Clinical Characterization and Risk Profile of Individuals Seeking Genetic Counseling for Hereditary Breast Cancer in Brazil

Hereditary breast cancer (HBC) accounts for 5–10% of breast cancer cases and it significantly increases the lifetime risk of cancer. Our objective was to evaluate the sociodemographic variables, family history of cancer, breast cancer (BC) screening practices and the risk profile of cancer affected or asymptomatic at-risk women that undergo genetic counseling for hereditary breast cancer in public Brazilian cancer genetics services. Estimated lifetime risk of BC was calculated for asymptomatic women using the Gail and Claus models. The majority of women showed a moderate lifetime risk of developing BC, with an average risk of 19.7% and 19.9% by the Gail and Claus models, respectively. The average prior probability of carrying a BRCA1/2 gene mutation was 16.7% and overall only 32% fulfilled criteria for a hereditary breast cancer syndrome as assessed by family history. We conclude that a significant number of individuals at high-risk for HBC syndromes may not have access to the benefits of cancer genetic counseling in these centers. Contributing factors may include insufficient training of healthcare professionals, disinformation of cancer patients; difficult access to genetic testing and/or resistance in seeking such services. The identification and understanding of these barriers is essential to develop specific strategies to effectively achieve cancer risk reduction in this and other countries were clinical cancer genetics is not yet fully established.     

Health care utilization by low-income clients of a community clinic: an archival study

An archival study was done of 500 medical records from a community clinic serving a low income predominantly Hispanic area of Los Angeles. The data collected included demographic characteristics and presented symptoms or reasons for visit, as well as diagnosis and treatment. The greatest number of patient visits were made for family planning services. A large porportion of the patients who received initial family planning services failed to return to the clinic for follow ups or additional supplies. A total of 208 pregnancy tests were performed in 151 of the 500 cases sampled. Of these, 152 were positive. The most frequently stated reason for requesting pediatric services was for physical exams, accounting for 30% of the visits. It should be noted that the discontinuity of care and insufficient utilization of preventive care seen in these results deserve serious attention by medical clinic administrators. The rate of patients who do not return for family planning after the initial visit is worrisome. A greater effort to attract women to family planning services at the time they request pregnancy verification could reduce the need for abortion of unwanted pregnancy. The data also indicate that changes in the wording of certain questions commonly asked of clients may be needed. This study allowed service providers to obtain important information about their performance, their needs, and the future direction that their services might take. This type of analysis is relatively low in cost and can yield important benefits, espicially if done on a periodical base in a search for policy implications.     

Neuroplastic Changes Following Social Cognition Training in Schizophrenia: A Systematic Review

Social cognitive impairment is a key feature of schizophrenia and social cognition training (SCT) is a promising tool to address these deficits. Neurobiological dysfunction in schizophrenia has been widely researched, but neuronal changes induced by SCT have been scarcely explored. This review aims to assess the neuroplastic effects of SCT in patients with schizophrenia spectrum disorders. PubMed and Web of Science databases were searched for clinical trials testing the effects of SCT in functional and structural brain measurements of adult patients with schizophrenia or schizoaffective disorders. A total of 11 studies were included: five used fMRI, two used EEG and ERP, one used ERP only, two used MEG and one study used MRI. Data extracting and processing regarding sociodemographic and clinical variables, intervention characteristics, neuroimaging procedures, neuroplastic findings, effect sizes and study quality criteria was completed by two raters. Results indicate a wide range of structural and functional changes in numerous regions and circuits of the social brain, including early perceptual areas, the limbic system and prefrontal regions. Despite the small number of trials currently available, evidence suggests that SCT is associated with neuroplastic changes in the social brain and concomitant improvements in social cognitive performance. There is a lack of extensive knowledge about the neural mechanisms that underlie social cognitive enhancement after treatment, but the reported findings may shed light on the neural substrates of social cognitive impairment in schizophrenia and how improved treatment procedures can be developed and applied.     

