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2019年09月17日 16:30:06    日报  参与评论()人

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三明市那间医院检查不孕莆田激素六项检查去哪好 The in-laws, or your love interest#39;s parents送礼对象:岳父岳母大人/公公婆婆;你男(女)朋友的父母;你重要的另一半的父母大人Gift-giving philosophy: You want your in-laws or significant other#39;s parents to feel comfortable around you, so give them the gift of comfort.送礼哲学:还有什么比最重要的另一半的父母大人和你在一起时觉得非常舒更开心的事情呢?所以给他们买能让人觉得舒的礼物吧。Shopping strategy: High-end department stores, sleep specialty stores, big box stores, bath and body stores, home goods stores like Restoration Hardware and even some drugstores will likely have the gifts you want.送礼策略:从高档百货店到睡眠用品专卖店,从大卖场到洗浴与身体护肤商店,再到Restoration Hardware这样的家居用品店,甚至是杂货店,你都能在这些商店里找到让人觉得舒适的商品Examples: Cashmere slippers, essential oil or lavender eye pillow.礼品样品:羊绒拖鞋、精油或者薰衣草眼枕。 /201312/269279龙岩那间医院性激素检查

南平做人授手术要多少钱AQUAMARINA, THE HOUSE, SITS ON A LIMESTONE promontory overlooking the Atlantic Ocean. Originally built as a bachelor pad, the three-bedroom house boasts its own disco, an enormous kitchen, huge teak doors, a yoga room and a glimmering rooftop swimming pool, topped at one end by a statue of a seated Buddha that radiates peace, harmony and a sense of prosperity. Visitors who climb some 40 feet down a path carved into the limestone bluff arrive at a private beach, where they can meditate, perhaps on the ebb and flows of world markets, as waves crash on nearby reefs. On a gloriously sunny day, Aquamarina is a stunning property, a steal, it would seem, for the .9 million price its owner, a re-insurance executive long departed for Singapore, is asking for it. 在俯瞰大西洋的一个石灰岩岬角上,坐落着一幢名为“水世界”(Aquamarina)的别墅。“水世界”最初是按单身汉寓所设计建造的,这幢三间卧室的别墅配有独立的迪斯科舞厅、宽敞的厨房、柚木大门、一个瑜伽室和波光粼粼的屋顶游泳池,游泳池一端放置的坐佛雕塑释放着一种安静、和谐、富足的禅意。访客们只要沿着通往石灰岩悬崖的小路攀爬大约12米,就能来到一处私人海滩。他们可以在那里冥想,随着海浪拍打着附近的礁石,他们也许可以体味全球市场的潮起潮落。在阳光灿烂的日子里,“水世界”的美令人惊艳,其790万美元(约合人民币4,827万元)的售价看起来也物超所值。这幢房产的主人是一位再保险行业的高管,他目前已长期移居新加坡。 #39;This is a unique property,#39; says Penny MacIntyre, a slim, no-nonsense realtor who delights in showing off the reflecting pools and waterfalls that the architect has incorporated into the house#39;s design. Most Bermuda high-end properties are a reflection of the island itself-proud, conservative stone mansions painted in deep reds, dark yellows, browns and blues. They are built in what is known as the Bermuda vernacular style and boast distinctive wooden window shutters, tapered chimneys and white roofs that collect rainwater for the flowers in the lush gardens that fill the island. Not Aquamarina. One of a handful of futuristic styled houses in Bermuda, Aquamarina, says MacIntyre, is #39;very modern and forward thinking.#39; 彭妮#12539;麦金泰尔(Penny MacIntyre)是一位身材苗条、说话直截了当的房地产经纪人,她说:“这幢别墅独一无二。”她很乐于向我们展示建筑师在设计时融入建筑之中的游泳池和瀑布。百慕大的大多数高端房产都能体现出这里引以为豪的建筑样式,那就是漆成深红色、深黄色、棕色和蓝色的传统型石头房屋。这些房屋的建筑风格被称为百慕大乡土风格,以独具一格的木质百叶窗、锥形烟囱和具有收集雨水功能的白色屋顶为特色。郁郁葱葱的花园在百慕大岛随处可见,屋顶收集的雨水就用来浇灌花园里的花。但“水世界”的建筑风格不属于这一类。