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惠州少精症的治疗费用是多少医护典范惠州做包皮过长好的医院

2019年11月22日 20:50:44    日报  参与评论()人

惠阳医院前列腺炎多少钱惠州原发性早泄治疗费用Stephanie Falk and her husband like smoothies from Jamba Juice. But the San Diego-based couple boycotted the chain for several months last year because it served its drinks in plastic foam cups.斯蒂芬妮#12539;福尔克(Stephanie Falk)和她的丈夫都喜欢Jamba Juice的奶昔。但是这对来自 地亚哥的夫妇去年连续数月拒绝购买这家连锁店的饮料,因为店里用泡沫塑料杯盛装饮料。#39;It#39;s the biodegradable factor. There#39;s no excuse. Everybody knows better,#39; said Ms. Falk, who like her husband is a wedding photographer.“我们考虑的是生物降解。店家不该找借口。所有人都明白这一点,”福尔克说,她和丈夫都是婚礼摄影师。Now, though, Jamba Juice Co. and several other food chains are starting to serve the same drinks in paper cups. Ms. Falk is a fan; her drink stays just as cold in Jamba Juice#39;s new doubled-walled paper cup, she said.而现在Jamba Juice和其他几家连锁餐厅都开始改用纸杯装饮料。福尔克表示持,她说她的饮料在Jamba Juice的新双层纸杯里同样清凉。The paper industry likes it a lot too. Production of white copy paper and other forms of #39;uncoated#39; paper has fallen about 38% since 1999, while demand for paper cups is growing as much as 5% a year, according to industry analysts. Environmental concerns from consumers and new bans on plastic foam in more U.S. cities are prompting food chains to make a switch.造纸行业对此也非常持。行业分析师表示,1999年以来,白色复印纸以及其他“裸”纸的产量下降了约38%,而纸杯的需求量则以每年5%的幅度递增。消费者对于环保的考量以及美国越来越多城市对于泡沫塑料的禁令促使连锁餐厅做出改变。Jamba Juice said last year it would adopt paper cups for its smoothies and other cold drinks #39;to improve our environmental footprint.#39; McDonald#39;s Corp. is replacing plastic foam cups with McCafe paper cups at all 14,000 McCafes across the country. The company says it is trying to be more environmentally conscious and cut costs on trash. Dunkin#39; Brands Group Inc. has said it is testing paper cups.Jamba Juice去年表示,他们将采用纸杯来装奶昔和其他冷饮,“以改善我们的环境记录”。麦当劳公司(McDonald#39;s Corp.)正在将全美14,000家麦咖啡 (McCafe)的泡沫塑料杯替换成纸杯。该公司表示,他们现在更加注重环保并缩减垃圾处理开。Dunkin#39; Brands Group Inc.说他们正在试用纸杯。These companies join Starbucks Corp. and some other chains that have been using paper cups for years. Production of paper used to make cups has risen about 16% over the past five years in the U.S., according to industry group American Forest and Paper Association.这些公司加入了星巴克等多年来都在使用纸杯的连锁店的行列。行业组织美国林业与纸业协会(American Forest and Paper Association)的数据显示,过去五年美国用于制造纸杯的纸类产量上升了约16%。Hoping to take advantage of the growth in demand, International Paper Inc. plans to double the size of a paper-cup manufacturing facility it runs in Kenton, Ohio. The company is coming up with new cup designs--like one aly in production that is fully biodegradable with a plant-based lining--and aggressively marketing the benefits of paper to potential customers.为了迎合这种增长的需求,International Paper Inc.计划将位于俄亥俄州肯顿(Kenton)的纸杯生产设备规模扩大一倍。该公司将推出新的纸杯设计,例如已投产的一款可完全降解的纸杯,内层采用植物原料;他们还努力向潜在客户营销,强调纸杯的优势。Paper cup and plate production volume is equivalent to about a quarter of the volume of the U.S. copy-paper market, according to consulting firm Fisher International Inc., which specializes in data on the pulp and paper industry.咨询公司Fisher International Inc.专长于纸类和纸浆行业的数据分析,其数据显示,美国纸杯和纸碟的产量相当于复印纸产量的四分之一。Still, #39;It seems like a moment in time where the big brands are choosing to take a public position for sustainability,#39; said Michael Lenihan, director of sales and customer relations at International Paper. Food businesses #39;are now recognizing it as a brand opportunity on a much broader scope.#39;不过,“似乎现在大品牌都选择站在公众立场来关注可持续发展”,International Paper 销售与客户关系总监迈克尔#12539;勒尼汉(Michael Lenihan)说。食品行业“如今在更广的层面上将其视为品牌的发展机遇”。Environmental advocates say paper is easier on the environment than plastic foam because the latter tends to break up in landfills and then is mistaken by animals for food. Plastic foam is difficult to recycle unless it is kept clean and separated from other types of plastics--so many plants in the U.S. don#39;t take it. It isn#39;t biodegradable.