the new era, firmly support the "two establishment", strengthen the "four consciousnesses", strengthen the "four self-confidences", achieve the "two maintenance", strengthen ideals and beliefs, stick to the initial mission, be loyal to the Constitution, the country and the people; Adhere to principles, dare to struggle, and be good at fighting; Exemplary practice of socialist core values, caring for the motherland, serving the people, abiding by professional ethics, observing social morality, family virtues and personal morality.

(2) can. Comprehensively assess the level of political ability, work ability, professionalism and technical skills to meet the requirements of the new era, focusing on political judgment, political understanding, political execution and learning and research ability, ability to handle affairs according to law, mass work ability, communication and coordination ability, implementation ability, reform and innovation ability, and emergency response ability.

(3) diligence. Comprehensive assessment of mental state and work style, focusing on understanding the situation of dedication, diligence, responsibility, forge ahead, courage to create, and dedication.

(4) achievements. Comprehensively examine and practice the people-centered development thought, perform post responsibilities in accordance with laws and regulations, undertake urgent and dangerous tasks, and do practical things for the masses of workers, focusing on understanding the quantity, quality, timeliness, cost, social and economic benefits, and satisfaction of service targets.

(5) Cheap. Comprehensively assess the situation of honest employment, focusing on the implementation of the spirit of the eight central regulations and their detailed rules, the implementation of the relevant rules and regulations of the system, the industry and the unit, compliance with rules and discipline, honesty and self-discipline.

Article 6 The staff of public institutions shall be assessed by classification, and the assessment contents shall be detailed and clear, reflecting the characteristics and specific requirements of staff in different industries, different types, different levels and different positions, and enhancing pertinence and effectiveness.

Article 7 In the assessment of the staff of public institutions providing public welfare services to the society, the responsibilities of public welfare services should be highlighted, and the assessment of service quality, code of conduct, technical skills and work style construction should be strengthened. Institutions in key industries such as propaganda, ideology, culture, education, science and technology, health and wellness should, in accordance with the relevant requirements of promoting the reform of talent evaluation mechanism by classification, respectively determine the core elements of staff assessment content, reasonably set the index weight, and implement differentiated assessment based on industry attributes.

The assessment of the staff of institutions that mainly provide support and guarantee for the organs, highlighting the assessment of the performance of support and guarantee duties. According to the actual situation, it can be assessed and coordinated with the staff of the competent authority (department).

Article 8 The assessment of professional and technical personnel in public institutions shall be based on the characteristics of professional and technical work, oriented by innovative value, ability and contribution, and pay attention to public service awareness, professional theoretical knowledge, professional ability level, innovative services and achievements, etc.

The assessment of management personnel of public institutions should be combined with the characteristics of management work, focusing on management level, organization and coordination ability, standardization of work, honesty and diligence.

The assessment of workers and technicians in public institutions should be combined with the characteristics of workers and technicians, and pay attention to skill level, service attitude, quality and efficiency.

Chapter III Annual Assessment

Ninth annual assessment is a comprehensive assessment of the overall performance of staff in public institutions on an annual basis, generally at the end of each year or the beginning of the following year.

Tenth annual assessment results are generally divided into four grades: excellent, qualified, basically qualified and unqualified.

Eleventh annual assessment to determine the excellent grade shall meet the following conditions:

(a) high ideological and political quality, firm ideals and beliefs, resolutely implement the decision-making arrangements of the CPC Central Committee, abide by laws and regulations, abide by professional ethics, and have good social morality, family virtues and personal morality;

(two) strong ability to perform job responsibilities, proficient in their own business, and high professional and technical skills or management level corresponding to job requirements;

(three) public service awareness and strong sense of responsibility, diligence and dedication, strong sense of reform and innovation, good work style;

(four) fully perform their duties, complete all tasks with high quality, outstanding work performance, contribution to the society or units, and high satisfaction with the clients;

(five) honest practice and have an exemplary role in observing the discipline of honesty.

Twelfth annual assessment to determine the qualified grade shall meet the following conditions:

(a) high ideological and political quality, able to implement the decision-making arrangements of the CPC Central Committee, consciously abide by laws and regulations and professional ethics, and have good social morality, family virtue and personal morality;

(two) strong ability to perform job responsibilities, familiar with their own business, and high professional and technical skills or management level corresponding to job requirements;

(three) public service awareness and strong sense of responsibility, serious and responsible work, good work style;

(4) Being able to perform job responsibilities, completing work tasks well, and having high satisfaction with the clients;

(five) honest practice.

Thirteenth institutions staff in any of the following circumstances, the annual assessment should be determined as the basic qualified grade:

(a) the ideological and political quality is average, and there are obvious shortcomings in implementing the decision-making arrangements of the CPC Central Committee and observing professional ethics, social ethics, family virtues and personal morality;

(two) the ability to perform job responsibilities is weak, and the professional and technical skills or management level corresponding to the job requirements are low;

(three) the public service consciousness and sense of responsibility are general, the work discipline is not strong, the work is negative, or the work style is obviously insufficient;

(4) Being able to basically perform job responsibilities and complete tasks, but the quantity, quality and efficiency of the work completed are insufficient, or there are certain mistakes in the work, or the satisfaction of the clients is low;

(five) can basically be honest, but there are some shortcomings.

Fourteenth staff of public institutions in any of the following circumstances, the annual assessment shall be determined as unqualified grade:

(a) the ideological and political quality is poor, and there are serious problems in implementing the decision-making arrangements of the CPC Central Committee, professional ethics, social ethics, family virtues, personal morality, etc.;

(two) the professional quality and working ability can not meet the requirements of the post;

(three) lack of public service awareness and sense of responsibility, lack of responsibility or inaction, or poor work style;

(4) Failing to perform post duties, failing to complete work tasks, or causing heavy losses or adverse social impact due to serious dereliction of duty in the work;

(five) there are problems in the practice of honesty, and the situation is more serious.

Fifteenth institutions staff annual assessment of excellent grades, generally not more than 20% of the total number of staff should participate in the annual assessment. The number of places with excellent grades should be tilted to front-line posts, hard posts and those who receive commendation and awards.

Institutions in the corresponding assessment year under any of the following circumstances, with the approval of the competent authority (department) or the comprehensive personnel management department of institutions at the same level, the proportion of outstanding grades in the annual assessment of staff can be appropriately increased, generally at 25%:

(a) the unit won the collective merit award;

(two) the unit has made significant innovations or outstanding contributions, and has been recognized by the relevant authorities (departments);

(three) the unit performance appraisal has obtained excellent grades.

The unit performance appraisal is unqualified grade, and there are many problems and accountability institutions. The competent authority (department) or the comprehensive personnel management department of institutions at the same level shall reduce the proportion of excellent grades in their annual assessment, generally not exceeding 15%.

Sixteenth to carry out the annual assessment of the staff of public institutions, you can set up an assessment committee or assessment work leading group, responsible for the organization and implementation of the assessment work, and the corresponding organization and personnel departments to undertake specific work. The assessment committee or assessment work leading group is established by the unit, and is generally headed by the main person in charge of the unit, and its members are composed of other leaders of the unit, relevant personnel of the organization and personnel department and the discipline inspection and supervision institution, and employee representatives. Established by the competent authority (department), the competent authority (department) generally organizes the person in charge of the personnel department as the director (team leader), and the members are composed of relevant personnel of the personnel department organized by the competent authority (department), relevant leaders of institutions, relevant personnel engaged in organizing personnel and discipline inspection and supervision, and employee representatives.

Seventeenth annual assessment is generally carried out in accordance with the following procedures:

(a) to formulate a plan. The assessment committee or the assessment leading group shall formulate the annual assessment work plan of public institutions, and after listening to the opinions of the staff through the workers’ congress or other forms, release it to the whole unit.

(2) summing up the work. The staff of public institutions shall summarize the post responsibilities, tasks, assessment contents and relevant requirements, fill in the annual assessment form, and report on their work within a certain scope when necessary.

(3) Evaluation, verification and evaluation. The assessment committee or the assessment leading group can adopt democratic assessment, performance evaluation, listening to the opinions of the competent leaders, internal evaluation of the unit, satisfaction survey of clients, third-party evaluation and other methods in line with the post characteristics, comprehensively evaluate the assessment objects, and put forward suggestions on assessment grades.

(4) determine the grade. The leading bodies of public institutions or the competent authorities (departments) shall organize the personnel departments to collectively study and approve the assessment grades. Those to be determined as excellent grades must be publicized within the scope of the unit, and the publicity period is generally not less than 5 working days. The assessment results shall be informed to the assessed personnel in written form and signed by myself.

Chapter IV Examination of Employment Period

Article 18 The employment period assessment is an all-round assessment of the overall performance of the staff of public institutions during a complete employment period. It is based on the employment (appointment) contract and the annual assessment results during the employment period, and is generally completed within one month before the expiration of the employment (appointment) contract.

Engagement assessment focuses on the completion of engagement task objectives.

Article 19 The results of employment assessment are generally divided into qualified and unqualified grades.

Twentieth staff of public institutions to complete the objectives and tasks of the employment period, and the annual assessment during the employment period is qualified and above, the employment period assessment should be determined as qualified.

Twenty-first staff of public institutions, without justifiable reasons, failed to complete the objectives and tasks of employment, employment assessment should be determined as unqualified grade.

Twenty-second institutions staff employment assessment should generally be carried out in accordance with the procedures of summing up the debriefing, evaluation, verification and evaluation, performance analysis, determination of grades, etc., combined with the actual situation, it can also be coordinated with the annual assessment.

Chapter V Peacetime Assessment and Special Assessment

Twenty-third peacetime assessment is a regular assessment of the daily work and consistent performance of staff in public institutions.

Article 24 The usual assessment of the staff of public institutions shall be mainly carried out in combination with daily management work. According to the characteristics of industries and units, methods such as work inspection, attendance record, heart-to-heart talk and listening to opinions can be adopted. The specific operation measures shall be determined by public institutions in light of the actual situation.

Institutions can explore the establishment of peacetime assessment records and form assessment results according to their own reality. The usual assessment results can be determined in the form of assessment reports, comments, grades or appraisals.

Twenty-fifth special assessment is a targeted assessment of the working attitude, responsibility, role and actual effect of the staff of public institutions in completing important special work, undertaking urgent and dangerous tasks, and responding to and handling emergencies.

According to the usual grasp of the situation, the outstanding performance or problems reflect more staff, you can conduct special assessment.

Twenty-sixth to carry out special assessment of the staff of public institutions, can be carried out in accordance with the procedures of understanding and verification, comprehensive judgment, result feedback, or combined with the promotion of special work flexible arrangements.

Special assessment results can be determined in the form of assessment reports, comments, grades or appraisals.

Chapter VI Application of Assessment Results

Article 27 Adhere to the combination of examination and use, and combine the examination results with selection and appointment, training and education, management and supervision, encouragement and restraint, accountability and accountability, etc., as the basis for the staff of public institutions to adjust their posts, positions, staff grades, salaries, evaluate their professional titles and rewards, and change, renew, dissolve and terminate their employment (appointment) contracts.

Twenty-eighth institutions staff annual assessment is determined to be qualified above grade, in accordance with the following provisions:

(a) increase the first salary scale;

(2) Pay performance pay in accordance with relevant regulations;

(three) the assessment year is calculated as the service life of the current post (staff) level.

