Genetic Cancer Risk Assessment and Counseling: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of identifying at-risk individuals through cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Cancer Genetic Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Key components include the intake (medical and family histories), psychosocial assessment (assessment of risk perception), cancer risk assessment (determination and communication of risk), molecular testing for hereditary cancer syndromes (regulations, informed consent, and counseling process), and follow-up considerations. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Senior capstone design and ethics: A bridge to the professional world

A senior level capstone design experience has been developed and offered with a particular emphasis on many of the professional issues raised in Accreditation Board for Engineering and Technology (ABET) Engineering Criterion IV. The course has sought to develop student awareness of the ethical foundation of the engineering profession, the global and societal framework within which engineers practice, and the environmental impact on engineering. The capstone design course also focused upon improving the technical communications skills of the graduating senior class with both extensive instruction in writing and multiple workshops dealing with the art of making an effective oral presentation. The effectiveness of the design course was assessed using Kirkpatrick’s model for evaluating training programs. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

A Web-based family problem-solving intervention for families of children with traumatic brain injury

We developed a Web-based intervention for pediatric traumatic brain injury (TBI) and examined its feasibility for participants with limited computer experience. Six families, including parents, siblings, and children with TBI, were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after participants completed on-line interactive experiences on problem solving, communication, and TBI-specific behavior management. Families were assigned to videoconference with NetMeeting (iBOT cameras) or ViaVideo. Participants ranked the Web site and videoconferences as moderately to very easy to use. ViaVideo participants rated videoconferencing significantly more favorably relative to face-to-face meetings than did NetMeeting participants. Both the Web site and videoconferencing were rated as very helpful. All families demonstrated improved outcomes on one or more target behaviors, including increased understanding of the injury and improved parent-child relationships. All parents and siblings and all but 1 child with TBI said they would recommend the program to others. We conclude that a face-to-face intervention can be successfully adapted to the Web for families with varied computer experience.     

Perceptions of Ethical Behaviour among Business Faculty in Canada

Faculty members at Canadian business schools were surveyed regarding their ethical perceptions of behaviours related to undergraduate instruction. Fifty-five behavioural statements were listed and respondents were asked to rate the extent to which they felt each behaviour was ethical or unethical. The only item that respondents endorsed as unequivocally unethical (90% indicated it was definitely unethical) was Becoming sexually involved with an undergraduate in one of your classes. We also compared the results of our sample to those of an American sample. Overall, an interesting pattern of differences emerged between the responses obtained in Canada and the U.S. In general, the direction of the significant differences was such that Canadian professors viewed the behaviours in question as less ethical than did their American counterparts.     

Cerebral blood flow and anxiety in older men: an analysis of resting anterior asymmetry and prefrontal regions

Asymmetric resting blood flow in prefrontal and hemispheric regions, assessed by single photon emission computed tomography (SPECT), was examined as a potential biological marker for enhanced trait and state anxiety in 30 older men (ages 55-81). Average and asymmetric perfusion in dorsolateral, medial, and orbital regions of the prefrontal lobes was also assessed. Results indicated a significant association between lower levels of resting dorsolateral blood flow and greater state anxiety responses to a series of stressful provocations (measured on a separate occasion). A significant curvilinear (U-shaped) relation between asymmetric dorsolateral perfusion and state anxiety was also identified; increased asymmetric blood flow favoring either the right or the left dorsolateral region related to higher levels of state anxiety. However, this association was attenuated by age and systolic blood pressure. Resting perfusion in the dorsolateral region may represent a more reliable biological marker for state anxiety than trait anxiety in older men.     

