医学教育发展的困局与突破

受“大跃进”思维模式影响,我国高等教育由精英化快速过渡到大众化,医学教育呈现出急剧膨胀的发展态势,在教育理念、培养体系、办学模式、学制结构、专业设置、教育质量等方面出现了许多新情况、新问题,陷入了发展困局.面对困局必须更新教育观念,加强统筹协调,推动医学教育科学发展.     

Effects of Varying Load Conditions on the Organization of Postural Adjustments during Voluntary Arm Flexion

One purpose of the experiments reported here was to further clarify the effect of varying loads on postural adjustments. Another was to reevaluate whether or not the timing of electromyographic (EMG) activity in the postural muscle is preprogrammed. To accomplish these goals, we compared the effect of the presence or absence of prior knowledge of a load on the timing of EMG activity in the postural muscle (biceps femoris [BF]) with that in the focal muscle (anterior deltoid [AD]). Although the sequence of EMG activation was similar under conditions with and without a load, the timing of postural EMG activities (BFi, ipsilateral BF; BFc, contralateral BF) in associated postural adjustments was dependent on the force of arm movement, and the latencies of postural EMG activities (BFi—BFc) were dependent on the speed of arm movement. This indicates that EMG changes in the upper (focal muscle) and lower limbs (postural muscle) were triggered by different motor programs. Moreover, similar EMG activities were observed in postural muscles when the subject had advance knowledge of the presence or the absence of a load. Thus, this suggests that BFi may be centrally preprogrammed (anticipatory regulation) and BFc may be feedback regulated. Furthermore, environmental information may be a critical source of influence on those postural responses.     

Why We Walk the Way We Do

By using inverse dynamics and forceplate recordings, this study established the principle of oscillating systems and the influence of gravity and body parameters on the programming of the gait parameters, step frequency and length. Calculation of the ratio of the amplitude of the center of mass (CM) and the center of foot pressure (CP) oscillations yielded an equation and established a biomechanical constant, the natural body frequency (NBF). NBF appears to be an absolute invariant parameter, specific to human standing posture and gait in terrestrial gravity, which influences the relative positions of CM and CP and whose value separates the frequency bands of standing posture from those for gait. This equation was tested by using the experimental paradigm of stepping in place and then used in calculating the magnitude of CM oscillations during gait. The biomechanical analysis of the experimental observations allows one to establish the relationships between body parameters and gravity and the central programming of locomotor parameters.     

Influence of Destabilization on the Temporal Characteristics of “Volitional” Stepping

Previous work suggests that there may be fundamental differences between compensatory stepping responses evoked by postural perturbation and visually cued “volitional” stepping (e.g., gait initiation). In contrast to visual cueing, postural destabilization evokes an array of sensory inputs that are intrinsically linked to the mobilization of rapid compensatory responses. The hypothesis examined in this study was that this fundamental difference would lead to distinct changes in the temporal characteristics of the stepping response. Six healthy young adults were instructed to step quickly in response to either visual cueing or anterioposterior platform motion. Both forward and backward stepping responses were characterized, using measures of vertical ground reaction force. A stereotypical temporal patterning of the stepping response occurred in both stimulus conditions and both directions of stepping, and anticipatory postural adjustments were evident in all trials. However, postural destabilization led to a more rapid initiation and execution of the temporal pattern, in comparison with visually cued responses. The most pronounced effect was seen in the duration of the response, which was reduced by a factor of two, with approximately proportional foreshortening of both the preparatory and swing phases. The results suggest that sensory information conveying a state of instability has a distinct influence on the characteristics of a subsequent stepping reaction. The persistence of the anticipatory postural adjustments suggests that the failure to see this element of the response in previous studies may reflect fundamental differences between volitional and unplanned compensatory stepping.     

