Fundamental units of numerosity estimation

Humans can approximately enumerate a large number of objects at a single glance. While several mechanisms have been proposed to account for this ability, the fundamental units over which they operate remain unclear. Previous studies have argued that estimation mechanisms act only on topologically distinct units or on units formed by spatial grouping cues such as proximity and connectivity, but not on units grouped by similarity. Over four experiments, we tested this claim by systematically assessing and demonstrating that similarity grouping leads to underestimation, just as spatial grouping does. Ungrouped objects with the same low-level properties as grouped objects did not cause underestimation. Further, the underestimation caused by spatial and similarity grouping was additive, suggesting that these grouping processes operate independently. These findings argue against the proposal that estimation mechanisms operate solely on topological units. Instead, we conclude that estimation processes act on representations constructed after Gestalt grouping principles, whether similarity based or spatial, have organised incoming visual input.

Gestalt theory in 20th-century history

During the century from the 1890 publication of Ehrenfels's proposition on Gestaltqualitäten to the 1989 dissolution of the European states governed by Marxist orthodoxy, Gestalt theory was drawn into the political fray in several ways. It was grotesquely misappropriated during the Nazi regime in support of race, territorial expansion, and war aims. On the other side, because it was seen as having a subjectivist taint, the Gestalt approach was anathema where dialectical materialist dogma reigned. In contrast, close reading of the seminal 1912 Wertheimer paper and the 1920 Köhler book reveals that the Gestalt founders' views accord well with current Gestalt research.

The Application of the Gestalt Theory in Music Psychotherapy for Piano

This paper presents an in-depth study and analysis of the application of the Gestalt theory to music psychotherapy for piano. The paper focuses on how to apply the "whole and part" and "epiphany" perspectives of the Gestalt learning theory to singing and music appreciation lessons. In addition, the Gestalt school's ideas of developing creative thinking, creating problematic situations, and transferring learning were demonstrated through the implementation of teaching cases. There are differences in the effects of different music on the distribution of body surface temperature; there are differences in the effects of yang music on the Directing Vessel compared to the effects of yin music on the Directing Vessel, and the effects are following the hierarchical model of thinking; there are individual differences in the magnitude of the effects of the same music on the body surface temperature of different people, and the identification of music needs to be combined with the three factors. The wavelet energy entropy (WEE) characteristics of EEG signals were extracted as the input of the designed and optimized deep belief network model, and the average emotional classification accuracy of EEG signals in the left and right brain regions could be obtained as 84.20% and 83.07%, respectively, under the condition of distinguishing brain regions and different music environments. Compared with the classification accuracies of DBN, restricted Boltzmann machine (RBM), and K nearest neighbor (kNN) algorithms in mixed music environments, the classification effects were improved by about 3.49%, 12.89%, and 7.24%. Relying on the ability-poor theory and Weiner attribution theory, different types of secondary school students, their psychological characteristics, and their causes were pointed out. Combined with the psychological characteristics, the case study illustrates the positive effect of music therapy on psychological support.

Attraction to similar options: The Gestalt law of proximity is related to the attraction effect

Previous studies have suggested that there are common mechanisms between perceptual and value-based processes. For instance, both perceptual and value-based choices are highly influenced by the context in which the choices are made. However, the mechanisms which allow context to influence our choice process as well as the extent of the similarity between the perceptual and preferential processes are still unclear. In this study, we examine a within-subject relation between the attraction effect, which is a well-known effect of context on preferential choice, and the Gestalt law of proximity. Then, we aim to use this link to better understand the mechanisms underlying the attraction effect. We conducted one study followed by an additional pre-registered replication study, where subjects performed a Gestalt-psychophysical task and a decoy task. Comparing the behavioral sensitivity of each subject in both tasks, we found that the more susceptible a subject is to the proximity law, the more she displayed the attraction effect. These results demonstrate a within-subject relation between a perceptual phenomenon (proximity law) and a value-based bias (attraction effect) which further strengthens the notion of common rules between perceptual and value-based processing. Moreover, this suggests that the mechanism underlying the attraction effect is related to grouping by proximity with attention as a mediator.

Oculometric signature of switch into awareness? Pupil size predicts sudden insight whereas microsaccades predict problem-solving via analysis

According to the Gestalt theorists, restructuring is an essential component of insight problem-solving, contributes to the "Aha!" experience, and is similar to the perceptual switch experienced when reinterpreting ambiguous figures. Previous research has demonstrated that pupil diameter increases during the perceptual switch of ambiguous figures, and indexes norepeinephrine functioning mediated by the locus coeruleus. In this study, we investigated if pupil diameter similarly predicts the switch into awareness people experience when solving a problem via insight. Additionally, we explored eye movement dynamics during the same task to investigate if the problem-solving strategies used are linked to specific oculomotor behaviors. In 38 participants, pupil diameter increased about 500 msec prior to solution only in trials for which subjects report having an insight. In contrast, participants increased their microsaccade rate only prior to non-insight solutions. Pupil dilation and microsaccades were not reliably related, but both appear to be robust markers of how people solve problems (with or without insight). The pupil size change seen when people have an "Aha!" moment represents an indicator of the switch into awareness of unconscious processes humans depend upon for insight, and suggests important involvement of norepinephrine, via the locus coeruleus, in sudden insight.

