Developmental trajectories to heroin dependence: Theoretical and clinical issues

We have built up a great deal of insight into the early developmental trajectories that lead to heroin use. These cluster under five domains: social disadvantage, parental drug use/psychopathology, childhood abuse and neglect, early onset psychopathology and antisocial behaviors, and a developmental sequence of drug onsets. While not all heroin users have these risk factors, the broad clinical picture shows these early correlates to be the predominant presentation. We discuss each of the early psychosocial correlates of heroin dependence, as well as possible early interventions. Given the chronicity of heroin dependence, interventions to prevent heroin use emerging would reduce the considerable burden of disease associated with the disorder.     

Meta‐Analysis of Counseling Outcomes for Youth With Conduct Disorders

Twenty‐one clinical trials were synthesized using a random‐effects model, which substantiated that counseling generally produces a medium effect in treating conduct disorder in youth at termination (d + = 0.30 to 0.57; k = 28). However, the lasting effects at follow‐up were unclear because few follow‐up studies (k = 13) have been conducted (d + = ?0.53 to 0.58), and only 2 randomized controlled follow‐up studies were located. No effects of moderating variables were evident. Implications for counseling practice and outcome research are addressed.     

Between Luxury and Need: The Idea of Distance in Philosophical Anthropology

Abstract

This paper offers a critical analysis of the use of the idea of distance in philosophical anthropology. Distance is generally presented in works of philosophical anthropology as the ideal coping strategy, which rests in turn on the thesis of the instinct deficiency of the human species. Some of the features of species life, such as its sophisticated use of symbolic forms, come to be seen as necessary parts of this general coping strategy, rather than a merely expressive outlet, incidental to the ultimate goal of life preservation. The paper analyses the arguments used in support of the thesis of instinct deficiency in Hans Blumenberg and considers their implications for the status of symbolic expression in species life. It contrasts the approach this thesis involves with one that proceeds by presenting and arguing from biological evolutionary evidence. The contrast is used to examine the questions: in what sense instinct deficiency is specifically anthropological, and in what precise sense philosophical anthropology is ‘philosophical’.     

Genetic Counseling Assistants: an Integral Piece of the Evolving Genetic Counseling Service Delivery Model

This study explores the potential impact of the genetic counseling assistant (GCA) position on the efficiency of the genetic counseling field, evaluates attitudes regarding expansion of the genetic counseling field to include the GCA, and presents data on GCA endeavors and GCA job tasks as reported by GCAs, certified genetic counselors (CGCs), and program directors (PDs). Data on GCA roles and attitudes toward different aspects of the GCA position were collected via surveys of CGCs who have worked with GCAs, PDs who have and have not had experience with GCAs in their programs, and GCAs. We analyzed responses from 63 individuals: 27 PDs, 22 CGCs, and 14 GCAs. GCAs’ impact on efficiency was calculated via internal analysis of genetic patient volume per genetic counselor within the University of Texas Southwestern (UTSW) patient database prior to, and since the addition of, a GCA to the practice. The response rates for PDs, CGCs, and GCAs were 27 %, 79 %, and 61 %, respectively. Every CGC stated the GCA increased their efficiency. CGCs with a GCA reported a 60 % average increase in patient volume. This figure was congruent with internal data from the UTSW cancer genetics program (58.5 % increase). Appropriate responsibilities for GCAs as reported by CGCs and PDs (>90 %) include: data entry, shipping tests, administrative tasks, research, and ordering supplies. Regarding GCAs delivering test results, there was response variation whether this should be a job duty: 42 % of CGCs agreed to GCAs delivering negative results to patients, compared to 22 % of program directors. Twenty-two percent of PDs expressed concern about the job title “Genetic Counseling Assistant.” Ninety percent of CGCs felt that GCA was a career path to becoming a CGC, compared to 42 % of PDs. Eighty-three percent of GCAs who decided to apply to CGC graduate programs were accepted. We conclude the addition of a GCA to a genetic counseling practice contributes to increased efficiency and is one way to expand the reach of the profession.     

Self-Reported Questionnaire Detects Family History of Cancer in a Pancreatic Cancer Screening Program

