Predictive Genetic Testing for Hereditary Breast and Ovarian Cancer: Psychological Distress and Illness Representations 1 Year Following Disclosure

This prospective study evaluates emotional functioning and illness representations in 68 unaffected women (34 carriers/34 noncarriers) 1 year after predictive testing for BRCA1/2 mutations when offered within a multidisciplinary approach. Carriers had higher subjective risk perception of breast cancer than noncarriers. Carriers who did not have prophylactic oophorectomy had the highest risk perception of ovarian cancer. No differences were found between carriers and noncarriers regarding perceived seriousness and perceived control of breast and ovarian cancer. Mean levels of distress were within normal ranges. Only few women showed an overall pattern of clinically elevated distress. Cancer-specific distress and state-anxiety significantly decreased in noncarriers from pre- to posttest while general distress remained about the same. There were no significant changes in distress in the group of carriers except for ovarian cancer distress which significantly decreased from pre- to posttest. Our study did not reveal adverse effects of predictive testing when offered in the context of a multidisciplinary approach.     

Racial Differences in Responses to the Caregiver Strain Questionnaire

The aim of this study was to examine differences in responses to the Caregiver Strain Questionnaire (CGSQ) between African American and White caregivers of children with emotional and behavioral challenges. Significant item- and scale-level differences were detected across groups with African Americans consistently reporting less strain. We examined whether these differences were more likely due to nonequivalent measurement than to real differences in the experience of caregiver strain. Confirmatory factor analysis showed that the model fit the data well for both racial groups, but there were some differences in structural components. Internal consistency was equivalent across the groups. In an examination of criterion validity, regression analyses showed that African American caregivers experienced a slower rate of increase in objective caregiver strain at a given increase in child internalizing problems. No other race differences were found in the regression analyses. In general, we conclude that the CGSQ can be useful for detecting caregiver strain and identifying family support needs for both White and African American caregivers. Differences across groups in reports of caregiver strain, however, call for more research on racial differences in the impact on the family of caring for a child with emotional and behavioral disorders.     

Developmental Differences in Metacognition and their Connections with Cognitive Development in Adulthood

This study investigated developmental differences in some metacognitive variables in ill-defined problem solving and their possible connections with cognitive development in adulthood. Participants were 57 individuals of different ages (adolescents, young adults, mature adults and older adults). They solved one well-defined and six ill-defined problems while their thinking-aloud was taped. They then answered a metacognitive statements questionnaire. Differences in performance were statistically significant in all problems: the best results in interpolation and divergent production problems were achieved by the younger adult group and the best performance on most dialectical everyday problems was found in the mature adults' group. We found no significant differences between age groups in the on-line monitoring of the solving process. Accuracy in metacognitive statements was however significantly better in the mature adult and the younger adult groups. Awareness of and reflection on one's own mental processes showed a similar developmental pattern to relativistic/dialectical thought: low expression in adolescence, an increase in early adulthood, a peak in mature adulthood and a minor decline in later years.     

The Role of Temperament in the Etiology of Child Psychopathology

A substantial proportion of children and adolescents come to suffer from psychological disorders. This article focuses on the temperament factors that are involved in the pathogenesis of child psychopathology. It is argued that besides the reactive temperament factor of emotionality/neuroticism, the regulative process of effortful control also plays an important role in the etiology and maintenance of internalizing and externalizing problems in youths. More specifically, vulnerability to child psychopathology is determined by a temperament that is characterized by high levels of emotionality/neuroticism and low levels of effortful control. Models are hypothesized in which reactive and regulative temperament factors either have interactive or additive effects on the development of psychological disorders in children, and conceptualized in terms of a developmental psychopathology perspective. Directions for future research and clinical implications of this temperamental view on psychopathology are discussed.     

