Risk information provided to prospective oocyte donors in a preliminary phone call

In order to accommodate for the present shortage of oocyte donors, oocyte-donation programs place ads in college newspapers and provide large monetary compensation to encourage participation. Large compensation acts as a strong incentive for young women to undergo the potentially risky procedure of donation. In this enticing situation, it is particularly important for programs to fully inform prospective donors of the risks of the procedure so that they can accurately weigh the costs and benefits of donating. However, because oocyte-donor programs must alleviate the shortage of donors if they wish to maintain a financially viable business, there is reason to fear that they may minimize or misrepresent risks when recruiting egg donors. In this pilot study, the risk information provided by programs (n=19) to prospective oocyte donors in a preliminary phone call inquiry was investigated. The majority of the programs provided incomplete and/or inaccurate risk information. Policy changes are recommended to reduce the potential for undue influence and to standardize and regulate the risk information provided to prospective egg donors.     

Psychometric Properties and Norms for the Personality Assessment Inventory in Egg Donors and Gestational Carriers

Although psychological evaluations are an integral element of screening for third-party reproduction and the Personality Assessment Inventory (PAI) is commonly used for these evaluations, little is known about the psychometric properties or normative scores on the PAI among egg donors and carriers. We evaluated the PAI among 1,044 egg donors and gestational carriers from various fertility clinics across the United States. PAI scales were generally internally consistent in this population, although range restriction appeared to attenuate reliability on several scales. The PAI profiles of egg donors and carriers had elevated positive impression management and suppressed clinical scale scores relative to the community standardization sample, as would be expected given the contingencies of this assessment context. Scores were similar across egg donors and carriers and were similar whether the carrier or donor was known or not known to the prospective parents. Sample-specific norms are provided for the use of the PAI in this setting.     

The impact of affective information on the professional judgments of more experienced and less experienced auditors

This study examines whether the presence of realistic, yet irrelevant, affective information differentially influences the professional judgments of more experienced and less experienced auditors. In this study, auditors with different experience levels were either provided or not provided with information designed to elicit a negative interpersonal emotional reaction towards a manufacturing client when making an inventory obsolescence risk judgment. The results indicate that the inventory obsolescence risk assessments of less experienced auditors were significantly higher when they were provided with negative affective information on a client than when no such information was provided. No such differences were found for the more experienced auditors. This study suggests that professional experience is one factor that influences individuals' assessments of the informational value of affective reactions. This has implications for developing effective training programs to increase professionals' awareness of the influence that emotional reactions can have on their judgment. Copyright © 2002 John Wiley & Sons, Ltd.     

Infants' detection of visual-tactual discrepancies: asymmetries that indicate a directive role of visual information

Infants' cross-modal functioning was investigated in two studies. In Study 1, 11-month-old infants were confronted with five different visual-tactual discrepancies created with a mirror arrangement. The infants' behavioral reactions to the discrepancies were compared with their behavior on matched control trials with a forced-choice judgement procedure. Infants detected discrepancies in which they saw an egg and felt a cube, saw a fur-covered cube and felt an egg, and saw a cross and felt a fur-covered cube. However, they provided no evidence that they detected discrepancies in which they saw a cube and felt a cross or saw a cube and felt a fur-covered cube. In Study 2, infants were confronted with discrepancies that were the converse of those which seemed to go unnoticed in Study 1: They saw either a cross or a fur-covered cube and felt a plain cube. Both of these new discrepancies were detected according to the forced-choice judgment procedure. The results indicate that texture as well as shape can serve as a basis for cross-modal matching for infants. The asymmetries in cross-modal matching that were observed across Studies 1 and 2 are interpreted as evidence that visual information plays a directive, goal-setting role for infants' manual explorations.     

Assessing the risk of ovarian hyperstimulation syndrome in egg donation: implications for human embryonic stem cell research

Stem cell research has important implications for medicine. The source of stem cells influences their therapeutic potential, with stem cells derived from early-stage embryos remaining the most versatile. Somatic cell nuclear transfer (SCNT), a source of embryonic stem cells, allows for understandings about disease development and, more importantly, the ability to yield embryonic stem cell lines that are genetically matched to the somatic cell donor. However, SCNT requires women to donate eggs, which involves injection of ovulation-inducing hormones and egg retrieval through laparoscopy or transvaginal needle aspiration. Risks from this procedure are fiercely debated, most notably risk of ovarian hyperstimulation syndrome (OHSS). This review examines risk of OHSS resulting from oocyte donation. We conclude that risk posed by OHSS in egg donation is not significant enough to warrant undue concern, and much of this can be eliminated when proper precautions are taken. This bears relevance to the future of stem cell research policymaking.     