A Gestalt inference model for auditory scene segregation

Our current understanding of how the brain segregates auditory scenes into meaningful objects is in line with a Gestaltism framework. These Gestalt principles suggest a theory of how different attributes of the soundscape are extracted then bound together into separate groups that reflect different objects or streams present in the scene. These cues are thought to reflect the underlying statistical structure of natural sounds in a similar way that statistics of natural images are closely linked to the principles that guide figure-ground segregation and object segmentation in vision. In the present study, we leverage inference in stochastic neural networks to learn emergent grouping cues directly from natural soundscapes including speech, music and sounds in nature. The model learns a hierarchy of local and global spectro-temporal attributes reminiscent of simultaneous and sequential Gestalt cues that underlie the organization of auditory scenes. These mappings operate at multiple time scales to analyze an incoming complex scene and are then fused using a Hebbian network that binds together coherent features into perceptually-segregated auditory objects. The proposed architecture successfully emulates a wide range of well established auditory scene segregation phenomena and quantifies the complimentary role of segregation and binding cues in driving auditory scene segregation.

Connection-based and object-based grouping in multiple-object tracking: A developmental study

Developmental research on Gestalt laws has previously revealed that, even as young as infancy, we are bound to group visual elements into unitary structures in accordance with a variety of organizational principles. Here, we focus on the developmental trajectory of both connection-based and object-based grouping, and investigate their impact on object formation in participants, aged 9-21 years old (N = 113), using a multiple-object tracking paradigm. Results reveal a main effect of both age and grouping type, indicating that 9- to 21-year-olds are sensitive to both connection-based and object-based grouping interference, and tracking ability increases with age. In addition to its importance for typical development, these results provide an informative baseline to understand clinical aberrations in this regard. Statement of contribution What is already known on this subject? The origin of the Gestalt principles is still an ongoing debate: Are they innate, learned over time, or both? Developmental research has revealed how each Gestalt principle has its own trajectory and unique relationship to visual experience. Both connectedness and object-based grouping play an important role in object formation during childhood. What does this study add? The study identifies how sensitivity to connectedness and object-based grouping evolves in individuals, aged 9-21 years old. Using multiple-object tracking, results reveal that the ability to track multiple objects increases with age. These results provide an informative baseline to understand clinical aberrations in different types of grouping.

[Delusions: current psychodynamic and neurocognitive approaches]

BACKGROUND

The symptom "delusions" is a central psychopathological symptom in psychiatric diseases. Since the beginning of psychiatry various disciplines have attempted to explain and understand delusions but even now no generally accepted definition of this phenomenon exists.

AIM

A comprehensive review of current psychopathological and neurobiological theories of delusions is given.

MATERIAL AND METHODS

PubMed and Google scholar searches were performed using the keywords "delusion", "psychodynamic" and "neurobiology", both in English and German. Relevant German textbooks of psychiatry were also included.

DISCUSSION

A differentiated perspective of the phenomenon of delusions appears to be necessary to approach this complex and fascinating symptom. A one-dimensional approach does not do justice to the complexity of delusions. The various explanatory approaches can increasingly be linked to each other and are no longer considered to be mutually exclusive.

Supporting productive thinking: The semiotic context for Cognitive Systems Engineering (CSE)

The central thesis of this paper is that Rasmussen framed his approach to Cognitive Systems Engineering from the perspective of a Triadic Semiotic Model. This frame became the context for integrating multiple intellectual threads including Control Theory, Information Theory, Ecological Psychology, and Gestalt Psychology into a coherent theoretical framework. The case is made that the triadic semiotic framework is essential for a complete appreciation of the constructs that were central to Rasmussen's approach: Abstraction Hierarchy, Skill-Rules-Knowledge Model, Ecological Interface Design, and Proactive Risk Management.

Pilot Study of the Importance of Factors Affecting Emergency Department Opioid Analgesic Prescribing Decisions

INTRODUCTION

Little is known about the factors driving decision-making among emergency department (ED) providers when prescribing opioid analgesics (OA). The aim of this pilot study was to identify the importance of factors influencing OA-prescribing decisions and to determine how this varied among different types of providers.

METHODS

This was an observational cross-sectional survey study of 203 ED providers. The importance of decisional factors was rated on a 5-point Likert scale. Differences between provider groups were tested using Chi-squared or ANOVA tests where applicable.

