Genetic Evaluation and Counseling of Couples with Recurrent Miscarriage: Recommendations of the National Society of Genetic Counselors

The objective of this document is to provide recommendations for genetic evaluation and counseling of couples with recurrent miscarriage (RM). The recommendations are the opinions of the multidisciplinary Inherited Pregnancy Loss Working Group (IPLWG), with expertise in genetic counseling, medical genetics, maternal fetal medicine, internal medicine, infectious disease, cytogenetics, and coagulation disorders. The IPLWG defines RM as three or more clinically recognized consecutive or non-consecutive pregnancy losses occurring prior to fetal viability (<24 weeks gestation). These recommendations are provided to assist genetic counselors and other health care providers in clinical decision-making, as well as to promote consistency of patient care, guide the allocation of medical resources, and increase awareness of the psychosocial and cultural issues experienced by couples with RM. The IPLWG was convened with support from the March of Dimes Western Washington State Chapter and the University of Washington Division of Medical Genetics. The recommendations are U.S. Preventive Task Force Class III, and are based on clinical experiences, review of pertinent English-language published articles, and reports of expert committees. This document reviews the suspected causes of RM, provides indications for genetic evaluation and testing, addresses psychosocial and cultural considerations, and provides professional and patient resources. These recommendations should not be construed as dictating an exclusive course of medical management, nor does the use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the circumstances of a specific case, should always supersede these recommendations.     

FACILITATING GENERALIZED REQUESTING BEHAVIOR IN BROCA'S APHASIA: AN EXPERIMENTAL ANALYSIS OF A GENERALIZATION TRAINING PROCEDURE

The effects of a generalization training procedure on requesting by 4 subjects with chronic Broca's aphasia were examined using a multiple baseline design across behaviors and subjects. Subjects were trained to request information on three topics sequentially. Generalization across topics and persons was assessed in weekly probe sessions consisting of 5-min conversational interactions with trainers and unfamiliar volunteers in a nontreatment setting. Results revealed generalization effects were greatest when trainers, as opposed to unfamiliar volunteers, served as conversational participants. Nevertheless, subjects' requests increased with all conversational participants to a level comparable to a normal comparison group assessed under conditions identical to the experimental probes. Social validation of treatment effects using a subjective evaluation procedure revealed significant improvement on the parameters of talkativeness, inquisitiveness, and conversational success.     

Further experiments on the perception of growth in three dimensions

Mark and Todd (1983) reported an experiment in which the cardioidal strain transformation was extended to three dimensions and applied to a three-dimensional (3-D) representation of the head of a 15-year-old girl in a direction that made the transformed head appear younger to the vast majority of their subjects. The experiments reported here extend this research in order to examine whether subjects are indeed detecting cardioidal strain in three dimensions, rather than detecting changes in head slant or making 2-D comparisons of the shape of the occluding contour. Three-dimensional surfaces were obtained by measuring a real head manually (Experiment 1) and with a laser scanner (Experiment 2), and transformed to different age levels using the 3-D strain transformation described by Mark and Todd (1983). There were no statistically significant differences in the accuracy with which relative age judgments could be made in response to pairs of profiles, pairs of 3/4 views, or pairs of mixed views (profile plus 3/4 view), suggesting that subjects can indeed extract the cardioidal strain level of the head in three dimensions. However, an additional effect that emerged in these studies was that judgments were crucially affected by the instructions given to subjects, which suggests that factors other than cardioidal strain are important in making judgments about rich data structures.     

Effects of frequency on visual word recognition tasks: where are they?

Compared the effect of frequency on lexical decision time (LDT) with that on reaction time (RT) in four other tasks, for the same words and subjects. Exp. 1 yielded an effect on semantic categorization RT (person vs. thing) similar in size and form to the effect on LDT. Exp. 2 yielded a substantial effect for syntactic categorization (noun vs. adjective), although weaker than the effect on LDT. In Exp. 3, the effect on naming RT for stress-final disyllabic words was identical to that on LDT, whereas the effect for stress-initial words was weaker. Exp. 4 showed no effect of frequency on delayed naming RT. The data undermine recent arguments for a (mainly) postidentification task-specific locus of frequency effects but are compatible with the older assumption (also characteristic of new PDP learning models) that lexical identification is a major locus of frequency effects (perhaps together with retrieval of meaning or phonology). But effects at that locus may be masked or diluted by other processes.     

