Leadership Perspectives on Integrating Psychologists into Specialty Care Clinics: An Evolving Paradigm

Integration of health psychologists into specialty care is a shift in the tertiary care construct that addresses all aspects of a patient’s presentation, including psychiatric/social history, psychological well-being, and behavioral contributions to the disease process, assuring both optimal health outcomes and cost-effectiveness in a financially challenging healthcare environment. In this paper, we discuss leadership perspectives (physician and psychologists) on the factors involved in integrating a health psychologist into a busy tertiary care environment. Ultimately, we hope that this information provides a primer on how to frame a proposal for an integrated health psychologist emphasizing the elements important to senior medical leadership and administration. First, we briefly discuss the current payer framework, providing support for integration emphasizing costs and other metrics. Second, we introduce organizational structure models and strategies for integration. Lastly, we will discuss the unique skillset psychologists possess, and additional skills necessary, to be effective in the changing landscape of healthcare. We think this information is important both for leaders attempting to integrate a health psychologist into specialty care and for the early career health psychologist embarking on his/her first senior staff position.     

Lateralization of two-transient stimuli

In this study of the precedence effect in binaural hearing, subjects adjusted the interaural delay of a wideband acoustic pointer to match the perceived intracranial position of transient test stimuli presented over headphones. The test stimuli had leading and lagging components (either brief noise bursts or clicks), each with its own interaural delay. In some test conditions, the leading and lagging stimuli were coherent copies of one another, whereas in others, they were independent samples of noise. The duration of the stimuli and the delay from the leading component to the lagging component were also varied. All the stimulus conditions showed a moderate or strong precedence effect (i.e., covariation of perceived lateral position of the composite two-transient stimulus with the interaural delay of the leading component). Predictions of the lateralization data are presented for variants of models based on temporal weighting and/or bandpass correlation. In one model variant, the binaural stimuli are temporally weighted to emphasize the onset and then subjected to bandpass correlation analysis. In another variant, it is assumed that the onset mechanism provides a rough estimate of the initial interaural delay that guides a slower and more focused bandpass correlation analysis. The accuracies of these two model's predictions were equivalent and superior to those of models that either represent leading and lagging cues equally (bandpass correlation with no onset effect) or do not represent lagging cues at all (a complete precedence effect). The results of these analyses show the need for both a strong onset effect and for bandpass correlation analysis and suggest two modeling approaches for achieving that goal.     

等级图形加工半球偏侧化的发展

以往的研究显示,大脑对等级视觉信息的加工有半球偏侧化的现象,左半球有加工局部特征的优势,右半球有加工整体的优势。本研究采用2年级、4年级、6年级和成人4个年龄组的被试,对等级复合图形中的靶子做选择判断,通过单侧呈现来考察整体-局部加工的大脑功能偏侧化发展。结果发现反应时发展呈现从局部优先到整体优先的过程,半球偏侧化发展呈现从无偏侧化到左侧呈现较右侧呈现更强的整体优先。发展的转折点可能在4～6年级(约9岁～12岁)之间。     

Our Growing Understanding of Subtle Energies and Their Function in the Evolving Universe

This article focuses on subtle energies (those energies that fall outside the four regularly recognized energy forces of gravity, electromagnetism, and the strong and weak nuclear forces). Research and insights from the social, physical, and healing sciences are discussed. Key concepts from these disciplines are explored creating a cross-disciplinary analysis of recent research. A case is made for building upon the growing understanding of the influence and importance of the subtle energies in our daily lives as well as the ongoing evolution of our species and planet. The author advocates for increased explorations in the use of these energies for positive social transformation and healing.     

