医师职业素养评测体系构建的研究进展

随着我国社会经济的发展,医疗体制的改革,医师职业素养的培养成为当今医疗体制下医学在校教育、住院医生培养、医疗卫生管理中必须关注的内容。目前国外对医师职业素养的培养做了大量的工作,也取得了较好的效果,但是对于职业素养的培养不仅需要理论教学的改革,更需要相应评估机制的建立。本文对国外医师执业素养评估的最新进展进行介绍,分析各种方法的优劣,以期为国内医学教育建立统一的、具有广泛公认度的测评体系提供参考。     

SCI论文与科研评价——兼谈论文编辑公司

《科学引文索引》(Science Citation Index,SCI)作为杂志质量的客观评价工具被引入我国后,逐渐成为我国科研评价重要的,乃至唯一的指标,对科研人员产生了强烈的导向作用,并催生了SCI论文热.比较了我国与其他国家大学及科研院所的科研评价体系和评价指标组成,分析了SCI论文在其中发挥的作用.结果表明,SCI论文在世界范围已经、正在并将继续在科研评价中发挥重要的作用,但将其唯一化、绝对化,不利于科研的发展.我国的SCI论文热也催生了国内论文服务公司的繁荣及乱象.     

没有SCI论文和科研成果不能成为好医生吗?

通过分析《科学引文索引》(science citation index,SCI)论文和科研成果与医生的衡量标准、临床工作、技术水平、考核和晋升的关系以及探讨SCI论文被引用的价值和科研成果的实践检验、临床应用,厘清做一个好医生与发表SCI论文及取得科研成果的关系,明确SCI论文和科研成果是综合评价、全面考核医生的指标之一;医生要以医为本,以研为辅,这是做一个好医生的坦途;没有SCI论文和科研成果可以做一个好医生,有了与临床相结合的SCI论文和科研成果,能够做一个更好的医生.     

Can pupillometry index auditory attentional capture in contexts of active visual processing?

The rare presentation of a sound that deviates from the auditory background tends to capture attention, which is known to impede cognitive functioning. Such disruption is usually measured using performance on a concurrent visual task. Growing evidence recently showed that the pupillary dilation response (PDR) could index the attentional response triggered by a deviant sound. Given that the pupil diameter is sensitive to several vision-related factors, it is unclear whether the PDR could serve to study attentional capture in such contexts. Hence, the present study aimed at verifying whether the PDR can be used as a proxy for auditory attentional capture while a visual serial recall task (Experiment 1) or a reading comprehension task (Experiment 2) – respectively producing changes in luminance and gaze position – is being performed. Results showed that presenting a deviant sound within steady-state standard sounds elicited larger PDRs than a standard sound. Moreover, the magnitude of these PDRs was positively related to the amount of performance disruption produced by deviant sounds in Experiment 1. Performance remained unaffected by the deviants in Experiment 2, thereby implying that the PDR may be a more sensitive attention-capture index than behavioural measures. These results suggest that the PDR can be used to assess attentional capture by a deviant sound in contexts where the pupil diameter can be modulated by the visual environment.     

Association Between Gait and Dual Task With Cognitive Domains in Older People With Cognitive Impairment

The authors investigated whether impaired gait and dual-task performances are associated with specific cognitive domains among older people with preserved cognition (PC), mild cognitive impairment (MCI), and mild Alzheimer's disease (AD). The sample comprised 40 older adults with PC, 40 with MCI, and 38 with mild AD. The assessment consisted of gait (measured by 10-m walk test and Timed Up and Go Test [TUGT]), dual task (measured by TUGT associated with a cognitive-motor task of calling a phone number), and cognition (domains of the Addenbrooke Cognitive Examination–Revised and Frontal Assessment Battery [FAB]). For data analysis, the Pearson product-moment correlation and the backward stepwise linear regression were conducted. Language, fluency, and visuospatial domains predicted the 10-m walk test measure specifically in PC, MCI, and AD groups. Only the visuospatial domain was independently associated with the TUGT measure in the MCI and AD groups. FAB score, language domain, and FAB score and fluency domain were the strongest predictors for the isolated cognitive-motor task measure in the PC, MCI, and AD groups, respectively. The visuospatial domain was independently associated with the dual-task test measure in all 3 groups. The study findings demonstrate the influence of specific cognitive domains in daily mobility tasks in people with different cognitive profiles.     