The role of emotions in predicting sperm and egg donation

Sperm and egg donation allows people who cannot have children naturally to become parents. However, in many countries there is a shortage of donors. Therefore, it is important to assess the factors that influence donation. Across two studies, we assessed the role of social‐cognitive and emotional factors in promoting and deterring sperm and egg donation. Study 1 (N = 138 men) found that feeling anxiety toward discovering a fertility problem and pride positively predicted sperm donation intention and information seeking behavior. By contrast, feeling anxiety toward the process of donation negatively predicted sperm donation intention and information seeking behavior. Study 2 (N = 193 women) found that pride positively and the anxiety toward the process negatively predicted egg donation intentions, but not information seeking behavior. These results suggest that it is important to consider the role of emotions in motivating and deterring people from becoming a sperm and egg donor.     

The experience of counselling for UK egg providers

Objective

The aim of this study was to address current gaps in knowledge regarding the appropriateness and quality of counselling provided to egg donors in the UK.

Methods

The present study used a cross-sectional, qualitative design. Semi-structured interviews were carried out with 29 UK egg donors to explore their experiences of egg donation and the counselling received.

Results

Of the 29 participants, 24 had received counselling. The remaining five did not receive counselling because they were either not accepted as a donor (n = 4) or were offered, but chose not to take up the session (n = 1). The findings are presented in relation to five themes: feeling supported via counselling; feeling well-informed; welcoming an individualised approach; the counselling setting; and thinking about the future.

Conclusion

Egg donors in this study had varying experiences of counselling offered to them as part of the egg donation process in the UK.

Implications

The findings indicate that there are some aspects of counselling in the UK that could be improved, including the routine offering of counselling throughout the egg donation process and the tailoring of counselling to meet egg donors' individual needs.     

Risk's Place in Decision Rules

To handle epistemic and pragmatic risks, Gärdenfors and Sahlin (1982, 1988) design a decision procedure for cases in which probabilities are indeterminate. Their procedure steps outside the traditional expected utility framework. Must it do this? Can the traditional framework handle risk? This paper argues that it can. The key is a comprehensive interpretation of an option's possible outcomes. Taking possible outcomes more broadly than Gärdenfors and Sahlin do, expected utility can give risk its due. In particular, Good's (1952) decision procedure adequately handles indeterminate probabilities and the risks they generate.     

Framing and Risky Choice as Influenced by Comparison of One's Achievements with Others: The Case of Investment in the Stock Exchange

Based on social comparison theory and equity theory, the first aim of this study was to examine the hypothesis that framing is affected not only by previous success or failure, but also by comparisons with relevant others' outcomes as well. The second aim of the study was to examine prospect theory propositions that people are risk aversive for gains and risk seeking for losses. A total of 220 students were administered scenarios that described outcomes of their stock investments (gains or losses). In addition, they were provided with information about their close friends' outcomes investing in similar stocks. Generally, the hypothesis regarding the influence of others' outcomes on framing was confirmed. However, results showed that, in contradiction to prospect theory, gain framing rather than loss framing was related to risk seeking behavior. Specifically, in the gain framing situation, the readiness to take risks was highest when the others' outcomes were equal to those of the participants. The limitations of prospect theory are discussed.     

活体肝移植伦理相关问题的质性研究

活体肝移植术虽部分解决了供肝短缺问题,但需从活的供体身上切取部分肝脏,使其承担手术创伤甚至死亡的风险,故存在诸多伦理问题。本文应用质性研究,对7名与活体肝移植相关的不同领域专家及6名手术相关者进行访谈,采用 Nvivo9．0软件辅助对访谈资料进行了分析。探讨活体肝移植的伦理审查、供体选择及心理评估的相关伦理问题。结果显示,尽管活体肝移植手术仍在全国多家医院进行,目前政府对活体肝移植伦理审查和监管更加严格,伦理审查缺少对供体、受体的心理综合评估。因此,建议建立健全并推广死亡器官捐赠注册系统以增加肝源,减少活体肝移植对供体带来的健康风险,并开发适用的心理综合评估工具,评估结果应列入伦理审查范围。     

