榄香烯联合替莫唑胺与单药替莫唑胺在 NSCLC 脑转移放疗后维持治疗中的比较研究

探讨榄香烯注射液联合替莫唑胺在非小细胞肺癌（NSCLC）脑转移患者放疗后维持治疗的疗效,将46例NSCLC脑转移放疗后患者,随机分为联合治疗组和对照组,分别采用榄香烯联合替莫唑胺和单药替莫唑胺维持化疗,观察两组疗效、免疫指标、不良反应及生存分析。结果显示两组无进展生存期（PFS）、总生存期（OS）差异无统计学意义（P＞0．05）。总缓解率及卡氏功能状态评分（KPS）两组比较差异有统计学意义（P＜0．05）。联合治疗组免疫功能提高,化疗不良反应减轻。榄香烯联合替莫唑胺维持治疗可以提高NSCLC脑转移患者放疗后的总缓解率,改善生活质量,减轻化疗的不良反应,应用安全。     

Parental loss of close family members and propensities towards absorption in offspring

Parental unresolved/disorganized responses to loss assessed in the Adult Attachment Interview predict infant disorganized (D) attachment. Parental experiences of loss near the birth of an infant should therefore increase the likelihood of D attachment to that parent. Liotti (1992) suggested that D attachment may increase tendencies to altered states of consciousness, and some support for this hypothesis has been obtained in clinical and high-risk samples. Here, Tellegen's Absorption Scale was used to measure propensities to altered consciousness in two low-risk samples of young adults (N=136, N=308). In both studies, participants whose parents experienced familial loss within two years of their birth showed elevated levels of absorption. These outcomes (a) support the proposed connection between disorganized attachment and tendencies to altered consciousness, and (b) suggest that queries regarding parental loss experiences should be further explored as a ‘rough and ready’ estimate of disorganized attachment in large-scale studies.     

PROGRAMMING FOR SURVIVAL: A MEETING SYSTEM THAT SURVIVES 8 YEARS LATER

Effective and useful interventions often deteriorate when researchers withdraw their direct supervision. We tested the survival of an intervention designed to produce effective weekly meetings in a student housing cooperative without direct researcher supervision. Chairperson performance, proposals completed per hour, and ratings of chairperson performance all increased when resident staff used a training manual, prompting checklist, and performance reviews. Eight years of follow-up revealed continuing high levels of meeting effectiveness. This study demonstrates a methodology for the direct observation and experimental analysis of intervention survival.     

Control and maintenance effects of long-term relaxation training in a case of hypertension

The effects of long-term, varied relaxation in a case of essential hypertension are described. The client's unusual achievement of voluntary control over his blood pressure was discussed in terms of new directions in the search of a relaxation specific factor.     

THEORETICAL,PRACTICAL, AND SOCIAL ISSUES IN BEHAVIORAL TREATMENTS OF OBESITY

Although showing superior maintenance, behavioral treatments of obesity typically produce small weight losses at a decelerating rate. Rather than reflecting poor compliance with treatment, these findings are consistent with known compensatory metabolic changes that operate to slow weight loss and promote regain. Other problems associated with dieting include failure of caloric regulation, hyper-responsivity to food palatability, and hunger, which is greatest under conditions of moderate restriction and unpredictability of access to food. The inevitability of treatment failure in many instances must be faced and efforts made to prevent further worsening of the obese patient's self-esteem. Prognosis and treatment planning may be aided by consideration of the historical difficulties of weight loss, the degree of hunger experienced on diets, which may reflect important physiological differences among individuals, and the use of food to optimize arousal level. Full involvement of the patient in setting goals and planning treatment is recommended.     

Contingency-shaped and rule-governed behavior: instructional control of human loss avoidance

Instructions can override the influence of programmed schedules of reinforcement. Although this finding has been interpreted as a limitation of reinforcement schedule control in humans, an alternative approach considers instructional control, itself, as a phenomenon determined by subjects' reinforcement histories. This approach was supported in a series of experiments that studied instructional and schedule control when instructions either did or did not accord with the schedule of reinforcement. Experiment I demonstrated that accurate instructions control discriminative performances on multiple avoidance schedules, and that such control persists in a novel discrimination. Experiments II and III showed that elimination of instruction-following occurs when inaccurate instructions cause subjects to contact a monetary loss contingency. Experiment IV demonstrated the reinforcing properties of accurate instructions. Skinner's view of rule-governed behavior is consistent with these findings, and can be extended to account for many aspects of instructional control of human operant behavior.     