它是百慕大为数不多的未来风格建筑,麦金泰尔称:“水世界非常现代、非常前卫。” But modern and forward thinking, it turns out, have never quite been the forte of this fish-hooked island, known for its stately British airs, pink sandy beaches and currently, the fourth-highest per-capita income in the world. While MacIntyre may drive a fairly modern SUV, a lot of residents here navigate Bermuda#39;s many twisting roads in small motorcycles that look straight out of a Steve McQueen movie. Downtown Hamilton, its capital, boasts one glass office tower, and its 10 stories stand out against the backdrop of much shorter, old colonial office buildings. Whereas the rest of the world seems to be opening its door to glitz and brand new, Bermuda, a self-governing British territory for four centuries, prides itself on a sheltered life with virtually no serious crime, no paparazzi and no income tax. 但是,事实表明,现代和前卫从来都不是这座鱼钩形岛屿的特色,百慕大岛以其庄严的英国风格、粉红色的沙滩和位列全球第四的人均收入而著称于世。尽管麦金泰尔开着一辆相当现代的SUV,但是,你能看到在百慕大蜿蜒交错的小路上,很多居民驾驶的却都是小型托车,这些托车就像是从史提夫#12539;麦昆(Steve McQueen)的电影中走下来的一样。在百慕大首都汉密尔顿的市中心伫立着一座玻璃幕 的办公大楼,相较于周围低矮得多的旧殖民风格办公楼,这座大楼十层的高度显得鹤立鸡群。当世界上的其他地区似乎敞开胸怀接纳浮华和崭新事物之时,令这个四个世纪的英国自治领引以为豪的是其几乎没有严重罪行、没有偷拍记者、没有所得税的安逸生活。 It#39;s the kind of world a lot of rich people love. Or perhaps loved. While Aquamarina may be a steal, it has sat vacant and unsold for about a year. And as MacIntyre begins to rattle off some sale figures, a disturbing reality emerges about the island#39;s small but lucrative market of island mansions, which range in price from .5 million to more than million. More than 50 of these homes were sold between 2007 and 2011, including the proudly named Castle Point (.5 million) and the slightly more modest Tradewinds (.5 million). Last year, there were 34 properties on the market that the island#39;s quirky and restrictive system allowed foreigners to buy. Of these, just one went into contract, in what was one of Bermuda#39;s worst real-estate years on record. And things have only started to pick up this year. #39;It#39;s been a quiet market,#39; she says. 这里是很多富人热爱的地方。或者说,曾经热爱的地方。尽管“水世界”也许物超所值,但这幢别墅已经空置并待售了几乎一年之久。当麦金泰尔开始滔滔不绝地罗列销售数据时,一个令人困惑的事实浮出了水面。百慕大的房地产市场虽然小,但利润不菲,房价从350万美元(约合人民币2,140万元)到4,000万美元(约合人民币2.44亿元)以上。在2007年至2011年间,已有50多幢房产成功出售,其中包括声名显赫的“城堡角”(Castle Point, 售价2,150万美元──约合人民币1.31亿元))和稍显低调的“贸风”别墅(Tradewinds, 售价1,150万美元──约合人民币7,027万元)。由于受到百慕大古怪的房产限购政策的影响,去年市场上可供外籍居民购买的住宅只有34套。而在这些房产中,成交的只有一套,这一年也成为了百慕大房地产交易史上最惨淡的一年。百慕大的房产交易状况直到今年才开始好转。麦金泰尔说:“市场一直颇为冷清。” Indeed, after decades of reigning as a supreme destination for some of the world#39;s elite, Bermuda is having a tough time competing for the patronage of the stupendously rich, creating a classic tug of war over old and new money. The island, an easy two- or three-hour jet jaunt from the U.S. coastline, still attracts such billionaires as Ross Perot and Michael Bloomberg, who maintain homes here. But government officials and business leaders say they are worried that the mores of high-end tourism are changing, along with the wealthy themselves, and that this magical archipelago must now fight to follow the money. #39;Bermuda is like a lady with a very long skirt on,#39; says David Dodwell, a hotelier who is also chairman of Bermuda#39;s tourism board. #39;We need to pull up our skirts a bit.#39; 图:盘点在百慕大置业的富豪实际上,作为过去几十年来一些世界精英人士首选的目的地,百慕大目前在赢得巨富的青睐上却颇为吃力,新财富与旧财富的较量也就此上演。