吉林长春大学第一医院是大医院还是小医院?知道网

明星资讯腾讯娱乐2019年09月16日 23:27:52
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China is a country on the move— especially around its Lunar New Year holiday. This year, the holiday crush promises to be even heavier than before.中国是一个“大迁徙”的国家,尤其是在春节假日左右。今年春运压力可能比以往都要大。Government officials estimate that Chinese people will take to the air, roads and railways 3.62 billion times over a 40-day period around the nation’s most important holiday this year. The total is about 200 million more than last year—nearly three trips per person for this country of 1.3 billion—as people jostle their way home for family gatherings or to indulge their new-found passion for travel.春节是中国最重要的节日,人们纷纷回家团聚或者外出旅行。中国政府官方预测,今年为期40天的春运期间,飞机、汽车、火车的客运总量将达36.2亿人次,比去年多2亿。算下来全国13亿人口平均每人乘车三次。Getting tickets to all those would-be travelers is a daunting challenge that annually tries patience as well as stamina. And it is the railway system that routinely is most unable to cope. Railways are the transport of choice for low-cost long-distance travel, and that’s where the ticketing system routinely falls down.对于春运期间出行的旅客来说,购票无疑是个可怕的挑战,每年都试探着人们耐心和毅力的底线。通常来说铁道系统压力最大,火车是低成本的远距离交通方式,因而火车购票系统经常崩溃。Much of the criticism has focused on the railway’s online purchasing system, which has been unable to keep pace with the huge demand and also failed stop scalpers from ending up with many of the hard-to-find tickets.大部分批评集中在铁道部的在线购票系统上,这一系统无法持巨大的车票订购需求量,还让黄牛有空可乘、卷走大量普通市民难以买到的车票。While insisting that online sales were the fairest way to get tickets in the hands of travelers, rail officials told reporters at the briefing the public needs to be patient. Efforts were being made to provide online identity checks that would reduce the ticket scalping problems.铁道部官方坚持说,在线购票是对旅客来说最公平的方式,同时铁道部在新闻发布会中对记者说旅客要多点耐心,他们正在努力规范网上购票实名登记制度和减少黄牛问题。The rail system stretches across 100,000 kilometers and its pricier high-speed service now boasts some 10,000 kilometers of track. But with high- speed tickets hard to come by, many travelers are left standing in the aisles of the slower trains.铁道系统全国线路长达10万公里,价格昂贵的高铁线路现已拓展至1万公里。但高铁车票难以买到,很多乘客只能坐慢速火车回家。While officials had little good news for rail passengers, they did manage to bring a few smiles to those traveling by car as the country’s notoriously expensive highway tolls will be waived for the duration of the official holiday.虽然政府机构没能给铁路乘客带来什么好消息,但他们的确努力为那些驾车回家的旅客提供便利,规定春节法定假日期间免除贵得出奇的高速公路费。But for those hoping to save a few yuan on the drive to that New Year’s Eve dinner – think again. New Year’s Eve isn’t officially part of the holiday, and if you want to get there on time, you’re going to have to pay.然而对那些想要省点钱、在除夕当天驾车回家吃年夜饭的人来说,先不要高兴得太早。因为除夕当天并非法定假日,如果你想赶上年夜饭的话还是得付高速公路费的。 /201401/2738578. Mosa#39;ab Elshamy. Cairo, Egypt. July 27, 2013.2013年7月27日,埃及开罗,摄影:莫萨·阿布·埃尔莎米I rushed to Rabaa Adaweya square shortly after midnight on July 27th after hearing that security forces were attacking Morsi supporters who had been camped there for two months. Throughout the night I would alternate between the front-line, the makeshift hospital and a room where dead were kept, documenting a level of brute violence and horror I hadn#39;t witnessed until that night. There was a constant stream of ambulances and motorbikes in the camp. The sound of sirens and panicked shouts mixed with that of live ammunition, and the air was filled with tear gas and black smoke.7月27日后半夜,得知安全部队袭击已扎营两月的穆尔西持者时,我立刻赶到开罗解放广场。整个晚上,我往返奔波于前线、临时医院和死亡人员放置所,记录下我前所未睹的残酷暴力与恐怖。营地周围救护车和托车往来不绝。炮火声中,汽笛轰鸣,人群惊慌尖叫。空气中弥漫着催泪瓦斯和滚滚黑烟。Twelve hours later, I put the camera away as I got exhausted and headed back home. On my way out I heard screams and noticed a large group of people. Two men carried a dead young man who had very recently been shot in the head. The man (on the right) was in a state of shock. Unaware that the man he carried was dead, he pleaded for a medic or an ambulance and screamed for God#39;s mercy. I quickly got the camera out and took this photo. It was the last picture I took on that horrific day, but it remains the most memorable.12小时后,我放下相机,筋疲力尽往家赶。路上尖叫声不断,我碰到了一群人,两个男子架着一个头部中弹死去的年轻人。右边的男子神情惊呆,他甚至没意识到自己架着的人已死去,还一个劲儿请求医治他,抬上救护车,求上帝的怜悯。我立刻拿出相机,拍下了这张照片。这是在那恐怖的一天我拍的最后一张照片,但却是最令人难忘的。 /201312/269457

An uproar from hundreds of homeless New Yorkers made it clear that Chinese tycoon Chen Guangbiao can#39;t easily win the hearts of Americans. Now some in China are saying that it#39;s time for the eccentric philanthropist--and his cash--to come back home.数百名纽约流浪汉的恼怒清楚地表明,中国富豪陈光标无法轻松赢得美国人的芳心。现在,中国国内一些人都在说,这位古怪的慈善家――以及他的钱――是时候回国了。Mr. Chen--yes, he of the infamous business card--treated 250 homeless guests to an expensive lunch at Loeb Boathouse in New York City#39;s Central Park on Wednesday. But the recycling magnate backtracked on his plan to hand out 0 in cash to attendees after being told by New York City Rescue Mission officials that the money would be better used by programs treating many of the guests for drug addiction.陈光标――是的,就是连名片都很出名的那位――在纽约市中央公园的洛布船屋请250名流浪汉吃了一顿豪华午餐。但是这位废品回收大王放弃了向现场流浪汉派发300美元现金的计划,因为纽约市援救任务(New York City Rescue Mission)组织的官员此前告诉他,这笔钱更好的用途是为他招待的许多“客人”治疗毒瘾的项目。About three dozen volunteer waiters--many of whom state-run China Daily said were Chinese students studying in the U.S.--showed up donning uniforms similar to those once worn by soldiers in China#39;s People#39;s Liberation Army, bearing the words #39;Serve the People.#39;大约三十多位志愿务员――据《中国日报》称许多是在美国的中国留学生――穿着红军制,衣上面还有 “为人民务”的字样。The event was so popular that some couldn#39;t get inside. Some, angered that they couldn#39;t get in or that they weren#39;t going to get the money they had anticipated, hurled curses like #39;liar#39; and #39;con man#39; at Mr. Chen.这个活动如此受欢迎,以至于一些人都进不去。一些人因为没能进去或是拿到此前预期的钱,生气地对着陈光标大骂“骗子”之类的话。Amid all that hostility, back home, some Chinese are saying Mr. Chen#39;s money would be better spent in his own country.与此同时中国国内的一些人也说,陈光标的钱花在自己国家身上会更好。#39;Was it really worth it? There are still so many poor people in China who need help!#39; one Weibo user. #39;Looks like it was to get famous!#39;一名新浪微(Weibo)用户写道:真是何苦啊?中国还有好多需要帮助的穷人啊!看来是为了出名吧!#39;Come on Chen Guangbiao, don#39;t take your show abroad,#39; another comment. #39;The people in the motherland need you more!#39;另一名用户在中写道:让陈光标来吧,别去国外作秀了,祖国人民更需要你!Others showed empathy for how the whole show went down. One user wrote, #39;It#39;s hard to judge. I don#39;t want to criticize other people#39;s methods if they are doing good.#39;也有其他用户对整个高调宣传的慈善举动如此收场表达了同情。一位用户写道:这难以评判;我不想批评别人做善事的方式。