A Mobile Colonoscopic Unit for Lynch Syndrome: Trends in Surveillance Uptake and Patient Experiences of Screening in a Developing Country

The Genetic and Endoscopic Surveillance Clinic is an annual outreach service offering accessible colonoscopic surveillance to known families with Lynch syndrome living in remote areas of the Western and Northern Cape Province of South Africa. Unfortunately attendance at this outreach clinic has been declining over several years and fewer than a quarter of participants, attending for surveillance, have been adherent with all their recommended screening appointments. Concerns exist for non-adherent individuals as screening can prevent colorectal cancer by removing the precancerous lesion or enabling the treatment of a malignancy at an early stage. This study explored the experience of surveillance from both the non-adherers’ and adherers’ perspectives and identified unique factors affecting attendance at the outreach clinic. Rates of compliance are calculated for 191 mutation-positive cases of Lynch syndrome, using strict attendance criteria, and compared to figures obtained from self-reported attendance. Non-compliance was under-reported and compliance was exaggerated when basing data on self-reported adherence to recommendations. Specific characteristics of the outreach clinic affecting compliance are identified and recommendations are made to facilitate improvements to the service. These improvements can result in increased compliance with screening regimens and ultimately reduce cancer-related mortality.     

The Effects of Residential Crowding Experience on Reactivity to Laboratory Crowding and Noise1

Sixty male and 60 female subjects previously classified as high and low on a residential crowding experience scale participated in an experiment involving a 2 × 3 × 2 × 2 (density, noise, crowding experience, gender) factorial design. The research was undertaken primarily to determine the influence of previous residential crowding experience as tapped by the Crowding Experience Scale (CES) on reactivity to the environmental stressors of noise and crowding. The results indicated that exposure to environmental stressors produced a deleterious effect on complex task performance and generated negative affect in the respondents. Interestingly, respondents who had reported high levels of experience with crowding showed relatively more crowding tolerance by performing significantly better on cognitively complex tasks (complex anagrams and story comprehension) and exhibiting more positive affect in conditions of high density as compared to low experience of crowding respondents. Reactions to noise were not influenced by crowding experience. Thus, prior experience of crowding as measured by the CES appears to influence reactivity to density in other settings.     

Affect and Performance on Cognitive Task as a Function of Crowding and Noise1

Sixty undergraduate males participated in an experiment with a 2 × 3 factorial design involving two levels of density and three levels of noise to demonstrate effects of the independent variables (density, noise) on cognitive task performance and affect. As predicted, it was found that crowding and noise lead to deterioration of subject's performance on cognitively complex tasks but not on simple (cognitive) task. Also, density and noise generated a negative feeling in the subjects. Significant two-way interaction for complex task, showed variation in performance of Ss of high and low density under low and high noise conditions. In addition, crowded-condition subjects reported more dissatisfaction about their performance and evaluated the presence of the experimenter as significantly less pleasant than their noncrowded-condition counterparts.     

Death‐contemplation and contemplative living: Socrates and the Katha Upanishad

This paper seeks to argue that Socrates’ thought on the connection between death‐contemplation and genuine philosophising as reported in Plato's Phaedo, is comparable in many ways to the insight on the same connection contained in the Katha Upanishad. While refraining from a general comparison of the Platonic and the Upanishadic systems, the paper attempts to show, through an original exposition of Phaedo as well as the Katha Upanishad, that both these classics emphasise the value of death‐contemplation for a thoughtful and fundamental assessment of human existence, which is but a genuine task of philosophy.     

After justification: Toward a Dalit public Lutheran theology

The aim of this article is to construct a “Dalit public Lutheran theology” as an “after‐justification” conversation, which drafts an agenda for the future of Lutheran theology in the twenty‐first century. In moving toward that construction, I first briefly explain Dalit theology, public theology, and Lutheran theology and shall discuss the rationale for a Dalit public Lutheran theology. From there I propose that Lutheran theology needs to take a contextual, post‐colonial and subaltern turn. Then I discuss the contours of Dalit public Lutheran theology by discussing one of the pivotal doctrine of Luther, “justification by grace through faith,” by engaging in a Dalit public discourse and propose “hospitality by love” as what comes after justification. Finally, I bring out the relevance of such a theology for our present‐day context. The method I employ in this article is subaltern methodology, which is to “read from below” or “read against the grain.” “After justification” is understood as “beyond” the understanding of doctrine of justification, as a forward‐looking public theological understanding of justification, where it finds fecundity and validity.     