A call to restructure the drug development process: Government over-regulation and non-innovative late stage (Phase III) clinical trials are major obstacles to advances in health care

The history of drug/vaccine development has included major advances guided primarily by risk/benefit analyses concerning the innovative agent, not by evidence-based clinical trials (Phase I–IV). Because the approval for new drugs is hindered under the present process, the system requires restructuring. The Phase I/II study period should be more flexible, using the “environment of knowledge” about the new agent, plus risk/benefit assessments. Phase III, as presently constructed, does not add new adverse events data, it provides a narrower profile of drug efficacy than properly done Phase II studies, and placebo-controlled trials continue to raise unresolved ethical and social issues. Phase III studies should be abandoned for most drugs, and substituted with properly powered Phase II doseranging studies plus careful post-marketing surveillance. Phase III should be a penalty for poor drug development, not a regulatory requirement. To accomplish efficient drug development, greater cooperation between pharmaceutical companies and governments in developing clinical trials is needed rather than over-regulation. These changes will synchronize the drug development and regulatory process with the current rapid drug discovery process, reduce drug development time and cost, and improve patient care. The author is Adjunct Professor of Medicine, Weill Medical College of Cornell University, New York, New York, USA.     

Algebras of Intervals and a Logic of Conditional Assertions

Intervals in boolean algebras enter into the study of conditional assertions (or events) in two ways: directly, either from intuitive arguments or from Goodman, Nguyen and Walker's representation theorem, as suitable mathematical entities to bear conditional probabilities, or indirectly, via a representation theorem for the family of algebras associated with de Finetti's three-valued logic of conditional assertions/events. Further representation theorems forge a connection with rough sets. The representation theorems and an equivalent of the boolean prime ideal theorem yield an algebraic completeness theorem for the three-valued logic. This in turn leads to a Henkin-style completeness theorem. Adequacy with respect to a family of Kripke models for de Finetti's logic, ukasiewicz's three-valued logic and Priest's Logic of Paradox is demonstrated. The extension to first-order yields a short proof of adequacy for Körner's logic of inexact predicates.     

On Modal μ-Calculus and Non-Well-Founded Set Theory

A finitary characterization for non-well-founded sets with finite transitive closure is established in terms of a greatest fixpoint formula of the modal -calculus. This generalizes the standard result in the literature where a finitary modal characterization is provided only for wellfounded sets with finite transitive closure. The proof relies on the concept of automaton, leading then to new interlinks between automata theory and non-well-founded sets.     

The Suspended Aesthetic: Slavoj Žižek on Eastern European Film

Slavoj iek's writings on Krzysztof Kies´lowski and Andrej Tarkovskij represent direct challenges to the Central and Eastern European tradition of spiritual art and to dominant aesthetic concepts as such. He refuses to separate the solemn films of Kies´lowski and Tarkovskij from popular culture and stresses their import as ethical statements by their directors. Despite this ethical emphasis, iek makes an important contribution to philosophical aesthetics. He implicitly defines art as a suspension of reality which reveals time in its fragility and potentiality. Defining iek's aesthetics in terms of suspension helps to explain his partiality for Kies´lowski and Tarkovskij and bears comparison to the Russian tradition of philosophical aesthetics, in particular Aleksej Losev and Alexander Bakshy.     

Young children's sensitivity to probabilistic phonotactics in the developing lexicon

A series of three experiments examined children's sensitivity to probabilistic phonotactic structure as reflected in the relative frequencies with which speech sounds occur and co-occur in American English. Children, ages 212 and 312 years, participated in a nonword repetition task that examined their sensitivity to the frequency of individual phonetic segments and to the frequency of combinations of segments. After partialling out ease of articulation and lexical variables, both groups of children repeated higher phonotactic frequency nonwords more accurately than they did low phonotactic frequency nonwords, suggesting sensitivity to phoneme frequency. In addition, sensitivity to individual phonetic segments increased with age. Finally, older children, but not younger children, were sensitive to the frequency of larger (diphone) units. These results suggest not only that young children are sensitive to fine-grained acoustic-phonetic information in the developing lexicon but also that sensitivity to all aspects of the sound structure increases over development. Implications for the acoustic nature of both developing and mature lexical representations are discussed.