距离美国海岸线的飞行时间只有两至三小时的百慕大,仍旧吸引了包括罗斯#12539;佩罗(Ross Perot)和迈克尔#12539;布隆伯格(Michael Bloomberg)在内的亿万富翁,他们都拥有百慕大的房产。但是政府官员和商业领袖表示,他们担心高端旅游的趋势连同财富人群本身都正在发生变化,担心迷人的百慕大现在不得不全力以赴去追逐财富。百慕大旅游协会主席、旅馆老板大卫#12539;多德维尔(David Dodwell)表示:“百慕大就像一位身着及地长裙的淑女。我们需要把裙摆拉起来一点儿。” Without question, the geography of money is changing-and at an unaccustomed velocity. According to an annual survey of global wealth by Boston Consulting Group, private wealth in the #39;new world,#39; primarily the Asia Pacific region, jumped around 12 percent last year alone, or more than double the rate of growth in the #39;old world,#39; including North America and Western Europe. This new breed of nouveau riche tends to favor a lifestyle of supernova toys, with private elevators hauling sports cars into their living rooms and bar drinks costing thousands of dollars each. They like their homes to be modern, their nightlife late and their clothes as shiny as their jewelry. All of which has very little to do with sleepy Bermuda, whose nightlife shuts down at the stroke of 10 during the week and whose hotels haven#39;t quite caught up with the concept of in-room infinity pools or 24-hour butler service. (Note: A special check-in area and afternoon tea is still considered a high-end perk at the Fairmont, the island#39;s upscale, flamingo-pink resort.) 毫无疑问,财富的地理版图正在以非同寻常的速度发生着变化。据波士顿咨询公司(Boston Consulting Group)的一份年度全球财富报告显示,“新世界”的私人财富(主要集中在亚太地区)单单去年就激增了约12%,这个增速达到了包括北美和西欧在内的“旧世界”的两倍以上。这些新贵一族大多喜好超级新潮的生活方式,比如安装能将运动跑车传送至客厅里的私人电梯,吧台里配备价值数千美元一杯的饮品。他们喜欢现代风格的家居,通宵达旦的夜生活以及闪亮如珠宝般的装。所有这些都几乎与沉睡的百慕大没有任何关系,因为在工作日,这里的夜生活通常会随着十点的钟声戛然而止,同时这里的酒店还远未掌握建造室内无边际游泳池或提供24小时务的理念。(注:特别的入住登记区和下午茶仍然被视为费尔蒙(Fairmont)的高贵象征,费尔蒙是百慕大的高档酒店,外 呈粉红色。) Beyond the need for celebrity chef restaurants and Prada boutiques, once-popular high-end resorts are discovering that it also takes a special cocktail of tax policies, real-estate laws and a host of business-friendly steps to reel in the big fish. That#39;s a challenging task, especially for the smaller locales like Bermuda. Upset about its own struggling economy and a gaping national debt, the island#39;s citizenry elected a new government last year that is promising some intriguing changes-including a few key overtures to the business community and the jet-setting rich it brings. But Bermuda is a place steeped in conservative traditions. Change does not come easy. 除了需要名厨掌舵的餐厅和普拉达(Prada)专卖店外,那些曾经风靡一时的高端度假胜地发现,为了捕到“大鱼”,自身还需要在税务政策、房地产法规和一系列有利于商业的举措上做出调整。这是一项非常严峻的挑战,对百慕大这样的小地方尤为如此。出于对百慕大经济困局和国债增加的不满,去年,百慕大的公民选举出了一个新政府,该政府承诺将实施一些错综复杂的改革举措─其中包括一些针对工商业界和被吸引来的超级富人的关键措施。但是,百慕大是一个植根于传统的地方。改变并非易事。 #39;I DON#39;T THINK Bermuda has enough zip for the younger crowd,#39; says Wendell Hollis, a leading corporate lawyer who has represented many of the billionaires who have bought real estate here over the past 20 years. A tall, blue-eyed ruddy-faced Bermudian, Hollis is walking about his home, which boasts a castle-like battlement built on the remains of a 17th century pirate fort, still armed with 13 small-bore antique cannons pointing out to repel whatever invaders might be lurking at sea. These days, he worries that his home country is missing out on an opportunity to attract more wealthy residents. A former senator and adviser to several governments here, Hollis once wrote a paper showing how just three rich individuals contributed over 0 million to the Bermuda economy. #39;How many tourists or ex-pat workers does it take to produce such a contribution?