关于医疗、科研的一点认识

临床医疗是医院的根本使命,在权重上医疗自然重于科研.医疗实践是科研的出发点与归宿,决定了科研的基本走向.当前,科研工作受到前所未有的重视,科研作为医疗人员绩效考核的权重过大,偏离了医院的根本使命,会对科研、医疗、医护人员乃至整个社会造成伤害.SCI论文与临床关系不密切,不宜用来评价临床医师的水准.应该建立科学的考评机制,考核标准应细化、全面,对科研的奖励应适度.对于医护人员的考核应以医疗为主、科研为辅.     

临床医学整合：中心化整合关键在于观念转变

医学转型的实质是推进医学的整合,微观层面以临床医学的整合为核心部分,宏观上则以临床医学与预防医学的整合为核心。在诸多整合之中,以临床医学的整合最为迫切,它是整个医学整合过程中的基础和开端。当前进行的临床中心化整合似乎已成为一种主导的趋势,然而,如何进行中心化整合却仍然存在诸多问题需要探讨,某些医院对专科化的热衷和偏爱更令人担忧,医学资本的诱惑也是当今临床整合的一道障碍,因此,医学整合任重而道远,不仅需要医学形式上的重组,更需要有观念上的根本转变。     

A neural cognitive model of argumentation with application to legal inference and decision making

Formal models of argumentation have been investigated in several areas, from multi-agent systems and artificial intelligence (AI) to decision making, philosophy and law. In artificial intelligence, logic-based models have been the standard for the representation of argumentative reasoning. More recently, the standard logic-based models have been shown equivalent to standard connectionist models. This has created a new line of research where (i) neural networks can be used as a parallel computational model for argumentation and (ii) neural networks can be used to combine argumentation, quantitative reasoning and statistical learning. At the same time, non-standard logic models of argumentation started to emerge. In this paper, we propose a connectionist cognitive model of argumentation that accounts for both standard and non-standard forms of argumentation. The model is shown to be an adequate framework for dealing with standard and non-standard argumentation, including joint-attacks, argument support, ordered attacks, disjunctive attacks, meta-level attacks, self-defeating attacks, argument accrual and uncertainty. We show that the neural cognitive approach offers an adequate way of modelling all of these different aspects of argumentation. We have applied the framework to the modelling of a public prosecution charging decision as part of a real legal decision making case study containing many of the above aspects of argumentation. The results show that the model can be a useful tool in the analysis of legal decision making, including the analysis of what-if questions and the analysis of alternative conclusions. The approach opens up two new perspectives in the short-term: the use of neural networks for computing prevailing arguments efficiently through the propagation in parallel of neuronal activations, and the use of the same networks to evolve the structure of the argumentation network through learning (e.g. to learn the strength of arguments from data).     

The impact of empathy on burnout in medical students: new findings

Introduction: Research on medical students has shown they are at a higher risk for burnout and that this burnout may become more prevalent as they advance in medical school. The literature, thus far, has not explored the construct of ,emotional empathy and whether this can impact burnout in medical students. Objective: To understand the relationship between empathy (Empathic Concern [EC] and Personal Distress [PD]) and burnout in medical students. Method: Five successive classes of medical students enrolled at a new medical school were given the Maslach Burnout Inventory and Davis’ Interpersonal Reactivity Index over the course of three successive years (n = 353). Two dimensions of empathy were evaluated to determine if they have an impact on three dimensions of burnout (Emotional Exhaustion/EE, Depersonalization/DP, Personal Accomplishment/PA). Results: data was analyzed using a linear mixed model for each of the three components of burnout based on gender, age, year in medical school, and two types of empathy: EC, and PD. Conclusion: It was discovered that students with high levels of EC had statistically lower scores of burnout over time while students with high levels of PD empathy showed statistically higher scores of burnout over three years. Implications for these findings are discussed.     

Are there gender differences in cognitive reflection? Invariance and differences related to mathematics

ABSTRACT

Cognitive reflection is recognized as an important skill, which is necessary for making advantageous decisions. Even though gender differences in the Cognitive Reflection test (CRT) appear to be robust across multiple studies, little research has examined the source of the gender gap in performance. In Study 1, we tested the invariance of the scale across genders. In Study 2, we investigated the role of math anxiety, mathematical reasoning, and gender in CRT performance. The results attested the measurement equivalence of the Cognitive Reflection Test – Long (CRT- L), when administered to male and female students. Additionally, the results of the mediation analysis showed an indirect effect of gender on CRT-L performance through mathematical reasoning and math anxiety. The direct effect of gender was no longer statistically significant after accounting for the other variables. The current findings suggest that cognitive reflection is affected by numerical skills and related feelings.     

