中医药临床实践的价值

把现代病因病理医学作为参照物,通过比较,指出中医的证是病人的全身综合反应状态,是病因病理医学之外的另外一个临床医学范畴。状态与病因病理是人类疾病的两个不同方面。从单纯状态病,西医难治和不治的疾病,常见病的治疗,中医药的近期疗效和远期疗效等方面阐述了中医药的临床价值。     

An accumulator model for responses and response times in tests based on the proportional hazards model

Latent trait models for responses and response times in tests often lack a substantial interpretation in terms of a cognitive process model. This is a drawback because process models are helpful in clarifying the meaning of the latent traits. In the present paper, a new model for responses and response times in tests is presented. The model is based on the proportional hazards model for competing risks. Two processes are assumed, one reflecting the increase in knowledge and the second the tendency to discontinue. The processes can be characterized by two proportional hazards models whose baseline hazard functions correspond to the temporary increase in knowledge and discouragement. The model can be calibrated with marginal maximum likelihood estimation and an application of the ECM algorithm. Two tests of model fit are proposed. The amenability of the proposed approaches to model calibration and model evaluation is demonstrated in a simulation study. Finally, the model is used for the analysis of two empirical data sets.     

Semi‐parametric proportional hazards models with crossed random effects for psychometric response times

The semi‐parametric proportional hazards model with crossed random effects has two important characteristics: it avoids explicit specification of the response time distribution by using semi‐parametric models, and it captures heterogeneity that is due to subjects and items. The proposed model has a proportionality parameter for the speed of each test taker, for the time intensity of each item, and for subject or item characteristics of interest. It is shown how all these parameters can be estimated by Markov chain Monte Carlo methods (Gibbs sampling). The performance of the estimation procedure is assessed with simulations and the model is further illustrated with the analysis of response times from a visual recognition task.     

Church Attendance,Problems of Measurement,and Interpreting Indicators: A Study of Religious Practice in the United States, 1975–2010

Church attendance is usually measured in surveys by asking a direct question about frequency of churchgoing over a preset period of time, which is typically a year. Different studies have cast doubt over the validity of this indicator as it tends to overestimate actual attendance to a significant degree. The aim of this article is to compare data on church attendance provided by two different types of research conducted in the United States between 1975 and 2010: survey data (GSS) and data obtained from time use surveys (ATUS). This comparison has three main objectives: (1) to confirm the hypothesis that survey data tend to overestimate actual attendance; (2) to show that this overestimation is not constant over time and space, but tends to vary in an erratic and unpredictable way; and (3) to demonstrate that data provided by time use surveys are more reliable than the frequencies of churchgoing provided by traditional surveys when the objective is to identify trends in religiosity in a population.     

Response-repetition effects depend on motor set: Evidence for anatomical coding in response selection

Successful motor performance requires a process of response selection that chooses the correct response out of a set of possible ones. Most theories of response selection assume that this selection process operates on spatial codes, which define the location of stimuli and responses in environmental coordinates, with little or no role for the anatomical codes of the effectors involved. In this study, we tested this assumption by investigating response-repetition effects in a response-cuing paradigm using two motor sets (fingers on one hand vs. fingers on two hands). Reaction time results demonstrated a robust response-repetition benefit that was greater for the one-hand set than for the two-hands set. Furthermore, with the one-hand set the repetition benefit was independent of cue type and cue-stimulus interval on the previous trial, whereas with the two-hands set it was strongly modulated by these two factors. These differential response-repetition effects for one- and two-hands motor sets demonstrate the important role of the neuro-anatomical hand distinction in response selection, thereby supporting multiple coding notions.     

Dynamic Social Networks in Recovery Homes

Acute treatment aftercare in the form of sober living environments—i.e., recovery houses—provide an inexpensive and effective medium-term treatment alternative for many with substance use disorders. Limited evidence suggests that house-situated social relationships and associated social support are critical determinants of how successful these residential experiences are for their members, but little is known about the mechanisms underlying these relationships. This study explored the feasibility of using dynamic social network modeling to understand house-situated longitudinal associations among individual Alcoholics Anonymous related recovery behaviors, length of residence, dyadic interpersonal trust, and dyadic confidant relationship formation processes. Trust and confidant relationships were measured 3 months apart in U.S. urban-area recovery houses, all of which were part of a network of substance use recovery homes. A stochastic actor-based model was successfully estimated from this data set. Results suggest that confidant relationships are predicted by trust, while trust is affected by recovery behaviors and length of residence. Conceptualizing recovery houses as a set of independent, evolving social networks that can be modeled jointly appears to be a promising direction for research.     

Parentification and Alcohol Use: Conditional Effects of Religious Service Attendance

This study tested a model of the relation between parentification and alcohol use through differentiation of self (DoS), with religious service attendance as a moderator. Results provided mixed support for the model. Perceived unfair parentification was associated with decreased DoS, and lowered DoS corresponded to increased alcohol use. Religious service attendance moderated the association between increased perceived unfairness and increased alcohol use. Implications for practice focused on assessing perceived unfairness and integrating clients’ religiousness.     

医学伦理审查如何适应转化医学的要求

随着转化医学的兴起,医学伦理审查面临前所未有的机遇与挑战.如何使医学伦理审查工作更好地适应转化医学发展的需要,提高审查质量,成为亟需解决的问题.在分析当前我国医学伦理审查工作现状和主要问题的基础上,进一步探讨了可行的解决方法,如进一步明确和强化管理部门服务功能、保证伦理委员会成员多样性和重视伦理审查多视角、强化伦理委员会后续跟踪审查、规范伦理审查委员的培训与继续教育等,为我国医学伦理审查工作的规范化发展和医学伦理审查质量的进一步提高提供参考.     

肺癌治疗中辨证论治与循证医学的矛盾与统一

肺癌的个体化治疗是依托于循证医学和飞速发展的分子生物学技术开启的西医治疗的新篇章,但同时也面临着很多困境。而中医辨证论治思想在朴素哲学思想的启领下,早已体现了个体化治疗的灵魂。笔者融合辨证论治思想,现代循证医学证据,提出了肺癌中西医治疗新的概念,从个体差异的绝对性出发,论述了辨证思想与循证医学共存的必然性及两者之间的矛盾。循证医学的结论可通过对大量个体化辨证治疗的研究而不断更新,从而更好地指导辨证治疗,这是未来中西医临床肺癌诊疗的必经之路。     

大数据时代背景下的医学思考*--转化医学新趋势前瞻

作为21世纪最具活力的医学发展模式,转化医学为基础和临床构建了交流沟通的高效平台,当前正朝着多学科、多领域、多系统的方向迈进。随着信息技术与生命科学的交叉融合,生物医学已经迈入大数据时代。大数据既保证了医学实践的深度,有深度才能洞悉本质;又保证了医学实践的高度,有高度才能总揽全局。因此,大数据的出现为深陷还原论泥潭的现代医学提供了有效的解决途径。大数据浪潮对医学基础研究和医疗实践的深远影响,必将为转化医学发展带来新的发展机遇。