儿童支气管异物32例误诊分析

支气管异物系儿科常见病,误诊原因很多,如病史陈述不详细、辅助检查的干扰等,更重要的一个原因就是异物的不典型位置。传统观念中,右下肺异物高发,实际上,受气流及异物体积的影响,轻而小的塑料可被回吸进入左上肺,而较大的异物受自身重力影响多进入右下肺。异物进入体内,引起的·临床表现多种多样,咳嗽、咯血、喘息甚至呼吸困难等,诸类症状在呼吸系统疾病中较为常见,因此这些症状的鉴别就显得尤为重要。在治疗方面,突破传统的支气管镜技术,提倡可以首先采取保守治疗,给予拍背、体位引流等手段,部分患儿可自行咳出异物,这样就避免了手术的风险,在保守治疗无效的情况下可转入外科通过纤维支气管镜取出。     

Renaissance Catholicism and Contemporary Liberalism

Contemporary (post‐1945) liberalism functions analogously to Roman Catholicism in the decades after 1443. Both ideologies, in their respective periods, represent the hegemonic ideology of Western civilization, despite the fact that both comprise a miscellany of competing belief systems. Both ideologies are dominated by a single hegemonic power—the United States and the Renaissance papacy, respectively—which strives for doctrinal stability. All who reject official “doctrine,” however, are rendered liable to violent suppression. In this, papal Catholicism and American liberalism display an ultra‐conservative outlook; but they also evince a powerfully millenarian streak, as evidenced by their dual proclamations of the “end of history” and their zealous missionary responses to macro‐historical events in the final decades of the fifteenth and twentieth centuries. For ideologues of both regimes, those events speak to an ultimate harmony of truth and value that only serves to entrench their own dogmatism. This, however, has dire consequences when it comes to war, as can be seen in the “crusading” character of contemporary liberal warfare. Ultimately, the Renaissance papacy proves unable to maintain its monopoly on Christian doctrine; and one has to wonder if a similar fate may befall America's perceived role as the champion of liberalism.     

Prime Minister Leadership Styles in Foreign Policy Decision-Making: A Framework for Research

Although the institutional contexts of prime ministers in parliamentary democracies and of U.S. presidents are very different, both types of executive leaders influence the decision-making processes through their leadership styles. Leadership style includes how the leaders relate to those around them, how they like to receive information, and how they make up their minds. While there are numerous empirical studies and theoretical frameworks on the leadership styles of U.S. presidents, few studies of prime ministers are concerned with personality and styles of leadership. This paper reviews the literature on U.S. presidential styles and on organizational leadership in order to construct a framework for the study of prime minister leadership styles. Components of the proposed framework are illustrated with examples of British prime ministers and German chancellors. In addition, categories of dependent variables to be explained by leadership style are discussed. I argue that leadership style has the greatest impact on the decision-making process and that although the direct effect of leadership style on foreign policy behavior is less, leadership style indirectly influences foreign policy through the decision-making process.     

Extending the Three- and Four-Headed Eagles: The Foreign Policy Orientations of American Elites During the 80s and 90s

With the breakdown of the foreign policy consensus of the Cold War years, there has been a resurgence in examining the beliefs of the public and their role in U.S. foreign policy. The most extensive of these studies has been conducted by Holsti and Rosenau who have found first three and then four competing schools of thought. Our purpose is to build off Holsti and Rosenau's analyses and extend their argument. Research based on the content analysis of foreign policy and national opinion journals from 1980 to 1989 demonstrates that there is more diversity and complexity in the range and content of beliefs held by American leaders than Holsti and Rosenau have yet been able to capture through their "three-" and "four-headed eagles." Although the three-headed eagle serves as a useful scheme for categorizing the broad foreign policy perspectives of American leaders, it de-emphasizes important differences in beliefs and ignores at least two foreign policy orientations that exist within their general categories. This is not a mere academic exercise, for it sheds light on the level of diversity and complexity of elite beliefs, which enriches an understanding of the politics of U.S. foreign policy since Vietnam. A preliminary examination of foreign policy and national opinion journals from 1990 to 1994 indicates that American elites are changing and adapting while at the same time, they are absorbing profound global changes into their prevailing belief systems, as predicted by the political psychological literature. This suggests that the diversity and complexity present in the 80s is likely to persist and grow throughout the 90s. Our research also suggests the importance of developing alternative methods to complement reliance on survey research in order to capture more fully the diversity and complexity of the foreign policy beliefs of Americans.     