Association between intimate partner violence during pregnancy and maternal pregnancy complications among recently delivered women in Bangladesh

Intimate partner violence (IPV), an actual or threatened physical, sexual, or psychological abuse by a current or former partner or spouse, is a common global public health issue. Understanding both the prevalence of IPV during pregnancy and its potential impact on the health of pregnant women is important for the development and implementation of interventions to prevent maternal morbidity and mortality. The purpose of this study was to explore the association between maternal experiences of IPV during pregnancy and pregnancy complications. A health‐facility‐based cross‐sectional study was conducted from July 2015 to April 2016 among 400 randomly selected women who were admitted to the postnatal wards of Rajshahi Medical College Hospital for delivery. Data were collected through face‐to‐face interviews using a structured questionnaire. Multivariable logistic regressions were performed to assess relationships between variables of interest after controlling for potential confounders. Results indicated that 39.0% of women reported physical IPV and 26.3% of women reported sexual IPV during pregnancy. Additionally, 69.5% of women experienced medical complications (MCs); of this group, 44.3% experienced obstetric complications (OCs) and 79.3% experienced any pregnancy complication (AC) during their last pregnancy. The experience of physical IPV during pregnancy was significantly associated with the experience of MCs (adjusted odds ratio (AOR): 2.05, 95% confidence interval (CI): 1.15–4.01), OCs (AOR: 4.23, 95% CI: 2.01–7.12) and AC (AOR: 5.26, 95% CI: 2.98–10.52). Women who experienced sexual IPV during pregnancy were also at increased risk of suffering from any MC, any OC, and AC. Maternal experience of IPV during pregnancy is positively associated with pregnancy complications. Preventing IPV directed at pregnant women might reduce maternal morbidity and mortality in Bangladesh.

     

Fundamental failure to think logically about scientific questions: An illustration of tunnel vision with the application of Wason's Card Selection Test to criminal evidence

Logic and science are in some respects fundamentally different disciplines, in that for example, application of rules of logic can yield conclusions that are at odds with physical reality. Not surprisingly, people have ample difficulty with logical thinking. Nonetheless, in some instances, logical thinking can fuel empirical decision making. In the current research, it was established that applying rules of logic to a particular area of empirical decision making, that is, criminal fact finding, is indeed quite difficult (Study 1). Furthermore, the ability to think logically was found to be associated with superior evaluation of criminal evidence (Study 2). Implications of these findings are discussed.     

Salience Versus Proportional Reasoning: Rethinking the Mechanism Behind Graphical Display Effects

Two experiments examined predictions from two separate explanations for previously observed display effects for communicating low‐probability risks: foreground:background salience and proportional reasoning. According to foreground:background salience, people's risk perceptions are based on the relative salience of the foreground (number of people harmed) versus the background (number of people at risk), such that calling attention to the background makes the risk seem smaller. Conversely, the proportional reasoning explanation states that what matters is whether the respondent attends to the proportion, which conveys how small the risk is. In Experiment 1, we made the background more salient via color and bolding; in contrast to the foreground:background salience prediction, this manipulation did not influence participants' risk aversion. In Experiment 2, we separately manipulated whether the foreground and the background were displayed graphically or numerically. In keeping with the proportional reasoning hypothesis, there was an interaction whereby participants given formats that displayed the foreground and background in the same modality (graphs or numbers, thereby making the proportion easier to form) saw the probability as smaller and were less risk averse than participants given the information in different modalities. There was also a main effect of displaying the background graphically, providing some support for foreground:background salience. In total, this work suggests that the proportional reasoning account provides a good explanation of many display effects related to communicating low‐probability risks, although there is some role for foreground:background salience as well. Copyright © 2018 John Wiley & Sons, Ltd.     

Real Objects Can Impede Conditional Reasoning but Augmented Objects Do Not

In this study, Knauff and Johnson‐Laird's (2002) visual impedance hypothesis (i.e., mental representations with irrelevant visual detail can impede reasoning) is applied to the domain of external representations and diagrammatic reasoning. We show that the use of real objects and augmented real (AR) objects can control human interpretation and reasoning about conditionals. As participants made inferences (e.g., an invalid one from "if P then Q" to "P"), they also moved objects corresponding to premises. Participants who moved real objects made more invalid inferences than those who moved AR objects and those who did not manipulate objects (there was no significant difference between the last two groups). Our results showed that real objects impeded conditional reasoning, but AR objects did not. These findings are explained by the fact that real objects may over‐specify a single state that exists, while AR objects suggest multiple possibilities.