治疗决策十题

治疗决策是临床决策中的重要组成部分。为了提高治疗决策水平,临床医生可以从以下几个基本环节入手深究决策依据、明确治疗目标、坚持疗效优化、强调安全第一、注意条件约束、注重时效原则、突出救治重点、减损方案危害、分析失悔程度和了解敏感阈值。     

Zur Dynamik der Interaktion in der Supervision

The manifold functions of a supervisor in following the course of complex processes together with the trainee, are: ? to keep the goals of the supervision in view, ? to establish a teaching alliance and to support the wish and ambitions of the candidate to learn, ? to build a platform for the complex interactions with the trainee with regard to the dynamics of the training situation and keeping in mind the institutional influences, ? to lay down the setting for the work, ? to explore and to reflect how transference and counter-transference influence the interaction between patient and analyst as well as between trainee and supervisor, ? to examine these interactions together focussing continuously on the interaction between candidate and patient, and to encourage the candidate to do the same on his own, ? to continuously formulate hypotheses about the core conflict, the transference phenomena and resistance of the patient, ? to explore and reflect on the cooperative work.     

从认知逻辑视角看西方伦理学的发展

本文希望从认知伦理学的视角出发探讨伦理学的发展,以及人类对道德问题认知的过程与人类一般认知的逻辑之间的一致性。人类认知的逻辑是由概念到判断再到推论的过程,伦理学史由德性伦理学到规范伦理学再到话语伦理学、元伦理学和新德性伦理学的过程,实际上就是人类在道德认知上从概念伦理学到判断伦理学再到推论伦理学最后回归到概念伦理学的过程。     

个人目标相关性对非临床抑郁者未来想象的影响

通过两个实验考查了非临床抑郁者未来想象的异常是否受到个人目标相关性的调节。实验1采用未来想象任务, 实验2采用可能性评估范式, 两个实验一致发现, 抑郁倾向者想象未来积极事件的异常, 受到了与个人目标相关性的调节：相对于非抑郁倾向者, 抑郁倾向者对未来与个人目标相关的积极事件的预期减弱, 而对未来与个人目标无关的积极事件的预期则没有表现出异常; 同时还发现, 抑郁倾向者表现出了对未来消极预期的普遍增强, 不受与个人目标相关性的影响。     

Sources of stimulus control during multiple discriminations

Pigeons learned to respond to the middle-sized member of six or seven sets of three stimuli differing in size. The sets were used successively, each serving as the discrimination problem from 10 to 16 times. After attaining criterion with one set, the birds received the others as probes. The number of responses in probes was related to the similarity of the probes to the prevailing discrimination problem. The birds responded either to the probe stimulus to which responding had most recently been reinforced, or to the probe stimulus closest in size to the positive member (S+) of the prevailing discrimination problem. Responses to a middle-sized probe-set stimulus occurred when it was the probe-set member most recently correlated with reinforcement, when it was one of two stimuli closest in size to S+, and when the stimulus closest in size to S+ was a negative member of the discrimination problem. All of the behavior could be explained in terms of control by the absolute sizes of the various stimuli.     

The Tragedy of the Commons as an Essentially Aggregative Harm

This article identifies ‘the tragedy of the commons’ as an essentially aggregative harm and considers what agents in such a scenario owe to one another. It proposes that the duty to take reasonable precautions requires that agents make efforts to establish collective solutions to any essentially aggregative harm to which they would otherwise contribute. Baylor Johnson has argued that the general obligation to promote the common good requires that agents make efforts to establish a collective agreement to avert a potential tragedy of the commons. This article agrees with Johnson's analysis but argues that there are also negative duties, which give commons users additional moral reason to take collective action to prevent the destruction of the utility of the commons. These duties link commons users to resolving this particular problem and provide grounds to demand that they make greater efforts to prevent the destruction of the commons compared to bystanders. The article suggests that fulfilling negative duties can require establishing collective institutions with the power to regulate human action and interaction. This analysis could be applied to a range of social problems which result from the aggregation of actions and practices.     

