Whose Gene Is It? A Case Discussion About Familial Conflict over Genetic Testing for Breast Cancer

A multidisciplinary group of genetic and other professionals discuss a complex case of familial conflict over access to genetic information. One twin wishes to know the results of her deceased mother's tests for BRCA1 mutations; a second twin objects to researchers making this information available. As the case discussion unfolds, the apparent facts of this case are called into question and the lines of ethical certainty become less clear.     

Knowledge of Breast Cancer Genetics Among Breast Cancer Patients and First-Degree Relatives of Affected Individuals

The cloning of BRCA1, a susceptibility gene for inherited breast cancer, has made genetic screening possible for individuals and families whose medical histories are suggestive of an inherited predisposition to breast cancer. To date, few systematic attempts have been made to determine the level of knowledge about breast cancer genetics among women who are likely to seek BRCA1 screening when it becomes widely available. The present study attempted to assess the general knowledge about BRCA1 mutations in two groups: (1) first-degree relatives (FDRs) of breast cancer patients; and (2) women with a previous diagnosis of breast cancer. A self-administered, thirty-item questionnaire was developed through a pilot study. Ten of the items were objective, factual questions about breast cancer genetics. Responses to these questions were used to generate an overall knowledge score for each respondent. The study population was moderately knowledgeable about breast cancer genetics, with an average score of 5.35 out of 10. Counselors should not underestimate the importance of evaluating each counselee's existing knowledge about breast cancer, which can affect the provision and reception of genetic information. In particular, specific areas of knowledge that may be confusing or misunderstood were identified and these topics are discussed in detail.     

人性观对心理学理论与研究的影响

心理学的基本理论,尤其是人格理论,通常都蕴含着对人性的假设。人性观的差异常常导致其理论建构的差异。而且人性观影响心理学研究的方式、方法,影响对心理成因的认识、对心理疾病的理解、及对异常矫正策略的选择。     

Resistance and adherence to the norms of genetic counseling

Genetic counseling for women of advanced maternal age who are considering prenatal testing continues to be based on a principle of nondirectiveness. We interviewed 11 genetic counseling students and four counselors about how they experience and manage, in practice, the tensions between the ideology of nondirectiveness and the acknowledged reality that one can never be truly nondirective. We found that our respondents creatively resolve this tension—simultaneously resisting and adhering to the values of nondirectiveness and information-giving—in individual and situation-specific ways. This resolution is facilitated by the extent to which information given to counselees is fluid, mobile and context-dependent, but these very features of information also have critical implications for both the norms and the practice of genetic counseling.     

A compensatory approach to optimal selection with mastery scores

A Bayesian approach for simultaneous optimization of test-based decisions is presented using the example of a selection decision for a treatment followed by a mastery decision. A distinction is made between weak and strong rules where, as opposed to strong rules, weak rules use prior test scores as collateral data. Conditions for monotonicity of optimal weak and strong rules are presented. It is shown that under mild conditions on the test score distributions and utility functions, weak rules are always compensatory by nature. The authors are indebted to Wilbert Kallenberg for his valuable comments and to Jan Gulmans for providing the data for the empirical example. The names of the authors are alphabetical; they are equally responsible for the contents of this paper.     

A note on analyzing ordered alternatives

A general method of devising stepwise multiple testing procedures with fixed experimentwise error is applied to the problem of non-parametric randomized block design with ordered alternatives. In addition, the method is applied to other models with ordered alternatives.The author wishes to thank the referees for helpful suggestions.     

Reliability of multiple classifications

Cohen's kappa index is reformulated for multiple classifications based on exchangeable random variables. It is found that kappa is between 0 and 1 inclusive. Two characterizations for kappa are stated in terms of the relationship between such random variables. Within the normal test score model, kappa increases with test reliability and test length. Furthermore, when based on binary classifications, kappa is an inverse U-shaped function of the cutoff score. These trends also hold for the beta-binomial test score model.Paper read at the Spring meeting of the Psychometric Society, Bell Laboratories (Murray Hill, New Jersey), March 1976.The editorial assistance and helpful comments of Leonard S. Feldt, Sarah P. Seaman-Huynh, and the three referees are gratefully acknowledged.     

Two simple classes of mastery scores based on the beta-binomial model

Two simple classes of mastery scores which are suitable for hand calculations are presented for beta-binomial test score distributions combined with linear and cubic referral success. The models provide a simple way to explore the consequences of selecting an arbitrary mastery score. Such assessment would be useful whenever the test user is not willing to posta priori a loss ratio, but wishes to look at the various consequences before aiming at a particular score.     

The effects of primary reward on the I.Q. performance of grade-school children as a function of initial I.Q. level

The effect of candy reward on I.Q. scores was investigated in 72 first- and second-grade children. All subjects were administered Form A of the Peabody Picture Vocabulary Test and, based upon these scores, were divided into three blocks: low, middle, and high. From each block, subjects were randomly assigned to one of three conditions (contingent reward, noncontingent reward, or no reward) that were in effect during administration of Form B. Results showed that candy given contingent upon each correct response increased I.Q. scores for the initially low scoring subjects, but had no influence on the scores of middle and high scoring subjects.     

Stopping rules for multi-category computerized classification testing

Computerized classification testing (CCT) aims to classify persons into one of two or more possible categories to make decisions such as mastery/non-mastery or meet most/meet all/exceed. A defining feature of CCT is its stopping criterion: the test terminates when there is enough confidence to make a decision. There is abundant research on CCT with a single cut-off, and two common stopping criteria are the sequential probability ratio test (SPRT) statistic and the generalized likelihood ratio statistic (GLR). However, there is a relative scarcity of research extending the SPRT to the multi-hypothesis case for when there is more than one cut-off. In this paper, we propose a new multi-category GLR (mGLR) statistic as well as a stochastically curtailed version of the CCT with three or more categories. A simulation study was conducted to show that the mGLR statistic outperformed the existing stopping rules by generating shorter average test length without sacrificing classification accuracy. Results also revealed that the stochastically curtailed mGLR successfully increased test efficiency in certain testing conditions.