环保者表示纸杯比泡沫塑料杯更有利于环境,因为后者会在填埋时碎裂而被动物误以为食物。泡沫塑料很难回收,除非它仍然干 并且和其他类型的塑料分离,所以美国的许多回收站并不接受它。它也无法进行生物降解。Such worries led San Francisco in 2007 and Seattle in 2009 to ban plastic foam, instead requiring food vendors to provide compostable or recyclable to-go containers. Other West Coast cities have followed suit, and New York#39;s City Council voted to ban plastic-foam containers in December unless the industry can prove it is recyclable.出于这样的担忧,旧金山在2007年、西雅图在2009年禁止使用泡沫塑料,而要求食品销售者提供可分解或者可循环使用的外带容器。其他西海岸的城市紧随其后,纽约市议会2013年12月投票禁止使用泡沫塑料容器,除非业者能够明泡沫塑料可以回收。#39;Customers are still trying to figure out how prevalent this is going to become,#39; says Alec Frisch, vice president and general manager of Georgia-Pacific LLC#39;s beverage category, which produces a range of paper cups, including double-walled and plastic-coated paper cups.“消费者仍在关注此类措施的普及情况”,乔治亚#12539;太平洋公司(Georgia-Pacific LLC)负责饮品类的副总裁兼总经理亚力克#12539;弗里施(Alec Frisch)说。该公司生产各种纸杯,包括双层纸杯以及外层覆有塑料的纸杯。The plastic-foam industry disputes the notion that foam is less environmentally friendly, chalking it up to misinformation. #39;I think there are a lot of misconceptions around polystyrene foam versus paper,#39; said Keith Christman, managing director for plastics markets at American Chemistry Council, which represents the industry. Foam is #39;composed 95% out of air, so you use less material in the first place making it.#39; That also results in less energy use and less bulk waste, he added.泡沫塑料行业对于产品不环保的观点并不认同,认为这是误传。“我认为人们在将泡沫塑料和纸比较时存在许多误解,”行业协会美国化学理事会(American Chemistry Council)塑料市场运营总监基思#12539;克里斯特曼(Keith Christman)说。泡沫塑料“95%由空气组成,所以在最初的生产环节可节省用料”。这也减少了能耗以及废料体积,他补充道。A survey commissioned by the ACC shows that in the 50 biggest U.S. cities, about 16% of the population is able to recycle food-service items made out of foam, compared with about 10% for paper.美国化学理事会开展的一项调查显示,在美国前50大城市中,16%的人会回收泡沫塑料制成的食品容器,相比之下纸制的回收率为10%。Indeed, paper cups aren#39;t as environmentally friendly as they seem. Only about 11% of recycling plants in the U.S. currently can recycle them, according to the American Forest and Paper Association, because they are typically coated in plastic or have beverage residue. The lack of an #39;easily recyclable cup designed for hot beverages#39; is one reason Dunkin#39; Brands is still weighing whether to switch to paper, Karen Raskopf, chief communications officer, said.事实上,纸杯并不像看起来那样环保。美国林业及纸业协会的数据显示,目前美国只有约11%的回收站能够回收纸杯,因为它们通常有塑料覆膜或者有饮料残留。缺少“适合热饮的易回收的纸杯”是Dunkin#39; Brands仍旧在权衡是否换为纸杯的原因之一,首席公关卡伦#12539;拉斯科普夫(Karen Raskopf)说。#39;At this point, we don#39;t know if our end solution will be paper or another material,#39; she added.“现在我们还不知道最终解决方案会是纸还是其他材料,”她补充道。Paper cups are slightly more expensive than foam, usually by a couple cents. Extras like double walls for insulation or plant-based lining to make it compostable add to the price.纸杯比泡沫塑料一般贵几分钱。像双层隔热的或者内层为可分解植物材料的纸杯价格更高。McDonald#39;s has been using double-walled paper cups--which have a small pocket of air between them to increase insulation--at about 2,000 restaurants along the West Coast since 2012. Now it is expanding into the Midwest and parts of the East Coast, says Ian Olson, director of sustainability.麦当劳从2012年起在美国西海岸的约2,000家餐厅使用双层纸杯,两层之间有空隙可容纳空气从而增强隔热效果。如今使用范围扩展到了中西部以及东海岸部分地区,可持续发展总监伊恩#12539;奥尔森(Ian Olson)说。While the paper cup is more expensive, McDonald#39;s says it will make up the difference in the trash. Most of the chain#39;s waste is paper-based--think wraps, fry cartons and Big Mac boxes--so paper cups can go into the same trash bin, and eventually into recycling bins.麦当劳表示,尽管纸杯更贵,但它在垃圾处理方面的优势可以补偿其高价格。这家连锁餐厅的大部分垃圾都是纸制的――比如包装纸、薯条盒和汉堡盒――所以纸杯可以放入相同的垃圾桶,最终进入回收桶。