对心血管病学若干进展的反思

心电起搏的发展经历曲折的过程,反映出以技术和设备为本的缺陷,以人为本可弥补这些缺陷;对介入新技术的过热应用反映了以技术为本的弊端;临床试验证据只反映某种情况下的患者共性,对试验证据的僵化理解和运用违背了循证医学的本义,以人为本可较好地解决这一矛盾;预防为主是以人为本的最好体现,应得到广泛的重视和实施.以人为本是医学的核心价值和出发点.     

循证烧伤医学与烧伤医学的发展

循证医学是以证据为基础的医学,其在烧伤医学的应用即为循证烧伤医学。循证医学主要实施策略是发现和提出问题;寻求烧伤医疗实践中或者文献中的有价值证据;进行实验或方法学的评价;应用于临床检验的实践中;评价实践结果。循证烧伤医学和循证医学对烧伤医学的学科发展和临床工作的开展具有重要的意义,烧伤医学今后的发展方向是循证烧伤医学。     

循证烧伤医学与烧伤医学的发展

循证医学是以证据为基础的医学,其在烧伤医学的应用即为循证烧伤医学.循证医学主要实施策略是发现和提出问题;寻求烧伤医疗实践中或者文献中的有价值证据;进行实验或方法学的评价;应用于临床检验的实践中;评价实践结果.循证烧伤医学和循证医学对烧伤医学的学科发展和临床工作的开展具有重要的意义,烧伤医学今后的发展方向是循证烧伤医学.     

透过循征医学看"以病人为中心"的医疗模式

随着医学模式由单纯生物医学模式向生物心理社会医学模式的转变 ,临床医学行为也由过去的以理论知识加个人经验为指导向以循征医学为依据的模式转变。循征医学所提倡的是科学治病 ,通过提供和运用当前最好的证据 ,促进医疗质量的提高 ,最终造福于病人。1　循征医学反映了“以病人为中心”的宗旨传统医学的医疗模式是以疾病和医生为中心。而伴随着生活水平的提高和医学的进步 ,人们对医疗保健的要求已不单纯满足于治疗疾病与症状的控制 ,而是希望改善疾病转归和提高生活质量转化。循征医学的医疗模式正是顺应了这种趋势 ,它所强调的是以病人…     

发展性阅读障碍的噪音抑制缺陷

发展性阅读障碍的缺陷本质一直是研究者们关注和争论的焦点。近些年, 有研究者提出了一种新的理论假设——噪音抑制缺陷假设, 并得到了许多研究证据的支持。这种缺陷在视觉和听觉通道中均存在, 说明阅读障碍具有多感觉/一般性噪音抑制缺陷。但也有研究者指出知觉噪音抑制本质上反映了注意的功能, 因而这种缺陷可能是由注意缺陷导致的。目前还缺乏直接证据支持汉语阅读障碍存在噪音抑制缺陷。最后本文对该领域未来的发展方向做出展望。     

循证医学与实事求是

循证医学主张“慎重、准确和明智地应用当前所能获得的最好的研究依据;结合临床医生的个人专业技能和多年临床经验;考虑患者的价值和愿望,将三者完美地结合制定出患者的治疗措施。”贯穿着临床医学对患者进行“以人为本”科学救死扶伤的实事求是理念。要使“循证医学”卓有成效,应当抓住二大关键：实事求是,维护“证据”的真实性,提高医术的可靠性。     

循证医学与心血管病学临床研究

循证医学是寻求、应用证据的医学。将现有的最佳证据自觉、明确、审慎地应用于照料病人的决策之中 ,同时结合临床医生的个人专业技能和临床经验、考虑患者的权利、价值和期望 ,将三者完美地结合以制定出治疗措施[1] 。其核心思想是 :在临床医疗实践中 ,对患者的诊治决策都应尽量以客观的科学结论为依据。循证医学要求医生对病人的诊断和治疗均应以临床流行病学研究的证据为指导原则。这些证据来自于大规模、随机化和有对照的临床研究及对同类研究所做的合理的荟萃分析 (ｍｅｔａ -ａｎａｌｙｓｉｓ) ,以评价治疗方案的有效性、安全性以及对…     

加强对学科指南的依从性

循证医学概念的提出使得临床医疗模式发生了重大变化,既往以经验为基础的医疗模式逐渐向循证医学模式过渡.早期临床指南常常是根据专家们的临床经验经充分讨论达成共识而拟订,没有系统性、科学性的研究证据,缺乏可靠性.循证医学强调证据及其质量,依据现有证据及其质量高低制定临床诊疗指南,即在综述和分析现有临床证据的基础上制定指南.由于以循证医学为导向的指南有临床证据基础,因此成为目前公认的最具权威性的指南制定方法[1].     

