A Data Analysis Method for Using Longitudinal Binary Outcome Data from a SMART to Compare Adaptive Interventions

Sequential multiple assignment randomized trials (SMARTs) are a useful and increasingly popular approach for gathering information to inform the construction of adaptive interventions to treat psychological and behavioral health conditions. Until recently, analysis methods for data from SMART designs considered only a single measurement of the outcome of interest when comparing the efficacy of adaptive interventions. Lu et al. proposed a method for considering repeated outcome measurements to incorporate information about the longitudinal trajectory of change. While their proposed method can be applied to many kinds of outcome variables, they focused mainly on linear models for normally distributed outcomes. Practical guidelines and extensions are required to implement this methodology with other types of repeated outcome measures common in behavioral research. In this article, we discuss implementation of this method with repeated binary outcomes. We explain how to compare adaptive interventions in terms of various summaries of repeated binary outcome measures, including average outcome (area under the curve) and delayed effects. The method is illustrated using an empirical example from a SMART study to develop an adaptive intervention for engaging alcohol- and cocaine-dependent patients in treatment. Monte Carlo simulations are provided to demonstrate the good performance of the proposed technique.     

Effects of Comt Genotype on Behavioral Symptomatology in the 22q11.2 Deletion Syndrome

The 22q11.2 Deletion Syndrome (DiGeorge/velocardiofacial syndrome) is associated with elevated rates of psychosis, and is also characterized by severe attentional difficulties and executive dysfunction. Behavioral manifestations of this syndrome could result from haploinsufficiency of the catechol-O-methyltransferase (COMT) gene, located within the 22q11 region. The goal of the present study was to examine COMT genotype in relation to behavioral symptomatology in this syndrome. Val^158/108Met was genotyped in 38 patients (16 Met/-, 22 Val/-) with confirmed 22q11.2 deletions who had received the Child Behavior Checklist (CBCL) as part of a comprehensive evaluation. Results indicated that the Val genotype was associated with significantly greater internalizing and externalizing behavioral symptomatology in children with 22q11.2 deletions. Val allele status was associated with a greater-than-four-fold increase in risk for clinically significant behavior problems in children with this syndrome. These data are consistent with previous findings of increased psychopathology associated with the Val genotype in normal individuals and suggest that a functional genetic polymorphism in the 22q11 region may influence behavior in individuals with COMT haploinsufficiency.     

Factor Structure of the Wide Range Assessment of Memory and Learning (WRAML) in Children With Insulin Dependent Diabetes Mellitus (IDDM)

Maximum likelihood confirmatory factor analysis was performed with the Wide Range Assessment of Memory and Learning (WRAML) for a clinical sample of 246 children with insulin-dependent diabetes mellitus (IDDM). Consistent with previous literature examining the factor structure of the WRAML, findings supported the validity of a three-factor model including Verbal Memory, Visual Memory, and Attention/Concentration (AC) factors for this clinical sample. However, in contrast to previous factor analytic research, results also supported the validity of an alternative two-factor model consisting of a combined modality Memory/Learning (ML) factor and an AC factor. While the results suggest that the three-factor solution may provide an adequate characterization of memory and learning in the majority of this sample of children with IDDM, it appears that certain groups of children with IDDM, particularly those children with early disease onset and those who experience hypoglycemic seizures, may exhibit a specific profile of differences that may result in a lack of differentiation between the verbal and visual modalities.     

Romantic Longings,Moral Ideals,and Democratic Priorities: On Richard Rorty's Use of the Distinction Between the Private and the Public

Abstract

The heart of Richard Rorty's philosophy is his distinction between the private and the public. In the first part of this paper, I highlight the profound influence that the inherited vocabularies of Romanticism and Moralism have had on Rorty's understanding of both the distinction and the problems he intends to solve with it. I also suggest that Rorty shares with Plato, Kant, and Nietzsche philosophical habits that cause him to treat two importantly different problems as one. Once the moral problem is disentangled from the political, it becomes clear that Rorty's distinction is unnecessary to the former and inadequate for the latter. In the second part of the paper, I argue that Rorty's non‐foundationalist pragmatism supports the view that the political problem is best resolved by what I call a democratic mechanism of arbitration. It is the lingering influence of Romanticism and Moralism, I suggest, that is the cause of Rorty's reluctance to embrace fully the political priority of democratic consensus. Finally, I discuss why this analysis of Rorty's liberalism may have implications for the general question of how best to resolve political disputes in pluralist societies.     

