论现代临床医学发展的人文走向

我们不能用静止的眼光看待当代的医学。在整个“以人为本”的环境背景和其它因素的影响下,近二十多年以来,现代医学正在开始走出人性冷漠的阴影,出现了一些重要的人文走向,尽管这还只是开始,但无疑给人们以希望和信心。     

The integration of familiarity and recollection information in short-term recognition: modeling speed-accuracy trade-off functions

Dual process models postulate familiarity and recollection as the basis of the recognition process. We investigated the time-course of integration of the two information sources to one recognition judgment in a working memory task. We tested 24 subjects with a response signal variant of the modified Sternberg recognition task (Oberauer, 2001) to isolate the time course of three different probe types indicating different combinations of familiarity and source information. We compared two mathematical models implementing different ways of integrating familiarity and recollection. Within each model, we tested three assumptions about the nature of the familiarity signal, with familiarity having (a) only positive values, indicating similarity of the probe with the memory list, (b) only negative values, indicating novelty, or (c) both positive and negative values. Both models provided good fits to the data. A model combining the outputs of both processes additively (Integration Model) gave an overall better fit to the data than a model based on a continuous familiarity signal and a probabilistic all-or-none recollection process (Dominance Model).     

Neuropsychological Measures that Predict Progression from Mild Cognitive Impairment to Alzheimer's type dementia in Older Adults: a Systematic Review and Meta-Analysis

This study aimed to determine the extent to which cognitive measures can predict progression from mild cognitive impairment (MCI) to Alzheimer’s type dementia (AD), assess the predictive accuracy of different cognitive domain categories, and determine whether accuracy varies as a function of age and length of follow-up. We systematically reviewed and meta-analyzed data from longitudinal studies reporting sensitivity and specificity values for neuropsychological tests to identify individuals with MCI who will develop AD. We searched articles in Medline, Cochrane, EMBASE, PsycINFO, and the Web of Science. Methodological quality was assessed using the STARDem and QUADAS standards. Twenty-eight studies met the eligibility criteria (2365 participants) and reported predictive values from 61 neuropsychological tests with a 31-month mean follow-up. Values were pooled to provide combined accuracy for 14 cognitive domains. Many domains showed very good predictive accuracy with high sensitivity and specificity values (≥ 0.7). Verbal memory measures and many language tests yielded very high predictive accuracy. Other domains (e.g., executive functions, visual memory) showed better specificity than sensitivity. Predictive accuracy was highest when combining memory measures with a small set of other domains or when relying on broad cognitive batteries. Cognitive tests are excellent at predicting MCI individuals who will progress to dementia and should be a critical component of any toolkit intended to identify AD at the pre-dementia stage. Some tasks are remarkable as early indicators, whereas others might be used to suggest imminent progression.     

Splenium development and early spoken language in human infants

The association between developmental trajectories of language‐related white matter fiber pathways from 6 to 24 months of age and individual differences in language production at 24 months of age was investigated. The splenium of the corpus callosum, a fiber pathway projecting through the posterior hub of the default mode network to occipital visual areas, was examined as well as pathways implicated in language function in the mature brain, including the arcuate fasciculi, uncinate fasciculi, and inferior longitudinal fasciculi. The hypothesis that the development of neural circuitry supporting domain‐general orienting skills would relate to later language performance was tested in a large sample of typically developing infants. The present study included 77 infants with diffusion weighted MRI scans at 6, 12 and 24 months and language assessment at 24 months. The rate of change in splenium development varied significantly as a function of language production, such that children with greater change in fractional anisotropy (FA) from 6 to 24 months produced more words at 24 months. Contrary to findings from older children and adults, significant associations between language production and FA in the arcuate, uncinate, or left inferior longitudinal fasciculi were not observed. The current study highlights the importance of tracing brain development trajectories from infancy to fully elucidate emerging brain–behavior associations while also emphasizing the role of the splenium as a key node in the structural network that supports the acquisition of spoken language.     

论医院伦理委员会的建设

医院伦理委员会作为维护医患关系之间权益公平的中介力量,把医学技术与人文关怀结合起来,在医患之间构筑起一种新型的关系,让患者得到细致入微的人本关怀。目前,我国在依法推进、规范医学伦理审查方面仍是空白,所以应尽快对医院伦理委员会的工作性质及作用做出明确的规定,以保障医疗工作更加安全。     

Use of health-related online sites

This report offers recommendations to physicians who provide information or services through online sites. The recommendations maintain that physicians responsible for health-related information should ensure that it is accurate, timely, reliable, and scientifically sound. Also, advice to the online users with whom physicians do not have pre-existing relationships or the use of decision-support programs that generate personalized information directly transmitted to users should be consistent with general and specialty-specific standards. In particular, these standards address truthfulness, protection of privacy, informed consent, and disclosures including limitations inherent in the technology. Finally, physicians who establish or are involved in health-related online sites must minimize conflicts of interest and commercial biases and, if patient specific information is transmitted, they must provide high-level security protections, as well as privacy and confidentiality safeguards.     

Reduced Alternating Gaze During Social Interaction in Infancy is Associated with Elevated Symptoms of Autism in Toddlerhood

In typical development, infants often alternate their gaze between their interaction partners and interesting stimuli, increasing the probability of joint attention toward surrounding objects and creating opportunities for communication and learning. Children with Autism Spectrum Disorder (ASD) have been found to engage less in behaviors that can initiate joint attention compared to typically developing children, but the role of such atypicalities in the development of ASD during infancy is not fully understood. Here, using eye tracking technology in a live setting, we show that 10-month-olds at high familial risk for ASD engage less in alternating gaze during interaction with an adult compared to low risk infants. These differences could not be explained by low general social preference or slow visual disengagement, as the groups performed similarly in these respects. We also found that less alternating gaze at 10 months was associated with more social ASD symptoms and less showing and pointing at 18 months. These relations were similar in both the high risk and the low risk groups, and remained when controlling for general social preference and disengagement latencies. This study shows that atypicalities in alternating gaze in infants at high risk for ASD emerge already during the first 10 months of life - a finding with theoretical as well as potential practical implications.     

Explaining Differences in Subjective Well‐Being Across 33 Nations Using Multilevel Models: Universal Personality,Cultural Relativity,and National Income

This multinational study simultaneously tested three prominent hypotheses—universal disposition, cultural relativity, and livability—that explained differences in subjective well‐being across nations. We performed multilevel structural equation modeling to examine the hypothesized relationships at both individual and cultural levels in 33 nations. Participants were 6,753 university students (2,215 men; 4,403 women; 135 did not specify), and the average age of the entire sample was 20.97 years (SD = 2.39). Both individual‐ and cultural‐level analyses supported the universal disposition and cultural relativity hypotheses by revealing significant associations of subjective well‐being with Extraversion, Neuroticism, and independent self‐construal. In addition, interdependent self‐construal was positively related to life satisfaction at the individual level only, whereas aggregated negative affect was positively linked with aggregate levels of Extraversion and interdependent self‐construal at the cultural level only. Consistent with the livability hypothesis, gross national income (GNI) was related to aggregate levels of negative affect and life satisfaction. There was also a quadratic relationship between GNI and aggregated positive affect. Our findings reveal that universal disposition, cultural self‐construal, and national income can elucidate differences in subjective well‐being, but the multilevel analyses advance the literature by yielding new findings that cannot be identified in studies using individual‐level analyses alone.