语义相似性下回忆和熟悉性的分离

该研究利用事件相关电位技术（ERPs）,采用以汉字为实验材料的学习-再认范式,考察了语义相似性下回忆和熟悉性的分离。本实验结果表明：熟悉性效应主要体现在330-430ms的额区,而回忆效应主要体现在430-600ms的中央区和顶区。本实验在以汉字为实验材料的情况下证明了,早期额区的N400新旧效应反映了熟悉性,晚期顶区LPC新旧效应反映了回忆,从汉语材料的角度,为双加工过程假说提供了新的证据。     

循证医学与实事求是

循证医学主张"慎重、准确和明智地应用当前所能获得的最好的研究依据;结合临床医生的个人专业技能和多年临床经验;考虑患者的价值扣愿望,将三者完美地结合制定出患者的治疗措施."贯穿着临床医学对患者进行"以人为本"科学救死扶伤的实事求是理念.要使"循证医学"卓有成效,应当抓住二大关键:实事求是,维护"证据"的真实性,提高医术的可靠性.     

Symmetry breaking analysis of prism adaptation's latent aftereffect

The effect of prism adaptation on movement is typically reduced when the movement at test (prisms off) differs on some dimension from the movement at training (prisms on). Some adaptation is latent, however, and only revealed through further testing in which the movement at training is fully reinstated. Applying a nonlinear attractor dynamic model (Frank, Blau, & Turvey, 2009) to available data (Blau, Stephen, Carello, & Turvey, 2009), we provide evidence for a causal link between the latent (or secondary) aftereffect and an additive force term that is known to account for symmetry breaking. The evidence is discussed in respect to the hypothesis that recalibration aftereffects reflect memory principles (encoding specificity, transfer-appropriate processing) oriented to time-translation invariance-when later testing conserves the conditions of earlier training. Forgetting or reduced adaptation effects follow from the loss of this invariance and are reversed by its reinstatement.     

On the fragility of skilled performance: what governs choking under pressure?

Experiments 1-2 examined generic knowledge and episodic memories of putting in novice and expert golfers. Impoverished episodic recollection of specific putts among experts indicated that skilled putting is encoded in a procedural form that supports performance without the need for step-by-step attentional control. According to explicit monitoring theories of choking, such proceduralization makes putting vulnerable to decrements under pressure. Experiments 3-4 examined choking and the ability of training conditions to ameliorate it in putting and a nonproceduralized alphabet arithmetic skill analogous to mental arithmetic. Choking occurred in putting but not alphabet arithmetic. In putting, choking was unchanged by dual-task training but eliminated by self-consciousness training. These findings support explicit monitoring theories of choking and the popular but infrequently tested belief that attending to proceduralized skills hurts performance.     

Memory distortion: an adaptive perspective

Memory is prone to distortions that can have serious consequences in everyday life. Here we integrate emerging evidence that several types of memory distortions - imagination inflation, gist-based and associative memory errors, and post-event misinformation - reflect adaptive cognitive processes that contribute to the efficient functioning of memory, but produce distortions as a consequence of doing so. We consider recent cognitive and neuroimaging studies that link these distortions with adaptive processes, including simulation of future events, semantic and contextual encoding, creativity, and memory updating. We also discuss new evidence concerning factors that can influence the occurrence of memory distortions, such as sleep and retrieval conditions, as well as conceptual issues related to the development of an adaptive perspective.     

Overthinking skilled motor performance: Or why those who teach can’t do

Skilled athletes often maintain that overthinking disrupts performance of their motor skills. Here, we examined whether these experiences have a basis in verbal overshadowing, a phenomenon in which describing memories for ineffable perceptual experiences disrupts later retention. After learning a unique golf-putting task, golfers of low and intermediate skill either described their actions in detail or performed an irrelevant verbal task. They then performed the putting task again. Strikingly, describing their putting experience significantly impaired higher skill golfers’ ability to reachieve the putting criterion, compared with higher skill golfers who performed the irrelevant verbal activity. Verbalization had no such effect, however, for lower skill golfers. These findings establish that the effects of overthinking extend beyond dual-task interference and may sometimes reflect impacts on long-term memory. We propose that these effects are mediated by competition between procedural and declarative memory, as suggested by recent work in cognitive neuroscience.     