The main challenge for food companies is to find a cup that functions as well as plastic foam and doesn#39;t cost the consumer more, said Bonnie Riggs, a restaurant industry analyst with consumer market research firm NPD Group. #39;I think it really doesn#39;t matter if it keeps everything hot and keeps everything cold and consumers don#39;t have to pay extra for it,#39; she said.食品公司面临的最大挑战是找到一款和泡沫塑料功能相同又不增加成本的杯子,消费者市场研究公司NPD集团的餐饮业分析师邦尼#12539;里格斯(Bonnie Riggs)说。“我认为只要能保冷保热,而且消费者不用额外付钱,什么样的杯子都没关系,”她说。 /201405/295041惠阳区妇幼保健人民中医院男科专家 This may be a statement of the obvious at Christmas, but our families can sometimes let us down. Evidence comes from a little-noticed survey published by the US Census Bureau in September.我们的家庭有时会让我们失望。美国人口普查局(US Census Bureau) 2013年9月发布的一项调查为这一观点提供了明,不过没引起多少关注。The findings are conveyed in a sad and simple graph. It reports a survey of “households experiencing hardship” in 2011 - and who helped them when times were tough. What counted as tough times? Having a phone disconnected, missing utility bill payments, falling into rent or mortgage arrears, or not seeing a doctor or dentist when needed.该项调查针对2011年“经历困境的家庭”,以及陷入困境时得到过谁的帮助,调查结果通过一幅简单而令人悲哀的图表呈现。那么怎样算是陷入困境呢?电话停机,漏缴公用事业账单,拖欠房租或房贷,或者生病了看不起医生或牙医。More than half of such households expected help from family members, as did almost half from friends. Rather fewer - about a fifth - hoped for help from a social agency, charity or church.一多半家庭期望得到家人的帮助,还有近一半则指望朋友帮助。只有很少一部分家庭(大约五分之一)希望得到社会机构、慈善团体或教堂的援助。The overwhelming majority were disappointed. It was rare for family members to provide help with rent arrears - about one time in six - and it was rarer still to receive financial help from other sources or for other purposes.结果绝大多数家庭的希望都落了空。家人极少帮忙付租金(大约六分之一),而从其他来源(或者为了其他目的)获得资金援助就更加罕见了。In short, hard-up Americans were confident of help in need from those close to them - and that confidence was misplaced. (If you#39;re looking for an explanation of the popularity of payday loans, this finding isn#39;t a bad start.)简言之,手头拮据的美国人相信能从亲友那儿得到帮助,但这种信任是没有根据的。(如果你想了解“发薪日贷款”为何如此流行,不妨从这份报告入手。)An optimistic ing of this research is that there are plenty of people whose families or friends did help them and thus never featured in the sample. Perhaps.这份研究当然也不乏乐观解读:也许有许多人得到了亲友的帮助,因此根本不在调查对象之列——或许吧。But as the economist Timothy Taylor comments, enough people experience disappointment to leave “lasting shadows”.但正如经济学家蒂莫西#8226;泰勒(Timothy Taylor)所言,生活中有太多人经历深切失望,这种失望给他们留下“持久的阴影”。This dispiriting stuff reminded me of Mark Granovetter#39;s work on “the strength of weak ties”, published in 1973. Granovetter, a sociologist, brought together two disparate strands of work: a survey of how people with professional or managerial jobs had found those jobs; and a theoretical analysis of the structure of social networks.这种令人沮丧的现实让我想起马克#8226;葛兰诺维特(Mark Granovetter)在1973年发表的《弱纽带的力量》(the strength of weak ties)。葛兰诺维特是社会学家,他将两项不相干的研究拉到一起:一个是关于人们怎样找到专业或管理工作的调查;另一个是对社会关系网结构的理论分析。Start with the theoretical observation first: the most irreplaceable social connections, paradoxically, are often rather weak or distant ones. A family group or clique of close friends all tend to know each other and know similar things at similar times. Their social ties are strong but also redundant, in the sense that there are many different paths through which information could pass from one member of that group to another.先谈理论观察:最不可取代的社会关系(听上去有点矛盾)往往是相当薄弱或者遥远的关系。家族或朋友圈成员倾向于在圈子内互相结交,他们在同一个时期知道的事情也大致相同。这种社会纽带虽强但也累赘,也就是说,信息在这些圈子内部的传播渠道非常多。By contrast, “weak ties” between one social cluster and another are valuable precisely because the social contact is unusual. Information passed along a weak tie will often be totally new - and if it doesn#39;t arrive through the weak tie, it is unlikely to arrive at all.与此形成反差的是,不同社会群体之间的“弱纽带”有价值,正是因为这样的社会联系不寻常。通过弱纽带传递的信息往往是全新的——换言之,如果不通过弱纽带,新信息可能压根传递不过来。