Billing for Medical Genetics and Genetic Counseling Services: A National Survey

In January 2007 the American Medical Association added a new Current Procedural Terminology® (CPT) code, 96040, for “Medical Genetics and Genetic Counseling Services.” In order to identify the impact of having this new code and to identify issues with implementation of the code, the National Society of Genetic Counselors (NSGC) CPT® Working Group surveyed NSGC members using an internet-based survey tool. The majority of respondents (94%) reported being aware of the new code and over half of the respondents (69%) said they were billing for genetic counseling. Approximately 24% of those billing reported using 96040. Many facilities are not using this code and the reported success of billing using 96040 is highly varied. Continued education may be beneficial to encourage reimbursement for 96040 and follow up is needed to assess the ongoing implementation and impact of the new CPT® code.     

Treatment of a Case Example With PTSD and Chronic Pain

This commentary reviews the case of GH, a survivor of a road traffic collision, who has chronic pain and posttraumatic stress disorder (PTSD). The case formulation, assessment strategy, and treatment plan are informed by the relevant experimental literature and empirically supported treatments using a cognitive behavioral perspective. Given this framework, the commentary includes a focus on the treatment of PTSD with an eye toward generalizing the therapeutic strategies to chronic pain problems. Psychoeducation, imaginal exposure to the traumatic event, in vivo exposure to avoided activities, and cognitive interventions including coping self-statements, correction of logical errors, decatastrophizing and developing alternative explanations are all included in the recommendations as part of a standard cognitive behavioral treatment for PTSD. Added to this standard PTSD protocol is the suggested use of interoceptive exposure to address GH’s feared bodily sensations. In the assessment domain, standard measures for pain and PTSD assessment are suggested along with tracking of depression and anxiety sensitivity. Some recognition of more recent approaches to cognitive behavioral therapy (e.g., Acceptance and Commitment Therapy) is given in considering potential obstacles to treatment.     

Clericalism: Enabler of Clergy Sexual Abuse

Sexual abuse by Catholic clergy and religious has become the greatest challenge facing Catholicism since the Reformation. Violations of clerical celibacy have occurred throughout history. The institutional church remains defensive while scholars in the behavioral and social sciences probe deeply into the nature of institutional Catholicism, searching for meaningful explanations for the dysfunctional sexual behavior. Clericalism which has traditionally led to deep-seated societal attitudes about the role of the clergy in religious and secular society, explains in part why widespread abuse has apparently been allowed. Clericalism has a profound emotional and psychological influence on victims, church leadership, and secular society. It has enabled the psychological duress experienced by victims which explains why many have remained silent for years. It has also inspired societal denial which has impeded many from accepting clergy sexual abuse as a serious and even horrific crime. Thomas P. Doyle is a Canon Lawyer and Certified Addictions Specialist.     

Agency and observation in knowledge of one's own thinking

This essay addresses the question how we know our conscious thinking. Conscious thinking typically takes the form of a series of discrete episodes that constitute a complex cognitive activity. We must distinguish the discrete episodes of thinking in which a particular content is represented in phenomenal consciousness and is present “before the mind's eye” from the extended activities of which these episodes form a part. The extended activities are themselves contentful and we have first‐person access to them. But because their content is not represented in phenomenal consciousness, this access cannot be broadly observational. Instead, I argue, it is agential. Furthermore, that extended activities are intentional explains the possibility of a nonobservational form of introspective access to the discrete episodes in consciousness.     

Supporting Integrity of Discrete Trial Teaching via Tiered Consultation: A Pilot Study

Empirically supported consultation procedures for supporting implementation of evidence-based interventions for Autism Spectrum Disorder (ASD), such as performance feedback, may be challenging to implement in public schools. Educators may find performance feedback aversive, and support personnel may find its directiveness incompatible with their professional roles. This pilot study extends recent advances in implementation science, by investigating the influence of tiered consultation on intervention integrity of Discrete Trial Teaching (DTT). A less intensive form of implementation support was examined for its feasibility and effectiveness. Collaborative Student Data Review (CSDR) includes discussion, general feedback, and modeling. Preliminary findings indicate that CSDR is a feasible and acceptable form of implementation support, and that it shows potential as a form of implementation support for DTT.     

Tactile-Based Pantomime Grasping: Knowledge of Results is Not Enough to Support an Absolute Calibration

Tactile-based pantomime-grasping requires that a performer use their right hand to ‘grasp’ a target previously held in the palm of their opposite hand – a task examining how mechanoreceptive (i.e., tactile) feedback informs the motor system about an object property (i.e., size). Here, we contrasted pantomime-grasps performed with (H+) and without (H?) haptic feedback (i.e., thumb and forefinger position information derived from the grasping hand touching the object) with a condition providing visual KR (VKR) related to absolute target object size. Just-noticeable-difference (JND) scores were computed to determine whether responses adhered to – or violated – Weber's law. JNDs for H+ trials violated the law, whereas H? and VKR trials adhered to the law. Accordingly, results demonstrate that haptic feedback – and not KR – supports an absolute tactile-haptic calibration.     

Longitudinal investigation of reciprocal relationship between stress reactions and hardiness

Although many studies have examined hardiness as a protective factor against stress reactions, to the authors' knowledge no studies have yet examined the impact of stress reactions on hardiness. However, there is theoretical support for this notion. In this longitudinal study of 1,571 Marine recruits who participated in a highly stressful training program, the authors applied regression-based cross-lagged analyses to examine associations between stress reactions and hardiness over time for both men and women, and they investigated social support as a moderator of these relationships. Men who were hardier at Time 1 (T1) reported lower stress reactions at Time 2 (T2), and men who experienced more stress reactions at T1 were less hardy at T2. Although the negative impact of stress reactions on hardiness was strongest when social support was low for both genders, stress reactions predicted enhanced hardiness when social support was high for women only.     

The driver vigilance telemetric control system (DVTCS): Investigating sensitivity to experimentally induced sleep loss and fatigue

Vigilance technologies are used in the Australian rail industry to address the risks associated with driver sleepiness and fatigue. The aim of this study was to investigate whether a new device, designed to detect lowered states of arousal using electrodermal activity (EDA), would be sensitive to experimentally induced sleepiness and fatigue. Fifteen individuals (7 of them female, 9 male; 18–32 years of age) spent 3 consecutive days in the laboratory, which included 1 night of sustained wakefulness (28 h). The participants completed a 10-min psychomotor vigilance task (PVT) and fatigue and sleepiness ratings every 2 h, and a 30-min driving simulator every 4 h. As was expected, simulated driving, PVT, and subjective ratings indicated increasing levels of sleepiness and fatigue during sustained wakefulness. The EDA device output did not coincide with these findings. The results indicated that the EDA indicator was not sensitive to increased sleepiness and fatigue at the levels produced in the present study.