中医院市场定位的两难选择及其对策

中医院的市场定位处于两难选择之中:中医药技术的潜在优势与现实局限性的矛盾、中医院管理者的价值取向与现实窘况的矛盾、中医院发展历史沉淀与市场竞争的矛盾、政府的中医药政策自身存在的矛盾等。这些矛盾涉及多方行为和利益主体,必须深化改革,以实现中医院的良性发展。     

The basic traumatic situation in the analytical relationship1

The author attempts to develop a concept of psychic trauma which would comply with the nucleus of this Freudian notion, that is, an excess of excitations that cannot be processed by the mental apparatus, but which would also consider the functions and the crucial role of objects in the constitution of the psychism and in traumatic conditions, as well as taking into account the methodological positioning according to which the analytical relationship is the sole possible locus of observation, inference and intervention by the psychoanalyst. He considers as a basic or minimal traumatic psychoanalytical situation that in which a magnitude or quality of emotions exceeds the capacity for containment of the psychoanalytical pair, to the point of generating a period or area of dementalisation in the psyche of one or both of the participants, of requiring analytical work on the matter and promoting a signifi cant positive or negative change in the relationship. Availing himself of Bion's theory about the alpha function and the metapsychological conceptions of Freud and Green concerning psychic representations, he presents two theoretical formulations relating to this traumatic situation, utilising them according to the ‘altered focus’ model proposed by Bion. He presents three clinical examples to illustrate the concept and the relevant theoretical formulations.     

One night of sleep deprivation affects reaction time, but not interference or facilitation in a Stroop task

The Stroop color-naming task is one of the most widely studied tasks involving the inhibition of a prepotent response, regarded as an executive function. Several studies have examined performance on versions of the Stroop task under conditions of acute sleep deprivation. Though these studies revealed effects on Stroop performance, the results often do not differentiate between general effects of sleep deprivation on performance and effects specifically on interference in the Stroop task. To examine the effect of prolonged wakefulness on performance on the Stroop task, we studied participants in a 40-h "constant routine" protocol during which they remained awake in constant conditions and performed a Stroop color-naming task every two hours. We found that reaction time was slowest when the color and word did not match (incongruent), fastest when the color and word did match (congruent), and intermediate when participants named the color of the non-word stimulus (neutral). Performance on all three trial types degraded significantly as a function of time awake. Extended wakefulness did not significantly change the additional time needed to respond when the color and word did not match (Stroop interference), nor did it change the amount of facilitation when color and word matched. These results indicate that one night of sleep deprivation influences performance on the Stroop task by an overall increase in response time, but does not appear to impact the underlying processes of interference or facilitation. The results suggest that the degree to which an "executive function" is affected by sleep deprivation may depend on the particular executive function studied and the degree to which it is subserved by the prefrontal cortex.     

学习时间在重复学习范式中的监测功能

通过让被试在自定步速的学习条件下完成重复学习任务,考察在重复学习范式中学习时间的监测功能。研究发现：在两次学习中,学习时间与学习判断等级和回忆成绩均有显著负相关;在第二次学习中,线索有效性不变,而随着线索利用率的提高,学习判断预测的准确性也显著提高。研究结果验证了学习时间的监测功能。     

前额叶在老年阶段的可塑性及相关机制

大量研究表明, 前额叶的结构和功能更容易受年老化影响; 然而, 近年来的研究发现, 前额叶的结构和功能在老年阶段具有一定的可塑性。对老年人进行认知训练, 能够延缓前额叶皮层厚度的萎缩, 提高白质完整性, 改善神经网络的功能连接和分化, 并可能通过调节多巴胺系统的活动改变前额叶皮质和皮质下结构的功能激活模式。有氧锻炼能够改善心脑血管功能, 保护和促进神经元的存活和生长, 引起前额叶灰质、白质体积的增加及功能激活的变化。认知训练与有氧锻炼等相结合的整合性训练不仅引起前额叶及相关认知功能的改变, 而且具有更好的生态学效度, 使老年人日常认知能力和生活质量得到提高。未来研究应采用多种技术手段, 从多个层面理解老年阶段前额叶的可塑性及相关机制; 加强对与前额叶关系密切的多种认知功能可塑性神经机制的研究; 并重视与整合性训练有关的前额叶可塑性。     

