多级评分认知诊断模型述评

认知诊断评估旨在探讨个体内部的知识掌握结构,并提供关于学生优缺点的详细诊断信息,以促进个体的全面发展。当前研究者已开发了大量0-1评分的认知诊断模型,但对于多级评分认知诊断模型的研究还比较少。本文对已有的多级评分认知诊断模型进行了归纳,介绍了模型的假设,计量特征以及适用范围,为实际应用者和研究者在多级评分认知诊断模型的比较和选用上提供借鉴和参考。最后,对未来关于多级评分诊断模型的研究方向进行了展望。     

Attitudes toward genetic counseling and prenatal diagnosis among a group of individuals with physical disabilities

Few studies have been published on the attitudes of people with physical disabilities toward genetic counseling and prenatal diagnosis. Articles in the lay press and social science literature on this topic, mainly written by disability rights activists and advocates, imply opposition to prenatal diagnosis and the field of clinical genetics by the physically disabled population. In this study, 15 adults with physical disabilities were interviewed regarding their attitudes toward genetic counseling and prenatal diagnosis. Genetic counseling and prenatal diagnosis were generally viewed favorably by this sample of the disability community. Only a small percentage of the sample perceived genetics to be eugenic. Implications for genetic counseling and future research are discussed.     

骨科疾病诊治中的临床思维

医学哲学是对医学科学成就总的概括,并以此为基础探讨生命活动和病程的一般规律,研究医学科学的思维方式,直至疾病预防、诊断治疗。同时研究辩证规律和范畴在医学科学中的表现,从而指导骨科医师解决在骨科疾病诊治中遇到的诸多问题,并有助于形成正确的临床思维。结合临床工作体会,探讨医学哲学在骨科疾病诊治临床思维中的应用。     

宫腔镜检查在诊断子宫内膜息肉中的价值分析

通过比较超声、宫腔镜检查与病理诊断子宫内膜息肉的结果,以及超声诊断结果阴性的病例中,宫腔镜与病理诊断的差异检出率,探讨宫腔镜检查对正确诊断子宫内膜息肉的重要性.回顾性收集连续在我院妇科行宫腔镜检查且证实子宫内膜息肉诊断的住院患者共730例.总结各病例超声诊断、宫腔镜检查及病理诊断的结果.统计分析显示,三者诊断子宫内膜息肉的检出率分别为82.7％、93.4％、90.8％.其中,由超声检查漏诊的子宫内膜息肉患者共126例,宫腔镜及病理检出率分别为96.8％、88.1％,且两者的阴性结果互不重叠,这种诊断差异在超声诊断结果示内膜增厚/内膜厚薄不均病例中尤为显著.因此,子宫内膜息肉的诊断方式中,宫腔镜诊断检出率最高,但仍有漏诊的病例由病理确诊,研究认为宫腔镜检查是确诊子宫内膜息肉的重要诊断方法.     

认知诊断分类中心的确定

期望反应模式是认知诊断分类的类中心,确定了诊断范围中属性及其层级关系后,类中心的数目由测验Q矩阵决定.类中心应该是完备的,即理论上有多少个知识状态就应该有多少个类中心,这涉及评分方式、Q矩阵设计、Q矩阵评价与修改、认知诊断测验如何实施等问题的讨论.重点给出多级评分认知诊断测验不同属性层级对应的完备Q矩阵设计的例子和罗列了Wang等人（2013）的Q矩阵修改的方法.     

Transcendence techniques and psychobiological mechanisms underlying religious experience

In this paper the author explores the process by which the combined influence of specific cultural factors and individual transcendence techniques activates psychobiological mechanisms that, in turn, trigger the appearance of special states of consciousness, namely religious trance. Most of these religious and spiritual experiences rationalize a threat common to all cultures, namely the risk of losing one's Ego.

The activation of individual transcendence techniques paraphrases denial defence mechanisms insofar as it involves avoidance of the external reality to preserve homeostasis. The mentioning in psychoanalytic terms of a ‘death instinct’ (i.e. a drive opposite to the attachment/life instinct) as a possible source of detachment/transcendence phenomena is still worth considering.

The Freudian example of ‘the cotton-reel mother’, whom the child could make disappear and then reappear again, is a powerful one of the phenomenon of detachment dynamics.

Cross-cultural research on the varieties of trance shows that Altered States of Consciousness can be induced by both collective and personal rituals that allow the subject to reach the altered states of consciousness by making the whole world appear or disappear in fantasy. While some of the highest forms of supernatural experience, such as ecstasy, mysticism and the communion with the Absolute, engender enough social approval to allow to believe that such experiences mitigate or prevent mental disorders, when the supernatural experiences occur in bizarre features they are indicators of a clear psychopathology.

The perspective of transcultural psychiatry offers the best method of outlining the great ethnographic variety of these experiences and, subsequently, making a comparative analysis of the links that exists among culture, psychopathology and the supernatural in a given situation.

From a clinical point of view, it becomes increasingly clear that psychiatrists need expertise to draw clinical inferences based on the specific patient's culture and his psychopathological presentation, especially when the patient's life history is characterized by the multi-faceted activity of transcendence techniques.     

成人注意缺陷多动障碍诊断与心理治疗的研究进展

注意缺陷多动障碍（ADHD）是指一种以注意缺陷、多动、冲动的行为表现为主要特征的精神病理障碍。对儿童注意缺陷多动障碍的研究有了长足的进步,但对成人注意缺陷多动障碍的研究相对较少。本文阐明了国际上对成人注意缺陷多动障碍的诊断与心理治疗的研究进展,希望引起国内临床心理学家、精神病学家和心理咨询师等的充分重视。     

走出慢性乙型、丙型病毒性肝炎诊断的误区

我国病毒性肝炎是一个非常重要的肝病,病毒性肝炎的诊断不仅依靠临床表现,肝功能指标的改变,也依赖于病毒标志物的检测。病毒血清学检查是确定诊断的唯一标准。乙、丙、丁型病毒性肝炎的血清标志物项目繁多,临床意义相差较大,正确理解能为诊断提供很大帮助。     

结核病诊治进展与科技革命

现代科技革命极大地促进了结核病各方面的发展.微生物学和免疫学的发展,揭示了结核病的病因、发病机制、病理生理的本质,分子生物学技术使结核病的基础研究不仅停留在器官、细胞水平,而是深入到蛋白质、核酸、基因的水平;基因治疗的方法可望从根本上治疗结核病.高新技术的产物如X线照片、电子计算机断层扫描、纤维支气管镜检查和新药的出现等极大地提高了临床诊治的能力.借助于各种先进的医疗设备而进行精确的诊断,基因治疗将成为一种崭新的治疗手段.     

以实质心理学为基础的评估：认知诊断

评价除了了解学习者的学习情况外,同时还应该提供学习者学习状况的诊断信息,以利于教学与学习。评价应该以认知心理学对学习过程的研究,作为编制测验的实质理论依据,进行认知诊断评估。本文针对认知诊断的心理学基础：知识的习得、知识诱发、知识表征、知识结构等进行梳理,以便测验开发者对认知诊断评估有更清晰的认识。