医疗质量模糊性特征研究

探讨医疗质量的特性,通过系统经验分析法,认为医疗质量具有模糊性特征,难以辨别优劣,导致卫生行政部门、医疗机构忽视提高医疗质量。行政部门应加强医疗技术管理,推行医院法人治理结构制度,做好信息公示。医疗机构也应加强服务过程管理,培养医护人员人文精神,落实规章制度,推行临床路径管理,减少医疗差错,加强医院感染管理,医护人员也应加强责任心,多方努力才有可能提高医疗质量、保障患者安全。     

医学教育中医师职业精神评估方法初探

医师职业精神是每个医师所必须达到并表现出来的一个基本胜任力,相应也是医学职业教育的重要内容。对医师职业精神的细化和评估是促进医师职业精神建设的基础,各种评估方法也是促进职业精神教育的基本工具。国外目前主要的医师职业精神评估方法为伦理知识和道德推理检测,定性、定量的观察评价。观察评估主体包括自评和不同来源的他评。结合医学教育的不同阶段选用合理的职业精神评估方法,可为国内医师职业精神的建设和教育提供参考和借鉴。     

Prospective and Concurrent Affective Dynamics in Self-Injurious Thoughts and Behaviors: An Examination in Young Adult Women

Affective dynamics, assessed using ecological momentary assessment (EMA), provide a nuanced understanding of within-person fluctuations of negative affect (NA) and positive affect (PA) in daily life. NA and PA dynamics have been associated with psychopathology and response to psychological treatments. NA and PA dynamics have been rarely studied concurrently in association with self-injurious thoughts and behaviors (SITB), transdiagnostic difficulties encountered regularly in clinical and community settings. Here we present EMA data from a large, diverse sample of young adult women with high rates of SITB to examine NA and PA dynamics (mean intensity, variability, and inertia). Specifically, we considered the prospective associations between past-year suicidal thoughts and past-year nonsuicidal self-injury and affective dynamics, as well as the concurrent associations between affective dynamics, EMA-reported suicidal thoughts, and EMA-reported urges for nonsuicidal self-injury. Results demonstrate that elevated mean NA and NA variability are robustly associated with all types of SITB assessed prospectively or concurrently. Interestingly, these associations were weakest for past-year nonsuicidal self-injurious behaviors, relative to past-year and concurrent suicidal or nonsuicidal self-injurious thoughts. Past-year suicidal thoughts further predicted increased NA inertia. Decreased PA inertia was associated with past-year nonsuicidal self-injury behavior, as well as concurrent EMA suicidal thoughts. We found no associations (prospective or concurrent) between SITB and mean PA intensity or PA variability. These results highlight the importance of understanding affective processes to develop real-world interventions to prevent nonsuicidal self-injury and suicidal behavior in daily life.     

Stopping rules for multi-category computerized classification testing

Computerized classification testing (CCT) aims to classify persons into one of two or more possible categories to make decisions such as mastery/non-mastery or meet most/meet all/exceed. A defining feature of CCT is its stopping criterion: the test terminates when there is enough confidence to make a decision. There is abundant research on CCT with a single cut-off, and two common stopping criteria are the sequential probability ratio test (SPRT) statistic and the generalized likelihood ratio statistic (GLR). However, there is a relative scarcity of research extending the SPRT to the multi-hypothesis case for when there is more than one cut-off. In this paper, we propose a new multi-category GLR (mGLR) statistic as well as a stochastically curtailed version of the CCT with three or more categories. A simulation study was conducted to show that the mGLR statistic outperformed the existing stopping rules by generating shorter average test length without sacrificing classification accuracy. Results also revealed that the stochastically curtailed mGLR successfully increased test efficiency in certain testing conditions.     

Quitters would not prosper: Examining the relationship between online assessment performance and assessment attrition behavior

Hiring managers are often hesitant to implement online assessments over concerns that higher‐quality candidates are more likely to quit lengthy assessment batteries than lower‐quality candidates. In this paper, we present the results of two studies that collectively challenge this assumption. In Study 1, data from 327,517 job‐seekers spanning eight hiring contexts showed that assessment performance was negatively associated with subsequent assessment attrition behavior. In Study 2, we replicated this pattern of effects in two additional samples comprising 1,844,604 applicants for hourly associate positions, and 18,937 applicants for nursing positions. Collectively, these findings suggest that some degree of attrition may ultimately benefit, rather than harm, organizations using prehire assessments.     

Support for distracted driving laws: An analysis of adolescent drivers from the Traffic Safety Culture Index from 2011 to 2017

IntroductionAdolescent drivers are often the focus of traffic safety legislation as they are at increased risk for crash-related injury and death. However, the degree to which adolescents support distracted driving laws and factors contributing to their support are relatively unknown. Using a large, nationally weighted sample of adolescent drivers in the United States, we assessed if perceived threat from other road users’ engagement in distracted driving, personal engagement in distracted driving behaviors, and the presence of state distracted driving laws was associated with support for distracted driving laws.MethodsThe sample included 3565 adolescents (aged 16–18) who participated in the Traffic Safety Culture Index survey from 2011 to 2017. A modified Poisson regression model with robust errors was fit to the weighted data to examine support for distracted driving laws. Models included age, gender, year, state distracted driving laws, personal engagement in distracted driving behavior, and perceived threat from other road users’ engaging in distracted driving.ResultsApproximately 87% of adolescents supported a law against texting and emailing compared to 66% who supported a universal handheld cellphone law. Support for distracted driving legislation was associated with greater perceived threat of other road users engaging in distracted driving while accounting for personal engagement in distracted driving, state distracted driving laws, and developmental covariates.DiscussionGreater understanding of the factors behind legislative support is needed. Public health interventions focused on effectively translating the risks of cellphone use while driving and effective policy will further improve the traffic safety culture.     

情感计算技术如何推动犯罪风险评估工具的发展？

摘 要 随着近年来人工智能深度学习技术的发展,情感计算与人格计算技术日渐成熟,在许多实际应用场景中取得了良好的表现,当前人工智能情感计算技术应用于犯罪风险评估领域,能够有效解决目前主流的风险评估工具难以解决的个体内差异性的预测因子评估问题以及被测评参与者因社会赞许性而导致结果失真的问题。本文在详细阐述目前主流评估工具的局限性基础上,详细阐述了以情感计算技术为支撑的动态风险评估工具的设计思路、目前已有的技术方案以及设计细节的理论依据,在此基础上最后提出以人工智能技术为支撑的新型评估工具的未来发展方向。     

多级评分认知诊断模型述评

认知诊断评估旨在探讨个体内部的知识掌握结构,并提供关于学生优缺点的详细诊断信息,以促进个体的全面发展。当前研究者已开发了大量0-1评分的认知诊断模型,但对于多级评分认知诊断模型的研究还比较少。本文对已有的多级评分认知诊断模型进行了归纳,介绍了模型的假设,计量特征以及适用范围,为实际应用者和研究者在多级评分认知诊断模型的比较和选用上提供借鉴和参考。最后,对未来关于多级评分诊断模型的研究方向进行了展望。     

Improved Test–retest Reliability Criteria as Applied to Probability Assessments

Test–retest reliability is a common indicator of response consistency. It is argued that using regression coefficients for detecting systematic response error is less appropriate than testing for shifts in the mean (median) and variance. This procedure is exemplified using probability response data. For this data, shifts in centrality were found to be about 2.5 times more likely than shifts in variability. The shifts in centrality did not favor any particular direction; however, variability tended to decrease over time in early sessions.