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.     

Effects of prolonged work on data entry speed and accuracy

In 2 experiments, participants used a keyboard to enter 4-digit numbers presented on a computer monitor under conditions promoting fatigue. In Experiment 1, accuracy of data entry declined but response times improved over time, reflecting an increasing speed-accuracy trade-off. In Experiment 2, the (largely cognitive) time to enter the initial digit decreased in the 1st half but increased in the 2nd half of the session. Accuracy and time to enter the remaining digits decreased across though not within session halves. The (largely motoric) time to press a concluding keystroke decreased over the session. Thus, through a combination of facilitation and inhibition, prolonged work affects the component cognitive and motoric processes of data entry differentially and at different points in practice.     

Computational approaches to the development of perceptual expertise

Dog experts, ornithologists, radiologists and other specialists are noted for their remarkable abilities at categorizing, identifying and recognizing objects within their domain of expertise. A complete understanding of the development of perceptual expertise requires a combination of thorough empirical research and carefully articulated computational theories that formalize specific hypotheses about the acquisition of expertise. A comprehensive computational theory of the development of perceptual expertise remains elusive, but we can look to existing computational models from the object-recognition, perceptual-categorization, automaticity and related literatures for possible starting points. Arguably, hypotheses about the development of perceptual expertise should first be explored within the context of existing computational models of visual object understanding before considering the creation of highly modularized adaptations for particular domains of perceptual expertise.     

Temporal kinetics of prefrontal modulation of the extrastriate cortex during visual attention

Single-unit, event-related potential (ERP), and neuroimaging studies have implicated the prefrontal cortex (PFC) in top-down control of attention and working memory. We conducted an experiment in patients with unilateral PFC damage (n=8) to assess the temporal kinetics of PFC-extrastriate interactions during visual attention. Subjects alternated attention between the left and the right hemifields in successive runs while they detected target stimuli embedded in streams of repetitive task-irrelevant stimuli (standards). The design enabled us to examine tonic (spatial selection) and phasic (feature selection) PFC-extrastriate interactions. PFC damage impaired performance in the visual field contralateral to lesions, as manifested by both larger reaction times and error rates. Assessment of the extrastriate P1 ERP revealed that the PFC exerts a tonic (spatial selection) excitatory input to the ipsilateral extrastriate cortex as early as 100 msec post stimulus delivery. The PFC exerts a second phasic (feature selection) excitatory extrastriate modulation from 180 to 300 msec, as evidenced by reductions in selection negativity after damage. Finally, reductions of the N2 ERP to target stimuli supports the notion that the PFC exerts a third phasic (target selection) signal necessary for successful template matching during postselection analysis of target features. The results provide electrophysiological evidence of three distinct tonic and phasic PFC inputs to the extrastriate cortex in the initial few hundred milliseconds of stimulus processing. Damage to this network appears to underlie the pervasive deficits in attention observed in patients with prefrontal lesions.     

Psychopathy is related to negative affectivity but not to anxiety sensitivity

Although the hypothesis that psychopathic individuals are characterized by a reduced capacity for experiencing anxiety is central to many theories of psychopathy, most prior studies have examined anxiety and fear measures generally considered outdated in the literature. Moreover, prior findings are mixed, with several studies reporting no relationships between psychopathy and anxiety, and others suggesting negative relationships for the affective, interpersonal aspects of the disorder and positive relationships for the antisocial behavior dimension. To examine whether psychopathy dimensions are associated with contemporary measures of anxiety, the Anxiety Sensitivity Index and State Trait Anxiety Inventory-Trait scale were administered to 157 male inmates. Participants also completed the MMPI-derived Welsh Anxiety Scale (WAS), commonly used in psychopathy studies. Analyses provide no evidence for a negative relationship between psychopathy's affective, interpersonal factor and anxiety sensitivity after controlling for trait anxiety. Trait anxiety and WAS scores were positively associated with the antisocial behavior dimension of psychopathy. Findings do replicate prior relationships between the WAS and psychopathy, suggesting the WAS may measure aspects of negative affectivity that differ from anxiety.     

Neuropsychological executive functioning in children at elevated risk for alcoholism: findings in early adolescence

One component of individual risk for alcoholism may involve cognitive vulnerabilities prodromal to alcoholism onset. This prospective study of 198 boys followed between 3 and 14 years of age evaluated neurocognitive functioning across three groups who varied in familial risk for future alcoholism. Measures of intelligence, reward-response, and a battery of neuropsychological executive and cognitive inhibitory measures were used. Executive functioning weaknesses were greater in families with alcoholism but no antisocial comorbidity. IQ and reward-response weaknesses were associated with familial antisocial alcoholism. Executive function effects were clearest for response inhibition, response speed, and symbol-digit modalities. Results suggest that executive deficits are not part of the highest risk, antisocial pathway to alcoholism but that some executive function weaknesses may contribute to a secondary risk pathway.     

Predicting abuse in adolescent dating relationships over 1 year: the role of child maltreatment and trauma

Three mediators of the relationship between childhood maltreatment and dating violence perpetration during midadolescence (i.e., trauma-related symptoms, attitudes justifying dating violence, and empathy and self-efficacy in dating relationships) were tested over 1 year with a sample of students from 10 high schools (N = 1,317). Trauma-related symptoms had a significant cross-time effect on predicting incidents of dating violence for both boys and girls. Attitudes and empathy and self-efficacy did not predict dating violence over time, although they were correlated with such behavior at both time points. Child maltreatment is a distal risk factor for adolescent dating violence, and trauma-related symptoms act as a significant mediator of this relationship. The importance of longitudinal methodology that separates correlates from predictors is discussed.     

An outcome management program for extending advances in choice research into choice opportunities for supported workers with severe multiple disabilities

We evaluated an outcome management program for increasing choice opportunities provided by 2 job coaches for 5 supported workers with severe multiple disabilities in a community job. The program involved specifying and monitoring behavioral outcomes among workers and staff, training staff, and supportive and corrective feedback. Increased choice provision occurred for both job coaches across a 1-year period. Results indicate how outcome management can help translate advances in choice research into routine practice.     

Differential memory-preserving effects of reminders at 6 months

Although reactivation and reinstatement reminders differ procedurally, differences in their memory-preserving effects have been described as artifactual. In three experiments, we examined this conclusion. One hundred and twelve 6-month-olds learned an operant task, forgot it, received a reactivation or reinstatement reminder to recover the inactive memory, and were tested after increasing delays until they forgot it again. In Experiments 1a and 1b, a single reactivation reminder extended infants' memory of an operant mobile task for 2 weeks after reminding, but a single reinstatement extended it for 4 weeks, when testing was discontinued. In Experiment 2, a single reinstatement extended 6-month-olds' memory of an operant train task for 19 weeks after reminding, when infants were almost 1 year old. After reactivation, infants remember this task for only 2 weeks. The finding that the memory-preserving effect of reinstatement is greater by an order of magnitude suggests that procedural differences between the two reminders have functional significance.     

How are social identities linked to self-conception and intergroup orientation? The moderating effect of implicit theories

Social identity approaches assume that social identification affects both self-conception and intergroup orientation. The authors contend that such social identification effects are accentuated when people hold a fixed view of human character and attribute immutable dispositions to social groups. To these individuals, social identities are immutable, concrete entities capable of guiding self-conception and intergroup orientation. Social identification effects are attenuated when people hold a malleable view of human character and thus do not view social identities as fixed, concrete entities. The authors tested and found support for this contention in three studies that were conducted in the context of the Hong Kong 1997 political transition, and discussed the findings in terms of their implications for self-conceptions and the meaning of social identification.