晚期非小细胞肺癌化疗的冷思考

晚期非小细胞肺癌提倡以化疗为主综合治疗,可以延长生存期,提高生存率。但目前化疗取得的疗效虽然较既往有提高,但提高生存期有限,且在药效经济学方面存在争议,缓解症状的作用也有限,联合靶向治疗的疗效也在观望中。临床肿瘤学工作者应正确认识,以循证医学为指导,开展规范化化疗,同时也注重个体化化疗,并期待晚期非小细胞肺癌化疗的新突破。     

Mapping the Terrain of a Foucauldian Ethics: A Response to the Surveillance of Schooling

Educators find themselves in the midst of arising tide of urban school reform marked byevermore centrally designed and monitoredsystems of accountability. In response to thislooming high-stakes gaze of surveillance, thisessay offers an ethics of educationalleadership predicated upon taking up thechallenge of creatively and courageouslyauthoring one's ethical self. It seeks tocontribute to mapping an ethical terrain whichcan support the production of pedagogicalpractices, initiatives, and agendas asdistinctive, bold responses to theproliferation of one-dimensional,technicist-driven efforts which narrowlycalculate and assess student learning, teacherwork, school effectiveness, and which offeranemic, foreclosed readings of a possiblefuture. My claim is that a consideration ofFoucault's ethics draws us closer torecognizing what such a project would mean andask of the educator as leader.     

Topics of Marital Conflict in the Everyday Lives of Empty Nest Couples and Their Implications for Conflict Resolution

To improve our understanding of marriage experiences during midlife, diary reports of naturalistic marital conflict were collected from 55 couples who were parents of grown children who had left the home. Communication, chores, and habits were the most frequent sources of disagreements reported by husbands and wives. Hierarchical linear models tested the unique associations between multiple conflict topics and interaction characteristics (length, recurrence, initiator, and importance) and constructive, angry, and depressive resolution strategies. Husbands and wives similarly rated money and habits as recurrent topics and conflicts concerning money and children as holding relatively high levels of current and long-term importance to the relationship. Compared with other topics, husbands and wives consistently perceived conflicts concerning habits and communication as being handled in relatively angry ways (e.g., defensiveness) and marital conflicts about children as eliciting greater depressive conflict (e.g., withdrawal, sadness). Husbands also viewed conflicts concerning relatives and commitment as being handled in relatively depressive ways. The findings explicate substantive sources of midlife marital disagreements and offer future research and clinical directions.     

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.     

Neuropsychological differentiation of progressive aphasic disorders

The differentiation of subtypes of primary progressive aphasia (PPA) remains challenging. We aimed to identify optimum neuropsychological measures for characterizing PPA, to examine the relationship between behavioural change and subtypes of PPA and to determine whether characteristic profiles of language, working memory, and behavioural changes occur in PPA. Forty-seven patients with PPA and multi-domain Alzheimer's disease (AD) together with 19 age-matched controls underwent a large battery of working memory and language tests. We found that simple tasks of sentence ordering, narrative production, and buccofacial praxis were particularly useful in differentiating non-fluent/agrammatic variant PPA (nfvPPA) from other PPA subtypes, whereas a test of single word comprehension was useful in detecting semantic dementia (SD). No individual tests were discriminating for logopenic variant PPA (lvPPA) relative to nfvPPA. LvPPA and multidomain AD exhibited similar language profiles. A principal components analysis revealed that characteristic PPA profiles extended beyond the realms of language, in particular, the presence of apraxia in nfvPPA, behavioural changes in SD, and working memory deficits in lvPPA. These findings suggest that not all tests are equally discriminatory for PPA and highlight the importance of a test profile in differentiating PPA. These results also support the view that lvPPA is a focal form of AD and emphasize the difficulties classifying lvPPA.     

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。     

早期检测血浆N-端脑利钠肽前体在高龄呼吸困难患者诊治策略中的应用价值

N-端脑利钠肽前体具有快捷、简易、安全可靠、耐受性好的特点,在呼吸困难的鉴别诊断上有其独特优势,已成为近年来临床开展的一项新技术。在高龄呼吸困难患者中具有光明的应用前景,本文就早期检测血浆N-端脑利钠肽前体在高龄呼吸困难患者诊治中的应用作一讨论。     

关注晚期癌症患者的生活质量

在强调整体医学的今天,在肿瘤治疗尚未出现理想疗效的前提下,肿瘤治疗目标应遵循生存率与生活质量(QOL)并重的原则。在诊治晚期癌症患者过程中不仅要关心他们的生存期,更要关心他们的生活质量。在诊治过程中要根据他们独特的心理和生理特征给予全方位关怀,减轻痛苦、维持生命质量和保证他们应有的人格尊严。