NIPT in a Clinical Setting: An analysis of Uptake in the First Months of Clinical Availability

The objective of our study was to describe the clinical experience in offering noninvasive prenatal testing (NIPT) for aneuploidy to pregnant patients, highlighting the clinical utility, barriers to acceptance and limitations of this novel test. Data were collected from 961 patients offered NIPT from 3/1/12 to 9/30/12. Univariate and multivariate logistic regression analysis was performed. Twenty-eight percent of patients elected NIPT and 72 % declined. Women continue to elect less sensitive and less specific screening through biochemical markers and nuchal translucency. Women considering all options at average risk for aneuploidy were less likely to accept NIPT testing than women who had a risk adjustment from an ultrasound marker or routine screening test. In our multi-ethnic population, Filipina women were significantly less likely to elect NIPT compared to other ethnicities. Five percent of NIPT ordered failed analysis. Several chromosome abnormalities were detected through CVS or amniocentesis that would not have been detected by NIPT. Even though NIPT offers a non-invasive, highly sensitive and specific analysis for aneuploidy, the majority of women in our study declined this option. NIPT should be offered in the context of genetic counseling so that women understand the limitations of the testing and make an educated decision about the testing option best suited to their situation.     

The spiritual benefits of travel for senior tourists

This research explores the spiritual benefits of travel for older adults and illustrates how travel meets seniors' self‐actualization and spiritual growth needs. The theoretical point of departure for this research is seniors' quest for meaning and self‐actualization, which act as push factors inducing older adults to travel. Semistructured depth interviews were conducted with 16 retired senior informants who had extensive travel experience. Using an interpretive method, this research reveals four key themes that illustrate the spiritual benefits of travel, thereby extending the growing literature on the motivations of senior travelers. These themes are described as “traveling generates meaning for older adults,” “traveling reveals the self to older adults,” “traveling encourages older adults to better understand others,” and “traveling enables older adults to better understand their relationship to nature”. In sum, the themes describe how older adults may meet their unique spiritual needs through travel and thereby enhance their spiritual development. This research represents one of a few studies examining senior tourism to employ an interpretive method and provides rich insights as a result. This research also extends the emerging research on spirituality in marketing by illustrating how the tourism industry may benefit from a perspective that considers the spiritual benefits of consumption. The research findings suggest that the intangible spiritual benefits of travel, in addition to the tangible benefits, should be highlighted in travel offers and tourism communications targeted to older adults. Copyright © 2014 John Wiley & Sons, Ltd.     

Religiosity and Exposure to Users in Explaining Illicit Drug Use among Emerging Adults

Religiosity is a protective factor against illicit drug use, but further investigation is needed to delineate which components of religiosity are protective against use. A racially diverse sample (N = 962) was surveyed about religiosity, exposure to users, and recent use of marijuana, powder cocaine, ecstasy, and nonmedical use of opioids and amphetamine. Results suggest that identifying as Agnostic increased odds of use for each of the five drugs; however, this effect disappeared when controlling for religious importance and attendance. High levels of religious attendance were protective against recent use of marijuana and cocaine, but protective effects diminished when controlling for exposure to users, which was a robust predictor of use of every drug. Religion is a protective mechanism against drug use, but this effect may diminish in light of exposure to users. Alternative preventative methods need to be directed toward individuals who are not religious or are highly exposed to users.     

Emotional and Behavioral Problems Among Impoverished Kenyan Youth: Factor Structure and Sex-Differences

Data on youth emotional and behavioral problems from societies in Sub-Saharan Africa are lacking. This may be due to the fact that few youth mental health assessments have been tested for construct validity of syndrome structure across multicultural societies that include developing countries, and almost none have been tested in Sub-Saharan Africa. The Youth Self-Report (YSR), for example, has shown great consistency of its syndrome structure across many cultures, yet data from only one developing country in Sub-Saharan Africa have been included. In this study, we test the factor structure of YSR syndromes among Kenyan youth ages 11–18 years from an informal settlement in Nairobi, Kenya and examine sex-differences in levels of emotional and behavioral problems. We find the eight syndrome structure of the YSR to fit these data well (Root Mean Square Error of Approximation = 0.049). While Kenyan girls have significantly higher internalizing (Anxious/Depressed, Withdrawn/Depressed, Somatic) problem scores than boys, these differences are of similar magnitude to published multicultural findings. The results support the generalizability of the YSR syndrome structure to Kenyan youth and are in line with multicultural findings supporting the YSR as an assessment of emotional and behavioral problems in diverse societies.     

