药物不良反应社会成本控制最优化的经济学分析

药物不良反应(adverse drug reaction,ADR)是导致患者住院的常见原因并造成高额的社会成本。由于避免ADR的边际成本是递增的,因此从经济学的角度来看,ADR的发生率不是最小化而是最优化问题,是在成本与效益之间找到最优平衡的问题,本文对ADR发生率的最优平衡点和相关的制度作了探讨。     

Implicit bias,confabulation, and epistemic innocence

In this paper I explore the nature of confabulatory explanations of action guided by implicit bias. I claim that such explanations can have significant epistemic benefits in spite of their obvious epistemic costs, and that such benefits are not otherwise obtainable by the subject at the time at which the explanation is offered. I start by outlining the kinds of cases I have in mind, before characterising the phenomenon of confabulation by focusing on a few common features. Then I introduce the notion of epistemic innocence to capture the epistemic status of those cognitions which have both obvious epistemic faults and some significant epistemic benefit. A cognition is epistemically innocent if it delivers some epistemic benefit to the subject which would not be attainable otherwise because alternative (less epistemically faulty) cognitions that could deliver the same benefit are unavailable to the subject at that time. I ask whether confabulatory explanations of actions guided by implicit bias have epistemic benefits and whether there are genuine alternatives to forming a confabulatory explanation in the circumstances in which subjects confabulate. On the basis of my analysis of confabulatory explanations of actions guided by implicit bias, I argue that such explanations have the potential for epistemic innocence. I conclude that epistemic evaluation of confabulatory explanations of action guided by implicit bias ought to tell a richer story, one which takes into account the context in which the explanation occurs.     

Young People's Experiences of Participation in Clinical Trials: Reasons for Taking Part

Given the lack of knowledge about safety and efficacy of many treatments for children, pediatric clinical trials are important, but recruitment for pediatric research is difficult. Little is known about children's perspective on participating in trials. The purpose of this study was to understand the experiences and motivations of young people who took part in clinical trials. This is a qualitative interview study of 25 young people aged 10–23 who were invited to take part in clinical trials. Interviews were audio or video recorded and analyzed using framework analysis. Young peoples' motivations were both personal benefit and helping others. Both incentives appeared to be more complex than expected. We introduce the terms “network of exchange” and “intergenerational solidarity” to describe these motivations. To improve recruitment, professionals should be more open about research opportunities, provide better information, and give young people feedback after the trial has ended.     

Illness Perceptions,Coping, Benefit Finding,and Adjustment in Individuals with Hepatitis C

Objective

To investigate the ability of illness perceptions, adaptive, and maladaptive coping strategies, and benefit finding to predict physical and psychosocial adjustment among individuals diagnosed with the hepatitis C virus (HCV), within an expanded self‐regulatory model of illness (SRM).

Method

A total of 126 participants with HCV completed an online questionnaire assessing illness perceptions, coping, benefit finding, and four adjustment outcomes, depression, physical functioning, life satisfaction and positive affect.

Results

Illness perceptions made significant contributions to the variance in adjustment outcomes across the four psychosocial and physical adjustment areas. At an individual level, personal control, identification with HCV symptoms, perceptions related to illness duration, illness coherence, and emotional responses to HCV made significant contributions to the prediction of adjustment. Similarly, the combined contributions of adaptive and maladaptive coping strategies explained significant variance across the four adjustment areas. Greater adoption of maladaptive coping strategies predicted poorer physical health, higher reported depression, greater life satisfaction, and positive affect outcomes, while increased engagement with adoptive coping strategies predicted higher positive affect. Increased benefit finding predicted greater positive affect, life satisfaction, and higher depression.

Conclusion

Results demonstrate the ability of the SRM features of illness perceptions and coping, and benefit finding to predict physical and psychosocial adjustment outcomes within the context of HCV.     