Immediate and Latent Interlimb Transfer of Gait Stability Adaptation Following Repeated Exposure to Slips

The authors trained 21 participants by using blocked-and-mixed exposure to right-side slips and then caused them to slip unexpectedly on the untrained left side. Authors retested participants with a right slip and a left slip at 1 week, 2 weeks, 1 month, and 4 months. The authors found that preslip stability on the first untrained left slip improved and was significantly greater than that on the first right slip, which probably contributed to the reduction in incidence of falls from ~30% to ~10%. Postslip stability and base of support (BOS) slip velocity were similar to those on the first right slip and much lower than those on the last right slip. Increases in pre- and postslip stabilities and BOS slip velocity during the left slip led to reductions in backward balance loss (BLOB) from ~95% on initial left slip to ~60% and to ~25% on the 1st and 3rd retest sessions, respectively. In contrast, BLOB remained at a constant ~40% level on the right slip of the same retest sessions. The results indicate a partial immediate transfer and a possible latent transfer.     

Comment on “Retention Characteristics of Motor Short-Term Memory Cues”

Marteniuk (1973) used negative results, which may be attributed to a lack of power, to question the adequacy of variable error as a measure of forgetting. He also used these negative results, along with constant error results which were consistent with the Laabs (1971, 1973) model of motor memory, to reject parts of the model related to variable error. Caution is advised when interpreting negative results and interchanging dependent measures.     

Patterns of Human Interlimb Coordination Emerge from the Properties of Non-Linear,Limit Cycle Oscillatory Processes

The present article represents an initial attempt to offer a principled solution to a fundamental problem of movement identified by Bernstein (1967), namely, how the degrees of freedom of the motor system are regulated. Conventional views of movement control focus on motor programs or closed-loop devices and have little or nothing to say on this matter. As an appropriate conceptual framework we offer Iberall and his colleagues’ physical theory of homeokinetics first elaborated for movement by Kugler, Kelso, and Turvey (1980). Homeokinetic theory characterizes biological systems as ensembles of non-linear, limit cycle oscillatory processes coupled and mutually entrained at all levels of organization. Patterns of interlimb coordination may be predicted from the properties of non-linear, limit cycle oscillators. In a set of experiments and formal demonstrations we show that cyclical, two-handed movements maintain fixed amplitude and frequency (a stable limit cycle organization) under the following conditions: (a) when brief and constantly applied load perturbations are imposed on one hand or the other, (b) regardless of the presence or absence of fixed mechanical constraints, and (c) in the face of a range of external driving frequencies from a visual source. In addition, we observe a tight phasic relationship between the hands before and after perturbations (quantified by cross-correlation techniques), a tendency of one limb to entrain the other (mutual entrainment) and that limbs cycling at different frequencies reveal non-arbitrary, sub-harmonic relationships (small integer, subharmonic entrainment). In short, all the above patterns of interlimb coordination fall out of a non-linear oscillatory design. Discussion focuses on the compatibility of these results with past and present neurobiological work, and the theoretical insights into problems of movement offered by homeokinetic physics. Among these are, we think, the beginnings of a principled solution to the degrees of freedom problem, and the tentative claim that coordination and control are emergent consequences of dynamical interactions among non-linear, limit cycle oscillatory processes.     

Strategy instruction for writing composition at school and at home

Abstract

The objectives of this study are 1) to analyze the effectiveness of a writing composition intervention program aimed to increase children's writing performance and other personal variables; 2) to analyze whether implementation in the environment (school and home) or responsible figures (parents and teachers) produced different effects in program effectiveness; and 3) to check whether increasing parental involvement in doing homework was sufficient to improve children's outcomes or whether prior family training is required to enable them to be efficient. The sample consisted of 112 students (5th-6th grade) and their families. 26 of them made up the EFP group (mothers implementing a writing program), 25 of them were assigned to the PAD group (mothers increasing help with writing homework), 35 to the PRO group (teachers applying a writing program) and 26 to the OC group (ordinary curriculum). We analyze the results and present and discuss our conclusions.     

Authors' Response to Lutzker's Evaluation

No abstract available for this article.     

The Parent Alienation Syndrome: A Family Therapy and Collaborative Systems Approach to Amelioration,by L. Gottlieb

No abstract available for this article.