Granovetter then supplemented this theoretical idea with his survey, showing that it was very common for people to find jobs - especially managerial jobs and jobs with which they were satisfied - through personal contacts. The old saw is true: it#39;s not what you know, it#39;s who you know. Or as Granovetter put it in his book Finding a Job, what matters most is “one#39;s position in a social network”.葛兰诺维特接着通过自己的调查对上述理论进行补充。调查显示,人们常常通过个人关系找到工作(尤其是管理工作,或者是称心如意的工作)。老话说得对:知道什么不重要,认识谁才重要。或套用葛兰诺维特在其著作《怎样找工作》(Finding a Job)中的说法,最重要的是“一个人在社会关系网中的位置”。But this is not because of crude nepotism: the key contacts who helped job-seekers find jobs were typically distant rather than close friends - old college contacts, perhaps, or former colleagues. Granovetter#39;s analysis made this finding make sense: it#39;s the more peripheral contacts who tell you things you don#39;t aly know.但这不同于裸的裙带关系:帮助求职者找到工作的关键联系人,一般关系并不密切,算不上老同学、前同事等密友。葛兰诺维特的分析为调查结果提供了合理的解释:比较的联系人才能提供你不知道的信息。More recent research - for instance, a “big data” analysis of millions of mobile phone records conducted by Jukka-Pekka Onnela, Albert-Laszlo Barabasi and others - has backed up Granovetter#39;s argument that the weaker ties are the vital ones.就拿最近一项研究为例,尤卡-佩卡#8226;翁内拉(Jukka-Pekka Onnela),奥尔贝特-拉斯洛#8226;鲍劳巴希(Albert-Laszlo Barabasi)等人分析了数以百万计的手机通话记录,用这些“大数据”对葛兰诺维特的观点提供了持,即弱纽带才是必不可少的。 /201401/273666仲恺新区治疗早泄哪家医院最好

陈江医院是公立的惠阳区医院治疗龟头炎哪家医院最好 Brazil doesn’t celebrate Thanksgiving. But it does celebrate another form of giving; uniquely American in its frenetic, media frenzied salute to the holidays: good ole Black Friday.巴西不庆祝感恩节。但是这个国家确实会用另一种形式来庆祝感恩节;以巴西特色的狂热,媒体的谄媚,来向美好的黑色星期五致敬。Carnival and the soccer field, Brazil has taken to imitating that day when millions of Americans camp out on frozen sidewalks in dilapidated tents in front of Walmart, all in the spirit of giving of their time and precious cash, in the hunt to trample and claw their way to a Panasonic可悲的是,除了狂欢节和绿荫场外,巴西自创的庆祝形式为数不多,反而是开始学起美国人。而这一天的美国,数百万美国人露宿在冰冷的街头,沃尔玛(Walmart)门前密布着破旧的帐篷,所有人都是本着付出时间和宝贵金钱的精神,就为了等大门一开争先恐后地购买一台松下平板电视机或者XBox One游戏机。But in the U.S., if Black Friday is a score card for Christmas retail sales, in Brazil it is more of a means for retailers to fraud eager shoppers, happy to participate in an American tradition that is still as foreign to them as the moon. If Brazilians were doing Black Friday right, they’d have people camping out in front of Patio Higienopolis Thursday night, or at least barging through the doors at 00:01 on Friday at the nearest FNAC.在美国,如果说黑色星期五是一张圣诞节假期的零售业绩记分卡,那么在巴西,它却更像是零售商欺骗热切的、愿意接受美国传统节日的购物者的一种手段,因为这个节日对他们而言还相当陌生。如果巴西人懂得怎么过黑色星期五的话,那就应该在周四晚上到Patio Higienopolis卖场门口扎营,或至少在周五凌晨第一时间闯入最近的FNAC门店。And as Black Friday approaches the second most populous nation in the Americas, city and state governments are taking to warning their shop-a-holic citizens, full of holiday cheer, that there are many Brazilian Grinches looking to take advantage of their gift giving selves by selling them up a river without a paddle.鉴于黑色星期五逐渐被巴西这个美洲第二人口大国所接受,市、州政府开始向他们的市民——那些充满假期欢乐的购物狂发出警告——有许多“巴西怪杰”打算利用他们奖励自己点礼物的想法打捞一笔。The consumer protection bureau of S#227;o Paulo, Brazil’s largest city, released a list Tuesday morning of 325 companies Brazilians should avoid this holiday season, primarily for e-commerce. The bureau, known as Procon, or Pro-Consumer, also published a list of tips today on what to look out for when shopping online. So while Black Friday in the U.S. is a day of deals, in Brazil it’s come to be known more as a day of fraud. As a result of last year’s fraudulent fiasco among on line and traditional retailers, the local government is using Black Friday as a way to remind consumers of their rights.在巴西最大的城市——圣保罗的消费者保护局周二早晨公布了一份巴西人应该在这个假期回避的325家公司名单,主要是针对电子商务。被称为消费者保护组织(Procon)或者维护消费者权益(Pro-Consumer)的保护局还在当天发布了有关在网络购物注意事项的指南清单。因此,虽然美国的黑色星期五是场购物盛宴,但到了巴西却变成诈骗盛宴。考虑到在去年发生的网络和传统零售商的诈骗丑闻,巴西地方政府把黑色星期五当成了提醒消费者维权的契机。