RESULTS

Overall, 142/203 (69.9 %) potential respondents participated in the study. The five highest-rated factors were (mean ± SD) patient's opioid prescription history (4.4 ± 0.8), patient's history of substance abuse or dependence (4.4 ± 0.7), diagnosis thought to be the cause of patient's pain (4.2 ± 0.8), clinical gestalt (4.2 ± 0.7), and provider's concern about unsafe use of the medication (4.0 ± 0.9). The importance of 6 of 21 decisional factors varied significantly between different groups of providers.

CONCLUSION

In this pilot study of ED providers, the self-reported importance of several factors influencing OA-prescribing decisions were significantly different among attending physicians, resident physicians, and advanced practice providers. Further investigation into how ED providers make OA-prescribing decisions is needed to help guide interventions aimed at improving appropriate pain management.

Response to Lynn, et al.'s “Evaluation of Woodard's Theory of Perceptually Oriented Hypnosis”

In this article some misunderstandings of Perceptually Oriented Hypnosis presented in the recent evaluation by Lynn, et al. are pointed out. Perceptually Oriented Hypnosis emphasizes individual differences naturally occurring in the experience of everyday life or being-in-the-world and differentiation as major themes to understanding hypnosis. Woodard advocates that qualitative research enhances our understanding of hypnotic experiencing and allows us to examine hypnotic phenomena that elude the laboratory and control settings.

Grouping by Contrast: Figure – Ground Segregation is Not Necessarily Fundamental

A central tenet of Gestalt psychology is that the visual scene can be separated into figure and ground. The two illusions we present demonstrate that Gestalt processes can group spatial contrast information that cuts across the figure/ground separation. This finding suggests that visual processes that organise the visual scene do not necessarily require structural segmentation as their primary input.

The Evolution of Explanations of a Perceptual Phenomenon: A Case History Using the Ternus Effect

The Ternus effect involves a multi-element stimulus that can lead to either of two different percepts of apparent movement depending upon a variety of stimulus conditions. Since Ternus's 1926 discussion of this phenomenon, many researchers have attempted to explain it. We examine the history of explanations of the Ternus effect and show that they have evolved to contemporary theoretical positions that are very similar to Ternus's own ideas. Additionally, we describe a new experiment showing that theoretical positions that emphasize element grouping and element identity within groups can predict the effects of certain stimulus manipulations on the Ternus effect.

Multiple Fingers - One Gestalt

The Gestalt theory of perception offered principles by which distributed visual sensations are combined into a structured experience ("Gestalt"). We demonstrate conditions whereby haptic sensations at two fingertips are integrated in the perception of a single object. When virtual bumps were presented simultaneously to the right hand's thumb and index finger during lateral arm movements, participants reported perceiving a single bump. A discrimination task measured the bump's perceived location and perceptual reliability (assessed by differential thresholds) for four finger configurations, which varied in their adherence to the Gestalt principles of proximity (small versus large finger separation) and synchrony (virtual spring to link movements of the two fingers versus no spring). According to models of integration, reliability should increase with the degree to which multi-finger cues integrate into a unified percept. Differential thresholds were smaller in the virtual-spring condition (synchrony) than when fingers were unlinked. Additionally, in the condition with reduced synchrony, greater proximity led to lower differential thresholds. Thus, with greater adherence to Gestalt principles, thresholds approached values predicted for optimal integration. We conclude that the Gestalt principles of synchrony and proximity apply to haptic perception of surface properties and that these principles can interact to promote multi-finger integration.

The role of shape complexity in the detection of closed contours

The detection of contours in noise has been extensively studied, but the detection of closed contours, such as the boundaries of whole objects, has received relatively little attention. Closed contours pose substantial challenges not present in the simple (open) case, because they form the outlines of whole shapes and thus take on a range of potentially important configural properties. In this paper we consider the detection of closed contours in noise as a probabilistic decision problem. Previous work on open contours suggests that contour complexity, quantified as the negative log probability (Description Length, DL) of the contour under a suitably chosen statistical model, impairs contour detectability; more complex (statistically surprising) contours are harder to detect. In this study we extended this result to closed contours, developing a suitable probabilistic model of whole shapes that gives rise to several distinct though interrelated measures of shape complexity. We asked subjects to detect either natural shapes (Exp. 1) or experimentally manipulated shapes (Exp. 2) embedded in noise fields. We found systematic effects of global shape complexity on detection performance, demonstrating how aspects of global shape and form influence the basic process of object detection.

