现代阳痿辨治思路创立与思辨

阳痿是临床常见、难治性病症,自古以来多从肾论治,尤其是壮阳一法几乎成为辨治阳痿的代名词.在万艾可面市后,中医药辨治阳痿的市场日见萎退,表面看是中医缺乏速效性治疗手段,实质上是在辨治阳痿的理论及临床方面存在客观的问题.本文拟从心肝在勃起中的指令性调节、气血在勃起中的实质性支撑,以及肾精、天癸在勃起中的本质性作用等角度,从勃起生理、病理、治疗等方面构建中医现代阳痿辨治的临床思路.     

Putting appraisal in context: Toward a relational model of appraisal and emotion

According to appraisal theory, emotions result from an individual's meaning analysis of the implications of his/her circumstances for personal well-being, and individual differences in emotion arise when individuals appraise similar situations differently. Relational models of appraisal attempt to describe the situational and dispositional antecedents of appraisals, and should allow one to predict such individual differences. In this article, we review three examples of our efforts toward developing relational appraisal models. In two, we start with a particular appraisal component, motivational relevance and problem-focused coping potential (Smith & Lazarus, 1990), respectively, and describe and test the relational model proposed for that component. In the third, as a precursor to developing a true relational model, we examine another appraisal component, emotion-focused coping potential, from a more dispositional perspective. We conclude by considering both the potential value of relational appraisal models, and future directions in the development of these models.     

Differentiation of Self and Attachment in Adulthood: Relational Correlates of Effortful Control

This study tested relations between differentiation of self, adult attachment, and effortful control in a sample of 225 adults. Results indicated that adult differentiation of self uniquely predicted greater effortful control, after accounting for variance due to attachment security. Greater ability to take I positions in relationships, along with lower emotional reactivity (ER) and attachment anxiety, were unique predictors of effortful control. Significant relationships emerged between dimensions of attachment and differentiation of self, with strongest associations observed between attachment avoidance and emotional cutoff (r = –.78), and attachment anxiety and ER (r = –.60).     

A dual process item response theory model for polytomous multidimensional forced-choice items

The use of multidimensional forced-choice (MFC) items to assess non-cognitive traits such as personality, interests and values in psychological tests has a long history, because MFC items show strengths in preventing response bias. Recently, there has been a surge of interest in developing item response theory (IRT) models for MFC items. However, nearly all of the existing IRT models have been developed for MFC items with binary scores. Real tests use MFC items with more than two categories; such items are more informative than their binary counterparts. This study developed a new IRT model for polytomous MFC items based on the cognitive model of choice, which describes the cognitive processes underlying humans' preferential choice behaviours. The new model is unique in its ability to account for the ipsative nature of polytomous MFC items, to assess individual psychological differentiation in interests, values and emotions, and to compare the differentiation levels of latent traits between individuals. Simulation studies were conducted to examine the parameter recovery of the new model with existing computer programs. The results showed that both statement parameters and person parameters were well recovered when the sample size was sufficient. The more complete the linking of the statements was, the more accurate the parameter estimation was. This paper provides an empirical example of a career interest test using four-category MFC items. Although some aspects of the model (e.g., the nature of the person parameters) require additional validation, our approach appears promising.     

Differential ordering of objects and attributes

By reference to nominated attributes, a genus, being a population of objects of one specified kind, may be partitioned into species, being subpopulations of different kinds. A prototype is an object representative of its species within the genus. Using this framework, the paper describes how objects can be relatively differentiated with respect to attributes, and how attributes can be relatively differentiating with respect to objects. Methods and rationale for such differential ordering of objects and attributes are presented by example, formal development, and application.For a genus comprisingn species of object there is a subsetP ofn distinct prototypes. With respect tom nominated attributes, each object in has anm-element characterization. Together these determine ann ×m objects × attributes matrix, the rows of which are the characterizations of the prototypical objects. Over then species in , an associated relative frequency vector gives the distribution of objects (and of their characterizations). The matrix and vector associate the objects in with points in a metric space (P, ); and it is with respect to various sums of distances in this attribute space that one can differentially order objects and attributes.The definition of the distance function is generalized across kinds of difference, types of characterization, scale-types of measurement, Minkowskiindex 1, and any form of distribution of objects over species. Explanatory and taxonomic applications in psychology and other fields are discussed, with focus on classification, identification, recognition, and search. The Braille code and the identification of its characters provide illustration.An anticipation and some preliminary indications were given in Sutcliffe and Bristow (1966), Sutcliffe (1972, 1973), and Nowakowska (1975). Subsequently the ideas have been extended and their applications realized in a computer program which, in its development, has so far gone through many minor and three major revisions to its present form in Sutcliffe (1985). The foregoing provided the foundation for the empirical applications and for the presentation in this paper of the ideas in their general form. the research has been supported by funds from the University of Sydney Research Grant and from the Australian Research Grants Scheme. In the working out and exposition of the ideas I have very much benefited from constructive critical comment given by C. R. Latimer, J. B. Michell, G. Oliphant, and E. Seneta, and from the professional programming skills of Michael Wilson and David Shillito. I am grateful for the invitation and the facilities for writing extended during 1983 by Georges Noizet, Laboratoire de Psychologie Expérimentale, Université René Descartes, Paris V, and by Samuel Messick, Vice President for Research, E.T.S. Princeton, N.J. Finally, I acknowledge the improvements in presentation of this paper which have arisen from the editor's and reviewers' comments.     