This is quite different from the U.S., of course, where consumers are more than aware of their rights, and might even tend to abuse them. Brazil is not a litigious society. You get trampled, you grin and bear it. There is a new Brazil emerging. One acutely aware of fair play. A web based company called ReclameAQUI, or Complain Here, set up a site to give consumers in Brazil a voice. This of course is their busiest time of year.这与美国相比,真是一个天一个地。当然,美国的消费者更清楚他们的权利,甚至是变得滥用自己的权利。巴西并非一个好打官司的社会。你的权利被践踏也只能咬咬牙认了。不过,巴西正在改头换面,这是一个更加认同公平交易的巴西。一家名为Complain Here的网络公司创建了一个网站,让巴西的消费者发出自己的呼声,当然,这是他们一年之中最忙碌的时候。Brazil is getting y for its fourth Black Friday, but this year is getting extra attention due to last year’s abundance of consumer complaints.巴西正为其第四个黑色星期五做准备,但是鉴于去年大量的消费者投诉,今年得到了越来越多的关注。Brazilian daily Estado de Sao Paulo has even taken to posting up to the minute story items about Black Friday, serving as a watchdog to the bad boys of Brazilian retail.巴西报纸圣保罗州报(Estado de Sao Paulo)甚至已经开始发布有关黑色星期五的详细的新闻报道,以监督巴西的零售业中的“坏孩子”。Last year, many Brazilians went to stores promising discounts upwards of 70%, only to find out the discounts were much lower, or were tied to other offers. Some stores simply raised prices weeks before Black Friday, only to lower them on the actual date in order to give consumers a sense that prices had dropped precipitously.去年,许多巴西人涌进那些宣传三折大减价的商家,结果却发现折扣根本没那么多,或者是附加了种种条件。一些商店干脆在黑色星期五前几周抬高售价,只是在节日当天降低价格,继而让消费者们感觉到是在大减价。“This year’s Black Friday will be a testing ground for retailers, ” said Rodrigo Bore, vice president of online retailer Buscapé. The company said it spent around 0 million on software and staff to build a system that validates price offerings from the retailers it showcases on its search engine. The prices of items marked down for Black Friday will be compared with the average value of the same goods sold over a three month period to see if there really is a discount in play, Bore told Estado on Tuesday.“今年的黑色星期五对于零售商而言是一块试验田。”电商Buscapé副总裁罗德里戈·尔(Rodrigo Bore)说。这家公司表示,为了建立一个系统,来验其搜索引擎中零售商报价的真实性,它在软件和人员方面投资了大约2亿美元。该系统将对黑色星期五打折商品的价格与前三个月同类商品的平均售价进行比对,以此来判断折扣是否真实。Search engine Busca Desconto, which helps organize Black Friday on line in Brazil, partnered with the Brazilian E-Commerce Chamber to create a code of ethics for participating e-tailers, in an effort to move them into good ole gringo-style customer service.搜索引擎Busca Desconto,不仅组织巴西的黑色星期五在线购物活动,同时还与巴西的电子商务商会(E-Commerce Chamber)合作,为参与电商制定行为准则,以此来规范他们的顾务,向“外国佬”的水平看齐。Chamber director Gerson Rolim said Brazilian retailers are notorious for phony sales. Part of the new code of ethics is to guarantee consumers that Black Friday sales are actual sales, below the average three month price. Another target, said Rolim, is to get e-tailers in particular to clarify exactly what items are on sale and what shoppers have to do in order to secure the discount. Getting a free TV if you buy a Mercedes C is not really a Black Friday sale.该商会负责人格尔森·罗里姆(Gerson Rolim)说巴西的零售商因虚假打折促销而臭名昭著。制定这套新的行为准则,一定程度上是为了向消费者们保,黑色星期五的打折是真实的,低于三个月的平均价格。罗里姆表示,另一个目标是让零售业者,尤其是电商,明确哪些商品在打折促销以及为了享受折扣,消费者们需要满足哪些要求。买奔驰车送电视机,这种活动算不上是黑色星期五的打折促销。If companies violate the code of ethics, they will be banned from participating in Black Friday sales in 2014. By then, Brazilians will be in their fifth year of Black Friday madness. Forget the phony sales. I say, let the trampling begin!如果有公司违反了这套行为准则,那么他们将被禁止参加2014年的黑色星期五减价促销活动。届时,巴西人将迎来黑色星期五疯狂的第五个年头。忘记虚假促销。我是说,让盛宴开始吧! /201312/268166惠城区人民医院地址

