Using progressive ratio schedules to evaluate tokens as generalized conditioned reinforcers

The properties of operant reinforcers are dynamic and dependent on a number of variables, such as schedule and effort. There has been sparse research on the generalized conditioned properties of token reinforcement. We evaluated leisure items, edible items, and tokens using a progressive ratio schedule with three children with diagnoses of ASD and developmental delays. The highest break points occurred during the token reinforcement condition for two out of three participants, but response rates tended to be higher with edibles. We then evaluated the effects of presession access to edibles on the break points of edible items and tokens with two participants. Break points decreased only in the edible reinforcement condition, and the participants chose to work for leisure items rather than edibles when presession access to edibles was in place. These findings suggest that the tokens functioned as generalized conditioned reinforcers.     

ON THE CORRESPONDENCE BETWEEN PREFERENCE ASSESSMENT OUTCOMES AND PROGRESSIVE‐RATIO SCHEDULE ASSESSMENTS OF STIMULUS VALUE

The current study examined whether stimuli of different preference levels would be associated with different amounts of work maintained by the stimuli, as determined through progressive‐ratio schedule break points. Using a paired‐choice preference assessment, stimuli were classified as high, moderate, or low preference for 4 individuals with developmental disabilities. The stimuli were then tested three times each using a progressive‐ratio schedule (step size of 1; the break‐point criterion was 1 min). In 10 of 12 possible comparisons, higher preference stimuli produced larger break points than did lower preference stimuli.     

INTRODUCTION: RETHINKING PHILOSOPHICAL PRESUMPTIONS IN LIGHT OF COGNITIVE DISABILITY

Abstract: This Introduction to the collection of essays surveys the philosophical literature to date with respect to five central questions: justice, care, agency, metaphilosophical issues regarding the language and representation of cognitive disability, and personhood. These themes are discussed in relation to three specific conditions: intellectual and developmental disabilities, Alzheimer's disease, and autism, though the issues raised are relevant to a broad range of cognitive disabilities. The Introduction offers a brief historical overview of the treatment cognitive disability has received from philosophers, and explains the specific challenges that cognitive disability poses to philosophy. In briefly summarizing the essays in the collection, it highlights the distinctive contributions the collection makes to ethics, political philosophy, bioethics, and the philosophy of disability. We hope that the richness of the topics explored by these essays will be a spur to further investigation.     

癌症晚期宁养医疗服务决策的功利主义评价

面对日益增多的癌症晚期患者,为了帮助该患病群体在制定医疗服务决策时保证医学疗护手段科学性,又能确保医疗决策伦理价值的正确性,以功利主义伦理理论为进路,通过讨论癌症晚期患者积极抗肿瘤医治、放弃治疗与宁养医疗服务三种不同医疗模式可能带来的结果与效用,阐明宁养医疗服务是癌症晚期患者全面利益观的体现,论证了其伦理价值取向的合理性,从而为广大群众能转变观念,接受、制定并执行宁养疗护计划提供依据与伦理支持,以期广泛推广。     

基于意定监护制度对预先医疗指示的思考

鉴于中国大陆地区尚未建立预先医疗指示制度,为保证患者自主权,尊重其医疗意愿,可通过《民法总则》规定的意定监护制度实现预先医疗指示,其理由在于二者存在相同的法理基础、双向交叉的概念内涵以及现实实践基础。但依据现有法律规制实践过程中仍然存在不足,包括协议缔结的具体规定不明确、生效条件模糊、监督机制欠缺等问题。为解决这些问题,考虑完善相关法律规定,明确主体资格,制定合理的缔结程序,严格限制生效条件,建立监督机制等。     

生前预嘱二十年变迁：从临床试验谈起

通过检索Clinicaltrial及Clinicalkey网站2000年~2020年生前预嘱相关的临床试验项目,以其为切入点,探讨生前预嘱相关临床试验的数量、研究类型与方法、受试者类别、干预方式、研究内容等方面的变化趋势,比较分析阻碍生前预嘱在我国推广实施的文化、制度、宣传、人员等方面的因素。借鉴国外生前预嘱发展变革经验,并立足我国基本国情、伦理文化以及医疗环境等特点,从完善法律制度、加强资助、加大宣传力度、提升科研质量等方面提出建议,以期促进生前预嘱在我国的推广发展。     