Although many said they saw the event as an elaborate publicity stunt, some of those in New York were less critical. #39;I think he#39;s a good guy and he#39;s helping our country,#39; Antone Hills, a shelter resident, told the Associated Press.尽管许多人说,他们把这场活动视为一场精心安排的作秀,但身在纽约的一些人却没有提出那么强烈的批评。住在简陋房屋中的纽约居民希尔斯(Antone Hills)对美联社(Associated Press)表示,他认为陈光标是一个好人,在向美国提供帮助。Mr. Chen, who made his money in the recycling business, served up a of sesame-seed-encrusted tuna, beef filet and berries with crème fraiche. He topped the event off with his own rendition of the song #39;We Are the World,#39; as well as magic tricks. All this added to his bizarre track record, which now includes trying to buy The New York Times, handing out #39;Fresh Air#39; containers on the streets of polluted Beijing and giving out cash on the streets.陈光标宴请的菜单包括芝麻吞拿鱼、牛排和淋上鲜奶油的浆果。在午宴结束时,他还亲自演唱了《四海一家》(We Are the World),并表演起了魔术。此次宴请是陈光标的又一次另类的慈善和环保行动。之前,他还试图收购《纽约时报》(The New York Times),在北京充满雾霾的街头免费派发罐装新鲜空气,以及在街上撒钱。There was at least one sour commentator on the Chinese blogosphere: #39;Is there something wrong with Chen? Saving money in China for the Americans, to win over Americans politically, to show of philanthropy without borders, I want to curse him, where does he get so much money,#39; one comment.不止一位网友在中国客圈发布了尖酸的。其中一条称:怀疑陈这人有问题,在中国赚钱给美国人发,政治目的讨好美国人,个人目的炫耀做善事无国界,真想骂陈光标煞笔,你哪来这么多钱。Another Weibo user stood up for Mr. Chen as one of China#39;s own. #39;How can they not understand Chen Guangbiao#39;s philanthropy? The funny thing is that you all say you are the backbone of China.#39;另一位微用户力挺陈光标,她说:他们却理解不了陈光标的慈善。但可笑的是这些人都称自己是中国的脊梁!But if there ever was a statement for a man with a net worth of 0 million that the majority might agree on, it was that #39;money can#39;t buy everything.#39;但对于一位身家为7.5亿美元的人来说,大多数人或许都认同的一个观点是“金钱不是万能的。” /201406/308349

  

  Chinese tourists,besotted with image of Paris, find harsher reality沉浸于巴黎美景中的中国游客,遇到了一个令人不快的现实Some Chinese are targeted and attackedby thieves. Others encounter indifference or rudeness, and some vow not toreturn.中国游客成为小偷下手目标。遇到问题时没人理会或受到粗鲁对待,让一些游客发誓决不再去。The New York Times Tourists maps on thePont des Arts in Paris, the No. 1 destination in Europe for China#39;s middleclass and legion of millionaires, who may have unrealistic expectations of thecity.游客站在巴黎艺术桥上查地图。巴黎是中国白领和富豪欧洲游的首选目的地,但这座城市可能会让他们有点扫兴。PARIS— Before arriving in the French capital, WuShuyun, a 56-year-old Chinese housewife, imagined Paris to be like a pristinefilm set for a romantic love story, picturing herself as a glamorous princesssurrounded by elegant Parisians, decked out, perhaps, in Chanel.Instead,Wu from Kunming in southwest China, said she was shocked by the cigarette buttsand dog manure, the rude insouciance of the locals and the gratuitous publicdisplays of affection. Though friends had warned her about thievestargeting Chinese people, she said she was nevertheless surprised when a memberof her tour group was mugged on a packed Metro car, as other riders watched.;For the Chinese, France has always been romantic, mysterious anddesirable. We have been told that #39;God lives in France,; she said recently after a two-week tour that included stops at theEiffel Tower and Galeries Lafayette, an imposing, upscaledepartment store with stained-glass domes where tour buses stop hourly todeposit tourists for marathon shopping sessions.;Once I realized that the Parisians wereindifferent, I made the decision: Try to make the most of this trip, but nevercome back to Paris again.;巴黎-在来到法国首都之前, 56岁的中国家庭主妇吴淑云,脑中的巴黎就像是老电影里描绘的那样是个浪漫之都,认为自己是会像迷人的公主一样被巴黎帅哥环绕,或许还能携手共赴香奈儿。恰恰相反,这位来自中国昆明的吴女士,说她被满地的烟头和便,还有当地人的粗鲁和莫名的热情所震撼。尽管有朋友警告他要注意专门针对中国人的小偷,他说,尽管如此,当他所在的旅游团在挤地铁时,他始终不敢相信,在其他乘客众目睽睽之下他居然被抢。“对于中国人来说,法国一直是浪漫,神秘和美妙的。我们都听说过“神都住在法国”,他说在最近的两个星期游览了埃菲尔铁塔、老佛爷百货商店、这给我留下极为深刻的印象,屋顶光华丽的高档百货公司,那里为了购物方便,旅游大巴每小时还跑一趟。“一旦我知道都是那种视而不见冷漠无情,我决定:去哪旅游,都不再去巴黎了”。Agrowing number of Chinese tourists in Paris — armed withwads of cash, typically unable to speak French and still somewhat naive aboutthe ways of the West after decades of China#39;s relativeisolation — are falling victim to their unrealisticexpectations of the city, while also being victimized by brazen thieves whotarget them because they are easily identifiable as Asian, Chinese tourismindustry officials here say.Alarmthat Chinese tourists are at risk from bandits is so acute that the Chinesegovernment recently considered sending police officers to Paris to help protectthem. Paris tourism officials said the proposal was shelved amid concerns overhow they would operate.TheFrench capital — celebrated for its beauty, culture and savoirfaire — still retains huge allure, making it the No. 1destination in Europe for China#39;s burgeoning middleclass and growing legion of millionaires, according to the European Federationof Chinese Tourism. Nearly 1 million Chinese tourists came to Paris last year,according to the Paris Tourism Office, spending more than 1 billion euros oneverything from Cartier watches to Michelin-starred restaurants, andoutspending both Japanese and Americans on shopping. Now, however, Paris#39; glittering image in China is losing its luster amid reports ofrobberies of Chinese tourists, according to Chinese newspapers and socialmedia.Agroup of 75 French luxury brands, including Louis Vuitton, Chaneland Hermès, warned last year that high-spending Chinesetourists fearful for their safety could choose to go to Italy or Britaininstead. Concerns about the consequences for the country#39;s vaunted tourism industryhave intensified as the French economy has stagnated.巴黎越来越多的中国游客——身揣大量现金,大都不会说法语,远隔西方几十年后,对这里的一些事还有点天真——有些城市让他们大失所望陷于无助。因为他们一副很显眼亚洲面孔,还成为了无耻小偷的下手目标,中国旅游业的官员说道。担忧!中国游客被劫风险呈上升趋势,以致中国政府最近考虑是否要派警察去巴黎保护他们。巴黎旅游局的官员表示,但对于如何执法该提案暂被搁置。法国首都——它以美丽,文化和多变而闻名——依旧散发着的巨大魅力,让巴黎成为中国白领和富豪欧洲游的首选目的地。据巴黎旅游局统计,去年来巴黎的中国游客约有1百万人,他们在诸如卡地亚表,米其林餐厅等其他方面上的花费超过10亿欧元。远超美日游客消费之和。然而现在,中国游客被抢的新闻,让巴黎所散发出的光芒在中国人的心中,慢慢消散,据中国媒体报道。包括路易·威登,香奈尔和爱马仕在内等75家法国奢侈品商,去年警告说,由于这些出手阔绰的中国游客担心自身安全,可能选择去意大利或英国作为代替。国家旅游业担心这个后果会导致本已不景气法国经济进一步恶化。