"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.     

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.     

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.     

Checking the Assumptions of Rasch's Model for Speed Tests

Two new tests for a model for the response times on pure speed tests by Rasch (1960) are proposed. The model is based on the assumption that the test response times are approximately gamma distributed, with known index parameters and unknown rate parameters. The rate parameters are decomposed in a subject ability parameter and a test difficulty parameter. By treating the ability as a gamma distributed random variable, maximum marginal likelihood (MML) estimators for the test difficulty parameters and the parameters of the ability distribution are easily derived. Also the model tests proposed here pertain to the framework of MML. Two tests or modification indices are proposed. The first one is focused on the assumption of local stochastic independence, the second one on the assumption of the test characteristic functions. The tests are based on Lagrange multiplier statistics, and can therefore be computed using the parameter estimates under the null model. Therefore, model violations for all items and pairs of items can be assessed as a by-product of one single estimation run. Power studies and applications to real data are included as numerical examples.     

Fitting Psychometric Models with Methods Based on Automatic Differentiation

Quantitative psychology is concerned with the development and application of mathematical models in the behavioral sciences. Over time, models have become more complex, a consequence of the increasing complexity of research designs and experimental data, which is also a consequence of the utility of mathematical models in the science. As models have become more elaborate, the problems of estimating them have become increasingly challenging. This paper gives an introduction to a computing tool called automatic differentiation that is useful in calculating derivatives needed to estimate a model. As its name implies, automatic differentiation works in a routine way to produce derivatives accurately and quickly. Because so many features of model development require derivatives, the method has considerable potential in psychometric work. This paper reviews several examples to demonstrate how the methodology can be applied. From the Presidential Address delivered at the 70th Annual Meeting of the Psychometric Society, Tilburg University, The Netherlands, July 5–8, 2005.     

Adolescent Psychopathy and the Big Five: Results from Two Samples

The present study examines the relation between psychopathy and the Big Five dimensions of personality in two samples of adolescents. Specifically, the study tests the hypothesis that the aspect of psychopathy representing selfishness, callousness, and interpersonal manipulation (Factor 1) is most strongly associated with low Agreeableness, whereas the aspect of psychopathy representing impulsivity, instability, and social deviance (Factor 2) is associated with low Agreeableness, low Conscientiousness, and high Neuroticism. Data from 13- and 16-year-old boys and their mothers from two samples of the Pittsburgh Youth Study are used to test these hypotheses. Results were consistent across age and rating source in supporting the initial hypotheses, providing support for the construct of juvenile psychopathy and the interpretation of psychopathy as a constellation of traits drawn from a general model of personality functioning.     

“Seeing Conversion Whole”: Testing a Model of Religious Conversion

Rambo (1993) theorized that religious conversion consists of a process involving seven dimensions, labeled context, crisis, quest, encounter, interaction, commitment, and consequences. To test the Rambo model, a new measure, the 97-item Adult Religious Conversion Experiences Questionnaire (ARCEQ), was developed, revised on the basis of feedback from a focus group, and administered by mail to 110 adult volunteers who self-identified as having experienced conversion. Reliability analysis of the subscales of the ARCEQ resulted in five (crisis, quest, encounter, commitment, and consequences) meeting the criterion ( > .80). A sixth (interaction) achieved a reliability of .76 and was retained, but the seventh (context) was dropped. Principal components factor analysis with Varimax rotation produced factors labeled Redemptive Love, Zealous Dedication, Dysphoric Need, Openness to Uncertainty, Extrinsic Crisis, and Experiential Learning, which could readily be interpreted in relation to Rambo's model. Subsidiary analyses showed a number of significant correlations between demographic characteristics of the sample and differences in religious conversion experience.     

Are multi‐layer backpropagation networks catastrophically amnesic?

Connectionist models with a backpropagation learning rule are known to have a serious problem. Such models exhibit catastrophic interference (or forgetting) with sequential training. Having learned a set of patterns, if the model is trained on another set of patterns, its performance on the first set can dramatically deteriorate very rapidly. The present study reconsiders this issue with four simulations. The model learned arithmetic facts sequentially, but the interference was only modest with random (hence approximately orthogonal) inputs. Essentially the same result was obtained when the inputs are made less orthogonal by adding irrelevant elements. Reducing the number of hidden units did not have major effects. This study suggests that the interference problem has been somewhat overstated.