#39; he asks. 知名的企业法律顾问温德尔#12539;霍利斯(Wendell Hollis)表示:“我并不认为百慕大具备吸引年轻一代的活力。”在过去的二十年中,霍利斯曾经代理过很多亿万富翁在百慕大置业的业务。这位高个子、蓝眼睛、面色红润的百慕大人正在他的宅院里散步,他的宅院拥有像城堡一样的城垛。这片城垛是在一处17世纪海盗堡垒的遗迹上修建的,如今仍然装备有13架小口径的古董大炮,它们指向大海,似乎随时准备击退任何潜在的侵略者。现在,他担心百慕大正在错失吸引更多富裕居民的机会。作为一名前参议员和数届政府的顾问,霍利斯曾经写过一篇论述三位富有人士是如何为百慕大经济做出超过一亿美元的贡献的文章。他问道:“多少旅行者或外派劳工才能做出如此大的贡献?” The kind of population Hollis would like to see more of has been enjoying the enchanting qualities of Bermuda since the 19th century. Mark Twain, an early booster here, was ed as saying: #39;You can go to heaven if you want. I#39;d rather stay in Bermuda.#39; He was joined by Vincent Astor, the son of Titanic victim John Jacob Astor IV, who used part of his inheritance to build an estate here, complete with a mini, narrow-gauge railroad, on a 22-acre property. In the 1920s, when Bermuda#39;s worthies decided to create the island#39;s first club and golf development, the Mid Ocean Club, it marketed heavily to wealthy Americans from New York and Boston. The Lowells might have talked only to the Cabots, and the Cabots only to God, but some of those conversations, according to the list of early club members, took place on the links of the Mid Ocean Club. 霍利斯所期望见到的这类富裕人群从19世纪起就发现了百慕大独特的魅力。百慕大早期的推崇者马克#12539;吐温(Mark Twain)曾经说过:“如果你愿意,你尽可以去天堂。我却情愿待在百慕大。”随后加入这一行列的还有文森特#12539;阿斯特(Vincent Astor)─泰坦尼克号遇难者约翰#12539;雅各布#12539;阿斯特四世(John Jacob Astor IV)的儿子。文森特使用部分遗产在百慕大修建了一处房产,并在这块22英亩(约合134亩)的地产上建造了与之配套的迷你窄幅铁轨。在20世纪20年代,当百慕大的杰出人士决定创建当地第一家高尔夫俱乐部中海俱乐部(Mid Ocean Club)时,他们向纽约和波士顿的富有阶层进行了大力宣传。洛厄尔家族可能只与卡波特家族交往,卡波特家族可能只与上帝沟通,但是据早期的会员名单显示,他们之间的这些对话是建立在同为中海俱乐部会员的基础之上的。 Today, the Astors, Lowells and Cabots have been replaced by Perots (as in Ross), McGraws (of McGraw Hill) and Pritzkers (of Hyatt Hotels). And in place of Mark Twain, Bermuda has long counted on actor Michael Douglas and his wife, Catherine Zeta-Jones, for a dash of celebrity glamour. The two raised their children here but have returned to New York, renting their home for the asking price of ,000 a month. Most of these big names maintain homes in a secluded area of the island known as Tucker#39;s Town but more commonly as Billionaires#39; Row. Few resort streets in the world can boast so many names of so many ultra-rich people living so close together. A visitor will find only one bored guard manning the gate to the neighborhood, known for its views of the Atlantic and its flowering white and pink oleander hedges. 如今,阿斯特家族、洛厄尔家族和卡波特家族已经被佩罗家族(罗斯#12539;佩罗)、希尔家族(麦格劳#12539;希尔,McGraw Hill)和凯悦酒店(Hyatt Hotel)的普利兹克家族(Pritzkers)所取代了。在接替马克#12539;吐温的标杆人物的选择上,百慕大一直都对演员迈克尔#12539;道格拉斯(Michael Douglas)和他的妻子凯瑟琳#12539;泽塔琼斯(Catherine Zeta-Jones)寄予厚望,希望他们能给这里带来些许名人效应。他们两人在百慕大养育了他们的孩子,但现已重返纽约,他们住宅的出租要价是每月28,000美元(约合人民币17.1万元)。大多数名人都居住在百慕大较为僻静的地区─塔克斯镇(Tucker#39;s Town),人们更习惯将这里称作亿万富翁街(Billionaires#39; Row)。世界上很少有哪处度假胜地可以让如此之多的超级富豪如此集中地置业。旅行者能够发现,在这个以大西洋美景和粉白两色的夹竹桃树篱而著称的小区,只有一位百无聊赖的看门人守在门口。 