Accordingto the Paris-based European Federation of Chinese Tourism, which represents 30travel agencies catering to Chinese tourists, the number of group tours comingto the French capital has fallen 20 percent so far this year compared with2013. The Paris Tourism Office said that a 21 percent jumpin the number of Chinese tourists last year had nearly halved in 2014.Chinesenerves were aly frayed after a group of 23 Chinese tourists on a tour ofEurope were attacked in March of last year in the gritty northern suburbs ofParis just hours after they landed at Charles de Gaulle Airport. The groupleader was injured, and the thieves fled with 7,500 euros — about ,600 — passports and plane tickets.Aftersix Chinese students studying winemaking were mugged in Bordeaux threemonths later, Beijing demanded that the French government takeaction.Pierre Shi, secretary general of theEuropean Federation of Chinese Tourism, said Chinese visitors were being preyedupon because they were known to carry large amounts of cash to avoid payingmultiple currency exchange fees. Bargain-seeking Chinese tour operators werealso booking hotels in Paris#39;northern suburbs.;Chinese tourists are attracted to Paris by the glamour, by thedesire to buy designer brands, by an image of France as acountry of philosophers and revolution,” said Shi,who runs his own travel agency, ID Travel Pro. “Butnow, they are afraid to come. Before, they wouldn#39;tthink twice.;面向中国游客的由30家旅游企业组成的巴黎中国旅游联合会,据该组织透漏,来法国首都的旅行团的数量同2013年相比下降了20%。巴黎旅游局说,去年中国游客数量增长了21%,而2014年的中国游客不及去年的一半。去年三月,一个由23名中国游客组成的旅行团,在他们降落巴黎北郊的戴高乐机场仅仅几小时后就遭到袭击。带队团长受轻伤,窃贼卷走了7500欧元(约合9600美元),护照以及机票。三个月后,在波尔多,当六名中国留学生被抢之后,北京强烈要求法国政府采取措施。欧洲中国旅游业联合会秘书长,皮埃尔施表示,中国游客成为下手目标,(主要)是因为都知道他们为了省下货币兑换手续费会带着大量现金。中国游客为了省钱还住远离市区的酒店里。“中国游客选择来巴黎旅游,是为了体验其独特魅力、购买名家设计产品,了解这个因哲学家和大革命而著名的国家”,“ID Travel Pro”旅行社老板说道。“以前,人们总是毫不犹豫选择来这里,可现在,他们都不敢来了。”Psychologistswarned that Chinese tourists shaken by thieves and dashed expectations were atrisk for Paris Syndrome, a condition during which foreigners suffer depression,anxiety, feelings of persecution and even hallucinations when their rosy imagesof Champagne, majestic architecture and Monet are upended by the stresses of acity whose natives are also known for being among the unhappiest people on theplanet.Theexpression was first coined 30 years ago by a Paris-based Japanese psychiatrist, Hiroaki Ota,after several Japanese visitors to Paris fell ill when their culture ofpoliteness and reserve rubbed up against Gallic haughtiness.Otasaid in an interview in his office that because China had been closed off tothe West for so long, some Chinese travelers could be at risk for culture shockand depression when faced with the harsher realities of a city they hadover-idealized. But he noted that the Chinese were less susceptible to ParisSyndrome than the Japanese, since they were fortified by a directness and anoutsized sense of self that was similar to the French.;Whereas Japanese are reserved, polite and formal, the Chinese have astrong sense of national pride like the French, and they are not shy,; he said.心理学家警告说,中国游客让小偷和失望折磨得容易患上巴黎恐惧症。当香槟,宏伟建筑和莫奈给他们带来美好印象被颠覆时,该症状就表现出抑郁,焦虑,迫害,甚至出现幻觉,他们会觉得是这个星球之上最不幸的人。首次提出这个说法(病症)的,是来自30年前,驻巴黎一位名叫Hiroaki Ota的日本精神病专家研究出来的。之前,几位到巴黎的日本游客,当他们的礼貌和含蓄碰上高卢鸡的傲慢,就病发了。Ota在他的办公室接受采访时表示,中国隔开西方这么久,当一些中国游客来到一座城市,发现这里的现实和想象中的不一样,这种反差使他们很容易受到(精神)打击而抑郁。但他指出,中国人患上巴黎综合症的要比日本人少,因为他们的坦率和自信,和法国人有点像。“相比日本人内敛,谦逊、呆板。中国人和法国人一样,有一种强烈的民族自豪感,而且都不怕羞,”他说。ThomasDeschamps, the head of research at the Paris Tourism Office, said culture shockwas particularly prevalent among travelers from Asia, who sometimes wronglyperceived the French capital as a museum.;They watch movies like #39;Amélie Poulain#39;; they think allParisians carry Louis Vuitton purses and smell like Dior,; he said. ;They don#39;tknow about the working-class suburbs, the overworked waiters, the grittierparts of the city. Paris is not a museum. People are busy, they are stressed, theyare living their lives.;Tohelp protect and reassure Chinese tourists, Deschamps said, the city has beefedup security at popular sites like the Eiffel Tower and the Louvre, whileinstituting warnings in Mandarin to be vigilant against pickpockets on theParis Metro.TheParis police have also introduced complaint forms in Chinese.Meanwhile,the tourism industry has redoubled its efforts to be more culturally sensitive.An online guide for hotels and businesses produced by the Chamber of Commercefor Tourism in Paris notes that for visiting Chinese, a ;simple smile and hello in their language will plainly please them.;Whilethieves and Gallic aloofness could be a hazard, some Chinese in Paris said theydeserved some of the blame for the French reactions theysometimes provoked.;The Chinese are used to spitting. We are used to snapping ourfingers to get attention, or even yelling,; said Shi,the Chinese travel agency federation chief. ;But if youdo that with a French waiter, they will ignore you even more.;巴黎旅游局研究主管,托马斯德尚表示,对亚洲游客人来说,在文化上所受到的冲击最为普遍,有时他们甚至以为法国首都就是一个物馆。“他们看过奥黛丽·多杜演的电影,就以为所有都挎着路易·威登包,喷着迪奥香水。他说。他们没见乡下的打工族,疲劳的侍者,还有这座城市的真实的一面。巴黎可不是一个物馆。这里的人们都比较忙,都有压力,他们都是为了生存而生活。”为了保护、安抚中国游客,德尚说,城该市已在像埃菲尔铁塔和卢浮宫等热门旅游点加强了安保,在巴黎地铁里还贴出普通话警示标识警惕扒手。巴黎还专门针对中国人设立了投诉站。同时,旅游部门进一步努力加强文化亲和力。巴黎的旅游商会专为中国游客,制作了网上酒店和消费指南,“用他们的话清晰地向他们送上真诚的微笑与问候”。虽然小偷和高卢人的冷漠可能是个祸害,但到巴黎的一些中国游客表示,(一些普通)法国人表现有时也让他们感到很气愤,他们理应该得到赔偿。“中国人吐痰时,我们会提醒他们注意,甚至是去喊”,中国旅行社联合会主席,施说到。“但要是一个法国务员去那么做,他们根本不搭理你。” /201409/332306。

  

  

  Pete Frates can no longer speak. But in the last two and a half weeks, a posted on Facebook by Mr. Frates, a 29-year-old former college baseball player, has inspired people like Bill Gates, LeBron James, Chris Christie and Taylor Swift to dump a bucket of ice on their heads and speak out for his cause.大学时曾是棒球运动员的皮特·弗雷迪斯(Pete Frates)再也没办法讲话了。但在过去的两周半时间里,29岁的他上传到Facebook上的一段视频,促使比尔·盖茨(Bill Gates)、勒布朗·詹姆斯(LeBron James)、克里斯·克里斯蒂(Chris Christie)和泰勒·斯威夫特(Taylor Swift)等人将一桶加了冰的水从头顶浇下,并且发声持他的目标。The “Ice Bucket Challenge” has lit social media on fire, raising both money and awareness for amyotrophic lateral sclerosis, commonly known as Lou Gehrig’s disease. About 30,000 Americans now have the disease, which attacks nerve cells and ultimately leads to total paralysis, though the mind remains sharp. Life expectancy is typically two to five years from the time of diagnosis.“冰桶挑战”这项活动在社交媒体上火了起来,既为肌萎缩性脊髓侧索硬化症(amyotrophic lateral sclerosis,简称ALS)的研究筹集到了资金,又增强了人们对这种病的认识。这种疾病通常被称作葛雷克氏症(Lou Gehrig’s disease)。目前,美国大约有3万人患有ALS,这种病会攻击神经细胞,最终会导致患者彻底瘫痪,但患者的思维仍会保持敏捷。确诊后,患者的寿命通常只有两到五年。(患者俗称“渐冻人”。——译注)The stunt goes like this: People make a of themselves dumping a bucket of ice water on their heads, post it on Facebook, Instagram or other social media sites, and then challenge friends to do the same within 24 hours or donate 0 to ALS. (Many do both.)这项活动是这样的:人们将自己把一桶冰水从头顶浇下的过程拍摄成视频,并上传到Facebook、Instagram或其他社交媒体网站上,然后向朋友发起挑战,让对方在24小时之内做同样的事情,否则就捐100美元(约合620元人民币)用于ALS研究。(很多人既接受挑战,也捐了款。)People have shared more than 1.2 million s on Facebook between June 1 and Aug. 13 and mentioned the phenomenon more than 2.2 million times on Twitter since July 29, according to those sites. Donations to the ALS Association have spiked. As of Sunday, the association said it had received .3 million in donations since July 29, compared with .7 million during the same period last year. It said there were about 260,000 new donors. (With a spate of celebrities and business executives joining in over the past few days and pledging contributions, that number is expected to rise.)