如何才能保持拉米夫定的疗效及降低耐药——临床优化治疗策略

探讨拉米夫定的临床优化治疗策略,包括选择适用人群,用药最佳时机,预防和应对耐药的方法。旨在提高和保持拉米夫定在慢性乙型肝炎抗病毒治疗的效果。     

Shifting goal posts: First and second order access

Snodgrass et al.’s (2009) commentary makes explicit one of the major problems in consciousness research; that there seem to be just as many definitions of basic terms are there are people in the field. Although Snodgrass et al.’s position appears at odds with the views expressed in Irvine (2009), many of their arguments are actually consistent with the proposed views, or else fail to engage with them as a consequence of the shifting goal posts of what basic terms mean.     

Psychological experiences of renal transplant patients: A qualitative analysis

Introduction: Organ‐sourcing developments now permit increasing numbers of renal transplants. Recipients commonly experience negative affect pre‐ and/or post‐transplant yet research on patient experience is lacking. Aims: This study aims to develop theory based on the lived experience of recipients, and to guide psychological and support interventions by counsellors and professional carers for the benefit of patients. Methods: A sample of eight participants was interviewed about their transplant experiences. The interview data were analysed using grounded theory methodology. Uniquely the research was conducted by a renal transplant patient, which potentially adds interpretive insight. Results: The central finding is that the issues facing transplant patients before and after transplant may be summarised as living with paradox and conflict. Thus, recipients may need to juxtapose anger/sadness about losses with an adaptive attitude to making the most of a second chance at life, and negotiate a positive relationship with an ‘alien’ organ. Conclusions/implications: The study offers evidence‐based guidance to counsellors supporting recipients to adjust to a changing sense of self, and to form adaptive relationships with self, others and the new kidney. Finally the research recommends action on improving awareness of and access to counselling and other supports for renal transplantees, and the need for in‐depth experiential research in this expanding area.     

Chronic fatigue syndrome/myalgicencephalomyelitis as a twentieth-century disease: analytic challenges

The challenges of chronic fatigue syndrome (often called myalgic encephalomyelitis, especially in the UK) (CFS/ME) to analytical and medical approaches are connected with our inability to understand its distressing somatic symptoms in terms of a single identifiable and understandable disease entity. The evidence for the roles of viral aetiologies remains inconclusive, as does our understanding of the involvement of the immune system. The history and social context of CFS/ME, and its relation to neurasthenia and psychasthenia are sketched. A symbolic attitude to the condition may need to be rooted in an awareness of psychoid levels of operation, and the expression and spread of CFS/ME may sometimes be aided by the ravages of projective identification. Psychic denial, sometimes violent, in sufferers (especially children and adolescents) and their families may be important in the aetiology of CFS/ME. We draw out common threads from psychodynamic work with five cases, four showing some symptomatic improvement, analytic discussions of three cases being presented elsewhere in this issue of JAP.     

Responsible engineering: Gilbane Gold revisited

This paper addresses several concerns in teaching engineering ethics. First, there is the problem of finding space within already crowded engineering curricula for meaningful discussions of ethical dimensions in engineering. Some engineering programs may offer entire courses on engineering ethics; however, most do not at present and may not in the foreseeable future. A promising possibility is to weave ethics into already existing courses using case studies, but most current case studies are not well integrated with engineering technical analysis. There is a danger that case studies will be viewed by both instructors and students as departures from “business as usual”—interesting perhaps, but not essentially connected with “real” engineering. We offer a case study, inspired by the National Society of Professional Engineer’s popular video Gilbane Gold, that can be used to make the connection. It requires students to engage in technical analysis, but in a context that makes apparent the ethical responsibility of engineers. Further, the case we present marks a significant departure from more typical cases that primarily focus on wrongdoing and its prevention. We concentrate more positively on what responsible engineering requires. There is a need for more such cases, regardless of whether they are to be used in standard engineering courses or in separate courses in engineering ethics. This article is the product of the NSF/Bovay Endowment “Workshop to Develop Numerical Problems Associated With Ethics Cases for use in Required Undergraduate Engineering Courses” (NSF Grant DUE-9455141) held at Texas A&M University in August 1995. For further information about this project, contact Michael J. Rabins, Director of the Ethics and Professionalism Program in the Look College of Engineering at Texas A&M University. Additional case studies from this workshop are available on the Internet site http://ethics.tamu.edu. The writing of this article was supported in part by “Engineering Ethics: Good Works” (NSF/EVS Grant SBR-930257). Michael Pritchard teaches ethics and is co-author of Engineering Ethics: Concepts and Cases (1995) with C.E. Harris and Michael Rabins (Wadsworth, Belmont CA). Mark Holtzapple teaches chemical engineering and is author of Foundations of Engineering (McGraw-Hill) which includes an ethics chapter suitable for freshman engineering students.     