At the first sign of trouble or through thick and thin? When nonconformity is and is not disengagement from a group

The current research tests the prediction that nonconformity can reflect engagement with rather than disengagement from social groups. We present two studies that contained indices of both nonconformity and disengagement to examine their relationship under different circumstances and to dissociate two forms of nonconformity: individually oriented vs. collectively oriented. Study 1 demonstrates that thinking about how a group norm may cause individual harm triggers a type of nonconformity that is associated with disengagement from the group, whereas thinking about how a norm may cause collective harm triggers a type of nonconformity that is not associated with disengagement. Study 2 investigates the relationship between nonconformity and disengagement among group members that vary in their level of collective identification. We demonstrate that whereas nonconformity among weakly identified group members is associated with disengagement, this is not the case among strong identifiers.     

Assessing normative approaches to communicating violence risk: a national survey of psychologists

There is growing attention to the importance of violence risk communication, and emerging empirical evidence of how evaluating clinicians who conduct risk assessments communicate their conclusions about the risk of violence toward others. The present study addressed the perceived value of different forms of risk communication through a national survey of practicing psychologists (N = 1,000). Responses were received from a total of 256 participants, who responded to eight vignettes in which three factors relevant to risk communication were systematically varied in a 2 x 2 x 2 within-subjects design, counterbalanced for order: (i) risk model (prediction oriented versus management oriented), (ii) risk level (high risk versus low risk), and (iii) risk factors (static versus dynamic). Participants were asked to rate the value of six styles of risk communication for each of eight vignettes. The most highly valued style of risk communication involved identifying risk factors applicable to the individual, and specifying interventions to reduce risk. These results were consistent with findings from several previous studies in this area, and reflect an emerging trend in preferences for style and context of risk communication of violence.     

No transfer of calibration between action and perception in learning a golf putting task

We assessed calibration of perception and action in the context of a golf putting task. Previous research has shown that right-handed novice golfers make rightward errors both in the perception of the perfect aiming line from the ball to the hole and in the putting action. Right-handed experts, however, produce accurate putting actions but tend to make leftward errors in perception. In two experiments, we examined whether these skill-related differences in directional error reflect transfer of calibration from action to perception. In the main experiment, three groups of right-handed novice participants followed a pretest, practice, posttest, retention test design. During the tests, directional error for the putting action and the perception of the perfect aiming line were determined. During practice, participants were provided only with verbal outcome feedback about directional error; one group trained perception and the second trained action, whereas the third group did not practice. Practice led to a relatively permanent annihilation of directional error, but these improvements in accuracy were specific to the trained task. Hence, no transfer of calibration occurred between perception and action. The findings are discussed within the two-visual-system model for perception and action, and implications for perceptual learning in action are raised.     

Role-Reversal: A Somewhat Neglected Mirror of Heritages of the Past

Within a clinical–theoretical framework focused on transference–countertransference dynamics, the authors reflect on role-reversal and on the reasons it has been neglected for a long time in literature. This primitive inter- and intra-psychic process, often at the forefront in our practice, will be discussed in its principal aspects (patient's unconscious identification with parents’ psychic culture and concomitant dissociation of the infant part of the self), signaling how the enactment can be an inevitable element which, putting into play the past dissociated object relationships, becomes a source of mutative understanding.     

Reflexive Attention Modulates Processing of Visual Stimuli in Human Extrastriate Cortex

Attention can be oriented reflexively to a location in space by an abrupt change in the visual scene. In the present study, we investigated the consequences of reflexive attention on the neural processing of visual stimuli. The findings show that reflexively oriented attention produces modulations in early sensory analysis at the same extrastriate neural locus as the earliest effects of voluntarily focused attention. In addition, stimulus processing was found to be enhanced at later stages of analysis, which reflect stimulus relevance. As is the case with behavioral measures of reflexive attention, these physiological enhancement effects are rapidly engaged but short-lived. As time passes between the initial attention-capturing event and subsequent stimuli, the extrastriate effect reverses, and the enhancement of higher order processing subsides. These findings indicate that reflexive attention is able to affect perceptions of the visual world by modulating neural processing as early as extrastriate visual cortex.     

Forgiveness,the Gift,and Ecclesiology

Abstract: This article responds to the work of George Lindbeck and John Milbank while putting forth a new position on the theology of gift and forgiveness. Saarinen constructs a rudimentary theological anthropology, focusing on God and human beings as givers. As an example of applying this “giver‐oriented perspective” he outlines a fourfold typology of forgiveness as (1) negative giving, forgetting; (2) negative and positive giving, forgetting; (3) negative giving, forgetting and remembering; (4) negative and positive giving, forgetting and remembering.