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.     

A longitudinal study of gender-related cognition and behaviour

Gender schema theory proposes that children's acquisition of gender labels and gender stereotypes informs gender-congruent behaviour. Most previous studies have been cross-sectional and do not address the temporal relationship between knowledge and behaviour. We report the results of a longitudinal study of gender knowledge and sex-typed behaviour across three domains in children tested at 24 and 36 months (N = 56). Although both knowledge and sex-typed behaviour increased significantly between 2 and 3 years, there was no systematic pattern of cross-lagged correlations between the two, although some concurrent relationships were present at 24 months. Future longitudinal work might profitably focus on younger children using reliable preverbal measures of gender knowledge and employing a shorter lag between measurement times.     

Perception of place-of-articulation information in natural speech by monkeys versus humans

Four monkeys and 6 humans representing five different native languages were compared in the ability to categorize natural CV tokens of /b/ versus /d/ produced by 4 talkers of American English (2 male, 2 female) in four vowel contexts (/i, e, a, u/). A two-choice "left/right" procedure was used in which both percentage correct and response time data were compared between species. Both measures indicated striking context effects for monkeys, in that they performed better for the back vowels /a/ and /u/ than for the front vowels /i/ and /e/. Humans showed no context effects for the percentage correct measure, but their response times showed an enhancement for the /i/ vowel, in contrast with monkeys. Results suggest that monkey perception of place of articulation is more dependent than human perception on the direction of the F2 onset transitions of syllables, since back-vowel F2s differentiate /b/ and /d/ more distinctively. Although monkeys do not provide an accurate model of the adult human in place perception, they may be able to model the preverbal human infant before it learns a more speech-specific strategy of place information extraction.     

A meta-analytic review of gender variations in children's language use: talkativeness, affiliative speech, and assertive speech

Three sets of meta-analyses examined gender effects on children's language use. Each set of analyses considered an aspect of speech that is considered to be gender typed: talkativeness, affiliative speech, and assertive speech. Statistically significant average effect sizes were obtained with all three language constructs. On average, girls were slightly more talkative and used more affiliative speech than did boys, whereas boys used more assertive speech than did girls. However, the average effect sizes were either negligible (talkativeness, d=0.11; assertive speech, d=0.11) or small (affiliative speech, d=0.26). Larger effect sizes were indicated for some language constructs depending on either the operational definition of the language measure, the method of recording, the child's age level, the interaction partner (adult or peer), group size, gender composition, observational setting, or type of activity. The results are interpreted in relation to social-developmental and social-constructionist approaches to gender; these views are presented as complementary--rather than competing--meta-theoretical viewpoints.     

Too proud to let go: narcissistic entitlement as a barrier to forgiveness

Narcissistic entitlement impedes forgiveness in ways not captured by other robust predictors (e.g., offense severity, apology, relationship closeness, religiosity, Big Five personality factors), as demonstrated in 6 studies. Narcissistic entitlement involves expectations of special treatment and preoccupation with defending one's rights. In Study 1, entitlement predicted less forgiveness and greater insistence on repayment for a past offense. Complementary results emerged from Study 2, which used hypothetical transgressions, and Study 3, which assessed broad forgiveness dispositions. Study 4 examined associations with the Big Five, and Study 5 extended the findings to a laboratory context. Study 6 demonstrated that entitlement predicted diminished increases in forgiveness over time. Taken together, these results suggest that narcissistic entitlement is a robust, distinct predictor of unforgiveness.     

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.     

The course of 253 analyses from selection to outcome

Two studies of the clinical work of experienced psychoanalysts are presented. Study I is a retrospective study of all the analytic work--161 cases--of sixteen analysts from 1973 to 1977, including their evaluations of the treatments at outcome. Study II is a prospective study of the ninety-two cases started in analysis by a group of twenty analysts between 1984 and 1989 and followed to termination, including their reports. The history of each treatment as reported and evaluated by the analyst is examined in terms of: nature of the population, the analyst's view of the case when the initial recommendation was made, duration of treatment, therapeutic benefit, rating of analyzability at termination of treatment, nature of the termination, and cases changed to psychotherapy. Some old shibboleths are challenged as perspective on both the limitations and achievements of psychoanalysis emerges from the findings of the study.