The Integration of Noninvasive Prenatal Screening into the Existing Prenatal Paradigm: a Survey of Current Genetic Counseling Practice

Since its introduction four years ago, noninvasive prenatal screening for fetal aneuploidy (NIPS) has been widely adopted as a screening tool for women at a high risk for fetal aneuploidy. As use expands into the general population, questions arise concerning the integration of NIPS into preexisting screening paradigms. This study aims to examine the use of NIPS in current practice among prenatal counselors, predominantly in the United States, in order to inform strategies for the optimal use of both new and existing screening techniques. We electronically surveyed 208 members of the National Society of Genetic Counselors to ascertain how NIPS is currently being used. Genetic counselors were also queried as to the advantages and disadvantages of offering NIPS to all patients regardless of a priori risk. Results indicate substantial variation in practice regarding which patients are offered NIPS and how counselors have incorporated this technology into existing screening routines. The majority of participants report offering NIPS in conjunction with another method of screening for fetal aneuploidy, indicating that NIPS is being used as an addition rather than as a replacement. These screening methods primarily include nuchal translucency (NT) (45.1 %, n = 78) and first trimester serum screening, with or without an NT (19.7 %, n = 34). Furthermore, the majority report that they would be concerned about losing the clinical value of an NT in a complete transition to NIPS (85.4 %, n = 164). Counselors are evenly split on the merits of expanding the use of NIPS to the general population (con: 55.3 %, n = 105; pro: 44.7 %, n = 85). The lack of consensus suggests that updated practice guidelines might benefit counselors. In addition, respondents emphasized the need to better educate patients and providers about the risks, benefits, and limitations of the test.     

The Curious Case of the De-ICD: Negotiating the Dynamics of Autonomy and Paternalism in Complex Clinical Relationships

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator (ICD) removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process.     

Offender and Offence Characteristics of School Shooting Incidents

School shootings are a concern due to their impact in the local community. This paper aimed to (a) establish frequent characteristics of the offender and offence, (b) explore the differences between offenders who are over the age of 18 years and those who are younger, and (c) consider the underlying themes of the offence characteristics. Data were collected on 28 cases through accessing resources such as West Law and case studies. The majority of the offenders were Caucasian and US citizens and suffered from depression. Their offences were primarily well planned, involved more than three deaths, and resulted in the offender committing suicide. Pearson's chi‐square test and Fisher's exact test identified significant differences between the two age groups. Offenders who were 18 years of age or under were more likely to experience depression, be US citizens and be linked to the school. Additionally, offenders who were 18 years of age or under were more likely to have stolen their weapons and made threats prior to the incident. Smallest space analysis revealed four thematic regions in relation to the offence characteristics: making an impact, delivering a message, doing unrestrained activity, and targeting specific individuals. These findings have implications for risk assessment and furthering understanding. Copyright © 2015 John Wiley & Sons, Ltd.     

Assessing the Effect of Language Demand in Bundles of Math Word Problems

Differential bundle functioning (DBF) analyses were conducted to determine whether seventh and eighth grade second language learners (SLLs) had lower probabilities of answering bundles of math word problems correctly that had heavy language demands, when compared to non-SLLs of equal math proficiency. Math word problems on each of four test forms (two at Grade 7 and two at Grade 8) were bundled together if they used the passive voice, conditional clause, relative clause, or a combination of any two. The results showed that the average total scores for SLLs was significantly lower than that for non-SLLs on each test form. However, only two bundles (passive voice and conditional clause at Grade 7 on Form 2) indicated statistically significant DBF against SLLs in favor of matched non-SLLs. An additional step was taken to determine whether the two bundles that showed statistically significant DBF against SLLs had biased the mean total scores for this group.The Walker, Zhang, Banks, and Cappaert (2012) procedure established for this purpose showed that this was not the case. Implications of the results are provided as well as suggestions for future research.     

Visual perspective in remembering and episodic future thought

According to the constructive episodic simulation hypothesis, remembering and episodic future thinking are supported by a common set of constructive processes. In the present study, we directly addressed this assertion in the context of third-person perspectives that arise during remembering and episodic future thought. Specifically, we examined the frequency with which participants remembered past events or imagined future events from third-person perspectives. We also examined the different viewpoints from which third-person perspective events were remembered or imagined. Although future events were somewhat more likely to be imagined from a third-person perspective, the spatial viewpoint distributions of third-person perspectives characterizing remembered and imagined events were highly similar. These results suggest that a similar constructive mechanism may be at work when people remember events from a perspective that could not have been experienced in the past and when they imagine events from a perspective that could not be experienced in the future. The findings are discussed in terms of their consistency with—and as extensions of—the constructive episodic simulation hypothesis.     

Social Desirability in Patients Seeking Surgical Treatment for Dentofacial Disharmony: Associations with Psychological Distress and Motivation for Treatment

The role of socially desirable responding in the report of treatment motivation and psychological distress by patients seeking surgical treatment for dentofacial disharmony was explored. Participants completed the Balanced Inventory of Desirable Responding (BIDR; Paulhus, 1988), which measures two components of socially desirable responding (SDR): impression management (IM), which is the purposeful tailoring of answers in order to create the most positive social image, and self-deceptive positivity (SDE), which is an honest, but overly positive self-presentation. When simple bivariate relationships were examined, statistically significant inverse associations were observed between socially desirable responding and specific motives for treatment and between SDR and psychological distress. However, the relationship between socially desirable responding and motives for treatment disappeared when the effect of psychological distress was controlled. The positive relationship between psychological distress and the report of social well-being, and self-image motives for treatment remained statistically significant even after the variance attributable to socially desirable responding was removed. Implications of the findings for the evaluation of psychological distress and treatment motivation in this population are discussed.     

Adjusting the Religious Autobiography Course for the Postmodern Classroom

Religious autobiography as an introductory course is popular yet problematic. Often, it lacks methodological breadth and functions to ensconce Western notions of subjectivity which elide difference, locatedness, and the reality of multiple or shifting identifications. These problems can be addressed by incorporating into the course a community‐based learning exercise in which each student is paired with a local senior citizen, conducts a series of interviews with the elder, and then writes an (auto‐)biography based on the interviews. Students are thus given a real‐life situation in which to test the applicability of theories and definitions of religion, as well as a relationship to a subject whose locatedness and relatively unprivileged “I” allow for the problematization of autobiography as a genre as well as an appreciation for the contextual nature of religiosity. This exercise transforms the religious autobiography course into a pedagogically fruitful, intellectually defensible, and institutionally savvy introductory course.     

Adult Attachment,Self‐Efficacy,Perspective Taking,and Conflict Resolution

Parents (N= 124) completed surveys assessing their adult attachment style, conflict resolution style, social self‐efficacy, and perspective taking. Findings supported hypothesized relationships between secure attachment and mutual forms of conflict resolution. More equivocal support was obtained for hypothesized pairings of specific nonsecure attachment styles and nonmutual conflict styles. Findings suggested mediating effects for social competencies (social self‐efficacy and perspective taking), which accounted for some of the negative association between attachment avoidance and mutual conflict style. Follow‐up analyses identified mediating effects of social competencies on specific combinations of attachment and conflict styles–thus suggesting avenues for counseling interventions.