惠州治疗包茎的费用THIS weekend, the singer and songwriter Leonard Cohen is celebrating his 80th birthday — with a cigarette. Last year he announced that he would resume smoking when he turned 80. “It’s the right age to recommence,” he explained.这个周末,歌手兼词曲创作者莱昂纳德·科恩点上一香烟,庆祝他的80岁生日(9月21日——译注)。去年他宣布,自己打算一到80岁就恢复吸烟。“这是重新开始的好年纪,”他说。At any age, taking up smoking is not sensible. Both the smoker and those who breathe his secondhand smoke can suffer not only long-term but acute health problems, including infections and asthma. And yet, Mr. Cohen’s plan presents a provocative question: When should we set aside a life lived for the future and, instead, embrace the pleasures of the present?吸烟在任何年纪都是不明智的。吸烟者和那些吸二手烟的人都会出现健康问题,既有长期的,也有急性的,比如感染和哮喘等。但是科恩的计划提出了一个刺激的问题:我们什么时候可以把未来的人生抛到一边,全新享受当下的快乐?At the start of the 20th century, only one-half of 1 percent of the ed States population was over the age of 80. Industrialized nations were preoccupied with infectious diseases such as tuberculosis and polio. Many of the common diseases of aging, such as osteoporosis, were not even thought of as diseases.在20世纪伊始,美国只有0.5%的人口超过80岁。肺结核和脊髓灰质炎等传染性疾病在工业化国家发病率很高。骨质疏松等普通的老年疾病在当时甚至不被视为疾病。Today, 3.6 percent of the population is over 80, and life is heavily prescribed not only with the behaviors we should avoid, but the medications we ought to take. More than half of adults age 65 and older are taking five or more prescription medications, over-the-counter medications or dietary supplements, many of them designed not to treat acute suffering, but instead, to reduce the chances of future suffering. Stroke, heart attacks, heart failure, kidney failure, hip fracture — the list is long, and with the ed States Department of Health and Human Services’ plan to prevent Alzheimer’s disease by 2025, it grows ever more ambitious.如今,美国3.6%的人口年过八旬,而我们的生活也被严格地规定了:不仅要注意避免某些行为,还要注意吃药。65岁以上的人之中,有一半人以上要吃五种乃至更多处方药、非处方药或膳食补充剂,其中很多并非用来治疗急性病,而是为了降低未来的发病率。中风、心脏病、心力衰竭、肾衰、髋关节骨折……这个名单很长,而且美国卫生和公众务部计划到2025年实现预防阿兹海默症,这个名单还会变得更庞大。Aging in the 21st century is all about risk and its reduction. Insurers reward customers for regular attendance at a gym or punish them if they smoke. Physicians are warned by pharmaceutical companies that even after they have prescribed drugs to reduce their patients’ risk of heart disease, a “residual risk” remains — more drugs are often prescribed. One fitness product tagline captures the zeitgeist: “Your health account is your wealth account! Long live living long!”在21世纪,衰老只与风险以及和它所带来的衰退有关。保险公司奖励客户常去健身,如果他们吸烟,就会惩罚他们。制药公司告诫医生们,就算他们给病人开了减少心脏病发病率的药,但仍然有“残余风险”——于是医生们就经常开出更多的药。一种健身产品的宣传词把握了这种时代精神:“健康就是财富!长寿万岁!”But when is it time to stop saving and spend some of our principal? If you thought you were going to die soon, you just might light up, as well as stop taking your daily aspirin, statin and blood pressure pill. You would spend more time and money on present pleasures, like a dinner out with friends, than on future anxieties.但是什么时候才能停止储蓄,花一点我们的本金?如果你觉得自己马上就要死掉,你可能会点上一烟,停掉每天的阿司匹林、斯他汀和降压药。你可能就不会那么忧虑未来,而是多花点时间和金钱来享受当下的快乐,比如和朋友出去吃饭之类的。When it comes to prevention, there can be too much of a good thing. Groups like the ed States Preventive Services Task Force regularly review the evidence that supports prevention guidelines, and find that after certain ages, the benefits of prevention are not worth the risks and hassles of testing, surgeries and medications. Recent guidelines for cholesterol treatment from the American College of Cardiology and the American Heart Association, for example, set 79 years as the upper limit for calculating the 10-year risk of developing or dying from heart attack, stroke or heart disease. They also suggest that, after 75, it may not be beneficial for a person without heart disease to start taking statins. But that doesn’t mean everyone follows this advice.预防措施也有可能过犹不及。美国预防工作组(Groups like the ed States Preventive Services Task Force)等组织经常研究持预防指导方案的据,发现到了特定年龄,预防措施所带来的好处并不能抵消检查、外科手术和药所带来的风险。比如说,最近美国心脏病学学院和美国心脏协会发布的胆固醇治疗指导手册把79岁作为上限,超过这个年龄就不必评估10年内心力衰竭、中风和心脏病发展及死亡的风险了。他们还建议,75岁以上、没有心脏病的人用斯他汀可能并没有好处。但这不意味着所有人都应该听从这个建议。Besides, isn’t 75 the new 65? Age seems a blunt criterion to decide when to stop. Is Mr. Cohen at 80 really 80? In his mid-70s, he maintained a rigorous touring schedule, often skipping off the stage. Maybe 80 is too young for him to start smoking again.