Do clinicians decide relying primarily on Bayesians principles or on Gestalt perception? Some pearls and pitfalls of Gestalt perception in medicine

Clinical judgment is a foundation of medical practice and lies at the heart of a physician's knowledge, expertise and skill. Although clinical judgment is an active part of all medical fields, thus including diagnosis and therapy, communication and decision making, it is still poorly defined. It can be considered a synthesis of intuition (mainly based on Gestalt principles) and an analytical approach. Gestalt perception finds its rationale in the evidence that perception of any given object or experience exhibits intrinsic qualities that cannot be completely reduced to visual, auditory, tactile, olfactory, or gustatory components. Thus, perceptions are not constructed in a "bottom-up" fashion from such elements, but are instead globally perceived, in a more "top-down" fashion. Gestalt perception, if cautiously and carefully combined with structured (techno)logical tools, would permit one to defoliate the often too-many-branches built diagnostic trees, and help physicians to better develop their competency. On the other hand, the practice of evidence-based medicine lies in the integration of individual clinical expertise and judgment with the best available external clinical evidence from systematic research. This article is aimed at providing some general concepts about Gestalt perception, and to discuss some aspects of clinical practice potentially influenced by this approach.

Romanticism and schizophrenia. First part: The recency hypothesis and the core Gestalt of the disease

Descriptions of irrational, incomprehensible, or unconstrained behavior such as is common nowadays in patients suffering from severe mental disorders can be found in the Bible, in Mesopotamian scripts, in classical Greek and Roman literature, and in the writings of many non-Western cultures. However, the presence of full-blown features of schizophrenia as seen today in psychiatric settings is controversial. Typical symptoms, the expected onset, duration and outcome, the impact of the disease on psychic functioning and the associated disability of the disease are mostly absent in those texts. Torrey (1980) and Hare (1988) have claimed that the disease did not exist before the year 1800 (this is known as the recency hypothesis). This would be the consequence of biological factors such as viruses, genetic or dietary factors or environmental contaminants associated to civilization. Others have put the emphasis on industrialization and its repercussions on social conditions such as family structure and migration. After analyzing the many manifestations of insanity in literary characters, in medical texts and in key historical figures, the arguments presented in this paper tend to support the recency hypothesis. A review of the core characteristics of schizophrenia and its impact on selfhood, intersubjetivity and ipseity, topics relatively neglected in recent psychiatric literature, opens the doors to consider in a second part the relationship between the features of Romanticism, starting by the “discovery of intimacy”, and its articulation with the disturbance of ipseity and selfhood characteristic of the disease.

External validation and comparison of three pediatric clinical dehydration scales

Objective

To prospectively validate three popular clinical dehydration scales and overall physician gestalt in children with vomiting or diarrhea relative to the criterion standard of percent weight change with rehydration.

Methods

We prospectively enrolled a non-consecutive cohort of children ≤ 18 years of age with an acute episode of diarrhea or vomiting. Patient weight, clinical scale variables and physician clinical impression, or gestalt, were recorded before and after fluid resuscitation in the emergency department and upon hospital discharge. The percent weight change from presentation to discharge was used to calculate the degree of dehydration, with a weight change of ≥ 5% considered significant dehydration. Receiver operating characteristics (ROC) curves were constructed for each of the three clinical scales and physician gestalt. Sensitivity and specificity were calculated based on the best cut-points of the ROC curve.

Results

We approached 209 patients, and of those, 148 were enrolled and 113 patients had complete data for analysis. Of these, 10.6% had significant dehydration based on our criterion standard. The Clinical Dehydration Scale (CDS) and Gorelick scales both had an area under the ROC curve (AUC) statistically different from the reference line with AUCs of 0.72 (95% CI 0.60, 0.84) and 0.71 (95% CI 0.57, 0.85) respectively. The World Health Organization (WHO) scale and physician gestalt had AUCs of 0.61 (95% CI 0.45, 0.77) and 0.61 (0.44, 0.78) respectively, which were not statistically significant.

Conclusion

The Gorelick scale and Clinical Dehydration Scale were fair predictors of dehydration in children with diarrhea or vomiting. The World Health Organization scale and physician gestalt were not helpful predictors of dehydration in our cohort.

Can healthy fetuses show facial expressions of "pain" or "distress"?

BACKGROUND

With advances of research on fetal behavioural development, the question of whether we can identify fetal facial expressions and determine their developmental progression, takes on greater importance. In this study we investigate longitudinally the increasing complexity of combinations of facial movements from 24 to 36 weeks gestation in a sample of healthy fetuses using frame-by-frame coding of 4-D ultrasound scans. The primary aim was to examine whether these complex facial movements coalesce into a recognisable facial expression of pain/distress.

METHODOLOGY/FINDINGS

Fifteen fetuses (8 girls, 7 boys) were observed four times in the second and third trimester of pregnancy. Fetuses showed significant progress towards more complex facial expressions as gestational age increased. Statistical analysis of the facial movements making up a specific facial configuration namely "pain/distress" also demonstrates that this facial expression becomes significantly more complete as the fetus matures.

