婴儿抚触研究进展

从婴儿抚触的概念、生理机制、作用、要求、方法、影响实施的因素等多个方面，综述了婴儿抚触的研究进展。     

Multiple types of motives don't multiply the motivation of West Point cadets

Although people often assume that multiple motives for doing something will be more powerful and effective than a single motive, research suggests that different types of motives for the same action sometimes compete. More specifically, research suggests that instrumental motives, which are extrinsic to the activities at hand, can weaken internal motives, which are intrinsic to the activities at hand. We tested whether holding both instrumental and internal motives yields negative outcomes in a field context in which various motives occur naturally and long-term educational and career outcomes are at stake. We assessed the impact of the motives of over 10,000 West Point cadets over the period of a decade on whether they would become commissioned officers, extend their officer service beyond the minimum required period, and be selected for early career promotions. For each outcome, motivation internal to military service itself predicted positive outcomes; a relationship that was negatively affected when instrumental motives were also in evidence. These results suggest that holding multiple motives damages persistence and performance in educational and occupational contexts over long periods of time.Philosophers and psychologists have long distinguished among various types of motives to engage in particular activities. Some motives are internal or intrinsic to the activities themselves. The artist is motivated to create a great painting. The scientist is motivated to produce a major discovery. The gardener is motivated to grow a bountiful garden. In each case, the desired consequence matters; the artist, the scientist, and the gardener are not just dabbling. In each case, the activities leading to that consequence may involve hardship and struggle. And in each case, the desired outcome is intimately, intrinsically connected to the activity itself. The artist will not hire someone else to make the painting, nor will the gardener hire someone else to create a beautiful garden. In contrast to these kinds of internal motives, people are often guided by what might be called instrumental motives, where the relation between the motive and the activity is largely arbitrary (i.e., the motive bears no intrinsic relation to the activity itself). The scientist may want to earn a good salary, to get promoted, and to win awards. Whereas there are many paths to high salaries, promotions, and recognition, there is only one path to scientific discovery—doing science.Researchers have studied the relation between what we are calling “internal” and “instrumental” motives for more than 40 y. Typically, past research has designated these different types of motives as “intrinsic” and “extrinsic” (1). However, there is an ambiguity to the terms “intrinsic” and “extrinsic” in that they might refer to the actor (e.g., “he is intrinsically motivated”) or to the task (e.g., “drawing is an intrinsically motivated activity”). In addition, the term “intrinsic motivation” often conveys the idea that the activity in question is pleasant or fun (2). We prefer the terms “internal” and “instrumental” to make clearer that the relation being described is between the activity (not the person) and the motive, and also to make clear that internally motivated activities need not be undertaken for the inherent pleasure they bring (2, 3).What happens to the performance of demanding, effortful activities when internal and instrumental motives are combined? Logic would suggest that if you have one reason for doing something, having two or more reasons to do the same thing would be even better, rendering motivation more tenacious, follow-through stronger, and outcomes better. Schools and workplaces are full of systems that attempt to tap people’s internal motives to act (e.g., because engaging in the activity is the moral, interesting, or meaningful thing to do), while also providing rewards intended to spark instrumental motives to pursue the same acts (e.g., grades, bonuses, promotions, and so forth). Tapping internal motives and the instrumental motives assumed to result from rewards seems to be a foolproof way to engage the full spectrum of motivational levers that lead people to act. However, in a direct challenge to this assumption, social science research suggests that far from boosting motivation, holding instrumental motives can undermine whatever internal motives may have been operating, leading to drops in overall motivation, persistence, and performance (4–6). In short, this work suggests that salient instrumental incentives trigger instrumental motives, acting to undermine motivation that would otherwise be based in the value and reward of doing the activity or engaging in the act for the sake of objectives that are intimately connected to the act itself. This effect, labeled the “motivational crowding out effect” by economists (7) and the “overjustification effect” by psychologists (6), has been demonstrated across a range of experimental contexts (4). In the present study, rather than focusing on the impact of rewards on motives, we assess motives that already exist to understand their interactive effects on a series of long-term outcomes.The general structure of this body of research consists of laboratory and field experiments in which internal motivation is either established or assumed, followed by the introduction of instrumental rewards or inducements to an experimental group, and the comparison of outcomes of this group and a control group. The robustness of this effect has been generally accepted [but is still the subject of debate (6, 8, 9)]; indeed, recent research has found a possible neural basis for the “undermining effect” of instrumental rewards on internal motivation (10).Although it is possible to demonstrate the negative impact of instrumental rewards on activity-specific motivation, existing research typically introduces instrumental rewards as exogenous “shocks” to the system. However, in the real world, rather than suddenly being presented with rewards for actions in which they were already engaging, individuals carry an assortment of motives into any course of action they pursue: a mixture of activity-specific and instrumental motives in various combinations and at varying strengths (11). Whereas the typical experimental paradigm has demonstrated the relationship between internal and instrumental motivation in controlled settings through the introduction of instrumental rewards, longitudinal field research on the relative and interactive impact of various kinds and levels of motives on meaningful outcomes over time has been relatively lacking. Furthermore, examining the impact of the set and strength of motives that propel people to launch a course of action—joining the military, entering