从6月1日到8月13日,人们在Facebook上分享了120万个视频。同时,自7月29日以来,这一现象在Twitter上被提到了超过220万次。上述数据分别来自这两家网站。ALS协会(ALS Association)收到的捐款也大幅增加。该协会表示,从7月29日到周日,收到了1330万美元捐款,而去年同期,该协会收到的捐款仅有170万美元。ALS协会称大约有26万名捐赠者是新增的。(鉴于过去几天里,大量名人和企业高管也参与进来并承诺捐款,这一数字预计会上升。)The Ice Bucket Challenge had been making the rounds on the Internet for several weeks before it was tied to ALS. Matt Lauer, the host of N’s Today Show, had water poured over his head on July 15 after being challenged by the golfer Greg Norman.在和ALS联系在一起之前,冰桶挑战活动就已经在互联网上流传了数周。7月15日,在被高尔夫球手格雷格·诺曼(Greg Norman)点名后,N节目《今日秀》(Today Show)的主持人马特·劳尔(Matt Lauer)让人将冰水从他头顶泼下。Mr. Lauer said that he would donate money to the Hospice of Palm Beach County. He challenged Brian Williams, Martha Stewart and Howard Stern.劳尔表示,将捐款给棕榈滩县安养院(Hospice of Palm Beach County)。他向布莱恩·威廉姆斯(Brian Williams)、玛莎·斯图尔特(Martha Stewart)和霍华德·斯特恩(Howard Stern)发出了挑战。In late July, Mr. Frates learned about the challenge from his friend Pat Quinn, a New Yorker who also has ALS, and wanted to turn the trend into a fund-raiser for the disease.7月底,弗雷迪斯从纽约的朋友帕特·奎因(Pat Quinn)那里了解到了这项挑战活动。奎因也是一名ALS患者。弗雷迪斯想把这个潮流转变成一项针对ALS的募捐。Mr. Frates nominated himself for the challenge. Instead of having ice water poured on his head — “ice water and ALS are a bad mix,” he said on his Facebook page — he posted a of himself bouncing his head to “Ice Ice Baby,” the 1989 hit song by the rapper Vanilla Ice. He challenged some friends, and the stunt sp quickly through Boston circles, then across the web until last week when a parade of boldfaced names joined in. (Last week, Mr. Frates again took the challenge, this time having ice dumped on his head at Boston Red Sox’s Fenway Park.)弗雷迪斯点名让自己接受该挑战。在弗雷迪斯上传的视频中,他没有让冰水从头顶淋下——他在Facebook上写道,原因是“ALS患者遇到冰水会有不好的后果”——而是跟着说唱歌手瓦尼拉·艾斯(Vanilla Ice)于1989年推出的热门歌曲《冰酷宝贝》(Ice Ice Baby)的节奏点头。他向一些朋友发出了挑战,这种做法很快便在波士顿多个圈子传开,后来又在网上迅速流传。一众名人上周也加入了进来。(上周,弗雷迪斯再度接受挑战。这一次,在波士顿红袜队[Boston Red Sox]的芬威球场[Fenway Park]里,他让人将冰水从自己的头顶浇下。)“Did we ever imagine the level of awareness or the money that is coming in? In our dreams we did,” said Mr. Frates’s mother, Nancy Frates.“我们以前想象过,人们对这种病的了解,会达到现在的程度吗?想过会有源源不断的捐款吗?想过,但是在梦里,”弗雷迪斯的母亲南茜·弗雷迪斯(Nancy Frates)说。There has been a backlash. Some have criticized the campaign for so-called slacktivism, where people will click and post online for social causes with little actual impact on the cause. “There are a lot of things wrong with the Ice Bucket Challenge, but the most annoying is that it’s basically narcissism masked as altruism,” said Arielle Pardes, a writer for Vice. On Slate, Will Oremus urged people to take the “no ice bucket challenge” and just donate the money.这场风潮也受到了非议。一些人批评,这场风潮只是“懒人公益行动”(slacktivism),人们只是为一项目标在网上点点按钮、发发帖子,但对这项事业本身并没有多少实际帮助。Vice的作者爱丽尔·帕尔戴斯(Arielle Pardes)说道,“冰桶挑战里有很多不妥当的地方,但是最令人反感的一点是,它基本上是把自恋包装成了利他行为。”在Slate网站上,威尔·奥尔穆斯(Will Oremus)敦促人们参加“不玩冰桶”的挑战,直接捐钱。Ms. Frates said that her son, the former captain of the Boston College baseball team, had been “living the life” when he called a family meeting in 2012. He revealed his illness and said that he did not want to whine, but would instead use the diagnosis as an opportunity to positively affect other people’s lives.南茜·弗雷迪斯说,她曾在波士顿学院(Boston College)棒球队当过队长的儿子,此前一直“过着充实的生活”,直到他在2012年召集了一次家庭会议。他袒露了自己的病情,但说自己不想抱怨,而是会把自己的诊断当做一个机会,努力为别人的生活带来积极的影响。The disease has progressed quickly in the past six months. Mr. Frates has lost the ability to move his arms and legs and now communicates through eye-gaze technology, his mother said. He was married last year to Julie Frates, whom he met eight months before he learned that he had ALS. They are expecting a baby in September.过去六个月里,病情发展很快。弗雷迪斯的母亲说,弗雷迪斯已经无法移动胳膊和腿,现在只能通过跟踪眼球运动的技术与人沟通。去年,弗雷迪斯与朱莉·弗雷迪斯(Julie Frates)结婚,两人是在他得知自己患有ALS的八个月前相识的。他们的孩子将于今年9月降生。In a last December, Mr. Frates said: “The story right now goes: You’ve got ALS, have it for a little while, a long while, but either way, the end is always the same. ALS always wins. So in order to rewrite the end of it, we need to raise awareness, money.”在去年12月的一段视频中,弗雷迪斯说:“现在的故事都是这样的:得了ALS,无论患病的时间是长是短,最后的结局都是一样的。ALS总会打败你。所以,为了改写故事的结局,我们需要提升公众的关注,也需要筹钱。” /201408/323329A study found that too much sitting down shortens telomeres, the protective caps which sit at the end of chromosomes.别“坐以待毙”。科学家研究发现,虽然锻炼越多的人往往更健康,但是最重要的因素还是坐着的时间长短。长时间坐着会缩短端粒——染色体末端的保护帽。Short telomeres have been linked to premature ageing, disease and early death. So spending less time on the sofa could help people live longer by preventing their DNA from ageing.端粒缩短会导致早衰、疾病甚至早逝,因此减少坐在沙发上的时间可以帮助防止DNA衰老,延长寿命。The research found that people who were frequently on their feet had longer telomeres, which were keeping the genetic code safe from wear and tear.研究发现经常站立的人,端粒往往更长,可以减少遗传密码磨损。Intriguingly taking part in more exercise did not seem to have an impact on telomere length.一个人坐着的时间越少,他的端粒就越长,他就越可能长寿。有趣的是,多锻炼身体似乎对端粒的长度并没有影响。Prof Mai-Lis Hellenius, from Karolinska University Hospital in Stockholm, said : ;In many countries formal exercise may be increasing, but at the same time people spend more time sitting.瑞典斯德哥尔的卡罗林斯卡医学院的海勒纽斯(Mai-Lis Hellenius)教授说:“在许多国家,正式的锻炼也许越来越多,但同时人们坐着的时间也越来越多。”;There is growing concern that not only low physical activity but probably also sitting and sedentary behaviour is an important and new health hazard of our time.“引起越来越多的担忧的不仅仅是体育锻炼时间少,久坐行为也是我们这个时代新的重大健康隐忧。”;We hypothesise that a reduction in sitting hours is of greater importance than an increase in exercise time for elderly risk individuals.;“我们认为对于早衰人群来说,减少坐着的时间比增加运动时间来得更加重要。”Telomeres stop chromosomes from fraying, clumping together and ;scrambling; genetic code.端粒能够使染色体避免磨损、凝结以及“扰乱”遗传密码。Scientists liken their function to the plastic tips on the ends of shoelaces, and say that lifespan is linked to their length.科学家将端粒的功能比作鞋带的塑料头,称寿命长短与端粒长短相关。Researchers looked at 49 overweight sedentary adults in their late sixties and measured the length of the telomeres in their blood cells.研究人员观察了49名六七十岁的肥胖久坐人士,并测量了血液细胞中的端粒长短。他们中有一半的人参与锻炼计划至少长达六个月,另一半的人则没有参加。Physical activity levels were assessed using a diary and pedometer to measure the amount of footsteps taken each day.研究人员通过记录日记以及使用步程计来测量每天走了多少步,以此来评估锻炼强度水平。The amount of time spent sitting down was worked out through a questionnaire.而坐着的时间则通过调查问卷的方式统计。 /201409/327318

