The Impact of Integrated Behavioral Healthcare on Glycemic Control

Integrated behavioral healthcare (IBH) is the “standard of care” to address psychosocial factors impacting diabetes outcomes; it is not standard in practice. This longitudinal, retrospective, chart-review examines IBH impact on glycemic control in an adult diabetes clinic. Adults (n?=?374) with?≥?1 behavioral health encounter,?≥?2 hemoglobin A1c (HbA1c) values, and HbA1c value?>?8% at initial IBH visit were included. Mixed effects linear piecewise models examined differences in slope trajectories for 365 days pre- and post-IBH intervention. Pre-intervention slope was not significant (z?=?? 1.09, p?=?0.28). The post-intervention slope was significant (z?=?? 6.44, p?<?0.001), indicating a significant linear decrease in HbA1c values. Results demonstrated that prior to engaging with behavioral health, there was no change in HbA1c. After initial IBH visit, there was a predicted reduction of?>?1% in HbA1c over the following year. These results suggest that IBH significantly improves patients’ metabolic status. Next steps for IBH research are offered.

     

Not all disfluencies are are equal: The effects of disfluent repetitions on language comprehension

Disfluencies can affect language comprehension, but to date, most studies have focused on disfluent pauses such as er. We investigated whether disfluent repetitions in speech have discernible effects on listeners during language comprehension, and whether repetitions affect the linguistic processing of subsequent words in speech in ways which have been previously observed with ers. We used event-related potentials (ERPs) to measure participants’ neural responses to disfluent repetitions of words relative to acoustically identical words in fluent contexts, as well as to unpredictable and predictable words that occurred immediately post-disfluency and in fluent utterances. We additionally measured participants’ recognition memories for the predictable and unpredictable words. Repetitions elicited an early onsetting relative positivity (100–400 ms post-stimulus), clearly demonstrating listeners’ sensitivity to the presence of disfluent repetitions. Unpredictable words elicited an N400 effect. Importantly, there was no evidence that this effect, thought to reflect the difficulty of semantically integrating unpredictable compared to predictable words, differed quantitatively between fluent and disfluent utterances. Furthermore there was no evidence that the memorability of words was affected by the presence of a preceding repetition. These findings contrast with previous research which demonstrated an N400 attenuation of, and an increase in memorability for, words that were preceded by an er. However, in a later (600–900 ms) time window, unpredictable words following a repetition elicited a relative positivity. Reanalysis of previous data confirmed the presence of a similar effect following an er. The effect may reflect difficulties in resuming linguistic processing following any disruption to speech.     

Productive and Re‐productive Thinking in Solving Insight Problems

Many innovations in organizations result when people discover insightful solutions to problems. Insightful problem‐solving was considered by Gestalt psychologists to be associated with productive, as opposed to re‐productive, thinking. Productive thinking is characterized by shifts in perspective which allow the problem solver to consider new, sometimes transformational, approaches. Re‐productive thinking, on the other hand, involves the application of familiar, routine, procedures. This article reports a study which investigated how self‐reported productive and re‐productive thinking are related to an individual's ability to solve insight problems. Our measures were tested against the Kirton Adaption‐Innovation Inventory (KAI), and a battery of spatial insight problems. The results indicated that productive and re‐productive thinking and the KAI were successful in predicting performance on spatial insight problems. Furthermore, the measures of productive and re‐productive thinking accounted for spatial insight performance independently of scores on the KAI. In addition, the results suggested that re‐productive thinking consists of two different components—one based on group conventions and the other on personal experience. Each contributed differently to solving insight problems.     

Secular and Liminal: Discovering Heterogeneity Among Religious Nones

This study examines the stability of religious preference among people who claim no religious preference in national surveys (i.e., religious nones). Using data from the Faith Matters Study, General Social Survey, and American National Election Study, we show that about 30 percent of religious nones in the first wave of the survey claim an affiliation with a religious group a year later. The percentage of religious nones remained stable in the two waves because a similar number of respondents moved in the opposite direction. Using various measures of religiosity, we show that most of these unstable nones report no significant change in religious belief or practice. We call them liminal nones as they stand halfway in and halfway out of a religious identity. We conclude by discussing the implications of our findings on the controversies surrounding the rise of religious nones in recent years.     

Attention orienting effects of hesitations in speech: evidence from ERPs

Filled-pause disfluencies such as um and er affect listeners' comprehension, possibly mediated by attentional mechanisms (J. E. Fox Tree, 2001). However, there is little direct evidence that hesitations affect attention. The current study used an acoustic manipulation of continuous speech to induce event-related potential components associated with attention (mismatch negativity [MMN] and P300) during the comprehension of fluent and disfluent utterances. In fluent cases, infrequently occurring acoustically manipulated target words gave rise to typical MMN and P300 components when compared to nonmanipulated controls. In disfluent cases, where targets were preceded by natural sounding hesitations culminating in the filled pause er, an MMN (reflecting a detection of deviance) was still apparent for manipulated words, but there was little evidence of a subsequent P300. This suggests that attention was not reoriented to deviant words in disfluent cases. A subsequent recognition test showed that nonmanipulated words were more likely to be remembered if they had been preceded by a hesitation. Taken together, these results strongly implicate attention in an account of disfluency processing: Hesitations orient listeners' attention, with consequences for the immediate processing and later representation of an utterance.     

