医疗机构单病种限价面面观

单病种限价收费是医院经营的一种管理模式,是指在临床诊疗收费中,对单一病种病人限定最高费用的做法,是医院的一种自发行为。这在一定程度上解决了群众看病难、看病贵的问题,缓解了社会医疗费用过度增长的压力,有助于医疗机构收费更趋于合理化。拟从社会的各个层面对医疗机构单病种限价问题进行深入地探讨。     

Randomization tests as alternative analysis methods for behavior‐analytic data

Randomization statistics offer alternatives to many of the statistical methods commonly used in behavior analysis and the psychological sciences, more generally. These methods are more flexible than conventional parametric and nonparametric statistical techniques in that they make no assumptions about the underlying distribution of outcome variables, are relatively robust when applied to small‐n data sets, and are generally applicable to between‐groups, within‐subjects, mixed, and single‐case research designs. In the present article, we first will provide a historical overview of randomization methods. Next, we will discuss the properties of randomization statistics that may make them particularly well suited for analysis of behavior‐analytic data. We will introduce readers to the major assumptions that undergird randomization methods, as well as some practical and computational considerations for their application. Finally, we will demonstrate how randomization statistics may be calculated for mixed and single‐case research designs. Throughout, we will direct readers toward resources that they may find useful in developing randomization tests for their own data.     

Studies of wheel-running reinforcement: parameters of Herrnstein's (1970) response-strength equation vary with schedule order

Six male Wistar rats were exposed to different orders of reinforcement schedules to investigate if estimates from Herrnstein's (1970) single-operant matching law equation would vary systematically with schedule order. Reinforcement schedules were arranged in orders of increasing and decreasing reinforcement rate. Subsequently, all rats were exposed to a single reinforcement schedule within a session to determine within-session changes in responding. For each condition, the operant was lever pressing and the reinforcing consequence was the opportunity to run for 15 s. Estimates of k and R(O) were higher when reinforcement schedules were arranged in order of increasing reinforcement rate. Within a session on a single reinforcement schedule, response rates increased between the beginning and the end of a session. A positive correlation between the difference in parameters between schedule orders and the difference in response rates within a session suggests that the within-session change in response rates may be related to the difference in the asymptotes. These results call into question the validity of parameter estimates from Herrnstein's (1970) equation when reinforcer efficacy changes within a session.     

Genetic polymorphisms of alcohol-metabolizing enzymes and their association with alcoholism risk,personality and anthropometric traits among Malaysian university students

Three single nucleotide polymorphisms (SNPs) in alcohol-metabolizing genes – ADH1B (Arg47His), ADH1C (Ile350Val) and ALDH2 (Glu504Lys) have been extensively associated with flush reaction and alcoholism. Therefore, we investigated the association of these three SNPs with alcohol-induced reactions (AIRs), alcoholism risk, personality and anthropometric traits among Malaysian university students. AIRs, Self-Rating of the Effects of Alcohol (SRE) and Ten-Item Personality were surveyed, anthropometric measurements and DNA samples were taken. Among 264 valid drinkers (111 males, 153 females; 229 ethnic Chinese, 35 ethnic Indians), the minor allele frequencies for ADH1B, ADH1C, ALDH2 among Chinese/Indians were .45/.07, .33/.40, .32/.41, respectively; distribution of ADH1B alleles significantly different between ethnicities. Current/former experiences of flushing, hives, heart palpitations after alcohol consumption; and sleepiness, headache reactions, early and overall SRE were significantly different between ethnicities and genders, respectively. Overall SRE score was associated with ADH1C and ALDH2 alleles. ‘Openness to Experiences’ was associated with ALDH2 genotypes and alleles; Glu/Glu or Glu carriers showed significantly higher means. ADH1B Arg/Arg and Arg carriers showed significantly higher total body and subcutaneous fats but association was abolished after controlling for ethnicity. In conclusion, gender and ethnicity, but not alcohol-metabolizing gene variants, play a role in influencing the manifestation of AIRs.     

An evaluation of the agreement between the conservative dual‐criterion method and expert visual analysis

The conservative dual‐criterion (CDC) method was developed to standardize the analysis of single‐subject experimental designs data, but to date its accuracy has been evaluated only by comparing results to the statistical parameters of graphs. Our study investigated agreement between expert visual analysts and the CDC method on 66 AB tiers from published multiple baseline graphs. We found strong agreement between the two methods for certain types of graphs and discuss implications of the findings and areas for future research.     

Does a rat free a trapped rat due to empathy or for sociality?

