Prior distributions on symmetric groups

Fully and partially ranked data arise in a variety of contexts. From a Bayesian perspective, attention has focused on distance-based models; in particular, the Mallows model and extensions thereof. In this paper, a class of prior distributions, the Binary Tree, is developed on the symmetric group. The attractive features of the class are: it provides a closed-form solution to the posterior distribution; and a simple way to interpret the parameters of the prior distribution. The advantages of the proposed method are illustrated by comparing it to metric-based models using data analyzed by other researchers in this context.This revised article was published online in August 2005 with the PDF paginated correctly.     

Behavioral adaptation to fixed-interval and fixed-time food delivery in golden hamsters

Food-deprived golden hamsters in a large enclosure received food every 30 sec contingent on lever pressing, or free while their behavior was continuously recorded in terms of an exhaustive classification of motor patterns. As with other species in other situations, behavior became organized into two main classes. One (terminal behaviors) increased in probability throughout interfood intervals; the other (interim behaviors) peaked earlier in interfood intervals. Which class an activity belonged to was independent of whether food was contingent on lever pressing. When food was omitted on some of the intervals (thwarting), the terminal activities began sooner in the next interval, and different interim activities changed in different ways. The interim activities did not appear to be schedule-induced in the usual sense. Rather, the hamsters left the area of the feeder when food was not due and engaged in activities they would normally perform in the experimental environment.     

胰腺癌综合治疗面面观

在胰腺癌的综合治疗中,手术切除是清除肿瘤负荷的最有效的局部治疗方法,但其效果会受到胰腺癌恶性行为和解剖位置的限制.从“重视全面、避免关注片面”的哲学高度,科学看待手术和其他综合治疗手段的关系和意义,有助于对胰腺癌的综合治疗有一个正确的理解,也有助于临床治疗措施的制定.本文首先对胰腺癌治疗过程的若干问题进行再思考,在此基础上再认识胰腺癌的综合治疗,最后对胰腺癌诊治发展进行展望,以期有一个相对全面的解读.     

ICU患者的浅镇静：我们追求的目标？

镇静治疗是ICU综合治疗的重要组成部分。随着ICU的发展,先后颁布了3个有关ICU患者的镇静指南,镇静治疗的理念也逐渐发生改变。2013年美国重症医学会颁布的ICU成人患者疼痛、躁动、谵妄治疗指南推荐的镇静目标为浅镇静。该指南是以大量临床研究结论为基础提出的,更具有广泛代表性和推广价值。本文从浅镇静的理论基础、具体实施方案、镇静深度的监测、镇静药物的选择以及浅镇静的局限性等方面具体阐述ICU患者浅镇静策略的相关问题,以期ICU同道能更好地理解和临床实施ICU成人患者的浅镇静策略。     

The Balance Between Providing Support,Prolonging Suffering,and Promoting Death: Ethical Issues Surrounding Psychological Treatment of a Terminally Ill Client

The concept of moral identity based on virtue ethics has become an issue of considerable import in explaining moral behavior. This attempt to offer adequate explanations of the full range of morally relevant human behavior inevitably provokes boundary issues between ethics and moral psychology. In terms of the relationship between the two disciplines, some argue for “naturalized (or psychologized) morality,” whereas, on the other hand, others insist on “moralized psychology.” This article investigates the relationship between virtue ethics and moral identity based on previous research on the relationship between ethics and moral psychology. This article especially attempts to show that meaningful links between the two concepts possible by using theoretical frameworks constructed by the most influential philosophers of science such as Kuhn and Lakatos.     

