医学人文科学的研究对象与方法论

医学人文科学要作为独立的学科门类,就必须有自己独特的研究对象和研究方法.研究对象不清和方法论不明是当今中国医学人文科学研究的基础性问题.笔者认为,人文科学的核心问题是那些与价值相关的主体间的关系、对话和对文本的理解与解释.澄清人文科学的研究对象与方法论,有助于我们明白临床上医疗纠纷的根蒂和中西医论争中的困惑.     

Developing an efficient clinical information system for a comprehensive psychiatric institute: I. Principles,design, and organization

The principles, design considerations, and components of a clinical information system intended to support and enhance the patient care, educational, and research missions of a comprehensive psychiatric institute are presented. Major characteristics of the system are its emphases on efficiency, simplicity, and intensive user involvement throughout the development of the system.     

Intrusion patterns in rapid serial visual presentation tasks with two response dimensions

A rapid serial visual presentation (RSVP) paradigm using both one and two response dimensions was used to test parallel processing models of stimulus dimensions. Fifty subjects were asked to report the identity and/or color of a target uppercase word inserted in a series of lowercase words. The results produced a predominance of posttarget intrusions for color responses and a predominance of pretarget intrusions for identity responses. The requirement of a response to a second dimension impaired hit rates but did not change the pattern of intrusions. An examination of the distributions of intrusions in each response dimension as a function of the response given to the other dimension showed an unexpectedly high percentage of simultaneous hits, a moderate covariation between both responses, and the same patterns of intrusions when compared with the general distributions. While these results seem to be compatible with parallel models of processing for stimulus dimensions, two modifications to this model are suggested. First, the processing of response dimension(s) needs some attentional resources. Second, provision for a mixed model is indicated, which would include trials where no illusory conjunctions are formed.     

Neighborhood frequency effects and letter visibility in visual word recognition

Two experiments are described that measured lexical decision latencies and errors to five-letter French words with a single higher frequency orthographic neighbor and control words with no higher frequency neighbors. The higher frequency neighbor differed from the stimulus word by either the second letter (e.g.,astre-autre) or the fourth letter (chope-chose). Neighborhood frequency effects were found to interact with this factor, and significant interference was observed only tochope-type words. The effects of neighborhood frequency were also found to interact with the position of initial fixation in the stimulus word (either the second letter or the fourth letter). Interference was greatly reduced when the initial fixation was on the critical disambiguating letter (i.e., the letterp inchope). Moreover, word recognition was improved when subjects initially fixated the second letter relative to when they initially fixated the fourth letter of a five-letter word, but this second-letter advantage practically disappeared when the stimulus differed from a more frequent word by its fourth letter. The results are interpreted in terms of the interaction between visual and lexical factors in visual word recognition.     

Phoneme monitoring and lexical processing: Evidence for associative context effects

In this paper, we propose a new version of the phoneme monitoring task that is well-suited for the study of lexical processing. The generalized phoneme monitoring (GPM) task, in which subjects detect target phonemes appearing anywhere in the test words, was shown to be sensitive to associative context effects. In Experiment 1, using the standard phoneme monitoring procedure in which subjects detect only word-initial targets, no effect of associative context was obtained. In contrast, clear context effects were observed in Experiment 2, which used the GPM task. Subjects responded faster to word-initial and word-medial targets when the target-bearing words were preceded by an associatively related word than when preceded by an unrelated one. The differential effect of context in the two versions of the phoneme monitoring task was interpreted with reference to task demands and their role in directing selective attention. Experiment 3 showed that the size of the context effect was unaffected by the proportion of related words in the experiment, suggesting that the observed effects were not due to subject strategies.     

Response to commentaries on “A neurobiological model for near-death experiences”

This work has received financial support from FONDECYT (Project 1111-88). The authors also acknowledge the helpful comments of Dr. Bruce Cassels.     

