蝴蝶效应与临床思维——一例多器官衰竭患者诊疗反思

多器官衰竭或多器官功能障碍综合征在临床中尤其是急诊及重症监护室内常见,各种病因所致的疾病进展到一定程度均可导致多器官衰竭。在本案例中,一例老年男性患者,以急性腹泻起病,后短时间内进展为多器官衰竭。通过对该例患者病史总结、病理生理机制的探讨,以及对整个诊疗过程的反思,结合“蝴蝶效应”理论,总结出一种新的临床思维,并探讨“蝴蝶效应”理论在对该例患者的诊断、治疗甚至医患沟通方面所起到的作用,以期通过参考该案例,对以后的临床工作起到一定帮助。     

神灵主义医学何以可能?

神灵主义医学,是人类历史上第一个医学范式,拥有一套完整的形而上学信念、方法论体系和解释机制。神灵主义医学已经长期存在,并且在当今世界也广泛存在,这是世界之中的事实,无需争论。站在当代医学发展的前沿回头看,神灵主义医学之所以能够长期指导人类的医疗实践,有其内在原因。人类的大量自限性疾病,为神灵主义医学的成功提供了广泛的归纳支持。安慰剂效应的发现,进一步揭示了神灵主义医学成功的内在可能性。超自然解释,是神灵主义医学治疗失败后,医师给予患者的无助安慰,却为巫医守住了信誉的最后堡垒。     

Effect size,statistical power,and sample size for assessing interactions between categorical and continuous variables

The reporting and interpretation of effect size estimates are widely advocated in many academic journals of psychology and related disciplines. However, such concern has not been adequately addressed for analyses involving interactions between categorical and continuous variables. For the purpose of improving current practice, this article presents fundamental features and theoretical developments for the variance of standardized slopes as a desirable standardized effect size measure for the degree of disparity between several slope coefficients. To estimate the effect size, a consistent and nearly unbiased estimator is described and a simple refinement is emphasized for extreme situations whenever appropriate. The essential problems of power and sample size calculations for testing the equality of slope coefficients are also considered. According to the analytic justification and empirical assessment, the exact approach has a clear advantage over the approximate methods. Both SAS and R computer codes are provided to facilitate practical accessibility of the proposed techniques in interaction studies.     

Effects of male testosterone and its interaction with cortisol on self- and observer-rated personality states in a competitive mating context

Increases in men’s testosterone (T) levels after intrasexual competitions and exposure to females facilitate competitive and courtship behaviours, suggesting T reactivity should affect relevant personality state changes. How exactly T reactivity, also under potential buffering effects of cortisol (C), relates to personality state changes is unclear. In a preregistered study, we aimed at inducing T increases in young men (N = 165) through dyadic intrasexual competitions while exposed to a female experimenter. We investigated self-reported and video-based observer-rated personality state changes, captured by the interpersonal circumplex and social impressions, in relation to hormonal levels. Results revealed increases in self-reported competitiveness and observer-rated self-assurance, relative to a control group, moderated by T reactivity and partly by T × C interactions, providing insights into hormone-personality response-links.     

The Faulty Magnitude Detector: Why SNARC‐Like Tasks Cannot Support a Generalized Magnitude System

Do people represent space, time, number, and other conceptual domains using a generalized magnitude system (GMS)? To answer this question, numerous studies have used the spatial‐numerical association of response codes (SNARC) task and its variants. Yet, for a combination of reasons, SNARC‐like effects cannot provide evidence for a GMS, even in principle. Rather, these effects support a broader theory of how people use space metaphorically to scaffold their understanding of myriad non‐spatial domains, whether or not these domains exhibit variation in magnitude.     

The role of response readiness in subliminal visuomotor processes

The present study aims to examine the impact of response readiness on visuomotor processes triggered by subliminal stimuli using a mixed paradigm involving the masked prime paradigm and a foreperiod paradigm. Experiment 1 ensured that response readiness was successfully manipulated in the mixed paradigm. Importantly, Experiment 2 found that the negative compatibility effect (NCE; a behavioral indicator of subliminal visuomotor processes) disappeared and that response time lost its power to modulate the compatibility effect (CE) with reduced response readiness (due to temporal uncertainty). These results of CEs both independent of response latency and across different levels of response latency indicate that response readiness is a prerequisite for obtaining the NCE. The findings suggest that automatic processing of subliminal stimuli is susceptible to top-down control for reducing the interference of irrelevant information, which ensures a high degree of adaptability and flexibility of our cognitive system in interactions with the changing environment.     

目标探测对记忆提取的影响

采用经典的"学习–再认"范式,在测验阶段设置了目标探测的干扰任务,通过比较目标探测和分心拒绝是否会对记忆提取产生不同的影响,以进一步探讨提取干扰与再认记忆之间的关系。结果发现,无论对目标进行显性(实验1)还是隐性(实验2)的探测反应,目标探测下旧词的再认反应均要比分心拒绝下更优,表明外显记忆的提取也会受到注意资源的调节。但更为重要的是,在辨别力指数(d′)及判断标准(C)上的差异分析发现,目标探测并没有提高被试的再认水平,而是降低了被试的判断标准,使得被试在目标探测条件下更容易对词做出"旧"反应。这种反应倾向与目标探测的动作反应方式无关,也不受词汇的编码加工水平深浅的调节。由此可见,外显记忆提取并非完全的"自动化加工",仍会受到注意资源的调节。     

视觉工作记忆回溯线索效应的产生机制：认知阶段分离

以往研究关于视觉工作记忆回溯线索效应的产生机制主要存在5种假设,目前依然存在争议。本研究通过改进前人研究实验范式,采用包含内源性回溯线索的颜色回忆报告范式,进一步对这5种假设进行检验。在实验1中,我们调控了线索与探测阵列之间的时间间隔,发现不同时间间隔不影响无线索条件的行为表现,而在正常线索条件中被试的记忆精度以及能记住的项目数量均优于无线索条件;在实验2中,我们对回溯线索伴随的干扰刺激类型进行控制,结果显示,在不同条件下记忆精度不存在差别,但当回溯线索伴随干扰刺激呈现时,被试能记住的项目数量会被降低,降低程度受干扰刺激的类型调制;在实验3中,我们对伴随回溯线索的干扰刺激的呈现时间进行控制,发现虽然回溯线索效应仍然存在,但干扰刺激的呈现时间不会影响效应程度。研究结果表明,回溯线索的出现使得被试能够在决策加工前完成内部注意资源的再分配,从而避免了同时进行这两种认知加工与记忆表征维持本身竞争认知资源。本研究为认知阶段分离假设提供了支持证据,对解决回溯线索效应产生机制的争议以及理解内部注意与视觉工作记忆的关系有重要意义。