The Laboratory-Clinician Team: A Professional Call to Action to Improve Communication and Collaboration for Optimal Patient Care in Chromosomal Microarray Testing

The International Standards for Cytogenomic Arrays (ISCA) Consortium is a worldwide collaborative effort dedicated to optimizing patient care by improving the quality of chromosomal microarray testing. The primary effort of the ISCA Consortium has been the development of a database of copy number variants (CNVs) identified during the course of clinical microarray testing. This database is a powerful resource for clinicians, laboratories, and researchers, and can be utilized for a variety of applications, such as facilitating standardized interpretations of certain CNVs across laboratories or providing phenotypic information for counseling purposes when published data is sparse. A recognized limitation to the clinical utility of this database, however, is the quality of clinical information available for each patient. Clinical genetic counselors are uniquely suited to facilitate the communication of this information to the laboratory by virtue of their existing clinical responsibilities, case management skills, and appreciation of the evolving nature of scientific knowledge. We intend to highlight the critical role that genetic counselors play in ensuring optimal patient care through contributing to the clinical utility of the ISCA Consortium's database, as well as the quality of individual patient microarray reports provided by contributing laboratories. Current tools, paper and electronic forms, created to maximize this collaboration are shared. In addition to making a professional commitment to providing complete clinical information, genetic counselors are invited to become ISCA members and to become involved in the discussions and initiatives within the Consortium.     

The Use of a Family History Risk Assessment Tool within a Community Health Care System: Views of Primary Care Providers

Primary care providers (PCPs) offered input regarding the incorporation of a family health history (FHH) risk assessment tool into a community health care system (CHCS). Sixteen PCPs participated in one of three focus groups. Perceived impediments included the lack of standard screening guidelines, effective screening tests, genetic counseling resources, and services for high-risk patients. The PCPs were concerned about their level of expertise, the cost of preventive health care, and genetic discrimination. They also were concerned about the use of a FHH tool by oncologists within the CHCS because of communication gaps between oncologists and PCPs, lack of clarity regarding follow-up and legal liability, and reimbursement issues. To integrate a FHH tool into a CHCS, PCPs will need consultation and referral services, evidence-based recommendations, and "just-in-time" educational resources. Oncologists who use the tool will need to develop a streamlined communication system with PCPs, establish clearly defined roles, and ensure patient follow-up.     

The relationship between performance-based self-esteem and self-reported work and health behaviors among Danish knowledge workers

Since knowledge intensive work often requires self-management, one might fear that persons who are dependent on work success for self-esteem will have difficulties in finding a healthful and sustainable balance between internal needs and external demands. Accordingly, we examined to what degree work-related performance-based self-esteem (PBS) was linked to work and health behaviors in 392 knowledge workers (226 women, 166 men). In the women group, multiple binary logistic regression analyses with repeated measurements showed that the PBS score was associated with 10 of the 17 examined work and health behaviors. For men the corresponding figure was 3 of 17. In both men and women, higher PBS scores were positively associated with reports of efforts and strivings for work as well as attending work while ill. In conclusion, statistically significant relationships between PBS and work and health behaviors were more clearly visible among women than men. Whether this gender difference is dependent on the study design, or on true inherent differences between women and men, cannot be concluded with any certainty. However, persons who described themselves as being relatively more dependent on work accomplishments for a high self-esteem, as expressed by the PBS score, seem to display work behaviors that may lessen their restitution time. In addition, they also seem to be more prone to work while sick.     

The Relationship between Temperamental Negative Affect,Effortful Control,and Sensory Regulation: A New Look

Temperamental negative affectivity (NA) and effortful control (EC) have long been of interest to psychologists, but sensory regulation (SR) has received less attention. Using confirmatory factor analysis, the present study reexamined the Rothbart model of EC and NA using the Children's Behavior Questionnaire (CBQ; M.K. Rothbart, S.A. Ahadi, K.L. Hershy, & P. Fisher, 2001), along with alternative models of EC, NA, and SR using the CBQ and Short Sensory Profile. The results failed to replicate the Rothbart model of EC and NA, which includes SR within the EC and NA factors. A good fit was found for a three‐factor model (EC, NA, and SR) that was replicated in a holdout sample. A three‐factor model also showed a good fit when EC, NA, and SR items similar to symptoms of behavior problems were eliminated.     