Information processing in chronic pain disorder: A preliminary analysis

Researchers have alternately suggested selective attention, impaired stimulus filtering, and affective language deficiency models as accounting for multiple somatic complaints in persons with chronic pain disorder. The purpose of the present study was to establish the comparative usefulness of these three models for explaining somatic focus in a chronic pain population. Nine chronic pain patients evidencing high somatic focus (somatizing chronic pain patients), 10 chronic pain patients evidencing low somatic focus (nonsomatizing chronic pain patients), and 10 healthy control subjects were administered a computerized version of the emotional Stroop test as a test of these models. A total of 105 pain-, depression-, and neutral-content words were used as Stroop test stimuli. Stroop test color-naming response latencies were submitted to a two-way Group × Word Type mixed-model ANOVA, with Word Type as the repeated measure. Results reveal that neither the selective attention model nor the affective language deficiency model adequately explain Stroop test performance in somatizing chronic pain patients. Findings provide tentative support for the impaired stimulus filtering model, with somatizing chronic pain patients evidencing similar Stroop test response delays across all words. These results suggest that chronic pain sufferers misinterpret bodily sensations. Findings are discussed in terms of a bilevel approach for treatment of somatizing chronic pain patients that would include assisting the patient in accurate appraisal and interpretation of physical symptoms.     

Recognition failure of recallable words: Exception due to poor integration

The phenomenon of recognition failure of recallable words shows a remarkable regularity across a wide variety of experimental conditions. A quadratric function, referred to as the Tulving-Wiseman function, summarizes this regularity. A few cases of deviation from this function have been identified and classified into two categories of exceptions to this function. An experiment was designed to deal with one of these categories, namely the exception that occurs because of poor integration between cue and target information of studied word pairs. An index based on confidence ratings of recall responses was developed to assess variability in integration. Poor integration was demonstrated especially for one presentation of low associative word pairs, and significant deviations from the function was obtained for this condition. Hintzman's (1991, 1992) hypothesis about mathematical constraints of the Tulving-Wiseman function was discussed and refuted. Finally, an interpretation of negative deviations from the Tulving-Wiseman function was proposed.     

Sexual-Assault History and Long-Term Physical Health Problems: Evidence From Clinical and Population Epidemiology

Having a history of sexual assault is associated with both poor general health and limitations in physical functioning, as well as with specific health problems such as chronic pelvic pain, premenstrual disturbance, other gynecologic symptoms, fibromyalgia, headache, other pain syndromes, and gastrointestinal disorders. In studies evaluating the possible role of depression in these associations, depression among sexually assaulted persons did not account for their poorer health. Although there are unanswered questions in the literature on the associations between sexual assault and health, existing findings are consistent with standard criteria for inferring causal relationships from observational data. For example, many assault-health associations are supported by multiple, independent studies, and many demonstrate dose-response relationships (i.e., more incidents of sexual assault, or more severe assaults, are associated with more adverse health outcomes).     

Refraining Resistance and Noncompliance in Cognitive Therapy

Despite its general success, not everyone responds to cognitive therapy. Some clients have difficulty complying with assignments and others appear to be frankly resistant. This article considers strategies for dealing with passive noncompliance and active resistance within cognitive therapy. In general, it is argued that the process of therapy is usually facilitated by staying within the cognitive model—that is, by exploring and working through those beliefs and attitudes that underlie noncompliance and resistance in the same manner that other problematic beliefs and attitudes are approached. Also considered are strategies for dealing with unrealistic expectations regarding the pace of change, therapists' errors leading to noncompliance and resistance, and instances in which the therapeutic model is simply insufficient.     

Gender differences in acute and chronic stress in Wistar Kyoto (WKY) rats

While females are considered more susceptible to depressive behavior, this assertion is not strongly supported by the experimental literature. Since stress contributes to depressive behavior, male and female Wistar Kyoto (WKY) rats were exposed to either one session (acute stress) or 5 sessions (chronic stress) of restraint plus cold in order to study depressive behavior in male and female rats. After their respective treatment exposure, rats were tested in the open field test (OFT) and for retention of a passive-avoidance (P-A) task. One stress session resulted in significant immobility in the OFT for males, whereas 5 sessions were required to produce similar immobility in female rats. Acute stress interfered with the retention of the P-A response for males, while both acute and chronic stress produced poor P-A responses in female rats. Food consumption decresed, progressively, as a function of stress sessions, in female rats, whereas feeding in males returned to control levels after five stress days. Both acute and chronic stress exacerbated the stress ulcer response in male rats, but not in female rats. Chronic, but not acute, stress resulted in an increase in serotonin transporter mRNA levels in the dorsal raphe nucleus of both male and, female rats. The general consensus from these data suggested that female rats were more vulnerable to chronic stress and consequently supported the notion that females may be more susceptible to stress induced behavioral depression.