“Bodyheartminding” (Xin 心): Reconceiving the Inner Self and the Outer World in the Language of Holographic Focus and Field

In this essay, inspired by the somatic turn in philosophy initiated by Richard Shusterman, I want to invoke the language of classical Confucian philosophy to think through the best efforts of William James and John Dewey to escape the mind-body and nature-nurture dualisms—that is, to offer an alternative vocabulary that might lend further clarity to the revolutionary insights of James and Dewey by appealing to the processual categories of Chinese cosmology. What I will try to do first is to refocus the pragmatist’s explanation of the relationship between mind and body through the lens of a process Confucian cosmology. And then, to make the case for James and Dewey, I will return to the radical, imagistic language they invoke to try and make the argument that this processual, holistic understanding of “vital bodyminding” is in fact what they were trying to say all along.     

推进新时代中国社区心理学新形态建设

建设中国特色的社区心理学是时代的呼唤和要求。在党的二十大精神指引下,新时代中国社区心理学需要坚持中国化时代化的马克思主义为指导以推进理论建设;以新时代社区心理建设为场域,助力社会主义核心价值观培育;构建新时代中国社区心理学服务路径,助推人民共同富裕。总体而言,中国特色社区心理学的理论建设与实践探索需要关注新时代社区发展中涌现出的新问题,提出解决中国社区发展问题的中国办法和中国方案,努力推进中国社区心理学新形态的建设。     

论生态学的马克思主义的人道主义

生态学的马克思主义基于对人类命运的关照,立足人道主义,反对以单纯保护生态为目的的生态中心主义和企图转嫁生态矛盾的生态帝国主义;认为资本主义的生产、分配和消费方式是引发生态危机的根源;要想摆脱已经上升为人和自然之主要矛盾的生态危机,不仅需要建立“无增长的”经济模式,倡导“劳动闲暇一元论”和日常生活的“简朴主义”,根除虚假需求,克服异化消费,使生产过程分散化、民主化和管理科学化,变控制自然为解放自然,提倡技术为全人类服务,使生态学充满人道主义,而且需要根除资本主义生产的利润动机,杜绝独裁主义的政治和生产逻辑,反对技术法西斯主义,最终废除资本主义制度,建立非极权的、更易于生存的、以实现生态与社会和谐发展为目标的“稳态社会主义”。     

The Prevention of Reading Difficulties

The purpose of this article is to provide practical advice about methods to prevent reading failure that is grounded in the new knowledge we have acquired about reading and learning to read over the past 2 decades. Recent research on reading is used to establish a set of facts about reading and reading growth that is relevant to establishing instructional objectives and methods for the prevention of reading difficulties. Within the context of our current understanding of the reasons many children find it difficult to learn to read, the article also identifies the instructional conditions that need to be in place to prevent the development of reading difficulties in all but a very small proportion of children. The article concludes with a discussion of issues and procedures for the early identification of children who are likely to experience difficulties learning to read.     

Resilience concepts and findings: implications for family therapy

Resilience is a term used to describe relative resistance to psychosocial risk experiences. There is abundant evidence that there is enormous variation in children's responses to such experiences but research to determine the processes underlying the variations needs to take account of several crucial methodological issues. The findings emphasize that multiple risk and protective factors are involved; that children vary in their vulnerability to psychosocial stress and adversity as a result of both genetic and environmental influences; that family-wide experiences tend to impinge on individual children in quite different ways; that the reduction of negative, and increase of positive, chain reactions influences the extent to which the effects of adversity persist over time; that new experiences which open up opportunities can provide beneficial 'turning- point' effects; that although positive experiences in themselves do not exert much of a protective effect, they can be helpful if they serve to neutralize some risk factors; and that the cognitive and affective processing of experiences is likely to influence whether or not resilience develops. The implications of these findings for family therapy are considered in terms of the need for therapists to look carefully at the ways in which different risk factors interact; to assess and take account of individual differences in susceptibility; to consider the extent to which risk factors impinge on the individual and, in that connection, to note the importance of patterns of social interaction outside as well as inside the family; to appreciate the role of both the peer group and individual characteristics in the development of negative and positive chain reactions; and to pay attention to the ways in which individuals process their experiences.     