The question of sanity restoration in jail

Severe mental illness, especially psychotic disorders that are worsening, acute or complicated, normally require intensive psychiatric care and treatment that is most appropriately provided in a mental hospital. For criminal defendants, transfer to a forensic security hospital has traditionally been the means of achieving hospital care for mentally disordered defendants who have been found incompetent to stand trial or not guilty by reason of insanity. In recent years, with the shortage of intermediate and long-term hospital beds in the United States, including forensic security hospital beds, jail-based competency restoration programs are being established, seemingly obviating hospital transfer. Potential advantages of and concerns about jail-based, as opposed to hospital-based, competency restoration programs are discussed in the literature. If defendants with severe mental illness traditionally treated in a forensic security hospital for competency restoration are now treated for competency restoration in jail, it is not inconceivable that insanity acquittees could one day be treated in jail for sanity restoration. With the premise that it is better to consider the potential consequences before this becomes a serious proposal and is implemented, this analysis examine the advantages and concerns that have been put forth for jail-based competence restoration programs as they may or may not apply to jail-based sanity restoration programs. Substantial commonality is recognized, but also some differences, as well as reason for skepticism of the purported virtues of either alternative to care and treatment in forensic security hospitals.     

Inaccuracy of family health information: implications for prevention

There is a conflict between the rest of the family's right to medical confidentiality and the individual's need to know about health risks for which she or he may show increased susceptibility. Research has shown increased risk in the development of a variety of disorders for those with a positive family history. In many cases the familial predisposition appears to interact with alterable environmental factors (e.g., diet). This suggests a need for targeting of preventive efforts at those at highest risk. As success of early detection and prevention programs increase, there will appear an increased need for accurate family health history information as an aid in early identification. Research on accuracy of family health information (Hastrup, Hotchkiss & Johnson, this issue) shows extensive inaccuracy. Implications of inaccurate information for self-directed and public health prevention are described. Research and progress in prevention will likely accelerate, continuing to alter the traditional view from one of the individual with a personal health history to one in which individuals share a familial (genetic + shared environment + similar behavior patterns) risk with others, who may also benefit from preventive programs.     

Looking for Trouble: Preventive Genomic Sequencing in the General Population and the Role of Patient Choice

Advances in genomics have led to calls for developing population-based preventive genomic sequencing (PGS) programs with the goal of identifying genetic health risks in adults without known risk factors. One critical issue for minimizing the harms and maximizing the benefits of PGS is determining the kind and degree of control individuals should have over the generation, use, and handling of their genomic information. In this article we examine whether PGS programs should offer individuals the opportunity to selectively opt out of the sequencing or analysis of specific genomic conditions (the menu approach) or whether PGS should be implemented using an all-or-nothing panel approach. We conclude that any responsible scale-up of PGS will require a menu approach that may seem impractical to some, but that draws its justification from a rich mix of normative, legal, and practical considerations.     

Regarding a Risk‐Pooling System of compensation

In this paper, I propose and defend a distinct and novel approach to compensation for risk impositions. I call it the Risk‐Pooling System of compensation. This system suggests that when X performs an action that imposes a risk of harm to Y, then X is liable to Y, and is therefore obliged to make an ex ante compensation that is roughly equivalent to the expected cost of potential harm to a social‐ risk pool. If and when Y suffers harm as a result of the risk imposed by X, they then receive an ex post compensation roughly equivalent to the cost of actual harm suffered. This system of compensation creates a social buffer between the risk imposer – the one who has the duty to pay compensation into the pool – and the victim – the one who has the right to receive compensation from the social pool. I contend that the Risk‐Pooling System is an improvement over its alternatives due to its capacity to produce the best social utilities, particularly, in terms of reducing information costs, obtaining optimal deterrence in the society and creating incentives for people to be engaged in social activities.     