不同性质的评价对特质焦虑者抑制功能影响的ERP研究

特质焦虑者作为焦虑障碍易感性个体,会表现出对威胁性刺激的注意偏向,从而损害中央执行系统的抑制功能。但是不同情绪性评价刺激会如何调控特质焦虑者的抑制功能还不太清楚。为此,本研究以脑电P3b为抑制功能指标,要求高低特质焦虑组在三种不同评价下完成反向眼跳范式,考察不同性质的评价如何影响特质焦虑的抑制功能。行为结果发现,高焦虑组比低焦虑组错误率更高;积极评价条件下,高焦虑组的反应时慢于低焦虑组。ERP结果进一步发现,无评价条件下,高焦虑组的P3b波幅大于低焦虑组;低焦虑者在积极评价条件下的P3b波幅大于消极评价条件,但是高焦虑者没有显著差异。结果表明,积极评价会损害高特质焦虑者的抑制功能,而消极评价则促进了高特质焦虑个体的抑制功能。     

Preserved metamemorial ability in patients with mild Alzheimer's disease: shifting response bias

Patients with mild Alzheimer's disease (AD) display a greater tendency to endorse unstudied items as "old" on memory tests than healthy older adults. This liberal response bias may result in mistaken beliefs about the completion of common tasks. This research attempted to determine whether it was possible to shift the response bias of mild AD patients to be more conservative on a recognition memory test through behavioral intervention. Patients with mild AD and matched controls were evaluated with two almost identical paradigms, separated by about one week. For each session, 30 words were studied and 60 words (half studied, half novel) were shown at test. During one session participants were told that 30% of words were old, and at the other session that 70% were old. We found that both groups were able to shift their response bias between the two conditions. That patients with mild AD were able to successfully shift their response bias demonstrates that--despite their overall liberal response bias and poor memory relative to controls--one component of metamemorial ability is preserved in patients with mild AD.     

The Effects of Incentives on Visual–Spatial Working Memory in Children with Attention-deficit/Hyperactivity Disorder

Working memory is one of several putative core neurocognitive processes in attention-deficit/hyperactivity disorder (ADHD). The present work seeks to determine whether visual–spatial working memory is sensitive to motivational incentives, a laboratory analogue of behavioral treatment. Participants were 21 children (ages 7–10) with a diagnosis of ADHD-combined type. Participants completed a computerized spatial span task designed to assess storage of visual–spatial information (forward span) and manipulation of the stored information (backward span). The spatial span task was completed twice on the same day, once with a performance-based incentive (trial-wise feedback and points redeemable for prizes) and once without incentives. Participants performed significantly better on the backward span when rewarded for correct responses, compared to the no incentive condition. However, incentives had no effect on performance during the forward span. These findings may suggest the use of motivational incentives improved manipulation, but not storage, of visual–spatial information among children with ADHD. Possible explanations for the differential incentive effects are discussed, including the possibility that incentives prevented a vigilance decrement as task difficulty and time on task increased.     

焦虑个体“冷”、“热”执行功能Stroop效应量比较

该文采用Stroop实验范式对筛选出的49名高焦虑个体和48名低焦虑个体的“冷”、“热”执行功能进行测量,以探讨不同焦虑程度个体“冷”、“热”执行功能间的差异。结果表明,在“冷”执行功能方面,高焦虑个体与低焦虑个体Stroop效应量之间没有显著差异;在“热”执行功能方面,两组被试情绪Stroop的效应量无差异;两类词;12的Stroop效应量差异显著;词汇类型×被试类型的交互作用非常显著;进一步的简单效应分析表明,两组被试的情绪Stroop效应量在消极词汇水平差异显著,两类词汇Stroop效应量在低焦虑组差异显著。说明高、低焦虑个体在“冷”执行功能上没有显著差异,高焦虑个体的“冷”执行功能正常,而“热”执行功能下降,表现为高焦虑个体对两极情绪的趋避关系失调,即对消极情绪具有偏向性,对积极情绪具有回避性。     

关于社会主义科技荣辱观的若干思考

随着科学技术的发展及其日益社会化,人们的思维方式、价值观念发生了变化,一些有违科技荣辱观的问题日益凸显。它们不仅败坏学术风气,损害我国科技界声誉,而且阻碍我国科学技术的进步,影响我国科教兴国战略的实施。因此,在当前建设社会主义核心价值体系、弘扬社会主义荣辱观的形势下和过程中,加强社会主义科技荣辱观的研究和建设,既十分紧迫,又非常重要。