The old money here say Bermuda has always had a special appeal, from its relatively close distance to the power elite of the U.S. Northeast, to a natural beauty that photographs can#39;t quite capture. The island is emerald green, one big park, complete with a botanical garden and the occasional postage-stamp-sized garden farm growing onions and carrots. Not one blade of grass appears to be withered or out of place, even though Bermuda has hardly any fresh water and depends almost entirely on rain for its water supply. Bermuda could be England with palm trees and decent weather. 这里的老派富人表示,百慕大一直都具有特殊的吸引力,一方面是由于这里距离美国东北部的权力精英相对较近,另一方面是由于这里有照片都无法捕捉到的美丽景致。百慕大岛满目苍翠,就像一个巨大的公园,一所植物园和众多种植着洋葱和胡萝卜的小型家庭农场点缀其间。这里的植物生机盎然、规划有序,尽管百慕大几乎没有淡水资源,淡水供应差不多全靠雨水。百慕大可以称作拥有棕榈树和宜人气候的英国。 In this setting, the rich seem to get lost amid a population that could care less about them and local papers that ignore their comings and goings. #39;Bermuda is very unassuming,#39; says Neal Churchill, a private banker with Butterfield Bank (UK) Ltd., who lived here for three years and was back for a visit from Monaco. #39;You can mingle with wealthy people and not know it.#39; Pink from the sun as he sips a cup of tea at a hotel pool, Churchill says homes are the only status symbol here. #39;There is no showing off here,#39; he says. #39;There are no flashy cars, no super yachts in the harbor.#39; Drinking a rum punch on the terrace of the Mid Ocean Club, Nir Sadeh, chairman of the club#39;s membership committee who also heads private banking at Butterfield, concurs. #39;It#39;s not flashy,#39; he says. #39;You have people walking down the street in shorts who are worth billions.#39; 在这样的环境中,巨商富贾似乎可以隐身,因为百慕大人对他们没有那么在意,当地报纸也不关心他们的行踪。巴特菲尔德(英国)有限公司(Butterfield Bank (UK) Ltd.)的私人家尼奥#12539;丘吉尔(Neal Churchill)表示:“百慕大非常低调。”丘吉尔曾经在这里居住过三年,目前又从洛哥返回百慕大游览。“你可能和巨富近在咫尺而并不自知。”当夕阳 下粉红色的光辉时,丘吉尔一边在酒店的游泳池品茶一边说,住宅是这里唯一的身份象征。他说:“这里没有人招摇过市,没有花哨的汽车,港口里也没有超级游艇。”尼尔#12539;萨德(NirSadeh)是中海俱乐部会员委员会的主席,他同时也是巴特菲尔德私人部门的主管。在中海俱乐部的阳台上,萨德抿了一口朗姆酒饮料并且表达了同样的观点。他说:“百慕大不招摇,你能在这里看到身价数十亿的人穿着短裤在街上闲逛。” The problem is this happens to be the polar opposite of what today#39;s new generation of global wealth wants. The 30-year-old Russian billionaire zigzagging around city streets in his new Lamborghini. The Chinese #39;whale#39; gambler giddy from another run of luck at the Baccarat tables in Macau. Bermuda doesn#39;t expect, or want, to attract all of this kind of wealth. But its government officials are staring down some awful declines in the country#39;s second-largest industry, tourism, that reflect Bermuda#39;s staleness. At its peak in 1980, Bermuda welcomed some 500,000 plane-arriving tourists a year, and counted on some 12,000 hotel beds, says Shawn Crockwell, the island#39;s minister of tourism. Last year, the island received about half that number by air, and had only 2,500 hotel beds to offer them. About 60 percent of last year#39;s tourists were low-spending visitors who arrived on the island on cruise ships. The remaining 40 percent arrive by air, a figure that continues to decline. #39;We need to reverse that ratio,#39; says Crockwell. 问题是,百慕大的这种特质恰好与当今新一代全球财富掌握者所期望的背道而驰。三十岁的俄罗斯亿万富翁驾驶着新兰基尼跑车(Lamborghini)在城市的街道上飞驰,中国的豪赌客在忙不迭地试手。