浅谈恙虫病的几点认识

恙虫病是自然疫源性急性传染病。通过恙虫病医疗实践，谈几点个人认识：恙虫病流行与该疫源地区鼠类活动有关；恙虫病疫源地会因气候变化而变更；重视恙虫病准确而及时诊断，尽量减少病人疾苦；恙虫病立克次体对人单核-吞噬细胞系统有特别的亲嗜性与专性细胞内寄生，是其临床病理基础；用氯霉素联合双黄连治疗恙虫病可获满意效果。     

An empirical couple typology based on differentiation

Both spouses of 100 married, heterosexual couples completed the Personal Authority in the Family System Questionnaire (PAFS-Q). A cluster analysis of the couples' scores on the four intimacy and fusion scales of the PAFS-Q produced four clusters that were meaningfully distinct in the patterns of differentiation of the wives and husbands. Couples comprising these clusters are described in terms of intergenerational theories of family interaction.This paper is based on the master's thesis of the first author submitted to the Graduate School of Texas Woman's University. A presentation based on this work was given at the 1988 annual convention of the Southwestern Psychological Association, Tulsa, Oklahoma. The authors thank Glenda Peters and Joe Natale for their contributions to the preparation of this paper. A more extensive report of the methodology and results of this study can be obtained from the second author.     

Resilience in siblings of children with sickle cell disease

This pilot study was conducted to identify factors responsible for promoting resilience in siblings of children with sickle cell disease. Twenty siblings (10–17 years of age) of children (5–13 years) with sickle cell disease were selected from the Pediatric Clinic of Howard University Center for Sickle Cell Disease. The siblings responded to questionnaires, and the data obtained was analyzed by chi-square for association. The results indicated that age, birth order, and gender had no effect on resilience in the siblings. However, family size, number of parents in the home, sibling's knowledge of the illness, degree of morbidity of the illness, socioeconomic status of the family, and parents' attitudes and childrearing practices were all found to affect resilience. These findings provide additional insight into the psychosocial aspects of, and genetic counseling for sickle cell disease, as well as for other chronic genetic disorders.     

The anthropological tradition in the philosophy of medicine

The tradition of anthropological medicine in philosophy of medicine is analyzed in relation to the earlier interest in epistemological issues in medicine around the turn of the century as well as to the current interest in medical ethics. It is argued that there is a continuity between epistemological, anthropological and ethical approaches in philosophy of medicine. Three basic ideas of anthropologically-oriented medicine are discussed: the rejection of Cartesian dualism, the notion of medicine as science of the human person, and the necessity of a comprehensive understanding of disease. Next, it is discussed why the anthropological movement has been superseded by the increasing interest in medical ethics. It is concluded that the present-day moral issues cannot be interpreted and resolved without clarification of the underlying anthropological images.     

Developing insight through supervision: relating, then defining

By the use of tape recordings, I attempt to understand the main ways in which a supervisor helps the supervisees to gain insights into their work with their patients. Through this research I became aware that insights come into being by way of a process involving unconscious identity and differentiation. I have use supervisory examples to illustrate the ways in which the supervisor interacts with the supervisee.     

Optimal temporal differentiation

In order to illuminate a light signaling a correct response, adult humans had to space their button presses according to a range of time requirements. In some conditions, the spacing needed only to exceed a minimum duration; in others, it had to fall between lower and upper bounds. Mean interresponse times always exceeded the lower limit, and decreased the more stringent were the upper bounds. Variability of interresponse times increased with larger lower bounds, but was unaffected by the size of the upper bound. Feedback about the direction of errors in conditions involving both upper and lower bounds did not affect the means, but it did reduce variability. Predictions were derived from optimality theory, based on the assumption that the critical factor was minimization of the time between correct responses. Without upper bounds, the theory overestimated the mean interresponse times by about 10%; with upper bounds, the theoretical predictions corresponded closely to the actual data. The results did not appear to reflect a scalar timing process. Optimality theory, in contrast to Weber's law, correctly predicted the variety of curves relating sensitivity to duration requirements.     

Discrimination and differentiation of response number in stimulus directed pecking of pigeons.

In Experiment 1, autoshaping trials terminated with food only if pigeons emitted more than a target number of responses during a trial in one condition and fewer than a target number in another. The median number of responses per trial shifted in accordance wtih the requirements. The responding of yoked-control birds that received response-independent reinforcers did not vary with the response requirements. In Experiment 2, the number of responses in autoshaping trial became the discriminative stimulus for reinforcement in the second component of a chained schedule. In one condition, responding was reinforced only if the number of responses in the first component was above a target value; in the other condition, responding was reinforced only if the number was below the target value. The distribution of the first-component response numbers did not shift systematically between discrimination conditions, but response rates in the second component indicated that the number of responses in the autoshaping trial was a discriminable property behavior.     

AIDS and ‘dirt’: Reflections on the ethics of ritual cleanliness

AIDS and the responses and attitudes it evokes surpass the analytic abilities of standard bioethics. These responses and attitudes are explored in terms of literary and anthropological categories, such as dirt, disorder, pollution and ritual cleanliness. Implications for medical education are suggested.     

Pure timing in temporal differentiation

Temporal control appears to depend on whether the critical durations are those of stimuli or those of responses. Stimulus timing (temporal discrimination) supports Weber's law, whereas response timing (temporal differentiation) indicates decreasing relative sensitivity with longer time intervals. The two types of procedure also yield different conclusions in scaling experiments designed to study the functional midpoint of two or more durations (temporal bisection procedures). In addition, the fractional-exponent power relation between emitted and required duration usually found with animals in differentiation experiments conflicts with deductions from formal analyses. The experiment reported here derived from considering differentiation arrangements as schedules of reinforcement. When analyzed from this perspective, the procedures are tandem schedules involving a required pause followed by a response, and it is the pause alone that involves temporal control. A choice procedure separated timing from responding, and enabled observations of pause timing in isolation. Pure temporal control in differentiation consisted of linear overestimation of the standard duration, and Weber's law described sensitivity. These results indicate that the two problems, the fractional-exponent power relations and the apparently different nature of sensitivity in differentiation and discrimination, disappear when temporal control is observed alone in differentiation.     

Medical Manichaeism

Medical discourse in the contemporary United States is rife with military metaphors. These metaphors have come under vigorous criticism over the last few decades but to no avail; the militaristic tendency has proven tenacious. This essay suggests that its tenacity stems, at least in part, from a dualistic understanding of medicine unaddressed by prior criticisms. For an alternative, this essay turns to Augustine of Hippo, balancing close readings of works that deal explicitly with medical themes—The Catholic Way of Life and the Manichean Way of Life (De moribus) and The Nature of the Good (De natura boni)—with a constructive approach. By adapting Augustine's privative account of evil, we can understand disease as a condition of loss and treatment as a task of restoration. This reconfiguration shifts the focus of our interpretive discourses from malicious invaders to a fuller affirmation of the lived experiences of those who are ill.