急诊室濒死病人临床诊治决策的影响因素

正确、合理的临床决策为病人提供理想的诊疗方案.在急诊室濒死病人的诊治过程中,急诊医生应本着以人为本的原则,根据病情的轻重缓急,抓住重点进行紧急处理.其中,病人疾病的性质与预后、疾病严重程度、医生技术水平、医院护理水平、医院的医疗设备与管理水平、诊治费用、医患关系、家属对待诊治的态度、医德医风、政策法规等对医生的临床诊治决策均有不同程度的影响.     

态射的建构与发展:发生认识论的一种动态形式化

发生认识论主要研究认识的心理发生及其形式化。对于后者的研究,上个世纪30年代皮亚杰建构了“群集”结构来解释儿童前运算阶段的思维方式,70年代又引入了数学范畴论来解释形式运算阶段的认知发展,再一次对儿童思维的发展与科学发展两者间的连续性给出了明证。数学范畴论是对数学对象的结构间变换进行形式化的一个数学分支,建构的思想以及对所建构结构进行转换是范畴论的本质,而其中作为范畴对象的态射与态射组合体现了其建构本质,且能最为妥贴地描述认识的动态发生与发展。新的理论建模将对应与转换揉合在一起更好地阐释认知发展过程中每一转换过程的机制与结构发展。本文试图通过介绍认识发生过程中对应、转换的发展,以及所引入数学范畴论中态射的概念,来阐释认识发生中认知生成工具———态射———的建构与发展,以及认知结构的系统发展,从而对皮亚杰晚年这一形式化工作予以简单说明与评价。     

Effects of Internet use on college students' political efficacy.

This study examines the relationship between three types of Internet use (information, entertainment, and interactive contacts) and two types of political efficacy (external and internal) among U.S. college students. Information related Internet use and interactive contacts predict college students' internal political efficacy. An unexpected finding was that visiting public agency sites negatively influenced college students' external political efficacy. This implies that the quality of current public sites is below the expectation of college students and that respondents who visited those sites might develop political cynicism. This study also reveals that online news sites are becoming a primary news source for college students.     

Enhanced proliferation of progenitor cells following long-term potentiation induction in the rat dentate gyrus

The dentate gyrus (DG) is among the few areas in the mammalian brain where production of new neurons continues in the adulthood. Although its functional significance is not completely understood, several lines of evidence suggest the role of DG neurogenesis in learning and memory. Considering that long-term potentiation (LTP) is a prime candidate for the process underlying hippocampal learning and memory, these results raise the possibility that LTP and neurogenesis are closely related. Here, we investigated whether or not LTP induction in the afferent pathway triggers enhanced proliferation of progenitor cells in the DG. LTP was induced by tetanic stimulation in perforant path-DG synapses in one hemisphere, and the number of newly generated progenitor (BrdU-labeled) cells in the DG was quantified. Compared with the control hemisphere (stimulated with low-frequency pulses), the LTP-induced hemisphere contained a significantly higher number of newly generated progenitor cells in the dorsal as well as ventral DG. When CPP, an NMDA receptor antagonist, was administered, tetanic stimulation neither induced LTP nor enhanced progenitor cell proliferation, indicating that NMDA receptor activation, rather than tetanic stimulation per se, is responsible for enhanced progenitor proliferation in the control animal. Our results show that tetanic stimulation of perforant path sufficient to induce LTP increases progenitor proliferation in adult DG in an NMDA receptor-dependent manner.     

Order effects in contingency learning: The role of task complexity

Dennis and Ahn (2001) found that during contingency learning, initial evidence influences causal judgments more than does later evidence (a primacy effect), whereas López, Shanks, Almaraz, and Fernández (1998) found the opposite (a recency effect). We propose that in contingency learning, people use initial evidence to develop an anchoring hypothesis that tends to be underadjusted by later evidence, resulting in a primacy effect. Thus, factors interfering with initial hypothesis development, such as simultaneously learning too many contingencies, as in López et al., would reduce the primacy effect. Experiment 1 showed a primacy effect with learning contingencies involving only one outcome but no primacy effect with two outcomes. Experiment 2 demonstrated that the magnitude of the primacy effect correlated with participants' verbal working memory capacity. It is concluded that a critical moderator for exhibition of the primacy effect is task complexity, presumably because it interferes with initial hypothesis development.     

Clinical psychologists' theory-based representations of mental disorders predict their diagnostic reasoning and memory

The theory-based model of categorization posits that concepts are represented as theories, not feature lists. Thus, it is interesting that the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) established atheoretical guidelines for mental disorder diagnosis. Five experiments investigated how clinicians handled an atheoretical nosology. Clinicians' causal theories of disorders and their responses on diagnostic and memory tasks were measured. Participants were more likely to diagnose a hypothetical patient with a disorder if that patient had causally central rather than causally peripheral symptoms according to their theory of the disorder. Their memory for causally central symptoms was also biased. Clinicians are cognitively driven to use theories despite decades of practice with the atheoretical DSM.     

Falling on sensitive ears: constraints on bilingual lexical activation

Abstract— Spoken word recognition is characterized by multiple activation of sound patterns that are consistent with the acoustic-phonetic input. Recently, an extreme form of multiple activation was observed: Bilingual listeners activated words from both languages that were consistent with the input. We explored the degree to which bilingual multiple activation may be constrained by fine-grained acoustic-phonetic information. Ina head-mounted eyetracking experiment, we presented Spanish-English bilinguals with spoken Spanish words having word-initial stop consonants with either English- or Spanish-appropriate voice onset times. Participants fixated interlingual distractors(nontarget pictures whose English names shared a phonological similarity with the Spanish targets) more frequently than control distractors when the target words contained English-appropriate voice onset times. These results demonstrate that fine-grained acoustic-phonetic information and a precise match between input and representation are criticalfor parallel activation of two languages.     

Meta-analysis of psychosocial interventions on survival time in patients with cancer

Objective: This study was to evaluate the effects of psychosocial interventions on survival in adult patients with cancer.

Method: MEDLINE via PubMed, Cochrane Library CENTRAL, CINAHL, and Korean electronic databases (September 2014) were searched. Methodological quality was assessed using Cochrane’s Risk of Bias for randomized studies. The RevMan 5.3 program of the Cochrane library was used for data analysis.

Results: Fifteen randomized controlled trials met the inclusion criteria, with a total of 2940 participants. Overall, psychosocial interventions was not associated with better survival (HR = .83, 95% CI [.68, 1.10], p = .06, I² = 64%). In subgroup analysis, based on six trials with 1448 subjects, psychoeducational interventions for cancer patients with non-metastatic at intervention implementation resulted in a 41% reduction in the risk of dying of cancer (HR = .59, 95% CI [.49, .71], p < .001, I² = 0%). For psychoeducational intervention, significant survival benefit were found when health staff delivered the intervention and at a follow-up time of more than 10 years.

Conclusions: Use of psychoeducational interventions for cancer patients at early stage appeared to have beneficial effects on survival, preferably for delivering of health staff. However, conduct of further psychosocial studies with adequate power will lead to better understanding of the effects of treatments on survival outcome.