Carry on: spontaneous object carrying in 13-month-old crawling and walking infants

Carrying objects requires coordination of manual action and locomotion. This study investigated spontaneous carrying in 24 walkers who were 13 months old and 26 crawlers who were 13 months old during 1-hr, naturalistic observations in the infants' homes. Carrying was more common in walkers, but crawlers also carried objects. Typically, walkers carried objects in their hands, whereas crawlers multitasked by using their hands simultaneously for holding objects and supporting their bodies. Locomotor experience predicted frequency of carrying in both groups, suggesting that experienced crawlers and walkers perceive their increased abilities to handle objects while in motion. Despite additional biomechanical constraints imposed by holding an object, carrying may actually improve upright balance: Crawlers rarely fell while carrying an object, and walkers were more likely to fall without an object in hand than while carrying. Thus, without incurring an additional risk of falling, spontaneous carrying may provide infants with new avenues for combining locomotor and manual skills and for interacting with their environments.     

The effects of a responsive parenting intervention on parent-child interactions during shared book reading

This study examined mother-child shared book reading behaviors before and after participation in a random-assignment responsive parenting intervention called Play and Learning Strategies (PALS) that occurred during infancy (PALS I), the toddler-preschool (PALS II) period, or both as compared with a developmental assessment (DAS) intervention (DAS I and/or II). The efficacy of PALS was previously demonstrated for improving mother and child behaviors within play contexts, everyday activities, and standardized measures of child language. We hypothesized that PALS effects would generalize to influence maternal and child behaviors during a shared reading task even though this situation was not a specific focus of the intervention and that this would be similar for children who varied in biological risk. Participation in at least PALS II was expected to have a positive effect due to children's increased capacity to engage in book reading at this age. Four groups of randomized mothers and their children (PALS I-II, PALS I-DAS II, DAS I-PALS II, DAS I-II) were observed in shared reading interactions during the toddler-preschool period and coded for (a) mother's affective and cognitive-linguistic supports and (b) child's responses to maternal requests and initiations. Support was found for significant changes in observed maternal and child behaviors, and evidence of mediation was found for the intervention to affect children's behaviors through change in maternal responsiveness behaviors. These results add to other studies supporting the importance of targeting a broad range of responsive behaviors across theoretical frameworks in interventions to facilitate children's development.     

Ekklesia in the Midst of Public Outrage Today

Abstract : How are recent widespread movements of public outrage a wake‐up call to churches? Where are there similarities between these movements and what the church is called to be about? How can false gods, hopes, and desires be exposed pastorally? How can the “subversive remembering” of Word and sacrament bring depth to accompany these movements and meaning to the downturns or betrayal of the” American dream” that people are experiencing?     

Cultural differences in process and person focus: Congratulations on your hard work versus celebrating your exceptional brain

Cultural differences in process-focused versus person-focused themes were examined using both cultural artifacts (Study 1) and self-reports (Study 2). In Study 1, the contents of Chinese and American graduation and encouragement cards were analyzed for their relative emphasis on person- versus process-focused themes. Person-focused themes center on recipients' stable traits and abilities, and their emotional well-being. In contrast, process-focused themes dwell on the recipients' hard work and effort, and emphasize the importance of continued self-improvement and growth. Messages on Chinese cards were significantly more process than person focused. The reverse was true of American cards. Chinese cards also contained more process-focused (e.g., winding roads) than person-focused images (e.g., student standing on a pedestal). American cards contained more person-focused than process-focused images, although this difference was significant only among encouragement cards. In Study 2, we presented Chinese and American participants with graduation card messages differing in focus. Chinese parents indicated that they would be more likely to select and Chinese students indicated that they would be more likely to receive process- than person-themed graduation card messages. American parents and students showed no effects of message focus. The findings illustrate how cultural beliefs are reflected in cultural artifacts and personal preferences.     

Contextual influences on resistance to disruption in children with intellectual disabilities

Training context can influence resistance to disruption under differing reinforcement schedules. With nonhumans, when relatively lean and rich reinforcement schedules are experienced in the context of a multiple schedule, greater resistance is found in the rich than the lean component, as described by behavioral momentum theory. By contrast, when the schedules are experienced in separated blocks of sessions (i.e., as single schedules), resistance is not consistently greater in either component. In the current study, two groups of 6 children with intellectual disabilities responded to stimuli presented in relatively lean or rich components. For both, reinforcers were delivered according to the same variable-interval reinforcement schedule; additionally, the rich component included the delivery of response-independent reinforcers. The Within group was trained on a multiple schedule in which lean and rich components alternated regularly within sessions; the Blocked group was trained on two single schedules in which sessions with either the lean or rich schedule were conducted in successive blocks. Disruption tests presented a concurrently available alternative stimulus disrupter signaling the availability of tangible reinforcers. All 6 Within participants showed greater resistance to disruption in the rich component, consistent with behavioral momentum theory. By contrast, there was no consistent or significant difference in resistance for Blocked participants. This finding is potentially relevant to the development of interventions in applied settings, where such interventions often approximate single schedules and include response-independent reinforcers.