Assessing Fear of Storms and Severe Weather: Validation of the Storm Fear Questionnaire (SFQ)

To date, research on storm phobia has been limited by a lack of validated self-report measures for evaluating the severity of anxiety, phobic avoidance, and distress associated with storms and severe weather. The current research presents the development and validation of the Storm Fear Questionnaire (SFQ), a 15-item self-report questionnaire that assesses the cognitive, affective, and behavioral aspects thought to be associated with Storm Phobia in adults. Three studies were conducted to assess 1) the factor structure, internal consistency, and convergent and discriminant validity of the SFQ, 2) the test-retest reliability of the SFQ, 3) the extent that scores on the SFQ were associated with subjective anxiety ratings during a Behavioral Approach Test (BAT) involving exposure to a virtual thunderstorm, and the extent to which SFQ scores distinguished community participants with versus without a fear of storms. Exploratory factor analyses supported a one-factor model with good internal consistency (Cronbach’s α?=?.95), good convergent and discriminant validity with self-report measures of anxiety, worry, depression, and other specific phobias, and acceptable test-retest reliability. Moreover, there was a significant positive association between SFQ scores and anxiety ratings following the BAT involving exposure to a virtual thunderstorm and participants with a high fear of storms reported significantly higher SFQ scores than those with a low fear of storms. In sum, the SFQ has good psychometric properties and appears to be a valuable tool for assessing the severity of fear associated with storms and severe weather. Research evaluating the diagnostic and clinical utility of the SFQ is still needed.     

Surviving a Lawsuit Against a Counseling Program: Lessons Learned From Ward v. Wilbanks

This article features information about a lawsuit brought by a former student against Eastern Michigan University and its counseling program. In addition to describing the major elements of the lawsuit, the authors reflect on lessons learned and offer recommendations for other counseling programs.     

判断与决策研究纵观:基于模糊痕迹理论的视角(英文)

模糊痕迹理论是用于解释记忆、判断与决策的综合性理论,该理论的提出和发展主要基于对信息存储、表征、提取和加工过程的研究。本文首先介绍了模糊痕迹理论的基本原则,在此基础上重点讨论了其要义(gist)如何发挥核心作用,使得模糊痕迹理论有别于其他传统的决策模型。该理论将高级直觉与原始冲动性进行了区分,并且预测决策误差来源于判断与决策的各种不同成分,如背景知识、信息表征、提取和加工过程等。模糊痕迹理论不仅可以解释诸如框架效应、合取谬误等传统决策与判断文献中常讨论的误差现象,同时基于该理论的研究还得到了一些与传统决策理论相悖的新发现。此外,对脑与行为如何发育性变化的研究为我们了解成人的认知过程提供了至关重要的新视角,这些对脑与行为的发育性研究和对特殊人群的研究结果也都支持了模糊痕迹理论对要义加工依赖的预测。     

Intersectional experiences of discrimination in a low‐resource urban community: An exploratory latent class analysis

There have been increasing calls for the application of an intersectionality framework to understand and address discrimination and health inequities among diverse communities. Yet there have been theoretical debates regarding to whom intersectionality applies and how intersectional experiences of discrimination are associated with health outcomes. The current study aimed to contribute to these theoretical debates and inform practical applications to reduce health inequities. Data were drawn from a community health survey in New Haven, CT (N = 1,293 adults) and analysed using latent class analysis. Results yielded 4 classes. Members of the 4 classes were similar sociodemographically. Three classes of participants reported experiencing discrimination, and members of these classes had greater stress, higher rates of smoking and sleep disruption, and worse overall health than members of the class reporting no discrimination. Members of 2 classes made multiple, or intersectional, attributions for discrimination, and members of these classes reported the most frequent discrimination. Findings suggest that community members who are sociodemographically similar may have diverse discrimination experiences. Multilevel interventions that address multiple forms of discrimination (e.g., racism and sexism) may hold promise for reducing discrimination and, ultimately, health inequities within low‐resource urban community settings.