CONCLUSIONS/SIGNIFICANCE

The study shows that one can determine the normal progression of fetal facial movements. Furthermore, our results suggest that healthy fetuses progress towards an increasingly complete pain/distress expression as they mature. We argue that this is an adaptive process which is beneficial to the fetus postnatally and has the potential to identify normal versus abnormal developmental pathways.

The metaphor-gestalt synergy underlying the self-organisation of perception as a semiotic process

Recently the basis of concept and language formation has been redefined by the proposal that they both stem from perception and embodiment. The experiential revolution has lead to a far more integrated and dynamic understanding of perception as a semiotic system. The emergence of meaning in the perceptual process stems from the interaction between two key mechanisms. These are first, the generation of schemata through recurrent sensorimotor activity (SM) that underlies category and language formation (L). The second is the interaction between metaphor (M) and gestalt mechanisms (G) that generate invariant mappings beyond the SM domain that both conserve and diversify our understanding and meaning potential. We propose an important advance in our understanding of perception as a semiotic system through exploring the affect of self-organising to criticality where hierarchical behaviour becomes widely integrated through 1/f process and isomorphisms. Our proposal leads to several important implications. First, that SM and L form a functional isomorphism depicted as SM <=> L. We contend that SM <=> L is emergent, corresponding to the phenomenal self. Second, meaning structures the isomorphism SM <=>L through the synergy between M and G (M-G). M-G synergy is based on a combination of structuring and imagination. We contend that the interaction between M-G and SM <=> L functions as a macro-micro comutation that governs perception as semiosis. We discuss how our model relates to current research in fractal time and verb formation.

The effect of Gestalt laws of perceptual organization on the comprehension of three-variable bar and line graphs

OBJECTIVE

We report three experiments investigating the ability of undergraduate college students to comprehend 2 x 2 "interaction" graphs from two-way factorial research designs.

BACKGROUND

Factorial research designs are an invaluable research tool widely used in all branches of the natural and social sciences, and the teaching of such designs lies at the core of many college curricula. Such data can be represented in bar or line graph form. Previous studies have shown, however, that people interpret these two graphical forms differently.

METHOD

In Experiment 1, participants were required to interpret interaction data in either bar or line graphs while thinking aloud. Verbal protocol analysis revealed that line graph users were significantly more likely to misinterpret the data or fail to interpret the graph altogether.

RESULTS

The patterns of errors line graph users made were interpreted as arising from the operation of Gestalt principles of perceptual organization, and this interpretation was used to develop two modified versions of the line graph, which were then tested in two further experiments. One of the modifications resulted in a significant improvement in performance.

CONCLUSION

Results of the three experiments support the proposed explanation and demonstrate the effects (both positive and negative) of Gestalt principles of perceptual organization on graph comprehension.

APPLICATION

We propose that our new design provides a more balanced representation of the data than the standard line graph for nonexpert users to comprehend the full range of relationships in two-way factorial research designs and may therefore be considered a more appropriate representation for use in educational and other nonexpert contexts.

A century of Gestalt psychology in visual perception: II. Conceptual and theoretical foundations

Our first review article (Wagemans et al., 2012) on the occasion of the centennial anniversary of Gestalt psychology focused on perceptual grouping and figure-ground organization. It concluded that further progress requires a reconsideration of the conceptual and theoretical foundations of the Gestalt approach, which is provided here. In particular, we review contemporary formulations of holism within an information-processing framework, allowing for operational definitions (e.g., integral dimensions, emergent features, configural superiority, global precedence, primacy of holistic/configural properties) and a refined understanding of its psychological implications (e.g., at the level of attention, perception, and decision). We also review 4 lines of theoretical progress regarding the law of Prägnanz-the brain's tendency of being attracted towards states corresponding to the simplest possible organization, given the available stimulation. The first considers the brain as a complex adaptive system and explains how self-organization solves the conundrum of trading between robustness and flexibility of perceptual states. The second specifies the economy principle in terms of optimization of neural resources, showing that elementary sensors working independently to minimize uncertainty can respond optimally at the system level. The third considers how Gestalt percepts (e.g., groups, objects) are optimal given the available stimulation, with optimality specified in Bayesian terms. Fourth, structural information theory explains how a Gestaltist visual system that focuses on internal coding efficiency yields external veridicality as a side effect. To answer the fundamental question of why things look as they do, a further synthesis of these complementary perspectives is required.

