SARS事件后对卫生体制的反思

SARS事件突出暴露了我国经济和社会发展不协调的问题,由于缺乏科学发展观统领医疗卫生事业的发展,在体制改革中片面突出经济增长在社会发展中的作用、片面追求市场化的支配地位,是导致病象的内在逻辑。从构建“和谐社会”的战略出发,认为应避免社会公共事务管理的“泛市场化”倾向,指出“有管理的市场化”是其应然走向,呼吁在改革实践中重新回复人文精神。     

Food and water intake as functions of resource consumption costs in a closed economy.

In two experiments, rats living in a closed economy were offered continuous, concurrent access to four resources: food, water, a nest, and a running wheel. Costs of consuming food and water were imposed with bar-press requirements, and the price of either one or both resources was raised. As the consumption cost increased, less was consumed in each bout of resource use. Bout frequency increased, but not sufficiently to compensate for the fall in bout size, and total intake fell. Food and water tended to be complementary resources, in that as intake of one fell with its price, intake of the other also decreased. This interaction was accounted for by the defense of the ratio of body water to lean body mass. As amount consumed decreased, increases in feed efficiency (weight gain per unit of food ingested) and the use of stored calories compensated for the reduced energy intake. There was evidence of competition between feeding and drinking at the higher costs: When both commodities were expensive, the decline in the intake of each one was greater than when only one commodity was expensive. Although the time spent nesting, running, and in unmonitored activity was adjusted when feeding or drinking took more of the rat's day, there was no particular activity that was sacrificed.     

Closed-economy multiple-schedule performance: Effects of deprivation and session duration

Three pigeons responded for food reinforcement on multiple variable-interval schedules in which the total consumption of food was entirely determined by the subjects' interaction with the schedules (a closed economy). The finding of overmatching, where response allocation between components is more extreme than the distribution of reinforcers, was reconfirmed. Generalized-matching sensitivity decreased from overmatching to undermatching values typical of conventional multiple schedules when food deprivation was increased by decreasing session duration, but not when deprivation was increased by decreasing overall reinforcer rate. Sensitivity also increased from undermatching to overmatching as session duration increased from 100 min to 24 hr, while deprivation was held constant by decreasing overall reinforcer rate. These results can be understood in terms of increases in the value of extraneous reinforcers relative to food reinforcers as deprivation decreases or as the economy for extraneous reinforcers becomes more closed. However, no published quantitative expression of the effects of extraneous reinforcers is entirely consistent with the results.     

Empowerment meets narrative: Listening to stories and creating settings

Comments on and summarizes some of the themes of a special issue on empowerment. Extends empowerment theory with the suggestion that both research and practice would benefit from a narrative approach that links process to practice and attends to the voices of the people of interest. Narrative theory and method tends to open the field to a more inclusive attitude as to what counts as data and to cross-disciplinary insights as well as citizen collaboration. Communal narratives are defined at various levels of analysis, including the community, the organizational, and the cultural. A definition of empowerment that includes a concern with resources calls attention to the fact that communal narratives and personal stories are resources. Implications for personal and social change are suggested.     

IMPROVING DIETARY PRACTICES OF ELDERLY INDIVIDUALS: THE POWER OF PROMPTING,FEEDBACK, AND SOCIAL REINFORCEMENT

Three intervention packages consisting of (a) enhanced prompts, feedback, and social reinforcement; (b) a lottery; and (c) serving as a confederate were added and removed in sequence as adjacent conditions in an extended withdrawal design to assess their effects on the dietary choices of elderly persons. Participants were 3 elderly residents of an independent living facility who were identified as making consistently poor dietary choices and who had medical conditions that necessitated changes in their eating habits. All 3 participants demonstrated a marked increase in healthy choices of food items in response to the package of enhanced prompts, feedback, and social reinforcement. No additional increase occurred with the introduction of the lottery and serving as a confederate. Food-choice data indicated that most of these improvements could be attributed to healthier entree and dessert choices. Group data for all residents suggested small improvements in dietary practices during the three intervention conditions, with the largest proportion of the group's healthy choices occurring when the lottery was added to enhanced prompts, feedback, and social reinforcement. Food-choice data indicated that most of these improvements could be attributed to healthier dessert choices alone.     

