Information Mismatch: Cancer Risk Counseling with Diverse Underserved Patients

As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine GC-patient communication in real time, to assess its effectiveness from the patient perspective, and then to pilot intervention strategies to improve the communication. We observed 64 English-, 35 Spanish- and 25 Chinese-speaking (n = 124) public hospital patients and 10 GCs in 170 GC appointments, and interviewed 49 patients who were offered testing using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory methods and revealed a fundamental mismatch between the information provided by GCs and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and question-asking; (5) vague discussions of screening and prevention recommendations. Our findings indicate a need to transform the standard model of genetic counseling communication using evidence-based principles and strategies from other fields of Medicine. The high rates of limited health literacy in the US, increasing access of diverse populations to genetic services, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence is likely to exacerbate health disparities in the genomic age.     

Subtyping obsessive-compulsive disorder: A taxometric analysis

Obsessive-compulsive disorder (OCD) is a heterogeneous condition comprising multiple symptoms. Researchers have identified OCD subtypes using a range of symptom-based research methods, including factor and cluster analyses and examination of differential treatment response. These methods can be challenged on the grounds that they fail to demonstrate the existence of discrete taxonomic entities. Furthermore, no study has examined subtyping on the basis of cognitive characteristics. In the present study, the categorical vs. dimensional status of 6 possible subtypes of OCD was examined using taxometric methods. Three potential cognitive subtypes (based on high levels of responsibility/threat estimation, perfectionism/certainty, and importance/control of thoughts) and 3 potential symptomatic subtypes (based on elevated levels of contamination obsessions and cleaning compulsions, checking, and obsessionality) were examined using the MAXEIG and MAMBAC procedures in a sample of 404 diagnosed cases of OCD. Findings favored dimensional models of the potential responsibility, perfectionism, checking, and contamination subtypes, but offered qualified support for taxonic models of the importance/control of thoughts and obsessional subtypes. Implications for the subclassification of OCD are discussed.     

Counting your blessings: Positive memories among grateful persons

We conducted two studies investigating the relationship of gratitude to autobiographical memory of positive and negative life events. Gratitude was assessed with an attitudinal measure and college students were asked to recall both positive and negative events from their past. In both studies, a significant positive relationship was found between trait gratitude and a positive memory bias. In Study 2 it was found that gratitude still reliably predicted positive memory bias after controlling for depression. Further, it was found that a positive intrusive memory bias was associated with gratitude in both studies. Thus, an important component of gratitude may be an enhanced tendency to recall positive events from one's life.     

Lessons Learned from the Parents Matter! Program

We present a discussion of some of the lessons the investigators learned during the development and implementation phases of the Parents Matter! Program (PMP). Lessons were learned that are relevant to various groups involved in large scale, multi-site, community-based intervention studies: investigators, community leaders, community members, project staff, and participants. Specific lessons learned include: (1) forge collaboration early: (2) maintain communication; (3) clearly delineate policies and procedures; and (4) develop proactive strategies. We also include a list of important questions to consider when contemplating similar projects.     

There is nothing paranormal about near-death experiences: how neuroscience can explain seeing bright lights, meeting the dead, or being convinced you are one of them

Approximately 3% of Americans declare to have had a near-death experience. These experiences classically involve the feeling that one's soul has left the body, approaches a bright light and goes to another reality, where love and bliss are all encompassing. Contrary to popular belief, research suggests that there is nothing paranormal about these experiences. Instead, near-death experiences are the manifestation of normal brain function gone awry, during a traumatic, and sometimes harmless, event.     

Metaphors for retirement: Unshackled from schedules

This study uses metaphor analysis to examine the meanings of retirement for a group of 35 retired Canadian executives and managers. Our analysis identified eight metaphors relating to the meanings of retirement. The findings provide us with a range of insights into the experience of retirement, from loss of purpose and identity to liberation from the constraints of work to retirement being constructed as a new beginning or renaissance. Based on the accounts given by each manager, metaphors were collated and compared across retirees to reveal four distinct configurations that conceptualize retirement as exploring new horizons, searching for meaning, contributing on your own terms and putting your feet up. We discuss the implications of these metaphor configurations for understanding the consumer and producer-oriented meanings of retirement and challenge dominant career constructions of retirement as disengagement and decline. Our findings reveal that retirement appears to be better understood by incorporating future-focused and agentic forms that contribute to different types of identity work in retirement.     

Toward a theory of discontinuous career transition: investigating career transitions necessitated by traumatic life events

Career researchers have focused on the mechanisms related to career progression. Although less studied, situations in which traumatic life events necessitate a discontinuous career transition are becoming increasingly prevalent. Employing a multiple case study method, we offer a deeper understanding of such transitions by studying an extreme case: soldiers and Marines disabled by wartime combat. Our study highlights obstacles to future employment that are counterintuitive and stem from the discontinuous and traumatic nature of job loss. Effective management of this type of transitioning appears to stem from efforts positioned to formulate a coherent narrative of the traumatic experience and thus to reconstruct foundational assumptions about the world, humanity, and self. These foundational assumptions form the basis for enacting future-orientated career strategies, such that progress toward establishing a new career path is greatest for those who can orientate themselves away from the past (trauma), away from the present (obstacles to a new career), and toward an envisioned future career positioned to confer meaning and purpose through work.     

Mental-state attribution drives rapid, reflexive gaze following

When presented with a face stimulus whose gaze is diverted, observers’ attention shifts to locations fixated by the face. Such “gaze following” has been characterized by some previous studies as a consequence of sophisticated theory of mind processes, but by others (particularly those employing the “gaze-cuing” paradigm) as an involuntary response that is triggered directly and reflexively by the physical features of a face. To address this apparent contradiction, we modified the gaze-cuing paradigm using a deception procedure to convince observers that prerecorded videos of an experimenter making head turns and wearing mirrored goggles were a “live” video link to an adjacent room. In two experiments, reflexive gaze following was found when observers believed that the model was wearing transparent goggles and could see, but it was significantly reduced when they believed that the experimenter wore opaque goggles and could not see. These results indicate that the attribution of the mental state “seeing” to a face plays a role in controlling even reflexive gaze following.     

A comparison of the mechanical effect of arm swing and countermovement on the lower extremities in vertical jumping

The purposes of this study were to quantify and compare how arm swing and countermovement affect lower extremity torque and work during vertical jumping and to gain insight into the mechanisms that enable the arm swing and countermovement to increase jump height. Five participants maximally performed two types of vertical squat jumps with (SJA) and without (SJ) an arm swing and two types of countermovement vertical jumps with (CJA) and without (CJ) an arm swing. The participants jumped from a force platform and all performances were videotaped with a high-speed video camera (200Hz). Jump heights, joint torques and work were calculated by combining kinematic and kinetic data. It was found that of the four jumping conditions, the participants jumped highest when they used an arm swing with countermovement (i.e., CJA). The increase of the countermovement jump height with an arm swing is the result of the increase of the lower extremity work. In the hip joint, the increase in torque caused by the countermovement predominantly occurred at the beginning of the propulsion phase, while the increase in torque caused by the arm swing occurred in the rest of the propulsion phase. A key finding of our study is that arm swing and countermovement have independent effects on lower extremity work, and their effects are additive in CJA to produce greater jump height.