创新思维:临床移植医学兴起与发展的灵魂

临床移植医学是人类在与疾病作斗争的过程中敢于幻想、勇于实践的结晶。在其兴起与发展的过程中,创新思维起着决定性作用,这在解决供肝短缺问题上体现得十分突出。我国临床移植医学的发展,同样也处处闪耀着创新思维的光辉。     

Psychiatric Diagnoses and Clinical Characteristics of Asian American Youth in Children's Services

This study examined the psychiatric diagnoses and clinical characteristics of the 981 Asian American children enrolled in the first phase of the Comprehensive Community Mental Health Services for Children and Their Families Program. Asian Americans were less likely than non- Asian Americans to receive diagnoses of depression and ADHD and more likely to receive diagnoses of anxiety and adjustment disorder. As compared to non-Asians, Asian Americans were significantly more likely to be rated with severe functional impairment in community role performance, self-harmful behavior, and thinking. There was also a trend for fewer externalizing behavior problems. Implications for research and practice are discussed.     

The role of levels of processing in disentangling the ERP signatures of conscious visual processing

We aimed to distinguish electrophysiological signatures of visual awareness from other task-related processes through manipulating the level of processing of visual stimuli. During an event-related EEG experiment, 36 subjects performed either color (low-level condition) or magnitude (high-level condition) evaluations of masked digits. Participants also assessed subjective visibility of each stimulus using the Perceptual Awareness Scale (PAS). Mean amplitude of the components of interest was analyzed (VAN − 140–240 ms; LP − 380–480 ms) with weighted regression mixed model. In the VAN component time window the mean amplitude correlated with PAS rating in both conditions. Mean amplitude in the LP time window correlated with PAS ratings in the high-level condition, but not in the low-level condition. Our results support the temporal unfolding of ERP makers of conscious processing, with an early component reflecting the initial perceptual experience and a late component being a correlate of the conscious experience of non-perceptual information.     

Innovative Practice,Clinical Research,and the Ethical Advancement of Medicine

Innovative practice occurs when a clinician provides something new, untested, or nonstandard to a patient in the course of clinical care, rather than as part of a research study. Commentators have noted that patients engaged in innovative practice are at significant risk of suffering harm, exploitation, or autonomy violations. By creating a pathway for harmful or nonbeneficial interventions to spread within medical practice without being subjected to rigorous scientific evaluation, innovative practice poses similar risks to the wider community of patients and society as a whole. Given these concerns, how should we control and oversee innovative practice, and in particular, how should we coordinate innovative practice and clinical research? In this article, I argue that an ethical approach overseeing innovative practice must encourage the early transition to rigorous clinical research without delaying or deferring the development of beneficial innovations or violating the autonomy rights of clinicians and their patients.     

精神分裂症肠道微生物与脑影像和临床表征的关系

微生物-肠-脑轴假设在精神分裂症发病机制中的研究受到越来越多的关注。以往研究初步考察了肠道微生物的构成与精神分裂症患者脑影像和临床表征之间的联系,但具体的作用路径尚不明确。当前研究通过总结最新研究进展,并在此基础上提出肠道微生物影响精神分裂症患者大脑结构和功能的机制假设。相关内容对于进一步阐明精神分裂症的病理机制,为将肠道微生物纳入精神分裂症的评估与干预提供理论基础。     

Developing an Occupation-Centred Framework for Trauma Intervention

Abstract

Experiencing work-related trauma can negatively impact coping abilities and daily life participation. Occupational therapists (OTs) often provide health services to workers who have experienced trauma, including military members, veterans, and public safety personnel. The Occupational Therapy Trauma Intervention Framework (OTTIF) is a novel clinical reasoning framework that matches a client’s level of readiness to engage with a spectrum of evidence-based OT approaches. Using surveys at two time points, evaluation of therapist experiences of using the OTTIF elicited positive feedback that suggests the OTTIF provides a useful occupation-centred framework for evidence-informed occupational therapy practice with clients who have experienced trauma.     

How Civil Society Organisations Changed the Regulation of Clinical Trials in India

ABSTRACT

In 2005 India changed its pharmaceutical and innovation policy that facilitated a dramatic increase in international clinical trials involving study sites in India. This policy shift was surrounded by controversies; civil society organisations (CSOs) criticised the Indian government for promoting the commercialisation of pharmaceutical research and development. Health social movements in India fought for social justice through collective action, and engaged in normative reasoning of the benefits, burdens and equality of research. They lobbied to protect trial participants from structural violence that occurred especially in the first 5–6 years of the new policy. CSOs played a major role in the introduction of new regulations in 2013, which accelerated a decline in the number of global trials carried out in India. This activism applied interpretations of global social justice as key ideas in mobilisation, eventually helping to institutionalise stricter ethical regulation on a national level. Like government and industry, activists believed in randomised controlled trials and comparison as key methods for scientific knowledge production. However, they had significant concerns about the global hierarchies of commercial pharmaceutical research, and their impact on the rights of participants and on benefits for India overall. Pointing to ethical malpractices and lobbying for stricter ethical regulations, they aimed to ensure justice for research participants, and developed effective strategies to increase controls over the business side of clinical research.     

The temporally-integrated causality landscape: A theoretical framework for consciousness and meaning

Theoretical approaches to understanding consciousness have begun to converge upon areas of general agreement, yet substantive differences remain. Here, I introduce a new theoretical framework for the emergence of consciousness from the functional integration of the thalamocortical system: the Temporally-Integrated Causality Landscape (TICL). TICL presents a novel perspective which addresses important phenomenological characteristics of consciousness that other frameworks, such as IIT, do not. First, the TICL is based upon the observation that conscious experiences are temporally continuous, not discrete. Secondly, the TICL establishes a thalamocortical basis for the point-of-view. According to TICL, consciousness is composed of contents that arise from neuronal subsystems that have meaning from the point-of-view of the larger, integrated system in which they are nested. Meaningful contents emerge from the subsystems because they exhibit a level of temporally-integrated causality (TIC) that is distinguishable from that of the larger system.