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.     

一种多级评分的广义认知诊断模型

认知诊断是近些年教育测量研究中的热点,大多数的认知诊断模型仅适用于0～1评分的情况.本文提出一种有多个潜变量多个滑动参数的多级评分认知诊断模型——GP-D1NA,只要由评分标准和知识状态能确定理想反应模式,就可以利用此方法进行认知诊断分析.在该方法中,我们给出项目滑动矩阵的概念,将被试的观测得分均看成由某个理想得分的滑动,并采用EM算法估计滑动矩阵.在模拟研究中,采用每掌握一个属性得1分的评分标准,结果表明线性型、收敛型、发散型、无结构型和独立型五种属性层级结构均有较高的判准率.     

Improving conditional discrimination learning and memory in five-year-old children: Differential outcomes effect using different types of reinforcement

Previous studies have demonstrated that discriminative learning is facilitated when a particular outcome is associated with each relation to be learned. When this training procedure is applied (the differential outcomes procedure; DOP), learning is faster and better than when the typical common outcomes procedure or nondifferential outcomes (NDO) is used. Our primary purpose in the two experiments reported here was to assess the potential advantage of DOP in 5-year-old children using three different strategies of reinforcement in which (a) children received a reinforcer following a correct choice (“ + ”), (b) children lost a reinforcer following an incorrect choice (“ ? ”), or (c) children received a reinforcer following a correct choice and lost one following an incorrect choice (“ + / ? ”). In Experiment 1, we evaluated the effects of the presence of DOP and different types of reinforcement on learning and memory of a symbolic delayed matching-to-sample task using secondary and primary reinforcers. Experiment 2 was similar to the previous one except that only primary reinforcers were used. The results from these experiments indicated that, in general, children learned the task faster and showed higher performance and persistence of learning whenever differential outcomes were arranged independent of whether it was differential gain, loss, or combinations. A novel finding was that they performed the task better when they lost a reinforcer following an incorrect choice (type of training “ ? ”) in both experiments. A further novel finding was that the advantage of the DOP over the nondifferential outcomes training increased in a retention test.     

Higher-order latent trait models for cognitive diagnosis

Higher-order latent traits are proposed for specifying the joint distribution of binary attributes in models for cognitive diagnosis. This approach results in a parsimonious model for the joint distribution of a high-dimensional attribute vector that is natural in many situations when specific cognitive information is sought but a less informative item response model would be a reasonable alternative. This approach stems from viewing the attributes as the specific knowledge required for examination performance, and modeling these attributes as arising from a broadly-defined latent trait resembling theϑ of item response models. In this way a relatively simple model for the joint distribution of the attributes results, which is based on a plausible model for the relationship between general aptitude and specific knowledge. Markov chain Monte Carlo algorithms for parameter estimation are given for selected response distributions, and simulation results are presented to examine the performance of the algorithm as well as the sensitivity of classification to model misspecification. An analysis of fraction subtraction data is provided as an example. This research was funded by National Institute of Health grant R01 CA81068. We would like to thank William Stout and Sarah Hartz for many useful discussions, three anonymous reviewers for helpful comments and suggestions, and Kikumi Tatsuoka and Curtis Tatsuoka for generously sharing data.     

精神疾病共病现象的辩证思考

由于大多数精神疾病的病因和发病机制不明,无特异性的生物学诊断指标,临床表现多样,有时很难用一种疾病解释.共病的概念应用于精神科临床,为精神科医生提供了一种辩证的诊断思维方法,对研究共病的本质和指导临床治疗都有重要的意义.     

Genetic Counseling for Fragile X Syndrome: Updated Recommendations of the National Society of Genetic Counselors

These recommendations describe the minimum standard criteria for genetic counseling and testing of individuals and families with fragile X syndrome, as well as carriers and potential carriers of a fragile X mutation. The original guidelines (published in 2000) have been revised, replacing a stratified pre- and full mutation model of fragile X syndrome with one based on a continuum of gene effects across the full spectrum of FMR1 CGG trinucleotide repeat expansion. This document reviews the molecular genetics of fragile X syndrome, clinical phenotype (including the spectrum of premature ovarian failure and fragile X-associated tremor-ataxia syndrome), indications for genetic testing and interpretation of results, risks of transmission, family planning options, psychosocial issues, and references for professional and patient resources. These recommendations are the opinions of a multicenter working group of genetic counselors with expertise in fragile X syndrome genetic counseling, and they are based on clinical experience, review of pertinent English language articles, and reports of expert committees. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the facts and circumstances of a specific case, will always supersede these recommendations.     

糖尿病足诊疗与预防进展

糖尿病足是糖尿病的严重并发症,血管狭窄闭塞、神经病变和感染是主要的临床表现,本文主要从糖尿病足的定义、病因、病理生理、临床表现、检测方法、分级及治疗和预防进展方面进行总结。糖尿病足的诊治是个系统工程,单一的方法难以治愈,且治疗效果欠佳,故我们在临床上以预防为主,早期诊断,早期治疗。     

Prevention-focused self-regulation and aggressiveness

The present research examined the relationship between individual differences in self-regulatory mechanisms as outlined in regulatory focus theory (promotion- and prevention-focused self-regulation) and aggressiveness. Two studies revealed that the more individuals’ habitual self-regulatory orientation is dominated by a prevention-focus, the more likely they are to score high on measures of cynical hostility, reciprocity norm endorsement, and aggressiveness. An additional study involving the manipulation of perceived violation of a reciprocity norm showed that predominantly prevention-focused participants were particularly sensitive to the experience of a norm violation and reacted in a hostile and aggressive manner following the norm violation experience. Findings indicate that a prevention-focused style of self-regulation is associated with aggressiveness and suggest that endorsement of (negative) reciprocity norms and sensitivity to norm violations are relevant factors that help explain the differences in aggressiveness observed among individuals with a predominantly prevention-focused style of self-regulation.     

辩证思维在头颈肿瘤诊治过程中的应用

辩证思维贯穿于整个临床诊疗过程中,每位医师在做出临床决策时,均自觉或不自觉地遵循着该原理。在头颈肿瘤的临床实践中,也应始终遵循辩证思维,使哲学思维和科学思维密切结合。合理、正确地运用辩证思维方法有助于深入认识头颈肿瘤疾病的发生、发展及演变过程,从而采取合理、有效的治疗措施。     

脑室系统血管畸形的诊断与治疗

为了增强对脑室系统的血管畸形的认识,回顾性总结24例脑室系统的血管畸形的基本临床资料。结果显示,除1例静脉畸形外,其余23例均接受手术,21例全切,2例部分切除,病理证实海绵状血管瘤13例,AVM10例,其中死亡1例。提示脑室系统血管畸形发病率低,出血及脑积水多见,手术切除是海绵状血管瘤和AVM的最佳选择,而静脉畸形应予保留。