A CLASSIFICATION SCHEME OF SOCIAL CONDITIONS OF REINFORCEMENT WITHIN GROUP OPERANT SYSTEMS1

Many different reinforcement contingencies are found in group operant systems, such as token economies and point systems. Some systems use group contingencies in which the reinforcement of any one participant may depend on the behavior of some other group member. Other programs are individual, in that participants earn reinforcers dependent only on their own behavior. The various possible arrangements of people and their response requirements are labelled “social conditions of reinforcement” in this paper. Previous attempts at classification have failed to categorize the variety of social conditions of reinforcement. In addition, some conditions that may produce behaviorally different effects have not been separated. The present paper classifies the social conditions of reinforcement found in applied programs in a three-dimensional scheme. The efficacy of the three major dimensions—reinforcing agent, recipient response requirement, and group response requirement—is supported by clinical and research data. The reinforcing agent dimension refers to the person(s) who dispenses reinforcers to group members. This major dimension is further subdivided: one or several agents may be either designated or nondesignated. Recipients are the group members who receive reinforcement. This dimension is also subdivided: one or several recipients in a social condition of reinforcement may obtain reinforcers either contingently or noncontingently. The group response requirement is a criterion that must be satisfied before any group participant is eligible for reinforcement. Some systems have no group requirement, and others have a group requirement that must be met by some designated or nondesignated participant(s). Supportive references and examples are given in the explanation of each dimension and subdimension. The behavioral impact of the various categories is emphasized. For all major dimensions, applied implications and research suggestions are discussed. Concluding remarks center on the utility of the present scheme, the classification of operant procedures other than positive reinforcement, and both theoretical and applied issues requiring further study (e.g., the long-term effects of participation in group contingencies).     

TOWARD A METHODOLOGY OF WITHDRAWAL DESIGNS FOR THE ASSESSMENT OF RESPONSE MAINTENANCE

Single-case experimental designs have advanced considerably in the evaluation of functional relationships between interventions and behavior change. The systematic investigation of response maintenance once intervention effects have been demonstrated has, however, received relatively little attention. The lack of research on maintenance may stem in part from the paucity of design options that systematically evaluate factors that contribute to maintenance. The present paper discusses three design options potentially useful for the investigation of response maintenance. These include: (a) the sequential-withdrawal, (b) the partial-withdrawal, and (c) the partial-sequential withdrawal designs. Each design is illustrated and potential limitations are discussed.     

An implicit technology of generalization

Traditionally, discrimination has been understood as an active process, and a technology of its procedures has been developed and practiced extensively. Generalization, by contrast, has been considered the natural result of failing to practice a discrimination technology adequately, and thus has remained a passive concept almost devoid of a technology. But, generalization is equally deserving of an active conceptualization and technology. This review summarizes the structure of the generalization literature and its implicit embryonic technology, categorizing studies designed to assess or program generalization according to nine general headings: Train and Hope; Sequential Modification; Introduce to Natural Maintaining Contingencies; Train Sufficient Exemplars; Train Loosely; Use Indiscriminable Contingencies; Program Common Stimuli; Mediate Generalization; and Train "To Generalize".     

THE EFFECT OF EXPERIMENTER FACIAL ORIENTATION DURING IMITATION MAINTENANCE1

The training and maintenance of imitative responding has become an important therapeutic process with language-handicapped children, as indicated by Garcia and DeHaven (American Journal of Mental Deficiency, 1974, 79 , 169–178). Typically a training “package” is used, that might entail the use of operant shaping, fading, reinforcement, and punishment techniques designed to increase correct imitation and decrease incorrect responding. Only recently have studies begun to concentrate on the components of these training “packages”. Steinman (Journal of Applied Behavior Analysis, 1970, 3 , 159–167) highlighted the roles played by less conspicuous but functionally important components of these packages. The present study attempted to provide a systematic extension of this work within an applied context. Using subjects who were responding at high levels during an imitation-maintenance procedure, experimenter facial orientation (experimenter's eyes and head oriented towards the subject's face and head), was systematically manipulated for experimentally determined “types” of imitative behavior. Differential responding within these parameters provided an evaluation of facial orientation as a functional component within this training package. Three retarded children participated in the study. Two types of topographically different imitative responses were defined for experimental purposes (“standing” and “sitting”). Each subject progressed through four conditions of the study, which called for the reinforcement of all imitative responses. But during preselected conditions, experimenter facial orientation was removed from the therapeutic package for one of the two topographical types of imitation. Results indicated that imitation of the two topographical types of models was dependent on the presence of experimenter facial orientation within the experimental procedure.