百慕大并不期待,或是希望全部吸引这种类型的财富。但是,百慕大的政府官员却发现这里的第二大产业─旅游业正经历着可怕的衰退,这反映出了百慕大止步不前的现状。百慕大的旅游部部长肖恩#12539;克罗克韦尔(Shawn Crockwell)表示,在百慕大最辉煌的1980年,这里一年接待的飞行旅客数量大约为50万名,那时百慕大拥有的酒店床位总数高达12,000张左右。去年,百慕大接待的飞行旅客数量只有1980年的一半,酒店床位数也缩减至仅2,500张。在去年百慕大接待的游客中,大约有60%都是消费较低的乘坐邮轮抵达的旅客。剩余40%的游客是乘坐飞机抵达百慕大的,而这一比例正在持续下降。克罗克韦尔表示:“我们需要扭转这一局面。” The British territory is also groaning under a record .4 billion in debt, the result of shrinking revenues not only from tourism but from the island#39;s largest business sector, reinsurance. (Bermuda is famous for a so-called economic #39;miracle#39; of sorts: It produces almost nothing and imports almost everything, and has no income, capital gains or sales taxes. Yet it has thrived with a strong standard of living for decades on payroll taxes and import duties.) In response, the newly installed government, run by the One Bermuda Alliance party, thinks one solution is to send more positive signals to the international money elite, the people and firms who create the jobs and the lifestyle that spurs a stale economy. #39;I didn#39;t think the business community was feeling the love,#39; says Bermuda#39;s new premier, Craig Cannonier. 百慕大这个英国自治领同时也在承受着达到纪录高位的14亿美元债务的困扰,这是财政收入锐减所带来的结果,导致这种局面的原因不仅包括旅游业的萧条,还有百慕大第一产业─再保险行业的衰退。(百慕大以所谓的经济“奇迹”而闻名:这里几乎不出产任何产品,并且几乎所有物品都依赖进口,这里也不征收任何收入税、资本增值税或消费税。然而,工资税和进口关税却让百慕大得以在几十年来一直维持着很高的生活标准。)为解决百慕大的困境,由百慕大统一联盟党(One Bermuda Alliance Party)领导的新政府认为,向国际财富精英释放更多的积极信号不失为一种方案,这些精英人士和公司创造就业岗位,创造能刺激停滞的经济恢复增长的生活方式。百慕大的新任总理克莱格#12539;康涅(Craig Cannonier)表示:“我认为工商业界没有感受到爱意。” Certainly, Bermudians will agree that the island, wrapped tightly in protectionism and red tape, has tended to irradiate a certain feeling of unfriendliness toward nonislanders. With just 69,000 souls jammed into its 21 square miles, the island has long feared that foreigners would push locals aside. So the country has done everything from setting time limits on how long nonresidents could live here (six years) to at one point banning Bermudians from selling any real estate to outsiders. In an interview, Cannonier, a bear-like U.S.-educated gas-station owner, says he is trying to put his foot down on a lot of this, quickly ending the residency limits. Members of his cabinet say it was a big move. #39;You would find that even if a top executive had term limits waived, there were term limits imposed on the nanny,#39; says Michael Fahy, Bermuda#39;s minister of home affairs. #39;If you are saying your nanny has to leave, then why stay?#39; 当然,百慕大人都会同意,保护主义和官僚习气浓重的百慕大一直都给人一种对非本岛居民不太友好的感觉。鉴于这个54平方公里的小岛上挤满了大约69,000名居民,百慕大一直担心外国人可能会令当地居民受到排挤。因此,百慕大向来竭尽所能地设置各种障碍,包括限制非本岛居民在此居住的期限(六年),并曾经一度禁止百慕大人向岛外人士出售任何房地产。在一次采访中,康涅表示,他正在试图尽快改变现状,在短期内结束居住限期政策。曾在美国接受教育的康涅身材魁梧,拥有加油站业务。他的内阁成员表示,此举是一项重大改变。百慕大内政部部长迈克尔#12539;费伊(Michael Fahy)称:“你会发现,即使某位高管能够免受居住限期的限制,保姆的居住限期仍然无法摆脱。