医学教育环境测量评价的实践与探索

重点讨论了医学教育环境测量和评价在医学教育改革中的地位和作用,在借鉴国外先进经验的基础上,在教育环境评价和教师评价方面提出了重视学生感受,重视教育环境的动态评价,科学公正地评价教师,建立全面系统的分析方法,建立评价的分析反馈机制等看法.     

未成年患者的同意能力研究

众所周知,医疗机构必须在取得成年患者的有效同意后才能实施医疗行为。而当患者是未成年人时,这种对医疗行为的同意是否有效呢?对此,国内外法学均未形成统一的定论。通过比较国外医事法学领域相对成熟的同意能力理论,初步建立我国未成年患者的同意能力理论体系,其中评估方法是关键。     

Examination of the MMPI-2 Restructured Clinical (RC) Scales in a Sample of Bariatric Surgery Candidates

The current study examined the MMPI-2 Restructured Clinical (RC) scales (Tellegen et al., MMPI-2 Restructured Clinical (RC) scales: Development, validation, and interpretation. Minneapolis: University of Minnesota Press, 2003) in a sample of 1,091 bariatric surgery candidates. The RC scales were developed to address concerns about limited discriminant validity of the Clinical scales. Internal consistency and external validity analyses were conducted to evaluate the RC scales in this setting. Results indicated that the RC scales are generally more internally consistent than the Clinical scales and display significantly better convergent and discriminant validity in predicting a variety of behavioral, psychological, and developmental variables relevant to preoperative bariatric psychological evaluations. Implications of the results and recommendations for future research with the RC scales in medical settings are discussed.     

Are investors really willing to agree to disagree? An experimental investigation of how disagreement and attention to disagreement affect trading behavior

Using a series of laboratory markets, this paper provides evidence that a willingness to engage in speculative trade is largely driven by a failure of traders to account for information about value implicit in other traders’ actions and that this behavior arises because traders construct myopic mental models that ignore the perspective of other traders. In a baseline set of markets, where traders are prompted to estimate fundamental value but are not overtly prompted to consider disagreement, I find that traders are generally insensitive to adverse selection and readily engage in suboptimal, speculative trade. Moreover, this effect does not decline across trials suggesting that market feedback alone is unlikely to correct traders’ behavior. In contrast, when traders are prompted to assess disagreement over asset values or when they trade in more transparent markets, they appear less willing to “agree to disagree.” These results provide insight into why investors depart from rational trading strategies and how investor psychology will influence trading behavior.     

Better safe than sorry: Precautionary reasoning and implied dominance in risky decisions

In four studies, student and nonstudent participants evaluated the possible outcomes of binary decisions involving health, safety, and environmental risks (e.g., whether to issue a dam‐failure evacuation order). Many participants indicated that false positives (e.g., evacuation, but no dam failure) were better than true negatives (e.g., no evacuation and no dam failure), thereby implying that the more protective action dominated the less protective action. A common rationale for this response pattern was the precautionary maxim “better safe than sorry.” Participants apparently evaluated outcomes partly on the basis of the decisions that might lead to them, in conflict with consequentialist decision models. Consistent with this explanation, the prevalence of implied dominance decreased substantially when the emphasis on decisions was reduced. These results demonstrate that an initial preference for a decision alternative can alter the evaluation of possible consequences of both the preferred alternative and a competing alternative, suggesting positive feedback loops that reinforce the initial preference. The rationality of considering the decision itself as an attribute of possible outcomes is discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

下腰痛影像诊断的综合效价分析

对61例下腰痛患者的影像学检查资料进行研究,分析各影像学检查方法的效价。结果显示所有患者均进行了3种以上的影像学检查,X线检查费用占总费用的11．67％,脊髓造影占24．67％,CT占14．33％,CTM占7．33％,MRI占42％;常规X线摄片对骨性结构具有较高的分辨率,为进一步影像学检查提供依据。因此,在下腰痛的诊断过程中,必须合理地选择影像学检查方法,以最合理的花费达到正确诊断,节约卫生资源。     

PARAMETRIC ANALYSIS OF PRESESSION EXPOSURE TO EDIBLE AND NONEDIBLE STIMULI

We assessed the effects of individually defined small, medium, and large periods of presession access to edible and nonedible reinforcers on response rates during sessions in which responding produced access to identical reinforcers. Any presession access to an edible reinforcer decreased response rates for 1 participant, and small and medium periods of presession access to nonedible reinforcers resulted in similar or increased response rates for 2 participants.     

TOKEN REINFORCEMENT: A REVIEW AND ANALYSIS

Token reinforcement procedures and concepts are reviewed and discussed in relation to general principles of behavior. The paper is divided into four main parts. Part I reviews and discusses previous research on token systems in relation to common behavioral functions—reinforcement, temporal organization, antecedent stimulus functions, and aversive control—emphasizing both the continuities with other contingencies and the distinctive features of token systems. Part II describes the role of token procedures in the symmetrical law of effect, the view that reinforcers (gains) and punishers (losses) can be measured in conceptually analogous terms. Part III considers the utility of token reinforcement procedures in cross‐species analysis of behavior more generally, showing how token procedures can be used to bridge the methodological gulf separating research with humans from that with other animals. Part IV discusses the relevance of token systems to the field of behavioral economics. Token systems have the potential to significantly advance research and theory in behavioral economics, permitting both a more refined analysis of the costs and benefits underlying standard economic models, and a common currency more akin to human monetary systems. Some implications for applied research and for broader theoretical integration across disciplines will also be considered.     

Cardiac modulation of startle: Effects on eye blink and higher cognitive processing

Cardiac cycle time has been shown to affect pre-attentive brainstem startle processes, such as the magnitude of acoustically evoked reflexive startle eye blinks. These effects were attributed to baro-afferent feedback mechanisms. However, it remains unclear whether cardiac cycle time plays a role in higher startle-related cognitive processes, as well. Twenty-five volunteers responded first by ’fast as possible’ button pushes (reaction time, RT), and second, rated perceived intensity of 60 acoustic startle stimuli (85, 95, or 105 dB; 50 ms duration; binaural; instantaneous rise time), which were presented either 230 or 530 ms after the R-wave, and eye blink responses were measured by EMG. RT was divided into evaluation and motor response time according to previous research. Increasing stimulus intensity enhanced startle eye blink, intensity ratings, and RT components. Eye blinks and intensity judgments were lower when startle was elicited at a latency of R + 230 ms, but RT components were differentially affected: the evaluative component was attenuated, and the motor component was accelerated when stimuli were presented 230 ms after the R-wave. We conclude that the cardiac cycle affects the attentive processing of acoustic startle stimuli.     

不同自我评价方式对高中生写作的影响

本研究考察了三种不同的自我评价方式对高中二年级学生写作活动的影响。结果表明,自我评价对写作成绩有一定改善,但短期内对一般性的学习动机与效能感无显著影响。写作结果自我评价方式有助于写作结果自我评价准确性的提高,单独的写作过程自我评价方式短期内对写作活动无显著促进作用,写作结果与写作过程的综合自我评价方式显著改善了写作活动。