  Washing your face seems pretty simple, yet dermatologists and beauty companies think there#39;s room for improvement.洗脸看起来特别简单,但皮肤科医生和化妆品公司却认为,它还有改进提高的空间。Easy does it is the message experts have for consumers, as a new generation of facial cleansers promises mild formulas that won#39;t dry out the skin. New devices offer deep-clean claims but with a lighter touch. Some doctors even say that people with good skin should wash their face just once a day -- at night.随着新一代洁面产品问世,许诺其温和配方不会使皮肤变干,专家们向消费者传递出这样的信息:洁面别着急,需要放轻松。新产品宣称能够提供深度清洁,而且对皮肤的触碰也更为柔和。有些医生甚至称,皮肤好的人每天只应洗一次脸──在晚上洗。It#39;s a tough sell for consumers familiar with strong formulas that can make skin feel tight and squeaky clean. Many people take that feeling as a sign of effectiveness, when actually it is a signal of overdrying or damage.这个说法很难让那些熟悉强力配方的消费者接受,这类配方能使皮肤感到紧绷和异常洁净。很多人认为这种感觉是产品效果好的表现,但实际上它是皮肤过干或受损的信号。And most people still assume that any skin problem -- whether dull skin, acne or age spots -- can be solved by scrubbing a bit harder. #39;They think, #39;All I need to do is clean it more thoroughly, more vigorously.#39; That#39;s everyone#39;s answer,#39; says Susan Taylor, medical director at Society Hill Dermatology in Philadelphia, and a spokesperson for Johnson amp; Johnson, makers of Neutrogena and Clean amp; Clear skin-care lines.大多数人仍认为任何皮肤问题─不论是暗沉肌肤、痤疮或老年斑──都能通过多用点儿力搓洗来解决。费城(Philadelphia) 索赛蒂希尔皮肤病医院(Society Hill Dermatology)医疗总监、强生公司(Johnson amp; Johnson)发言人、露得清(Neutrogena)及可伶可俐(Clean amp; Clear)护肤系列制造商苏珊?泰勒(Susan Taylor)说:“他们认为‘我唯一需要做的就是更彻底、更用力地清洁它。’那是每个人的。”Most cleansing products have a surfactant, a chemical or natural compound that helps break through the surface tension of the skin. The cleanser absorbs dirt and oil and removes them during rinsing, according to Menas Kizoulis, scientific engagement leader on Johnson amp; Johnson Consumer Cos.#39; Ramp;D team.强生公司消费部研发组科研参与负责人米那斯?伊佐利斯(Menas Kizoulis)说,大多数清洁产品都含有一种表面活性剂,它是一种有助于打破皮肤表面张力的化学或天然合成物。清洁用品会在漂洗过程中吸收并消除污垢和油脂。While removing dirt and oil, the surfactant interacts with the stratum corneum, the skin#39;s outermost layer and protective barrier -- and that is where problems begin. The surfactant can remove the good oils skin produces, resulting in overdrying, Mr. Kizoulis says. And it also can remain in the stratum corneum, exacerbating irritation.在祛除污垢与油脂时,表面活性剂会与角质层发生反应。角质层是皮肤的最外层,也是它的防护屏障──而这正是问题的根源。伊佐利斯称,表面活性剂会祛除皮肤产生的有益油脂,导致皮肤过干。而且它还会遗留在角质层中,加剧对肤质的刺激。Stinging, burning and irritation are #39;actually a sign of harmful stripping of the skin,#39; says Patricia Farris, a Metairie, La.-based dermatologist and a fellow at the American Academy of Dermatology. A compromised skin barrier also makes a person more susceptible to infection and environmental harms, such as pollution. #39;Feeling squeaky clean -- we don#39;t want to go there. It#39;s too aggressive,#39; says Dr. Farris.美国皮肤病学会(American Academy of Dermatology)会员、路易斯安那州梅泰里市(Metairie, La.)皮肤病学家帕特丽夏?法里斯(Patricia Farris)称,刺痛感、灼烧感和红肿“实际上都是皮肤遭到有害剥离的迹象”。皮肤保护层受损还会使人更容易感染,遭到污染之类的环境侵害。法里斯士说:“感觉异常洁净──我们不想干净成那样儿。那太过激了。”Stephanie Samuel, a 28-year-old attorney in Chicago, told her dermatologist, #39;I get the squeaky clean feeling.#39; To which the doctor responded, #39;No! No squeaky!#39; Ms. Samuel now uses a gentle cleanser in the morning and an exfoliating cleanser in the evening.芝加哥28岁的律师斯蒂芬妮?塞缪尔(Stephanie Samuel)告诉她的皮肤科医生说:“我就觉得自己特别干净。”她的医生对此回应道:“不!不要特别干净!”如今,塞缪尔白天使用的是一种温和洁面乳,晚上使用的是一种去角质洁肤露。Facial cleansing has been a growth opportunity for the skin-care industry in recent years, with sales of cleansing liquids, creams, bars and wipes topping .8 billion last year, up nearly 4% from the prior year and more than 7% from 2010, according to Euromonitor International.根据欧睿国际(Euromonitor International)的数据,近些年来,洁面已成为护肤品行业的一个增长点。去年,清洗液、洁肤霜、清洁皂和湿巾的销售额高达18亿美元,比前年增长近4%,较2010年增长超过7%。When the founders of Clarisonic set out to create their first face-cleansing device, there weren#39;t many supporters. #39;Cleansing is the boring step. People don#39;t like to do it,#39; one dermatologist told Robb Akridge, a co-founder of Clarisonic, a unit of L#39;Oreal, and the brand#39;s global general manager. Another dermatologist gave Dr. Akridge this mandate, he recalls: #39;You have to make cleansing sexy.#39;当科莱丽 (Clarisonic)的创始人着手打造他们首个洁面仪时,当时的持者并不多。一位皮肤科医生告诉科莱丽──现在是欧莱雅旗下公司──联合创始人之一、该品牌全球总经理罗伯?阿克瑞芝(Robb Akridge)说:“清洁是特别无聊的事情,人们都不喜欢做。”另一名皮肤科医生也给了阿克瑞芝一项任务,他回忆说:“你必须得让清洗这事儿变得有意思。”The resulting product, a motorized oscillating brush, has renewed consumer interest in the cleansing category, many dermatologists say. The bristles move rapidly back and forth by about a millimeter, which #39;wiggles#39; the dirt out of the pores, Dr. Akridge says.许多皮肤病医师称,针对这个目标生产出来的产品──一种电动振动刷──重建了消费者对洁面的兴趣。阿克瑞芝士说,这些刷毛一毫米一毫米地来回迅速移动,就把污垢从毛细孔中“揪”出来了。It takes only a light touch to use the device. But Clarisonic knew some people would #39;want to push hard, like they are scrubbing the floor,#39; Dr. Akridge said. So it added a stopgap measure: When too much pressure is used, the motor keeps running but the bristles stop moving.阿克瑞芝士还称,在使用这款洁面仪时,只需轻轻触碰脸部即可。但科莱丽料到有些人会“想要使劲按压,就像他们在擦地板一样。”所以它增用了一个权宜之计:当使用者用力过大时,该仪器还会继续运转,但刷毛却停下来不动了。Another source of growth is pre-moistened facial towelettes, or wipes. Ido Leffler, co-founder of Yes to Inc., a line of natural skin-care products, says consumers like the convenience, whether using them at the gym or for a quick cleanse at night. Friends tell him they keep wipes on their bedside table. #39;They get home after a little bit of a big night, a little bit tired and little bit drunk, and remove their makeup using the towelette,#39; Mr. Leffler said. Amy Hart, Yes to product development manager, says the towelettes deliver a different textural feel than washing with water but the same cleanliness.另一个增长源是预湿面巾,或称湿巾。生产天然护肤品系列的Yes to公司联合创始人伊多?莱夫勒(Ido Leffler)说,不论是在健身房使用湿巾,还是在夜间用它进行快速清洁,消费者都喜欢它的便利。朋友们告诉他,他们都会在床头柜上放些湿巾。莱夫勒称:“他们在晚上参加活动后回到家,有点累,还有点醉,就会用面巾纸抹掉脸上的妆容。”Yes to产品研发经理艾米?哈特(Amy Hart)称,与用水洗相比,这些面巾能起到同样的清洁作用,但却能给使用者带来不同的质感。Face washing at night is most important, dermatologists say. It removes dirt, grime and pollutants that have gathered on the skin during the day, as well as makeup. Some doctors say people without a serious skin-care issue, such as acne, can skip the soap and just rinse in the morning.皮肤科医生说,在夜间洗脸最重要。它会清除白天聚集在皮肤上的尘垢、污渍和污染物,还有妆容。有些医生说,没有严重护肤问题(比如痤疮粉刺)的人早上可以不用肥皂,用水冲洗下即可。#39;Your skin has just slept on a pillow, it is clean, it doesn#39;t necessarily need to be washed,#39; said Gervaise Gerstner, a Manhattan dermatologist and consultant for L#39;Oreal Paris. Dry skin from overcleansing is a problem for people as they age, she says.巴黎欧莱雅(L#39;Oreal Paris)顾问、曼哈顿的一名皮肤科医生杰瓦伊斯?格斯特纳(Gervaise Gerstner)说:“你睡觉的时候皮肤只接触了枕头,很干净,真没必要洗。”她还称,等人们老了的时候,那些因为过度清洗引发的干性皮肤就会是一个问题。