Use of Genetic Tests among Neurologists and Psychiatrists: Knowledge,Attitudes, Behaviors,and Needs for Training

This study explores neurologists’ and psychiatrists’ knowledge, attitudes, and practices concerning genetic tests. Psychiatrists (n?=?5,316) and neurologists (n?=?2,167) on the American Medical Association master list who had agreed to receive surveys were sent an email link to a survey about their attitudes and practices regarding genetic testing; 372 psychiatrists and 163 neurologists responded. A higher proportion of neurologists (74 %) than psychiatrists (14 %) who responded to the survey had ordered genetic testing in the past 6 months. Overall, most respondents thought that genetic tests should be performed more frequently, but almost half believed genetic tests could harm patients psychologically and considered legal protections inadequate. Almost half of neurologists (49 %) and over 75 % of psychiatrists did not have a genetics professional to whom to refer patients; those who had ordered genetic tests were more likely than those who did not do so to have access to a genetic counselor. Of respondents, 10 % had received patient requests not to document genetic information and 15 % had received inquiries about direct-to-consumer genetic testing. Neurologists reported themselves to be relatively more experienced and knowledgeable about genetics than psychiatrists. These data, the first to examine several important issues concerning knowledge, attitudes and behaviors of neurologists and psychiatrists regarding genetic tests, have important implications for future practice, research, and education.     

Harvey Cushing,M.D., in His World

Harvey Cushing, M.D. (1869–1939), is the acknowledged father of the discipline of neurosurgery who inspired others to join him in this new field. He was a prolific researcher in the area of human growth disturbances. And he was among the most literary of doctors having won the Pulitzer Prize for his two-volume biography of his mentor and teacher William Osler, M.D. A driven man, he both inspired and intimidated others. This essay explores Cushing’s character and background along with his relationship to Osler. It seeks to understand why and how he may be considered a great figure in spite and because of his demanding and often problematic character. It further seeks to place Cushing in the context of the transition of American society and American medicine in the latter decades of the nineteenth and early decades of the twentieth century. Portions of this essay were originally delivered as part of a Grand Rounds presentation for the Department of Neurosurgery at the New York Presbyterian Hospital Weill Cornell Center.     

Post-training disruption of Arc protein expression in the anterior cingulate cortex impairs long-term memory for inhibitory avoidance training

The activity-regulated-cytoskeletal-associated protein (Arc) has a well established role in memory consolidation and synaptic plasticity in the hippocampus and amygdala. However the role of Arc within the anterior cingulate cortex (ACC), an area of the brain involved in processing memory for pain, has yet to be examined. Here we sought to determine if Arc protein within neurons of the rat ACC is necessary for the consolidation of a single-trial, contextual inhibitory avoidance (IA) task. Immunohistochemistry and western blotting revealed an increase in Arc protein within the ACC following IA training in a shock-specific manner, suggesting that ACC Arc expression may play a critical role in the consolidation of the aversive task. To directly test this hypothesis, male Sprague-Dawley rats were trained on the IA task and given post-training intra-ACC infusions of Arc antisense oligodeoxynucleotides (ODNs), designed to suppress Arc translation, or control scrambled ODNs that do not suppress Arc translation. Memory retention was tested 48h after training. Arc antisense-induced disruption of Arc protein expression in the ACC impaired long-term memory for the IA task as compared to rats given intra-ACC infusions of the scrambled control ODNS, suggesting that Arc expression in the ACC is important for the consolidation of emotional memory. Results further indicate that knock down of Arc 6h after training impairs IA memory. This is consistent with time course findings indicating elevated Arc expression at 3 and 6h after IA training but not 12 or 48h. Taken together, these findings support the hypothesis that Arc expression in the ACC participates in synaptic plasticity that underlies long-term memory.     

War exposure and post-traumatic stress as predictors of Portuguese colonial war veterans' physical health

The relationship between war exposure and post-traumatic stress disorder (PTSD) has been largely investigated but the impact of the combat experience on physical health has only recently merited attention. The authors investigated the relationship between war exposure and psychological and physical health among 350 Portuguese colonial war veterans. The role of current PTSD symptoms as a mediator of these relationships was also investigated. The results showed that 39% of the veterans met criteria for current PTSD diagnosis and psychological distress was present in half of the sample. Pain, fatigue, and sleep problems were the most reported physical symptoms and mental health and gastro-intestinal problems, the most reported illnesses. Combat exposure variables were significant predictors of current health. The results indicated that veterans with higher exposure to war trauma maintained higher current levels of psychological distress and presented more physical health problems and physical symptoms than those less exposed. Mediation analyses showed that current PTSD was a full mediator of the relationship between war exposure and physical health outcomes.     

Counselors', Rehabilitation Providers', and Teachers' Perceptions of Mental and Physical Disabilities

The diversity perceptions of human service professionals may be critical indicators of effective service provision. Specifically, this study explored the disability perceptions of counselors, rehabilitation providers, and teachers (N = 172) enrolled in a large, southeastern university. A 76% response rate was achieved in the study, indicating clear differences by human service providers' preparation area and perceptions of disability type. Implications for preparation and future research are discussed.     

Reducing implicit prejudice: Matching approach/avoidance strategies to contextual valence and regulatory focus

Two general strategies for reducing prejudice are to approach equality and to avoid prejudice. The current research investigated the importance of matching two factors, contextual valence and regulatory focus, on the efficacy of these two strategies in reducing implicit prejudice. The findings demonstrate that although an approach strategy is more effective in decreasing prejudice on the Implicit Association Test in a positive rather than a negative context, an avoidance strategy is more effective in decreasing prejudice in a negative rather than a positive context (Study 1). In addition, the results show that although an approach strategy is more effective in decreasing prejudice when a promotion rather than a prevention focus is primed, an avoidance strategy is more effective in reducing prejudice when a prevention rather than a promotion focus is primed (Study 2). The implications of these findings for current interventions aimed at decreasing implicit prejudice are discussed.     

Effects of role model deservingness on overcoming performance deficits induced by stereotype threat

Previous research has shown that exposure to successful role models can restore performance that had been impaired by stereotype threat, and that some role models are more effective than others. The present research examined the effects of role model deservingness on women's mathematics test performance after being placed under stereotype threat. In Experiment 1, a woman who attained success by herself (deserved) proved a more effective role model than an equally likable and successful woman whose success was handed to her (not deserved). In Experiment 2, women role models proved more effective at combating stereotype threat when their successes were attributable to internal‐stable (deserved) than external‐unstable (not deserved) causes, an effect that was partially mediated by reduction in extra‐task thinking. The results are seen as having implications for theories of stereotype threat and causal attribution. Copyright © 2010 John Wiley & Sons, Ltd.     

I Believe I Am So Called: Reflections on a Vocation in Medical Education

This essay is concerned with the fulfillment of ordination commitments through a pastoral role in medical education and review of medical research with human subjects. Stylistically, it combines memoir with the genre known as “creative non-fiction.” Its major issues have to do with the identity formation and transformation of the author, the function and ethics of institutional review boards, the teaching of medical ethics to medical students, and courses involved in the doctor–patient relationship and in palliative care intended to increase the sensitivity and self-awareness of physicians-in-becoming. This essay was presented in its initial form at the Annual Fellows Meeting of the Society for Values in Higher Education in 2010.