Among them, if the annual assessment is determined as an excellent grade, it should be tilted under the same conditions when allocating performance pay; Priority should be given to job promotion and job title evaluation under the same conditions.

Twenty-ninth institutions staff annual assessment is determined to be basically qualified grade, in accordance with the following provisions:

(a) ordered to make a written inspection, the deadline for improvement;

(two) shall not increase the salary scale;

(3) Reduce performance pay accordingly;

(four) this assessment year is not calculated as the service life of the current post (staff) level, and the post (staff) level shall not be promoted in the next assessment year;

(five) for two consecutive years, it has been determined to be basically qualified, and it shall be adjusted or handled.

Thirtieth institutions staff annual assessment is determined to be unqualified grade, in accordance with the following provisions:

(a) shall not increase the salary scale;

(2) Reduce performance pay accordingly;

(three) to the lower level post (staff) level modulation;

(four) the assessment year is not calculated as the service life of the current post (staff) level;

(five) if it is determined to be unqualified and does not agree to adjust the post, or if it is determined to be unqualified for two consecutive years, the employment (appointment) contract may be terminated according to regulations.

Among them, if the post (employee) level has been reduced according to the regulations when being dealt with and punished, and the annual assessment of that year is determined to be unqualified, in order to avoid repeated punishment, level modulation will not be sent to the lower post (employee).

Thirty-first institutions staff annual assessment of uncertain grades, in accordance with the following provisions:

(a) shall not increase the salary scale;

(2) Reduce performance pay accordingly;

(three) the assessment year is not calculated as the service life of the current post (staff) level, and if the grade is uncertain for two consecutive years, the post will be adjusted according to the situation.

Article 32 If the employment period of the staff of a public institution is determined to be qualified and the employed post still exists, the employment (appointment) contract may be renewed through consultation between the staff and the institution.

If the term of employment is determined to be unqualified, the contract will not be renewed at the expiration of the contract; If it is really necessary to renew the employment (appointment) contract under special circumstances, it shall be reported to the competent authority (department) for examination and approval.

Article 33 The conclusive materials formed by the staff assessment of public institutions shall be kept in the personnel files of cadres.

Thirty-fourth peacetime assessment, special assessment results as an important reference for the annual assessment, employment assessment.

Using the results of usual assessment and special assessment, we should strengthen the incentive and restraint, cultivate education, encourage the advanced and spur the backward.

Article 35 If problems are found in the staff of public institutions during the assessment, they shall be dealt with and punished according to the nature and seriousness of the problems. Anyone suspected of committing a crime shall be investigated for criminal responsibility according to law.

Thirty-sixth staff of public institutions who are dissatisfied with the grades determined to be basically qualified or unqualified may apply for review and lodge a complaint in accordance with relevant regulations.

Chapter VII Related Matters

Thirty-seventh employees of institutions who are employed for the first time, who are dissatisfied with the assessment year for half a year (including probation period), will participate in the annual assessment, only write comments, and are not sure about the grade.

For staff who are not employed for the first time, the working hours in other units in the same year are combined with the working hours in this unit. If they are dissatisfied with the annual assessment for half a year (including the probation period), they will participate in the annual assessment and only write comments, with uncertain grades; For those who have completed the annual assessment for half a year (including the probation period), their current institutions shall conduct annual assessment and determine the grade, and the original work unit shall provide relevant information.

The working hours of other units mentioned in the preceding paragraph can be comprehensively identified according to the relevant records of cadres’ personnel files, labor contracts and social insurance payment certificates.

Thirty-eighth annual assessment of the staff assigned by public institutions shall be handled in accordance with the following provisions:

(a) temporary, aid, overseas staff, in general, during the period of assignment by the work time of more than half a year to assess the unit and in an appropriate way to listen to the opinions of the sending unit or receiving unit.

(II) The staff sent by the unit to study and train and perform tasks, and the professional and technical personnel who have been approved to innovate part-time or start an enterprise on the job, or who have been sent to work in an enterprise and participate in project cooperation, shall be assessed by the unit where the personnel relationship is located, and the grades shall be determined mainly according to the performance of study and training, task execution, innovation and entrepreneurship, and the relevant units shall provide the performance outside.

Article 39 The assessment of personnel who hold positions in both management positions and professional and technical positions in public institutions shall be based on the responsibilities and tasks of the two positions, and the dual-post and dual-assessment shall be implemented.

Fortieth, based on the characteristics of their work, we should explore and improve the assessment methods for scientific researchers in universities, research institutes and other institutions, reasonably determine the assessment period and frequency, and promote scientific researchers to devote themselves to research and create scientific research results.

Forty-first sick leave, personal leave, non-unit sent out to study and train for more than half a year in the annual assessment, to participate in the annual assessment, uncertain grade.

Female employees who take maternity leave for more than half a year in accordance with the regulations shall participate in the annual assessment and determine the grade.

Forty-second staff members of public institutions suspected of violating discipline and law have been put on file for review and investigation, but the case has not been closed, so they will take part in the annual assessment, do not write comments, and are uncertain about their grades. If the case is not punished or given a warning after the case is closed, the grade shall be fixed according to the regulations.

Forty-third staff members of public institutions who have been punished by party discipline and government affairs or organized to handle and admonish them shall participate in the annual assessment and shall be handled in accordance with relevant regulations.

At the same time, if it is punished by party discipline and government affairs and organized to deal with it, the annual assessment results shall be determined according to the treatment and punishment that have a greater impact on its annual assessment results.

Forty-fourth staff of institutions who do not participate in the assessment without justifiable reasons, but still refuse to participate after education, are directly determined to be unqualified.

Forty-fifth institutions or competent authorities (departments) should strengthen the overall planning of assessment work, optimize the workflow, pay attention to the use of Internet technology and information technology, carry out assessment work simply and efficiently, and improve the quality and efficiency of assessment.

Forty-sixth comprehensive personnel management departments and competent authorities (departments) of public institutions at all levels shall strengthen the guidance and supervision of the assessment of staff in public institutions.

Those who engage in malpractices for personal gain, take revenge and resort to deceit in the assessment process will be severely dealt with in accordance with the relevant provisions.

Chapter VIII Supplementary Provisions

Forty-seventh organs of the staff assessment, with reference to these provisions.

Article 48 All localities and departments may, in accordance with these Provisions and in light of the actual situation, formulate specific measures or detailed rules for staff assessment of public institutions.

Article 49 The Organization Department of the CPC Central Committee and the Ministry of Human Resources and Social Security shall be responsible for the interpretation of these Provisions.

Article 50 These Provisions shall come into force as of the date of promulgation.

Let the needs of special children be seen, she is a "special soldier" among the teachers …

"Xiong Haizi" who always makes trouble; "strange children" who are incompatible with the class; A "smart and stupid kid" who knows everything about the game and learns in a mess …

In the eyes of Ding Meizhen, director of Hongkou Special Education Guidance Center and vice president of Miyun School in Hongkou District, "every problem behavior of children is actually a signal to ask adults for help", and "no child can be left behind" on the road of education.

As a "special soldier" in the teaching team and a "leader" in the integrated education major, Ding Meizhen led the teachers in the special education center to pay attention to special children and innovate to create a new form of "cloud support" for integrated education.

Therefore, she won the title of "National Model Teacher" in 2024 and the nomination award of "Touching Shanghai Person of the Year in 2024".

Qing sa Rong he education

During her 35-year teaching career, Ding Meizhen has been engaged in primary education for 10 years and special education for more than 10 years. Nowadays, it has been more than 10 years to carry out integrated education management, guidance, research and service in ordinary primary and secondary schools.

During the day, she guides the integrated education in the school, and at night, she returns to the special education guidance center to conduct in-depth research on the problems in the integrated education, so as to provide full protection for the mechanism, personnel and resources of the integrated education in the school, so that every special student can enjoy high-quality medical and educational services.

In order to "let every child enjoy a quality and fair education", Ding Meizhen explored and formed the paradigm of "one person, one case" combining medical education with regular students, so that every special child can enjoy the "four links" complete service chain of "identification and placement", "early evaluation and planning", "teaching and rehabilitation training" and "phased evaluation and adjustment" from the moment of discovery.

She also set up a "parents’ school" for students with special needs in regular classes, and held a three-dimensional picture book reading and parental support service project for special children in "Yuedu Garden" on weekends to actively promote social acceptance and integration environment.

Let the need be seen

"The diverse educational needs of children need to be seen." In Ding Meizhen’s view, children’s "strange behavior" is actually a signal to parents and teachers for help. "For example, some children are always causing trouble, dragging their homework, forgetting things, and having a poor sense of time. It may be because their executive function is relatively weak, their emotional and behavioral control ability is weak, and it is difficult to perform multi-line tasks at the same time. There are many deep-seated developmental reasons behind it."

"If a child has these problem behaviors, parents will criticize and blame him blindly, which will not only help the child, but also cause him more harm." Ding Meizhen believes that the first step of integrated education is to identify the physical and mental causes behind children’s behavioral problems as soon as possible, find out their individual needs as soon as possible, and give targeted educational support as soon as possible.

Every year when the new school year starts in September, Hongkou District Special Education Guidance Center will conduct a "touch arrangement" for freshmen in the whole district. Full-time itinerant instructors will observe, understand and exchange students’ situation one by one according to the cases reported by the class teacher, judge their behavior characteristics and provide guidance services for teachers.

The goal of "arranging work" is to identify the special educational needs of some children and let them be seen.

Explore diversified education

For the special education of special children, Ding Meizhen has always had an idea: "diverse ecology breeds diverse needs, and diverse support creates diverse splendor".

In order to solve the problem that students studying in regular classes have difficulty in adapting to campus and teachers are difficult to accept, Ding Meizhen adopts the concept of "24-hour home-school-medical rehabilitation" and adopts the working mode of multidisciplinary cooperation and combination of medical education to effectively promote the all-round development of physical and mental health of special students.

At the same time, in view of the difficulties of teachers in ordinary schools in identifying and supporting special children, Ding Meizhen condensed the methods of identifying students in multiple ways, provided professional interpretation, scientifically drew portraits of special students, and guided teachers to scientifically understand students and provide accurate support.

She also led the team to create 38 shared courses such as stereoscopic picture book reading and music therapy, designed more than 100 kinds of teaching AIDS shared by teachers and students, and developed a resource group consisting of 25 special services; Innovate the online and offline resource system to help teachers teach accurately.

Ding Meizhen also led the team to explore the digital empowerment innovation of integrated education, research and develop the "four clouds" of ability evaluation, remote interaction, special education resources and information management, and build a "one-stop" management and service platform for integrated education to realize the digital transformation of integrated education across time and space.

Text: Bai Yu

Image provided by Hongkou District Education Bureau.

Editor: Xie Ran

Proofreading: Cao Er

Editor in charge: Wu Hua

Please indicate the source when reprinting this article.

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The number of people participating in long-term care insurance in China has reached 169 million, with a total of 1.95 million people enjoying treatment.

  In the early morning of summer, Song Jinhui, a nurse, came to Xianlin New Village early in the morning to help Uncle Xu, a resident with Alzheimer’s disease, wash, feed and change his medicine. "Fortunately, with long-term care insurance and professional care services and cost subsidies, the pressure on us to take care of the elderly is much less." Uncle Xu’s daughter said gratefully.