CORRESPONDENCE BETWEEN SINGLE VERSUS DAILY PREFERENCE ASSESSMENT OUTCOMES AND REINFORCER EFFICACY UNDER PROGRESSIVE‐RATIO SCHEDULES

Research has suggested that a daily multiple‐stimulus‐without‐replacement (MSWO) preference assessment may be more sensitive to changes in preference than other assessment formats, thereby resulting in greater correspondence with reinforcer efficacy over time ( DeLeon et al., 2001 ). However, most prior studies have measured reinforcer efficacy using rate of responding under single‐operant arrangements and dense schedules or under concurrent‐operants arrangements. An alternative measure of reinforcer efficacy involves the evaluation of responding under progressive‐ratio (PR) schedules. In the present study, 7 participants were given a single paired‐stimulus (PS) preference assessment followed by daily MSWO preference assessments. After each daily MSWO, participants responded for each stimulus on a PR schedule. The correspondence between break points and preferences, as assessed by the 2 assessment formats, was examined. Results demonstrated that both preference assessments did equally well at predicting reinforcer efficacy, although the PS more consistently identified the most effective reinforcer.     

晚期非小细胞肺癌TKIs治疗：关注与思考

以表皮生长因子受体（EGFR）为靶点的酪氨酸激酶抑制剂（TKIs）对晚期非小细胞肺癌EGFR突变患者的治疗效果令人瞩目。本文分析总结近年国内外相关研究,指出低剂量TKIs的应用虽有待进一步证实,但优于标准剂量组,并从安全性、改善肿瘤血管结构和功能、与细胞毒化疗的关系三方面探讨大剂量TKIs的应用效果。进一步分析指出大剂量联合小剂量TKIs能够最大程度地防止或延迟耐药的发生,进而控制疾病的进展。从而,为晚期非小细胞肺癌EGFR突变患者的TKIs治疗选择提供参考。     

Teaching Elder: Erik H. Erickson

A renowned child psychoanalyst, Erik H. Erikson (1902–1994) is perhaps best known for his work on developmental theory (Childhood and Society, 1950) and his studies of the lives of Martin Luther (Young Man Luther, 1958) and Gandhi (Gandhi's Truth, 1969). Twice he found himself intensely engaged in the role of teacher – once as a young artist who had been called by a friend to help in the progressive school formed for the children of Sigmund and Anna Freud's patients in Vienna (1927–1932), and years later (1960–1970) as a tenured professor at Harvard. This essay describes Erickson's teaching experience in both settings and suggests some of the reasons he was honored by Harvard in 1980 as a “humane teacher.” Implications from Erikson's educational practice are drawn that demonstrate how Erikson moved beyond the rote memorization and authoritarian educational practice he experienced as a youth. The essay suggests Erikson's teaching stance at Harvard fits the author's theological tradition's use of the term “teaching elder.”     

Profiles of dyadic adjustment for advanced prostate cancer to inform couple-based intervention

Objective: The purpose of the study is to describe from a relational perspective, partners’ psychological adjustment, coping and support needs for advanced prostate cancer.

Design: A mixed methods design was adopted, employing triangulation of qualitative and quantitative data, to produce dyadic profiles of adjustment for six couples recruited from the urology clinics of local hospitals in Tasmania, Australia.

Methods: Dyads completed a video-taped communication task, semi-structured interview and standardised self-report questionnaires.

Results: Themes identified were associated with the dyadic challenges of the disease experience (e.g. relationship intimacy, disease progression and carer burden). Couples with poor psychological adjustment profiles had both clinical and global locus of distress, treatment side-effects, carer burden and poor general health. Resilient couples demonstrated relationship closeness and adaptive cognitive and behavioural coping strategies. The themes informed the adaption of an effective program for couples coping with women’s cancers (CanCOPE, to create a program for couples facing advanced prostate cancer (ProCOPE-Adv).

Conclusion: Mixed method results inform the development of psychological therapy components for couples coping with advanced prostate cancer. The concomitance of co-morbid health problems may have implications for access and engagement for older adult populations in face-to-face intervention.