临床医学整合：中心化整合关键在于观念转变

医学转型的实质是推进医学的整合,微观层面以临床医学的整合为核心部分,宏观上则以临床医学与预防医学的整合为核心。在诸多整合之中,以临床医学的整合最为迫切,它是整个医学整合过程中的基础和开端。当前进行的临床中心化整合似乎已成为一种主导的趋势,然而,如何进行中心化整合却仍然存在诸多问题需要探讨,某些医院对专科化的热衷和偏爱更令人担忧,医学资本的诱惑也是当今临床整合的一道障碍,因此,医学整合任重而道远,不仅需要医学形式上的重组,更需要有观念上的根本转变。     

Modelling audiovisual integration of affect from videos and music

Two experiments examined how affective values from visual and auditory modalities are integrated. Experiment 1 paired music and videos drawn from three levels of valence while holding arousal constant. Experiment 2 included a parallel combination of three levels of arousal while holding valence constant. In each experiment, participants rated their affective states after unimodal and multimodal presentations. Experiment 1 revealed a congruency effect in which stimulus combinations of the same extreme valence resulted in more extreme state ratings than component stimuli presented in isolation. An interaction between music and video valence reflected the greater influence of negative affect. Video valence was found to have a significantly greater effect on combined ratings than music valence. The pattern of data was explained by a five parameter differential weight averaging model that attributed greater weight to the visual modality and increased weight with decreasing values of valence. Experiment 2 revealed a congruency effect only for high arousal combinations and no interaction effects. This pattern was explained by a three parameter constant weight averaging model with greater weight for the auditory modality and a very low arousal value for the initial state. These results demonstrate key differences in audiovisual integration between valence and arousal.     

Discounting model selection with area‐based measures: A case for numerical integration

A novel method for analyzing delay discounting data is proposed. This newer metric, a model‐based Area Under Curve (AUC) combining approximate Bayesian model selection and numerical integration, was compared to the point‐based AUC methods developed by Myerson, Green, and Warusawitharana (2001) and extended by Borges, Kuang, Milhorn, and Yi (2016). Using data from computer simulation and a published study, comparisons of these methods indicated that a model‐based form of AUC offered a more consistent and statistically robust measurement of area than provided by using point‐based methods alone. Beyond providing a form of AUC directly from a discounting model, numerical integration methods permitted a general calculation in cases when the Effective Delay 50 (ED50) measure could not be calculated. This allowed discounting model selection to proceed in conditions where data are traditionally more challenging to model and measure, a situation where point‐based AUC methods are often enlisted. Results from simulation and existing data indicated that numerical integration methods extended both the area‐based interpretation of delay discounting as well as the discounting model selection approach. Limitations of point‐based AUC as a first‐line analysis of discounting and additional extensions of discounting model selection were also discussed.     

Balancing awareness: Vestibular signals modulate visual consciousness in the absence of awareness

The processing of visual and vestibular information is crucial for perceiving self-motion. Visual cues, such as optic flow, have been shown to induce and alter vestibular percepts, yet the role of vestibular information in shaping visual awareness remains unclear. Here we investigated if vestibular signals influence the access to awareness of invisible visual signals. Using natural vestibular stimulation (passive yaw rotations) on a vestibular self-motion platform, and optic flow masked through continuous flash suppression (CFS) we tested if congruent visual–vestibular information would break interocular suppression more rapidly than incongruent information. We found that when the unseen optic flow was congruent with the vestibular signals perceptual suppression as quantified with the CFS paradigm was broken more rapidly than when it was incongruent. We argue that vestibular signals impact the formation of visual awareness through enhanced access to awareness for congruent multisensory stimulation.     

Learning new vocabulary during childhood: Effects of semantic training on lexical consolidation and integration

Research suggests that word learning is an extended process, with offline consolidation crucial for the strengthening of new lexical representations and their integration with existing lexical knowledge (as measured by engagement in lexical competition). This supports a dual memory systems account, in which new information is initially sparsely encoded separately from existing knowledge and integrated with long-term memory over time. However, previous studies of this type exploited unnatural learning contexts, involving fictitious words in the absence of word meaning. In this study, 5- to 9-year-old children learned real science words (e.g., hippocampus) with or without semantic information. Children in both groups were slower to detect pauses in familiar competitor words (e.g., hippopotamus) relative to control words 24 h after training but not immediately, confirming that offline consolidation is required before new words are integrated with the lexicon and engage in lexical competition. Children recalled more new words 24 h after training than immediately (with similar improvements shown for the recall and recognition of new word meanings); however, children who were exposed to the meanings during training showed further improvements in recall after 1 week and outperformed children who were not exposed to meanings. These findings support the dual memory systems account of vocabulary acquisition and suggest that the association of a new phonological form with semantic information is critical for the development of stable lexical representations.     