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer death; approximately 5–10% of PDAC is hereditary. Self-administered health history questionnaires (HHQs) may provide a low-cost method to detail family history (FH) of malignancy. Pancreas Center patients were asked to enroll in a registry; 149 with PDAC completed a HHQ which included FH data. Patients with FH of PDAC, or concern for inherited PDAC syndrome, were separately evaluated in a Prevention Program and additionally met with a genetic counselor (GC) to assess PDAC risk (n?=?61). FH obtained through GC and HHQ were compared using Wilcoxon signed-rank sum and generalized linear mixed models with Poisson distribution. Agreement between GC and HHQ risk-assessment was assessed using kappa (κ) statistic. In the Prevention Program, HHQ was as precise in detecting FH of cancer as the GC (all p?>?0.05). GC and HHQ demonstrated substantial agreement in risk-stratification of the Prevention Program cohort (κ?=?0.73, 95% CI 0.59–0.87.) The sensitivity of the HHQ to detect a patient at elevated risk (i.e., moderate- or high-risk) of PDAC, compared to GC, was 82.9% (95% CI 67.3–92.3%) with a specificity of 95% (95% CI 73.1–99.7%). However, seven patients who were classified as average-risk by the HHQ were found to be at an elevated-risk of PDAC by the GC. In the PDAC cohort, 30/149 (20.1%) reported at least one first-degree relative (FDR) with PDAC. The limited sensitivity of the HHQ to detect patients at elevated risk of PDAC in the Prevention Program cohort suggests that a GC adds value in risk-assessment in this population. The HHQ may offer an opportunity to identify high-risk patients in a PDAC population.     

Characteristics of men who have sex with men on the internet but identify as heterosexual, compared with heterosexually identified men who have sex with women.

We compared men who have sex with other men on the Internet with the remainder of the sample of men who reported only sex with women on the Internet, in a sample of 1,846 Swedish men recruited from a major Swedish portal. We report on the self-identified heterosexual men in the sample who reported engaging in cybersex in the past year, and for whom there was complete data on sexual identity and the gender of cybersexual partners. Of the 244 cases with full data, 76% were heterosexual in both identity and behavior, 16% were gay or bisexual in identity and reported both male and female cybersexual contacts on the Internet, and 8% indicated their sexual preference was heterosexual but also reported at least one male sexual partner on the Internet. Thus, 11% of self-identified heterosexual men had sex with other men online. Comparing the two groups, the men who had sex with men (MSM) who did not identify (MSM-NI) spent significantly more time per week online, although a similar amount of time on sexual pursuits, as the heterosexual men. The MSM-NI were significantly more likely to agree that their online sexuality had affected their sexuality in a positive way, to have bought sex from prostitutes, to agree that they do things online that they would not do offline, have cybersex more often, use a web-camera and microphone more often, flirt and visit contact sites more often, and agree more often that sexual thoughts and behaviors are causing problems, desire to have sex creates problems, and sometimes fail to meet commitments due to their sexual behavior. These data taken together suggest that MSM-NI online are not uncommon and are characterized by the extent of their cybersexual involvement that sometimes extends to other men. Such men may rationalize this cybersex with other men as not, or minimally, sexual in much the same way as Humphreys characterized MSMs in public restrooms.     

A NOTE ON KRIPKE's FOOTNOTE 56 ARGUMENT FOR THE ESSENTIALITY OF ORIGIN

In footnote 56 of his Naming and Necessity, Kripke offers a ‘proof’ of the essentiality of origin. On its most literal reading the argument is clearly flawed, as was made clear by Nathan Salmon. Salmon attempts to save the literal reading of the argument, but I argue that the new argument is flawed as well, and that it can’t be what Kripke intended. I offer an alternative reconstruction of Kripke's argument, but I show that this suffers from a more subtle fault.     

The Effect of Instructor Gender and Race/Ethnicity on Gaining Compliance in the Classroom1

How instructors' gender and race impacts their ability to gain compliance in the classroom when utilizing various bases of social power was investigated using a 2 × 2 × 3 between‐subjects design. Male and female participants (n = 297) completed the Interpersonal Power Inventory while viewing a photo depicting an instructor. The instructors depicted were male or female of varying ethnicities (Caucasian, African American, and Latino). Results indicated that instructor gender and race influenced student compliance rates when soft (subtle and noncoercive) bases of power were utilized. With regard to individual power bases, student gender, instructor gender, instructor race, and the Instructor Gender × Instructor Race interaction were found to impact compliance rates. Implications for classroom instructors, as well as other powerholders, are discussed.     

Identity bifurcation in response to stereotype threat: Women and mathematics

Three studies explored women’s bifurcation of feminine identity as a response to threatening stereotypes in the domain of mathematics. Study 1 demonstrated that women in a math class who previously had completed a large number of math courses disavowed “feminine characteristics” strongly associated with stereotypes about women’s potential for math success (e.g., flirtatiousness, planning to have children) but not characteristics perceived to be weakly associated with these stereotypes (e.g., empathy, nurturance), more than women who had completed fewer math courses. Studies 2 and 3 directly manipulated stereotype threat by presenting a scientific article reporting stereotype-consistent sex differences in math aptitude. As predicted, women strongly identified with mathematics responded to this threatening article by disavowing feminine characteristics strongly associated, but not those weakly associated, with the relevant negative stereotypes, while women not strongly identified with mathematics showed no such differentiation in response. Theoretical and practical implications of these results are discussed.