明清文本对痨病病人社会形象的建构

痨病作为一种慢性传染性疾病,其在明清时的社会形象不仅与今日不同,且在不同文本中的形象亦有差别。既有辛劳过度、内心抑郁难解、感情忠贞不二等正面形象,又有会传染给他人、需要常年被照顾、纵欲过度等负面形象。明清医学认为痨病的病因多样,且痨病的传染性有其独特的传染逻辑,使得多样的痨病病人形象成为可能。通过对明清不同文本中痨病病人形象的解构,认为书写者在书写文本时,自由选择了更能凸显其书写目的的痨病病人形象。这也启示我们,今日应当破除笼罩在病人周围的重重意义之网,关心病人的疾痛和体验。

     

慢性乙型肝炎的联合抗病毒治疗可以降低核苷类药物的耐药率

慢性乙型肝炎是一种很难治愈的疾病，需要长期治疗以抑制病毒的复制，改善预后。现有的核苷（酸）类药物有较强的抗病毒效果，但在长期治疗过程中，容易发生病毒的耐药突变。多种药物的联合治疗可有效降低核苷（酸）类药物的耐药率，有助于长期治疗。     

Resistance to change and preference for variable versus fixed response sequences

In Experiment 1, 4 pigeons were trained on a multiple chain schedule in which the initial link was a variable-interval (VI) 20-s schedule signalled by a red or green center key, and terminal links required four responses made to the left (L) and/or right (R) keys. In the REPEAT component, signalled by red keylights, only LRLR terminal-link response sequences were reinforced, while in the VARY component, signalled by green keylights, terminal-link response sequences were reinforced if they satisfied a variability criterion. The reinforcer rate for both components was equated by adjusting the reinforcer probability for correct REPEAT sequences across sessions. Results showed that initial- and terminal-link responding in the VARY component was generally more resistant to prefeeding, extinction, and response-independent food than responding in the REPEAT component. In Experiment 2, the REPEAT and VARY contingencies were arranged as terminal links of a concurrent chain and the relative reinforcer rate was manipulated across conditions. For all pigeons, initial-link response allocation was biased toward the alternative associated with the VARY terminal link. These results replicate previous reports that operant variation is more resistant to change than operant repetition (Doughty & Lattal, 2001), and show that variation is preferred to repetition with reinforcer-related variables controlled. Behavioral momentum theory (Nevin & Grace, 2000) predicts the covariation of preference and resistance to change in Experiments 1 and 2, but does not explain why these aspects of behavior should depend on contingencies that require repetition or variation.     

REINFORCER MAGNITUDE ATTENUATES: APOMORPHINE'S EFFECTS ON OPERANT PECKING

When given to pigeons, the direct‐acting dopamine agonist apomorphine elicits pecking. The response has been likened to foraging pecking because it bears remarkable similarity to foraging behavior, and it is enhanced by food deprivation. On the other hand, other data suggest the response is not related to foraging behavior and may even interfere with food ingestion. Although elicited pecking interferes with food capture, it may selectively alter procurement phases of feeding, which can be isolated in operant preparations. To explore the relation between operant and elicited pecking, we provided pigeons the opportunity to earn different reinforcer magnitudes during experimental sessions. During signaled components, each of 4 pigeons could earn 2‐, 4‐, or 8‐s access to grain for a single peck made at the end of a 5‐min interval. In general, responding increased as a function of reinforcer magnitude. Apomorphine increased pecking for 2 pigeons and decreased pecking for the other 2. In both cases, apomorphine was more potent under the component providing the smallest reinforcer magnitude. Analysis of the pattern of pecking across the interval indicated that behavior lost its temporal organization as dose increased. Because apomorphine‐induced pecking varied inversely with reinforcer magnitude, we conclude that elicited pecks are not functionally related to food procurement. The data are consistent with the literature on behavioral resistance to change and suggest that the effects of apomorphine may be modulated by prevailing stimulus—reinforcer relationships.     