  The long-term care insurance system is an important decision-making arrangement made by the CPC Central Committee and the State Council to actively cope with the aging population, and it is also an important institutional arrangement to make up for the shortcomings of the social insurance system. The Party’s Report to the 20th CPC National Congress proposed to establish a long-term care insurance system. In recent years, China has actively carried out the pilot work of long-term care insurance, constantly expanding the scope of the pilot, providing nursing services for the disabled elderly and increasing living security. By the end of 2022, the number of people participating in long-term care insurance had reached 169 million, with a total of 1.95 million people enjoying treatment and a total expenditure of 62.4 billion yuan. What role has long-term insurance played in better realizing "a sense of security for the elderly"? How to promote the high-quality development of long-term insurance? The reporter conducted a survey and interview.

  The pilot project of long-term insurance is progressing smoothly, effectively reducing the financial burden of disabled families.

  Early in the morning, in Changqing Nursing Home in Fuzhou, Fujian Province, nurse Huang Changxiu helped Wu Apo, a paraplegic, get up, change clothes and have breakfast. In the evening, push the old man to the garden to relax and chat; At night, every two hours, I will help Wu Apo turn over in her sleep … … This kind of day and night companionship made Wu Apo praise Huang Changxiu.

  "There are three old people living in this room, and they usually rely on Xiao Huang to take care of them. After a long time, she knows our living habits like the back of her hand, and it’s not good for anyone else. " Wu Apo said.

  Wu Apo, a native of Fuzhou, is in her 70s this year. A few years ago, she accidentally suffered from spinal cord disease, so she couldn’t take care of herself after operation and lived in a nursing home. Although life is always taken care of, the nursing expenses of several thousand yuan also make Wu Apo and her family feel a lot of pressure.

  When she read a newspaper, she learned that a pilot project of long-term care insurance was being carried out in the local area, and disabled people could enjoy compensation for nursing expenses. Wu Apo’s family immediately consulted China Life Insurance Fujian Branch, a long-term insurance agency, and submitted the application materials.

  "A few days later, the staff came to the nursing home to evaluate my physical condition. After identification, the agency confirmed that I met the conditions for long-term insurance payment, provided me with compensation of 1,350 yuan per month after deducting relevant expenses, and paid the nursing fee directly to the nursing institution. " Wu Apo said with a smile, "This good policy not only reduces the nursing expenses of disabled people, but also makes us feel the care of society and our belief in living a good life is more firm."

  Disabled elderly people who care at home can also enjoy the long-term insurance policy. Zhou Apo, an 88-year-old Fuzhou resident, was bedridden after accidentally falling down. At the beginning of February this year, her family applied to the relevant departments of Fuzhou for long-term insurance treatment. After identification and publicity, at the end of February, Zhou Apo began to enjoy customized professional nursing services and cost subsidies.

  "I am old myself, and taking care of the elderly feels powerless." Zhou Apo’s daughter told the reporter that thanks to the long-term insurance policy, the nursing staff came to the door every day to massage and change the medicine for her mother, and also enlightened her to maintain a good mood. "Because of diabetes, the old man’s feet were once severely ulcerated, and now they have basically healed. The old man is very happy and our whole family is very satisfied."

  Long-term care insurance mainly provides basic nursing guarantee and economic compensation for severely disabled people, which not only helps the elderly to improve their quality of life, but also reduces the family burden. In 2016, the Guiding Opinions on Piloting the Long-term Care Insurance System identified the first batch of 15 pilot cities for long-term care insurance. Up to now, the number of pilot cities has expanded to 49.

  It is understood that Fuzhou officially launched the pilot project of long-term insurance in 2021, relying on medical insurance funds, personal account transfer and other financing, handled by commercial insurance companies, and purchasing professional services from designated nursing institutions. As of April 17, 101 designated nursing institutions have joined the pilot project of long-term care insurance, and 4312 people have enjoyed long-term care insurance treatment.

  According to the relevant person in charge of the National Medical Insurance Bureau, at present, the pilot project of long-term insurance is progressing smoothly and has achieved phased goals. First, it has effectively reduced the financial burden of disabled families. Second, it promoted the development of the service system, and the number of service institutions in the pilot areas reached 7600, four times that of the original. The third is to solve the employment problem, and the number of nursing staff has increased from more than 30,000 to 330,000.

  Kevin·Z, director of the Department of Risk Management and Insurance in Peking University, said that the establishment of the long-term care insurance system has played a positive role in implementing the national strategy of actively coping with the aging population and better realizing the "sense of security".

  Explore the expansion of long-term care insurance coverage and continuously improve the supply level of nursing services.

  To promote the better development of long-term insurance, all localities and departments are actively exploring and practicing in expanding coverage and improving service level.

  — — The service tentacles extend to the countryside, and policy innovation promotes the coverage of long-term insurance to increase steadily.

  "There are also long-term insurance in the village, and life in later years is more secure." Li Chenghong, an old man from Baihe Village, Baihe Town, Qingpu District, Shanghai, said that local cadres came to introduce the long-term insurance policy, which made him feel very warm and provided tangible help.

  In recent years, many long-term insurance pilot cities have made great efforts to improve the service capacity of rural nursing insurance, and rural residents who meet certain standards of disability and dementia can also enjoy the same care services as urban insured workers.

  "The long-term insurance service extends to the countryside, which is conducive to filling the shortcomings of rural old-age services and establishing a more equal urban and rural social security system." Kevin·Z said.

  It is noteworthy that the "Notice on Launching the Pilot Business of Responsibility Switching between Life Insurance and Long-term Care Insurance" issued by the former China Banking and Insurance Regulatory Commission proposed to launch the pilot business of switching from May 1 this year. At present, many insurance companies have identified products that can carry out conversion business.

  According to industry insiders, switching business refers to changing the responsibility of death or expiration payment in life insurance policies into the responsibility of nursing payment. When the insured enters the agreed nursing state due to specific diseases, accidental injuries, etc., he can get the insurance payment in advance. Piloting the conversion between life insurance and long-term care insurance can effectively improve the supply capacity of long-term care insurance in a short time and alleviate the pressure of nursing expenses for disabled people.

  According to Zhu Ming, director of the Center for Health Economy and Medical Security Research of Nankai University, this conversion can be regarded as a prepayment mechanism of life insurance benefits, which is more conducive to meeting the needs of disabled elderly people for nursing security in a timely manner than paying compensation after the death of the insured, and is more meaningful to the elderly and their families. "The insurance density and depth of life insurance products are relatively high. Making full use of existing life insurance products to carry out conversion business can effectively improve the supply capacity of long-term insurance." Zhu Ming said.

  — — Take multiple measures to improve the supply capacity of nursing service.

  "The old man in the wheelchair stood up again, the old man with cognitive impairment suddenly called out my name, and the old man in poor health ate half a bowl of rice … … These moments make me feel that my work is very valuable. " Shi Yumeng, a nurse in Xicheng District, Beijing, said.

  Only by being professional and attentive can the nursing staff exchange for the warmth of the elderly. In recent years, various localities have introduced measures to support personnel training in the field of old-age care. Henan has included the majors of aged care service and management, and the manufacturing of rehabilitation AIDS in vocational colleges into the scope of vocational education support; Shijiazhuang, Hebei Province will raise the subsidy standard for first-line on-the-job nursing staff who have obtained the vocational skill appraisal certificate; Many places hold nursing skill competitions to encourage nurses to do "ordinary things" with the power of example.

  Nursing institutions "pass on help" and cultivate more "caring people". Shandong has launched the service model of "institutional guidance+family care", relying on nursing institutions to include the families, relatives and neighbors of disabled people into the nursing service team, and provide professional guidance and teach service skills at regular visits. These trained nurses can cooperate with the on-site professional care provided by nursing institutions, extend the time for disabled people to obtain standardized services, and effectively alleviate the contradiction between supply and demand of nursing services.

  The reporter found that in order to provide better care services, relevant departments and agencies in the pilot areas strengthened supervision of care services and urged them to improve their quality. For example, by establishing an "online+offline" supervision and inspection method for care services, we can ensure that policies are put in place.

  Strengthen cooperation in various fields and continue to promote the development of disability protection.

  Experts said that to provide long-term care for the wider population, it is necessary to improve the coverage level of long-term care insurance through policy innovation, and at the same time further strengthen the top-level design, and all departments and fields work together to solve the difficulties that restrict the high-quality development of long-term care insurance.

  "In promoting the system, we should pay attention to grasping the relationship between local pilot projects and higher-level promotion and implementation. While conducting practical exploration through regional pilots, we should pay attention to summing up experience in a timely manner and rationally study and formulate relatively unified disability and dementia assessment standards and nursing service standards. " Kevin·Z suggested that the assessment criteria for disability levels that have been clearly defined at the national level should be promoted to be implemented in local areas.

  The financing mechanism needs to be optimized and improved urgently. "From the pilot situation in various places, there are great differences in financing channels and financing standards, and a reasonable and unified institutional framework should be promoted in a timely manner." Zhu Ming said.

  The value of long-term insurance lies not only in economic compensation, but also in service guarantee, which is inseparable from the coordination of various fields. Yu Hua, secretary of the Party Committee and president of the Insurance Association, said that the insurance industry should implement the national strategy of actively responding to the aging population, start with solving the contradiction between supply and demand, strengthen cooperation with industries such as medical care, nursing and health services, and continue to promote the development of service guarantee for the elderly in China.

  Kevin·Z believes that to establish a long-term care insurance system that meets the actual needs of the people, we should pay more attention to the development of a matching long-term care service system, pay attention to both "soft power" and "hard conditions", and make continuous efforts in the training of professional talents, the construction of supporting facilities and the supply of auxiliary equipment.

  Zhu Minglai suggested that to develop long-term care insurance, it is necessary to vigorously develop the nursing industry. The pilot area of long-term care insurance system should be equipped with enough nursing service institutions and personnel.

  The pilot work of responsibility conversion between life insurance and long-term care insurance has just begun. How can insurance institutions better promote this work?

  "In the process of switching business, insurance institutions should put the protection of consumers’ rights and interests in an important position, fully explain to consumers the changes in policy protection before and after switching, avoid misunderstandings and disputes, and really do a good job." Kevin·Z said.

  The relevant person in charge of the financial management department said that the next step will be to pay close attention to the pilot development and guide and urge life insurance companies to take effective measures to improve their operating procedures and internal control systems; Summarize the pilot experience in time and study and expand the product range applicable to the conversion business.

  Insiders said that to realize the healthy and sustainable operation of long-term insurance, it is necessary to strengthen supervision through the application of scientific and technological means. "It is necessary to improve the online monitoring ability of the whole process of evaluation, verification and supervision, better meet the needs of business management and customer service, and reduce ‘ False disability ’ ‘ Fake service ’ As well as the lack of connection between disability assessment and nursing needs, care resources are provided efficiently and accurately to people who really need them. " The relevant person in charge of China Life Insurance Fujian Branch said.

Washington post, USA: Can American family politics quit the stage?

  Xinhua News: On February 4th, Washington post website published an article entitled "Family Power". The article said that throughout American history, family political dynasties are not uncommon, such as Adams family, Roosevelt family, Kennedy family and so on. Today, 10% of members of Congress have a close relative in the House of Representatives or the Senate. Political dynasties, like slander and political favors, are unique products of America. The article is summarized as follows.


