平板运动试验心脏变时功能不全对冠心病的诊断价值

为探讨平板运动试验(treadmill exercise testing,TET)心脏变时功能不套(chronotropic incompetence,CI)对冠心病(coronary heart disease,CHD)的诊断价值,分析112例临床拟诊冠心病患者,先后均行TET及冠状动脉造影检查(coronary angiography,CAG),并按CAG结果分为CHD组和非CHD组,分析比较两组间心脏变时性指标;并对传统的ST标准、CI指标及两项指标联合诊断冠心病的敏感性、特异性、准确性进行比较.运动后最大心率小于预测最大心率的85％和变时性指数(chronotropic response index,CRI)小于0.8为心脏变时功能不全.结果表明CHD组运动后最大心率、CRI两种变时功能不全的指标均低于非CHD组(P＜0.01);与传统的ST段标准相比,CI指标诊断CHD的敏感性、特异性、准确性无明显差异(P＞0.05),而两项指标联合诊断冠心病的敏感性与传统的ST段标准相近,特异性及准确性显著高于传统ST标准,差异有统计学意义(P＜0.05).故CI指标是诊断CHD的重要价值的指标,可以提高TET对CHD的诊断率.     

公立医院“药事服务费”背后的利益博弈与调适

公立医院增设药事服务费是医疗收费的一次重大改革,涉及多方利益.正确、科学调适“利益”问题,事关改革成败.药事服务费利益调适应遵循与医改整体目标相一致、患者利益第一、政府责任以及因地制宜原则.提出伦理调适与政策、经济调适并重;加大行政监管力度;药事服务费制度与现行收费制度改革同步;以此为契机建立新的医院考核评价机制等建议.     

Correlation between ductility and work function in NiAl–Ce–Cr alloys

In spite of many superior high-temperature properties of intermetallics, it has been difficult to understand their intrinsic brittleness. To eliminate or improve the embrittlement, the conventional alloying technique based on the trial-and-error method is still the most effective and practical. However, it remains a main challenge for both physicists and materials scientists to provide either an alloying principle or a deep insight into its toughening mechanism at an atomic or electronic level. This letter reports a simple experimental approach that uses work function (WF) as a sensitive indicator of the role of alloying in changing mechanical behavior. NiAl is chosen as a typical example. It is found that with the addition of Cr and Ce, the ductility of NiAl increases significantly. Such an increase in ductility corresponds to a concomitant decrease in the WF, which is attributed to a change in the nature of the atomic bonding or in the electronic structure induced by the alloying. This fundamental understanding on the embrittlement nature of NiAl could provide some alloying guidelines or principles for other intermetallics.     

Emotion and appraisal: A study using ecological momentary assessment

This study employed Ecological Momentary Assessment to test predictions from appraisal theories of emotion about the relationships between emotions and appraisals, using a sample of police officers from Singapore. Strong support was obtained for the predictions, thus demonstrating ecological validity of appraisal theories while circumventing shortcomings of previously used methods in appraisal studies. The results also indicate that the emotions were accounted for by specific configurations of appraisals over and above those accounted for by individual constituent appraisals.     

Teaching Engineering Ethics using BLOCKS Game

The aim of this study was to investigate the use of a newly developed design game called BLOCKS to stimulate awareness of ethical responsibilities amongst engineering students. The design game was played by seventeen teams of chemical engineering students, with each team having to arrange pieces of colored paper to produce two letters each. Before the end of the game, additional constraints were introduced to the teams such that they faced similar ambiguity in the technical facts that the engineers involved in the Challenger disaster had faced prior to the space shuttle launch. At this stage, the teams had to decide whether to continue with their original design or to develop alternative solutions. After the teams had made their decisions, a video of the Challenger explosion was shown followed by a post-game discussion. The students’ opinion on five Statements on ethics was tracked via a Five-Item Likert survey which was administered three times, before and after the ethical scenario was introduced, and after the video and post-game discussion. The results from this study indicated that the combination of the game and the real-life incident from the video had generally strengthened the students’ opinions of the Statements.     

广泛期小细胞肺癌一线化疗进展

小细胞肺癌(small cell lung cancer,SCLC)生长迅速,具有高度的侵袭性,就诊时多数患者已发生远处转移,对于广泛期小细胞肺癌,治疗仍以全身化疗为主,在过去30余年里,EP/CE方案作为标准一线化疗方案在治疗广泛期小细胞肺癌中取得了较高的缓解率,但多数患者在化疗停止6个月内疾病发生进展,2年的生存率不足5％,我们需要更加积极有效的一线化疗方案,本文综述了近10余年来广泛期小细胞肺癌的一线化疗进展.     

Asian culture in transition: is it related to reported parenting styles and transitivity of simple choices?

Does culture shape reported parenting styles and cognitive processes like transitive reasoning, of choosing A over B, B over C, and then A over C (transitivity)? Asian‐American, Caucasian‐American, and Indian university students differed significantly in transitivity and in reported parental styles. India participants were more intransitive and, contrary to traditional findings in the literature, reported their parents as more laissez‐faire, individualistic, and competitive than did Caucasian‐Americans. Recent technological and industrial advances in India likely explain some of these obtained differences. Predictions from Adlerian theory and work of Kurt Lewin, that parenting styles would relate to transitivity of choices, were indirectly supported. Stronger evidence was found that culture impacts both reported parental styles and transitivity of simple choices.     

Perception—Action Coupling during Bimanual Coordination: The Role of Visual Perception in the Coalition of Constraints That Govern Bimanual Action

Constraints pertaining to interlimb coordination have been studied extensively in the past decades. In this debate, F. Mechsner (2004) has taken a provocative position by putting primary emphasis on perceptual principles that mediate coordinative stability. Whereas the present authors agree that the role of perceptual principles is of critical importance during coordination, they take issue with Mechsner's extreme position and with the evidence forwarded to support a purely perceptual-cognitive approach to bimanual coordination. More specifically, the authors emphasize that current knowledge about brain function argues against a dualism between perception and action, criticize the presented evidence that posture manipulations during coordination provide decisive evidence against motoric and muscular constraints, and report on potential pitfalls associated with the use of visual transformation procedures to support complex coordination patterns.     

Discerning the spirit(s) in the natural world: Toward a typology of “spirit” in the religion and science conversation

Recent developments in Christian theological thinking on the doctrine of the Holy Spirit (pneumatology) have raised questions about the relationship between “spirit” and science. Cursory review of the religion and science literature, however, yields a wide array of uses and understandings of the concept of spirit. Current attempts to assess the relationship of pneumatology to science require an inventory or basic classification scheme of the various notions of spirit that have been in circulation over the past generation. This essay presents a preliminary typology of such uses in order to enable scholars and researchers to chart courses for future research in this area.     

大学生人际信任半径与信任水平研究

自编《大学生内-外信任问卷》,考察大学生人际信任半径和信任水平的现状,结果表明:(1)问卷具有良好的信度和效度;(2)男生的信任半径大于女生,信任水平低于女生;(3)学生干部的信任半径小于非学生干部,信任水平高于非学生干部;(4)大学生信任半径随着消费水平的升高而减小;(5)高年级学生的信任半径大于低年级学生,信任水平却低于低年级学生;(6)信任半径和信任水平呈现出相反的变化趋势。