医学与文学的传统及创新

论述医学与文学关系的文章习惯以阿波罗开头。文学与医学直到最近才成为医学人文学里的一个新的学术分支 ,但文学与医学的关系至少可追溯到古希腊。本文中 ,我将讨论如何看待医学与文学关系的四种传统方式 :其一 ,疾病的形象 (ｉｍａｇｅｓ) ,即文学中患病、苦难和死亡的主题 ;其二 ,治疗者的形象 ;其三 ,医生—诗人或医生—作家类型 ;其四 ,文学作为一种治疗方法。然后 ,我将简要讨论文学在今日医学教育中的作用并提供一个思辨性的结论。1　传统1 1　患病、苦难和死亡的主题与医学一样 ,文学关涉患病、苦难和死亡这些与人类同样古老的主题…     

The validity of the successive intervals method of psychometric scaling

The degree to which scale values computed by the method of successive intervals diverge from theoretically true values is seen to be due to three types of error: error due to inequalities in variances of the distributions from which the scale values are computed, error due to non-normality of the distributions, and sampling error. The contribution of each type of error to the total error is evaluated; the latter is seen to be surprisingly small under appropriate conditions. Certain aspects of the formal methodology underlying scaling procedures are also briefly considered.This paper reports research undertaken in cooperation with the Quartermaster Food and Container Institute for the Armed Forces, and has been assigned number 475 in the series of papers approved for publication. The views or conclusions contained in this report are those of the authors. They are not to be construed as necessarily reflecting the views or indorsement of the Department of Defense.     

Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.     

Sleep-related attentional bias in good, moderate, and poor (primary insomnia) sleepers

Evidence was sought of an attentional bias toward a highly representative object of the bedroom environment in good, moderate, and poor (primary insomnia) sleepers. Using a flicker paradigm for inducing change blindness, the authors briefly presented a single scene comprising a group of bedroom environment and neutral objects to participants and then briefly replaced this scene with an identical scene containing a change made to either a bedroom environment or a neutral object. In a 3 x 2 entirely between-participants design, change-detection latencies revealed a sleep-related attentional bias in poor sleepers but not in good sleepers. A possible bias in moderate sleepers was also revealed. It is suggested that attentional bias has a role in the perpetuation and possibly precipitation of primary insomnia.     

The effects of overhearing peers discuss an authority's fairness reputation on reactions to subsequent treatment

Fairness heuristic theory was used to examine how information from one's peers affects an individual's interpretation of, and reactions to, an authority's subsequent behavior. Participants (N=105) overheard their peers discuss an experimenter's reputation (fair, unfair, or absent) before interacting with the experimenter who behaved more versus less fairly. Results showed that the social cues biased participants' subsequent information processing: controlling for the experimenter's behavior, interactional justice mediated the effect of social cues on retaliation. Social cues and the authority's behavior also interacted to predict retaliation. Participants who were treated less fairly retaliated more after being led to expect fair treatment than did participants who heard no prior information about the experimenter.     

The cognitive foundations of reading and arithmetic skills in 7- to 10-year-olds

A range of possible predictors of arithmetic and reading were assessed in a large sample (N=162) of children between ages 7 years 5 months and 10 years 4 months. A confirmatory factor analysis of the predictors revealed a good fit to a model consisting of four latent variables (verbal ability, nonverbal ability, search speed, and phonological memory) and two manifest variables (digit comparison and phoneme deletion). A path analysis showed that digit comparison and verbal ability were unique predictors of variations in arithmetic skills, whereas phoneme deletion and verbal ability were unique predictors of variations in reading skills. These results confirm earlier findings that phoneme deletion ability appears to be a critical foundation for learning to read (decode). In addition, variations in the speed of accessing numerical quantity information appear to be a critical foundation for the development of arithmetic skills.     

The social context of imitation in infancy

Infants increasingly generalize deferred imitation across environmental contexts between 6 and 18 months of age. In three experiments with 126 6-, 9-, 12-, 15-, and 18-month-olds, we examined the role of the social context in deferred imitation. One experimenter demonstrated target actions on a hand puppet, and a second experimenter tested imitation 24h later. When the second experimenter was novel, infants did not exhibit deferred imitation at any age; when infants were preexposed to the second experimenter, all of them did. Imitating immediately after the demonstration also facilitated deferred imitation in a novel social context at all ages but 6 months. Infants' pervasive failure to exhibit deferred imitation in a novel social context may reflect evolutionary selection pressures that favored conservative behavior in social animals.     

Timing variability in circle drawing and tapping: probing the relationship between event and emergent timing

R. Ivry, R. M. Spencer, H. N. Zelaznik, and J. Diedrichsen (2002) have proposed a distinction between timed movements in which a temporal representation is part of the task goal (event timing) and those in which timing properties are emergent. The issue addressed in the present experiment was how timing in conditions conducive to emergent timing becomes established. According to what the authors term the transformation hypothesis, timing initially requires an event-based representation when the temporal goal is defined externally (e.g., by a metronome), but over the first few movement cycles, control processes become established that allow timing to become emergent. Different groups of participants (N = 84) executed either 1 timed interval, 4 timed intervals, or 2 timed intervals separated by a pause. They produced the intervals by either circle drawing, a task associated with emergent timing, or tapping, a task associated with event timing. Analyses of movement variability suggested that similar timing processes were used in the 2 tasks only during the 1st interval. Those results are consistent with the transformation hypothesis and lead to the inference that the transition from event-based control to emergent timing can occur rapidly during continuous movements.