音高模式加工的大脑偏侧化研究

作为一种超音段成分,音高在言语的理解和产生过程中承担着重要作用,这些作用主要包括:区别不同声调的词汇意义,区别陈述、疑问等不同的语调,标志话语的情绪色彩等。音段、语义和句法信息的加工具有左脑优势,但音高模式加工的单侧优势及其机制还存在很多争论,本文从音高模式加工的两个主要理论———功能假设和声音信号假设出发,对相关研究加以评述。     

The Effects of Brain Lateralization on Motor Control and Adaptation

ABSTRACT

Lateralization of mechanisms mediating functions such as language and perception is widely accepted as a fundamental feature of neural organization. Recent research has revealed that a similar organization exists for the control of motor actions, in that each brain hemisphere contributes unique control mechanisms to the movements of each arm. The authors review present research that addresses the nature of the control mechanisms that are lateralized to each hemisphere and how they impact motor adaptation and learning. In general, the studies suggest an enhanced role for the left hemisphere during adaptation, and the learning of new sequences and skills. The authors suggest that this specialization emerges from a left hemisphere specialization for predictive control—the ability to effectively plan and coordinate motor actions, possibly by optimizing certain cost functions. In contrast, right hemisphere circuits appear to be important for updating ongoing actions and stopping at a goal position, through modulation of sensorimotor stabilization mechanisms such as reflexes. The authors also propose that each brain hemisphere contributes its mechanism to the control of both arms. They also discuss the potential advantages of such a lateralized control system.     

Lateralization of cognitive processes in the brain

The lateralization of cognitive processes in the brain is discussed. The traditional view of a language-visuo/spatial dichotomy of function between the hemispheres has been replaced by more subtle distinctions. The use of magnetic resonance imaging (MRI) to study brain morphology has resulted in a renewed focus on the relationship between structural and functional asymmetry. Focus has been on the role played by the planum temporale area in the posterior part of the superior temporal gyrus for language asymmetry, and the possible significance of the larger left planum. The dichotic listening technique is used to illustrate the difference between bottom-up, or stimulus-driven laterality versus top-down, or instruction-driven laterality. It is suggested that the hemispheric dominance observed at any time is the sum result of the dynamic interaction between bottom-up and top-down processing tendencies. Stimulus-driven laterality dominance is always monitored and modulated through top-down cognitive processes, like shifting of attention and changes in arousal. A model of top-down modulation of bottom-up laterality is presented with special reference to the understanding of psychiatric disorders.     

Lateralization effects in lexical decision tasks

Subjects were timed as they judged whether items presented to them were English words or not. Comparisons were made between responses to nouns and to verbs, on the one hand, and between concrete and abstract nouns, on the other hand. No asymmetries were found.     

Lateralization of object-shape information in semantic processing

An experiment was conducted to examine whether perceptual information, specifically the shape of objects, is activated during semantic processing. Subjects judged whether a target word was related to a prime word. Prime-target pairs that were not associated, but whose referents had similar shapes (e.g. LADDER-RAILROAD) yielded longer "no" responses than unassociated prime-target pairs, suggesting that shape information had been activated. A visual-field manipulation showed that, in right-handed subjects, this effect was localized in the left hemisphere. This finding is consistent with behavioral, brain imaging, and lesion data, which suggest that object shape at the category level is represented in the left hemisphere.     

大脑两半球功能不对称性与儿童学业成绩

本研究调查了 3 1 8名小学一至三年级学生大脑两半球优势情况 ,然后对不同优势半球学生的语文和数学成绩进行了比较。结果发现优势半球为右半球的学生人数较少 ,只有 3 .8% ,明显少于优势半球为左半球的学生 (χ2 =2 3 9.83 0 ,p<0 .0 0 1 )。对不同优势半球学生的语文和数学成绩的比较 ,未发现两者有显著差异 (语文 :F=1 .1 3 0 ,p>0 .0 5 ;数学 :F=0 .5 75 ,p>0 .0 5 )。     