Bilateral theta-burst TMS to influence global gestalt perception

While early and higher visual areas along the ventral visual pathway in the inferotemporal cortex are critical for the recognition of individual objects, the neural representation of human perception of complex global visual scenes remains under debate. Stroke patients with a selective deficit in the perception of a complex global Gestalt with intact recognition of individual objects – a deficit termed simultanagnosia – greatly helped to study this question. Interestingly, simultanagnosia typically results from bilateral lesions of the temporo-parietal junction (TPJ). The present study aimed to verify the relevance of this area for human global Gestalt perception. We applied continuous theta-burst TMS either unilaterally (left or right) or bilateral simultaneously over TPJ. Healthy subjects were presented with hierarchically organized visual stimuli that allowed parametrical degrading of the object at the global level. Identification of the global Gestalt was significantly modulated only for the bilateral TPJ stimulation condition. Our results strengthen the view that global Gestalt perception in the human brain involves TPJ and is co-dependent on both hemispheres.

A century of Gestalt psychology in visual perception: I. Perceptual grouping and figure-ground organization

In 1912, Max Wertheimer published his paper on phi motion, widely recognized as the start of Gestalt psychology. Because of its continued relevance in modern psychology, this centennial anniversary is an excellent opportunity to take stock of what Gestalt psychology has offered and how it has changed since its inception. We first introduce the key findings and ideas in the Berlin school of Gestalt psychology, and then briefly sketch its development, rise, and fall. Next, we discuss its empirical and conceptual problems, and indicate how they are addressed in contemporary research on perceptual grouping and figure-ground organization. In particular, we review the principles of grouping, both classical (e.g., proximity, similarity, common fate, good continuation, closure, symmetry, parallelism) and new (e.g., synchrony, common region, element and uniform connectedness), and their role in contour integration and completion. We then review classic and new image-based principles of figure-ground organization, how it is influenced by past experience and attention, and how it relates to shape and depth perception. After an integrated review of the neural mechanisms involved in contour grouping, border ownership, and figure-ground perception, we conclude by evaluating what modern vision science has offered compared to traditional Gestalt psychology, whether we can speak of a Gestalt revival, and where the remaining limitations and challenges lie. A better integration of this research tradition with the rest of vision science requires further progress regarding the conceptual and theoretical foundations of the Gestalt approach, which is the focus of a second review article.

Contributing to the early detection of Rett syndrome: the potential role of auditory Gestalt perception

To assess whether there are qualitatively deviant characteristics in the early vocalizations of children with Rett syndrome, we had 400 native Austrian-German speakers listen to audio recordings of vocalizations from typically developing girls and girls with Rett syndrome. The audio recordings were rated as (a) inconspicuous, (b) conspicuous or (c) not able to decide between (a) and (b). The results showed that participants were accurate in differentiating the vocalizations of typically developing children compared to children with Rett syndrome. However, the accuracy for rating verbal behaviors was dependent on the type of vocalization with greater accuracy for canonical babbling compared to cooing vocalizations. The results suggest a potential role for the use of rating child vocalizations for early detection of Rett syndrome. This is important because clinical criteria related to speech and language development remain important for early identification of Rett syndrome.

Grouping and emergent features in vision: toward a theory of basic Gestalts

Gestalt phenomena are often so powerful that mere demonstrations can confirm their existence, but Gestalts have proven hard to define and measure. Here we outline a theory of basic Gestalts (TBG) that defines Gestalts as emergent features (EFs). The logic relies on discovering wholes that are more discriminable than are the parts from which they are built. These wholes contain EFs that can act as basic features in human vision. As context is added to a visual stimulus, a hierarchy of EFs appears. Starting with a single dot and adding a second yields the first two potential EFs: the proximity (distance) and orientation (angle) between the two dots. A third dot introduces two more potential EFs: symmetry and linearity; a fourth dot produces surroundedness. This hierarchy may extend to collinearity, parallelism, closure, and more. We use the magnitude of Configural Superiority Effects to measure the salience of EFs on a common scale, potentially letting us compare the strengths of various grouping principles. TBG appears promising, with our initial experiments establishing and quantifying at least three basic EFs in human vision.

Transfer of associative grouping to novel perceptual contexts in infancy

Learning can be highly adaptive if associations learned in one context are generalized to novel contexts. We examined the development of such generalization in infancy in the context of grouping. In Experiment 1, 3- to 4-month-olds and 6- to 7-month-olds were habituated to shapes grouped via the organizational principle of common region and were tested with familiar and novel pairs as determined by the principle of proximity. Older infants generalized from common region to proximity, but younger infants did not. Younger infants failed to generalize when the task was easier (Experiment 2), and their failure was not due to inability to group via proximity (Experiment 3). However, in Experiment 4, even younger infants generalized grouping on the basis of connectedness to proximity. Thus, the ability to transfer learned associations of shapes to novel contexts is evident early in life, although it continues to undergo quantitative change during infancy. Moreover, the operation of this generalization mechanism may be induced by means of bootstrapping onto functional organizational principles, which is consistent with a developmental framework in which core processes scaffold learning.