如果你说你家的保姆不得不离开百慕大,那你为什么要留在这里呢?” The rich are also getting a break on real estate now. Since 1926, Bermuda has imposed restrictions on purchases of land by non-Ber- mudians. Eventually, non-Bermudians were allowed to purchase only the most expensive of houses-those that have an annual rental value in the six-figure range. Today, that works out to homes worth about .5 million and up. What#39;s more, foreigners had to pay a 25 percent license fee on home buys, which can drive even a billionaire a little batty. The high-rental rule remains, but Cannonier has temporarily cut the tax on real-estate sales to 8 percent of the purchase price, which then increases to 12.5 percent after 18 months. For now, a million home no longer requires an extra million, which MacIntyre, the realtor, says is #39;a very welcome change of pace.#39; 目前,在房地产购买方面,富人可以稍稍舒一口气了。自1926年起,百慕大就开始对非百慕大人在购买地产上施加限制了。结果是,非百慕大人只能购买最贵的房子,即那些年租金在六位数以上的住宅。按目前的房价计算,这意味着最低350万美元(约合人民币2,140万元)的房子。除此之外,外国人还必须付25%的房产购买许可费,其金额之大足以使亿万富翁咋舌。现在,高租金条例仍然有效,但是,康涅已经将房产购置税税率暂时降至了8%,在18个月后,这一税率将上调至12.5%。目前来看,购买价格400万美元(约合人民币2,440万元)的房产已经不再需要额外付100万美元的成本了,房地产经纪人麦金泰尔称:“这是非常喜人的改变。” But even government boosters say moves like these can only go so far in creating the kind of full-service playground the rich can so easily find elsewhere now. The island, for example, likes to boast that it has more golf per square mile than anywhere in the world. That#39;s fine, except that today#39;s rich-fitter and more active-want other options for high-end recreation, including celebrity trainers and yoga instructors working out of space-age gyms. In the Caribbean, it is possible to find a host of new private-jet airports, compared with Bermuda#39;s one commercial facility. And once upon a time, it was charming that the country limited residents to one puny car per household, a policy dating back to when Mark Twain and Woodrow Wilson teamed up to help get motor vehicles banned for decades. But it is not exactly comfortable for today#39;s stretch-limo crowd, which has to make due with the island#39;s sparse supply of Mercedes-Benzes, which are available to rent by the hour. 但是,即使政府持者也表示,诸如此类的举措充其量只能创造出那种全方位务的玩乐之所,而富人们在其他地方轻而易举就能找到这类场所。举例来说,百慕大总是喜欢吹嘘这里高尔夫球场的密度高于全球任何其他地方。这么说没有问题,只是当今更加健康、更有活力的富人们喜欢的是其他的高端项目,比如在现代感十足的健身房里接受明星教练和瑜伽老师的指导。在加勒比海地区,你可以找到众多新建的私人飞机场,而百慕大却只有一个商业机场。曾几何时,政府实施的每个家庭只能购买一辆小型汽车的限购政策还称得上迷人,该政策起初由马克#12539;吐温和伍德罗#12539;威尔逊(Woodrow Wilson)共同推动出台,使汽车被禁止了几十年。但是,对于现在习惯了加长豪华轿车的人群来讲,这个政策并不那么令人感到舒,他们不得不诉诸于百慕大紧俏的、按小时租赁的梅赛德斯#12539;奔驰(Mercedes-Benzes)资源。 From a corporate standpoint-and the island is keenly aware of how many wealthy executives encamp here when business flourishes-Bermuda doesn#39;t even rate as an especially great tax haven. Sure it lacks taxes, but its conservative ethos requires a far more careful company-registration process than many newer and hotter resort countries have. Feeling the heat, the government two years ago extended the date that companies have before their tax-exempt status expires. Officials in Bermuda also argue that their island country maintains a program for registering off-shore companies that is respected around the world. Still, the number of tax-exempt companies in Bermuda has hovered around 12,000 over the past 15 years. In the Cayman Islands, by comparison, the number has nearly doubled in 10 years to more than 75,000. 从企业的角度来看,百慕大根本算不上最理想的避税天堂。当然,百慕大非常清楚,在当年经济繁荣之时有多少富有的公司高管纷纷到此安营扎寨。的确,百慕大的税赋很轻,但是由于百慕大的氛围较为保守,相较于许多新的、更热门的度假胜地,这里的公司注册流程要严格得多。在感受到压力之后,两年前,百慕大政府延长了企业的免税期。百慕大的官员还辩称,百慕大拥有一个享誉全球的离岸公司注册项目。