Quelles méthodes et quelle modélisation d’analyse de l’activité de travail de l’encadrement ? L’exemple de l’encadrement des chantiers de la construction

By referring to the ergonomic analysis of work and to the management sciences, the authors propose an analysis model of the managers’ activity. Until then, few researchs were realized in ergonomics science with this population which has to prepare and to organize the works of other operators. According to the authors, it is possible to apply to this population the model of “the centre de décision”. It allows to understand how their activity is determined by “upstream” centres and then how it determines the activity of centres “approval”. Applied to the project and site managers, this model brings solutions to transform their work and the work of the workmen.     

吸烟利弊权衡对戒烟计划的预测作用：一个有调节的中介模型

考察吸烟利弊权衡对戒烟计划的预测,以及戒烟意愿的中介作用和未来取向的调节作用。对340名吸烟者进行问卷调查结果的统计分析发现：（1）吸烟利弊权衡显著正向预测戒烟计划;（2）戒烟意愿对吸烟利弊权衡和戒烟计划的关系起完全中介作用;（3）未来取向负向调节吸烟利弊权衡和戒烟计划的关系,但对吸烟利弊权衡和戒烟意愿关系的调节不显著。这些结果说明,吸烟者戒烟计划发展经历前决策和前行动阶段,且该过程受未来取向的调节。     

Positive affect and learning: exploring the “Eureka Effect” in dogs

Animals may experience positive affective states in response to their own achievements. We investigated emotional responses to problem-solving in dogs, separating these from reactions to rewards per se using a yoked control design. We also questioned whether the intensity of reaction would vary with reward type. We examined the response (behavior and heart rate) of dogs as they learned to gain access to different rewards: (1) food (2) human contact, and (3) dog contact. Twelve beagles were assigned to matched pairs, and each dog served as both an experimental and a control animal during different stages of the experiment. We trained all dogs to perform distinct operant tasks and exposed them to additional devices to which they were not trained. Later, dogs were tested in a new context. When acting as an experimental dog, access to the reward was granted immediately upon completion of trained operant tasks. When acting as a control, access to the reward was independent of the dog’s actions and was instead granted after a delay equal to their matched partner’s latency to complete their task. Thus, differences between the two situations could be attributed to experimental dogs having the opportunity to learn to control access to the reward. Experimental dogs showed signs of excitement (e.g., increased tail wagging and activity) in response to their achievements, whereas controls showed signs of frustration (e.g., chewing of the operant device) in response to the unpredictability of the situation. The intensity of emotional response in experimental dogs was influenced by the reward type, i.e., greatest response to food and least to another dog. Our results suggest that dogs react emotionally to problem-solving opportunities and that tail wagging may be a useful indicator of positive affective states in dogs.     

Is there an effect of handedness on the position of the egocentric reference?

Forty normal subjects (20 left-handed; 20 right-handed) were submitted to a proprioceptive straight ahead pointing task while blindfolded to study the effect of the hand used and of the hand preference on the estimation of the subjective sagittal middle. Results showed that left-handed and right-handed subjects both deviated to the left of the objective sagittal middle and presented an effect of the hand used and of the starting point affecting their straight ahead performance in a similar way. In all subjects whatever their manual preference, using the left hand and starting 30 degrees to left induced a tendency to deviate to the same side, whereas using the right hand and starting 30 degrees to right induced a tendency to place the subjective middle to the right of the objective middle. These results are interpreted with regard to the hypothesis of a cortical control of the position of the egocentric reference.     

Transfer of movement sequences: bigger is better

Experiment 1 was conducted to determine if proportional transfer from "small to large" scale movements is as effective as transferring from "large to small." We hypothesize that the learning of larger scale movement will require the participant to learn to manage the generation, storage, and dissipation of forces better than when practicing smaller scale movements. Thus, we predict an advantage for transfer of larger scale movements to smaller scale movements relative to transfer from smaller to larger scale movements. Experiment 2 was conducted to determine if adding a load to a smaller scale movement would enhance later transfer to a larger scale movement sequence. It was hypothesized that the added load would require the participants to consider the dynamics of the movement to a greater extent than without the load. The results replicated earlier findings of effective transfer from large to small movements, but consistent with our hypothesis, transfer was less effective from small to large (Experiment 1). However, when a load was added during acquisition transfer from small to large was enhanced even though the load was removed during the transfer test. These results are consistent with the notion that the transfer asymmetry noted in Experiment 1 was due to factors related to movement dynamics that were enhanced during practice of the larger scale movement sequence, but not during the practice of the smaller scale movement sequence. The findings that the movement structure is unaffected by transfer direction but the movement dynamics are influenced by transfer direction is consistent with hierarchal models of sequence production.     

