Creation and Implementation of an Environmental Scan to Assess Cancer Genetics Services at Three Oncology Care Settings

An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS. The ES used a data collection form and semi-structured interviews to aid in data collection. The ES was completed within 6 months, and sufficient data were captured to identify opportunities and threats to the QI project’s success, as well as potential barriers to, and facilitators of guideline-based cancer genetics services at each OCS. Previously unreported barriers were identified, including inefficient genetic counseling appointment scheduling processes and the inability to track referrals, genetics appointments, and genetic test results within electronic medical record systems. The ES was a valuable process for QI project planning at three OCS and may be used to evaluate genetics services in other settings.     

Affective Expression in Children's Fantasy Play,Primary Process Thinking on the Rorschach,and Divergent Thinking

The relationships among expression of primary process thinking on the Rorschach, affective expression in fantasy play, and divergent thinking were investigated in first and second grade children. Sixty children received the Rorschach (Holt's scoring system), a play task (Affect in Play Scale), and the Alternate Uses Test. Major hypotheses were supported because the amount of primary process thinking on the Rorschach (frequency and percent) was significantly, positively related to amount of affective expression and primary process expression in play. Also, expression of affect in play (frequency, variety, integration, and comfort) was significantly, positively related to divergent thinking, independent of IQ for both boys and girls. On the Rorschach, percent of primary process was significantly related to divergent thinking for boys. The results suggest that the ability to think imaginatively in a free-association style and the ability to have access to affect-laden material are related processes.     

Descriptive and Predictive Analyses of Industrial Buyers' Use of Online Information for Purchasing

The impact of demographic differences between sales reps and their managers is explored using data gathered from 340 manager-rep dyads. Education and gender differences between sales reps and managers, but not age differences, are shown to affect sales reps' role stress, organizational attachment, and perceptions of opportunities for advancement, as well as managers' ratings of the reps' performance. Study results support findings of previous research addressing relational demography and the similarity-attraction paradigm. The chief divergence of this study is that it depicts the role of frequency of contact between sales rep and manager in the link between demographic similarity and several outcome variables.     

Moral Judgement and Moral Motivation

I criticize an important argument of Michael Smith, from his recent book The Moral Problem (Oxford: Blackwell, 1994). Smith's argument, if sound, would undermine one form of moral externalism – that which insists that moral judgements only contingently motivate their authors. Smith claims that externalists must view good agents as always prompted by the motive of duty, and that possession of such a motive impugns the goodness of the agent. I argue (i) that externalists do not (ordinarily) need to assign moral agents such as a motive, and (ii) that possession of this motive, when properly understood, is morally admirable.     

Development and validation of the Affect in Play Scale-brief rating version (APS-BR)

The Affect in Play Scale (APS; Russ, 1987, 2004) is one of few reliable, standardized measures of pretend play, yet the fact that it requires videotaping and extensive training to score compromises its clinical utility. In this study, we developed and validated a brief rating version (APS-BR) that does not require videotaping. Construct validity was established by comparing scores from the original APS and the APS-BR using an existing data set of videotaped play (n = 46). We examined associations between scores on the APS-BR and theoretically relevant measures of divergent thinking and emotional memories. Scores on the APS-BR related strongly to those on the APS, and the pattern of correlations for each scale and relevant criterion measures was similar in strength and direction, supporting the APS-BR as an alternate form of the APS. In addition, we completed a pilot study to examine the efficacy of using the APS-BR in its intended in vivo format (n = 28). Results from both studies suggest that the APS-BR is a promising brief measure of children's pretend play that can be substituted for the APS in clinical and research settings.     

Human coffee drinking: manipulation of concentration and caffeine dose.

In a residential research ward coffee drinking was studied in 9 volunteer human subjects with histories of heavy coffee drinking. A series of five experiments was undertaken to characterize adlibitum coffee consumption and to investigate the effects of manipulating coffee concentration, caffeine dose per cup, and caffeine preloads prior to coffee drinking. Manipulations were double-blind and scheduled in randomized sequences across days. When cups of coffee were freely available, coffee drinking tended to be rather regularly spaced during the day with intercup intervals becoming progressively longer throughout the day; experimental manipulations showed that this lengthening of intercup intervals was not due to accumulating caffeine levels. Number of cups of coffee consumed was an inverted U-shaped function of both coffee concentration and caffeine dose per cup; however, coffee-concentration and dose-per-cup manipulations did not produce similar effects on other measures of coffee drinking (intercup interval, time to drink a cup, within-day distribution of cups). Caffeine preload produced dose-related decreases in number of cups consumed. As a whole, these experiments provide some limited evidence for both the suppressive and the reinforcing effects of caffeine on coffee consumption. Examination of total daily coffee and caffeine intake across experiments, however, provides no evidence for precise regulation (i.e., titration) of coffee or caffeine intake.     

Affective expression in children's fantasy play, primary process thinking on the Rorschach, and divergent thinking

The relationships among expression of primary process thinking on the Rorschach, affective expression in fantasy play, and divergent thinking were investigated in first and second grade children. Sixty children received the rorschach (Holt's scoring system), a play task (Affect in Play Scale), and the Alternate Uses Test. Major hypotheses were supported because the amount of primary process thinking on the Rorschach (frequency and percent) was significantly, positively related to amount of affective expression and primary process expression in play. Also, expression of affect in play (frequency, variety, integration, and comfort) was significantly, positively related to divergent thinking, independent of IQ for both boys and girls. On the Rorschach, percent of primary process was significantly related to divergent thinking for boys. The results suggest that the ability to think imaginatively in a free-association style and the ability to have access to affect-laden material are related processes.