术前人文关怀对肺癌手术患者全麻诱导心理和生理的影响

为探讨术前进行人文关怀式沟通和健康教育对肺癌手术患者全麻诱导后心理和生理的影响,将83例非同期别的肺癌手术患者（均采用全身麻醉,双腔管气管插管辅助通气）分成两组。观察组进行人文关怀式沟通,对照组采用普通沟通。判定方法采用焦虑自评量表（SAS）,根据焦虑评分反映两组患者入院即刻及手术前的心理变化情况,监测全麻诱导即刻与全麻诱导气管插管后5min患者平均动脉压（MBP）的波动、心率（HR）的变化,用两个时间段两个变量的差值来反映两组患者全麻诱导期发生心理和生理反应的情况。结果显示,两组患者入院即刻焦虑差异无统计学意义（P〉0．05）;手术前SAS评分两组患者较入院即刻降低（P〈0．05）,并且观察组与对照组相比下降更明显（P〈0．01）;观察组患者MBP波动无统计学意义（P〉0．05）、HR波动有统计学意义（P〈0．05）。因此,证实人文关怀式沟通和健康教育能够减轻肺癌患者在心理和生理两个方面对麻醉和手术产生的不良反应。     

Learning to Optimize Speed,Accuracy, and Energy Expenditure: A Framework for Understanding Speed-Accuracy Relations in Goal-Directed Aiming

Over the last century, investigators have developed a number of models to explain the relation between speed and accuracy in target-directed manual aiming. The models vary in the extent to which they stress the importance of feedforward processes and the online use of sensory information (see D. Elliott, W. F. Helsen, & R. Chua, 2001, for a recent review). A common feature of those models is that the role of practice in optimizing speed, accuracy, and energy expenditure in goal-directed aiming is either ignored or minimized. The authors present a theoretical framework for understanding speed-accuracy tradeoffs that takes into account the strategic, trial-to-trial behavior of the performer. The strategic behavior enables individuals to maximize movement speed while minimizing error and energy expenditure.     

THE “GHOSTS” OF IRAS PAST AND THE CHANGING CULTURAL CONTEXT OF RELIGION AND SCIENCE

Beginning with our cosmic ancestors and the 1950s ancestors of Institute on Religion in an Age of Science (IRAS, the “Ghosts”), this essay highlights the wider, post‐World War II cultural context, including other science and religion organizations, in which IRAS was formed. It then considers eight challenges from today's context. From the context of science there are (1) the challenge of scale that leads us to question our place in the scheme of things and can lead to a challenge to morale concerning whether we make any difference; (2) the challenge of human variability that leads to the question whether there is a single human moral nature; and (3) the challenge of detailed explanation that leads to the question of what is the task of theology in relation to detailed scientific explanation. From the religion context there are (4) the challenge of objectivity—studying religion without practicing religion; and (5) the challenge of pluralism and the variety of cultural and religious perspectives. From the context of the growing and diverse science‐and‐religion enterprise, considered from the perspective of IRAS developed in the first part of this essay, there are the challenges of (6) apologetics and (7) intellectualization. Finally, from the context of our growing, worldwide consumerist culture that is contributing to the radical alteration of the planetary environment, leading to much suffering, there is (8) the challenge of becoming more motivated to act for the long‐term global good.     

Segregation of copper in an Fe–Cu alloy under pulsed electric current

Effect of electric current on the segregation of copper precipitates in the Fe–13.6Cu alloy is evaluated. Results of this approach present two stages of segregation, namely, grain-boundary segregation during the solidification and interphase-boundary segregation during the decomposition of a solid solution. The segregation becomes apparent not only because the thermodynamic barrier for segregation is decreased, but also because the diffusion is greatly enhanced. Based on the thermodynamic and kinetic aspects, the segregation process under electric current would be of great interest and of physical importance because this kind of electric current-induced segregation was much stronger than the thermal diffusion segregation.     

Mixed Generation Sensitivity Analysis: An Optimal Scenario Study

There are several generating units available to meet the load demand on any given day. The mixed‐integer programme case engages generating units that can be shut down or operated between minimum and maximum output levels within a specific time demand block. An examination of these conditions espouses the utilization of renewable energy technology as a reliable power generation source and its effectiveness and augmentation in a robust, heavily subjugated thermal generation system. The mixed‐integer problem has the predisposition to generate many subproblems during the computation. However, with careful selection of the parameters in the model, the challenges are easily overcome. Hydroelectric energy is significant from an operational standpoint as it requires little or no ramp‐up time, commonly found in many combustion technologies. The essential load‐following capability, peaking capacity and voltage stability attributes render hydroelectric energy as a significant part in ensuring reliable electricity service and in meeting customer needs in a market‐driven industry. When this renewable resource is combined with the thermal generation, an improved reliability function is apparent. Yet, in order to minimize the environmental effects inherent in this type of energy resource, the renewable power supply is expected to produce an effectual, consistent output. The integration of renewable generation within the electrical system entails intricate analysis of the transmission line upgrades throughout the system. These upgrades are designed to relieve congestion, improve reliability and provide voltage support by thoroughly evaluating the alternatives to accommodate the new expansion efforts. This paper examines the system integration of renewable generators, via simulated studies, in the context of electrical operations from the hydroelectric generation perspective. Copyright © 2014 John Wiley & Sons, Ltd.     