杏仁核情绪功能偏侧化的成像研究述评

从意识水平、性别、情绪类型3个方面讨论了大脑两半球杏仁核在情绪功能方面表现出的不对称性。初步证据显示大脑两侧的杏仁核功能的确存在偏侧化,并且与右侧杏仁核相比,左侧杏仁核出现更多激活。右侧杏仁核可能负责的是早期的、基础的、不易被检测到的“幕后”的情绪工作;左侧杏仁核负责随后具体的、持续的、容易被检测到的“幕前”的情绪工作。由于目前针对杏仁核偏侧化的专门研究不多,其具体机制不清楚。该文还对杏仁核偏侧化的理论假设和未来研究方向做了简要的介绍     

Lateralization of temporal lobe dysfunction and verbal encoding

The contribution of encoding deficits to verbal-learning difficulties known to be associated with temporal lobe dysfunction was investigated. Auditory and visual false-recognition tasks, which assess verbal encoding strategies, were given to patients with left-temporal-lobe (LTL) and right-temporal-lobe (RTL) surgical excisions and to a group of normal controls (NC). On both auditory and visual tasks, LTL patients made significantly more false-recognition errors than the other subjects on related, but not unrelated, words in the test list. The findings indicate that LTL patients are able to initially encode verbal material and that a breakdown in information processing occurs at a later stage. On the auditory tasks, the performance of RTL patients did not differ from that of NC subjects. However, on the visual tasks, RTL patients, as compared to both LTL and NC subjects, made fewer false-recognition errors. The performance of RTL patients, in contrast to LTL patients, could be interpreted as a reduced encoding of the visual attribute of verbal material. Another possible explanation considered was difficulty in familiarity discrimination.     

利手与语言功能偏侧化的遗传模型

利手与语言功能偏侧化现象不仅具有跨文化一致性和发生、发展上的关联性, 还具有明显的生态学优势, 从遗传角度探讨它们的成因是必要的。早期遗传模型认为, 存在一对等位基因分别决定左、右利手。当代单基因模型则将语言功能偏侧化也纳入进来, 认为等位基因不仅可以决定具有方向性的偏侧化, 而且可以使偏侧化有一定几率向左或向右。在这个框架下形成了方向-随机等位基因模型、X-连锁隐性基因模型和右侧位移理论, 它们对等位基因的位置和功能有不同表述, 对利手的划分标准、性别差异以及遗传和环境的关系也有不同阐释。今后需加强对语言偏侧化的数据验证, 进一步阐明语言感知、理解与利手的关系, 并注重基因怎样决定表型、基因多效性和多基因合作等问题的研究。     

Lateralization of defence mechanisms related to creative functioning

Eighty-four undergraduate students were randomly divided into left and right visual half-field groups. They were tested in either visual half-field with a percept-genetic test of anxiety and defense mechanisms (the MCT). The subjects also took a test of creative functioning (the CFT) and degree of lateralization in the MCT was related to level of creativity in the CFT. Subjects low in creativity were significantly lateralized on measures typical for the right visual half-field group (isolation and repression) and tended to differ on a left visual half-field measure (regressive strategies). For high creative subjects no differences were found between the visual half-field groups. Also, high creative persons more often responded with non-hemisphere-specific defenses than low creative ones. The results were interpreted as due to differing levels of transmission of information between the two hemispheres of the brain.     

Lateralization of lexical codes in auditory word recognition

Three experiments examined the lateralization of lexical codes in auditory word recognition. In Experiment 1 a word rhyming with a binaurally presented cue word was detected faster when the cue and target were spelled similarly than when they were spelled differently. This orthography effect was larger when the target was presented to the right ear than when it was presented to the left ear. Experiment 2 replicated the interaction between ear of presentation and orthography effect when the cue and target were spoken in different voices. In Experiment 3, subjects made lexical decisions to pairs of stimuli presented to the left or the right ear. Lexical decision times and the amount of facilitation which obtained when the target stimuli were semantically related words did not differ as a function of ear of presentation. The results suggest that the semantic, phonological, and orthographic codes for a word are represented in each hemisphere; however, orthographic and phonological representations are integrated only in the left hemisphere.