另外,75岁不就是新的65岁吗?在决定停止做某事的时候,年龄似乎是一个模糊的标准。80岁的科恩真的是80岁吗?在他75岁左右的时候还保持着严格的巡演计划,经常从台上跳下来。或许对于他来说,80岁重新开始抽烟还太年轻了。Advances in the science of forecasting are held out as the answers to these questions. Physician researchers at the University of California, San Francisco, and at Harvard, have developed ePrognosis, a website that collates 19 risk calculators that an older adult can use to calculate her likelihood of dying in the next six months to 10 years. The developers of ePrognosis report that frail older adults want to know their life expectancy so they can not only plan their health care but also make financial choices, such as giving away some of their savings.预测科学的进步可以为这些问题提供。加州大学旧金山分校和哈佛大学的医学研究者们开发了ePrognosis网站,它整理出19种风险计算法,可供老人计算自己在未来6个月到10年内的死亡率。ePrognosis的开发者说,较为脆弱的老年人想知道自己的预期年龄,以便规划自己的保健计划,同时做出财务选择,比如说花掉一些积蓄。Even more revolutionary is RealAge, a product of Sharecare Inc. that has quantified our impression that as we age, some of us are really older, while others are younger than the count of their years. It uses an algorithm that assesses a variety of habits and medical data to calculate how old you “really” are.更有革命性的是Sharecare公司开发的产品RealAge。我们当中有些人比实际年龄显老,有些人比实际年龄显得年轻,RealAge就是把这种感觉量化出来。它使用一种算法,通过生活习惯、药数据等资料计算你“事实上”有多大年纪。Websites like these can be a convenient vehicle to disseminate information (and marketing materials) to patients. But complex actuarial data — including its uncertainties and limitations — is best conveyed during a face-to-face, doctor-patient conversation.类似网站可以成为方便的工具,向病人传播信息(以及市场信息)。但是复杂精算数据中包括了各种不确定性和局限性,病人最好还是同医生当面交流。We are becoming a nation of planners living quantified lives. But life accumulates competing risks. By preventing heart disease and cancer, we live longer and so increase our risk of suffering cognitive losses so disabling that our caregivers then have to decide not just how, but how long, we will live. The bioethicist Dena Davis has argued that emerging biomarkers that may someday predict whether one is developing the earliest pathology of Alzheimer’s disease (like brain amyloid, measured with a PET scan) are an opportunity for people to schedule their suicide. Or at least start smoking.我们成了一个过着量化生活的计划者之国。但是生活会积累各种互相冲突的风险。通过心脏病和癌症预防,我们的寿命更长了,但这同时也增加了丧失认知能力的风险,患者会完全丧失生活能力,必须由照顾他们的人去决定他们该活多长、该怎样活。生物伦理学家蒂娜·戴维斯(Dena Davis)说,目前正在发展的生物标记技术或许有一天可以预测出一个人是否会出现阿兹海默症的早期症状(比如通过PET扫描脑淀粉样蛋白),这或许会使一些人去规划自杀——或者至少是开始吸烟。Our culture of aging is one of extremes. You are either healthy and executing vigorous efforts to build your health account, or you are dying. And yet, as we start to “ache in the places where [we] used to play,” as one of Mr. Cohen’s songs puts it, we want to focus on the present. Many of my older patients and their caregivers complain that they spend their days going from one doctor visit to the next, and data from the National Health Interview Survey suggests one reason. Among older adults whose nine-year mortality risk is 75 percent or greater, from one-third to as many as one-half are still receiving cancer-screening tests that are no longer recommended.我们的老龄文化是在走极端。你要么就保持健康,并且积极努力,建立自己的健康账户,要么你就死。然而,正当我们开始如科恩的歌中所唱:“在我们曾经嬉戏的地方受苦”,我们也想关注当下。我有很多老年病人,他们和他们的照顾者常常抱怨整天都在到处求医问药,国民健康访问调查(National Health Interview Survey)的数据提供了一个原因——在那些9年内死亡风险达到75%或以上的老年人中,有1/3到一半的人仍在接受对他们来说并不推荐的癌症筛查。I don’t plan to celebrate my 80th birthday with a cigarette or a colonoscopy, and I don’t want my aging experience reduced to an online, actuarial accounting exercise. I recently gave a talk about Alzheimer’s disease to a community group. During the question and answer session, one man exclaimed, “Why doesn’t Medicare pay us all to have dinner and two glasses of wine once a week with friends?” What he was getting at is that we desire not simply to pursue life, but happiness, and that medicine is important, but it’s not the only means to this happiness. A national investment in communities and services that improve the quality of our aging lives might help us to achieve this. Perhaps, instead of Death Panels, we can start talking about Pleasure Panels.