然而,在过去的十五年中,百慕大免税企业的数量一直保持在12,000家左右的水平。相比之下,在过去十年中,开曼群岛的免税企业的数量已经增加了近一倍,达到了75,000多家。 SO THE QUESTION remains: How far into the fast lane will the island go to up its new-rich appeal, or will it just disappear someday off the high-end radar, like so many ships in the Bermuda Triangle? 所以问题依然是:为提高自己对新财富的吸引力,百慕大还会在快车道上走多远?还是百慕大某天会从高端财富的雷达上销声匿迹,就像在百慕大三角区消失的那些船只一样? As his government dreams up more ideas, including considering a proposal to start a high-end casino here (bow-tied gamblers included), Cannonier provides a telling story about Ross Perot. Manning his gas station one day, he recalls seeing the 83-year-old former U.S. presidential candidate show up in his gardening boots. #39;Here#39;s a guy who can walk around Bermuda pretty much as he likes,#39; Cannonier says. #39;They don#39;t have to worry about the paparazzi. We#39;ve done a great job at protecting their privacy. That#39;s one of the great things about Bermuda. They can come and relax.#39; 为了提振百慕大经济,康涅政府绞尽了脑汁,他们正在考虑在百慕大建设一所高端的提议(也会接待非富豪的高级专业人士)。康涅讲述了一个关于罗斯#12539;佩罗的生动故事。他回忆起一天,当他正在自己的加油站工作时,他突然看到了这位83岁的、穿着园艺靴的美国前总统候选人。康涅称:“佩罗几乎可以在百慕大随心所欲地走动。他们不需要担心偷拍记者。我们在保护名人的隐私上做得非常出色。这也是百慕大的优势之一。名人来到这里完全可以放松心情。” For some, the country#39;s best step may be just to concoct yet one more Bermuda miracle: a middle ground, way out here in the middle of the Atlantic Ocean, where East meets West, where new money finds enough razzle dazzle but old money can still enjoy the very anonymity and British DNA they have so long cherished. Hollis, the corporate attorney, likes to point out that the island, first settled by a ship running aground, goes by the motto #39;where fate take us#39; and that now it#39;s about time Bermuda forged its own. 在一些人看来,百慕大的最佳选择或许是打造一个新的百慕大奇迹:一个位于大西洋核心的中间地带,一个东西方交汇的地方,一个新财富能够纵情欢乐而旧财富也能享受传统上的私密性和英式风范的地方。企业法律顾问霍利斯指出,百慕大 这个被搁浅的船只征的小岛─一直信奉着“听天由命”的信条,现在,百慕大是时候掌握自己的命运了。 But if it does, some Bermudians past and present will always have a divided view of their home. Jon Paradine, the owner of Aquamarina and a native Bermudian who is now living half way around the world, says, sure, the island needs to #39;improve its product#39; and up its entertainment value. But get him talking about the days he spent there, the stunning views of the turquoise blue waters, the magnificently fresh salty air, and talk of change fades. Suddenly, it is hard to imagine how any of it-the dull shopping on Front Street, the MIA limos-really matters. As far as Paradine is concerned, his home would go for million, easy, in Singapore, but you#39;ll never find it there either. #39;The beach in Aquamarina is the most beautiful beach I#39;ve ever seen,#39; says Paradine. #39;I miss the natural beauty of Bermuda.#39; 但是,一旦百慕大开始掌握自己的命运,一些百慕大人─不管过去还是现在─对家乡产生复杂的情感。“水世界”的主人、土生土长的百慕大人乔恩#12539;帕拉丁(Jon Paradine)现在居住在世界的另一端,他表示,百慕大确实需要“改善形象”、提高自身的价值。但是,如果让他聊聊他在家乡度过的时光,他回忆起的则是迷人的湛蓝海景和带着咸味的清新海风,关于变革的话题也逐渐被淡忘了。忽然间,很难想象前街(Front Street)乏味的商铺、迈阿密机场的豪华轿车有什么意义。帕拉丁知道,“水世界”这样的住宅在新加坡可以轻易地卖出5,000万美元(约合人民币3.06亿元),只是你在新加坡绝对找不到这样的房子。帕拉丁称:“水世界的海滩是我见过的最美的海滩。我想念百慕大的自然之美。” /201311/263741 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福州哪家医院宫腹腔镜好福州看卵巢多囊的医院

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