自闭症谱系障碍社交动机理论：机制及干预探索

自闭症谱系障碍(Autism Spectrum Disorder, ASD)表现为社会交往困难以及重复刻板兴趣或行为。社交动机理论提出ASD个体是由于社交动机缺乏导致的社交障碍。目前该理论缺乏理论元素及结构关系的系统论证, 及基于此理论的低龄ASD儿童群体的研究证据。本研究拟采用心理实验法、眼动及近红外脑成像技术, 探索低龄ASD儿童早期社交奖赏、社交定向异常眼动标记及眶额叶脑区活动的神经机制。此外, 通过音乐奖赏强化学习的干预方式改善该理论的核心元素(社交奖赏), 观测能否改善ASD儿童的社交动机。本研究的开展有望对该理论进行系统验证, 并形成改善社交行为的潜在干预方案。     

Irrelevant behaviour,information processing and arousal homeostasis

Summary This paper expands a new hypothesis on the causal mechanisms underlying irrelevant behaviour. It begins with a critical summary of earlier theories which attempted to explain displacement activities, but failed to predict the consistency with which certain types of behaviour are shown in stressful situations by a variety of species. Behavioural and physiological studies suggest that these behaviour patterns are closely associated with the incipient activation of sleep. The functional significance of this link and some of the causal processes which may be responsible for it are discussed. Paradoxically, however, displacement activities occur when animals are in a state of high arousal. The concept of arousal is reconsidered in the light of information theory and assumed to be closely correlated with the information processing rate in the nervous system. The relationships between neural and autonomic arousal are considered in this context. It is argued that over-arousal may occur when information handling exceeds the limited channel capacity of the system, with a consequent loss of efficiency. It is pointed out that there are mechanisms capable of controlling the information influx into the brain, and it is hypothesized that they are tied up in a feedback mechanism which regulates arousal and which involves the activation of a de-arousal system, corresponding to the neurological sleep mechanism. Displacement activities are viewed as consequences of this regulatory activation of the sleep system. This hypothesis is then compared with existing theories of displacement and its relationship with them is discussed.

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Zusammenfassung Die Arbeit erweitert eine neue Hypothese über die kausalen Mechanismen, die dem übersprungverhalten zugrunde liegen. Sie beginnt mit einer kritischen Übersicht der früher vorgeschlagenen Theorien und zeigt auf, daß diese nicht die Beständigkeit, mit der gewisse Verhaltensweisen von einer Anzahl von Tierarten in Stress-Situationen gezeigt werden, erklären. Verhaltens- und physiologische Studien deuten an, daß diese Verhaltensweisen in einem engen Zusammenhang mit einer partiellen Schlafaktivierung stehen. Die funktionelle Bedeutung dieses Zusammenhanges und die möglichen physiologischen Mechanismen, die dafür verantwortlich sein könnten, werden diskutiert. Paradoxerweise werden aber Übersprungsverhalten dann gezeigt, wenn sich Tiere in einem gesteigerten Wachzustand befinden. In diesem Zusammenhang wird das Arousal-Konzept im Lichte der Informationstheorie neu beleuchtet und es wird angenommen, daß der Arousal-Zustand eines Tieres im engen Zusammenhang mit der jeweiligen Informationsverarbeitungsrate im Nervensystem steht. Die Verhältnisse zwischen neuralem und autonomischen Arousal werden diskutiert. Es wird vorgeschlagen, daß sich Überarousal dann einstellt, wenn die Informationsverarbeitungsrate die Kanalkapazität des Systems übersteigt mit einem sich daraus ergebenen Wirkungsgradverlust. Es wird darauf hingewiesen, daß es Mechanismen gibt, die den Informationsfluß in das Gehirn regeln und angenommen, daß diese innerhalb eines Rückkopplungssystems funktionieren, welches Arousal reguliert. Diese Regelung benötigt die Aktivierung eines Arousal herabsetzenden Systems, das in den neurologischen Schlafmechanismen besteht. Das Auftreten von Übersprungsverhalten wird als eine Konsequenz dieser regulatorischen Aktivierung des Schlafsystems angesehen. Die Hypothese wird dann mit den vorhandenen Übersprungsverhaltenstheorien verglichen.

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The research underlying this paper has been supported by grants from the U.S. Air Force Office of Scientific Research through the European Office of Aerospace Research, the Science Research Council and the Royal Society to Professor N. Tinbergen, F. R. S. and myself. It was partly carried out at the Department of Zoology, Oxford. I am grateful to Dr. S. A. Hillyard who by revising an earlier version contributed much to whatever merits this paper has.