"以病人为中心"医疗服务模式的理念与发展

纵观20世纪医疗服务的发展历程,医疗服务的发展经历了“以疾病为中心”的传统医疗服务模式到“以病人为中心”的新的医疗服务模式的转变;目前,以“以病人为中心”的医疗服务模式已经成为我国现代医院改革与发展的主题。因此,在阐述医疗服务模式变革与发展的基础上,系统论述了“以病人为中心”的医疗服务模式的内涵与特点,新的理念、新的认识,也带来了新的希望,新的医疗服务模式将不断地改善与提高人们的健康状况与生活质量。     

Substantive unconscious and adjective unconscious: the contribution of Wilfred Bion

The author first provides her readers with a brief summary of some of Freud's ideas, as found throughout his work, on the notion of 'unconscious'. The notion of unconscious as noun is contrasted to the idea of unconscious as adjective, this latter being proposed as a quality, or a state, ever temporary, dynamic, and subject to the constant changes going on in the individual's internal psychic world, as well as to external conditions. After presenting some considerations, the author then contrasts the Kleinian model of the mind to the Freudian, and Wilfred Bion's contribution is discussed at some length. Within Bion's conception of psychic functioning, the model of 'dream' is highlighted and, in this regard, clarifications are sought regarding Bion's view of the unconscious. To conclude, a brief and superficial approximation to the work of Carl Jung is touched upon, although the author admits to knowing little of Jung's positions.     

Relations of Tripartite Dimensions of Emotion to Childhood Anxiety and Mood Disorders

This study examined preliminary higher-order models relating tripartite dimensions of emotion to severity of anxiety and depressive disorders in 100 clinically referred children and adolescents. In light of the accumulating support for multifactor models of vulnerability and negative emotion in children, the present investigation was designed to establish preliminary estimates of the structure and magnitude of the relations of three emotion factors with dimensions of social anxiety, depression, panic, generalized anxiety, obsessions/compulsions, and separation anxiety. Results were consistent with structures that minimally specified two higher-order emotion factors, yet only some parameter estimates were consistent with theory regarding the tripartite model. Problems with the measurement of tripartite factors and possibilities for further research are outlined.     

The Client Is the Most Important Common Factor: Clients' Self-Healing Capacities and Psychotherapy

I first briefly review the dodo bird verdict and suggest that we should be responding to it by looking for a new way to conceptualize how therapy works. Then I describe the dominant medical or treatment model of psychotherapy and how it puts the client in the position of a dependent variable who is operated on by supposedly potent therapeutic techniques. Next I argue that the data do not fit with this model. An alternative model is that the client is the most important common factor and that it is clients' self-healing capacities which make therapy work. I then argue that therapy has two phases—the involvement phase and the learning phase—and that the involvement phase is the most important. I next review the five learning opportunities provided by therapy. Finally, I argue that a relational model of therapy focused on consultation, collaboration, and dialogue is better than a treatment model.     

多层线性模型在纵向研究中的运用

纵向研究中传统统计技术主要是重复测量的方差分析和多元回归分析，但是这两种技术存在一些局限性，不能合理而充分地解释纵向研究资料。近年来出现的多层线性模型能够更有效地利用纵向数据。为促进多层线性模型在纵向研究中的运用，简要论述了传统统计技术的局限，介绍了多层线性模型的原理及其在纵向研究中的作用，以一组模拟数据为例对多层线性模型中各种参数在纵向研究中的含义进行了详细讨论，对于纵向研究中运用多层线性模型时须注意的问题提出了建议。     

The effects of reinforcement magnitude on functional analysis outcomes

The duration or magnitude of reinforcement has varied and often appears to have been selected arbitrarily in functional analysis research. Few studies have evaluated the effects of reinforcement magnitude on problem behavior, even though basic findings indicate that this parameter may affect response rates during functional analyses. In the current study, 6 children with autism or developmental disabilities who engaged in severe problem behavior were exposed to three separate functional analyses, each of which varied in reinforcement magnitude. Results of these functional analyses were compared to determine if a particular reinforcement magnitude was associated with the most conclusive outcomes. In most cases, the same conclusion about the functions of problem behavior was drawn regardless of the reinforcement magnitude.     

Representation and working memory in early arithmetic

Working memory has been implicated in the early acquisition of arithmetic skill, but the relations among different components of working memory, performance on different types of arithmetic problems, and development have not been explored. Preschool and Grade 1 children completed measures of phonological, visual-spatial, and central executive working memory, as well as nonverbal and verbal arithmetic problems, some of which included irrelevant information. For preschool children, accuracy was higher on nonverbal problems than on verbal problems, and the best and only unique predictor of performance on the standard nonverbal problems was visual-spatial working memory. This finding is consistent with the view that most preschoolers use a mental model for arithmetic that requires visual-spatial working memory. For Grade 1 children, performance was equivalent on nonverbal and verbal problems, and phonological working memory was the best predictor of performance on standard verbal problems. For both age groups, problems with added irrelevant information were substantially more difficult than standard problems, and in some cases measures of the central executive predicted performance. Assessing performance on different components of working memory in conjunction with different types of arithmetic problems provided new insights into the developing relations between working memory and how children do arithmetic.     

The Meaning vs. The Medical Model in the Empirically Supported Treatment Program: A Consideration of The Empirical Evidence

A review of the debate on the Empirically Supported Treatment Program is presented. It is argued that underlying the specifics of the debate are fundamentally incompatible paradigms: a meaning vs. a medical model. The findings from two gold standard multi-site studies are reviewed to conclude that the control condition meets requirements for an empirically supported treatment. The empirical finding of the failure of clinical training to improve treatment outcomes is explained by the focus on rational factors in training. It is recommended that training of therapists focus on enhancing experiential capacity rather than mastery of manualized treatment approaches.     

On the effects of signaling reinforcer probability and magnitude in delayed matching to sample

Two experiments examined whether postsample signals of reinforcer probability or magnitude affected the accuracy of delayed matching to sample in pigeons. On each trial, red or green choice responses that matched red or green stimuli seen shortly before a variable retention interval were reinforced with wheat access. In Experiment 1, the reinforcer probability was either 0.2 or 1.0 for both red and green responses. Reinforcer probability was signaled by line or cross symbols that appeared after the sample had been presented. In Experiment 2, all correct responses were reinforced, and the signaled reinforcer durations were 1.0 s and 4.5 s. Matching was more accurate when larger or more probable reinforcers were signaled, independently of retention interval duration. Because signals were presented postsample, the effects were not the result of differential attention to the sample.     

On the existence and uniqueness of JML estimates for the partial credit model

A necessary and sufficient condition is given in this paper for the existence and uniqueness of the maximum likelihood (the so-called joint maximum likelihood) estimate of the parameters of the Partial Credit Model. This condition is stated in terms of a structural property of the pattern of the data matrix that can be easily verified on the basis of a simple iterative procedure. The result is proved by using an argument of Haberman (1977). The author wishes to thank the Editor and the anonymous reviewers for their comments that helped to substantially improve the final version of this paper. This research was supported in part by a MURST grant (ex 60%).