Acquisition of Predictable Vertical Visual Targets: Eye-Head Coordination and the Triggering Effect

The study was designed to investigate target acquisition in the vertical plane with emphasis on establishing strategy differences associated with acquisition triggering methods. Eight subjects were tested. Measurements consisted of target acquisition time, eye-head latency differences, velocity of gaze, eyes and head, and head amplitude. Using 3-way repeated measures analyses of variance the results show that the strategy for acquisition of predictable visual targets in vertical plane with the head unrestrained significantly depended on (a) the direction of the gaze motion with respect to the gravity vector (i.e., there is significant up-down asymmetry), (b) the angular distance of the target, and (c) the method of triggering the command to acquire the target—external versus internal. The data also show that when vertical acquisition is compared with triggering methods in the horizontal plane there is a difference in overall strategy for the acquisition of targets with the same spatial distances from straight ahead gaze when both the eyes and head are used. Among the factors contributing to the difference in strategy for vertical target acquisition are the gravitational vector, the relationship of target displacement and vestibular activitation, biomechanical and neural control asymmetries, and the difference in the vertical field of view.     

Cases to cases: A study of psychotherapy

The background to the study was a research project on psychotherapy (279 subjects) in the context of the Finnish Student Health Service. Patients were divided into three groups by duration of treatment. For each group, a hypothetical case was constructed. The hypothetical case in relation to short-term treatment (less than six months) is someone whose temporarily disturbed mental balance is supported by the therapist. The hypothetical case in relation to medium-term treatment (one to two years) exhibits recovery through release from self-objects. The hypothetical case in relation to long-term treatment (two to five years) was marked by the partial working through of object relationships.     

It's Not Just a Headache,Dear

No abstract available for this article.     

Optimal versus heuristic planning of object manipulations: A review and a computational model of the continuous end-state comfort effect

Human beings select actions that facilitate the execution of later actions. For example, humans tend to select grasps that ensure that forthcoming object manipulations end in a comfortable posture (“end-state comfort effect”). Basic experimental results and their explanation within the optimal control framework are reviewed. I conclude that the discrete grasp selection tasks, which are commonly used to study anticipatory planning, leave room for alternative explanations. Moreover, the results of seven experiments employing a continuous grasp selection task seem incompatible with the optimal control (of end-state comfort) account. I introduce the weighted integration of multiple biases (WIMB) model, which accounts for many aspects of the selection of human grasp orientations in continuous tasks. Additionally, it accounts for the precision effect and hysteresis effect. The model shows that the brain may rely on a simple heuristic and does not actually has to anticipate the end-state of a movement to select effective grasps for object manipulations.     

A Little Goes a Long Way: The Impact of Distal Social Support on Community Integration and Recovery of Individuals with Psychiatric Disabilities

Although an extensive body of literature highlights the important role of social support for individuals with psychiatric disabilities, definitions of support tend to be restricted—focusing on intimate relationships such as friend and family networks and ignoring the role of casual relationships existing naturally in the community. This mixed-methods study of 300 consumers of mental health services in the Southeastern US aims to better understand the impact of community supports, termed distal supports, on community integration and recovery from mental illness. Qualitative content analysis, tests of group mean differences, and hierarchical linear regression analyses revealed the following: (1) participants primarily reported receiving tangible support (e.g., free medication/discounted goods) from distal supports rather than emotional support (e.g., displays of warmth/affection) or informational support (e.g., provision of advice); (2) women and older participants reported more distal supports than men or younger participants; and (3) distal supports played a unique role in predicting community integration and recovery even after accounting for the influence of traditional support networks. Results highlight the importance of considering diverse types of social support in naturally occurring settings when designing treatment plans and interventions aimed at encouraging community participation and adaptive functioning for individuals with psychiatric disabilities.