我并不打算用香烟或结肠镜检查来庆祝我的80岁生日,我也不希望我的衰老体验会仅仅变成网上的精算数据。最近,我在一个社区团体内做了一次关于阿兹海默症的讲演。在问答环节,一个人大声说:“老年医疗保险为什么不付我们每周一次与朋友共进晚餐,再来两杯红酒的钱。”他的意思是责备我们不只是想要活着,还想幸福地活着,医药很重要,但并不是获得这种幸福的唯一手段。一项在社区和务业内的全国调查表明,提高老年生活质量或许能帮助我们获取这种幸福。或许我们应该开始讨论“快乐项目”而不是“死亡项目”(Death Panels,美国民众对奥巴马医改不信任的代称——译注)了。 /201410/338102 One homeowner is resorting to bartering for the latest iPhone as a tactic to sell abeleaguered property in Detroit.近日,底特律一所房子的主人表示愿意用新款iPhone与这所房子作交换。The owner has dropped the asking price on a three-bedroom home in east Detroit from ,000 to a new iPhone 6 as the owner is desperate to sell ahead of the area’s tax auction season where ;thousands; of homes near foreclosure will flood the market, real estate broker Larry Else told A News.据地产经纪人拉里称,该男子本想在当地的税收拍卖季即上千所丧失抵押品赎回权的房子涌入房产市场之前卖掉这所房子,可一直未能如愿,于是决定将房子标价从最初的5000美元降低为一部新iPhone 6的价格。;This house is really not worth much at all,; Else said.拉里说:“这所房子真的不值太多钱。”The windows are broken and there is no front door. The broker himself has not been inside the home because his company has a policy of not going in unsecured houses alone. Detroit#39;s declining fortunes have been precipitous, with an exodus has that left its population about a third of what it used to be in its heyday, according to the U.S. Census Bureau.房子的窗户坏了,前门也没有了。连这位地产经纪人自己都没有进去过这间房子里,因为其所在公司有规定不得独自出入不安全的房屋。底特律近来的颓败形势严峻,美国人口调查局的数据显示,现在在此居住的人口只有其鼎盛时期的三分之一。;It#39;s a little dicey,; Else said of the neighborhood.说起这所房子周围的环境,拉里说“有点危险”。Now, the property has accrued more than ,000 in back taxes and will enter foreclosure next year if that debt is not settled. So while the owner is asking for an iPhone 6 -- or, he said he would also accept a 32GB iPad -- the true cost of the sale comes from the buyer assuming the cost of the back taxes. Else said that because he is selling the property as a quick claim deed, it would be up to the buyer to arrange either a payment plan or lump sum payment with county officials to settle the back taxes.现在这所房子光税款就拖欠了6000美元,再不解决,明年就面临丧失抵押品赎回权的危险。所以,房主愿意用一部iPhone 6或32G的iPad来交换这所房子,再加上所需缴纳的税款,该房子也就值这么多钱。拉里说由于急着卖这所房子,所以税款是一次付清还是分期付款都由买家说了算。That isn#39;t deterring the new-found interest in the property, as Else said that he received four offers today alone, ranging in seriousness.这种方式让不少人产生了兴趣,拉里说他一天内就接到了4个人的严肃报价。One woman said she was ;interested in the house for the wood,; Else said, explaining that the prospective buyer is apparently on a quest for white pine planks. Another bidder said that they would be willing to hand over an iPhone 5, and another offered 0 for the property, Else said.一位女士说她对“这所房子的木材感兴趣”,拉里解释说她是想要房子上的白松木板。另一名买家称愿意拿出一部iPhone 5交换,还有一名买家报价850美元。Else hinted that the most likely buyer is someone who aly lives on the block and put in a 0 bid, but their familiarity with the area appeared to put them at the head of the pack. Else said that the area is ;full of similar houses. There’s lots of vacancy.;拉里称最有可能的买家是住在与房子所在地同一条街上的人,他出价700美元,他对房子周边地区很熟悉使他比较有优势。拉里说该房屋所在的区域内“有很多类似的房子,大多都是空置的”。He said he expects one of the four offers to work out, and may even finalize the sale tonight.拉里说他希望能与4名买家中的一个交易成功,并在当晚确定价钱。This is not the end of his bartering business, however, as Else said that he#39;s aly gotten another call from a homeowner who has had trouble selling their property.拉里的“物物交换”生意并没有到此结束,因为他又接到另一个房主的电话,那名房主也在卖房子时遇到了困难。;I did get a call from a seller today who said #39;We#39;ve been having a hard time selling our house. We have it listed for ,000. Could I get a 1994 Chevy for this house?#39;; Else said.“我确实又接到了一个电话,那名房主说‘我们的房子也很难卖,标价是2万美元。我想用这所房子换辆94年的雪佛兰汽车可以吗?’” /201410/338815惠城区妇幼保健人民中医院治疗龟头炎多少钱惠州妇幼保健院有泌尿科吗

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