Time Costs for Genetic Counseling in Preconception Carrier Screening with Genome Sequencing

Advances in technology and the promise of personalized health care are driving greater use of genome sequencing (GS) for a variety of clinical scenarios. As health systems consider adopting GS, they need to understand the impact of GS on the organization and cost of care. While research has documented a dramatic decrease in the cost of sequencing and interpreting GS, few studies have examined how GS impacts genetic counseling workloads. This study examined the time needed to provide genetic counseling for GS in the context of preconception carrier screening. Genetic counselors prospectively reported on the time spent in the results disclosure process with 107 study participants who were part of the NextGen study. We found that the median time for results disclosure was 64 min (ranged from 5 to 229 min). Preparation work was the most time-consuming activity. Qualitative data from journal entries, debrief interviews with genetic counselors, and detailed case conference notes provided information on factors influencing time for results disclosure and implications for practice. Results suggest that expanded carrier screening could require significant increases in genetic counseling time, unless we are able to generate new resources to reduce preparation work or develop other strategies such as the creation of new models to deliver this type of service.     

Interference in the perceived segregation of equal-luminance element-arrangement texture patterns

Perceived segregation in element-arrangement patterns composed of squares of equal size and luminance, but of two different hues, was investigated in two experiments. Element-arrangement patterns consist of two types of elements, arranged in alternating vertical stripes in the top and bottom regions and in a checkerboard pattern in the center region. Perceived segregation of the striped and checkerboard regions decreased with increasing luminance of the interspaces between the squares, a high-luminance surround, and the increased spacing of the squares. When the luminance of the horizontal interspaces was increased, the decrease in perceived segregation was greater than that when the luminance of the vertical interspaces was increased. Two explanations of the interference of the interspace luminance are discussed. One explanation is in terms of inhibitory interactions among cortical filters tuned to spatial frequency and orientation. A second explanation is in terms of interference with preattentive grouping processes.     

Family therapy and anthropology: a case for emotions

The idea that emotions are socially constructed challenges traditional views in both family therapy and anthropology and also opens the possibility for further collaboration. This paper reviews the traditional position of orthodox family therapy theory with respect to motivation and emotions. It argues that a social constructionist position can build on original family therapy insights about the connectedness of family members and offer a view which transcends mind-body dualism. Bateson's concept of ethos is seen as a forerunner of this view and, with the increasing interest in meaning and cross-cultural issues, Bateson's ideas deserve renewed attention. Implications of a social constructionist view of emotions for family therapists are outlined.