a university, becoming a volunteer—on the outcomes they later experience provides a test of naturally co-occurring motives on behavior. Additionally, as we will demonstrate, tests of the impact of different kinds of motives on outcomes occurring in real-world contexts need not depend on the introduction and withdrawal of instrumental rewards (as in experimental studies), but instead on the measurement of the strength of various kinds of motives that launched the course of action from the start.Prior work, mostly led by Deci and Ryan (2, 3), has demonstrated the ample benefits of intrinsic motivation or, at the very least, extrinsic motivation that has been internalized (what they call “autonomous motivation” in contrast to “controlled motivation,” which reflects compliance with others’ desires or external regulations), for well-being and a host of outcomes in education and health contexts. This research has treated motivation as a property of self-determination and has had a powerful impact on how social scientists understand and study motivation in a variety of contexts. However, in three important ways, our work takes a different approach to the impact of motives on outcomes, one that complements Deci and Ryan’s seminal research. First, although their approach to motivation considers whether motivation is intrinsic or extrinsic to the self (e.g., “I’m doing this because it’s natural to me” vs. “because I’ll feel badly if I don’t/others will criticize me if I don’t”) (3), our focus is on whether the motives people hold are internal or external to the activity (e.g., the scientist who pursues science to produce a discovery vs. to earn a salary or win awards). This distinction matters, because the theory of motivation presented by Deci and Ryan concerns identity, or how much of one’s motivation emanates from one’s psychological needs and sense of self (1) as opposed to other forces.Second, Deci and Ryan reserve “intrinsic” motivation as a label for only those activities that are undertaken for the inherent satisfaction they bring to the self, free from influence of what one’s parents, teachers, managers, or others think should be done or what one feels one should do (what they call “controlled motivation”), even if those reasons become somewhat or fully internalized (what they call “autonomous motivation”). Although this disqualifies most activities from ever being truly intrinsically motivated, “internal” motivation represents a broader category, one that we use here. It focuses on the relation between the outcomes pursued and the activity itself, rather than on relations between the activity and one’s self-definition or values (3).Furthermore, the outcomes that are assessed in experimental studies in this realm typically occur over a period of minutes, hours, or weeks rather than longer lengths of time, as occur in actual educational or workplace settings. Specifically, the ability of instrumental motives to effectively undermine the positive influence of internal motives on engagement in a course of action has not been demonstrated in a real-world context in which the outcomes have the potential to shape individual education and career trajectories and, more broadly, to shape public institutions. Even less is known about the impact of holding additional types of motives at varying levels of strength in these realms.There is some research that may provide clues. Researchers have reported the negative impact of holding multiple motives on individuals’ experience of a course of action they have voluntarily undertaken, demonstrating that holding multiple motives yields more stress and less satisfaction with the activity at hand (12). Other research in educational contexts that has differentiated between autonomous and controlled motivation (3) suggests that autonomous motivation predicts stronger persistence and better performance (13, 14), whereas controlled motivation predicts lower engagement and performance (15, 16). Furthermore, students experiencing high levels of both autonomous and controlled motivation have lower GPAs and procrastinate more than those with high levels of autonomous motivation and low levels of controlled motivation (17). Similarly, evidence from workplaces suggests that employees experiencing high levels of both autonomous and controlled motivation are poorer performers, even when their levels of initiative are high (18). Although these studies focus on the relationship between motivation inherent in the individual rather than for the activity at hand, the pattern is instructive: motivation that stems from sources external to the self undermines key outcomes.Clarifying the relation between different types of motives is of great practical significance. Whether called instrumental, controlled, or extrinsic (2, 3), some level of motivation from sources external to the activity itself is likely to occur in anyone undertaking a paid activity, which includes essentially every working adult. Because most people must work to make a living, instrumental consequences are ever present, and instrumental motives are likely present; thus, understanding the ways in which the strength of these motives vary and interact with motives internal to the activity is essential if we are to create work environments in which people work effectively and energetically.In the present study, we hypothesized that having strong internally based motives for undertaking a course of action will be associated with stronger persistence and better performance, but when these internally based motives are accompanied by strong instrumentally based motives, outcomes will be worse across a range of indicators of persistence and performance. We tested our hypotheses with data drawn from nine classes of West Point cadets at the start of their education, linking the strength of their various motives for attending West Point with outcomes that reflect their persistence and quality as military personnel between 4 and 14 y later. Although others have established the importance of grit for making it through West Point (19), the impact of cadets’ motives on this and later career outcomes is not yet understood.Specifically, we conducted analyses of data drawn from 11,320 cadets from nine consecutive entering classes of West Point cadets (the classes of 1997–2006). Data from the class of 2003 were dropped, as the survey instrument used that year used response categories that did not align with the questions for the items pertaining to cadets’ motives for attending West Point. We assessed the impact of cadets’ motives for attending West Point on the likelihood that they would successfully complete their studies and become commissioned officers, remain military officers beyond the mandatory 5-y period of service required following graduation, and be selected for consideration for early promotion during their 5 y of mandatory service.     