Improving clinical outcomes in psychiatric care with touch-screen technology

Patient-focused research, which uses clinical characteristics to predict outcomes, is a field in which information technology has been effectively integrated with practice. The present research used touch-screen technology to monitor the daily self-report measures of 1,308 consecutive inpatients and day patients participating in a 2-week cognitive-behavioral therapy group. Providing regular feedback was effective in reducing symptoms for patients at risk of poor outcomes (Newnham, Hooke, & Page, 2010b). The use of touch screens in psychiatric monitoring encourages a collaborative dialogue between patients and therapists and promotes engagement in the process of progress monitoring and treatment evaluation.     

Docosahexaenoic Acid and Visual Functioning in Preterm Infants: A Review

Preterm children are at risk for a number of visual impairments which can be important for a range of other more complex visuocognitive tasks reliant on visual information. Despite the relatively high incidence of visual impairments in this group there are no good predictors that would allow early identification of those at risk for adverse outcomes. Several lines of evidence suggest that docosahexaenoic acid (DHA) supplementation for preterm infants may improve outcomes in this area. For example, diets deficient in the long-chain polyunsaturated fatty acid DHA have been shown to reduce its concentration in the cerebral cortex and retina, which interferes with physiological processes important for cognition and visual functioning. Further, various studies with pregnant and lactating women, as well as formula-fed infants, have demonstrated a general trend that supplementation with dietary DHA is associated with better childhood outcomes on tests of visual and cognitive development over the first year of life. However, research to date has several methodological limitations, including concentrations of DHA supplementation that have been too low to emulate the in utero accretion of DHA, using single measures of visual acuity to make generalised assumptions about the entire visual system, and little attempt to match what we know about inadequate DHA and structural ramifications with how specific functions may be affected. The objective of this review is to consider the role of DHA in the context of visual processing with a specific emphasis on preterm infants and to illustrate how future research may benefit from marrying what we know about structural consequences to inadequate DHA with functional outcomes that likely have far-reaching ramifications. Factors worth considering for clinical neuropsychological evaluation are also discussed.     

The Role of Emotion Dysregulation in the Links Between Sibling Victimization and Internalizing Symptoms in Middle Childhood

Despite sibling victimization being a relatively common occurrence, there is a dearth of research examining the outcomes associated with this interpersonal stressor, including internalizing symptoms. The current study sought to advance the literature by longitudinally examining the links from sibling victimization to depression and anxiety symptoms while also considering peer victimization in a sample of elementary school-age youth (51.8% boys, M age?=?8.72) who were initially in 3rd and 4th grade. Further, emotion dysregulation was examined as a mediator of these associations. Youth provided self-reports at three separate time points approximately 6 months apart. Path analysis models indicated that emotion dysregulation mediated the association between sibling, but not peer, victimization and increased depression symptoms. However, neither sibling nor peer victimization were associated with anxiety symptoms over time. Results suggest the importance of attending to sibling victimization for the prevention of emotion dysregulation difficulties and ultimately early symptoms of depression. Youth assessments need to include questions about both sibling and peer victimization, and sibling victimization needs to be included as a target of prevention and intervention for subsequent internalizing difficulties.

     

A Critique of Information Ethics

Luciano Floridi presents Information Ethics (IE) as an alternative to traditional moral theories. IE consists of two tenets. First, reality can be interpreted at numerous, mutually consistent levels of abstraction, the highest of which is information. This level, unlike the others, applies to all of reality. Second, everything, insofar as it is an information object, has some degree of intrinsic value and hence moral dignity. I criticize IE, arguing that Floridi fails to show that the moral community should be expanded beyond beings capable of suffering or having preferences. Next, I look at Floridi’s extended case against consequentialism generally and utilitarianism in particular. I try to show that his criticisms are flawed. Third, I argue that, for the most part, it is not clear what IE’s practical implications are. I conclude with a critical discussion of the one area of information ethics, traditionally conceived, that Floridi has written about at length, privacy.     

Fear of the drunk driver: Analysis of an emergent social problem

This paper analyzes public perceptions of drunk driving with respect to risk of being victimized, seriousness of the offense, and fear of being victimized. This is based on a state‐wide survey of Louisiana driver's license holders. Compared to other crimes, even murder and rape, it was found that drunk driving ranked highest in its fear invoking quality. An argument is made that this phenomenon should be interpreted from a theoretical standpoint viewing the crimi‐nalization process as a form of collective behavior. Implications for understanding fear of crime as a function of perceived risk and seriousness are discussed, and the implications of the findings for understanding of further legislation and policy action against drunk driving is examined.