慢性心力衰竭患者临床管理与评估

尽管近年来在慢性心力衰竭(CHF)的治疗方面取得了较大的进展,但CHF患者仍有较高的住院率及病死率.CHF临床实践指南的发布促进了规范化治疗.为了取得良好的医疗效果,临床医生必须对心力衰竭患者提供一系列复杂的药物治疗及严格的自我控制措施.随着医学的不断发展,出现了包括心脏再同步化起搏、左心室辅助装置或心脏移植等治疗,而这些手段常需要在对患者进行危险性评估的基础上进行.严格遵循指南并使CHF患者出院后的教育与各种支持项目相结合才能够在一定程度上减低患者的再住院率及病死率.     

Direct Learning

The theory of direct perception holds that perception is specific to properties of ambient energy arrays. This article explores a similar approach to perceptual and perceptual-motor learning: Change due to learning is portrayed as specific to properties of ambient energy arrays. This type of learning is labeled direct learning. It is argued that a theory of direct learning explains a wide range of phenomena in ecologically relevant and informationally rich situations as well as in simpler experimental situations. Previous experimental results are reanalyzed and reinterpreted from the perspective of direct learning. To achieve this, the notion of information space is introduced. In information spaces, points represent ambient energy variables, paths represent change due to learning, and vector fields represent information that guides learning. These concepts also allow the theory of direct learning to be connected to and to take advantage of the theory of ordinary differential equations.     

Projective identification as a communication its grammar in borderline psychotic children

This paper distinguishes between the grammar of wishes in neurotic patients and the grammar of imperative needs in borderline patients. The treatment of a borderline psychotic boy 30 years ago was uninformed by subsequent developments in technique arising from the theory of projective identification as a communication rather than as an attack or a defense. Issues that need addressing in borderline patients, especially those who are children, include (a) developmental delay, (b) the distinction between defenses and overcomings in the paranoid position, (c) rectification fantasies of vengeance, and (d) rectification fantasies of justice and other moral imperatives.     

Geometries and Dynamics of a Rod Determine How It Is Used for Reaching

Displacing an object with a hand-held rod provided a simple paradigm for studying tool use. The authors asked how reaching was affected by manipulations of rod properties. Adults held a rod (length = .10 to 1.5 m), with its tip in the air; walked toward an object on a table; chose a place to stop; and displaced the object with the rod's tip. In 3 experiments (Ns = 9, 22, and 17 participants), the authors manipulated rod length, mass, and mass distribution to determine whether and how geometric and dynamic properties affected the chosen distance and the posture. Both the chosen stopping distance and the postures were well accommodated to rod characteristics. Postural adaptations took place only in the arm, which was organized as a synergy. Predictably, rod length explained most of the variance, but small and reliable differences in both distance and posture depended on mass and mass distribution. The chosen distance anticipated not only rod length but also the upcoming posture needed to control the rod.     

The Stepfamily Enrichment Program: A Prelim inary Evaluation Using Focus Groups

The Stepfamily Enrichment Program is a multicouple intervention designed to help stepfamilies successfully negotiate the process of family formation. This study was a pilot test, using data generated from a focus group interview, to provide preliminary, evaluative information on program effectiveness. Couples reported positive behavior and attitude changes in themselves and other family members at the end of the five-week program. Saliency of program topics, program atmosphere, and group process were considered important aspects of the intervention.     

Behavioral Skills Training With Teachers: Booster Training for Improved Maintenance

Behavioral skills training (BST) has been employed within many different populations for the reduction of problem behaviors and acquisition of new skills; however, these changes have not always maintained over time. This study evaluated the effects of a booster training for re-establishing the classroom management proficiencies that teachers had acquired previously, but had declined over a 12-month period. The single-subject experimental results showed the booster training to be effective in re-establishing teacher performance of skills as measured by both analogue role-play and in situ postassessments within the classroom. These findings suggest that a booster training utilizing BST may be an important strategy for maintaining skill performance over time.     

Ethical Perceptions of Field Sales Personnel: An Empirical Assessment

Much research attention has been directed over the past twenty-five years to ethical issues in marketing. One area of marketing that is gaining research interest is the selling arena. Despite the extant literature on selling ethics, few studies have focused on identifying situations that pose ethical problems for field sales personnel. This paper reports results of an investigation that examined salespeople's perceptions concerning what selling situations or practices are ethical questions, what situations are presently addressed by company policies, and what situations should be addressed by company policies. Findings reveal that salespersons seemingly are desirous of receiving more management guidance than they currently are receiving regarding their ethical concerns. Implications for managers and researchers are provided.     

Perceptions of Motivational Components: Salesmen and Saleswomen Revisited

Although empirical work has examined differences between salesmen and saleswomen on various aspects, no comprehensive study has examined gender-based distinctions in salespeople's work motivation. The paucity of research attention on this topic is surprising given the plethora of literature in organizational behavior. This paper reports the results of an investigation that explored male and female salespeople's perceptions of expectancies, instrumentalities, and valence for rewards. Findings reveal minimal contrast between the two groups. Implications for practitioners and researchers are provided.     

Transpersonal Psychology: Defining the Past,Divining the Future

Retrospective analysis of definitions published over some 35 years suggests the major subject areas of the field can be summed up in three themes: beyond-ego psychology, integrative/holistic psychology, and psychology of transformation. Theme frequency analysis reveals that early emphasis on alternative states of consciousness has moderated into a broader approach to human transcendence, wholeness, and transformation. This expanded definition of transpersonal psychology suggests the field has much in common with integral psychology. As a comprehensive, historically based content summary, this tripartite definition contributes a small but vital piece to the foundation of a transpersonal vision that is spreading across the globe. While transpersonal psychology still needs to embody the inclusiveness and diversity that it represents, its vision is one of great relevance to the contemporary human condition.     

CYBER COMMUNITY IN THE VALLEY OF THE SHADOW OF DEATH

This article provides an examination of the communicative needs and practices of those who have survived the loss of a loved one to suicide. Based on a study of a face-to-face support group for parents of children lost to suicide, and over 10,000 e-mails from a number of online support groups for survivors of the loss of a loved one to suicide, this article discusses intense communicative relations, exclusion from the general society, self-accrediting of experts in grief, reconstruction of identity to include the loss, ownership of the suicide, and rebuilding community.