Deception,Catholicism, and Hope: Understanding Problems in the Communication of Unfavorable Prognoses in Traditionally-Catholic Countries

The doctor's use of deception in appropriate circumstances has commonly been considered a necessity of the medical art. Resistance to full and frank communication is typical of many traditionally Catholic countries, and particularly of Italy, a western country where Catholicism remains particularly influential. The Catholic teaching on truth and lies, and the problem of telling the truth to a severely ill patient is discussed. It is suggested that the contemporary Catholic model of gradually telling a terminal patient the truth, which looks reasonable and feasible in theory, is rarely followed in practice, as in the majority of cases the truth is not told tout court. Problems stem from the way in which medicine is currently practiced in Italy; from the synergism between Catholicism and the medical tradition's grounded paternalism; and from the ambiguity of the term ‘hope’. Catholic ethics in fact recommends that the truth must be told without destroying hope, but the Catholic meaning of ‘hope’ is very different from its meaning in current language.     

Consciousness lost and found: subjective experiences in an unresponsive state

Anesthetic-induced changes in the neural activity of the brain have been recently utilized as a research model to investigate the neural mechanisms of phenomenal consciousness. However, the anesthesiologic definition of consciousness as “responsiveness to the environment” seems to sidestep the possibility that an unresponsive individual may have subjective experiences. The aim of the present study was to analyze subjective reports in sessions where sedation and the loss of responsiveness were induced by dexmedetomidine, propofol, sevoflurane or xenon in a nonsurgical experimental setting. After regaining responsiveness, participants recalled subjective experiences in almost 60% of sessions. During dexmedetomidine sessions, subjective experiences were associated with shallower “depth of sedation” as measured by an electroencephalography-derived anesthesia depth monitor. Results confirm that subjective experiences may occur during clinically defined unresponsiveness, and that studies aiming to investigate phenomenal consciousness under sedative and anesthetic effects should control the subjective state of unresponsive participants with post-recovery interviews.     

Rapid acquisition of choice and timing and the provenance of the terminal-link effect

Eight pigeons responded in a concurrent-chains procedure in which terminal-link schedules changed pseudorandomly across sessions. Pairs of terminal-link delays either summed to 15 s or to 45 s. Across sessions, the location of the shorter terminal link changed according to a pseudorandom binary sequence. On some terminal links, food was withheld to obtain start and stop times, measures of temporal control. Log initial-link response ratios stabilized within the first half of each session. Log response ratio was a monotonically-increasing but nonlinear function of programmed log terminal-link immediacy ratio. There was an effect of absolute terminal-link duration on log response ratio: For most subjects, preference for the relatively shorter terminal-link delay was stronger when absolute delays were long than when absolute delays were short. Polynomial regressions and model comparison showed that differences in degree of nonlinearity, not in sensitivity to log immediacy ratio, produced this effect. Temporal control of stop times was timescale invariant with scalar variability, but temporal control of start times was not consistent across subjects or terminal-link durations.     

镇静与镇痛在ICU机械通气患者中的应用变化

探讨ICU内机械通气患者应用镇痛剂、镇静剂及肌松剂的情况及其对机械通气和预后的影响。回顾性分析我院中心ICU2006年、2007年收治的244例行有创机械通气治疗超过48h患者的临床资料,并将患者分为2006年组和2007年纽,用统计软件分析患者在年龄、性别、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、基础疾病,气管插管时间、机械通气时间、ICU住院天数、镇痛与镇静剂应用的时间、机械通气时是否使用肌松剂、Ramsay评分及病死率方面是否存在差别。统计分析显示2006年组和2007年组在年龄、性剐、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、是否使用肌松剂及基础疾病方面无差别;与2006年组相比2007年组患者气管插管时间、机械通气时间及ICU住院天数均缩短,镇痛与镇静剂应用时间均缩短,Ramsay评分降低,病死率下降。提示对机械通气的危重症患者应合理使用镇痛剂与镇静剂。     

The Nearing Death Process and Pastoral Counseling

Philosophic concepts of death are pervasive throughout all societies as shared values, differing in particulars, but similar in general. So, too, is the prospect of a death a consideration for every person, an eventual reality brought most forcefully to mind as it nears. This article explores various mindsets those who provide pastoral counseling will encounter among clients and suggest effective approaches to providing the mental and spiritual solace sought. Further, consideration is given to the psychological and spiritual mein of the pastoral counselor, and how this can affect both client and counselor.