The Tao of Creating Sacred Relationships

SUMMARY

This article articulates the major premises of Sheldon Z. Kramer's book, Transforming the Inner and Outer Family: Humanistic and Spiritual Approaches to the Mind-Body Systems Therapy(The Haworth Press, Inc., 1995). This overview briefly introduces and explains the power of meditation in psychotherapy, meditation and the use of the body, creating congruent communication, working with incongruence in couples and bridging the inner and outer couple.     

The predictive capacity of self-reported motivation vs. early observed motivational language in cognitive behavioural therapy for generalized anxiety disorder

ABSTRACT

Client motivation to change is often considered a key factor in psychotherapy. To date, research on this client construct has largely relied on self-report, which is prone to response bias and ceiling effects. Moreover, self-reported motivation has been inconsistently related to treatment outcome. Early observed client in-session language may be a more valid measure of initial motivation and thus a promising predictor of outcome. The predictive ability of motivational factors has been examined in addiction treatment but has been limited in other populations. Addressing this lack, the present study investigated 85 clients undergoing cognitive behavioural therapy (CBT) alone and CBT infused with motivational interviewing (MI-CBT) for severe generalized anxiety disorder. There were two aims: (1) to compare the predictive capacity of motivational language vs. two self-report measures of motivation on worry reduction and (2) to examine the influence of treatment condition on motivational language. Findings indicated that motivational language explained up to 35% of outcome variance, event 1-year post-treatment. Self-reported motivation did not predict treatment outcome. Moreover, MI-CBT was associated with a significant decrease in the most detrimental type of motivational language compared to CBT alone. These findings support the importance of attending to in-session motivational language in CBT and learning to respond to these markers using motivational interviewing.     

“THE PROMISE” in patients and in Ibsen's “A Doll's House”

Some people are possessed by a need for, and an inordinate intensity of narcissistic promise. The prospect of entitlement can be conscious or unconscious. Being made happy (and being rescued from difficulties) is expected to be guaranteed and brought about by a current psychic representation (imago) of a parental figure from early childhood. This kind of symbiotic tie is illustrated by clinical material from a patient, and by two heroines of Ibsen's plays: Nora, from The Doll's House, and Hedda Gabler, from the play of the same name. The three women have different reactions to the non-fulfillment of what the patient called “THE PROMISE.”     

When Suspicious Minds Go Political: Distrusting and Justifying the System at the Same Time

Drawing on the sensitivity to mean intentions model, we hypothesized that sensitivity to injustice from a victim's perspective (victim sensitivity) is negatively related to the acceptance of political reforms due to an inclination to attribute ulterior motives to policy makers. In Study 1 with a Canadian sample, initial evidence for this mediational model was obtained, as victim sensitivity uniquely predicted distrust of policy makers through general trait suspiciousness. In Study 2, victim‐sensitive Austrians and Germans ascribed sinister motives to initiators of an economic reform when contextual cues of initiators' untrustworthiness were given. This situational suspiciousness led them to subsequently oppose this particular reform, and it even generalized to the whole economic system by reducing economic‐system justification. However, in both studies, mutually suppressive tendencies toward both opposing and justifying the system occurred. This suggests that victim‐sensitive individuals may be torn between distrusting and endorsing the system because it can not only victimize but also promote a sense of security from victimization by conferring order.     

初治肺结核患者服药依从性的相关因素分析

为了了解初治肺结核患者服药依从性状况及影响因素,采用分层整群随机抽样方法抽取样本,利用自制调查表和Morisky依从性量表获取数据信息,并用SPSS 16.0软件进行统计分析.参与调查的578例初治肺结核患者中,依从性低组为194例,占33.6％,依从性正常组为384例,占66.4％.影响服药依从性的主要因素为职业、治疗时期、生活满意度、病情严重程度等（P＜0.05）.可见初治肺结核患者不规则服药受多方面因素影响,应加强各方督导,提高服药依从性.