The 10th Oxbridge varsity medical ethics debate-should we fear the rise of direct-to-consumer genetic testing?

In an increasingly data-driven age of medicine, do companies that offer genetic testing directly to patients represent an important part of personalising care, or a dangerous threat to privacy? Should we celebrate this new mechanism of patient involvement, or fear its implications?The Universities of Oxford and Cambridge addressed these issues in the 10th annual Medical Ethics Varsity Debate, through the motion: “This House Regrets the Rise of Direct-to-Consumer Genetic Testing”. This article summarises and extends key arguments made in the debate, exploring the impacts of such genetic testing on both the individual patient and broader society, with special consideration as to whether companies can ever truly guarantee anonymity of genetic data.     

Too Busy to Change: High Job Demands Reduce the Beneficial Effects of Information and Participation on Employee Support

Despite the abundant literature on organizational change management, the success of change initiatives in organizations remains low. In this study, we investigate employee support for change in the context of two change management practices (information and participation). We use the Theory of Planned Behavior (TPB) to examine why these change management practices foster employee support, and the extent to which the efficacy of these practices depends on current job demands. Participants were 106 employees undergoing a building relocation at their place of employment who responded to an initial questionnaire at time 1 (pre-occupancy) and a follow-up questionnaire 2 months later (post-occupancy). We found that the TPB variables mediated the effects of information and participation on employee support (both intentions at time 1 and self-reported behaviors at time 2). The indirect relationships from information and participation to employee support were significant at low and medium, but not at high levels of job demands. The positive effects of information and participation on employee support can be largely attributed to employee attitudes and subjective norms. Thus, consultants should target employee attitudes and norms when garnering employee support, but also be aware of the limitations of these practices when employees are preoccupied with their work. This study demonstrates that the TPB can account for the beneficial effects of change management practices on employee support. It also reports the novel finding that change management practices are less effective at high levels of job demands.     

Paradoxical olfactory function in combat Veterans: The role of PTSD and odor factors

Stress- and trauma-related disorders, including posttraumatic stress disorder (PTSD), are characterized by an increased sensitivity to threat cues. Given that threat detection is a critical function of olfaction and that combat trauma is commonly associated with burning odors, we sought a better understanding of general olfactory function as well as response to specific trauma-related (i.e. burning) odors in combat-related PTSD. Trauma-exposed combat Veterans with (n = 22) and without (n = 25) PTSD were assessed for general and specific odor sensitivities using a variety of tools. Both groups had similar general odor detection thresholds. However, the combat Veterans with PTSD, compared to combat Veterans with comparable trauma exposure but without PTSD, had increased ratings of odor intensity, negative valence, and odor-triggered PTSD symptoms, along with a blunted heart rate in response to burning rubber odor. These findings are discussed within the context of healthy versus pathological changes in olfactory processing that occur over time after psychological trauma.     

Greater delay discounting among girls,but not boys,with ADHD correlates with cognitive control

Cognitive neuroscience models suggest both reward valuation and cognitive control contribute to reward-based decision-making. The current study examined the relationship between cognitive control and delay discounting (i.e., choosing smaller, immediate over larger, delayed rewards) in a large sample of boys and girls diagnosed with attention-deficit/hyperactivity disorder (ADHD; N = 95) and typically developing control children (TD; N = 59). Specifically, we examined performance on multiple measures of cognitive control (i.e., Go/No-Go task, Stop Signal task, and Spatial Span task) and delay discounting (i.e., Classic Delay Discounting and Real-Time Delay Discounting tasks), as well as the relationship between these measures. Results indicated that sex moderated the effects of group on task performance. Specifically, girls with ADHD, but not boys with the disorder, exhibited atypical delay discounting of real-time rewards. Results from correlational analyses indicated that delay discounting and cognitive control were not significantly correlated in the overall sample. Multiple regression analyses demonstrated that among girls with ADHD poorer spatial working memory and inhibitory control predicted greater real-time discounting. Collectively, findings provide support for distinct patterns of cognitive control and delay discounting among school-aged girls and boys with ADHD. Additionally, findings suggest that among girls with ADHD, those who exhibit relatively poor working memory and inhibitory control might be a particularly vulnerable subgroup with the greatest propensity to exhibit maladaptive decision-making.     

Knowing when to hold ‘em: regret and the relation between missed opportunities and risk taking in children,adolescents and adults

Regret over missed opportunities leads adults to take more risks. Given recent evidence that the ability to experience regret impacts decisions made by 6-year-olds, and pronounced interest in the antecedents to risk taking in adolescence, we investigated the age at which a relationship between missed opportunities and risky decision-making emerges, and whether that relationship changes at different points in development. Six- and 8-year-olds, adolescents and adults completed a sequential risky decision-making task on which information about missed opportunities was available. Children also completed a task designed to measure their ability to report regret when explicitly prompted to do so. The relationship between missed opportunities and risky decision-making did not emerge until 8 years, at which age it was associated with the ability to explicitly report regret, and was stronger in adults than in adolescents. These novel results highlight the potential importance of the ability to experience regret in children and adolescents’ risky decision-making.     

