Investigation of the Use of a Family Health History Application in Genetic Counseling

The paper-based pedigree is the current standard for family health history (FHH) documentation in genetic counseling. Several tools for electronic capture of family health data have been developed to improve re-use and accessibility, data quality and standardization, ease of updating, and integration with electronic medical records. One such tool, the tablet-based Proband application, provides a flexible approach to data capture in dynamic and diverse clinical settings. This study compared Proband FHH collection to paper-based methods and investigated the usability of Proband in a clinical setting. After one use by 23 genetic counselors and students, Proband had 91% accuracy with a FHH audio scenario, which was significantly less (p?<?0.001) than paper’s 96% accuracy. These differences were attributed to incorrect or missing ages of grandparents (p?<?0.001) and great-aunts/uncles (p?=?0.012) and missing documentation of consanguinity (p?<?0.001). Possible explanations for these differences include greater experience with paper FHH documentation and pre-populated prompts for consanguinity on the paper template used. Proband’s perceived usability increased with use, with individual System Usability Scores increasing between first and last use (p?=?0.033). We conclude that tools for dynamic, provider-driven FHH documentation such as Proband show promise for improving risk assessment accuracy and quality patient care.     

Creativity in Medical Education: The Value of Having Medical Students Make Stuff

What is the value of having medical students engage in creative production as part of their learning? Creating something new requires medical students to take risks and even to fail--something they tend to be neither accustomed to nor comfortable with doing. “Making stuff” can help students prepare for such failures in a controlled environment that doesn’t threaten their professional identities. Furthermore, doing so can facilitate students becoming resilient and creative problem-solvers who strive to find new ways to address vexing questions. Though creating something new can be fun, this is not the main outcome of interest. Rather, the principle reason we recommend devoting precious curricular time to creative endeavors is because it helps medical students become better doctors.     

Parallel Neural Systems for Classical Conditioning: Support From Computational Modeling

Classical conditioning has been explained by two main types of theories that postulate different learning mechanisms. Rescorla and Wagner (1972) put forth a theory in which conditioning is based on the ability of the US to drive learning through error correction. Alternatively, Mackintosh (1973) put forth a theory in which the ability of the CS to be associated with the unconditioned stimulus is modulated. We have proposed a reconciliation of these two mechanisms as working in parallel within different neural systems: a cerebellar system for US modulation and a hippocampal system for CS modulation. We developed a computational model of cerebellar function in eyeblink conditioning based on the error correction mechanism of the Rescorla-Wagner rule in which learning-related activity from the cerebellum inhibits the inferior olive, which is the US input pathway to the cerebellum (Gluck et al., 1994). We developed a computational model of the hippocampal region that forms altered representations of conditioned stimuli based on their behavioral outcomes (Gluck & Myers, 1993; Myers et al., 1995). Overall, computational modeling and empirical findings support the idea that, at least in the case of eyeblink conditioning, there may be two different neural systems: the cerebellum which mediates US-based error correction and hippocampus which alters representations of CSs.     

Attempts to Improve Children's Identifications From Sequential-Presentation Lineups

The effectiveness of practice and stringent lineup instructions in improving children's identifications from sequential-presentation lineups was investigated. Elementary school children ( N = 144) viewed a slide sequence of a crime followed by practice or control procedures. In the practice conditions, children either practiced themselves (self) or watched a videotape of a child practicing (modeled). Practice consisted of 2 target-absent lineups (unmixed) or a target-absent lineup and a target-present lineup (mixed) of female photos unrelated to the crime. The control conditions did not engage in identification practice. All witnesses were given stringent instructions for identifying the criminal from target-present or target-absent sequential-presentation lineups. Multiple responding was dramatically reduced. Practice affected gender differentially. Female children increased in correct identifications, whereas male children increased in false rejections. None of the practice procedures reduced foil identifications from target-absent lineups.     

Aging Well in an Upscale Retirement Community: The Relationships Among Perceived Stress,Mattering, and Wellness

Residents (N = 142) of a southeastern, upscale retirement community completed measures of wellness, perceived stress, and mattering. Participants scored higher than did a group of adults under age 60 on 4 of 5 second‐order wellness factors and Total Wellness, with medium to large effect sizes. Implications for counselors are discussed.     

How Low Will Men with High Self-Esteem Go? Self-Esteem as a Moderator of Gender Differences in Minimum Relationship Standards

Men tend to establish minimum standards that are similar to those of women for high investment relationships (e.g., marriage) but set lower standards for relationships requiring less investment (e.g., a one-night stand). The purpose of the present study was to examine whether self-esteem moderates these gender differences in minimum standards for romantic relationships. This was accomplished by conducting a cross-sectional study with undergraduate participants (57 men and 124 women) from the southern region of the United States. Participants completed a self-esteem measure and reported their minimum standards for partners across various levels of relational involvement. As predicted, high self-esteem was associated with higher standards for low investment relationships among women but lower standards among men.     

Decisions to Seek Healthcare Based on Family Health History Among Urban Appalachian Women

Family health history (FHH) is a valuable health promotion tool that can be used to assess disease risk and make lifestyle and screening recommendations. However, few FHH resources exist for medically underserved populations such as the urban Appalachian community in Cincinnati Ohio. Women of Appalachian heritage with less than a college education who did and did not participate in a prior FHH education session were interviewed by phone in a semi-structured format. Interviewees were asked to discuss their understanding of FHH and the role FHH played in seeking (or not seeking) medical care. Analysis of their discussion identified four overarching themes as well as a model identifying conditions that facilitated or impeded the choice to seek medical care based on FHH. Findings from this study may be used to develop targeted FHH educational interventions in the urban Appalachian and other communities.     

Genetic Counselors’ Religiosity & Spirituality: Are Genetic Counselors Different from the General Population?

Although there is evidence that the religious beliefs of genetic counselors (GCs) can induce internal conflict in at least some genetic counseling scenarios, empirical research on the religiosity of GCs is limited. This study compares genetic counselors to a representative sample of the adult U.S. population on multiple religiosity measures. After controlling for several sociodemographic factors the percentage of GCs who report having a religious affiliation is similar to the general U.S., but GCs are less likely to affiliate with conservative Christian religions and are more likely to be Jewish. GCs are significantly less likely than the general U.S. population to: believe in god, attend religious services, pray, and believe in an afterlife even after controlling for relevant sociodemographic factors. Despite the lower levels of religiosity, a majority of GCs do report themselves to be moderately to highly spiritual. We explore potential reasons for religiosity differences as well as possible implications in the context of the GC scope of practice.     

The cryptomnesic origins of Jung's dream of the multi-storeyed house

Abstract :  Jung first recounted his dream of the multi-storeyed house in the 1925 seminars to illustrate the concept of the collective unconscious and explain the influence of phylogeny on his split with Freud. However, his telling the story of the dream belies a cryptomnesic influence of the early writings of psychoanalysis because Josef Breuer used a similar image to illustrate the structure of the psyche which Édouard Claparède associated with a phylogenetic inheritance. When telling the story of the dream, Jung misrepresented Freud's position, creating the impression of there being a bigger difference between their theories than was actually the case, and giving the dream a fictional significance for the breakdown of their relationship. In fact, Jung followed Freud into the fields of mythology and phylogenetics, and their split was due primarily to their different attitudes towards sexuality rather than phylogeny. The dream image has therefore led to a misunderstanding of Freudian theory when viewed from within a Jungian perspective. Freud believed there was a phylogenetic layer in the psyche, though he held a different view to Jung on its nature and importance.