群体健康与关系"正义"

生命伦理学具有广泛性和综合性,着眼于群体健康是当前生命伦理学发展的趋势.在群体水平的生命伦理学的研究中,有关"正义"的概念是核心的问题.涛慕思·W·博格提出了正义的"关系概念",借以考察范围广泛的社会制度与健康结果的产生具有什么样的因果关系,进而强调社会制度的制定者和支持者对其产生的健康结果负有责任.通过对此"关系概念"进行分析,以期对中国国内健康领域问题的解决有所启示.     

医疗风险管理与医患关系的调适

医疗行为具有高风险属性,但医疗机构经营目标不是追求自身利益最大化,而是公众健康,因此医疗机构风险管理的手段和目标应该着眼于影响目标实现的各种不确定因素,这就要求把医患关系状况纳入风险管理范畴。在当前社会环境下,医疗机构自觉地自留一部分风险成本更有利于经营目标的实现和医患关系的协调。     

权变管理理论与《易经》哲学思考

随着全球经济一体化的日益深入,组织所面临的内外环境更加复杂．权变管理理论对组织的决策、计划、领导等方面的作用越来越受到人们的重视,本文将结合《易经》哲学的一些观点从变化观、系统观、过程观等方面对权变管理理论进行探讨．     

Defining the Nature and Impact of Goals in Children and Adolescents with a Chronic Health Condition: A Review of Research and a Theoretical Framework

This paper presents a review of research related to goals in youth with a chronic health condition (CHC) and a related framework to inform theory and research. Performed literature review using PsychINFO and Medline with a combination of many key words related to health, goals, and youth. Sixteen studies related to goals in youth with a CHC were identified. An integrative framework to inform research on goals in pediatric CHCs was presented based on studies reviewed. The impact of a CHC on goals and related behaviors, impact of goal conflict and collaboration, interventions with goal-setting components, and impact of developmental, disease, socioeconomic, and cultural factors were described. Recommendations for future research were discussed. The application of theory related to the nature and impact of goals in youth with a CHC will advance the field from a research and clinical standpoint.     

IMPROVING RESIDENTIAL TREATMENT SERVICES: IMPLEMENTATION AND NORM-REFERENCED EVALUATION OF A COMPREHENSIVE MANAGEMENT SYSTEM

Ensuring effective service delivery by direct-care personnel in institutional living units for persons with developmental disabilities historically has been a difficult process, despite considerable attention from researchers, service providers, and governmental regulatory agencies. In this investigation, we conducted a normative evaluation of the extent and quality of treatment services currently provided in residential living units (Experiment 1) and evaluated a comprehensive management system designed to improve such services (Experiment 2). Results of the first experiment, encompassing 22 living units in three states, indicated that on the average two thirds of observed resident behavior did not involve any therapeutic activity. The results also provided social validity for the criteria used to evaluate the quality of treatment provision based on opinions of mental retardation professionals. Results of the second experiment indicated that a behavioral management program implemented during 23 separate time periods across five living units was accompanied by consistent and durable decreases in resident nontherapeutic activity as well as increases in specifically designated habilitative activity. The results provide support for the successful incorporation of behavioral management technology into human service settings on a large-scale, long-term basis.     

THE EFFICACY OF AN ALL-POSITIVE APPROACH TO CLASSROOM MANAGEMENT

This study addressed the question of whether an all-positive approach to classroom management can be effective. The on-task behavior and academic performance of eight, second- and third-grade children with behavior problems were examined. Results indicated that an all-positive approach that relied primarily on praise was not effective. However, when an individualized reward system was used, the children's rates of on-task behavior were high and stable. Similar effects were observed for academic productivity. Thus, a classroom can be managed using only positive consequences. However, to be successful, such an approach may require a considerable amount of teacher time and effort, particularly potent, varied and individual rewards, and high rates of appropriate behavior previously established using both positive and negative consequences.     

A STAFF MANAGEMENT SYSTEM FOR MAINTAINING IMPROVEMENTS IN CONTINENCE WITH ELDERLY NURSING HOME RESIDENTS

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system included self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.     

Modelling argumentation and modelling with argumentation

This paper discusses the epistemological and methodological bases of a scientific theory of meaning and proposes a detailed version of a formal theory of argumentation based on Anscombre and Ducrot's conception. Argumentation is shown to be a concept which is not exclusively pragmatic, as it is usually believed, but has an important semantic body. The bridge between the semantic and pragmatic aspects of argumentation consists in a set of gradual inference rules, called topoi, on which the argumentative movement is based. The content of each topos is determined at the pragmatic level, while the constraints on the forms of the topoi attached to a sentence are determined at the semantic level. Applications and possible applications toartificial intelligence and to cognitive sciences are discussed. In particular, the gradual models used to account for argumentation are shown to be extremely promising for Knowledge management, a discipline which includes knowledge acquisition, knowledge representation, transmission of knowledge (communication, interfaces, etc.), knowledge production (decision help, reasoning, etc.). A first formal model is presented and discussed: it is shown in details how it accounts for most of the argumentative features of sentences containing but, little and a little, and how it can be extended to describe sentences containing other argumentative connectives. However, this model is shown to be too simple and to violate the compositionality principle, which is shown, in the first section, to bean important methodological principle for any scientific theory. After a detailed analysis of the possible reasons for this violation, an improved model is proposed and its adequacy is discussed.     

BEHAVIORAL MANAGEMENT OF EXERCISE TRAINING IN VASCULAR HEADACHE PATIENTS: AN INVESTIGATION OF EXERCISE ADHERENCE AND HEADACHE ACTIVITY

A behavioral package was used to shape and maintain the adherence of 5 subjects with vascular headache to a program of aerobic exercise training. Repeated measures of exercise behavior were examined through the use of a bidirectional changing criterion design. Repeated measures of headache activity were also collected. Results demonstrated a functional relationship between the behavioral package and exercise adherence, because all 5 subjects showed exercise behavior that matched bidirectional changing exercise criteria. The results also indicated clinically significant collateral reductions in vascular headache activity in 4 subjects. Subjects whose aerobic fitness levels were not masked by vasoactive medication also showed measurable increases in aerobic fitness. The results are discussed in terms of the methodology used to demonstrate a functional relationship between the adherence package and exercise behavior and the possible mechanism(s) by which aerobic exercise activity might affect vascular headache activity.     

CONTINGENCY MANAGEMENT INTERVENTIONS: EFFECTS ON TREATMENT OUTCOME DURING METHADONE DETOXIFICATION

We examined the effectiveness of a contingency management program in preventing relapse to illicit opiate use and increasing treatment retention during outpatient methadone detoxification treatment. Twenty male opiate addicts were randomly assigned to an experimental or control group. Following a 3-week methadone stabilization period, men in both groups received identical gradual methadone dose reductions during Weeks 4 through 9 and were maintained on placebo during Weeks 10 through 13. Beginning in Week 4, control patients received $5.00 for providing a specimen twice weekly. Experimental patients received $10.00 and a take home methadone dose for each opiate-free urine specimen but forfeited the incentives and participated in more intensive clinic procedures when specimens were opiate positive. The contingency management procedure slowed the rate of relapse to illicit opiate use. Experimental patients provided significantly more opiate-free urines during the methadone dose reduction in Weeks 4 through 9 than control patients, although the difference between groups was no longer significant during placebo administration in Weeks 10 through 13. In addition, the contingency management program improved treatment retention and reduced symptom complaints during the detoxification. The usefulness and limitations of contingency management procedures for outpatient methadone detoxification are discussed.