A Review of Behavioral Interventions for Anxiety‐Related Behaviors in Lower‐Functioning Individuals with Autism

Anxiety is highly prevalent in persons with autism and affects individuals with higher‐functioning autism (HFA) and lower‐functioning autism (LFA). Although there is emerging support for the efficacy of cognitive‐behavioral therapy (CBT) in treating anxiety in autism, these findings are largely based on HFA samples. Moreover, CBT may be inappropriate for individuals with LFA who may struggle to grasp the cognitive components of the therapy because of their more limited verbal abilities. Behavior analytic interventions may be better suited to treat anxiety in this population; however, the quantity and quality of the extant literature have yet to be reviewed. Toward this end, the extant behavioral intervention literature was reviewed. Seven studies met the inclusion criteria and were evaluated against quality indicators for within‐subject design research. Next, the efficacy of each treatment component was assessed using established criteria for defining empirically supported therapies. Results revealed behavioral interventions to be efficacious, with desensitization and reinforcement emerging as efficacious treatment components, while prompting, modeling, and antianxiety stimuli were established as possibly efficacious. However, given that some of the quality indicators were not met, these results should be interpreted with some caution. Additional research is needed to form a more conclusive evidence base for the treatment of anxiety in individuals with LFA. Copyright © 2016 John Wiley & Sons, Ltd.     

The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

eHealth is an innovative method of delivering therapeutic content with the potential to improve access to third-wave behaviural and cognitive therapies. This systematic review and meta-analysis aimed to determine the efficacy and acceptability of third-wave eHealth treatments in improving mental health outcomes. A comprehensive search of electronic bibliographic databases including PubMed, PsycINFO, Web of Science, and CENTRAL was conducted to identify randomized controlled trials of third-wave treatments in which eHealth was the main component. Twenty-one studies were included in the review. Meta-analyses revealed that third-wave eHealth significantly outperformed inactive control conditions in improving anxiety, depression, and quality-of-life outcomes and active control conditions in alleviating anxiety and depression with small to medium effect sizes. No statistically significant differences were found relative to comparison interventions. Findings from a narrative synthesis of participant evaluation outcomes and meta-analysis of participant attrition rates provided preliminary support for the acceptability of third-wave eHealth.Third-wave eHealth treatments are efficacious in improving mental health outcomes including anxiety, depression, and quality of life, but not more so than comparison interventions. Preliminary evidence from indices of participant evaluation and attrition rates supports the acceptability of these treatments.     

Using system differences to orchestrate change: a systems-guides intervention model

Successful community-based interventions require that change agents give attention to the complexities of interwoven systems, described in the literature as complicated or complex, purposeful or purposive. The author further notes the separate standards, norms, principles and/or goals (here-named systems-guides) of systems. This paper describes the author's experience as a consultant to a multi-system collaboration where observed tensions among participants resulted in the author's implementation of a three-step systems-guides model, which can increase change agents' effectiveness with systems. The steps comprise: detection (of systems, systems-guides, and discrepancies between them; here through observation); documentation (of discrepancies; here through small group discussions); dissemination (to systems participants; here to the collaboration). Two small but fundamental systems changes emerged from systems participants, not from the change agent/author who facilitated systems members' recognition of discrepancies. A major limitation in the implementation of this systems-guides model centers on the critical necessity of the close relationship change agents must have with the involved systems.     

Links between behavioral regulation and preschoolers' literacy, vocabulary, and math skills

This study investigated predictive relations between preschoolers' (N=310) behavioral regulation and emergent literacy, vocabulary, and math skills. Behavioral regulation was assessed using a direct measure called the Head-to-Toes Task, which taps inhibitory control, attention, and working memory, and requires children to perform the opposite of what is instructed verbally. Hierarchical linear modeling (HLM) was utilized because children were nested in 54 classrooms at 2 geographical sites. Results revealed that behavioral regulation significantly and positively predicted fall and spring emergent literacy, vocabulary, and math skills on the Woodcock Johnson Tests of Achievement (all ps<.05). Moreover, growth in behavioral regulation predicted growth in emergent literacy, vocabulary, and math skills over the prekindergarten year (all ps<.05), after controlling for site, child gender, and other background variables. Discussion focuses on the role of behavioral regulation in early academic achievement and preparedness for kindergarten.     

A Comparison of Mood and Quality of Life Among People with Progressive Neurological Illnesses and Their Caregivers

The current study was designed to investigate differences in mood and a range of QOL domains among 423 patients and 335 caregivers of people with motor neurone disease (MND), Huntington’s disease (HD), Parkinson’s, and multiple sclerosis (MS). Patients and caregivers completed an anonymous questionnaire that evaluated their mood (anxiety, depression, fatigue, confusion) and QOL (physical, psychological, social, environment). The results demonstrated that caregivers of people with MND and HD experienced most problems with their mood and QOL compared to caregivers of people in the other illness groups. There were few differences in mood or QOL between patients and caregivers. Patients generally showed greater confusion, physical impairment, and psychological maladjustment. The findings suggest that educational and intervention programs need to be developed to help both patients and their caregivers to adjust and cope with these illnesses, particularly caregivers of people with MND and HD.