Uptake of Preimplantation Genetic Diagnosis in Female BRCA1 and BRCA2 Mutation Carriers

Women with a germline pathogenic variant in the BReast CAncer susceptibility genes (BRCA1 or BRCA2) have an increased risk of early-onset breast and ovarian cancer. In addition to weighing cancer screening and risk-reduction options, healthy BRCA mutation carriers of childbearing age may choose to preclude passing the mutation to the next generation. In the current study, we report on preimplantation genetic diagnosis (PGD) practices in BRCA-positive Israeli women who were offered PGD at no cost. Methods: we measured PGD uptake, decision satisfaction or regret, and predictors of uptake. Of the 70 participant female carriers, only 25.7% chose to use PGD to prevent transmission of the mutation, and were not predicted by age or religious affiliation. For those who chose IVF/PGD, satisfaction with the decision regarding IVF and PGD was significantly higher than those who did not have IVF and PGD (p?<?0.04). Experiencing previous infertility was the only significant predictor of uptake of IVF/PGD (p?<?0.001), which may suggest that BRCA status is secondary to infertility in the decision-making process for PGD in women with a BRCA mutation.     

Neighborhood consistency and memory for number facts

Verguts and Fias (Memory & Cognition 33:1-16, 2005a) proposed a new model of memory for simple multiplication facts ( $ 2 \times 3 = 6 $ ; $ 8 \times 7 = 56 $ ) in which learning and performance is governed by the consistency of a problem’s correct product with neighboring products in the times table. In the present study, to directly investigate effects of neighborhood consistency, participants memorized a set of 16 novel “pound” arithmetic equations. The pound arithmetic table included eight tie equations with repeated operands (e.g., 4 # 4 = 29) and eight nontie equations (e.g., 5 # 4 = 39). In the consistent problem set, tie and nontie answers in adjacent columns and rows shared a common decade or unit value. In the inconsistent problem set, neighboring tie and nontie problems did not share a common decade or unit. Across 14 study–test blocks, memorization of the pound arithmetic table presented a robust effect of neighborhood consistency, with the rate of learning nearly doubling that of the inconsistent condition. An analysis of error types showed that consistency fostered the development of a categorical structure based on problem operands and that tie problems were encoded as a distinct subcategory of problems. There was also a substantial learning advantage for tie problems relative to nonties both with consistent and inconsistent neighbors. The results indicate that neighborhood consistency can have a major impact on memory for number facts.     

Development and Evaluation of a Decision Aid for BRCA Carriers with Breast Cancer

BRCA+ breast cancer patients face high risk for a second breast cancer and ovarian cancer. Helping these women decide among risk-reducing options requires effectively conveying complex, emotionally-laden, information. To support their decision-making needs, we developed a web-based decision aid (DA) as an adjunct to genetic counseling. Phase 1 used focus groups to determine decision-making needs. These findings and the Ottawa Decision Support Framework guided the DA development. Phase 2 involved nine focus groups of four stakeholder types (BRCA+ breast cancer patients, breast cancer advocates, and genetics and oncology professionals) to evaluate the DA's decision-making utility, information content, visual display, and implementation. Overall, feedback was very favorable about the DA, especially a values and preferences ranking-exercise and an output page displaying personalized responses. Stakeholders were divided as to whether the DA should be offered at-home versus only in a clinical setting. This well-received DA will be further tested to determine accessibility and effectiveness.     

“Testing Times,Challenging Choices”: An Australian Study of Prenatal Genetic Counseling

In many countries pregnant women deemed to be at increased risk for fetal anomaly following a screening test may attend a genetic counseling session to receive information and support in decision-making about subsequent diagnostic testing. This paper presents findings from an Australian study that explored 21 prenatal genetic counseling sessions conducted by five different genetic counselors. All were attended by pregnant women who had received an increased risk result from a maternal serum screening (MSS) test and who were offered a diagnostic test. Qualitative methods were used to analyze the content and structure of sessions and explore the counseling interactions. Findings from this cohort demonstrate that, within these prenatal genetic counseling sessions, counselor dialogue predominated. Overall the sessions were characterized by: a) an emphasis on information-giving b) a lack of dialogue about relevant sensitive topics such as disability and abortion. Arguably, this resulted in missed opportunities for client deliberation and informed decision-making. These findings have implications for the training and practice of genetic counselors and all healthcare professionals who communicate with women about prenatal testing.     

Scaffolding feedback to maximize long-term error correction

Scaffolded feedback was tested against three other feedback presentation methods (standard corrective feedback, minimal feedback, and answer-until-correct multiple-choice feedback) over both short- and long-term retention intervals in order to assess which method would produce the most robust gains in error correction. Scaffolded feedback was a method designed to take advantage of the benefits of retrieval practice by providing incremental hints until the correct answer could be self-generated. In Experiments 1 and 3, on an immediate test, final memory for the correct answer was lowest for questions given minimal feedback, moderate for the answer-until-correct condition, and equally high in the scaffolded feedback condition and the standard feedback condition. However, tests of the maintenance of the corrections over a 30-min delay (Experiment 2) and over a 1-day delay (Experiment 3) demonstrated that scaffolded feedback gave rise to the best memory for the correct answers at a delay.     