Thinking graphically: Connecting vision and cognition during graph comprehension

Task analytic theories of graph comprehension account for the perceptual and conceptual processes required to extract specific information from graphs. Comparatively, the processes underlying information integration have received less attention. We propose a new framework for information integration that highlights visual integration and cognitive integration. During visual integration, pattern recognition processes are used to form visual clusters of information; these visual clusters are then used to reason about the graph during cognitive integration. In 3 experiments, the processes required to extract specific information and to integrate information were examined by collecting verbal protocol and eye movement data. Results supported the task analytic theories for specific information extraction and the processes of visual and cognitive integration for integrative questions. Further, the integrative processes scaled up as graph complexity increased, highlighting the importance of these processes for integration in more complex graphs. Finally, based on this framework, design principles to improve both visual and cognitive integration are described.     

Beyond the Caster Semenya Controversy: The Case of the Use of Genetics for Gender Testing in Sport

Caster Semenya won the eight-hundred-meter title in the Berlin World Athletics Championships in 2009. Few hours after, Caster was at the center of a harsh contestation on gender. The International Association of Athletics Federations started an investigation, which was not respectful of her privacy. Caster’s case highlights the need for an improvement in the awareness of genetic counseling principles amongst professionals, the public and various stakeholders. We critically examine the historical steps of gender verification in the Olympics, the violation of genetic counseling principles in Caster’s case and outline some reflections on the complexity of the genetics of Disorders of sex development (DSD). Variability in both genotypes and phenotypes in DSD may not allow any etiological or functional classification at this point in time that could permit uncontroversial gender verification for fairer sport participation. We strongly suggest revisiting the pertinence of gender verification, and the process whereby this is done.     

The effect of mother-infant skin-to-skin contact on plasma cortisol and β-endorphin concentrations in preterm newborns

The aim of this study was to assess the effect of mother-infant skin-to-skin contact on plasma β- endorphin and cortisol concentrations in stable, preterm infants on a newborn intensive care unit. Blood samples were obtained before and at the end of a 20-min period of skin-to-skin contact. Similarly paired samples, obtained at the same times and after the same interval, without skin-to- skin contact, were obtained on another day and served as controls. Both cortisol and β-endorphin concentrations fell significantly after the skin-to-skin session (cortisol: geometric mean change 66%, p=0.008; β-endorphin: geometric mean change 74%, p=0.002). There was also a significant fall in cortisol levels during the control session (geometric mean change 78%, p=0.02), in contrast to β-endorphin levels, in which there was no significant change. Analysis of variance showed that the fall in β-endorphin, but not the fall in cortisol, during the skin-to-skin session was significant when compared with the control session. These results emphasize the hormonal responsiveness of the preterm newborn to relatively minor interventions. We conclude that maternal skin-to-skin contact results in a significant reduction in circulating β-endorphin in the newborn; there was no evidence of any adverse effect.     

Intensive Outpatient Comprehensive Behavioral Intervention for Tics: A Clinical Replication Series

Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious behavioral treatment for Tourette’s disorder. In its standard format, CBIT is completed in 8 sessions over a 10-week period. Unfortunately, significant obstacles (e.g., not having a provider nearby; inability to attend weekly sessions) prevent many individuals from participating in standard outpatient CBIT. An intensive outpatient program that compresses CBIT into a week may help overcome many of these barriers. The present clinical replication series examines treatment outcomes in 5 individuals with Tourette’s disorder. Importantly, 4 out of the 5 participants reported clinically meaningful tic reductions on the Yale Global Tic Severity Scale (YGTSS) at the posttreatment assessment, with an average decrease of 11.5 points across those 4 participants. This represents a 28% decrease in the average posttreatment YGTSS score from the average baseline YGTSS score. Of the 3 participants who completed the 1-month follow-up assessment, 2 participants continued to endorse reductions in their baseline tic severity on the YGTSS and were rated as having a positive response on the Clinician Global Impressions–Improvement subscale. Clinical implications are discussed.     

Testing equality of correlated proportions with incomplete data on both responses

Two test statistics are proposed for testing the equality of two correlated proportions when some observations are missing on both responses. The performance of these tests in terms of size and power is compared with other tests by means of Monte Carlo simulations. The proposed tests are easily computed and compare favorably with other tests.