"人造美女"的生命伦理学思考

"人造美女"是一个纯粹的市场炒作的概念,其背后隐匿着深刻的生命伦理难题,并直接面对现实的医学伦理学问题.其中,生命价值、技术对生命干涉限度、美容与健康的冲突、医疗商业化等生命伦理学难题格外突出,而医疗伤害、技术滥用等是更为现实的医学伦理学问题.     

"人造美女"热的冷思考

"人造美女"是对美的本质的亵渎,是对女性价值全面性的否定,同时也是对医学人道主义和医学伦理基本原则的全面践踏.作为一名医务工作者,应该避免经济利益的驱动,全心全意地践行医德誓言,把治疗伤疾、维护人们的身心健康作为自己的神圣信条和基本准则.     

Comparing Cognitive Behavioral Therapy and Systemic Therapy for Social Anxiety Disorder: Randomized Controlled Pilot Trial (SOPHO-CBT/ST)

This randomized controlled trial (RCT) aimed to pilot the newly developed manualized and monitored systemic therapy (ST) for social anxiety disorder (SAD), as compared to manualized and monitored cognitive behavioral therapy (CBT). We conducted a prospective multicenter, assessor-blind pilot RCT on 38 outpatients (ICD F40.1; Structured Clinical Interview for DSM (SCID); Liebowitz Social Anxiety Scale, LSAS-SR >30). The primary outcome was level of social anxiety (LSAS-SR) at the end of treatment. A total of 252 persons were screened, and 38 patients were randomized and started therapy (CBT: 20 patients; ST: 18 patients; age: M = 36 years, SD = 14). Within-group, simple-effect intent-to-treat analyses (ITT) showed significant reduction in LSAS-SR (CBT:d = 1.04; ST:d = 1.67), while ITT mixed-design ANOVA demonstrated the advantage of ST (d = 0.81). Per-protocol analyses supported these results. Remission based on reliable change indices also demonstrated significant difference (LSAS-SR: 15% in CBT; 39% in ST;h: 0.550), supported by blind diagnosticians’ ratings of those who completed therapy (SCID; 45% in CBT, 78% in ST,p = .083). No adverse events were reported. CBT and ST both reduced social anxiety, supporting patient improvement with the newly developed ST for SAD; this has yet to be verified in a subsequent confirmatory RCT.     

E‐Mailed Standardized Cognitive Behavioural Treatment of Work‐Related Stress: A Randomized Controlled Trial

The aim of this study was to assess the effects of a 7‐week standardized cognitive behavioural treatment of work‐related stress conducted via e‐mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow‐up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS‐42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory – General Survey (MBI‐GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention‐to‐treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001<p?0.025). In the treatment group, the effects were large to moderate (0.9 (stress)?d?0.5 (anxiety)). The between‐group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow‐up, the effects were more pronounced, but this result requires replication in view of high attrition at follow‐up. The results warrant further research on Internet‐driven standardized cognitive behavioural therapy for work‐related stress. Such research should include the direct comparison of this treatment with face‐to‐face treatment, and should address the optimal level of therapist contact in Internet‐driven treatment.     

Kinesthetic Compensation for Sensorimotor Rearrangements

ABSTRACT

The authors report a new sensorimotor phenomenon in which participants use hand-sensed kinesthetic information to compensate for rotational sensorimotor rearrangements. This compensation benefits from conscious awareness and is related to hand posture. The technique can reduce control inefficiency with some misalignments by as much as 64%. The results support Y. Guiard's (1987) Guiard, Y. 1987. Asymmetric division of labor in human skilled bimanual action. Journal of Motor Behavior, 19: 486–517. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar] suggestion that in bimanual tasks one hand provides an operational frame of reference for the other hand as in a closed kinematic chain. Results with right-handed participants show that the right and left hands are equally effective at providing such a cue. A constant-angular-targeting-error model, similar to that used for hand movements by H. Cunningham and I. Vardi (1990) and for walking by S. K. Rushton, J. M. Harris, M. R. Lloyd, and J. P. Wann (1998), is used to model the trajectories of targeting hand movements demonstrating the phenomenon. The model provides a natural parameter of the error.     

Proprioception as a Basis for the Temporal Anticipation of Motor Responses,

The present study attempted to distinguish between the proprioceptive Decay and proprioceptive Input Hypotheses of motor timing behavior. The hypothesis that an increased level of proprioceptive cues results in more proficient temporal anticipation was also tested. 90 male Ss were required to anticipate (no preview) the coincidence of a moving pointer and a stationary one. The timing response was executed with the right hand while 3 levels of proprioceptive cues were indirectly manipulated in the left arm. While results were unable to distinguish between the hypotheses, support was found for the hypothesis that an increased level of proprioceptive feedback administered during the interval can increase anticipatory response consistency.     

Self-Selected Visual Information During Discrete Manual Aiming

The authors examined strategic selection of visual samples during manual aiming. Participants (N = 12) wore liquid-crystal goggles while performing discrete movements to a small target. Initially, participants controlled a 40-ms visual sample via a switch in their nonaiming hand. Subsequently, experimenter-imposed strategies required participants to take visual samples before movement initiation or early or late in the movement. Although participants adopted a variety of strategies to optimize the use of vision, they were more likely to select a sample during the early stages of the movement. Experimenter-imposed early and late instructions resulted in longer movement times than did self-selected sampling. Compared with late sampling, early sampling resulted in a temporal advantage with similar accuracy.     

Fitts’ Law as a Function of System Dynamics and Target Uncertainty

Fitts’ law was found to hold for discrete movements executed by subjects controlling the velocity of a cursor with a control stick. The slope of movement time versus index of difficulty was approximately twice as large as for a comparable position control system. Target uncertainty also increased the slope of total time versus index of difficulty, and this effect is interpreted in terms of adaptive tuning of the human movement system.     

Submovement Organization,Pen Pressure,and Muscle Activity Are Modulated to Precision Demands in 2D Tracking

The authors investigated how tracking performance, submovement organization, pen pressure and muscle activity in forearm and shoulder muscles were affected by target size in a 2D tracking task performed with a pen on a digitizer tablet. Twenty-six subjects took part in an experiment, in which either a small dot or a large dot was tracked, while it moved quasirandomly across a computer screen at a constant velocity of 2 cm/s. The manipulation of precision level was successful, because mean distance to target and the standard deviation of this distance were significantly smaller with the small target than with the large target. With a small target, subjects trailed more behind the center of target and used submovements with larger amplitudes and of shorter duration, resulting in higher tracking accuracy. This change in submovement organization was accompanied by higher pen pressure, while at the same time muscle activity in the forearm extensors and flexors was increased, indicating higher endpoint stability. In conclusion, increased precision demands were accommodated by both a different organization of submovements and higher endpoint stability in a 2D tracking task performed with a pen on a digitizer tablet.