Aging and decision‐making competence: an analysis of comprehension and consistency skills in older versus younger adults considering health‐plan options

Older adults need to maintain strong decision‐making capabilities as they age. However, we know little about how age‐related physical and psychological changes affect older adults' judgment and decision processes. This paper reports the results of research comparing older versus younger adults' performance on evaluation and choice tasks about health‐plan options. In particular, comprehension and consistency in judgments (across separate versus joint evaluation contexts) were examined. Results indicated that increasing age was related to greater comprehension errors and inconsistent preferences, even when covariates (education, income, gender, self‐perceived skill and health, decision style, and attitude toward delegation) were taken into account. Discussion of the results emphasizes difficulties in interpreting the meaning of age differences in performance on decision tasks and the need for research that ascertains the seriousness of the consequences of age differences in real‐life tasks. The implications for providing decision‐aiding interventions for older adults are highlighted. Copyright © 2002 John Wiley & Sons, Ltd.     

Dynamics and constraints in insight problem solving

This article reports 2 experiments that investigated performance on a novel insight problem, the 8-coin problem. The authors hypothesized that participants would make certain initial moves (strategic moves) that seemed to make progress according to the problem instructions but that nonetheless would guarantee failure to solve the problem. Experiment 1 manipulated the starting state of the problem and showed that overall solution rates were lower when such strategic moves were available. Experiment 2 showed that failure to capitalize on visual hints about the correct first move was also associated with the availability of strategic moves. The results are interpreted in terms of an information-processing framework previously applied to the 9-dot problem. The authors argue that in addition to the operation of inappropriate constraints, a full account of insight problem solving must incorporate a dynamic that steers solution-seeking activity toward the constraints.     

Categories of insight and their correlates: An exploration of relationships among classic‐type insight problems,rebus puzzles,remote associates and esoteric analogies

A central question in creativity concerns how insightful ideas emerge. Anecdotal examples of insightful scientific and technical discoveries include Goodyear's discovery of the vulcanization of rubber, and Mendeleev's realization that there may be gaps as he tried to arrange the elements into the Periodic Table. Although most people would regard these discoveries as insightful, cognitive psychologists have had difficulty in agreeing on whether such ideas resulted from insights or from conventional problem solving processes. One area of wide agreement among psychologists is that insight involves a process of restructuring. If this view is correct, then understanding insight and its role in problem solving will depend on a better understanding of restructuring and the characteristics that describe it. This article proposes and tests a preliminary classification of insight problems based on several restructuring characteristics: the need to redefine spatial assumptions, the need to change defined forms, the degree of misdirection involved, the difficulty in visualizing a possible solution, the number of restructuring sequences in the problem, and the requirement for figure‐ground type reversals. A second purpose of the study was to compare performance on classic spatial insight problems with two types of verbal tests that may be related to insight, the Remote Associates Test (RAT), and rebus puzzles. In doing so, we report on the results of a survey of 172 business students at the University of Waikato in New Zealand who completed classic‐type insight, RAT and rebus problems.     

Philosophy on steroids: a reply

Brent Kious has recently attacked several arguments generally adduced to support anti-doping in sports, which are widely supported by the sports medicine fraternity, international sports federations, and international governments. We show that his attack does not succeed for a variety of reasons. First, it uses an overly inclusive definition of doping at odds with the WADA definition, which has global, if somewhat contentious, currency. Second, it seriously misconstrues the position it attacks, rendering the attack without force against a more balanced construal of an anti-doping position. Third, it makes unwarranted appeals to matters Kious considers morally ‘clear’, while simultaneously attacking a position many others take to be equally morally ‘clear’, namely that of anti-doping. Such an inconsistency, attacking and appealing to the moral status quo as befits one’s argument, is not acceptable without further qualification. Fourth, his position suffers from a general methodological flaw of over-reliance upon argumentation by analogy. Moreover, it is argued that the analogies, being poorly selected and developed, fail to justify his conclusion that the anti-doping lobby lacks philosophical and moral authority for its stance. These issues are symptomatic of a more fundamental problem: any attempt at providing a blanket solution to the question of whether doping is morally acceptable or not is bound to run up against problems when applied to highly specific contexts. Thus, rather than reaching any particular conclusion for or against doping products or processes in this article, we conclude that an increased context-sensitivity will result in a more evenhanded appraisal of arguments on the matter.     

Constructive anger verbal behavior predicts blood pressure in a population-based sample.

The creation of an observational Constructive Anger Behavior-Verbal Style Scale (CAB-V) and its relation to resting blood pressure (BP) in an age- and sex-stratified, population-based sample is examined. Participants (N = 1,862) provided hypertension risk factor information, had resting BP assessed multiple times, and completed a videotaped interview, which was later coded for CAB-V and Hostile Style. High CAB-V scores remained a significant predictor of lower resting BP when controlling for the effects of standard hypertension risk factors (age, sex, body mass index, physical activity, alcohol use, smoking status, parental myocardial infarction history, education, and diabetic status) and psychosocial measures (anxiety, depression, hostility, social support, and Hostile Style). This relation also remained when excluding known hypertensive persons. Results suggest that constructive anger expression may have an independent beneficial association with resting BP.