Response-reinforcer contingency and spatially defined operants: testing an invariance property of phi

A chamber containing 72 response keys defining the circumference of a circle 1 m in diameter was used to examine the relation between differentiation of response location and a measure of response-reinforcer contingency known as the phi coefficient. A different target key was specified in each successive phase, and response location was differentiated with respect to the target. Criterional and noncriterional responses (i.e., responses "near" and "far" from the target) were defined using targeted percentile schedules to control the overall probability of each response class. By manipulating criterional (and, hence, noncriterional) response probability and the reinforcement probabilities conditional on each, a mathematical invariance property peculiar to phi in contingency analysis was examined. Specifically, diagonally interchanging cell frequencies in a 2 x 2 table relating criterional/noncriterional responses to reinforcement/nonreinforcement leaves phi unchanged. Hence, the degree of response differentiation predicted by phi remains unchanged under the four permutations implied by the various diagonal interchanges. This predicted invariance was examined under values of phi equal to .33, .58, and .82. Increasing phi generally increased the stereotypy of response location. Three of the permutations generated almost interchangeable performance at different phi values. The remaining permutation, however, generated functions relating response concentration to phi with slopes shallower than those obtained under the other permutations. This resulted from relatively higher levels of differentiation, compared to the other permutations, at low phi values. These data strongly suggest boundary conditions on the ability of phi to reflect completely the local processes that are indexed by phi at a molar level.     

Liking, Arousal Potential, and the Emotions Expressed by Music

Previous research indicates that the specific emotions expressed by stimuli may be closely associated with their pleasing and arousing qualities, and this parallels psychomusicological research on the relationship between these two stimulus qualities. In light of this, the present research contends that the emotions expressed by musical stimuli are associated with their pleasing and arousing qualities. Sixty subjects rated 32 musical excerpts on 11-point scales representing the expression of eight specific emotions. Statistical analyses showed that these emotion ratings were predictable on the basis of 60 additional subjects' ratings of each excerpt in terms of 'liking' and 'arousal potential'. This indicates that ratings of liking and arousal potential are essentially similar to ratings of the specific emotions expressed by musical stimuli. These results are discussed in terms of the relationship between liking and arousal potential, and the implications that this may have for research on affective processes.     

Shaping the location of a pigeon's peck: effect of rate and size of shaping steps.

For several pigeons, pecking at particular locations within a ten-inch-wide response area was reinforced by grain presentations. The reinforced locations changed systematically to "shape" response location back and forth across the area. The rate and size of these shifts in reinforced locations were varied in both between-subject and within-subject comparisons to evaluate the influence of these variables on the shaping process. Larger step sizes produced larger shifts in location for all sizes inspected, with all sizes from .5 to 3.0 inches effective in shaping behavior. More rapid steps were approximately as effective as slower steps for all rates of shift inspected from 25 reinforcers to 400 reinforcers per step. These data suggest that shaping peck location proceeds most efficiently with rapid, relatively large shifts in criterion performance.     

Time limits for completing fixed ratios. IV. Components of the ratio

Pigeons received food after completing a fixed ratio if the temporal properties of responding exceeded minimum duration requirements. In one set of conditions, a minimum time had to elapse before the first response of the ratio (the initial pause). In another set, the minimum duration was the time between the first and last response of the ratio. Obtained times increased as a power function of required times in both conditions. The power function resembled that occurring in experiments involving temporal differentiation of individual responses, interresponse times, latencies, and entire fixed-ratio sequences. Moreover, in all of these experiments individual performances could be described as a function of the base duration (the duration occurring in the absence of temporal requirements) and the specific time requirement. Control conditions indicated that the effects resulted from temporal requirements and not from reinforcer intermittency.     

从中西医学的竞争和渗透谈现代中医临床思维的变革

现代中医的临床思维正在发生着变革,一个以辨病为纲,辨证为目,辨病论治为经,辨证论治为纬的临床思维新模式,已经呼之欲出。这正是２１世纪中医学发展的必由之路,学术界必从唯物辩证法的角度来审视这场变革,并因其势而利导之。