Empirical Priors in Polytomous Computerized Adaptive Tests: Risks and Rewards in Clinical Settings

The use of empirical prior information about participants has been shown to substantially improve the efficiency of computerized adaptive tests (CATs) in educational settings. However, it is unclear how these results translate to clinical settings, where small item banks with highly informative polytomous items often lead to very short CATs. We explored the risks and rewards of using prior information in CAT in two simulation studies, rooted in applied clinical examples. In the first simulation, prior precision and bias in the prior location were manipulated independently. Our results show that a precise personalized prior can meaningfully increase CAT efficiency. However, this reward comes with the potential risk of overconfidence in wrong empirical information (i.e., using a precise severely biased prior), which can lead to unnecessarily long tests, or severely biased estimates. The latter risk can be mitigated by setting a minimum number of items that are to be administered during the CAT, or by setting a less precise prior; be it at the expense of canceling out any efficiency gains. The second simulation, with more realistic bias and precision combinations in the empirical prior, places the prevalence of the potential risks in context. With similar estimation bias, an empirical prior reduced CAT test length, compared to a standard normal prior, in 68% of cases, by a median of 20%; while test length increased in only 3% of cases. The use of prior information in CAT seems to be a feasible and simple method to reduce test burden for patients and clinical practitioners alike.     

叙事医学反思性写作对共同决策价值探析

以叙事医学工具反思性写作为切入点,首先从医方、患方及外部环境三个角度分析了当前医患共同决策所面临的临床实践困境,其次在对反思性写作概念、实践特点概述的基础上,提出了叙事能力对临床工作的重要性、叙事医学伦理对决策困境的作用,最后从促使医方自我反思,避免引导式决策及权威主义;弥合医患视阈差异,达成决策共识;阐明并澄清患者偏好及价值观,促进个体化共同决策;提高患者参与决策意愿,调动参与决策积极性;缓和医患关系,实现医患共情,促进共同决策良性互动五个方面阐述了反思性写作对医患共同决策困境的助力作用。

     

艾滋病防控中获取患者信息的伦理问题刍议

当前艾滋病获取患者信息中,存在公私观念上的摩擦、相关规定与环节存在疏漏、对信息弱势群体关照不足的伦理难题。问题背后包含着患者为了公共健康的伦理目的却又失去伦理关系的风险,“失德”名声带来的耻感与歧视,遵守政策规范却缺少应有的尊重与保护等矛盾。问题的解决需要在文化背景和利益关系下思量个人身心秩序与社会整体秩序间如何权衡,结合历史、理论与现实维度提出路径。“信”的建立是关键所在,包括公共卫生部门公信力的树立和相应制度措施建设,同时在信息活动中需要给“私”以合理地位,并注重艾滋病治疗相关医学信息的宣传。     

医生的超然与介入

超然是医生职业化的必然要求 ,介入是职业伦理的外在体现。适度的超然为医生职业的权威性提供了保证 ,过度的超然造成职业的冷漠。恰当的介入体现了医生的责任感和人文关怀 ,过度的介入造成医生心理的倦怠 ,从而造成情感冷漠。为了达到医患之间的和谐 ,了解超然和介入的一般性质 ,寻求超然与介入的平衡至关重要。阐述超然与介入的一般性质 ,同时为超然与介入的平衡提供一些建议     

Bowen家庭治疗模式评析

和其它经典的家庭治疗一样,Bowen家庭治疗模式也建立在系统理论的基础之上。他认为,个人症状的出现,在于个人与家庭情感的融合而使自己丧失了自我判断和选择的能力。因此,主张用代际互动疗法来解构病态的三角关系,增加与扩大家庭中的互动,从而增强个体的自我分化程度,以减轻焦虑。     

Kindergarten self-control mediates the gender reading achievement gap: A population-based cohort study

Could superior self-control explain the gender difference in reading achievement favoring girls? To test this idea, we drew on a unique population-based sample (N = 11,336) where self-control was measured in kindergarten using a multimethod battery of assessments. Girls showed substantially higher levels of self-control in kindergarten (β = 0.47) and outperformed boys on standardized tests of reading achievement in third/fourth grade (β = 0.20). Further, kindergarten self-control prospectively predicted reading achievement throughout elementary school (β = 0.37). Connecting these findings, our mediation analyses revealed that the female self-control advantage in kindergarten could account for subsequent gender differences in reading achievement. Our results suggest that early gender differences in self-control may represent a key pathway through which gender disparities in reading skills, vocabulary knowledge, and reading comprehension occur.     

左侧眶额皮层在自动情绪调节下注意选择中的作用：来自经颅直流电刺激的证据

前人研究表明自动情绪调节能够自上而下地影响情绪及情绪性注意过程。近来有研究提示自动情绪调节与眶额皮层(orbitofrontal cortex, OFC)有关。也有研究表明左侧OFC的激活影响负性注意偏向。本研究采用经颅直流电刺激技术,考察阈下启动情绪控制目标条件下,抑制左侧眶额皮层兴奋性是否影响负性注意偏向。结果发现,使用阴极刺激抑制左侧OFC活动可以加快被试对与恐惧刺激位置一致的探测点的反应。该结果提示左侧眶额皮层是自动情绪调节下情绪性注意选择相关的重要脑区。