组织型插图对不同认知方式个体说明性文本阅读的影响

采用图文相继呈现、文本逐句阅读的范式,通过反应时技术与出声思维的方法考察了组织型插图对不同认知方式个体说明性文本阅读过程与阅读结果的影响,结果发现,与单一文本相比,场独立个体在有插图条件下的阅读成绩显著提高,而阅读时间没有增加,并产生了更多的推理、细化和提问策略;而场依存个体在有插图条件下的阅读成绩显著提高,阅读时间也显著增多,而理解策略没有变化。这说明组织型插图对两种认知方式个体说明性文本的阅读均起到促进作用,但场独立个体没有因为增加组织型插图而付出更多的加工努力,而是通过调整理解策略的方式来提高阅读效果;而场依存个体在阅读过程中没有根据组织型插图调整理解策略,阅读效果的提高是以付出更多的加工努力为代价的。     

自身免疫性胰腺炎的诊治进展

自身免疫性胰腺炎（AIP）是一种特殊类型的慢性胰腺炎,以胰腺肿大及胰管不规则狭窄为特征.AIP分两个亚型：Ⅰ型AIP好发于亚洲老年人,为淋巴浆细胞硬化性胰腺炎;Ⅱ型AIP多见于西方人,为导管中心型胰腺炎.AIP缺乏特异性血清标志物,诊断主要依赖于其特征性改变.依据AIP诊断标准国际共识,AIP的诊断包括影像学、血清学、胰腺外器官受累、组织病理学和诊断性激素治疗5个方面.糖皮质激素是AIP的首选治疗方法,但复发率高,免疫调节剂对维持AIP的持续缓解具有一定作用.AIP总体预后良好,胰管结石和癌变是其潜在的并发症,但发生率极低.     

Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

On the Decision to Explore New Alternatives: The Coexistence of Under‐ and Over‐exploration

The decision whether to explore new alternatives or to choose from familiar ones is implicit in many of our daily activities. How is this decision made? When will deviation from optimal exploration be observed? The current paper examines exploration decisions in the context of a multi‐alternative “decisions from experience” task. In each trial, participants could choose a familiar option (the status quo) or a new alternative (risky exploration). The observed exploration rates were more sensitive to the frequent outcome from choosing new alternatives than to the average outcome. That is, the implicit decision whether to explore a new alternative reflects underweighting of rare events: Over‐exploration was documented in “Rare Disasters” environments, and insufficient exploration was evident in “Rare Treasures” environments. In addition, the results reveal a decrease in exploration of new alternatives over time even when it is always optimal and some exploration even when it is never reinforcing. These results can be captured with models that share a distinction between “data collection” and “outcome‐driven” decision modes. Under the data collection mode, the decision maker collects information about the environment, to be used in future choices. Under the outcome‐driven mode, the decision maker relies on small samples of previous experiences with familiar versus unfamiliar alternatives, before the selection of a specific alternative. The predictive value of a two‐parameter “explorative sampler” quantification of these assumptions is demonstrated. Copyright © 2013 John Wiley & Sons, Ltd.     

腹腔镜胆囊切除术中不同麻醉方式对眼内压的影响

探讨全麻喉罩复合硬膜外阻滞麻醉对腹腔镜胆囊切除患者眼内压（IOP）的影响,60例患者行腹腔镜胆囊切除患者根据麻醉方式的不同随机分为全麻喉罩复合硬膜外阻滞组（A 组）与气管插管全麻组（B 组）,每组各30例。记录麻醉前（T0）、气管插管（置入喉罩）前（T1）、气管插管（置入喉罩）后即刻（T2）、CO2气腹后10min（T3）、术毕患者清醒拔除气管导管（喉罩）前（T4）时的 IOP 。结果显示：喉罩全麻复合硬膜外阻滞用于腹腔镜胆囊切除,与单纯气管插管全麻比较,可有效降低患者在诱导插管、CO2气腹与患者清醒吸痰、拔管所引起的 IOP 升高反应（P＜0．05）。     

Development and Pilot Evaluation of Smartphone-Delivered Cognitive Behavior Therapy Strategies for Mood- and Anxiety-Related Problems: MoodMission

Given the ubiquity and interactive power of smartphones, there are opportunities to develop smartphone applications (apps) that provide novel, highly accessible mental health supports. This paper details the development of a smartphone app, “MoodMission,” that aims to provide evidence-based Cognitive Behavior Therapy (CBT) strategies for mood- and anxiety-related problems, contributing to the prevention of clinically significant depression and anxiety disorders and serving as an adjunct to therapeutic interventions delivered by trained health professionals. MoodMission was designed to deliver strategies in the form of real-time, momentary responses to user-reported low moods and anxiety. The development process involved: (a) construction of a battery of strategies, (b) empirical evaluation, (c) a software and behavioral plan design and testing process, (d) user feedback, and (e) a public launch. A pilot study of 44 participants completed the Mobile Application Rating Scale (MARS; Hides et al., 2014) for usability testing and feedback. MoodMission was rated significantly higher than standardized health app norms on the majority of the domains, including Entertainment, Interest, Customization, Target Group, Graphics, Visual Appeal, Quality of Information, Quantity of Information, Visual Information, Credibility of Source, Recommendation to Use, Estimated Frequency of Use, and Overall Rating (Hedges’s g range 0.57–1.97, p < .006). Case examples illustrate the practical uses of the app. In addition to clinical applications, MoodMission holds promise as a research tool either as an augmentation to clinician-delivered therapy, or as a vehicle for standardizing client access to specific CBT strategies (e.g., in studies intending to study different change processes).