If We Build It … Will They Come? – Establishing a Cancer Genetics Services Clinic for an Underserved Predominantly Latina Cohort

Background: Cancer genetic counseling and testing is a standard of care option for appropriate families and can identify individuals at increased risk prior to diagnosis, when prevention or detection strategies are most effective. Despite documented efficacy of cancer risk reduction in high-risk individuals, underserved and minority individuals have a disproportionate cancer burden and limited access to genetic counseling. Methods: A needs assessment survey documented gaps in knowledge and interest in prevention. Satellite clinics were established at two indigent healthcare systems. Cancer genetics CME lectures were conducted and referral guidelines disseminated to clinicians who referred patients for counseling. Results: An increase in clinician knowledge was demonstrated post-CME and reflected by quality referrals. Eighty-eight percent of patients kept their appointments. In the predominantly Latina⁶ (n=77) clinic population, 71.4% were affected with cancer, and 17 mutation positive families were identified. Preliminary data shows a positive impact on patients' motivation and behavior. The majority has expressed satisfaction and reduction in anxiety. Conclusions: This study demonstrates feasibility and acceptability of cancer genetics services in this population, suggesting the potential to reduce cancer morbidity in underserved, high-risk families.“Latino” is the most common census term for individuals of Spanish, Mexican, Central and South American, Cuban, or Puerto Rican descent, referring to ethnicity, and is generally considered a more ethnically/culturally based term for individuals of the aforementioned groups. As this cohort is female the feminine noun “Latina” is used     

Stimulus and response chunking in the Hebb Digits task

Using the Hebb Digits task, an incidental sequential learning paradigm, the effects of chunking of both the presentation and response phases of performance were examined. In the first experiment, consistent stimulus chunking increased learning, and performance was at an equivalent level to this when consistent chunking of both stimuli and responses was present. Consistent chunking of the responses alone did not significantly improve learning over a baseline condition where neither stimuli nor responses were chunked. The disruption of response organization in a second experiment, through a random response condition, failed to impact learning in non-chunked and stimulus chunked conditions. A third experiment found that response chunking did benefit learning in a condition where stimuli were presented in random chunks. A final experiment suggested extended processing of the digits could not account for performance gains in the stimulus chunking condition. Overall, the results suggest that the enhanced effects of chunking on learning were stimulus-driven rather than response-driven, except under conditions that constrained a consistent pattern of stimulus organization.     

Are True Scores and Construct Scores the Same? A critical examination of their substitutability and the implications for research results

Relations between constructs are estimated based on correlations between measures of constructs corrected for measurement error. This process assumes that the true scores on the measure are linearly related to construct scores, an assumption that may not hold. We examined the extent to which differences in distribution shape reduce the correlation between true scores on a measure and scores on the underlying construct they are intended to measure. We found, via a series of Monte Carlo simulations, that when the actual construct distribution is normal, nonnormal distributions of true scores caused this correlation to drop by an average of only .02 across 15 conditions. When both construct and true score distributions assumed different combinations of nonnormal distributions, the average correlation was reduced by .05 across 375 conditions. We conclude that theory‐based scales intended to measure constructs usually correlate highly with the constructs they are constructed to measure. We show that, as a result, in most cases true score correlations only modestly underestimate correlations between different constructs. However, in cases in which the two constructs are redundant, this underestimation can lead to the false conclusion that the constructs are ‘correlated but distinct constructs,’ resulting in construct proliferation.     

Selective preservation of place names in an aphasic patient: A short report

Abstract

This report describes the case of a severely aphasic patient who shows selective preservation for the names of countries.     

An Ecological Approach to Reducing the Social Isolation of People With an Intellectual Disability

An ecological approach to understanding insecure attachments and social isolation among people with an intellectual disability is constructed using Gibson's (1979/1986) affordance-based theory. Although environmental affordances and individual limitations interact to limit the development of social competence, we believe that by focusing on the immediate environment, community-based approaches to helping people with an intellectual disability are often ignored, which increases the burden on individual caregivers. A more comprehensive strategy, which extends Gibson's theory of affordances, allows us to consider how higher level social systems influence the immediate environment and provides the context for understanding why successful change occurs when a multifaceted, holistic approach that works on several levels is adopted. Examining these systems within an ecological framework fundamentally redefines our thinking by shifting the focus from a person's disability to a more nuanced understanding of a person's abilities within the context of appropriate environmental supports in which the person's disability becomes less salient.     

