Genetic Cancer Risk Assessment and Counseling: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of identifying at-risk individuals through cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Cancer Genetic Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Key components include the intake (medical and family histories), psychosocial assessment (assessment of risk perception), cancer risk assessment (determination and communication of risk), molecular testing for hereditary cancer syndromes (regulations, informed consent, and counseling process), and follow-up considerations. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Senior capstone design and ethics: A bridge to the professional world

A senior level capstone design experience has been developed and offered with a particular emphasis on many of the professional issues raised in Accreditation Board for Engineering and Technology (ABET) Engineering Criterion IV. The course has sought to develop student awareness of the ethical foundation of the engineering profession, the global and societal framework within which engineers practice, and the environmental impact on engineering. The capstone design course also focused upon improving the technical communications skills of the graduating senior class with both extensive instruction in writing and multiple workshops dealing with the art of making an effective oral presentation. The effectiveness of the design course was assessed using Kirkpatrick’s model for evaluating training programs. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Searching in the center: pigeons (Columba livid) encode relative distance from walls of an enclosure

Pigeons (Columba livia) searched for food hidden in the center of a square enclosure. On occasional tests without food, the enclosure was (a) unchanged from training (control tests), (b) moved to different corners of the testing room (corner tests), or (c) doubled in size (expansion tests). The birds showed localized search in the center of the enclosure on control and corner tests. On expansion tests, some birds searched near the center of the enclosure, suggesting relative-distance encoding. Other birds searched at locations that maintained the training distance from walls, suggesting absolute-distance encoding. These results are consistent with previous studies on chicks (Gallus gallus) in similar enclosures and contrast with previous results on pigeons' responses to expansions of discrete landmark arrays.     

Eye-fixation patterns of high- and low-span young and older adults: down the garden path and back again

Young and older adults' eye fixations were monitored as they read sentences with temporary ambiguities such as "The experienced soldiers warned about the dangers conducted the midnight raid." Their fixation patterns were similar except that older adults made many regressions. In a 2nd experiment, high- and low-span older adults were compared with high- and low-span young adults. Pint-pass fixations were similar, except low-span readers made many regressions and their total fixation times were longer. High-span readers also used the focus operator "only" (e.g., "Only experienced soldiers warned about the dangers.") to immediately resolve the temporary ambiguities. No age group differences were observed. These results are discussed with reference to theories of the role of working memory in sentence processing.     

The associative memory deficit of older adults: further support using face-name associations

Previous studies have established an associative deficit hypothesis (Naveh-Benjamin, 2000), which attributes part of older adults' deficient episodic memory performance to their difficulty in creating cohesive episodes. In this article, the authors further evaluate this hypothesis, using ecologically relevant materials. Young and old participants studied name-face pairs and were then tested on their recognition memory for the names, faces, and the name-face pairs. The results extend the conditions under which older adults exhibit an associative deficit. They also show that reduced attentional resources are not the sole mediator of this deficit.     

Systematic application and removal of protective equipment in the assessment of multiple topographies of self-injury

We evaluated the effects of systematic application and removal of protective equipment on three topographies of self-injurious behavior (SIB) exhibited by a girl who had been diagnosed with autism. Results showed that when protective equipment was applied, SIB decreased to near-zero levels. In addition, withdrawal of protective equipment for specific topographies of SIB (by removing only the corresponding padding) increased rates of SIB only for that topography of SIB. Next, a functional analysis of hand SIB showed that protective equipment suppressed this behavior in all conditions and that the behavior was maintained by automatic reinforcement when padding was removed. Results are discussed in terms of sensory extinction as a possible mechanism responsible for response suppression.     

Lying to insurance companies: the desire to deceive among physicians and the public

This study examines the public's and physicians' willingness to support deception of insurance companies in order to obtain necessary healthcare services and how this support varies based on perceptions of physicians' time pressures. Based on surveys of 700 prospective jurors and 1617 physicians, the public was more than twice as likely as physicians to sanction deception (26%versus 11%) and half as likely to believe that physicians have adequate time to appeal coverage decisions (22%versus 59%). The odds of public support for deception compared to that of physicians rose from 2.48 to 4.64 after controlling for differences in time perception. These findings highlight the ethical challenge facing physicians and patients in balancing patient advocacy with honesty in the setting of limited societal resources.     

"Capacity" reconsidered: interindividual differences in language comprehension and individual alpha frequency

The influence of interindividual differences in cognitive mechanisms on language comprehension remains controversial not only due to conflicting experimental findings, but also in view of the difficulty associated with determining which measure should be used in participant classification. Here, we address the latter problem by proposing that an electrophysiological measure, individual alpha frequency (IAF), may be a suitable means of classifying interindividual differences in sentence processing. Interindividual differences in IAF have been shown to correlate with performance on memory tasks and speed of information processing. In two experiments using event-related brain potentials (ERPs), IAF-based participant groups differed systematically with regard to the processing of ambiguous sentences such that the low-IAF group showed a sustained positivity in the ambiguous region, while the high-IAF group did not. These interindividual differences were independent of whether the ambiguity was syntactic (Experiment 1) or sentence-level semantic (Experiment 2). Moreover, they were reliable only when participants were classified according to IAF, but not in classifications based on reading span, speed of processing (reaction time), or accuracy of processing (error rate).     

Perceptions of Ethical Behaviour among Business Faculty in Canada

Faculty members at Canadian business schools were surveyed regarding their ethical perceptions of behaviours related to undergraduate instruction. Fifty-five behavioural statements were listed and respondents were asked to rate the extent to which they felt each behaviour was ethical or unethical. The only item that respondents endorsed as unequivocally unethical (90% indicated it was definitely unethical) was Becoming sexually involved with an undergraduate in one of your classes. We also compared the results of our sample to those of an American sample. Overall, an interesting pattern of differences emerged between the responses obtained in Canada and the U.S. In general, the direction of the significant differences was such that Canadian professors viewed the behaviours in question as less ethical than did their American counterparts.     

Training parents to implement pediatric feeding protocols

Four different multicomponent training packages were evaluated to increase the treatment integrity of parents implementing pediatric feeding protocols. In Study 1 we exposed 3 parents to a training package that consisted of written protocols (baseline), verbal instructions, therapist modeling, and rehearsal training. Results suggested that the package was successful in increasing treatment integrity of the feeding protocols to high levels. Study 2 investigated three different parent-training packages comprised of components used in Study 1. Two parents were exposed to written protocols, verbal instructions, and modeling; 2 parents were exposed to written protocols, verbal instructions, and rehearsal; and 2 parents were exposed to written protocols and verbal instructions. Results of Study 2 showed that each parent-training package produced very high treatment integrity. Follow-up data in the clinic and home for 5 participants suggested that the results were durable for up to 3 months. These results demonstrate a first step in the transfer and application of research findings into routine clinical practice because we evaluated several methods for training parents to implement behavioral feeding protocols, and we demonstrated that these methods resulted in high levels of treatment integrity in a controlled clinical setting.