Inclusion of Alternative and Complementary Therapies in CACREP Training Programs

Abstract

Given a heightened focus within the mental health profession on creative, complementary, and alternative practices, the authors surveyed CACREP programs with respect to their inclusion of such approaches in counselor training. For the purpose of this study, these approaches were designated as complementary and alternative methods (CAM) and defined as those therapeutic practices that fall outside of the established traditional realm of medical, psychiatric, and psychological practice (hypnotherapy, breath work, meditation, Qigong, Reiki, Thought Field Therapy, etc.). Sixty-two programs responded. Over half (54%) stated that they currently include these approaches in course offerings. This article includes a discussion of creativity, expressive arts, and energy psychology as they relate to complementary and alternative therapies in mental health and medicine.     

论现代临床医学发展的人文走向

我们不能用静止的眼光看待当代的医学。在整个“以人为本”的环境背景和其它因素的影响下,近二十多年以来,现代医学正在开始走出人性冷漠的阴影,出现了一些重要的人文走向,尽管这还只是开始,但无疑给人们以希望和信心。     

Students as Members of University-based Academic Research Ethics Boards: A Natural Evolution

University based academic Research Ethics Boards (REB) face the particularly difficult challenge of trying to achieve representation from a variety of disciplines, methodologies and research interests. Additionally, many are currently facing another decision – whether to have students as REB members or not. At Ryerson University, we are uniquely situated. Without a medical school in which an awareness of the research ethics review process might be grounded, our mainly social science and humanities REB must also educate and foster awareness of the ethics review process throughout the academic community. Our Board has had and continues to have students as active members. While there are challenges to having students as Board members, these are clearly outweighed by the advantages, for both the academic community and the future of ethically sound research in the social sciences and humanities. Moreover, the challenges are often based on misconceptions and can be easily overcome through increased education and understanding of the research ethics review process by the academic community at large. The purpose of this paper is to describe and discuss the experiences, advantages and challenges of having students as REB members. The advantages of having students as REB members include the following: (1) Students are the proposed participants in many of our reviewed protocols and student members may illuminate unique issues of participation. (2) Students are active and highly engaged members of the REB. (3) Having students on the REB enhances awareness of research ethics within the University. (4) Student REB members have an opportunity to mentor other students and provide leadership for both undergraduate and graduate students. (5) Students are more vigorously recruited than faculty members and often apply for student positions with enthusiasm and preparation. (6) In creating an atmosphere of excellence in research, engaging students at the beginning of their research career will help in creating tomorrow’s leaders in research and research ethics. The challenges of having students as REB members include the following: (1) Faculty members may be uneasy regarding the prospect of students reviewing protocols. (2) Faculty members may be concerned about confidentiality and respect with students reviewing faculty research protocols. (3) There may be an increased burden for students who serve as members on an REB. (4) There is concern that students will offer less continuous service to the REB. (5) There is a common misconception that students do not have the experience to carry out ethical reviews. While there are challenges from faculty members and others regarding having students as REB members, these challenges are often based on misconceptions about the nature of the REB work and the ethics review process in general. These challenges are also often based on the misconception of the ethics review process as one of peer review and evaluation, instead of a community-based and inclusive process. Having student members is a long-term strategy for both overcoming the misconceptions of the REB as a “necessary evil” and for fostering an awareness of the imperative for ethically sound research in the social sciences and humanities.     

Paul Tillich and Pitirim A. Sorokin on Love

An analysis of Paul Tillich's three‐volume Systematic Theology and Pitirim A. Sorokin's The Ways and Power of Love: Types, Factors, and Techniques of Moral Transformation reveals how a metaphysical dialogue on God and love contributes to scientific and theological scholarship on altruism. This article focuses on similarities and differences in Tillich and Sorokin. Similarities include a belief in the importance of the ontological/love connection and the conclusion that a special state, ecstasy, is integral to the experience of genuine love. Differences serve to complement rather than negate. For example, Tillich's recognition that ecstatic connections with the divine within finitude are fragmentary balances Sorokin's view that these ecstatic peaks are reached only by the few. The similarities give resonance and point to the overall creation, while the differences often serve as counterpoint to balance the ideas of the scientist and the theologian.