  


  John adams (left), the second president of the United States, and john quincy adams, the sixth president, have a father-son relationship.


    


  William henry harrison (left), the ninth president of the United States, and Benjamin Harrison, the 23rd president, are grandparents.


   


  Theodore roosevelt (left), the 26th President of the United States, and franklin delano roosevelt, the 32nd President of the United States, are uncles and nephews.


  The American people won their freedom from the autocratic monarch through violent revolution, but soon succumbed to the view that some families were destined to be in the leading position-as long as we could choose them.


  Bush. Clinton. Bush. Clinton? Although it is unusual for two families to occupy the Oval Office in turn for many years in American history, political dynasties are as unique as slander and political favors.


  Political families have a long history.


  Most precocious children can probably list several famous families in American history: Adams family, Roosevelt family and Kennedy family. However, when it comes to the story that politicians are in a favorable position because of their families, these household names are only the beginning.


  Although we may try to condemn the idea of inherited advantages in the era of "American Idol", hamilton fish II, hamilton fish III and hamilton fish IV were all elected to Congress for a reason-and one of the reasons is their ancestor hamilton fish I, who served as a US Congressman, a New York Governor and a US Senator.


  


  Political genes? You might think so when you think of the Frelinghuysen family from New Jersey. Six members of the family entered the Congress (including four senators and two representatives), including the current representative Rodney Frelinghuysen. This is endurance.


  So, in the case that another family dynasty may be coming soon-because not only Hillary Clinton is the wife of the former president, but Mitt Romney is also the son of the former governor and presidential candidate of Michigan-we looked through high school textbooks and called several wise historians to ask them such a question: What happened?


  According to Pedro Dahl Bo, a professor of economics at Brown University, in the first US Congress established in 1789, fully 45% of the members had relatives working in Congress. He said: "Although the population of the United States was relatively small at that time, it could not explain why so many members of Congress had relatives working in Congress." Today, 200 years later, 10% of members of Congress have a close relative in the House of Representatives or the Senate. Moreover, this phenomenon transcends party boundaries.


  Evidence abound: Gore family, murkowski family, Rockefeller family, Baker family, Dole family, Bono family and Meeks family. Nancy pelosi, Speaker of the House of Representatives-the first woman to hold this post-is the daughter of Thomas Dalessandro Jr., a former congressman.


  Dahl Bo said: "Some families are good at politics. Maybe it’s a family trait. Holding power increases the possibility of future generations taking power. Being in Congress opens the door for relatives to enter Congress. Power brings power. "


  Stephen Hess, a historian of the Brookings Institution, was first famous for writing the book "American Political Dynasty" in 1966. At the beginning of the book, the fact was put forward: by then, 700 families had produced two or more congressmen, that is to say, 17% of the members of the US Senate and House of Representatives came from these families.


  Hess said: "Who was the most competent at first?". With the passage of time, it has gradually become a family problem. " He said that the first leaders of the United States were all selected from the "essence of the country", as long as these elites were white men who believed in Christianity among the bourgeoisie.


  Theory of "small resource pool"


  We can also consider this phenomenon through the theory of "small resource pool". In the early days of the founding of the United States, I always saw the same surname repeatedly, because there were fewer outstanding people to choose from. Historian Edward Lenehan said: "The scope of aristocratic families is very small-the choice is very small-in a newly established country, when most people are still trying to fill their stomachs, only this small group of educated people have time and leisure to engage in politics. You can’t let a group of inferior people manage affairs. "


  Jack Lacaway, a historian at Stanford University, said that there was also a sense of vigilance in balancing the influence of family status. He said: "The founding fathers unanimously stated that government positions should not be passed down from generation to generation in the hands of one family."


  Lacaway cited the cold attitude of the Founding Fathers towards the Cincinnati Association as an example. Cincinnati Association is the earliest hereditary association in the United States (the organization’s headquarters is currently located in Dupont roundabout). It was founded in 1783 by the former generals of the Continental Army and was named after Lucius Quinctius Cincinnatus, the dictator of ancient Rome. Thomas Jefferson and Benjamin Franklin both expressed dissatisfaction with this organization, because its membership is passed down from father to son, and there are no soldiers among its members. Lacaway said: "This is a military elite organization based on the principle of heredity, and since the beginning of the revolution, there has been a strong prejudice against the view that political power should be passed down from generation to generation."


  As far as politics is concerned, David Kennedy, a historian at Stanford University who has nothing to do with the Kennedy family, said that the Founding Fathers "agreed and understood this. They expect’ natural aristocrats’ or what they call’ the family of the earliest immigrant descendants in Virginia’ to take up competent positions. At that time, people would not criticize what was wrong with this. "


  One of the earliest and most famous political families is the Adams family, although David mccullough, the author of john adams, does not agree to use the word "dynasty" in his beloved Adams family.


  Why? Mccullough said, because they are not a "real" dynasty. Although john adams’s son, john quincy adams, did become the sixth president of the United States (and john quincy adams’s son, charles francis adams, also became a member of Congress and served as the US ambassador to Britain), mccullough thought that this word was somewhat inappropriate.


  "The children and grandchildren of the Adams family have been educated to serve public utilities since childhood. John adams never ignored the call of responsibility, although it was detrimental to his economic income and threatened his life and marriage. "


  Mccullough asked, "Is this a fine tradition of a family? Instill the children with the concept of serving public utilities. " However, if his son did not succeed his father in the White House, would it be more beneficial to the United States? Mccullough doesn’t think so. He said, "john quincy adams is a great man. He is not an important president. He is not the greatest president. But he is not an incompetent president. "


  Mccullough on the other end of the phone raised his voice. "He is the only president who returned to the House of Representatives after retiring from the presidency, which is unprecedented. He struggled with slavery day after day in the House of Representatives, not to mention that he was old and exhausted. He fell down at work forever. "


  Family values tend to be out of date.


  Kennedy said that when john quincy adams became the sixth president of the United States in 1825, the concept of great family shouldering great obligations was somewhat outdated, and it encountered the rise of andrew jackson in the 1820s and the more tolerant "Jackson Democracy", which gave people from humble origins legal rights.


  David Kennedy said: "A politician can be a hillbilly from a remote and backward area who walked out of a legendary cabin. In fact, the cabin has become synonymous with humble origins. " He pointed out that nowadays, candidates from humble origins may speak out the truth. Senator john edwards once said "I am the son of a worker" more than once. Similarly, Barack Obama told an inspiring story about his rise from adversity. Kennedy said, "You can be a member of the Roosevelt family", a rich boy, or a noble family, "but you must be a defender of civil rights".


  As Hess said, the political dynasty in the United States has always been unstable. Many of the founding fathers’ families retired from the stage after playing the role. George Washington has no biological children. His stepson Jackie died of typhus. Similarly, the Jefferson family, Madison family and Lincoln family’s tradition of engaging in politics did not last for many generations.


  Hess said, "It’s not that these families stayed too long. Perhaps a member of the Kennedy family stayed a little too long, but on the whole, they all retired gracefully. If we can look at history through a long enough lens, people will find that the fact is that either they lose interest in us or we lose interest in them, and then they fade out of sight. "


  Is this good for us? Hess said: "In the long run, they treat us well, and we treat them well." That’s about it. Presidents from these recognized dynasties can be found on any list of the top ten presidents listed by historians. Who wants to exclude theodore roosevelt or franklin delano roosevelt or john adams? John F. Kennedy awakened a generation of young activists, while william howard taft’s government was famous for its anti-trust law and postal savings system.


  However, it is undeniable that there are also many backbenchers (ordinary members of the lower house of the British Parliament-this note), and the country can get by without them. President william henry harrison and his grandson Benjamin Harrison are not bad? Today, the Taft family member who has attracted the attention of the national public is Bob Taft, the former governor of Ohio who just left office last year-when he left office, his public support rate was as low as 7% and he was convicted of four misdemeanors.


  In a country with a population of 300 million, the theory of "small resource pool" is no longer applicable, so there are always some factors that make these families still active in politics. You can raise money through relationships. This is an explanation. Political skills learned from my father? Management consciousness-or power desire? The electoral college is more inclined to the noble family?


  In the future, people will make a real historical evaluation of the existing and seeking members of the two political dynasties, Bush and Clinton. At the same time, the twin daughters of Chelsea Clinton and Bush will also be eligible to compete for the White House. (Editor: Liu Ruichang)

Editor: Wang Yuxi

Their hearts are packed in backpacks.

This article is reproduced from WeChat WeChat official account: Medical circles., by Yan Xiaoliu.

"Since the heart can grow, it will certainly be made."

On the second day after the "artificial heart" was implanted, Mr. A, 42, got out of bed and moved. Previously, he was bedridden for many years due to illness, and he had to rely on people to help him eat and bathe.

 

"His recovery is ideal. The ventilator was withdrawn on the first day after surgery. " Recently, Huang Keli, one of the chief surgeons and director of the Heart Surgery Center of Sichuan Provincial People’s Hospital, told the medical community that Mr. A had dilated cardiomyopathy and was in end-stage heart failure.(hereinafter referred to as heart failure). The attending doctor put it on the waiting list for heart transplantation. However, according to its existing heart function, the life expectancy is less than one year. "I’m afraid I can’t wait for the day of transplantation."

Mr. a’s angiography after artificial heart implantation. /Photo courtesy of Sichuan Provincial People’s Hospital

 

The heart is the "engine" of the human body, the atrium is responsible for the whole body blood return, and the ventricle is responsible for pumping blood. End-stage heart failure means that this "engine" is so worn out that it can’t be repaired and may turn off at any time. Almost all heart diseases continue to deteriorate and eventually progress to heart failure.

 

On December 3, 1967, in Cape Town, South Africa, 45-year-old surgeon Christian Bernard.(Christiaan Barnard)Complete the world’s first human heart transplant. A heart of a 25-year-old woman who died in a car accident was implanted in the chest of a 55-year-old man with severe heart failure. Although the male patient died of pneumonia 18 days after the operation, it opened a new era, and the medical community began to try to "exchange hearts for hearts".

 

However, this treatment mode is doomed to be a drop in the bucket. The high cost of surgery and post-maintenance is one aspect. The number of donors and the matching degree are another hurdle for the transplant recipients. In addition, the heart has the shortest preservation time among all transplanted organs. The taken heart is allowed to warm ischemia for only 3-4 minutes, and can only be preserved for 6-8 hours at a suitable temperature. This significantly increases the difficulty of transplantation.

 

According to China Cardiovascular Health and Disease Report 2019, according to the prevalence of cardiovascular diseases in China, the number of patients with heart failure in China is about 8.9 million, and the number of patients with advanced heart failure is nearly 1 million. The number of heart donors in China can’t meet the requirements of heart transplantation in China. The data shows that in 2015-2018, there were 35 nationwide.(excluding Hong Kong, Macao and Taiwan)Since the full implementation of brain-dead heart donation in the heart transplantation center, 1583 cases of heart transplantation have been completed.

 

Huang Keli said with regret: "We have already met two or three patients who are in urgent need of heart transplantation, and they regret to die because they can’t wait for a donor."