三种洗手用品洗手效果比较

目的比较临床医护人员使用传统的肥皂、洗手液、无水洗手液三种洗手用品洗手的效果。方法分别对三种洗手用品的效果进行细菌学监测并作统计学分析。结果肥皂、洗手液、无水洗手液洗手后平均菌数分别为10．1cfu／cm^2、8．3cfu／cm^2和3．6cfu／cm^2。结论无水洗手液洗手效果优于传统的肥皂和洗手液,且方便、快速、高效,值得临床广泛推广。     

失效模式与效应分析在麻醉复苏期风险管理中的应用

目的识别麻醉复苏期患者医疗处置过程中的潜在风险,改进复苏流程。方法运用失效模式与效应分析(FMEA)工具,对患者麻醉复苏期医疗处置流程进行分析,查找每个医疗环节中可能存在的风险;针对管理制度不完善、具体流程不明确、人员职责不清楚及技能培训不到位等关键环节,实施改进措施1年。结果麻醉复苏期患者医疗风险危机值(RPN)由改进前的1 721降至357,不良事件发生率由改进前的2.40%降至0.97%(P0.01)。结论运用FMEA对麻醉复苏期患者实施医疗风险管理,有助于规范患者麻醉复苏工作流程,保障了患者复苏期全过程的安全,有利于麻醉复苏工作质量的持续改进。     