“I Am Uncertain About What My Uncertainty Even Is”: Men’s Uncertainty and Information Management of Their BRCA-Related Cancer Risks

Men with a germline pathogenic BRCA1 or BRCA2 variant have increased risks for developing breast, pancreatic, prostate, and melanoma cancers, but little is known about how they understand and manage their cancer risks. This study examines how men with BRCA-related cancer risks manage uncertainty and information about their risks. Twenty-five men who were either a BRCA carrier or have a BRCA-positive first-degree family member that put the participant at 50% chance of also being a BRCA carrier were interviewed for this study. Using uncertainty management theory as a theoretical framework, this study demonstrates that men manage uncertainty by seeking information from female family members, websites, and healthcare providers, and are under-informed about their cancer risks. Further, in handling their information, men prefer information about cancer risk percentages and screening recommendations in the form of lists presented to them via websites, printed literature, proactive healthcare providers, and an identifiable male spokesperson. Finally, men used BRCA-related cancer risk information to make decisions about whether or not to engage in screening and prevention, manage their BRCA-related cancer risks, and overall family well-being—yet often at the expense of their own individual risks. Implications for genetic counseling and family conversations are discussed.     

Evaluation of Potential Kidney Donors with the Personality Assessment Inventory: Normative Data for a Unique Population

Many transplant centers require personality assessment and/or psychiatric clearance prior to allowing an individual to donate a kidney. This is a unique cohort for personality assessment, and there is no normative information available for this population on standardized self-report measures such as the Personality Assessment Inventory (PAI). We evaluated a prospective sample of 434 kidney donor candidates with development of normative T-scores relevant to this specific comparison group. Compared to the original normative group from the PAI manual, potential kidney donors are 5–7 T-score points above the mean on PIM, RXR, DOM, and WRM and 4–6 points below the mean on the majority of the remaining scales. Raw score/T score conversion tables are provided. The normative data provided here is meant to supplement the original normative information and aid psychologists in evaluation of this unique medical population.     

From Campers to Counselors: a Resource for Prospective Genetic Counseling Students

When thinking about the future of the genetic counseling field, one place to start is with prospective genetic counseling graduate school applicants. Although resources and mentorship opportunities exist for genetic counselors entering the field, the process of deciding on a career, applying to graduate programs, and being admitted can be daunting. As members of the profession, we should take responsibility for ensuring that individuals have the information and resources necessary to make an educated decision about whether genetic counseling is the correct path for them and to take the initial steps along this path. In this article, we present our Genetic Counseling Boot Camp as a model for other genetic counselors to use in developing their own local programs. This type of program can benefit prospective genetic counselors as they begin their professional journeys and can also provide value for the organizers and presenters who are already seasoned in the field.     

The Influence of Compensation Method and Disclosure Level on Information Search Strategy and Escalation of Commitment

In this study we examined the extent to which compensation method and public disclosure influenced information search strategy and escalation of commitment. A laboratory experiment involving 182 student subjects employed a 3 (compensation: no-pay, salary, and contingent) by 2 (disclosure level: public and private) fully randomized, crossed design. Results show that in light of negative feedback concerning performance results of an investment portfolio, subjects whose initial allocation decisions were announced publicly reduced their search for prospective information, increased the search for retrospective information, and exhibited greater escalation of commitment than subjects who did not announce their initial investment strategy. The search for retrospective information and escalation of commitment was monotonically higher across the no-pay, salary, and contingent pay conditions respectively, while the search for prospective information decreased correspondingly. This study provides evidence that escalation of commitment is positively related to the search for retrospective information and negatively related to the search for prospective information. The results obtained from this experiment complement and extend prior work in the areas of accountability, cognitive dissonance and escalation of commitment. © 1997 by John Wiley & Sons, Ltd.     

Using statistical risk information to assess oral contraceptive safety

The effect of variations in the presentation of oral contraceptive risk information on perceived safety was investigated. Four tests of the hypothesis that consumers focus on the absolute value of the numbers presented when assessing risk probabilities were performed with the following results: (1) when base rates are given, risks are perceived as less likely than when base rates are not given; (2) risks seem smaller when the information provided focuses on the number that will not die than when the number of expected deaths is presented; (3) contrary to our expectation, respondents do not focus on foreground numbers when risk was represented in an ‘X out of Y occurrences’ format; (4) respondents judged a risk of ‘4.15 times greater’ as less likely than when the information was presented as ‘415% greater risk’. We concluded that consumers convert statistical risk information into judgements about the magnitude of the number presented (small or large number) and utilize this more meaningful information when making risk judgements.