借鉴循证医学方法促进SARS治疗决策科学化

面对突如其来的严重急性呼吸综合征(SARS),其预防和治疗方案层出不穷.究竟哪一种预防或治疗方法对SARS最有效?怎样面对现有的困难?如何借鉴循证医学的理念及方法,促进SARS治疗决策科学化至关重要.     

Collective decision making reduces metacognitive control and increases error rates,particularly for overconfident individuals

This research aimed to investigate the changes in judgment accuracy, confidence, control thresholds, and decision outcomes when people act in two-person groups (dyads) compared with acting individually. First, we used interacting dyads to determine the metacognitive and behavioral outcomes of collective decision making and compared them with those of individuals. Second, we examined whether these changes were related to the trait-confidence and bias of individuals working together. Using a within-person design, undergraduate psychology students (N = 116) completed a General-knowledge Test individually, then together as a dyad. Each question was accompanied by a confidence rating and a decision to bet $10 on the answer. Dyads had significantly higher confidence and lower control thresholds than individuals. They were also significantly more decisive (made more bets) and reckless (lost a higher rate of bets) than when working alone. Thus, we observed a higher rate of decision errors for groups than individuals. The results also demonstrated the important role of individual differences: Overconfident individuals became even more confident, decisive, and reckless when working together compared with less confident or underconfident individuals working together. These findings have important theoretical and applied implications for collective decision making; metacognitive bias and potentially control thresholds may be targeted to alleviate the larger error rates and guide the formation of more effective groups.     

A Qualitative Exploration of Counselor Educators' Collaborative Authorship Perceptions and Practices

Limited research exists that examines the ethics of counselor educators' collaborative authorship practices. The study purpose was to explore the collaborative authorship decision-making perceptions and practices of counselor educators (N = 11). We identified six themes: (a) human process and communication, (b) context and nature of relationships, (c) learning experiences about authorship, (d) academic and career stage expectations, (e) collaborative authorship practices, and (f) philosophy of authorship. Implications and recommendations for research are discussed.     

Abstract morphemes and lexical representation: the CV-Skeleton in Arabic

Overlaps in form and meaning between morphologically related words have led to ambiguities in interpreting priming effects in studies of lexical organization. In Semitic languages like Arabic, however, linguistic analysis proposes that one of the three component morphemes of a surface word is the CV-Skeleton, an abstract prosodic unit coding the phonological shape of the surface word and its primary syntactic function, which has no surface phonetic content (McCarthy, J. J. (1981). A prosodic theory of non-concatenative morphology, Linguistic Inquiry, 12 373-418). The other two morphemes are proposed to be the vocalic melody, which conveys additional syntactic information, and the root, which defines meaning. In three experiments using masked, cross-modal, and auditory-auditory priming we examined the role of the vocalic melody and the CV-Skeleton as potential morphemic units in the processing and representation of Arabic words. Prime/target pairs sharing the vocalic melody but not the CV-Skeleton consistently failed to prime. In contrast, word pairs sharing only the CV-Skeleton primed reliably throughout, with the amount of priming being as large as that observed between word pattern pairs sharing both vocalic melody and CV-Skeleton. Priming between morphologically related words can be observed when there is no overlap either in meaning or in surface phonetic form.     

Neuropsychological Assessment of Mental Capacity

The assessment of mental capacity to assist legal determinations of competency is potentially a growth area for neuropsychology, although to date neuropsychologists have published relatively little in this area. In this paper a systematic review of methods used to assess capacity is presented, including coverage of specialized tests and interviews used for this purpose. A neuropsychological model for conducting capacity assessments is proposed. This model involves comprehensive assessment of a wide range of cognitive abilities as well as assessment of specific skills and knowledge related to the type of capacity being assessed. The purpose of proposing this model is to stimulate further discussion and debate about the contribution neuropsychologists might make in this area.     

Autonomy gone awry: a cross-cultural study of parents’ experiences in neonatal intensive care units

This paper examines parents experiences of medical decision-making and coping with having a critically ill baby in the Neonatal Intensive Care Unit (NICU) from a cross-cultural perspective (France vs. U.S.A.). Though parents experiences in the NICU were very similar despite cultural and institutional differences, each system addresses their needs in a different way. Interviews with parents show that French parents expressed overall higher satisfaction with the care of their babies and were better able to cope with the loss of their child than American parents. Central to the French parents perception of autonomy and their sense of satisfaction were the strong doctor–patient relationship, the emphasis on medical certainty in prognosis versus uncertainty in the American context, and the sentimental work" provided by the team. The American setting, characterized by respect for parental autonomy, did not necessarily translate into full parental involvement in decision-making, and it limited the rapport between doctors and parents to the extent of parental isolation. This empirical comparative approach fosters a much-needed critique of philosophical principles by underscoring, from the parents perspective, the lack of emotional work" involved in the practice of autonomy in the American unit compared to the paternalistic European context. Beyond theoretical and ethical arguments, we must reconsider the practice of autonomy in particularly stressful situations by providing more specific means to cope, translating the impersonal language of rights" and decision-making into trusting, caring relationships, and sharing the responsibility for making tragic choices.     

Detailed analysis of the male copulatory motor pattern in mammals: hormonal bases

Data obtained, using a polygraphic technique, on the characteristics of the motor and genital copulatory responses of male rabbits, rats, mice, hamsters, and guinea pigs are reviewed. This methodology provided detailed information, not accessible to other analyses, on the frequency and dynamic organization of copulatory pelvic thrusting trains of the species studied. This comparative analysis showed that: (1) The male rat may display two types of ejaculatory responses, differing in the dynamic organization of the pelvic thrusting train, and in the duration of the intravaginal thrusting period preceding ejaculation. (2) In the guinea pigs and small rodents, but not in rabbits, pelvic thrusting at ejaculatory responses persists during intromission, and a period of fast intravaginal thrusting is associated with ejaculation. (3) The motor copulatory pattern of the rabbit, but not of the rat, hamster, or guinea pig, is affected by castration and hormone treatment, suggesting that, in rabbits, androgen acts both on motivation and on the spinal neural systems related to copulation.     

Disability or end-of-life? Competing narratives in bioethics

Bioethics, and indeed much ethicalwriting generally, makes its point throughnarratives. The religious parable no less thanthe medical teaching case uses a simple storyto describe appropriate action or theapplication of a critical principle. Whilepowerful, the telling story has limits. In thispaper the authors describe a simple teachingcase on ``end-of-life' decision making that wasill received by its audience. The authors ill-receivedexample, involving the disconnection ofventilation in a patient with ALS (Lou Gherig'sDisease) was critiqued by audience members withlong-term experience as ventilation users. Inthis case, the supposedly simple narrative ofthe presenters conflicted with the lifehistories of the audience. The lessons of thisstory, and the conflict that resulted, speakcritically to the limits of simple teachingcases as well as the strengths of narrativeanalysis as a tool for the exploration ofbioethical case histories. This revised version was published online in June 2006 with corrections to the Cover Date.     

Understanding Obsessive–Compulsive Disorder: Focus on Decision Making

Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive abilities that are strictly linked to the functioning of the frontal lobe and its related fronto-subcortical structures, such as executive functioning deficits and insufficient cognitive-behavioral flexibility. This article focuses on decision making, an executive ability that plays a crucial role in many real-life situations, whereby individuals choose between pursuing strategies of action that involve only immediate reward and others based on long-term reward. Although the role of decision-making deficits in the evolution of OCD requires further research, the collected findings have significant implications for understanding the clinical and behavioral heterogeneity that characterizes individuals with OCD.