‘For Fun’: (De) Humanizing Gisberta—The Violence of Binary Gender Social Representation

In 2006, Gisberta Salce Júnior died inside of a pit, in an abandoned building, after being tortured for 3 days by a group of teenagers, in Porto, Portugal. Gisberta was a transgender woman who had moved to Portugal from Brazil in the 1980’s. In this paper, we explore the media coverage of her death as an illustrative case of existing social representations of gender, resulting in two main findings: that even those who are seen as communities of support and recognition perpetuate discourses of gender binary norms, and that the only apparent possibility to humanize and transcend these norms is materialized in artistic performance and production, which allows for a more emotional connection to the ‘subject’ as a human individual rather than a mere transgression. The analysis of articles about Gisberta revealed that there is a very strong social representation of gender as a binary, consisting rigidly of female and male poles. As such, the social representation of those individuals who transgress this binary, embodying alternative performances of gender, as was the case with Gisberta, is reduced to their sexuality, their embodiment of something other than the gender binary. Different perspectives were identified: media, the courtroom, the teenagers, LGTB activists and the arts. Through this analysis and division, it was possible to conclude that these binary norms are embedded to the extent that they permeate even the discourses of those who tend to speak for trans people, in such a way that it seems almost impossible to escape them, with one powerful exception: that of artistic expression, which seems to be the only topos from which true recognition is achieved. This case is an extreme example of the necessity to transcend gender norms and allow for recognition of individuals as such.     

Aggressive Hook Ups: Modeling Aggressive Casual Sex on BDSM for Moral Permissibility

Aggressive techniques within casual sex encounters, such as taking sexual liberties without permission or ignoring rejection, can, perhaps unintentionally, complicate consent. Passive recipients may acquiesce out of fear, which aggressors may not realize. Some philosophers argue that social norms are sufficiently well known to make this misunderstanding unlikely. However, the chance of aggression leading to non-consensual sex, even if not great, is high enough that aggressors should work diligently to avoid this potentially grave result. I consider how this problem plays out in the common mating ritual of hooking up. I argue that aggressive hook ups can only be permissible if they are modeled on BDSM encounters: the participants must obtain prior consent and prepare safe words for voiding that consent during the hook up. While this solution removes the spontaneity of aggressive sex, I argue that spontaneously aggressive hook ups with strangers cannot be permissible.     

A Decision Support System for Prioritizing Investments in an Energy Efficiency Program in Favelas in the City of Rio de Janeiro

This study proposes an integrated qualitative and quantitative assessment of expert opinions aiming at ranking a set of five shantytowns (favelas) located in the city of Rio de Janeiro. These communities are candidates for investments in an energy efficiency program implemented by the local electric utility company. The city, state, and federal governments want to eliminate domination of these areas by organized criminal gangs and present the city as a peaceful metropolis while hosting two big sports events: the soccer World Cup in 2014 and the Olympic Games in 2016. In recent years, some favelas were chosen to be prototypes for an ambitious project to reshape Rio de Janeiro. This involves first sending in special tactics police to drive drug gangs out, then installing the Pacifying Police Unit in the favela. Once security has been established, it is possible to improve general living conditions in these areas, including by providing public services such as health clinics, formal electricity connections and cable television. The core of the energy efficiency program was to convert informal customers to formal ones, because such communities were responsible for approximately 40% of the commercial losses (stolen energy) in the city. The model specification presented in this paper was set up with ten relevant criteria for decision making, identified through an in‐depth interview with the decision maker. The relative importance of the criteria and the performance of each favela regarding each criterion were measured by the Simos method. The preferences resulting from this method were translated into a nine‐point scale. The imprecision of subjective judgment was partially compensated by using a fuzzy analytical hierarchy process. Some criteria were ordinal, such as ‘Fair Relationship with the Community’ and ‘Complexity to Rebuild the Distribution Lines’, whereas other were cardinal, like ‘Percentage of Clients in Default’ and ‘Commercial Loss Due to Energy Theft’. At the end, the model was efficient in ranking the five favelas, therefore contributing to a rational and transparent approach for capital investment in social projects. Copyright © 2014 John Wiley & Sons, Ltd.     

Benchmarking Scientific Image Forgery Detectors

Science and Engineering Ethics - Research integrity climate is an important factor that influences an individual’s behavior. A strong research integrity culture can lead to better research...