When Parents Refuse: Resolving Entrenched Disagreements Between Parents and Clinicians in Situations of Uncertainty and Complexity

When shared decision making breaks down and parents and medical providers have developed entrenched and conflicting views, ethical frameworks are needed to find a way forward. This article reviews the evolution of thought about the best interest standard and then discusses the advantages of the harm principle (HP) and the zone of parental discretion (ZPD). Applying these frameworks to parental refusals in situations of complexity and uncertainty presents challenges that necessitate concrete substeps to analyze the big picture and identify key questions. I outline and defend a new decision-making tool that includes three parts: identifying the nature of the disagreement, checklists for key elements of the HP and ZPD, and a “think list” of specific questions designed to enhance use of the HP and ZPD in clinical decision making. These tools together will assist those embroiled in complex disagreements to disentangle the issues to find a path to resolution.     

生物医学人体受试者研究未来面临的挑战

人体受试者研究的伦理问题在今后将会愈益引起关注,如何看待知情同意的代理权？如何处理不同文化背景下的知情同意原则？在商业利益诱惑下背离本人健康利益和知情同意是否有效？受试者的利益回报,以及体试验研究要求的双盲,随机、对照等原则可能面临的新问是,都是人体受试者研究未来面临的挑战。     

问题发现过程认知阶段划分的探索性研究

采用建构认知模型法探索问题发现过程认知阶段的存在性及顺序性问题。基于已有研究,提出问题发现过程可划分为信息搜寻、现状表征、寻求目标、建立联系、提出问题、评价和修正问题等六个阶段的基本假设。用出声思维和秩次聚类分析的方法对高低能力组共40名大学生问题发现过程的阶段性进行考察,结果显示：六个阶段中有两对阶段出现位置非常接近,可将其进行整合,构成现状搜寻与表征、目标探索、提出问题、评价和修正问题等四个阶段。在不同问题领域与不同能力被试群体中,各认知阶段的顺序性没有差异。     

Moving Onwards: An Action Continuation Strategy in Finding the Way

In four studies, we examined people's strategies when deciding between multiple routes of equivalent length in way‐finding tasks. The results reveal the important role of continuing behavior when faced with a choice from multiple viable routes. After affirming the existence of asymmetric preferences for alternatives (Studies 1 and 2), we observed that variations of simple known‐environment mazes supported action continuation as prevailing process over alternative strategies such as preference for long initial path segments, paths with a least deviating angle, and a modified hill climbing strategy (Study 3). Moreover, asymmetric preferences disappeared with the absence of initial behavior to inform subsequent decision making (Study 4). Results are discussed within the context of decision making, navigation strategies, and everyday life path finding. Copyright © 2014 John Wiley & Sons, Ltd.     

On the processing of canonical word order during eye fixations in reading: Do readers process transposed word previews?

Whether readers always identify words in the order they are printed is subject to considerable debate. In the present study, we used the gaze-contingent boundary paradigm (Rayner, 1975) to manipulate the preview for a two-word target region (e.g., white walls in My neighbor painted the white walls black). Readers received an identical (white walls), transposed (walls white), or unrelated preview (vodka clubs). We found that there was a clear cost of having a transposed preview compared to an identical preview, indicating that readers cannot or do not identify words out of order. However, on some measures, the transposed preview condition did lead to faster processing than the unrelated preview condition, suggesting that readers may be able to obtain some useful information from a transposed preview. Implications of the results for models of eye movement control in reading are discussed.     

Responses to the September 11, 2001, Terrorist Attacks: Experience of an Indirect Traumatic Event and Its Relationship With Perceived Benefits

Little is known about how people might benefit from an indirectly experienced traumatic event. The authors examined the relationship between perception of benefit and trauma symptoms in response to a relatively severe, but indirectly experienced, traumatic event. The authors sampled from 2 colleges located in the southeastern United States (N = 136). Individuals responded to questionnaires that assessed perceived benefits and trauma symptoms 1-2 weeks after the terrorist attacks of September 11, 2001, and again approximately 10 weeks later. Participants did perceive benefits from witnessing this event, although their perception of benefit declined over time. Level of trauma symptoms correlated positively with perception of benefit, and experiencing a previous trauma also correlated positively with perceived benefits. Additional analysis indicated that level of trauma symptoms mediated the relationship between previous trauma and perception of benefit. These findings help to elucidate understanding of the development of perceived benefits in response to indirectly experienced events.