This report evaluates whether a rat releasing a trapped rat from a restraint tube is better explained as due to its empathic motivation or to the pursuit of social contact. In the first condition, each of six rats chose in an E maze between entering an empty goal box versus entering a goal box where its entrance caused a rat trapped in a restraint tube to be released. Rats preferred the goal box with the trapped rat over the empty goal box. In the second condition, these rats chose between releasing a restraint‐tube‐trapped rat in one goal box and another rat in the second goal box that was not locked into its restraint tube. Rats showed no preference between alternatives. In the third condition, rats chose between a goal box containing a rat with an open restraint tube and an empty goal box. Rats preferred the rat with the open restraint tube over the empty goal box. These results support attributing the response of releasing a rat from a restraint tube to the reinforcing power of social contact rather than interpreting this response as empathically motivated.     

African American Single Mothers and Children in Context: A Review of Studies on Risk and Resilience

This paper presents a comprehensive review of research linking single-parent family structure to parenting processes, maternal well-being, and child developmental outcomes among African Americans. The approaches used to study these families, related methodological and conceptual concerns, and the factors linked to maternal well-being, effective parenting processes, family functioning, and child outcomes are addressed. Much work remains to be done on conceptualizing and assessing parenting processes among African Americans in general and single African American mothers in particular. Researchers must examine more carefully the circumstances that foster or impede successful parenting among these mothers. Studies also are needed to disentangle the interactions between economic stress and parenting behavior and to determine the extent to which the findings can be applied to middle-income single African American parents.     

Relationship quality and accuracy of detecting a romantic partner's fear of being single

How attuned are romantic partners to each other’s fear of being single, and is accuracy associated with relationship quality? In this study, 104 couples reported their fear of being single, perceptions of their partner’s fear of being single, and relationship quality. Partners had significant accuracy when judging fear of being single, but a tendency toward overestimation. Partners also were not systematically similar and did not project their own fears onto partners. Tracking accuracy was positively associated with some aspects of the perceiver’s relationship quality, but not with the target’s relationship quality. Mean-level bias was largely unassociated with relationship quality for the perceiver or target, except for lower investment from the target when the perceiver over-estimated their fear of being single.     

GOD, WAR, AND CONSCIENCE

Many military officers believe that they morally ought to obey legal orders to fight even in unjust wars: they have a moral obligation to exercise indiscriminate obedience to legal orders to fight. I argue that officers should not be required to exercise indiscriminate obedience: certain theistic commitments to which many citizens and officers adhere prohibit indiscriminate obedience to legal orders to fight. This theistic argument constitutes adequate reason not to require officers to exercise indiscriminate obedience. However, this raises a further question: namely, whether it is appropriate to rely on such a theistic argument when shaping the moral requirements of military officership. I argue that citizens and officers have good reason to make public decisions solely on religious grounds and so are free to follow my theistic argument when shaping the requirements of military officership.     

"Without being in psychoanalysis I would never have dared to become pregnant": psychoanalytical observations in a multidisciplinary study concerning a woman undergoing prenatal diagnostics

As is well known, Freud described the clinical practice of psychoanalysis as the 'loam' of his cultural-theoretical work, an assessment which is shared by many psychoanalysts up to the present, including the authors of this paper. The complex interplay between unconscious phantasies on the one hand, and the real experiences arising from the new possibilities opened up by prenatal diagnostics on the other, is described with reference to a report of an intensive, long psychoanalysis with an analysand from a family burdened with a genetically transmitted illness (haemophilia). The holding and containing function of the analyst enabled this analysand, despite traumatic experiences with the miscarriage of a healthy child triggered by a prenatal diagnosis and the later abortion of a haemophiliac baby, nevertheless to have the courage to go through another pregnancy and give birth to a healthy girl. The intensive clinical investigation of the unconscious phantasies, conflicts and traumas around the prenatal diagnostics proved to be not only therapeutically fruitful for the analysand, Ms F. It also facilitated insights into those individual chances and risks which appear to be an integral part of the opportunities presented by todays prenatal diagnostics and, through them, it lead to a cultural-critical look at the ambivalence of medical-technical progress. These insights, which are only attainable through psychoanalysis, can represent a distinctive contribution of psychoanalysis to a multi-disciplinary dialogue with medical practitioners, geneticists, ethicists and health policy-makers. By referring to a large EU study on 'Ethical Dilemmas due to Prenatal and Genetic Diagnostics', this paper gives a practical example of such a discussion. Ms F. was psychoanalytically interviewed as part of this study, 16 years after the conclusion of her analysis. The summary of these interviews, which is set against the account of the treatment, offers an impressive insight not only into the long-term effects of a psychoanalysis under very particular personal circumstances, but also into the lasting consequences of decisions made in the context of prenatal diagnostics. Finally, the results of the individual case study are brought together with the clinical outcomes of the EU study, and some considerations are formulated concerning the protective and risk factors facing women during and after prenatal diagnostics. The paper is an appeal to psychoanalysts, with their specific competence in dealing with unconscious phantasies and conflicts and their high level of professionalism in dealing with traumatised patients, to get involved in fresh dialogue with prenatal diagnosticians and their patients.