现行《医疗事故处理办法》的修改探析

现行《医疗事故处理办法》颁布实施１０ 年之久,新形势下需要对其进行修改和完善。“办法”的修改应该体现平等保护医患双方合法权益原则,合理界定医疗事故范围,调整医疗事故鉴定委员会的组成,建立完善的证据管理制度,明确医疗事故损失赔偿的范围和额度。     

Perceived stress in prodromal Huntington disease

This study examines perceived stress and its relationship to depressive symptoms, life changes and functional capacity in a large sample of individuals who are positive for the Huntington disease (HD) gene expansion but not yet diagnosed. Participants were classified by estimated proximity to HD diagnosis (far, mid, near) and compared with a non-gene-expanded comparison group. Persons in the mid group had the highest stress scores. A significant interaction between age and time since HD genetic testing was also found. Secondary analyses using data from a different data collection point and including a diagnosed group showed the highest stress scores in the diagnosed group. Possible explanations and implications are discussed.     

Development of key-pecking, pause, and ambulation during extended exposure to a fixed-interval schedule of reinforcement

Six pigeons key-pecked under a fixed-interval (FI) 3-min schedule of food presentation. Each pigeon was studied for 200 daily sessions with 15 intervals per session (3,000 total food presentations). Analyses included the examination of latency to first peck (pause), mean rate of key pecking, and ambulation. Characterizations of stable performance were assessed across measures of behavior and evaluated using commonly employed stability criteria. Stability of response rate and pause was identified better by assessments that evaluated variability and trend, rather than just variability. Between-subject differences in rate of acquisition and terminal values of steady-state performance of pause were observed, and stable pause durations took longer to develop than did stable key-pecking rates. Relative variability in response rate and pause duration decreased as the means increased. A temporally organized pattern of key-pecking (the so-called FI scallop) developed within 50 sessions of exposure to the schedule. Overall ambulation decreased during the early sessions of exposure and further analyses showed greater rates of ambulation during the pause than after it for 4 of the 6 pigeons. Performance under the FI 3-min schedule developed relatively slowly, and key-pecking, pause, and ambulation developed at different rates.     

RELATIONS AMONG ACUTE AND CHRONIC NICOTINE ADMINISTRATION,SHORT-TERM MEMORY,AND TACTICS OF DATA ANALYSIS

Emerging evidence suggests that nicotine may enhance short‐term memory. Some of this evidence comes from nonhuman primate research using a procedure called delayed matching‐to‐sample, wherein the monkey is trained to select a comparison stimulus that matches some physical property of a previously presented sample stimulus. Delays between sample stimulus offset and comparison stimuli onset are manipulated and accuracy is measured. The present research attempted to systematically replicate these enhancement effects with pigeons. In addition, the effects of nicotine were assessed under another, more dynamic, memory task called titrating‐delay matching‐to‐sample. In this procedure, the delay between sample offset and comparison onset adjusts as a function of the subject's performance. Correct matches increase the delay, mismatches decrease the delay, and titrated delay values serve as the primary dependent measure. Both studies examined nicotine's effects under acute and chronic administration. Neither provided clear or compelling evidence of memory enhancement following nicotine administration despite reliable and systematic dose‐related changes in response latency measures. A modest dose‐related effect on accuracy was found, but the magnitude of the effect appears to be directly related to tactics of data analysis involving best‐dose analyses of a very circumscribed subset of trial types.     

On the development and mechanics of delayed matching-to-sample performance

Despite its frequent use to assess effects of environmental and pharmacological variables on short-term memory, little is known about the development of delayed matching-to-sample (DMTS) performance. This study was designed to examine the dimensions and dynamics of DMTS performance development over a long period of exposure to provide a more secure foundation for assessing stability in future research. Six pigeons were exposed to a DMTS task with variable delays for 300 sessions (i.e., 18,000 total trials; 3,600 trials per retention interval). Percent-correct and log-d measures used to quantify the development of conditional stimulus control under the procedure generally and at each of five retention intervals (0, 2, 4, 8 and 16-s) individually revealed that high levels of accuracy developed relatively quickly under the shorter retention intervals, but increases in accuracy under the longer retention intervals sometimes were not observed until 100-150 sessions had passed, with some still increasing at Session 300. Analyses of errors suggested that retention intervals induced biases by shifting control from the sample stimulus to control by position, something that was predicted by observed response biases during initial training. These results suggest that although it may require a great deal of exposure to DMTS prior to obtaining asymptotic steady state, quantification of model parameters may help predict trends when extended exposure is not feasible.     

Stability of pigeon body weight under free-feeding conditions

Increases in regulatory oversight of animal research require verification of effects of standard practices. There are no formal guidelines for establishing free-feeding weights in adult pigeons. In the present study, pigeons were obtained from a commercial supplier, weighed upon arrival, and then held in quarantine for 7 days with free access to food. Subsequently, still with continuous access to food, they were weighed daily for 30 days. No significant changes in weights occurred over the 30-day period for male pigeons, indicating that seven days is sufficient for establishing a baseline body weight. A secondary finding of higher day-to-day variability in the weights of female pigeons may serve as a method of sexing pigeons.     

An acquired deficit of audiovisual speech processing

We report a 53-year-old patient (AWF) who has an acquired deficit of audiovisual speech integration, characterized by a perceived temporal mismatch between speech sounds and the sight of moving lips. AWF was less accurate on an auditory digit span task with vision of a speaker's face as compared to a condition in which no visual information from the lower face was available. He was slower in matching words to pictures when he saw congruent lip movements compared to no lip movements or non-speech lip movements. Unlike normal controls, he showed no McGurk effect. We propose that multisensory binding of audiovisual language cues can be selectively disrupted.     

Acute and chronic effects of cocaine on the spontaneous behavior of pigeons

The present experiment examined the effects of acute and daily cocaine on spontaneous behavior patterns of pigeons. After determining the acute effects of a range of doses, 9 pigeons were divided into three groups that received one of three doses of cocaine daily, either 1.0, 3.0, or 10.0 mg/kg cocaine. Measures were taken of spontaneous locomotion, pecking, preening, and emesis. Under daily administration, cocaine induced consistent and substantial enhancements of its locomotor effects in all 9 pigeons, consistent with the phenomenon of locomotor sensitization. The maximum locomotor output did not differ according to the size of the daily dose. Locomotion was not elevated following tests of the saline vehicle, suggesting the effect was due to cocaine, not to a change in baseline or reactivity to the injection procedure. Cocaine dose‐dependently decreased preening when given acutely, and those effects were not altered by repeated cocaine administration. Pecking occurred at very low rates and was unresponsive to cocaine treatment. Cocaine‐induced emesis showed a dose‐dependent increase under initial tests with cocaine, and those effects were attenuated following daily exposure. In a final condition, cocaine was replaced with daily saline for 30 days to assess the persistence cocaine‐related increases in locomotion. Approximately half of the pigeons continued to show enhanced effects even after 30 days without cocaine, so although persistence was obtained, it showed marked intersubject variability. The data indicate that the effects of repeated cocaine administration on the behavior of pigeons shows parallels with many effects commonly reported with rodents (i.e., increased locomotion following repeated treatment, decrease in preening or grooming, persistence following drug withdrawal).