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.     

Harvesting the living?: separating "brain death" and organ transplantation

The chronic shortage of transplantable organs has reached critical proportions. In the wake of this crisis, some bioethicists have argued that there is sufficient public support to expand organ recovery through use of neocortical criteria of death or even pre-mortem organ retrieval. I present a typology of ways in which data gathered from the public can be misread or selectively used by bioethicists in service of an ideological or policy agenda, resulting in bad policy and bad ethics. Such risks should lead us to look at alternatives for increasing organ supplies short of expanding or abandoning the dead donor rule. The chronic problem of organ scarcity should prompt bioethicists to engage in constructive dialogue about the relation of the social sciences and bioethics, to examine the social malleability of the definition of death, and to revisit the question of the priority of organ transplants in the overall package of healthcare benefits provided to most, but not all, citizens.     

Sensory discrimination and intelligence: testing Spearman's other hypothesis

At the centenary of Spearman's seminal 1904 article, his general intelligence hypothesis remains one of the most influential in psychology. Less well known is the article's other hypothesis that there is "a correspondence between what may provisionally be called 'General Discrimination' and 'General Intelligence' which works out with great approximation to one or absoluteness" (Spearman, 1904, p. 284). Studies that do not find high correlations between psychometric intelligence and single sensory discrimination tests do not falsify this hypothesis. This study is the first directly to address Spearman's general intelligence-general sensory discrimination hypothesis. It attempts to replicate his findings with a similar sample of schoolchildren. In a well-fitting structural equation model of the data, general intelligence and general discrimination correlated .92. In a reanalysis of data published byActon and Schroeder (2001), general intelligence and general sensory ability correlated .68 in men and women. One hundred years after its conception, Spearman's other hypothesis achieves some confirmation. The association between general intelligence and general sensory ability remains to be replicated and explained.     

Putting personality in social context: extraversion, emergent leadership, and the availability of rewards

The present research tested relations between extraversion and emergent leadership among men in situations that differed in potential reward availability. Four-person groups of men engaged in a Leaderless Group Discussion (LGD) task and were randomly assigned to be evaluated by an attractive female observer, an attractive male observer, or not be evaluated. Evolutionary theories suggest that impressing a female evaluator in an intrasexually competitive situation should hold greater reward potential for men than impressing either a male evaluator or no evaluator. Accordingly, more extraverted men (who are more sensitive to reward cues) should display more group leadership when being evaluated by a woman than either a man or no one. Self-and peer ratings confirmed that more extraverted men were significantly more likely to emerge as leaders, but only in the female-evaluator condition. The results are discussed in terms of the interplay between personality, situational factors, and evolutionary principles.     

Concurrent validity of the Peabody Picture Vocabulary Test-Third Edition as an intelligence and achievement screener for low SES African American children

Authors tested the validity of the Peabody Picture Vocabulary Test-Third Edition (PPVT-III) as a screening measure for intelligence and achievement. The PPVT-III and Kaufman Assessment Battery for Children (KABC) were administered to 416 African American children of low socioeconomic status in a counterbalanced design. Results indicated that the PPVT-III correlated .58 with the KABC Mental Processing Composite (MPC) score; however, participants scored significantly lower (M = 8.3 points) on the PPVT-III than on the MPC. Although receiver operating characteristic (ROC) analyses supported the use of the PPVT-III as a valid intellectual and achievement screener, the selection of a single cutoff score for the PPVT-III was problematic. The purpose of the screening program should guide selection of a cutoff score for the PPVT-III.     

Staying alive: evolution, culture, and women's intrasexual aggression

Females' tendency to place a high value on protecting their own lives enhanced their reproductive success in the environment of evolutionary adaptation because infant survival depended more upon maternal than on paternal care and defence. The evolved mechanism by which the costs of aggression (and other forms of risk taking) are weighted more heavily for females may be a lower threshold for fear in situations which pose a direct threat of bodily injury. Females' concern with personal survival also has implications for sex differences in dominance hierarchies because the risks associated with hierarchy formation in nonbonded exogamous females are not offset by increased reproductive success. Hence among females, disputes do not carry implications for status with them as they do among males, but are chiefly connected with the acquisition and defence of scarce resources. Consequently, female competition is more likely to take the form of indirect aggression or low-level direct combat than among males. Under patriarchy, men have held the power to propagate images and attributions which are favourable to the continuance of their control. Women's aggression has been viewed as a gender-incongruent aberration or dismissed as evidence of irrationality. These cultural interpretations have "enhanced" evolutionarily based sex differences by a process of imposition which stigmatises the expression of aggression by females and causes women to offer exculpatory (rather than justificatory) accounts of their own aggression.     

Role of the unquantified electroencephalography in psychiatric research

This paper outlines potential research applications of the unquantified (paper or digital) electroencephalography (EEG) in psychiatry. Three main areas are highlighted: first, the need for thorough familiarity with the unquantified EEG is emphasized, including the ability to confidently recognize all normal and abnormal activities that could influence further analysis of the record as well as artifacts that can contaminate the tracings; second, the fact that definitive studies relating EEG abnormalities to psychiatric symptomatology and clinical response are lacking; and third, the potential for EEG to be utilized as a tool to decrease the risk of invasive research studies is discussed.