Impaired processing of prosodic and musical patterns after right hemisphere damage

The distinction between the processing of musical information and segmental speech information (i.e., consonants and vowels) has been much explored. In contrast, the relationship between the processing of music and prosodic speech information (e.g., intonation) has been largely ignored. We report an assessment of prosodic perception for an amateur musician, KB, who became amusic following a right-hemisphere stroke. Relative to matched controls, KB's segmental speech perception was preserved. However, KB was unable to discriminate pitch or rhythm patterns in linguistic or musical stimuli. He was also impaired on prosodic perception tasks (e.g., discriminating statements from questions). Results are discussed in terms of common neural mechanisms that may underlie the processing of some aspects of both music and speech prosody.     

Emotion-induced amnesia in rats: working memory-specific impairment, corticosterone-memory correlation, and fear versus arousal effects on memory

We have shown previously that psychological stress (predator exposure) impairs spatial memory in rats. We have extended that finding here to show that predator stress selectively impaired recently acquired (hippocampal-dependent) spatial working memory without affecting long-term (hippocampal-independent) spatial reference memory. We also investigated why predator exposure impairs memory. Was spatial memory impaired because of the fear-provoking aspects of predator exposure or only because the cat was a novel and arousing stimulus? If the latter possibility was correct, then any novel and arousing stimulus, independent of its emotional valence (i.e., aversive or appetitive), would impair memory. We found that spatial working memory was not impaired when the male rats were exposed to a sexually receptive female rat, a stimulus that was novel and arousing to them, but not aversive. We also found that there was an equivalent increase in serum corticosterone levels in male rats exposed to either a cat or a female rat, but only the cat-exposed rats exhibited a significant correlation between corticosterone levels and impaired memory. Overall, this series of experiments demonstrates that (1). predator stress selectively impaired working (hippocampal-dependent), but not reference (hippocampal-independent), memory; (2). a fear-provoking stimulus, and not merely novelty and increased arousal, impaired spatial memory; and (3). increased corticosterone levels correlated with impaired spatial working memory only under predator exposure, that is, fear-provoking conditions.     

Visual perspective taking for avatars in a Simon task

In modern digital applications, users often interact with virtual representations of themselves or others, called avatars. We examined how these avatars and their perspectives influence stimulus–response compatibility in a Simon task. Participants responded to light/dark blue stimuli with left/right key presses in the presence of a task-irrelevant avatar. Changes in stimulus–response compatibility were used to quantify changes in the mental representation of the task and perspective taking toward this avatar. Experiments 1 and 2 showed that perspective taking for an avatar occurred in orthogonal stimulus–response mappings, causing a compatibility effect from the avatar’s point of view. In the following two experiments we introduced a larger variety of angular disparities between the participant and avatar. In Experiment 3, the Simon effect with lateralized stimulus positions remained largely unaffected by the avatar, pointing toward an absence of perspective taking. In Experiment 4, after avatar hand movements were added in order to strengthen the participants’ sense of agency over the avatar, a spatial compatibility effect from the avatar’s perspective was observed again, and hints of the selective use of perspective taking on a trial-by-trial basis were found. Overall, the results indicate that users can incorporate the perspective of an avatar into their mental representation of a situation, even when this perspective is unnecessary to complete a task, but that certain contextual requirements have to be met.     

Early developments in the ability to understand the relation between stimulus and reward

Delayed nonmatching to sample (DNMS) is used to test the recognition memory function dependent on the medial temporal lobe. Children cannot succeed on this task until about 21 months. Because robust recognition is present well before then, the late emergence of another ability must account for the late success on DNMS. Evidence is presented here that the critical late-maturing competence is the ability to grasp the relation between stimulus and reward--that is, to understand that the stimulus is a symbol or marker for the reward. Infants of 9 and 12 months were tested on 3 conditions of DNMS. A sample object was presented. After a delay, the sample and a novel object appeared; choice of the novel object was rewarded. In the standard task, the reward was in a well beneath the stimulus. In the verbal-reward condition the reward was not a separate object but was praise and applause. In the Velcro condition, the reward, although a separate and separable object, was attached to the base of the stimulus. Most infants at both ages succeeded in the verbal-reward and Velcro conditions but not in the standard condition.