An Empirical Evaluation of Millon's Dimensional Polarities

LASTPAGE study investigated the theoretical consistency for Millon's dimensional polarities (T. Millon &; R. D. Davis, 1996; T. A. Widiger, 1999) by administering the Millon Index of Personality Styles (MIPS; T. Millon, 1994) and Millon Clinical Multiaxial Inventory-III (MCMI-III; T. Millon, 1997) to 50 university counseling center students. Data were analyzed by correlating the MIPS polarity dimension scales with the personality disorder scales of the MCMI-III. Findings suggested more inconsistencies than consistencies with the underlying theoretical model. The greatest discrepancies were found for the expected relationships between the polarity dimensions and the narcissistic and compulsive scales, and to a lesser degree, the schizoid, avoidant, schizotypal, and negativistic scales. Discussion concerned how these divergencies might best be understood in light of Millon's conceptualization of Axis II disorders.     

Judgments of learning: Evidence for a two-stage process

Three experiments tested the hypothesis that people make judgments of learning (JOLs) by attempting to retrieve the target first. If this were the whole story, then the reaction time (RT) functions for making JOLs with no special instructions would parallel those found when people are told to first attempt retrieval and then make a JOL. In the present data, monotonic functions, showing an increase in RT with decreasing JOL, were found when people were instructed to retrieve covertly or overtly and then make a JOL, as would be expected if retrieval fluency entirely determined JOLs. However, the functions for making uninstructed JOLs were different: Low JOLs were made quickly, not slowly, and the curves were inverted U shapes, rather than linear. Furthermore, people's memory performance was somewhat better, especially on low-JOL items, when they were instructed to first retrieve as opposed to when they were told only to make JOLs. To account for these data, we propose a two-stage model of JOLs, with the first stage occurring prior to attempted retrieval.     

A hot/cool-system analysis of delay of gratification: dynamics of willpower

A 2-system framework is proposed for understanding the processes that enable--and undermine--self-control or "willpower" as exemplified in the delay of gratification paradigm. A cool, cognitive "know" system and a hot, emotional "go" system are postulated. The cool system is cognitive, emotionally neutral, contemplative, flexible, integrated, coherent, spatiotemporal, slow, episodic, and strategic. It is the seat of self-regulation and self-control. The hot system is the basis of emotionality, fears as well as passions--impulsive and reflexive--initially controlled by innate releasing stimuli (and, thus, literally under "stimulus control"): it is fundamental for emotional (classical) conditioning and undermines efforts at self-control. The balance between the hot and cool systems is determined by stress, developmental level, and the individual's self-regulatory dynamics. The interactions between these systems allow explanation of findings on willpower from 3 decades of research.     

Familiarity and retrieval processes in delayed judgments of learning

Two processes are postulated to underlie delayed judgments of learning (JOLs)--cue familiarity and target retrievability. The two processes are distinguishable because the familiarity-based judgments are thought to be faster than the retrieval-based processes, because only retrieval-based JOLs should enhance the relative accuracy of the correlations between the JOLs and criterion test performance, and because only retrieval-based judgments should enhance memory. To test these predictions, in three experiments, the authors either speeded people's JOLs or allowed them to be unspeeded. The relative accuracy of the JOLs in predicting performance on the criterion test was higher for the unspeeded JOLs than for the speeded JOLs, as predicted. The unspeeded JOL conditions showed enhanced memory as compared with the speeded JOL conditions, as predicted. Finally, the unspeeded JOLs were sensitive to manipulations that modified recallability of the target, whereas the speeded JOLs were selectively sensitive to experimental variations in the familiarity of the cues. Thus, all three of the predictions about the consequences of the two processes potentially underlying delayed JOLs were borne out. A model of the processes underlying delayed JOLs based on these and earlier results is presented.     

Arabic digit naming speed: task context and redundancy gain

There is evidence for both semantic and asemantic routes for naming Arabic digits, but neuropsychological dissociations suggest that number-fact retrieval (2x3=6) can inhibit the semantic route for digit naming. Here, we tested the hypothesis that such inhibition should slow digit naming, based on the principle that reduced access to multiple routes would counteract redundancy gain (the response time advantage expected from parallel retrieval pathways). Participants named two single digit numbers and then performed simple addition or magnitude comparison (Experiment 1), multiplication or magnitude comparison (Experiment 2), and multiplication or subtraction (Experiment 3) on the same or on a different pair of digits. Addition and multiplication were expected to inhibit the semantic route, whereas comparison and subtraction should enable the semantic route. Digit naming time was approximately 15ms slower when participants subsequently performed addition or multiplication relative to comparison or subtraction, regardless of whether or not the same digit pair was involved. A letter naming control condition in Experiment 3 demonstrated that the effect was specific to digit naming. Number fact retrieval apparently can inhibit Arabic digit naming processes.