Repeated Exposure to Forward Support-Surface Perturbation During Overground Walking Alters Upper-Body Kinematics and Step Parameters

Locomotion requires both proactive and reactive control strategies to maintain balance. The current study aimed to: (i) ascertain upper body postural responses following first exposure to a forward (slip) support-surface perturbation; (ii) investigate effects of repeated perturbation exposure; (iii) establish relationships between arms and other response components (trunk; center of mass control). Young adults (N = 11) completed 14 walking trials on a robotic platform; six elicited a slip response. Kinematic analyses were focused on extrapolated center of mass position (xCoM), bilateral upper- and forearm elevation velocity, trunk angular velocity, and step parameters. Results demonstrated that postural responses evoked in the first slip exposure were the largest in magnitude (e.g., reduced backward stability, altered reactive stepping, etc.) and preceded by anticipatory anterior adjustments of xCoM. In relation to the perturbed leg, the large contra- and ipsilateral arm responses observed (in first exposure) were characteristically asymmetric and scaled to the degree of peak trunk extension. With repeated exposure, xCoM anticipatory adjustments were altered and in turn, reduced posterior xCoM motion occurred following a slip (changes plateaued at second exposure). The few components of the slip response that persisted across multiple exposures did so at a lesser magnitude (e.g., step length and arms).     

Common and specific gait patterns in people with varying anatomical levels of lower limb amputation and different prosthetic components

The present study’s aim was to identify the kinematic and kinetic gait patterns and to measure the energy consumption in people with amputation according to both the anatomical level of amputation and the type of prosthetic components in comparison with a control group matched for the gait speed. Fifteen subjects with unilateral transtibial amputation (TTA), forty with unilateral transfemoral amputation (TFA) (9 with mechanical, 17 with CLeg and 14 with Genium prosthesis) and forty healthy subjects were recruited. We computed the time-distance gait parameters; the range of angular motion (RoM) at hip, knee and ankle joints, and at the trunk and pelvis; the values of the 2 peaks of vertical force curve; the full width at half maximum (FWHM) and center of activity (CoA) of vertical force; the mechanical behavior in terms of energy recovery (R-step) and energy consumption. The main results were: i) both TTA and TFA show a common gait pattern characterized by a symmetric increase of step length, step width, double support duration, pelvic obliquity, trunk lateral bending and trunk rotation RoMs compared to control groups. They show also an asymmetric increase of stance duration and of Peak1 in non-amputated side and a decrease of ankle RoM in amputated side; ii) only TFA show a specific gait pattern, depending on the level of amputation, characterized by a symmetric reduction of R-step and an asymmetric decrease of stance duration, CoA and FWHM and an increase of Peak1 in the amputated side and of hip and knee RoM, CoA and FWHM in the non-amputated side; iii) people with amputation with Genium prosthesis show a longer step length and increased hip and knee RoMs compared to people with amputation with mechanical prosthesis who conversely show an increased pelvic obliquity: these are specific gait patterns depending of the type of prosthesis. In conclusion, we identified both common and specific gait patterns in people with amputation, either regardless of, or according to their level of amputation and the type of prosthetic component.     

风险条件下的跨期选择

跨期选择是指对发生在未来不同时间点上的结果做出权衡的决策过程。由于大部分跨期选择的情景都处于某种风险之中, 把风险变量纳入跨期选择的研究中则至为关键。针对以往研究在研究范围、理论构建、现实意义等诸方面的不足, 本研究拟采用实验室实验与纸笔测验相结合的方法, 深入揭示高、中、低三种概率水平下风险对跨期选择的影响特征, 探索其发生的机制、各类经典效应的大小。在此基础上, 根据全国不同地区的大样本调查结果, 了解各地区风险条件下跨期选择的差异及其与本地宏观经济指标(如, 消费者物价指数)的关联, 进而探讨研究的现实意义。本研究期望对风险条件下的跨期选择做出系统、全面的科学探索, 并为国家相关部门制定政策提供有价值的参考。     

An empirical Q-matrix validation method for the sequential generalized DINA model

As a core component of most cognitive diagnosis models, the Q-matrix, or item and attribute association matrix, is typically developed by domain experts, and tends to be subjective. It is critical to validate the Q-matrix empirically because a misspecified Q-matrix could result in erroneous attribute estimation. Most existing Q-matrix validation procedures are developed for dichotomous responses. However, in this paper, we propose a method to empirically detect and correct the misspecifications in the Q-matrix for graded response data based on the sequential generalized deterministic inputs, noisy ‘and’ gate (G-DINA) model. The proposed Q-matrix validation procedure is implemented in a stepwise manner based on the Wald test and an effect size measure. The feasibility of the proposed method is examined using simulation studies. Also, a set of data from the Trends in International Mathematics and Science Study (TIMSS) 2011 mathematics assessment is analysed for illustration.