胎儿产前超声诊断中的人文关怀

随着医学的进步,医学模式的转变,越来越提倡医学对人们心理和社会因素的关怀。同时随着产前诊断技术和超声诊断技术的迅速发展和日臻完善,以及社会、经济的发展和变革,也越来越重视对孕妇及家属的人文关怀。胎儿产前超声诊断中的人文关怀不仅是对人的关怀,也是对技术、对心理健康、对生命的关怀。     

老年人恶性肿瘤诊疗中的决策

恶性肿瘤已成为严重威胁老年人健康的疾病,而且其发生率还呈逐渐上升的趋势。如何处理好老年医学和肿瘤学的交叉问题,对老年人恶性肿瘤患者选择适当的诊疗方法,对减轻老年患者的痛苦,延长老年患者的生存时间具有重要意义。     

医师知识结构和思维方式与肺血栓栓塞症诊断

肺血栓栓塞症是常见的临床病症,因其临床表现多样,易发生误诊漏诊而导致较高的病死率。但“凡事预则立,不预则废”,充分掌握肺血栓栓塞症的知识、以正确的思维方式引导临床诊疗可以有效减少和避免误诊漏诊。     

解读2009年GINA——5岁及5岁以下儿童哮喘诊断与管理

2009年5月,全球哮喘防治创议组织（GINA）发布了“Global Strategy for the Diagnosis and Management of Asthma in Children 5 Years and Younger（5岁及5岁以下儿童哮喘诊断和管理的全球策略”。这是由GINA执行委员会所组织的儿科专家组,根据当前所能得到的循证医学证据为基础,并且考虑到5岁及5岁以下儿童哮喘管理所面临的特殊挑战（包括诊断困难、药物和药物输出装置的有效性和安全性、缺乏在该年龄段新疗法的数据等）,专门针对这个年龄组的儿童,所提出的哮喘诊断和管理方面的报告。     

腰腿痛患者现病史的客观采集及其评价

腰腿痛患者的现病史采集比较困难,临床上经常引发混乱,甚至会被忽略.作者根据临床经验总结了一套相时系统和客观的分析思路.借此启发和提示临床医生临诊分析的主观能动性.作者还通过对现病史采集在医学发展史上的地位变化的回顾,提出了现代临床医学对患者症状特征进行归纳分析的重要性.     

人工智能辅助的自闭症早期患者的筛查与诊断

自闭症谱系障碍(AutisticSpectrumDisorders,ASD)的症状早在婴幼儿期就会显现,越早发现,越早干预,治疗效果越好。传统自闭症早期筛查与诊断在评估方法、流程上存在局限,无法满足大规模筛查和诊断需求。随着人工智能技术的快速发展,使用智能化方法进行自闭症早期大规模无感筛查与诊断逐渐成为可能。近10年间,国内外对自闭症智能化识别方法的探索在经典任务行为、面部表情和情绪、眼动、脑影像、运动控制和运动模式、多模态6个领域积累了丰富的研究成果。未来研究应围绕构建国内自闭症早期智能医学筛查与诊断体系,开发针对婴幼儿患者的筛查工具,构建融合多模态数据的自闭症婴幼儿智能化识别模型,建立结合脑影像技术的自闭症精细化诊断方法等方面来开展。     

Acquisition of lever-press responding in rats with delayed reinforcement: A comparison of three procedures

The present study examined the acquisition of lever pressing in rats under three procedures in which food delivery was delayed by 4, 8, and 16 seconds relative to the response. Under the nonresetting delay procedure, food followed the response selected for reinforcement after a specified interval elapsed; responses during this interval had no programmed effect. Under the resetting procedure, the response selected for reinforcement initiated an interval to food delivery that was reset by each subsequent response. Under the stacked delay procedure, every response programmed delivery of food t seconds after its occurrence. Two control groups were studied, one that received food immediately after each lever press and another that never received food. With the exception of the group that did not receive food, responding was established with every procedure at every delay value without autoshaping or shaping. Although responding was established under the resetting delay procedure, response rates were generally not as high as under the other two procedures. These findings support the results of other recent investigations in demonstrating that a response not previously reinforced can be brought to strength by delayed reinforcement in the absence of explicit training.     

Attitudes toward maternal serum screening in Chinese women with positive results

Maternal serum screening for fetal Down syndrome has been integrated into routine antenatal care in most clinics in Taiwan. We examined the attitudes toward serum screening and the possible implications in women with positive results. From January to July 1995, 276 women were referred to the Genetic Counseling Clinic, Mackay Memorial Hospital for amniocentesis because of positive screening results, and 214 participated in this study. All women opted for amniocentesis after genetic counseling. Over 40% stated that they made decisions independently after being informed of the serum screening. Need for certainty was the most frequently mentioned reason. Two-thirds believed that serum screening could provide a diagnosis. Almost all women would apply for maternal serum screening for future pregnancies. This study demonstrated that Chinese women need more counseling and autonomy regarding maternal serum screening.     

Effects of D-amphetamine on response acquisition with immediate and delayed reinforcement.

The present study examined in 8-hour sessions the effects of d-amphetamine (1.0, 5.6, and 10 mg/kg) on the acquisition of lever-press responding in rats that were exposed to procedures in which water delivery was delayed by 0, 8, or 16 seconds relative to the response that produced it. Both nonresetting- and resetting-delay conditions were studied. Although neither shaping nor autoshaping occurred, substantial levels of operative-lever responding developed under all conditions in which responses produced water. The lowest dose (1.0 mg/kg) of d-amphetamine either had no effect on or increased operative-lever pressing, whereas higher doses typically produced an initial reduction in lever pressing. Nonetheless, overall rates of operative-lever pressing at these doses were as high as, or higher than, those observed with vehicle. Thus, response acquisition was observed under all reinforcement procedures at all drug doses. In the absence of the drug, most responding occurred on the operative lever when reinforcement was immediate. Such differential responding also developed under both nonresetting- and resetting-delay procedures when the delay was 8 seconds, but not when it was 16 seconds. d-Amphetamine did not affect the development of differential responding under any procedure. Thus, consistent with d-amphetamine's effects under repeated acquisition procedures, the drug had no detrimental effect on learning until doses that produced general behavioral disruption were administered.     

Choice As A Function Of Reinforcement Ratios In Delayed Matching-to-sample

Pigeons were studied in two experiments using a delayed matching-to-sample task. In Experiment 1, 4 subjects were exposed to a task in which the proportion of reinforcement associated with matching and nonmatching, and the overall proportion of reinforcement associated with selecting each choice, regardless of the sample stimulus, were varied. Choice was sensitive to both proportions. A least squares regression analysis showed that Wixted's (1989) proportions of reinforcement model closely fit the data from Experiment 1; however, the model failed to make accurate qualitative predictions for some test conditions. In Experiment 2, 4 subjects were exposed to a delayed matching-to-sample task in which the retention intervals and the reduction in delay to reinforcement signaled by the onset of the sample stimulus were independently varied. When the retention interval was short and when the delay-reduction value of the sample stimulus was high, the sample exerted greater control over choice; the control by the overall proportion of reinforcements for selecting each choice stimulus was correspondingly low. Conversely, when the retention interval was long and the delay-reduction value of the sample stimulus was low, the sample exerted relatively less control over choice; control by the overall proportion of reinforcements obtained for selecting each choice stimulus was correspondingly high. A signal detection analysis found that sensitivity to reinforcement varied directly with retention interval. Data were also consistent with misallocation models. No evidence was found to suggest that pigeons ignore the rate at which selecting individual choice stimuli is reinforced, as has been reported in studies with human subjects.