Clinical judgement and the medical profession

OBJECTIVES

Clinical judgment is a central element of the medical profession, essential for the performance of the doctor, and potentially generating information also for other clinicians and for scientists and health care managers. The recently renewed interest in clinical judgement is primarily engaged with its role in communication, diagnosis and decision making. Beyond this issue, the present article highlights the interrelations between clinical judgement, therapy assessment and medical professionalism.

METHODS

Literature review and theory development.

RESULTS

The article presents different methodological approaches to causality assessment in clinical studies and in clinical judgement, and offers criteria for clinical single case causality. The article outlines models of medical professionalism such as technical rationality and practice epistemology, and characterizes features of professional expertise such as tacit knowledge, reflection in action, and gestalt cognition.

CONCLUSIONS

Consequences of a methodological and logistical advancement of clinical judgment are discussed, both in regard to medical progress and to the renewal of the cognitive basis of the medical profession.

Differential therapeutic outcomes of community-based group interventions for women and children exposed to intimate partner violence

Two community-based group therapies, emotion focused versus goal oriented, are compared among women exposed to intimate partner violence (n = 46) and their children ( n = 48) aged between 6 and 12 years. A series of repeated measures analyses are employed to evaluate the effects of time from baseline to postintervention following random assignment. Main and treatment effects for women provide support for the relative effectiveness in increasing quality of social support in the emotion-focused intervention and in the reduction of both family conflict and alcohol use for the goal-oriented intervention.

Objects and events as determinants of parallel processing in dual tasks: evidence from the backward compatibility effect

The backward-compatibility effect (BCE) is a major index of parallel processing in dual tasks and is related to the dependency of Task 1 performance on Task 2 response codes (Hommel, 1998). The results of four dual-task experiments showed that a BCE occurs when the stimuli of both tasks are included in the same visual object (Experiments 1 and 2) or belong to the same perceptual event (Experiments 3 and 4). Thus, the BCE may be modulated by factors that influence whether both task stimuli are included in the same perceptual event (objects, as studied in cognitive experiments, being special cases of events). As with objects, drawing attention to a (selected) event results in the processing of its irrelevant features and may interfere with task execution.

Transfer and scaffolding of perceptual grouping occurs across organizing principles in 3- to 7-month-old infants

Previous research has demonstrated that organizational principles become functional over different time courses of development: Lightness similarity is available at 3 months of age, but form similarity is not readily in evidence until 6 months of age. We investigated whether organization would transfer across principles and whether perceptual scaffolding can occur from an already functional principle to a not-yet-operational principle. Six- to 7-month-old infants (Experiment 1) and 3- to 4-month-old infants (Experiment 2) who were familiarized with arrays of elements organized by lightness similarity displayed a subsequent visual preference for a novel organization defined by form similarity. Results with the older infants demonstrate transfer in perceptual grouping: The organization defined by one grouping principle can direct a visual preference for a novel organization defined by a different grouping principle. Findings with the younger infants suggest that learning based on an already functional organizational process enables an organizational process that is not yet functional through perceptual scaffolding.

VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism. A systematic review of management outcome studies

Clinical outcome studies have shown that it is safe to withhold anticoagulant therapy in patients with suspected pulmonary embolism (PE) who have a negative D-dimer result and a low pretest probability (PTP) either using a PTP model or clinical gestalt. It was the objective of the present study to assess the safety of the combination of a negative VIDAS D-dimer result in combination with a non-high PTP using the Wells or Geneva models to exclude PE. A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Seven studies (6 prospective management studies and 1 randomised controlled trial) reporting failure rates at three months were included in the analysis. Non-high PTP was defined as "unlikely" using the Wells' model, or "low/intermediate" PTP using either the Geneva score, the Revised Geneva Score, or clinical gestalt. Two reviewers independently extracted data onto standardised forms. A total of 5,622 patients with low/intermediate or unlikely PTP were assessed using the VIDAS D-dimer. PE was ruled out by a negative D-dimer test in 2,248 (40%, 95% confidence intervals [CI] 38.7 to 41.3%) of them. The three-month thromboembolic risk in patients left untreated on the basis of a low/intermediate or unlikely PTP and a negative D-dimer test was 3/2,166 (0.14%, 95% CI 0.05 to 0.41%). In conclusion, the combination of a negative VIDAS D-dimer result and a non-high PTP effectively and safely excludes PE in an important proportion of outpatients with suspected PE.

The emergence of dynamic form through phase relations in dynamical systems

Theories of visual form have been plagued with the problem of the correspondence between aspects of the form across time and across spatial location. Following Bateson's idea that knowledge emerges from the relations among multiple flows of difference, our computational model illustrates how visual form can emerge from the phase relations between two such flows in a way that eliminates the correspondence problem. Computationally, the first flow of process in a Boolean network falls into one among many different attractor cycles each of which cycles at a given fundamental frequency. A second cyclic systemic flow, with its own frequency, is computationally necessary before a person can experience the patterns (transients, attractors) of the first flow on a computer monitor; and the frequency of this second flow is a control variable. Dynamic visual form, in this computational logic, emerges from the phase relations between the frequencies of the two flows. These dynamic forms exhibit, simultaneously, many kinds of apparent motion suggesting that the processes generating apparent motion are not merely illusions but are in the service of dynamic form perception. This model of perceptual organization and moving form is discussed in relation to other approaches.