负性情绪刺激的反应启动效应事件相关电位的实验研究

目的：许多研究观察到，有机体对负性情绪刺激的反应比对中性或正性刺激快，本研究应用事件相关电位中的单侧化准备电位将反应时划分为刺激加工阶段和反应准备阶段，从而得以直接观察负性刺激的反应启动效应。方法：本研究选取国际情感图片系统的正、中、负性图片作为剌激材料，以正常大学生为被试，令其按键表示对图片情绪属性的判断，同时记录脑电。结果：正、负性情绪刺激引起的刺激锁定单侧化准备电位的潜伏期比中性条件下的潜伏期缩短，观察反应锁定单侧化准备电位的潜伏期可见，负性刺激引起的潜伏期显著短于中性和正性条件。结论：对情绪性刺激的心理加工评价过程较短，观察反应锁定单侧化准备电位的潜伏期可见，负性剌激引起的潜伏期显著短于中性和正性条件，表明负性刺激具有反应启动效应.     

不同消化道重建方案治疗早期贲门癌患者的疗效观察

目的比较不同消化道重建方案治疗早期贲门癌患者的疗效。方法选取120例早期贲门癌患者并随机分为3组。A组实施食管残胃前壁吻合联合幽门成型的消化道重建方案,B组实施食管残胃后壁吻合联合唇式包埋的消化道重建方案,C组实施食管残胃3S空肠间置吻合的消化道重建方案。比较3组患者的手术情况、治疗前后的营养指标以及治疗前后的EORTC QLQ-C30评分情况。结果 3组患者的手术时间、术中出血量以及术后住院时间等无显著差异(P0.05);3组患者治疗后的血红蛋白、总蛋白、白蛋白、维生素B_(12)、体质量等指标显著改善(P0.05),且3组间比较有显著差异(P0.05)。3组患者治疗后的EORTC QLQ-C30评分均显著优于治疗前(P0.05),且3组间比较有显著差异(P0.05)。结论对于早期贲门癌患者,实施食管残胃前壁吻合联合幽门成型的消化道重建方案的疗效好。     

米非司酮治疗围绝经期功血的临床疗效观察

目的观察米非司酮治疗围绝经期功血的临床疗效。方法55例围绝经期功血患者，随机分为两组：A组28例。应用米非司酮治疗；B组27例，应用妇康片治疗。比较两组之间的止血效果、闭经率、生活质量。结果治疗期间A组全部病例均出现闭经。贫血得到明显改善。停药后绝经率53，57％，复发率7．15％，生活质量满意率75％，与B组比较差异有统计学意义。结论米非司酮治疗围绝经期功血疗效好，停药后复发率低，副作用小。是一种理想的药物治疗方法。值得推广。     

单耳堵塞对沙土鼠中脑下丘神经元谷氨酸受体密度的影响

目的考察单耳堵塞对沙土鼠中脑下丘(IC)背侧核(ICd)、外侧核(ICx)和中央核(ICc)部位谷氨酸(Glu)受体密度的影响。方法实验在30只沙土鼠上进行,雌雄不拘。分别在沙土鼠出生后3周龄(21dpn)、6周龄(42dpn)和成年(70dpn)实施单耳堵塞,4周后以体外受体标记放射自显影方法,考察比较IC左右侧各部位的银粒密度变化,并以此为相对指标,分析动物IC的神经元Glu受体密度的变化。结果成年组两侧IC神经元Glu受体密度没有显著性差异;3周龄和6周龄组呈现堵耳对侧的Glu受体密度明显少于堵耳同侧的不均衡分布(ICd部位:t=2.53,P=0.0186,t=1.77,P=0.0443;ICx部位:t=1.90,P=0.0359,t=2.03,P=0.0367;ICc部位:t=1.07,P=0.0332;t=2.35,P=0.0208)。并且3周龄组ICc部位的两侧Glu受体密度比值最小(0.61±0.03)。结论出生后6周前单耳堵塞对沙土鼠IC的神经元Glu受体发育具有明显影响,与Glu受体相关的下丘听觉功能发育将延续到出生后6周。