For men, the biggest face washing issue is which product they use -- or lack thereof. About half of men wash their face solely with water, says Rob Candelino, vice president of marketing for skin care at Unilever, maker of a Dove Men+Care brand. Of men who do use a cleanser, many use a bar of regular body soap, shampoo or whatever else they can find in the shower. Making matters worse, men generally don#39;t moisturize or wear sunscreen every day and so tend to be more susceptible to drying and sun damage, Mr. Candelino says. Alcohol-based products like after-shave can also cause irritation, he says.对于男性而言,洁面的最大问题是他们使用哪款产品──或者少用了哪种产品。联合利华(Unilever)护肤市场部副总裁罗布?坎戴里诺(Rob Candelino)称,约有一半的男性只用清水洗脸。联合利华是多芬男士+护理(Dove Men+Care)品牌的生产商。而那些使用了清洁产品的男性,许多人都只用一块普通的沐浴皂、洗发露或他们能在浴室找到的其他什么东西。让情况更糟的是,男性通常都不会天天给肌肤保湿或涂抹防晒霜,所以皮肤通常更易干燥和被太阳晒伤。坎戴里诺还称,像男士须后水这种含有酒精的产品也会引发红肿。Dr. Gerstner suggests men wash their face with a cleanser in the evening to remove dirt and oil. The morning cleanse -- which often overlaps with the morning shave -- is optional, especially if the skin is feeling dry, she said. To make shaving easier, men can apply a warm, moist towel to the face beforehand to soften the skin and beard.坎戴里诺士建议男性在夜间使用清洁产品洗脸来祛除尘垢和油脂。她说,晨间的清洁工作──常常会和早上的刮脸重合──不是必须的,尤其是如果你感到皮肤干燥的话。为了让刮脸更容易,男性可以事先用一条温暖潮湿的毛巾擦脸来让皮肤和胡须软化。Many Americans, especially teens, prefer cleansers that foam or create suds. #39;They like the sensation,#39; says Cindy Kee, senior brand manager at Cetaphil, a line of gentle skin-care products, both foaming and nonfoaming, from Galderma Laboratories. People also tend to believe foam cleans better, which it doesn#39;t.许多美国人,尤其是青少年更偏爱泡沫型或能产生起泡肥皂水的清洁用品。丝塔芙(Cetaphil)高级品牌经理辛迪?凯(Cindy Kee)说:“他们就喜欢这种感觉。”丝塔芙是高德美公司(Galderma Laboratories)旗下温和护肤系列品牌,包括泡沫型和不起泡产品。人们一般倾向于认为,泡沫型清洁效果更好,但事实并非如此。The urge to scrub is often formed as a teenager, when the skin is producing more oil and breakouts are common. #39;Teens really crave that deep-down-to-the-pores type clean,#39; says Katie Decker, group brand director at Johnson amp; Johnson. The average age of the first breakout is 13. From 13 to 17, girls spend an average of 34 minutes a day on skin care, 11 minutes more than the national average for all women, Ms. Decker says.想要擦洗的冲动通常是在一个人青少年时形成的,这个时期,皮肤分泌了更多的油脂、长痘非常普遍。强生集团品牌总监凯蒂?德克尔(Katie Decker)说:“青少年真的渴望那种深到毛孔内部型的清洁。”人们首次长痘的平均年纪是13岁。德克尔士还称,从13岁到17岁,女生每天平均会花34分钟来护肤,这比全国所有女性花费的平均时间要长11分钟。Acne sufferers are likely to overcleanse, either with harsh products or rough scrubbing. #39;You can#39;t wash the pimples off your face,#39; say Katie Rodan, a dermatologist and co-founder of the Proactiv three-step system, which is owned by Guthy Renker. Many acne cleansers deposit a treatment product, such as benzoyl peroxide or salicylic acid, to kill bacteria and absorb oil.痤疮患者更易进行过度清洁,要么会使用刺激性强的产品,要么会使劲擦洗。高伦雅芙(Proactiv)三步祛痘法联合创始人、皮肤科医生凯蒂?罗丹(Katie Rodan)说:“你不能把你脸上的痘痘洗掉。”高伦雅芙现归高西伦克(Guthy Renker)所有。很多痤疮洗护用品中都含有治疗药物,像过氧化苯甲?或水杨酸,就是为了杀菌和吸油。Exfoliators, which contain particles that scrape dead cells from the surface of the skin, are getting gentler, too. Procter amp; Gamble Co.#39;s Olay brand recently released the Pro-X Microdermabrasion Plus Advance Cleansing System, which it says offers a gentler experience using a device with a motorized rotating brush, a foam head and a one-minute timer.含有能刮掉皮肤表面死细胞的微粒的去角质产品也变得越来越温和。宝洁公司(Procter amp; Gamble Co.) 玉兰油(Olay)品牌近来发布了Pro-X微晶亮肤洁面仪+高级清洁套装(Pro-X Microdermabrasion Plus Advance Cleansing System)。该公司称,使用配有一电动旋转刷、一个泡沫喷雾头和一分钟计时器的洁面仪,它会提供更温和的体验。The need for exfoliation increases with age, as the skin#39;s ability to repair and shed itself slows. #39;You can see visible differences as the skin piles up,#39; Ms. Goodman says.随着年纪的增长,皮肤自行修复的能力减弱,自行脱落的速度也减慢,所以人们对去角质产品的需求会随之增加。古德曼(Goodman)说:“当皮肤皱在一起时,你就能看到这些显而易见的不同。”Many exfoliators contain sharp, jagged crystals made from particles of apricot pits or nuts that can cut into the skin, causing irritation and inflammation, says Laura Goodman, a senior scientist at Pamp;G. The crystals in the Pro-X formula are small, round and made of sodium bicarbonate -- also known as baking soda -- which dissolve during cleansing.宝洁公司高级科学家劳拉古德曼(Laura Goodman)称,很多去角质产品都含有锋利的、锯齿状的晶体,这些晶体由杏仁或坚果的微粒制成,它们会刺进皮肤,引发红肿和炎症。而Pro-X产品配方中的晶体微小圆润,且由碳酸氢钠─也被称为苏打粉─制成,它们在清洁过程中就会溶解。 /201311/266491

  

  A patient with abdominal pain dies from a ruptured appendix after a doctor fails to do a complete physical exam. A biopsy comes back positive for prostate cancer, but no one follows up when the lab result gets misplaced. A child#39;s fever and rash are diagnosed as a viral illness, but they turn out to be a much more serious case of bacterial meningitis. 如果医生没能做好全面身体检查,腹痛病人可能会死于阑尾破裂。前列腺癌活体组织检查结果呈阳性,但却没人跟进,因为实验室结果被弄混了。小孩发烧和出疹被诊断为病毒性疾病,但最后却发现是严重得多的细菌性脑膜炎。 Such devastating errors lead to permanent damage or death for as many as 160,000 patients each year, according to researchers at Johns Hopkins University. Not only are diagnostic problems more common than other medical mistakes -- and more likely to harm patients -- but they#39;re also the leading cause of malpractice claims, accounting for 35% of nearly billion in payouts in the U.S. from 1986 to 2010, measured in 2011 dollars, according to Johns Hopkins. 约翰霍普金斯大学(Johns Hopkins University)研究人员表示,每年有多达16万名病人因此类致命失误而出现永久损伤或死亡。研究人员称,诊断问题比其他医疗失误更为普遍,而且更容易伤害到病人,同时它们也是医疗过失诉讼的主因,按照2011年美元价值计算,它们在1986年至2010年间共计近390亿美元的赔偿额中占35%。 The good news is that diagnostic errors are more likely to be preventable than other medical mistakes. And now health-care providers are turning to a number of innovative strategies to fix the complex web of errors, biases and oversights that stymie the quest for the right diagnosis. 好消息是,误诊比其他医疗失误更容易预防。现在医疗机构开始采用一系列创新措施来纠正失误、偏误和疏忽等妨碍医生做出正确诊断的问题。 Part of the solution is automation -- using computers to sift through medical records to look for potential bad calls, or to prompt doctors to follow up on red-flag test results. Another component is devices and tests that help doctors identify diseases and conditions more accurately, and online services that give doctors suggestions when they aren#39;t sure what they#39;re dealing with. 其中一个解决办法是自动化──用电脑筛查医疗记录从而找出可能的误诊,或提醒医生跟进标有红色警示的检查结果。另一方面是帮助医生更准确诊断疾病和病情的设备和测试,还有在医生对病人病情不确定时给他们建议的网上务。 Finally, there#39;s a push to change the very culture of medicine. Doctors are being trained not to latch onto one diagnosis and stick with it no matter what. Instead, they#39;re being taught to keep an open mind when confronted with conflicting evidence and opinion. 最后还有推动医疗文化的改革。医生受到的教导是不能抓住一种诊断不放,而是应该在面对相互冲突的据和观点时保持开放的思想。 #39;Diagnostic error is probably the biggest patient-safety issue we face in health care, and it is finally getting on the radar of the patient quality and safety movement,#39; says Mark Graber, a longtime Veterans Administration physician and a fellow at the nonprofit research group RTI International. 美国退伍军人事务部(Veterans Administration)资深医师、非营利研究机构RTI International研究员马克#12539;格雷伯(Mark Graber)说:“误诊可能是我们在医疗行业面临的最大的病人安全问题,现在终于纳入到了病人诊治质量和管理运动中。” The effort will get a big boost under the new health-care law, which requires multiple providers to coordinate care -- and help prevent key information like test results from slipping through the cracks and make sure that patients follow through with referrals to specialists. 这些举措在最新的医疗法律下将会得到大大的推进。法规要求多家医疗机构协调护理治疗,并帮助预防检查结果等关键信息被遗漏,确保病人按照医生的推荐去找专家。 There are other large-scale efforts in the works. The Institute of Medicine, a federal advisory body, has agreed to undertake a million study of the impact of diagnostic errors on health care in the U.S. 另外还有一些大规模的举措正在进行中。为美国联邦政府提供咨询的医学研究所(Institute of Medicine)已经同意承担一项100万美元的有关误诊对美国医疗影响的研究。 In addition, the Society to Improve Diagnosis in Medicine, which Dr. Graber founded two years ago, is working with health-care accreditation groups and safety organizations to develop methods to identify and measure diagnostic errors, which often aren#39;t revealed unless there is a lawsuit. In addition, it#39;s developing a medical-school curriculum to help trainees improve diagnostic skills and assess their competency. 此外,格雷伯士两年前创立的改善医疗诊断协会(Society to Improve Diagnosis in Medicine)正在与医疗认机构及安全组织合作,研究确定和衡量诊断失误的方法,通常情况下除非有人起诉,否则误诊是不会公之于众的。另外,协会还在设计一个医学院课程表,帮助学员提高诊断技能并对他们的能力进行评估。 Robert Wachter, associate chairman of the department of medicine at the University of California, San Francisco, says defining and measuring diagnostic errors is an important step. #39;Right now, none of the incentives for improvement in health care are based on whether the doctor made the correct diagnosis,#39; Dr. Wachter says. But equally important, he adds, #39;we need to nurture bottom-up innovation.#39; 加州大学旧金山分校(University of California, San Francisco)医药部副主任罗伯特#12539;瓦赫特(Robert Wachter)说,对诊断失误进行确定和衡量是重要的一个步骤。他说:“目前医疗改善的激励措施没有一项是基于医生是否做出了正确诊断的。”不过他又说,同样重要的是,“我们需要鼓励从下至上的创新”。 That#39;s aly happening. Large health-care systems are mining their electronic records for missed signals. At the Southern California Permanente Medical Group, part of managed-care giant Kaiser Permanente, a #39;Safety Net#39; program periodically surveys its database of 3.6 million members to catch lab results and other data that might fall through the cracks. 创新已经开始。大型医疗系统正在筛查他们的电子记录以查找误诊的迹象。在管理式医疗行业巨头凯泽永久医疗集团(Kaiser Permanente)旗下的南加州永久医疗机构(Southern California Permanente Medical Group),其“安全网”(Safety Net)项目会定期对其数据库中360万名会员进行问卷调查,从而捕捉到有可能被遗漏的实验室结果及其他数据。 In one of the first uses of the system, a case manager reviewed 8,076 patients with abnormal PSA test results for prostate cancer, and more than 2,200 patients had follow-up biopsies. From 2006 to 2009, 745 cancers were diagnosed among those patients -- and Kaiser had no malpractice claims related to missed PSA tests. 在首次使用该系统的过程中,一位病例管理员查到8,076名病人的前列腺癌PSA检查结果不正常,2,200多名病人随后有做活体组织检查。2006至2009年,这些病人中有745人被诊断患有癌症,而凯泽并未接到有关遗漏的PSA检查的过失起诉。 The program is also being used to find patients with undiagnosed kidney disease, which is often found via an abnormal test result for creatinine, which should be repeated within 90 days. From 2007 to 2012, the system found 7,218 lab orders placed for patients with an abnormal test that had not been repeated. Of those, 3,465 were repeated within 90 days of a notice to patients that they needed a repeat test, and 1,768 showed abnormal results. The majority, 1,624, turned out to be new cases of the disease. 该项目还被用于查找患有未被诊断的肾脏疾病的病人。肾脏疾病通常是通过异常肌酸酐检查结果发现的,并且应在90天内进行复查。2007年至2012年,系统发现有7,218张做异常检查的实验室检查单未进行复查。其中3,465单在通知病人90天内需要复查后进行了复查,1,768人呈现异常结果。最后大多数人,也就是1,624人被诊断为患有肾脏疾病。 Michael Kanter, regional medical director of quality and clinical analysis, says the system enables clinicians to go back #39;as far as is feasible to find all of the errors that we can and fix them.#39; 负责质量和临床分析的区域医学主任迈克尔#12539;坎特(Michael Kanter)说,该系统使得临床医师能够“尽最大可能回去查找并弥补所有的失误”。 Because the disease is slow moving, Dr. Kanter says, people with a five-year-old undiagnosed case may not have been harmed. Likewise, with many early prostate cancers, #39;in many of these cases it doesn#39;t mean harm would have reached the patient,#39; he says. #39;But we don#39;t want patients not to have the information they should have had through some kind of lapse in the system.#39; 坎特士说,由于这种病是慢性病,所以五年没有被诊断出来的人可能并不会有大碍。同样的,他说,对于早期前列腺癌来说,“在很多案例中并不意味着病患已经危及到了病人,但我们不想因为系统里的某种过失导致病人对本应知道的信息不知情”。 Electronic records aren#39;t a panacea, of course, and can even lead to information overload. In a survey of Veterans Administration primary-care practitioners reported last March in JAMA Internal Medicine, more than two-thirds reported receiving more patient-care-related alerts than they could effectively manage -- making it possible for them to miss abnormal test results. 当然,电子纪录并非万应良药,而且还有可能导致信息过载。去年3月,在《美国医学会杂志#12539;内科学》(JAMA Internal Medicine)上发表的对美国退伍军人事务部初诊医师所做的一项调查显示,超过三分之二的医师收到的有关看病的通报数量超过了自己所能有效管理的范围──这就有可能导致他们遗漏异常的检查结果。 Some researchers suggest the best solution isn#39;t to flood doctors with information but to provide a second set of eyes to find things they may have missed. 有研究人员表示,最佳的解决办法并不是把海量的信息塞给医生,而是为他们提供第二双眼睛查找他们有可能遗漏的东西。 The focus now is preventing dangerous delays in follow-ups of abnormal test results. In a pilot program, researchers at the Houston VA developed #39;trigger#39; queries -- a set of rules -- to electronically identify medical records of patients with potential delays in prostate and colorectal cancer evaluation and diagnosis. Records included charts that had no documented follow-up for abnormal findings suspicious for cancer after a certain period, according to the research team#39;s leader, Hardeep Singh, chief of health policy and quality at Michael E. DeBakey VA Medical Center in Houston and an assistant professor of medicine at Baylor College of Medicine. 目前的重点在于防止在异常检查结果的跟进过程中出现危险性延误。在一个试点项目中,退伍军人事务部休斯顿分部的研究人员设计出了“触发”查询,这是一套规则,通过计算机确认在前列腺和结肠直肠癌评估和诊断中可能有延误的病人的病历记录。研究小组负责人哈迪普#12539;辛格(Hardeep Singh)表示,记录包括特定时期后对表明有疑似癌症的异常检查结果无正式跟进记载的图表。辛格是休斯顿Michael E. DeBakey VA Medical医学中心医疗政策及质量主任,以及贝乐医学院(Baylor College of Medicine)医药学助理教授。 The queries were run on nearly 600,000 records of patients seen at one VA facility in 2009 and 2010. Dr. Singh says the use of triggers, which helped find abnormal PSA tests and positive fecal occult blood tests, could detect an estimated 1,048 instances of delayed or missed follow-up of abnormal findings annually and 47 high-grade cancers. 