Genetic Evaluation and Counseling of Couples with Recurrent Miscarriage: Recommendations of the National Society of Genetic Counselors

The objective of this document is to provide recommendations for genetic evaluation and counseling of couples with recurrent miscarriage (RM). The recommendations are the opinions of the multidisciplinary Inherited Pregnancy Loss Working Group (IPLWG), with expertise in genetic counseling, medical genetics, maternal fetal medicine, internal medicine, infectious disease, cytogenetics, and coagulation disorders. The IPLWG defines RM as three or more clinically recognized consecutive or non-consecutive pregnancy losses occurring prior to fetal viability (<24 weeks gestation). These recommendations are provided to assist genetic counselors and other health care providers in clinical decision-making, as well as to promote consistency of patient care, guide the allocation of medical resources, and increase awareness of the psychosocial and cultural issues experienced by couples with RM. The IPLWG was convened with support from the March of Dimes Western Washington State Chapter and the University of Washington Division of Medical Genetics. The recommendations are U.S. Preventive Task Force Class III, and are based on clinical experiences, review of pertinent English-language published articles, and reports of expert committees. This document reviews the suspected causes of RM, provides indications for genetic evaluation and testing, addresses psychosocial and cultural considerations, and provides professional and patient resources. These recommendations should not be construed as dictating an exclusive course of medical management, nor does the use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the circumstances of a specific case, should always supersede these recommendations.     

Improving the Rigor of Mechanistic Behavioral Science: The Introduction of the Checklist for Investigating Mechanisms in Behavior-Change Research (CLIMBR)

Diverse fields rely on the development of effective interventions to change human behaviors, such as following prescribed medical regimens, engaging in recommended levels of physical activity, getting vaccinations that promote individual and public health, and getting a healthy amount of sleep. Despite recent advancements in behavioral intervention development and behavior-change science, systematic progress is stalled by the lack of a systematic approach to identifying and targeting mechanisms of action that underlie successful behavior change. Further progress in behavioral intervention science requires that mechanisms be universally prespecified, measurable, and malleable. We developed the CheckList for Investigating Mechanisms in Behavior-change Research (CLIMBR) to guide basic and applied researchers in the planning and reporting of manipulations and interventions relevant to understanding the underlying active ingredients that do—or do not—drive successful change in behavioral outcomes. We report the rationale for creating CLIMBR and detail the processes of its development and refinement based on feedback from behavior-change experts and NIH officials. The final version of CLIMBR is included in full.     

T-PALS framework to assess children who stutter with coexisting disorders: A tutorial

The purpose of this paper is to present a tutorial on a diagnostic framework developed to assess children who stutter and exhibit co-existing disorders. While we have guidelines for treating these children, there are no specific guidelines for assessing them. We provide a rationale for the development of T-PALS with support from the literature. The T-PALS framework assesses 5 foundational key elements for the child: Temperament (T), Pragmatics (P), Articulation/phonology (A), Language (L), and Stuttering (S). Both qualitative and quantitative measures are used within each dimension. This framework is discussed with reference to using two clinical case examples. T-PALS observation data are presented as well as treatment suggestions for each case. We conclude that T-PALS may be a useful framework for both clinicians and researchers, working with children who present with stuttering and comorbid conditions. Clinicians are encouraged to reach beyond the traditional focus on solely assessing the stuttering behavior, even when that is the main concern for referral, and to consider a broader view of the child. It is hoped that this more integrative approach to assessment may yield a more holistic diagnostic picture of a dual diagnosis child from which treatment goals can be derived.     

语音情绪变化内隐加工的神经生理机制

人类迅速高效识别语音情绪变化的神经生理机制仍是一个未解之谜。本研究试图通过对被试内隐加工语音情绪变化的即时脑电数据做时域和频域分析, 揭示语音情绪变化加工的神经生理机制。结果发现语音情绪变化诱发N2/P3复合成分, theta频段能量增加和试次间相位相干系数(ITC)增大, beta频段能量降低和ITC增大。这些神经生理指标受情绪变化模式的调节, 情绪变化越激烈, 诱发N2/P3复合成分的潜伏期越早, theta能量和相位变化更强烈。这些结果说明语音情绪变化加工是一个变化检测与整合的过程, 该过程主要由theta和beta频段能量和试次间相位的变化来实现。     

Ethical Issues and Guidelines for Conducting Data Analysis in Psychological Research

Psychologists are directed by ethical guidelines in most areas of their practice. However, there are very few guidelines for conducting data analysis in research. The aim of this article is to address the need for more extensive ethical guidelines for researchers who are post–data collection and beginning their data analyses. Improper data analysis is an ethical issue because it can result in publishing false or misleading conclusions. This article includes a review of ethical implications of improper data analysis and potential causes of unethical practices. In addition, current guidelines in psychology and other areas (e.g., American Psychological Association and American Statistical Association Ethics Codes) were used to inspire a list of recommendations for ethical conduct in data analysis that is appropriate for researchers in psychology.     

“It Would Be a Shame to Lose Them”: A Critical Historical,Scoping, and Expert Review on the Use of Projective Assessments in Occupational Therapy,Part II

Projective assessments have a long history in occupational therapy, yet their relevance may be questioned. Part I of this article provided a critical history of their development and a scoping review of the evidence. This second article outlines an interview-based qualitative study of the clinical and academic perspectives of nine experts. Through this comprehensive two-part article, conceptual and methodological issues are articulated in order to suggest educational and clinical guidelines, and future research avenues. The place of projective assessments in occupational therapy is demonstrated as a salient specialty area of practice in the current evolving landscape of mental health.     

Empirically Supported Therapies and Therapy Relationships: What are the Serious Problems and Plausible Alternatives?

Task forces have identified practice guidelines based upon empirically supported therapies and therapy relationships. A case is made for (a) the serious problems in and (b) the plausible alternatives to, the general strategy underlying the task forces. The invitation is to address and to solve the serious problems, and to give serious consideration to the plausible alternatives.     

2010年我国急性ST段抬高型心肌梗死诊断与治疗指南解读评析

近年来我国急性心肌梗死的发病率一直呈明显上升趋势,已接近国际平均水平。对于STEMI版早期诊断并及时开通梗死相关动脉、增加心肌再灌注、防止心肌进一步坏死,可显著降低心血管事件的发生。本文从STEMI的诊断、早期医疗、再灌注治疗、辅助治疗及二级预防等几个方面对2010年我国急性ST段抬高型心肌梗死的诊断与治疗指南进行了详细解读分析。     

从指南看冠心病降脂治疗的现状及分析

层出不穷的试验研究和不断更新的指南使人们对冠心病防治的认识不断加深,但指南的实施和普及却不理想,大多数冠心病患者并未真正受益于降脂治疗。现就NCEP-ATP指南的更新和目前冠心病患者降脂治疗的现状、主要影响因素(患者的依从性、医务工作者的医疗质量、药物有效性以及效价比与经济条件)及可能的改善措施做一综述。