 

Only the "very few" who have saved the Milky Way in their previous lives can get this extremely scarce resource and be reborn. And a universal artificial heart that can temporarily or permanently play a substitution role has become the best choice for patients with end-stage heart failure.

 

Professor Christian Bernard became famous for successfully completing the world’s first heart transplant. /Getty Images

 

Artificial heart is not like "heart"

 

Artificial heart is not a new word. In ancient Greek mythology, "Death" Thanatos had an iron core and a copper heart. The absolute protagonist "Iron Man" who saved the modern world is also an immortal superhero created by artificial heart.

 

Modern medicine defines an artificial heart as a ventricular assist device/system that partially or completely replaces the pumping function of the heart to maintain the whole body blood circulation by biomechanical means. In 2013, the American Heart Association(AHA)In the management guide of heart failure, ventricular assist device is listed as one of the optional treatment schemes.


Based on human body structure, ventricular assist devices can be divided into left ventricular assist and right ventricular assist. The device that acts on both ventricles at the same time is described as "total artificial heart" by the medical community.

 

"From the global situation, from June 2006 to July 2018, nearly 25,000 patients received ventricular assist device implantation." Professor Zhou Jianye, deputy director of the Key Laboratory of Regenerative Medicine of Fuwai Hospital of China Academy of Medical Sciences, once told The Paper that there are three main clinical applications of artificial heart, as a transition to waiting for heart transplantation, to win more time for patients to wait for suitable donors; Provide short-term replacement support for patients with acute heart failure, and remove it after cardiac function is restored; To provide long-term replacement for patients with end-stage heart failure and support patients to carry artificial hearts for long-term survival.

 

In Sichuan Provincial People’s Hospital, after multidisciplinary evaluation by the Heart Center, Huang Keli and his team installed the third generation artificial heart for Mr. A. Its core components include an external controller shaped like a backpack, and a metal blood pump like a water pipe tee, which is half the size of a fist.

 

Image source: Photo courtesy of Sichuan Provincial People’s Hospital

 

"The heart is like a pump, which contracts and relaxes day and night to provide power for blood circulation. The purpose of artificial heart is to build an auxiliary flow channel of the heart and help realize blood circulation. The blood pump is connected with the patient’s own heart by two artificial blood vessels. Blood flows from the ventricle through blood vessels and into the blood pump. The impeller in the blood pump rotates to generate centrifugal force, which pumps the blood out and flows into the ascending aorta through the outflow vessel, partially or completely replacing the heart function. " Huang Keli explained.

 

The blood pump is connected to the controller outside the body through a pump cable, and the patient needs to carry it with him. Huang Keli introduced that the controller weighs about 3kg and has a battery pack and a speed control system to provide power.

 

Image source: Photo courtesy of Sichuan Provincial People’s Hospital

 

The "medical field" found that the first and second generation artificial hearts were pulsatile pumps and axial pumps respectively. The first generation of pulsatile artificial heart, also known as positive displacement pump, is bulky and difficult to implant. The volume of the second generation artificial heart becomes smaller, but the impeller speed is high, which may damage red blood cells and coagulation system and easily cause thrombosis.

 

Huang Keli said that the equipment of the third-generation artificial heart is small in size, easy to implant, and generates almost no heat during operation. Because of the non-contact bearing, the core parts can rotate without any mechanical contact with the surrounding components, which reduces the loss caused by mechanical friction. Because the core parts are not in direct contact with blood, the thrombus problem is also obviously improved.

 

It also has some problems, such as high cost, inconvenient carrying, high energy consumption, limited battery life and easy to be affected by external magnetic fields.

 

"The implanted artificial heart can continue to work until a heart transplant is performed. In addition to not being able to swim, patients can live like normal people, walking, showering, working normally and traveling. " Huang Keli told the "medical community" that the first patient in the clinical trial of artificial heart in China has been living with the machine for 3 years. And Mr. A also set a record, which is the first artificial heart officially listed in China.(Left ventricular assist system)Implant surgery patients.

 

Image source: Photo courtesy of Sichuan Provincial People’s Hospital

 

R&D road: full of hardships, not smooth road.

 

"Since the heart can grow, it will certainly be made." This is William John kolff, the "father of artificial organs" and the pioneer of artificial heart.(Willem Johan Kolff)What I said.

 

In 1957, kolff and the 35-year-old Japanese scholar Akitsu Tetsuo.(Tetsuzo Akutsu)Cooperate to develop the world’s first artificial heart. In his manuscript, Akujin said that the idea of research and development began with the imitation of the human heart. "In any case, it is necessary to make the artificial look exactly like the real heart." He filled the office with machine tools, kneaded clay, watered gypsum and cut metal. He works day and night, making all the parts by hand. Finally, the finished product comes out, which looks like a real heart and has four chambers, including left atrium, left ventricle, right atrium and right ventricle. Pulsating flow is generated by using circulating hydraulic pressure.

 

William John kolff (left) and Tetsuo Akujin. /Cleveland Clinic

 

December 12, 1957(It is also said that it was January 1958)With the support of cardiopulmonary bypass, kolff and Ajujin implanted their artificial heart into experimental dogs. After the termination of cardiopulmonary bypass, the artificial heart continued to maintain blood circulation for 90 minutes. In 1958, the relevant experimental results were reported at the fourth meeting of the American Artificial Organ Association.

 

Since then, more and more research teams around the world have tried artificial hearts.

 

In 1969, the United States completed the world’s first biventricular assist device implantation. Denton Arthur Cooley, American doctor(Denton Arthur Cooley)For a 47-year-old man, the "Liotta-Cooley Total Artificial Heart" named after him was implanted.(Liotta-Cooley artificial heart)As a transitional treatment before heart transplantation. This is a pneumatic "artificial heart". With the help of external power, the patient lived on it for 64 hours and then received a heart transplant. 32 hours after heart transplantation, the patient died of Pseudomonas pneumonia.

 

The second case of artificial heart implantation occurred more than 10 years later. In 1981, the surgeon was still Cooley, and the device was an upgraded version with two pneumatic biventricular pumps.(Akutsu-Ⅲ artificial heart). 55 hours after implantation, the patient received a heart transplant. Ten days after operation, the patient died of infection, renal failure and pulmonary complications.

 

These two artificial hearts used by Cooley have not been used in clinic.

 

The picture comes from the Internet.

 

In 1970, the University of Utah introduced Jarvik-7 artificial heart, which is still a pneumatic biventricular pump. On December 2, 1982, the device was first placed in a 61-year-old patient with heart failure. The patient died 112 days after operation. From 1985 to 1991, about 170 patients used Jarvik-7 as a transitional treatment before heart transplantation. During this period, the incidence of sepsis and multiple organ failure was high. In 1991, the US Food and Drug Administration(FDA)Stop the clinical application of the device on the grounds that it does not meet the FDA management terms.

 

After 1990s, Jarvik-7 was innovated and renamed, and was successfully applied in clinic in the United States, Canada and France in 2001. In 2004, FDA approved it as an adjuvant treatment before transplantation. In March 2012, the FDA of the United States used "humanitarian use equipment"(HUD)",approved as the endpoint treatment. HUD is set up for special medical devices, especially those designed to serve a few special patients, which affect less than 8,000 people every year in the United States, and bring benefits that outweigh the possible injury or disease risks caused by use.

 

In 2000, the world’s first fully-built artificial heart came out, including electric pump system.(including 2 artificial ventricles and 4 valves)Control system, battery and transcutaneous energy transmission system(TET)Coil. The electric pump placed in the body passes through TETAnd radio frequency AC system for charging and signal transmission. Because there is no pipeline penetrating the chest wall, the risk of infection of patients is greatly reduced. However, this device is bulky and weighs 900g, which is only suitable for patients with large chest volume. It has not been approved by FDA for more than 20 years.

 

The world’s first all-in-one artificial heart is large and weighs 900g g. /AFP
 

 

"The road to research and development of total artificial heart is full of hardships and needs to overcome many difficulties. Due to serious complications such as infection, bleeding, thromboembolism and biocompatibility after early implantation, the patient died, and many clinical trials of total artificial heart projects were forced to stop. " In 2014, Hu Shengshou, academician of China Academy of Engineering and dean of Fuwai Hospital of China Academy of Medical Sciences, wrote in How Far Is Total Artificial Heart from Us? "wrote.

 

As a result, some researchers who are committed to the research and development of total artificial heart, such as Akujin, turned to single ventricular assist devices.

 

Huang Keli said that the left ventricle is the main power source for pumping blood to the whole body. In many severe cases of heart failure, if the left ventricular problem can be solved, enough cardiac function can be provided.

 

Clinical trials have also found that some patients who use left ventricular assist devices eventually recover to the point where they can live on the original heart without an assist device. The reason is that their overwhelmed myocardium, with the help of cardiac AIDS, gets precious breathing time and finally regains strength. This also saves it from heart transplantation. "After transplantation, patients need long-term and high-dose anti-rejection drugs. This may cause damage to liver and kidney function and increase the risk of malignant tumors. " Huang Keli said that when the ventricular assist device is implanted, the drugs used by patients are much simpler, mainly anticoagulation.

 

The data show that the left ventricular assist device implanted by Mr. A has been worn by patients abroad for 10.5 years.

 

In June 2016, 25-year-old American guy Stan Larkin was widely concerned by the media. He lived for 555 days by using a biventricular assist device, and finally waited for a heart transplant. /Daily Mail

 

Judging from the current situation of technical development, in order to permanently replace the human heart, cardiac auxiliary devices have to overcome many technical difficulties. Including: low anticoagulation or non-anticoagulation, less power requirements, quieter, easy to implant and monitor, longer battery life, no parts outside the body. Eventually, they should become "implanted and forgotten" devices.

 

At present, the combination of artificial heart and regenerative medicine has become one of the mainstream research directions. For example, cells are extracted from patients’ leg muscles, cultured and made into sheets, and then implanted into patients’ hearts together with artificial hearts. Cells will work with the heart muscle. Once the heart function is strong enough, the artificial heart can be taken out and the patient will live on his own heart.

 

The dreams of the pioneers are gradually being realized by later generations.

86 trillion yuan! China bonds are officially included in the Bloomberg Barclays Index.

  CCTV News:Since April 1st, China government bonds and policy bank bonds denominated in RMB have been officially included in the world’s major bond index — — "Bloomberg Barclays Global Composite Index" means that the internationalization of China’s bond market has taken an important step, which is another important milestone for China to integrate into the global financial system after the RMB was included in the IMF’s "SDR basket".

  According to Bloomberg, the specific inclusion of China bonds will be completed step by step within 20 months. In the first month, China bonds will account for 5% of the index, and then it will increase by 5% every month, and it will be fully included in 20 months.

  After being fully included in the "Bloomberg Barclays Global Composite Index", RMB bond assets will account for 6.03% of the total market value of the index, making it the fourth largest monetary bond in this index after the US dollar, the euro and the Japanese yen.

  Data show that China’s bond market is 86 trillion yuan, making it the third largest bond market in the world, among which, international investors hold about 1.8 trillion yuan.

  After China bonds are included in the world’s major bond indexes for the first time, it will attract more and more foreign investors to participate in the China bond market, increase the liquidity of the bond market, and bring sustained and strong allocation power to the domestic bond market. The industry predicts that the full inclusion of the index will bring at least $100 billion in capital inflow to China every year.