2009年和2010年,在退伍军人事务部下属一家医院就诊过病人的近60万份记录得到了这样的查询。辛格士说,使用“触发”查询帮助找到了异常PSA检查和阳性大便潜血检查,每年可以查到约1,048例异常检查结果的后续跟进被延误或遗漏,以及47例重度癌症。 The VA has funded a randomized trial to test whether an automated surveillance system of triggers can improve timely diagnosis and follow-up for five common cancers. 退伍军人事务部资助了一个随机试验,测试“触发”自动化监测系统是否能改善五种常见癌症的及时诊断和跟进。 #39;This program is like finding needles in a haystack, and we use information technology to make the haystack smaller and smaller so it#39;s easier to find the needles,#39; Dr. Singh says. 辛格士说:“这个项目就像是在干草堆中找针,我们利用信息技术让干草堆变得越来越小,这样就更容易找到针。” More health-care systems are also turning to electronic decision-support programs that help doctors rank possible diagnoses by likelihood based on symptoms and notes in the medical record. In a study of one such system, called Isabel, researchers led by Dr. Graber found that it provided the correct diagnosis 96% of the time when key clinical features from 50 challenging cases reported in the New England Journal of Medicine were entered into the system. The American Board of Internal Medicine is studying how Isabel could be linked to assessments of physician skill and knowledge. 越来越多的医疗系统也开始采用电子决策持程序来帮助医生根据症状和病历笔记为诊断结果的可能性进行排序。在一个名为“伊莎贝尔”(Isabel)的程序的研究中,由格雷伯士带领的研究小组发现,刊登在《新英格兰医学杂志》(New England Journal of Medicine)上的50个疑难案例中的关键临床特征输入系统时,系统96%的情况下都给出了正确的诊断。美国内科学委员会(The American Board of Internal Medicine)正在研究如何将“伊莎贝尔”与医师技能和知识的评估联系起来。 Another system, DXplain, developed at Massachusetts General Hospital in Boston, was shown in a study last year to significantly improve diagnostic accuracy among first-year medical residents. 另外一个名叫DXplain的系统是由波士顿麻省总医院(Massachusetts General Hospital)开发的。去年的一项研究显示,该系统能显著增强第一年住院医师诊断的准确性。 Edward Hoffer, associate clinical professor at Harvard and senior computer scientist at Mass General who leads the DXplain program, says the aim now is to have DXplain #39;push#39; diagnostic suggestions to physicians through an electronic-medical-records system rather than requiring doctors to initiate a query, which some are still reluctant to do. #39;We have to focus our attention on dealing with situations where doctors think they know what the diagnosis is, but they don#39;t,#39; Dr. Hoffer says. 负责DXplain项目的是哈佛大学(Harvard)临床副教授、麻省总医院高级计算机科学家爱德华#12539;霍弗(Edward Hoffer),他说,当前的目标是让DXplain通过电子病例记录系统向医生“推送”诊断建议,而不是要求医生发起查询,有些医生仍然不愿意主动查询。霍弗士说:“我们要把重点放在处理医生自以为知道诊断结果、但事实上不知道的情况。” New devices also hold promise for confirming a diagnosis and avoiding unnecessary tests. A number of companies are rushing to provide aids such as portable diagnostic equipment and lab tests that can analyze tiny samples of blood and other bodily fluids quickly to detect disease. 新设备也有望对确认诊断和避免不必要的检查提供帮助。多家公司正加速提供便携式诊断设备和实验室结果等援助,可以帮助分析微小的血样及其他体液,从而迅速发现疾病。 Consider MelaFind, which came to market in the U.S. in 2011. The device allows dermatologists to noninvasively examine moles as deep as 2.5 millimeters beneath the surface to gauge the level of #39;disorganization,#39; an indicator of irregular growth patterns that are a sign of melanoma, among the deadliest cancers. 以2011年进入美国市场的MelaFind为例。皮肤科医生可使用该设备无创检查在皮下深达2.5毫米处的痣,从而检测“组织破坏”的水平。“组织破坏”的水平可反应不规则生长模式,不规则生长模式是黑色素瘤等最致命癌症的迹象。 New York dermatologist Macrene Alexiades-Armenakas says she uses MelaFind to confirm that a mole is to be removed and prioritize the level of disorganization in multiple abnormal moles. In some cases, when another doctor or the patient has been concerned about a mole, MelaFind supported #39;clinical diagnosis of a benign mole, thereby sparing them a biopsy,#39; she says. 纽约皮肤专家麦克兰纳#12539;亚历克西亚德斯-阿门内卡斯(Macrene Alexiades-Armenakas)说,她用MelaFind实某颗痣是否需要去除,以及对多颗异常痣的“组织破坏”水平进行排序。她说,有时候,当其他医生或病人对某颗痣表示担心时,MelaFind会持“良性痣的临床诊断,从而让他们省去了活体组织检验的程序”。 But such devices will never replace a thorough physical exam with a trained eye and careful follow-up, says Dr. Alexiades-Armenakas: #39;These diagnostic tools are aids to increase our accuracy and adjuncts to good physical diagnosis, not a substitute.#39; 亚历克西亚德斯-阿门内卡斯士说,不过这样的设备永远替代不了全面的体检以及训练有素的眼睛和仔细的后续跟进。她说:“这些诊断工具是提高准确性和好的检体诊断的辅助手段,而不是替代手段。” Some efforts to cut down on errors take a different route altogether -- and try to improve diagnoses by improving communication. 有些尝试减少失误的措施则走的是完全不同的路线──尝试通过改善沟通来改善诊断质量。 For instance, there#39;s a push to get patients more engaged in the diagnostic process, by encouraging them to speak up about their symptoms and ask the doctor, #39;What else could this be?#39; At Kaiser Permanente, a pilot program provides patients with a pamphlet that encourages them to think about and write down their symptoms and what concerns or fears they have, encouraging them to ask specific questions to be sure they understand their diagnosis and the next steps they must take. 例如,有的机构在促使病人在诊断过程中更积极主动,鼓励病人说出自己的症状并且询问医生:“这还会是什么病?”凯泽永久的一个试点项目为病人提供小册子,鼓励他们思考并写下自己的症状以及他们的担忧或恐惧,鼓励他们提出具体的问题,从而确保他们理解自己的诊断结果以及下一步需要采取的步骤。 Medical schools, meanwhile, are teaching doctors to be more receptive to patient input and avoid #39;anchoring,#39; the habit of focusing on one diagnosis and excluding other possible scenarios, and #39;premature closure,#39; not even considering the correct diagnosis as a possibility. 与此同时,医学院也在教导医生们更加虚心听取病人的意见并避免“锚定”,即习惯集中在一种诊断上,不考虑其他可能的情形,还要避免“过早下结论”,即根本不把正确诊断作为一种可能性进行考虑。 The Critical Thinking program at Dalhousie University in Halifax, Nova Scotia, established last year, aims to help trainees step back and examine how biases may affect their thinking. Developed by Pat Croskerry, a physician known for his research on the role of cognitive error in diagnosis, it uses a list of 50 different types of bias that may lead to diagnostic error. 加拿大新斯科舍省哈利法克斯(Halifax)的达尔豪斯大学(Dalhousie University)去年创立了批判性思考项目。该项目旨在帮助学员退一步思考,审视偏误会对自己的思维有何影响。该项目由帕特#12539;克罗斯克里(Pat Croskerry)开发,他是一名以研究诊断过程中认知错误的影响而闻名的医师。项目列出了50种不同种类可能导致诊断失误的偏误。 The program is being integrated throughout four years of the medical school. Students study cases such as a psychiatric patient with shortness of breath who was assumed to be merely having an anxiety attack; doctors overlooked that she was a smoker on birth-control pills, a risk for the blood clot that later traveled to her lung and killed her. 该项目被整合到了达尔豪斯大学医学院的四年制教学中。学生们会学习很多案例,比如呼吸短促的精神病人被认为只是焦虑发作,医生没注意到她是用避药的吸烟者,这导致她体内产生血块,随后血块到了肺里,最终令她丧命。 #39;If we can teach physicians how to think more critically,#39; Dr. Croskerry says, #39;they would be more effective in delivering good care and arriving at the right diagnosis.#39; 克罗斯克里士说:“如果我们教会医生们如何以更批判性的思维思考,他们就会更有效地给病人看病并做出正确诊断。” /201312/268156

  

  

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