The oedipus complex in the work of sigmund freud and heinz kohut: A post-modern critique

Abstract

The work of Sigmund Freud and Heinz Kohut in relation to the concept of the Oedipus complex is presented. A summary is given of post-modern assumptions about the nature and role of knowledge, and, on the basis of these assumptions, two questions are raised in relation to Freud's and Kohut's Oedipal theories. Provisional responses are made to these questions, which focus on the hermeneutical value and ethical-political implications of the concept of the Oedipus complex.     

The sociology of the sacred: A conversation with Jeffrey Alexander

Over the past 20 years, Jeffrey C. Alexander has been a leading social theorist and a pioneer of the ‘strong program’ in cultural sociology, which emphasises the significance of cultural structures of meaning for social life. Following an introductory overview of his work, this article records a public conversation with Alexander about the role and significance of the concept of the sacred in his sociological work. Issues addressed in this conversation include situating Alexander's interest in the sacred in his intellectual biography (including his significant intellectual influences), the mistrust of the concept of the sacred within the wider sociological community, the universality of cultural structures of sacred meaning, the limitations of sociological analysis focused on sacred meaning and methodological approaches to the study of the sacred.     

Communication of Genetic Information by Other Health Professionals: The Role of the Genetic Counsellor in Specialist Clinics

Many children with chronic genetic diseases are followed by specialty clinics that provide genetic information as part of the care. Health services restrictions in the Republic of Ireland (ROI) can make the wait for an appointment with a genetic counsellor long. We examined whether genetic information was being adequately understood when presented by medical, but non-genetics staff to long term patients, using our national metabolic service as an example. The aim was to inform health professionals about the need or role of a genetic counsellor in a specialist setting. A questionnaire was used to assess knowledge among parents and patients affected by galactosaemia and Maple Syrup Urine Disease (MSUD). Twenty seven families with galactosemia and 10 with MSUD were interviewed in clinic. Comparative analysis showed significant differences in knowledge between parents of children with galactosemia and adult patients (p = 0.001) and between ethnicities (p > 0.05). While parents are well informed, the majority expressed a wish for more information about the condition and its transmission. Adult patients with galactosemia and parents from certain ethnic backgrounds could especially benefit from genetic counselling. This study highlights the need for a genetic counsellor in specialist clinics.     

Media Coverage of Direct-to-Consumer Genetic Testing

Media coverage of Direct-to-Consumer (DTC) genetic testing shapes public perception of such testing. The purpose of this study was to determine and assess the themes presented by U.S. news media regarding DTC genetic testing. We performed a Lexis-Nexis search with the keywords “Direct-to-Consumer” and “genetic test” for news stories published from 2006–2009. The sample was coded on themes of genetic determinism, privacy, discrimination, validity, regulation, the Genetic Information Nondiscrimination Act (GINA), utility, and cost. Ninety-two news stories were included. Stories displayed moderate genetic determinism and were neutral about validity and utility. Stories indicated that insurance and employers were the most likely sources of discrimination, yet identified the physicians and DTC companies as groups most likely to violate privacy. Stories claimed lack of regulation would harm consumers, but most post-GINA stories did not discuss the law. The costs of tests were frequently included. The results of this study show a broad range of views toward DTC genetic testing and its potential impacts. The genetics community should be aware that the public has been exposed to multiple views of DTC genetic testing when discussing these tests.     

The biochemistry of memory: The 26year journey of a 'new and specific hypothesis'

This Special Issue of Neurobiology of Learning and Memory dedicated to Dr. Richard Thompson to celebrate his 80th birthday and his numerous contributions to the field of learning and memory gave us the opportunity to revisit the hypothesis we proposed more than 25years ago regarding the biochemistry of learning and memory. This review summarizes our early 1980s hypothesis and then describes how it was tested and modified over the years following its introduction. We then discuss the current status of the hypothesis and provide some examples of how it has led to unexpected insights into the memory problems that accompany a broad range of neuropsychiatric disorders.     

Mediators of the shame-guilt-psychological adjustment relationship

Lynch, J. S., Hill, E. D., Nagoshi, J. L. & Nagoshi, C. T. Mediators of the shame-guilt-psychological adjustment relationship. Scandinavian Journal of Psychology 53, 437-443. A college student sample (109 women, 90 men) was administered measures of psychological adjustment, shame, guilt, personal fear of invalidity, and aspects of empathy, including personal distress in emergencies and fantasy involvement. Consistent with previous studies, shame but not guilt was significantly positively correlated with poor psychological adjustment. Path analyses with bootstrapped mediation tests indicated that the shame-adjustment relationship was significantly mediated by fear of invalidity, personal distress, and fantasy involvement. A novel finding was that the relationship between guilt and maladjustment was significantly mediated by proneness to fantasy. The findings are discussed in terms of an integrated theory of the shame-fear/distress-maladjustment relationship as a framework for understanding the maladaptive, individualistic shame experience.