  Bloomberg Barclays Global Composite Index

  "Bloomberg Barclays Global Composite Index" is one of the most important fixed income reference benchmarks in the world, and it is one of the three most important bond indexes in the world. The other two indexes are "JPMorgan Chase Bond Index" and "Citigroup Bond Index".

  At present, the total assets covered by the Bloomberg Barclays Global Composite Index are as high as 54 trillion US dollars, and the main currencies of the index components include US dollars, euros, Japanese yen and British pounds.

  China’s bond market is increasingly attractive internationally.

  In recent years, China’s bond market has been continuously opened to the outside world, the channels for foreign investors to allocate China’s bond assets have been gradually broadened, the number of foreign investors entering the market and the transaction scale have increased steadily, and the level of interconnection between domestic and foreign bond markets has been effectively improved, which has made China’s bond market increasingly attractive internationally.

  In the long run, the inclusion of "Bloomberg Barclays Global Composite Index" is the first step for China bonds to be included in the world’s major bond indexes, which also provides an implementation model for the other two major global bond indexes to be included in the China component. Many international experts believe that China’s bond market still has great development potential, and it is expected to attract more overseas investors to allocate bonds in China market in the future. The further development and opening-up of China’s bond market will benefit China and the global economy, including better serving the growth of the real economy and promoting the diversification of global asset allocation.

Tik Tok officially released a music App, and I tried it for everyone.

Original shichao bad review

Recently, a music App called Soda Music, which was officially produced by Tik Tok, has been quietly put on the App Store.

Tik Tok, music App, two elements together, is really curious.

However, soda music is still in the internal testing stage, and poor friends need to get an invitation code if they want to use it.

As it hAppens, Shichao has an invitation code for soda music in his hand, so let’s take a look with you today to see if this music app officially produced in Tik Tok is good or not ~

When you turn on soda music for the first time, you need to pick your favorite music style and favorite song language, so that the App can filter out your favorite songs in a targeted way.

After the selection is completed, you can start listening to the song ~

The song playing interface of soda music can be said to be the same as that of Tik Tok. Simply slide up and down to quickly cut songs, and double-click to add music to favorites.

And Tik Tok’s "housekeeping" algorithm recommendation is also directly copied to soda music.

Compared with other music software on the market, soda music pays more attention to algorithmic recommendation, instead of users’ trouble of actively looking for songs to listen to, and because it follows the interface of Tik Tok, soda music gives people a very clean first impression.

However, as for the songs recommended by soda music, it is not reliable, and Shichao will not evaluate it for a while. After all, algorithm learning requires a lot of learning about your listening habits.

Anyway, according to Shi Chao’s usual experience in using music software, I always feel that some algorithms are somewhat unreliable. After all, it is difficult to accurately quantify the music taste.

After all, many times, the boundaries between musical styles are very vague.

I don’t know if soda music can follow Tik Tok’s excellent algorithm recommendation mechanism and change my prejudice on music App algorithm recommendation.

The regular functions of sharing and music comment area are hidden in the secondary menu of soda music, and you can see them by clicking the comment and share below the song.

Soda music also supports song downloading. If you open VIP, you can choose among three kinds of sound quality: "extremely high sound quality", "high sound quality" and "standard sound quality".

In addition to listening to songs by algorithmic recommendation, soda music also has a discovery column. After opening it, you can listen to the radio station according to your favorite music style, and there is also a song list recommendation.

These functions are also the standard functions of the music App, which is really not new ~

I believe that the poor friends should be most concerned about the music copyright of soda music. At present, the music library of soda music is not complete ~

Shichao searched Jay Chou, and there are only two songs in the music library of soda music. . .

Even some songs that once exploded in Tik Tok were not included in the music library of soda music. . .

For example, the famous song "Wolf disco" by Shichao’s colleagues is only the Tik Tok version in the music library of soda, not the original song of Gem.

There are also some famous musicians’ songs with VIP permission. For example, most of Eason Chan’s songs can only be heard after you have turned on the VIP function.

As far as music library is concerned, soda music is far from enough. After all, in today’s music software market, whoever has copyright and a more comprehensive music library will "master the core technology".

At present, the music library of soda music is far from enough to shake the status of those music software "big brother", but soda music has found its own position from the beginning:

Discover a small group of good songs.

Shichao can translate the meaning of this slogan for everyone: it may be difficult for us to be "just" with mainstream music software in the music library, but we are very confident in our algorithm and will be able to recommend your favorite songs according to your listening preferences.

However, soda music also has its own advantages: soda music and Tik Tok share the same ecology.

After your friends sign up for an account to play soda music, they will be directly related to your Tik Tok, and the attention list and the number of fans will be synchronized.

Poor friends can directly listen to the music collected in Tik Tok Music Library in soda music, and many music bloggers in Tik Tok who are concerned by everyone can also publish their own songs through the platform of soda music.

The function of the software itself is actually less, but it is also an advantage. Compared with other music software on the market, it can be said to be very pure.

As for whether it can play back and forth with other big brothers through the ecology of Tik Tok, it’s really hard to say now.

In fact, the fact that Tik Tok can make music software is natural and expected. It is not difficult to find out that the frequency of brainwashing Divine Comedy in Tik Tok in recent years is really high.

Tik Tok’s ability in music communication is obvious to all.

And after these years of development, Tik Tok has also brought a lot of musicians. It can be said that now they have a unique advantage in music.

In fact, as far as Shichao is concerned, I still look forward to the success of soda music. After all, it must be a good thing for our consumers to have an App on the market.

Original title: "Tik Tok officially released a music App, and I tried it for everyone. 》

Read the original text

Wuling Hongguang PLUS in Dali area is on sale! The latest offer 58,900, if you miss it, there is no

[Autohome Dali Discount Promotion Channel] Good news! In order to give back to the majority of consumers, a strong promotion is being carried out in Dali area. As a practical MPV that is deeply loved by the market, Wuling Hongguang PLUS can now enjoy a cash discount of up to 1,000 yuan. The starting price is already as low as 58,900 yuan, which undoubtedly provides car buyers with a very attractive price advantage. If you want to seize this rare car purchase opportunity, you may wish to click "Check the car price" in the quotation form to get more favorable car purchase conditions.

大理地区五菱宏光PLUS特价出售!最新报价5.89万,错过就没有

The exterior design of Wuling Hongguang PLUS draws elements of fashion and practicality. The front face adopts a unique family-style design. The air intake grille adopts a large-size polygonal shape and is matched with exquisite chrome decoration, which not only enhances the visual impact of the vehicle, but also shows its atmospheric and stable style. The overall lines are smooth and the body proportions are coordinated, showing the dual practicality of business and home use, highlighting the unique charm of Wuling Hongguang PLUS.

大理地区五菱宏光PLUS特价出售!最新报价5.89万,错过就没有

Wuling Hongguang PLUS, with its refined body proportions and practical design concept, outlines a unique side profile. It has a body length of 4720mm, a width of 1840mm and a height of 1810mm, showing a solid body size. The wheelbase reaches 2800mm, ensuring the comfort and flexibility of the interior space. The front and rear wheel tracks are both 1606mm, giving the vehicle a balanced stability. The tire specification is 205/65 R16, with a smooth wheel hub design, which not only enhances the driving performance, but also adds a visual dynamic element.

大理地区五菱宏光PLUS特价出售!最新报价5.89万,错过就没有

The interior design of Wuling Hongguang PLUS is simple and practical, focusing on the combination of comfort and practicality. The plastic steering wheel is used, although it is not a luxury configuration, it is light to operate, and supports manual up and down adjustment to adapt to the driver’s needs. The center console is equipped with a clear and easy-to-read multimedia screen, providing USB interface, including a position in the front row, which is convenient for passengers to charge and data transfer. As for the seats, it is made of fabric material, and the seat cushions and backrests have been carefully designed to provide front and rear and backrest adjustment functions to ensure the comfort of long-distance driving. The rear seats support the overall reclining, so that the interior space can be flexibly adjusted according to needs, which is practical.

大理地区五菱宏光PLUS特价出售!最新报价5.89万,错过就没有

Wuling Hongguang PLUS is equipped with a 1.5T turbocharged engine, which has a maximum power of 108 kilowatts and a maximum torque of 250 Nm, and has 147 horsepower performance. This engine is combined with a 6-speed manual transmission to provide strong and stable power support for the vehicle.

Summarizing the evaluation of Autohome owners, Wuling Hongguang PLUS successfully creates a luxurious and spectacular visual experience with its atmospheric exterior design and spacious space. The owner said that this car not only meets his needs for practicality, but also satisfies his face and impresses others on the owner’s taste and bearing. On the road of choosing Wuling Hongguang PLUS, the owner undoubtedly made a wise decision and hopes that other consumers can experience the same satisfaction.

Strengthen and make good use of county-level media center to improve the efficiency of grassroots social governance

  Author: Ma Xianying (Party Secretary and Director of Beijing Daxing District Media Center)

  Strengthening and making good use of county-level media centers is an important part of the all-media communication system, and it is also an effective starting point for improving the effectiveness of grassroots social governance. General Secretary of the Supreme Leader stressed that it is necessary to do a solid job in the construction of county-level media integration centers to better guide and serve the masses. The Fourth Plenary Session of the 19th CPC Central Committee proposed "to establish an all-media communication system based on content construction, supported by advanced technology and guaranteed by innovative management". The Central Committee of the Communist Party of China’s Proposal on Formulating the 14th Five-year Plan for National Economic and Social Development and the Long-term Target for the Year 2035 clearly puts forward "promoting the deep integration of media, implementing the all-media communication project, strengthening the new mainstream media, and building and making good use of the county-level media integration center". It can be said that strengthening and making good use of county-level media integration centers is related to the high-quality development of media integration, the expansion of mainstream public opinion, grassroots social governance and the long-term stability of the country.

  First, the content construction focuses on grassroots social governance and expands the mainstream public opinion position.

  (A) as a good regional news propaganda "bridgehead"

  County-level media integration centers should seize the greatest advantage of "regionality and intimacy", undertake the mission of news reporting and public opinion guidance within the county, shift the focus of propaganda content to local hot events and people’s livelihood news, take the tentacles of news propaganda at the grassroots level, record the voices of the people from grassroots communities, produce people’s livelihood news that local people like and show the fireworks in grassroots life. "It’s not poetic to find a sentence behind closed doors, but to levy one’s own poem". "We should go deep into life, understand the essence of life among the people, and thoroughly understand the inside story of life. Only by chewing life thoroughly and digesting it completely can it become a profound plot and a moving image, and the works created can stir people’s hearts. " County-level media integration centers should take root at the grassroots level, go deep into life, go deep into the masses and practice, strengthen the excavation and dissemination of local characteristics and excellent culture, open more news columns with local characteristics, produce accurate, short, lively and attractive information, do excellent local propaganda works, create exclusive media integration products, play their unique and irreplaceable role in creating regional cultural identity, and better enhance communication, guidance, influence and credibility. During the epidemic prevention and control period, many county-level media have produced propaganda works that are in line with local conditions, and carried out epidemic prevention and control work in a more grounded content and form, which have played a good role.

  (2) Dig deep into the "reservoir" for collecting people’s feelings and opinions.