Response-reinforcer independence and the economic continuum: A preliminary analysis

Three pigeons were exposed to 1-hr and 4-hr sessions during which they earned food under a fixed-ratio 50 schedule of reinforcement while obtaining additional food according to either a variable-interval or a variable-time schedule. Postsession food was provided after the 1-hr sessions. The frequency of the variable-interval and variable-time food presentations was varied under the two session durations. The various combinations of within-session earned and unearned food, as well as the postsession food, defined conditions on the open-to-closed economy continuum. Key pecks tended to increase as the frequency of either variable-interval or variable-time food decreased. An economic-continuum analysis based on an independence quotient as a measure of response-reinforcer independence is presented to account for the effects.     

TO WAIT OR TO RESPOND?

Emitting a certain response and waiting for a specified time without making that response had the same consequence. In Experiment 1, food-deprived pigeons were as likely to wait as to respond only if waiting provided food at a much higher frequency than did pecking. In Experiment 2, the consequence for humans was a brief light flash and tone. People were not biased for responding over waiting. Instead, their choices suggested crude payoff maximization. In Experiment 3, pigeons again obtained food, but they were not food deprived and could eat freely at each opportunity. Their behavior was more like that of the humans of Experiment 2 than that of food-deprived pigeons given small quantities of food at each feeding opportunity. The three experiments together showed that biases for responding over waiting were neither inherent characteristics of species nor inevitable outcomes of particular schedules. Choice between active search and waiting depended on ecological–motivational factors even when species and schedules were held constant.     

Performance in continuously available multiple schedules

Three pigeons were given continuous access in their home cages to food reinforcement on two-component multiple variable-interval variable-interval schedules. The reinforcer rates in the two components were varied over seven experimental conditions, and a partial replication over five conditions was arranged one year later. When component reinforcer rates were unequal, ratios of component response rates were more extreme than ratios of obtained component reinforcer rates, a result which in a generalized-matching analysis is termed overmatching. This finding contrasts sharply with results obtained when multiple schedules are arranged in shorter sessions, in which performance is characterized by undermatching when subjects are deprived of food, and by matching, or equality between component response- and reinforcer-rate ratios, when deprivation is minimal. More molecular data obtained in two subsequent conditions suggested that this finding did not reflect local fluctuations or asymmetries in deprivation. Theories of multiple-schedule performance that predict that matching cannot be exceeded are disconfirmed by the present results.     

Collaboration and Guided Discovery

Collaboration and guided discovery, collectively described as collaborative empiricism, are two primary features of Aaron T. Beck’s Cognitive Therapy (CT) that remained central to his work throughout his long and productive career. This commentary highlights how collaboration and guided discovery were described during the early development of CT. In addition, conversations with Beck are cited that reveal how his own life may have influenced their inclusion and importance in his therapy.     

Forum: A New Culture of Learning

These brief essays by Mary Hess, Eugene Gallagher, and Katherine Turpin are solicited responses from three different contexts to the provocative book by Douglas Thomas and John Seely Brown, The New Culture of Learning (2011). Mary Hess writes from a seminary context, providing a critical summary of the authors' major concepts and their ramifications, positive and negative, for theological education and the church. Eugene Gallagher writes from a liberal arts setting, identifying characteristics of the face‐to‐face classroom that would go missing in a careless adoption of online learning environments. Finally, Katherine Turpin reports from the classroom, chronicling her experience in a course she redesigned for a graduate theological setting to employ some of the authors' pedagogical principles and strategies. Together, these responses offer critical appreciation and constructive critique of the work Thomas and Seely Brown have done – and point the conversation forward.