The effects of exposure to political and domestic violence on preschool children and their mothers

The purpose of this study was to examine the effects of exposure to political violence on preschool children and their mothers. We explored whether these dyads are different from dyads with no known history of exposure to violence and from mother–child dyads with known exposure to domestic violence. Specifically, we explored differences in mothers' psychological status (depression and anxiety), dyadic emotional availability (EA), children's social information processing, and children's social behaviour, in a sample of 216 dyads divided into three groups (exposure to political violence, no exposure to violence, and exposure to domestic violence). We found evidence to support our hypotheses that children exposed to domestic violence exhibit the highest levels of social maladjustment with smaller but still significant differences between children exposed to political violence and children in the comparison group. As expected, the lowest EA scores were found in the exposure to domestic violence group, followed by dyads in the exposure to political violence group. Dyads belonging to the comparison group (no exposure) exhibited the highest levels of EA. These findings contribute to our understanding of the meaning of exposure to political violence, as well as sharpen the difference between exposure to political and domestic violence.     

Psychological and behavioral implications of connectedness to communities with opposing values and beliefs

Without a doubt, people can feel simultaneously connected to multiple communities (e.g., Deaux, 1993; Roccas & Brewer, 2002). But, to what degree can people feel simultaneously connected to communities with opposing beliefs and values? And, more importantly, what are the psychological implications of being dually connected to these communities? Capitalizing on a sample of individuals positioned to potentially feel connected to two very distinct communities, we examined jail inmates' (N = 256) sense of connectedness to the criminal community and to the community at large. Results indicated that (a) connectedness to the community at large is orthogonal to connectedness to the criminal community, supporting the supposition that it is possible to be dually connected to opposing communities; and (b) connectedness to the community at large moderated the relationship between criminal connectedness and indicators of psychological distress, suggesting that connectedness to the criminal community is especially problematic when it occurs in tandem with connectedness to the community at large. These findings are consistent with predictions from the self-expansion model.     

Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions

Assessing treatment fidelity is a core methodological consideration in the study of treatment outcome; it influences both the degree to which changes can be attributed to the intervention and the ability to replicate and disseminate the intervention. Efforts to increase access to evidence-based psychological treatments are receiving unprecedented support; but pressures exist to adapt treatments to service settings, running the risk of compromising fidelity. However, little evidence is available to inform the necessary conditions for the transportation of interventions to service provision settings, and the degree to which fidelity is even evaluated or emphasized in dissemination and implementation programs varies dramatically. Moreover, adaptation is associated with several benefits for dissemination efforts and may address relevant barriers to adoption. A particularly promising strategy for maximizing the benefits of both fidelity and adaptation is the use of transdiagnostic interventions. Such treatments allow for greater flexibility of the pacing and content of treatment, while still providing structure to facilitate testing and replication. Preliminary evidence supports the efficacy of this strategy, which may be particularly conducive to dissemination into service provision settings. At this time, further research is needed to evaluate the relationships among fidelity, adaptation, and outcome, and to determine the potential for transdiagnostic treatments to facilitate dissemination.     

我国乙型肝炎病毒携带者健康权现状分析

乙型肝炎病毒携带者健康权包括医疗保障权、劳动权、受教育权以及包括婚姻、家庭、社会交往在内的其他生活平等权。本文分析了我国乙肝携带者健康权现状,对我国近年来的乙肝维权工作进行回顾,并从减轻医疗费用负担、规范医疗市场、完善法律法规、推动非政府组织的发展等方面对维护和保障乙肝携带者健康权提出建议。