Lies and Body Cruelties in the Analytic Hour

Discussing an intensive case study of female sexual dysfunction, this paper studies mutual deregulation and disintegration as it unfolds in the transference–countertransference dyad. I propose that ethical transgressions are potentiated in analytic dyads in which the analyst's hope for either solitude or mutuality is foreclosed. This hope can be foreclosed by the particulars of the therapeutic interaction as well as by the theoretical and clinical aspects of analytic training. The deregulation that both precipitates and follows such transgression can be healed (in the analyst, in the analysis) only by the restitution of the therapist's agency, the reduction of paranoid-schizoid guilt and shame, and the location (in the analyst) of depressive, “I-Thou” remorse.     

Bill Clinton and John E Kennedy: The Dark Side of Charisma

In this review essay, I provide a summary of the basic tenets of Stuart A. Pizer's book, Building Bridges: The Negotiation of Paradox in Psychoanalysis. Focusing on the concepts of negotiation, paradox, and potential space, he privileges them as constituting the basic structure and process of the analytic relationship. Therapeutic action resides specifically in the analyst's optimizing of the potential space within which intrapsychic and interpersonal negotiation can occur. Negotiating paradox is a uniquely human capacity, difficult to sustain, but essential for a “distributed” self, one that is decentered and dynamic rather than disassociated. Pizer extends the reach of these concepts by developing them in relation to gender, evolution, species, and mediation. He also considers that which is nonnegotiable, a relational property between analyst and patient, at the brink of which deep analysis occurs. The book, with its elegant theoretical model and clinically useful tool, provides a rich potential space within which I was able to engage fruitfully.     

Effect of Age and Gender in the Control of Elbow Flexion Movements

In previous studies of rapid elbow movements in young healthy men, characteristic task-dependent changes in the patterns of muscle activation when movement speed or distance was varied have been reported. In the present study, the authors investigated whether age or gender is associated with changes in the patterns of muscle activity previously reported in young men. Arm movements of 10 healthy older and 10 healthy younger participants (5 men and 5 women in each group) were studied. Surface electromyograms (EMGs) from agonist (biceps) and antagonist (triceps) muscles, kinematic and kinetic parameters, as well as anthropometric and strength measures were recorded. All 4 groups of participants showed similar task- (distance or speed) dependent changes in biphasic EMG activity. Similar modulation of the initial rate of rise of the EMG, integrated agonist and antagonist EMG activity, as well as their relative timing were observed in all 4 groups. Those results suggest that older individuals of both genders retain the control strategies for elbow movements used by young individuals. Despite the qualitative similarities in the patterns of muscle activation, the men moved more quickly than the women, and younger participants moved more quickly than older participants. Those performance differences could not be explained in terms of differences in body size and strength alone.     

Cohort Differences in Hand Test Performance: A Time Lagged Analysis

In order to examine the impact of cultural differences (cohort and/or time of measurement) on the intrapsychic processes of older adults, two samples (1976, n = 102; 1986, n = 88) of older persons were compared with regard to their Hand Test (HT; Bricklin, Piotrowski, & Wagner, 1962; Wagner, 1983) performance. Relative to those studies investigating cultural effects in personality at the socioadaptational level (Neugarten, 1977), no research to date has examined this issue utilizing projective methods of assessment. Time-lagged analyses of HT scores of these two samples of elderly adults suggested that there appear to be clear age-related variance in HT performance for both content and derived HT variables. Age-related within-sample variability for most HT scores supported this interpretation. These findings are in contrast to those utilizing more standardized, nomothetic measures of personality functioning that suggest stability of personality in adulthood.