  Communication, dialogue and integration have become the future direction of county-level media development in the new era. The masses have individual needs in education, medical care, housing and other aspects, and they also have differentiated expressions for grassroots social governance. County-level media integration centers should do a good job in the ties and channels between party committees and governments and grassroots people, and provide bottom-up and unimpeded channels for the masses to appeal. It is necessary to master the right to guide public opinion, focus on the major policies, central work and major trends of the party Committee and government, face up to the urgent problems of the masses, actively explore and set governance issues, contact government departments to actively dock, solve doubts and solve problems, and gradually form a consensus through continuous dialogue and communication, and jointly negotiate governance decisions. Set up sections and columns such as "hand-clapping", message boards, online letters and visits, online 12345, etc., collect information from all parties, collect people’s demands, gather people’s wisdom, gather people’s strength, collect public opinion, do a good job in giving information and reaching the next situation, guide public opinion and build consensus. Local and county-level media centers have set up all-media political columns, which is to spread the policies of party committees and governments at all levels to every family and everyone through effective means of communication and discourse, and to build a publicity and promotion platform for the work of various departments and units. This is an important duty to serve the overall situation around the center, and it is also an important work for the media to participate in social governance.

  (C) build a "barrage" to ease social sentiment.

  County-level media center should not only be an effective channel to smooth and standardize the expression of grassroots demands, interest coordination and rights and interests protection, but also become an important starting point to ease the masses’ emotions and effectively resolve and solve the contradictions among the masses. During the epidemic period, local county-level media centers grasped the time, degree and effectiveness of public opinion guidance, exerted the credibility of the official mainstream media, increased the authoritative news release, timely released the latest developments of local epidemic prevention and control, strengthened the publicity stage of policy measures, continuously boosted the spirit, gathered strength, effectively eased regional social sentiment, and provided strong public opinion support and information aggregation services for the region to win the epidemic prevention and control war.

  Second, advanced technology empowers grassroots social governance and builds a comprehensive service platform.

  "With the continuous development of the whole media, there are full media, holographic media, all-staff media and full-effect media. Information is everywhere, omnipresent and unused, which leads to profound changes in public opinion ecology, media structure and communication methods, and news public opinion work is facing new challenges." In the era of "everyone has a microphone", technological innovation is the driving force to build "four all" media.

  (A) to create a mobile priority "main force."

  With the continuous development of the information society, news clients and various social media have become the first source of information for many cadres and people, especially young people, and everyone may become the source of information. To take the mass line well in the all-media era, it is necessary to "integrate" the mass line with the Internet in order to turn this "biggest variable" into "the biggest positive energy". County-level financial media must be driven by advanced technology, be good at using the Internet, push the main force into the main battlefield in an all-round way, and play an active role. It is necessary to establish independent and controllable clients, connect various functional departments in the county, continuously broaden the channels of convenience services, and "integrate" the functions of government services, living services, public utility services and localization services through market operation and technical means, effectively embedding them into local medical care, accommodation, education and other areas of residents’ lives. Through the county-level media center, the new era civilization practice center, the government service center, the city command and management center, etc., a comprehensive service platform integrating "information release, government service, supervision and politics, and civilized practice" will be formed, and "one end is in hand, and the world has it all" will build a news end, a life end and a volunteer end that the people in the county can’t live without.

  (B) open up a "test field" for applicable technologies.

  It is necessary to reconstruct the technology layout with users as the center, strengthen the application of intelligent technologies such as big data and user analysis, strengthen the study of user habits and preferences, strengthen the connection between media and users, optimize the user interaction experience, and create more and better interactive platforms conducive to strengthening and innovating social governance. Simplify the process of user participation in social governance and reduce the cost of user participation. County-level media integration centers are constrained by grass-roots funds, technology and talents, so they don’t necessarily pursue big screen, big plane and big technology, but integrate advanced and applicable technologies with platforms instead of embedding fragmented technologies and short-term project construction. We should attach great importance to the construction of various terminals such as network, terminal, micro and screen, and promote the transformation of one-way communication to interactive, service-oriented and experiential scenes. It is necessary to actively connect with provincial platforms, and make good use of the revolutionary achievements of information technology such as 5G, big data, cloud computing, Internet of Things, blockchain and artificial intelligence to drive integrated development. It is necessary to introduce new technologies in a market-oriented mechanism, integrate various resources by relying on provincial media integration systems, focus on short videos, live broadcasts, data news, and truly use new technologies such as AR, robot writing, and big data to create new advantages in all-media communication.

  (C) build a "big stage" to serve the masses.

  County-level media integration centers should adhere to the policy of "opening the door to run newspapers", establish media integration sub-centers and mass propaganda teams, set up a stage for the masses and let them sing operas. All-media publicity such as policy announcement, live broadcast with posts, live broadcast with goods, etc. will be set up around helping enterprises to bail out, helping farmers to increase income, employment in colleges and universities, business environment, etc., so as to aggregate the resources of all sectors of society, meet the needs of the market and users, realize offline contact and online convenience, and realize the organic integration of "news+service+government affairs+business". Make good use of client, user community, online politics and other platforms to contact the masses, strengthen in-depth interaction, attract users to participate in the production and dissemination of news information and other content, provide clues and materials, and share exchange comments. It is necessary to actively change the consciousness of serving social governance, realize the change from "supporting role" to "leading role", solve the problem of nowhere and disorderly expression of public opinion and wisdom of grassroots people, truly realize "I say you listen" and "I say everyone listens" and realize the "last mile" of grassroots social governance. When dealing with major emergencies, especially in the prevention and control of major infectious diseases, it is necessary to construct online and offline channels, collect relevant information and help clues, help solve the practical problems faced by the masses, and strive to provide the people with richer, more efficient and more convenient online and offline integrated services.

  Third, innovate management, improve grassroots social governance, and build a community information hub

  General Secretary of the Supreme Leader pointed out that with the development of the Internet, especially the mobile Internet, the social governance model is changing from one-way management to two-way interaction, from offline to online and offline integration, from simple government supervision to more emphasis on social collaborative governance. County-level media integration centers must innovate the management system and mechanism, and give play to the synergy of the media, so as to truly integrate into the county governance system.

  (A) Weaving a "network" of community collaboration

  Rural community is the basic circle of people’s daily life and public service, the "last mile" of the policy of benefiting the people, and the source of social problems and social contradictions. County-level media integration centers should build a community-oriented public service platform for media integration, establish a network based on community participation, and bring communities, streets, properties, neighborhood committees and residents together to facilitate contact and communication between all parties and enhance mutual understanding. Using technology to provide residents with information around the community, convenience information, life services, etc. on the platform, so that residents’ lives are more convenient and intelligent. Guided by socialist core values, we should focus on theoretical preaching, changing customs and new fashions of civilization, and take the creation of spiritual civilization and voluntary service as the starting point, from "standing by and watching" to "rolling up our sleeves". We should aim at the urgent, difficult and troublesome things of the masses, solve problems in the bud and resolve contradictions at the grassroots level.

  (B) to create a collaborative "circle of friends."

  It is necessary to rely on the service platform, give full play to the role of media integration, enhance the ability of mobilization and organization, establish and improve the inter-departmental cooperation mechanism of various government departments, establish the government information disclosure mechanism, the people’s appeal expression and government response mechanism, and the multi-subject democratic consultation and coordination communication mechanism, so as to realize the cooperation between business departments and propaganda departments, multi-level cooperation in counties and towns, online and offline cooperation, and stimulate the enthusiasm, initiative and creativity of multi-subjects to participate in governance. We will ensure multi-subject consultation and co-governance, realize the multi-subject governance of Shanglian Party Committee and government and Zhongtong, and release it to the public, ensure that the voices of the masses can be actively reflected and given back in time, and enhance the relationship viscosity and collaborative participation and communication ability among multi-subjects.

  (C) the establishment of regional coordination "platform group."

  County-level media integration centers should jump out of the center, face the region and face the future, make a fuss about the word "communication", connect the central media and provincial media antennas, and connect the regional atmosphere, integrate linkage and coordinated development, and constantly improve the linkage mechanism construction. Establish and improve the public opinion guidance and mechanism for major public opinions and emergencies, strengthen the cross-regional news public opinion and social governance cooperation mechanism, hold seminars, organize expert think tanks, and establish regional media-merging alliances, so as to contribute to "media-merging power" for promoting rural revitalization, cultural and tourism exchanges, accelerating the integration and development of economic regions, and realizing regional linkage.

  Media convergence is not only a communication proposition, but also a governance proposition. Strengthening the use of county-level media centers, improving the efficiency of grassroots social governance, and creating an important platform for mass participation and open sharing will help to connect the needs and expectations of grassroots people with the positive actions of party committees and governments, extend services to the grassroots, solve problems at the grassroots level, and consolidate the ruling foundation more effectively and forcefully. This is the foundation of the county-level media integration center.

When a doctor runs a personal clinic, he should calculate the "management" account, general practitioner or development direction.

  News background > >

  A few days ago, National Health Commission and other five departments formulated the Opinions on Promoting the Development of Clinics. The Opinions put forward innovative reform measures such as encouraging qualified doctors to set up specialist or general clinic full-time or part-time. From 2019 to 2020, 10 cities including Beijing, Shanghai, Shenyang, Nanjing, Hangzhou, Wuhan, Guangzhou, Shenzhen, Chengdu and Xi ‘an will carry out pilot projects to promote the development of clinics, and improve the policies on clinic construction and management according to the pilot experience, and promote them throughout the country. In addition, the Opinions also encourage doctors who have been practicing in medical institutions for five years and obtained intermediate or above titles to set up specialized clinics full-time or part-time. Encourage qualified general practitioners, or specialists with the scope of general practitioners, to set up full-time or part-time general clinics. In addition, the Notice on Optimizing the Inter-departmental Examination and Approval of Social Medical Institutions proposes that the facilities of medical institutions below 300 square meters do not need to go through the formalities of fire protection design and completion acceptance; Medical institutions that have little impact on the environment and do not need environmental impact assessment shall implement environmental impact registration form for filing management. Obviously, for clinics, the pace of national promotion is getting faster and faster.

  Reporter survey > >

  If the "Opinions" are implemented, many doctors will "go out" of hospitals to open clinics, and ordinary people can find their favorite experts nearby. So, what are the difficulties for doctors to open clinics? Are doctors willing to run private clinics? What is the current clinic market in Xi ‘an?

  Xi ‘an currently has a certain number of clinics. In 2018, the statistical briefing on the development of health care in Xi ‘an pointed out that there were 2,242 clinics, health clinics and infirmary in primary health care institutions in Xi ‘an. The reporter visited and found that most of these clinics are in residential areas, some are handed down from generation to generation, some are directly employed after graduating from medical school, and even fewer have more than 5 years of experience in public hospitals. The patients who go to the clinic are mainly migrant workers with strong mobility and incomplete medical insurance coverage.

  Clinic case > >

  Yuan Lintian and Luo Laning: Nearly 10 million people have borrowed money to invest, and I believe that they will pay back the money sooner or later.

  Yuan Lintian used to be a dentist in the Stomatological Hospital of Air Force Military Medical University. Yuan Lintian’s lover, Luo Laning, turned out to be a doctor in the reproductive medicine department of Tang Dou Hospital. After the couple switched jobs, they chose their own jobs and started Yuan Lintian Children’s Stomatological Hospital, one in charge of technology and the other in charge of operation.

