Adjunct Prenatal Testing: Patient Decisions Regarding Ethnic Carrier Screening and Fluorescence In Situ Hybridization

Little has been reported regarding how women make decisions about genetic carrier screening for Ashkenazi Jewish genetic disease and cystic fibrosis (CF), and for fluorescent in situ hybridization (FISH) during pregnancy. Thirty-seven women who underwent genetic counseling and prenatal diagnosis were interviewed about their prenatal decision making. Respondents were largely Caucasian (95%), and undergoing prenatal diagnosis because of maternal age (78%). Sixty-three percent of those who reported having genetic carrier screening correctly defined it; 83% felt positively about it. Primary reasons reported for electing screening were: to get information, to be prepared, perception of risk, wanting peace of mind and percieved inability to care for an affected child. Women who declined screening felt they had very little or no risk, and some were deterred by cost. Ninety-five percent of respondents elected to have FISH; most were motivated by its speed in providing information and peace of mind or by timing of when the procedure was performed. Those who declined FISH reported being less concerned about having an affected child, receiving bad news, or waiting 2 weeks for results and slightly less affected by their feelings toward medical testing or physician's suggestion. These findings suggest decision-making factors differ between those electing and declining adjunct prenatal testing and increased knowledge about these factors may impact the way in which these services are offered by health care professionals. Prospective research with a larger population will be useful in further delineating the factors that influence prenatal decisions about adjunct testing measures.     

Paws + cause = pause? Memory load and memory blends in homophone recognition

Previous research has shown that separate information sources, activated closely together in time, can induce errors suggestive of memory blends. In Experiment 1, homophones were used to induce such memory errors. In a study task, participants made relatedness judgments to word pairs that included homophones (e.g., PAWS-BEAR). During this task, one group (study-similar) maintained memory loads with words that were orthographically similar to the presented homophones (e.g., JAWS). Another group (test-similar) maintained memory loads similar to those obtained for the study homophone's alternate spelling (e.g., CAUSE). A third group maintained no memory load during the task. In a surprise recognition test, participants were presented both previously viewed homophones (PAWS) and non-presented alternate spellings (PAUSE). We hypothesized that partially activated alternate spellings, in conjunction with the orthographically similar memory words, would result in the creation of blended memories. The results followed suit: The test-similar condition produced significantly elevated false alarms, relative to both the study-similar and the no-load conditions. Experiment 2 replicated these results while including memory loads to control for potential orthographic confusions. The findings are discussed in terms of multiple, episodic memories later activated as single, blended memories.     

Using the multifaceted Rasch model to improve the TAT/PSE measure of need for achievement

We used the Rasch (1980) model to develop new pictures for the Thematic Apperception Test (C. D. Morgan & Murray, 1938; McClelland, Atkinson, Clark, & Lowell, 1953) or picture story exercise to measure need for achievement (nAch). In Experiments 1 and 2, we analyzed stories to assess the difficulty level of a total of 8 pictures using the multifaceted Rasch model with picture difficulty, story probe difficulty, and participant ability as facets with a partial credit model (FACETS; Linacre, 2005). A total of 6 pictures were retained and 4 new ones added for Experiment 3 in which 201 participants wrote 6 stories to a random set of the 10 pictures. FACETS analysis revealed improved person separation reliability. In Experiment 4, 206 participants wrote 1 story to the Studying picture either before or after filling out a battery of achievement-related questionnaires. The 2 experimental groups did not differ in the amount of nAch in their stories. The coder facet was demonstrated with 2 independent coders using the revised coding system for nAch.     

The Virtues of Evidence

Evidence-based medicine has been defined as the conscientious and judicious use of current best evidence in making clinical decisions. This paper will attempt to explicate the terms "conscientious" and "judicious" within the evidence-based medicine definition. It will be argued that "conscientious" and "judicious" represent virtue terms derived from virtue ethics and virtue epistemology. The identification of explicit virtue components in the definition and therefore conception of evidence-based medicine presents an important starting point in the connection between virtue theories and medicine itself. In addition, a unification of virtue theories and evidence-based medicine will illustrate the need for future research in order to combine the fields of virtue-based approaches and clinical practice.     