Cultural Expectations of One's Own and Other Nations' Foreign Policy Action Templates

One useful conceptualization of culture is that of a preestablished set of behavioral competencies, which in turn form behavioral dispositions. According to this variant of culture theory, decision-makers faced with new situations will rely on established behavioral competencies in forming an initial policy response. This assumption can also be applied at the nation-state level, where established behavioral predispositions may lessen uncertainty and stress in ambiguous yet salient foreign policy situations. Likewise, observers in one nation-state may be able to identify such behavioral dispositions in other nation-states, lending greater transparency and predictability to international interactions. Do such culturally based action templates exist? Are they recognizable even to ordinary citizens? Citizens in Russia, Japan, and the United States were asked to posit the most likely and least likely behavioral responses to a variety of foreign policy situations by their own nation and by the other two nations in the sample. The results indicate that recognition of such templates takes place, and that recognition of one nation's template content by citizens of the other nations typically matches recognition of template content by the nation's own citizens. The research also shows that such action templates can be eroded and become unrecognizable over time, both to insiders and to outsiders.     

Development and Evaluation of a Decision Aid About Prenatal Testing for Women of Advanced Maternal Age

Objective: To develop and evaluate a decision aid designed to prepare patients of advanced maternal age for counseling about prenatal diagnostic testing. Setting: A regional genetics center. Design: A before/after study. Interventions: Participants used an audioguided workbook to learn about options and outcomes and to clarify personal risks, values, questions, and predispositions. Subjects: 21 women of advanced maternal age and 17 spouses. Main outcome measures: Knowledge of prenatal testing alternatives, decisional conflict, level of anxiety, and acceptability of the decision aid. Results: After using the decision aid, participants had significantly reduced decisional conflict (uncertainty) and a significant increase in knowledge. There was no effect on state or trait anxiety. More than three-quarters of participants were satisfied with the length, clarity, balance, and acceptability of the decision aid. Conclusions: The decision aid shows promise as a useful aid for preparing couples for counseling.     

TEACHING SEVERELY MULTIHANDICAPPED STUDENTS TO PUT ON THEIR OWN HEARING AIDS

Two experiments were conducted with six severely multihandicapped students with hearing impairments to: (a) train the six students to put on their own hearing aids independently, and (b) provide an empirical evaluation of a comprehensive instructional program for putting on a hearing aid by assessing acquisition, maintenance, and generalization of that skill across environments. All six students acquired the skill rapidly, with two students requiring remedial training on one step of the program. Because for two of the original three students the newly learned skill failed initially to generalize to other environments, a second experiment was initiated to assess generalization across environments as well as to replicate the efficiency of the acquisition program. When a variation of the multiple-probe baseline technique was used, the behavior of three additional students generalized to other settings without direct training in those settings.     

外语焦虑、紧张情绪与认知负荷对外语说谎的影响：来自中-英双语者的证据

采用错误陈述范式探究中-英双语者用母语和外语说真话和说谎时的认知神经差异,涉及外语焦虑、认知负荷和说谎诱发的紧张情绪。对P200和CNV观察发现:(1)中-英双语者用英语说真话的P200波幅比用母语大,说明被试用英语说话时受外语焦虑情绪影响;(2)中-英双语者用英语说谎与说真话的P200波幅无显著差异,但用母语说谎和讲真话的P200波幅差异显著,说明被试用外语说谎没有用母语说谎诱发的紧张情绪大;(3)中-英双语者说谎时的CNV波幅比说真话时大,说明被试说谎比说真话的认知负荷更大;(4)中-英双语者用英语说谎时的CNV波幅比用汉语说谎时大,说明被试用外语说谎比用母语说谎产生了更大的认知负荷。相关分析表明,英语熟练程度是影响中-英双语者用母语和外语说谎时的认知神经差异的重要变量。     

Is World Poverty a Moral Problem for the Wealthy?

This article discusses the question of poverty and wealth in light of several theses put forward by Larry Temkin. The claim that there is a sort of cosmic injustice involved when great disparities of ability or of wealth are found. He is concerned especially about disparities that are undeserved. It is agreed that this is unfortunate, but not agreed that they are unjust in a sense that supports the imposition of rectification on anyone else. Nor is poverty typically undeserved in the only really relevant sense: the poor simply do not produce enough to earn them high incomes, and probably correct incomes they derive are indeed what such efforts are worth in the circumstances. That persons with very low incomes may merit our sympathy is accepted, but sympathy leads to charity, rather than to the involuntary exploitation of the better off. The essay concludes with further observations about the relevance of free markets, and points to the iniquities of the restrictions on commerce that are the most potent source of perpetuated poverty today.