  "We originally planned the outpatient service with an area of 500 square meters and 6 dental chairs. However, in the process of preparation, it was found that the plan could not meet the high demand of customers for dental care, so the outpatient area increased from 500 square meters to 1100 square meters, and then to 2000 square meters in the stomatological hospital. In order to provide customers with the best technology and services, and constantly acquire the latest equipment, instruments and equipment have also added the latest high-tech products. In this way, I used up all my savings, borrowed several more, and invested nearly 10 million yuan. I didn’t think so much at first, and now I don’t know when I can return the money. However, it is a health industry, and sooner or later the money will be returned. " Luo yanin told reporters that it is really impossible for doctors to open clinics without some economic mind.

  Here, Yuan Lintian strongly disagreed. "No matter where you treat people, the professional ethics of doctors must be kept in mind. There is no hurry about making money." In the eyes of his lover, Yuan Lintian said such a thing at the moment, which is the performance of "I don’t know how expensive the rice, oil and salt are".

  "The hospital has more than 20 people at the beginning, and now there are more than 70 full-time staff. Every month’s salary, social security, and patients’ fixed consumables, water, electricity, rent, etc. require fixed expenditures of millions. "Luo yanin calculated accounts.

  "If I don’t come out of the hospital in the establishment, I will probably be promoted to the top, then I will work for a long time, do scientific research, and finally retire." Yuan Lintian has a new goal-to share his "lifelong learning", so Yuan Lintian’s Stomatological Hospital is not only a specialist clinic, but also a training base. "I went to many private dental clinics to see that their pediatric dental skills are really general, and there are too many needs to be improved. However, doctors have a high threshold for further study and few places, and there are only a few places a year. Most of them are doctors in local basic public institutions. Now I have brought doctors from nearly 200 private dental clinics. How many people will benefit from their studies! "

  Li Jun’s family: The Chinese medicine museum entered tens of thousands in the 1990s, but now it is meager profit to open a clinic.

  Li Jun is now the director of psychiatric outpatient office of Yanta Ganlu Hospital in Xi ‘an, and once worked in a public hospital in weiyang district, Xi ‘an.

  Speaking of doctors’ clinics, Li Jun’s family is the earliest representative of early adopters. Li Jun’s father was a deputy chief physician of traditional Chinese medicine, and worked in several public hospitals successively. Until an accidental opportunity in the 1990s, influenced by the coastal cities of Shenzhen and Guangzhou, Li Jun’s father decided to quit his job and open his own Chinese medicine museum with the encouragement of his wife who worked in the hospital.

  This was definitely a rare thing in those days. "After all, it is a golden rice bowl. Who dares to throw it away?" Li Jun said, "At that time, my dad rented a room near the Bell Tower. Next door was a barber shop selling boiler accessories. My dad’s Chinese medicine museum was among them, but it was also fresh."

  "Are there many patients in such a simple Chinese medicine museum?" In the face of a reporter’s question, Li Jun said, "From this incident of my dad, I can see that if you want to open a clinic, you must have good medical skills. If you want to have many patients every day, you must have a high reputation." Li Jun’s father has accumulated many patients in his medical career for many years, so a large number of patients came here after opening the clinic.

  "Once my dad’s colleagues and friends went to the clinic and saw so many people, they were also moved to give up the golden rice bowl and the whole clinic. However, when I saw that the health fee was entangled with my dad, I immediately retired. " Li Jun mentioned that some people are envious when they see that there are many people in the clinic, but they don’t know that once they start, they need to worry about their own daily business issues, such as industry and commerce, taxation and so on, in addition to lean medical technology.

  Li Junjia’s Chinese medicine museum earned tens of thousands of dollars a month in the 1990s, but now, after removing the expenses such as personnel every month, the remaining money is equivalent to the salary of students who work in other medical schools. "Without medical insurance reimbursement, ordinary people don’t come. With medical insurance reimbursement, the profit is much lower. It can cost a lot to open a clinic by yourself." Therefore, Li Jun believes that in the current era of meager profit, doctors have to calculate an account before opening a full-time clinic.

  Doctor’s opinion > >

  Subject research, promotion of professional titles

  Become a stumbling block for doctors to "start a business"

  Tian Zhufang, director of endocrinology department of Xi ‘an Central Hospital and leader of endocrinology discipline: There is no end to learning, and I will not come out to open a clinic.

  "I am responsible for the development of endocrinology in our hospital, and I am still taking students. I think there is no end to learning, life science is very profound, and there are still many things we need to explore. If I leave the hospital, I think it may be a bit difficult to explore my subject. The people are looking forward to the big experts going to the door to see a doctor, but if the big experts are doing basic health care, will there be no one to overcome the academic difficulties in the future? "

  The reporter asked again, is it ok to work part-time? Tian Zhufang added, "I think it is even more impossible to take a part-time job. When I go to the clinic, I see 80 patients for more than a day, and I have to make rounds every day. I also often have multidisciplinary consultations in the hospital and often have academic meetings on weekends. Don’t say part-time, I’m already working at full capacity. "

  Some young doctors also said that they would not resign. Xiao Zhang has just been promoted as an attending physician, and many non-public hospitals have extended "olive branches" to him, but he is worried: "If you leave the system and the front line of scientific research, will it be difficult to be promoted in the future?"

  Dr. Y, who doesn’t want to be named: The economic pressure is also quite great. I hope to increase some income.

  There are also doctors who have revealed their infinite desire for this policy. "Everyone thinks that doctors are a very decent job, but in fact we are also very helpless. Our salary is not as high as the outside world imagined, but the salary assessment is higher than the outside world imagined. The salary that is often sent to our hands is the same." Dr. Y, who didn’t want to reveal his name, said that at most, his salary can make his family basically live normally, because he took his parents to live together. In the first two years, he borrowed money to change a three-bedroom house. The child will take the college entrance examination this year and get married in a few years. In fact, the economic pressure is quite great, and he doesn’t even say that he has opened an outpatient clinic. If he can practice more openly and part-time, he will feel good.

  Dean of a 3A hospital in Xi ‘an: High-quality medical resources are scarce. I’m afraid there is no spare capacity for part-time doctors.

  A third-class hospital in Xi ‘an has drawn up a statement, mentioning that several well-known experts in the hospital have not been in the outer hospital and other related contents. The fact is that those experts do make house calls outside, once a week for half a day. Then the hospital fixed these experts in the outpatient clinic on weekends. At the time of this incident, the state has issued relevant policies to encourage doctors to practice more. Even if you practice more, opening a clinic part-time is really a "problem" for the managers of large hospitals.

  Some people have no choice but to say that some doctors now practice more or open part-time clinics, which seems to be "stealing chickens and touching dogs". It seems that once they are found by hospitals, they will be afraid of "decapitation". In this regard, the dean of a 3A hospital in Xi ‘an said that he is not narrow-minded as a hospital manager, but only considers the development of the hospital. In fact, at present, the overall quality medical resources are scarce, and people’s energy is limited after all, and their work based on our hospital is stretched. How can there be any spare capacity to do part-time jobs?

  Mr. Z, a neurosurgeon in a public 3A hospital in Xi ‘an: Treatment requires teams and equipment, which is not that simple.

  "I am a surgeon who runs a clinic. I really don’t know what I can do." Mr. Z said, "Western medicine is based on accurate diagnosis, which means that patients have to do a lot of tests. Each piece of equipment is worth tens of millions. How much money do I have to raise to open such a hospital? Moreover, even if the number of patients with different diseases increases year by year, not everyone will get difficult and critical diseases. For example, patients with cerebral hemorrhage are not suitable to come to the hospital during the mild period. If they are found in time through a variety of diagnoses, they can immediately carry out related treatment, regardless of surgical treatment or interventional treatment, they also need teams and equipment. Surgery is inseparable from surgery. There are too many problems such as laminar flow level and disinfection supply in the operating room behind an operation, which is not as simple as I thought. " Speaking of this, Mr. Z also mentioned a more direct problem. If the patient is not rescued in his own hospital, his family will be painful but acceptable. But if you are in the "doctor’s clinic", it is estimated that there may be a "medical trouble".

  At present, the "doctor’s clinic" in Xi ‘an is mainly specialized in stomatology, plastic surgery and traditional Chinese medicine.

  Through investigation, the reporter found that the most popular "doctor’s clinics" are stomatology, Chinese medicine, orthopedics and plastic surgery. Some doctors said that contrary to the market supply of specialized clinics everywhere, the people’s demand for doctor clinics is more in the field of "general practitioners". General practitioners are generally generalists who deal with common diseases, frequently-occurring diseases and general emergencies in the form of outpatient service. As far as the medical needs of ordinary people are concerned, the general practitioner is actually the key role of basic diagnosis and treatment, and it is also the "doctor’s clinic" that everyone needs to increase most.

  The lack of general practitioners or the "pain point" for doctors to open clinics. The "Implementation Plan for Reforming and Improving the Incentive Mechanism for Training and Using General Practitioners in Xi ‘an" was issued at the end of 2018. The "Plan" proposes that by 2020, there will be 2 to 3 qualified general practitioners for every 10,000 residents in urban and rural areas. As far as national big data is concerned, China currently has 1.8 general practitioners per 10,000 residents. Compared with the huge demand, it is far from meeting the daily needs of ordinary people for general practitioners only by policy promotion.

  Reporter’s notes > >

  As long as medical behavior is standardized and legal, it is worth practicing.

  During the interview, the reporter found that there are still many problems that doctors need to understand if they want to open a clinic. Such as "regional health planning" indicators, administrative examination and approval, etc. As far as administrative examination and approval is concerned, the reason why many doctors give up is that the hospital’s "birth permit" is difficult to handle. In fact, the two documents, the Notice on Further Reforming and Perfecting the Examination and Approval of Medical Institutions and Physicians, published in June 2018, and the Notice on Optimizing the Cross-departmental Examination and Approval of Social Medical Institutions, published in January 2019, re-mentioned that the examination and approval and practice registration of medical institutions at level 2 and below are "two certificates in one".

  There is also the problem of promotion of professional titles that young doctors are worried about. In fact, on June 12 this year, the Opinions on Promoting the Sustainable, Healthy and Standardized Development of Social Medical Services issued by the National Health and Wellness Commission proposed that professional and technical personnel of social medical services participate in the evaluation of professional titles as well as professional and technical personnel of public medical institutions, and are not limited by the proportion of posts.

  It is hoped that the hospital can establish a benign mechanism for doctors who are treated differently by the hospital because of "part-time" and "multi-point practice". At the same time, if doctors are allowed to do their job well, they can "part-time subsidize their families".

  For surgeons, it is a bit difficult to open a clinic, but joining a "doctor group" and signing a contract with a big hospital is an effective channel for "flying knife" to be legal and compliant, and it may also be a part-time way more suitable for surgeons. Of course, we also need the support and understanding of the hospital, provided that we do our job well.

  However, regardless of the above form, as long as the medical behavior is standardized and legal, it can meet the needs of patients, optimize the diagnosis and treatment structure, and promote the health of ordinary people, which is worth practicing. Huashang Daily reporter Grace Wai Wong

Source: Huashang. com-Huashang Daily