Transnationalism as a motif in family stories

Family stories have long been recognized as a vehicle for assessing components of a family's emotional and social life, including the degree to which an immigrant family has been willing to assimilate. Transnationalism, defined as living in one or more cultures and maintaining connections to both, is now increasingly common. A qualitative study of family stories in the family of those who appear completely "American" suggests that an affiliation with one's home country is nevertheless detectable in the stories via motifs such as (1) positively connotated home remedies, (2) continuing denigration of home country "enemies," (3) extensive knowledge of the home country history and politics, (4) praise of endogamy and negative assessment of exogamy, (5) superiority of home country to America, and (6) beauty of home country. Furthermore, an awareness of which model--assimilationist or transnational--governs a family's experience may help clarify a clinician's understanding of a family's strengths, vulnerabilities, and mode of framing their cultural experiences.     

Risky decision making across three arenas of choice: are younger and older adults differently susceptible to framing effects?

In the present study, the authors investigated the effects of framing of options on risky decision making in groups of younger adults (M = 23.8 years, n = 192) and older adults (M = 69.1 years, n = 192). The participants were assigned to one of three scenarios varying in the goods at stake (human lives, paintings, money). The authors observed a majority preference in favor of the risky options after negative, but not positive framing. They also found, as they had predicted, that the type of framing effect varied across scenarios, with a bidirectional framing effect for the life-death scenario and unidirectional (risk averse) framing effects when public property (paintings) or personal property (money) were at stake. It is important to note that these choice preference patterns were highly similar across the age groups, which reinforced the conclusion that younger and older adults are equally susceptible to framing effects.     

Validity and reliability of the general well-being schedule with northern plains American Indians diagnosed with type 2 diabetes mellitus

The General Well-being Schedule is a brief indicator of subjective feelings of psychological well-being and distress. It is easy to administer, reliable, and valid, although its validity with American Indians has not been established. This study then assessed reliability, validity, and factor structure for a sample of 88 diabetic American Indians, who sought care for diabetes at an Indian Health Service hospital. Cronbach alpha was .89. A factor analysis indicated four dimensions. Adequate concurrent and divergent validity were noted in association with scores on the Beck Depression Inventory-Second Edition, the depression scale on the Symptom Checklist-90-Revised, and Family-Adaptation, Partnership, Growth, Affection, & Resolve. These results suggest that the General Well-being Schedule is a reliable and valid measure of general well-being for this population of American Indians.     

Talker continuity and the use of rate information during phonetic perception

Research has shown that speaking rate provides an important context for the perception of certain acoustic properties of speech. For example, syllable duration, which varies as a function of speaking rate, has been shown to influence the perception of voice onset time (VOT) for syllableinitial stop consonants. The purpose of the present experiments was to examine the influence of syllable duration when the initial portion of the syllable was produced by one talker and the remainder of the syllable was produced by a different talker. A short-duration and a long-duration /bi/-/pi/ continuum were synthesized with pitch and formant values appropriate to a female talker. When presented to listeners for identification, these stimuli demonstrated the typical effect of syllable duration on the voicing boundary: a shorter VOT boundary for the short stimuli than for the long stimuli. An /i/ vowel, synthesized with pitch and formant values appropriate to a male talker, was added to the end of each of the short tokens, producing a new hybrid continuum. Although the overall syllable duration of the hybrid stimuli equaled the original long stimuli, they produced a VOT boundary similar to that for the short stimuli. In a second experiment, two new /i/ vowels were synthesized. One had a pitch appropriate to a female talker with formant values appropriate to a male talker; the other had a pitch appropriate to a male talker and formants appropriate to a female talker. These vowels were used to create two new hybrid continua. In a third experiment, new hybrid continua were created by using more extreme male formant values. The results of both experiments demonstrated that the hybrid tokens with a change in pitch acted like the short stimuli, whereas the tokens with a change in formants acted like the long stimuli. A fourth experiment demonstrated that listeners could hear a change in talker with both sets of hybrid tokens. These results indicate that continuity of pitch but not formant structure appears to be the critical factor in the calculation of speaking rate within a syllable.