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.     

A Cross-Lagged Panel Approach to Understanding Social Support and Chronic Posttraumatic Stress Disorder Symptoms in Veterans: Assessment Modality Matters

Although there is a strong and consistent association between social support and posttraumatic stress disorder (PTSD), the directionality of this association has been debated, with some research indicating that social support protects against PTSD symptoms, whereas other research suggests that PTSD symptoms erode social support. The majority of studies in the literature have been cross-sectional, rendering directionality impossible to determine. Cross-lagged panel models overcome many previous limitations; however, findings from the few studies employing these designs have been mixed, possibly due to methodological differences including self-report versus clinician-administered assessment. The current study used a cross-lagged panel structural equation model to explore the relationship between social support and chronic PTSD symptoms over a 1-year period in a sample of 264 Iraq and Afghanistan veterans assessed several years after trauma exposure. Approximately a third of the sample met criteria for PTSD at the baseline assessment, with veterans’ trauma occurring an average of 6 years prior to baseline. Two separate models were run, with one using PTSD symptoms assessed via self-report and the other using clinician-assessed PTSD symptoms. Excellent model fit was found for both models. Results indicated that the relationship between social support and PTSD symptoms was affected by assessment modality. Whereas the self-report model indicated a bidirectional relationship between social support and PTSD symptoms over time, the clinician-assessed model indicated only that baseline PTSD symptoms predicted social support 1 year later. Results highlight that assessment modality is one factor that likely impacts disparate findings across previous studies. Theoretical and clinical implications of these findings are discussed, with suggestions for the growing body of literature utilizing these designs to dismantle this complex association.     

Does Traumatic Brain Injury Attenuate the Exposure Therapy Process?

Research indicates that exposure therapy is efficacious for combat-related posttraumatic stress disorder (PTSD) comorbid with traumatic brain injury (TBI) as is shown by reduced PTSD treatment outcome scores. What is unknown, however, is whether the process of fear extinction is attenuated in veterans with TBI history. Increased PTSD symptomatology and possible cognitive deficits associated with TBI sequelae may indicate additional or longer exposure sessions to achieve habituation and extinction comparable to individuals without TBI history. As such, a more extensive course of treatment may be necessary to achieve comparable PTSD treatment outcome scores for individuals with TBI history. Using a sample of veterans with combat-related PTSD, some of whom were comorbid for TBI, this study compared process variables considered relevant to successful treatment outcome in exposure therapy. Individuals with and without TBI demonstrated similar rates of fear activation, length and number of exposure sessions, within-session habituation, between-session habituation, and extinction rate; results remained consistent when controlling for differential PTSD symptomatology. Furthermore, results indicated that self-perception of executive dysfunction did not impact the exposure process. Results suggest that individuals with PTSD and TBI history engage successfully and no differently in the exposure therapy process as compared to individuals with PTSD alone. Findings further support exposure therapy as a first-line treatment for combat-related PTSD regardless of TBI history.     

Perception of Candomble Practitioners About Herbal Medicine and Health Promotion in Ceará, Brazil

Candomble, a Brazilian religion of African origin that worships Orishas, promotes “healing” assistance during its worship rituals using therapy with plants and beliefs. From its ancestry tradition, the respect and beware with nature are expressed. Therefore, the aim of this study is to investigate the perception of ethnoecology and health promotion among Candomble practitioners from a Candomble temple in the state of Ceará, Brazil. The ethnography was designed to allow greater immersion into the current mystique. This immersion results in the breaking of existing prejudices and admiration for their worldview. Thus, it can be observed that people seek Candomble to get rid of “bad” health difficulties, such as insomnia, depression, eyesight problems among others, which are commonly treated with herbal preparations, baths, and teas, using plants native to the region; however, their indications are not always in accordance with scientific evidence. In parallel with biomedicine, their hospitable and healthcare practices are considered by most as the equivalent to traditional healthcare actions, but greater recognition of biomedicine is necessary. Based on this perspective, the use of native plants in Candomble is examples of memory, hospitality, and humanization for the community wellness.     

Discrimination and Reversal Learning by Toddlers Aged 15-23 Months

Few studies have investigated simple discrimination and discrimination reversal learning by children younger than 2 years. Extant research has shown that teaching discrimination reversals may be challenging with this population. We used social reinforcement and correction procedures to teach simple simultaneous discrimination and discrimination reversal tasks involving three pairs of animal pictures displayed in a paper notebook. Participants were eight typically developing toddlers aged 15-23 months. All learned at least one simple discrimination/discrimination reversal problem. Four children learned all problems and showed evidence of learning set formation. Perhaps surprisingly, discrimination reversals were sometimes learned more rapidly than original discriminations. The procedures suggest a potentially efficient methodology for investigating more complex aspects of relational learning in toddlers.

     

In the grip of fear: Dissociations in attentional processing of animal fearful individuals

Using a modified attention paradigm we investigated specific attentional mechanisms in processing animal feared stimuli. In this paradigm arrays of four pictures were displayed and after its disappearance from view a probe (a letter, X or P) then followed unpredictably in the location of one of the four pictures. The results showed that discriminations of probes tended to be impeded by spider stimuli, compared to snake stimuli. This effect was potentiated by high anxiety but only for those individuals fearful of spiders, since no such effect was observed for snake fearful individuals. Moreover, the discrimination of the probes was not facilitated when presented after the feared stimuli. The implications of these findings are discussed as a function of the cognitive bias involved in specific fear.     

“Reading” Paintings: Evidence for Trans-Symbolic and Symbol-Specific Comprehension Processes

Art-based reading instruction and interventions for elementary and middle school students are growing in popularity despite scant theoretical rationale and empirical research support. This study explored the degree to which painting comprehension processes map onto text comprehension processes in this population. In particular, we used think aloud protocols to examine the painting comprehension processes used by 35 fourth-grade and 34 eighth-grade students and compared the manifest processes to the literature on text comprehension. Protocol analysis revealed six painting comprehension processes—observing, activating prior knowledge, inferring and interpreting, elaborating, evaluating and responding, and monitoring—comprising 23 subprocesses. Of the identified painting comprehension subprocesses, 17 are commonly associated with text comprehension. These findings suggest that compositions—be they encoded visually, linguistically, or in another symbol system—may entail comprehension processes that transcend symbol systems, as well as processes that are particular to a given symbol system.     

Gender Differences in Experiences with Couples Treatment for IPV

Evidence suggests that conjoint treatment can be effective for certain violent couples in certain situations (Finkel in Rev Gen Psychol 11:193–207, 2007; LaTaillade et al. in J Cogn Psychother 20:393–410, 2006; Fals-Stewart et al. in J Consult Clin Psych 73:239–248, 2005; Stith et al. in J Marital Fam Ther 29(3):407–426, 2003). However, not as much is known about which aspects of conjoint treatment make a difference, nor if male and female participants experience these elements of treatment differently. Knowing which components of couples’ treatment clients perceive as helpful—and whether their perceptions differ by gender—will allow us to redefine models with an eye toward making them more effective. In this study we used qualitative methods to examine the aspects of a particular couples’ treatment program (Stith and McCollum in Aggress Violent Beh 16(4):312–318, 2011) that clients found useful while also considering the differences between men’s and women’s responses. Fourteen couples, in which the male had been identified as the primary aggressor, were interviewed multiple times to gain their perspectives about components of the program they found helpful and their suggestions for program improvement. Themes are analyzed by gender. Implications for treatment and future research are provided.