That 'gut feeling'

Upper abdominal pain can be a dilemma in general practice. Sometimes the likely diagnosis is clear in your mind after the first sentence of the patient's history is revealed--and only gets confirmed the further you delve into the history and examination. On other occasions the diagnosis is far more elusive. In this issue of Australian Family Physician, Sprio Tsipouras raises the importance of the doctor's 'gestalt' in managing these elusive cases. What is gestalt? How do we develop it?

Young infants readily use proximity to organize visual pattern information

Four experiments relying on novelty and spontaneous preference procedures were performed to determine whether 3-4-month-old infants utilize the Gestalt principle of proximity to organize visual pattern information. In Experiment 1, infants familiarized with arrays of elements that could be organized into either columns or rows were tested for their preference between vertical and horizontal bars. The infants preferred the novel organization of bars. Experiments 2 and 3 showed that the novelty preference could not be attributed to an a priori preference or an inability to discriminate between the elements comprising the patterns. Experiment 4 replicated the results of Experiment 1 in a bars --> elements version of the task, indicating that extended exposure is not necessary for infants to organize based on proximity. The results suggest that infants readily organize visual pattern information in accord with proximity. Implications of this finding for models of the ontogenesis and microgenesis of object perception in infants and adults are discussed.

Consultant nurse?consultant physician: a new partnership for patient-centred care?

AIMS AND OBJECTIVES

The aim was to describe the process of role transition by an individual who has assumed the position of a consultant nurse in cardiovascular health care. The objective was to explain the 'gestalt' of being a consultant nurse and how the 'gestalt' has evolved.

BACKGROUND

The development of the consultant nurse role is new, research has described the value and potential contribution of the role. The literature suggests that the role still requires further evaluation and description to be understood better. DESIGN. A free-association narrative interview method was chosen as the research design.

METHOD

An in depth interview, tape-recorded and analysed along with field note analysis was the method for eliciting the narrative.

RESULTS

The analysis of the narrative reveals an emerging 'gestalt' for being a consultant nurse. Various concepts and phenomena attributable to the role are identified from the experience described. The gestalt explains the journey of the individual through an 'apprenticeship' to role attainment, whereby a new sense of professional self or 'Me' is realized.

CONCLUSION

The significance of the paper lies in the analysis of the narrative and the insights it gives to help other aspirant consultant nurses. It is through the understanding of these insights that individuals could plan their own learning and development to be achieved in the role of consultant nurse.

RELEVANCE TO CLINICAL PRACTICE

To be effective and provide effective patient care, one can argue that appropriate learning needs to take place. Those that have been appointed to the role have battled to find achievement and acceptance. These battles may be made easier to win if the role is better understood and appropriate preparation provided. Only then will the real potential of the role be realized in improved patient care outcomes.

Beyond content analysis and non-verbal behaviour - what about atmosphere? A phenomenological approach

OBJECTIVE

Basic research and careful observation of clinical practice have yielded a vast amount of empirical data on communication in health care. This research has been guided by the assumption that good communication will be better understood and easier to teach when its single constituents are identified. This paper points to the limitation of this approach.

METHODS

Based upon the terminology of phenomenological thinking grounded in neo-phenomenology (Hermann Schmitz) contradictory findings from the literature on patient-centred communication in Internal Medicine and Oncology are used as a starting point to elucidate different paradigms in conducting research in clinical communication.

RESULTS

The phenomenological approach of the German philosopher Hermann Schmitz (*1928) is briefly presented. It is based upon experiences that 'on the average everybody can vividly access or retrieve from his memory'. Empirical research does not provide unequivocal advice how to communicate with an individual patient. Likewise, researchers note unexpected reactions from real patients-they do not behave as the expert would assume. The inclusion of the phenomenon of a certain atmosphere is proposed referring to the impression of 'something in the air' that sometimes can be identified during communication or upon entering a room. Even though it can be sensed with high evidence, it cannot be deduced from particular observations. Instead, the atmosphere is part of a situation in which meaning is dissolved in chaotic manifoldness. Sensing an atmosphere is a function of the lived body (Leib) as opposed to phenomena that are mediated by the senses.

CONCLUSION

Current research and teaching models cover only part of the phenomenology of professional communication. How research and education might profit from the addition of Schmitz' philosophical approach will be outlined in this article.

PRACTICE IMPLICATIONS

Including perceptions of the lived body (Leib) should improve research in clinical communication and teaching courses.