手术前签字与人文关怀

针对临床上存在的手术前患者本人签字有违人文关怀,提出对病人的主体地位和自由权的尊重体现了人文关怀的本质;必要时病人权利让渡也是尊重病人的表现,在临床上具有可取性;医患沟通的目的是为了促进病人的健康和幸福。     

The effect of hardiness on PTSD symptoms: A prospective mediational approach

Psychological hardiness has been associated with lower PTSD in military personnel, but the processes of action remain unclear. This study uses a prospective design to examine whether hardiness has an indirect effect on PTSD symptoms through avoidance coping. Our sample included 163 Norwegian military personnel who served in international operations between 2009 and 2010. Regression analyses were performed to estimate the coefficients in a simple mediation model, with baseline PTSD symptoms, combat exposure, and deprivation of basic needs entered as control variables. The results showed that the effect of hardiness on PTSD symptoms worked through reducing the use of avoidance coping. It was concluded that an avoidant-focused coping style acts as a vulnerability factor for PTSD symptoms, whereas hardiness acts as a resilience factor against symptoms development.     

Functional analysis and treatment of problem behavior evoked by noise.

We conducted a four‐part investigation to develop methods for assessing and treating problem behavior evoked by noise. In Phase 1, 7 participants with developmental disabilities who were described as being hypersensitive to specific noises were exposed to a series of noises under controlled conditions. Results for 2 of the participants verified that noise was apparently an aversive event. In Phase 2, results of functional analyses indicated that these 2 participants' problem behaviors were maintained by escape from noise. In Phase 3, preference assessments were conducted to identify reinforcers that might be used during treatment. Finally, in Phase 4, the 2 participants' problem behaviors were successfully treated with extinction, stimulus fading, and a differential‐reinforcement‐of‐other‐behavior (DRO) contingency (only 1 participant required DRO). Treatment effects for both participants generalized to their home environments and were maintained during a follow‐up assessment. Procedures and results were discussed in terms of their relevance to the systematic assessment of noise as an establishing operation (EO) and, more generally, to the identification of idiosyncratic EO influences on behavior.     

Persistent operational synchrony within brain default-mode network and self-processing operations in healthy subjects

Based on the theoretical analysis of self-consciousness concepts, we hypothesized that the spatio-temporal pattern of functional connectivity within the default-mode network (DMN) should persist unchanged across a variety of different cognitive tasks or acts, thus being task-unrelated. This supposition is in contrast with current understanding that DMN activated when the subjects are resting and deactivated during any attention-demanding cognitive tasks. To test our proposal, we used, in retrospect, the results from our two early studies (Fingelkurts, 1998; Fingelkurts et al., 2003). In both studies for the majority of experimental trails we indeed found a constellation of operationally synchronized cortical areas (indexed as DMN) that was persistent across all studied experimental conditions in all subjects. Furthermore, we found three major elements comprising this DMN: two symmetrical occipito-parieto-temporal and one frontal spatio-temporal patterns. This new data directly supports the notion that DMN has a specific functional connotation - it provides neurophysiologic basis for self-processing operations, namely first-person perspective taking and an experience of agency.     

NONCONTINGENT REINFORCEMENT: A FURTHER EXAMINATION OF SCHEDULE EFFECTS DURING TREATMENT

We conducted 2 studies to determine whether dense and thin NCR schedules exert different influences over behavior and whether these influences change as dense schedules are thinned. In Study 1, we observed that thin as well as dense NCR schedules effectively decreased problem behavior exhibited by 3 individuals. In Study 2, we compared the effects of 2 NCR schedules in multielement designs, one with and the other without an extinction (EXT) component, while both schedules were thinned. Problem behavior remained low as the NCR schedule with EXT was thinned, but either (a) did not decrease initially or (b) subsequently increased as the NCR schedule without EXT was thinned. These results suggest that dense schedules of NCR decrease behavior by altering its motivating operation but that extinction occurs as the NCR schedule is thinned. The benefits and limitations of using dense or thin NCR schedules are discussed.     

Effects of a motivating operation manipulation on the maintenance of mands

We assessed the maintenance of newly acquired mands under presession reinforcer access (reinforcer efficacy abolished) and no presession reinforcer access (reinforcer efficacy established) conditions with 3 children with autism spectrum disorder. Results suggested that the no presession access condition established the value of the reinforcer and evoked responding relative to the presession access condition. Results are discussed in the context of implications for assessing maintenance of previously acquired skills.     

An assessment of antecedent events influencing noncompliance in an outpatient clinic

Several studies have shown that various factors can influence noncompliance, including task novelty, rate of presentation, and task preference. This study examined the impact of selected antecedent variables on noncompliance in an outpatient clinic setting. In two experiments involving 6 typically developing children, the consequences for noncompliance remained constant. During Experiment 1, demands that included noncontingent access to adult attention were contrasted with the same demands that did not include attention within a multielement design. In Experiment 2, demands were altered by decreasing the difficulty or amount of work or providing access to attention. In both experiments, results indicated idiosyncratic responses to the manipulated variables, with decreases in noncompliance observed following introduction of one or more antecedent variables with 5 of the 6 participants. These results suggested that noncompliance can be reduced via changes in antecedent variables, including adding potential positive reinforcers to the task situation, and that it is possible to probe variables that alter noncompliance in an outpatient clinic setting.     

The challenge of characterizing operations in the mechanisms underlying behavior

Neuroscience and cognitive science seek to explain behavioral regularities in terms of underlying mechanisms. An important element of a mechanistic explanation is a characterization of the operations of the parts of the mechanism. The challenge in characterizing such operations is illustrated by an example from the history of physiological chemistry in which some investigators tried to characterize the internal operations in the same terms as the overall physiological system while others appealed to elemental chemistry. In order for biochemistry to become successful, researchers had to identify a new level of operations involving operations over molecular groups. Existing attempts at mechanistic explanation of behavior are in a situation comparable to earlier approaches to physiological chemistry, drawing their inspiration either from overall psychology activities or from low-level neural processes. Successful mechanistic explanations of behavior require the discovery of the appropriate component operations. Such discovery is a daunting challenge but one on which success will be beneficial to both behavioral scientists and cognitive and neuroscientists.