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.     

四卡问题的内容促进效应的实验研究

本研究设计了２种抽象材料和４种具体材料的四卡问题,对４３６名大学生进行测试,以考察被试解决四卡问题时所采用的思维方式并检验命题内容对推理的影响。结果表明,四卡问题十分困难,具体内容的四卡问题并不能产生促进效应,大学生的推理表现出“匹配偏向”的特点。     

EVOLUTION IN THERMODYNAMIC PERSPECTIVE: A HISTORICAL AND PHILOSOPHICAL ANGLE

Abstract. The recently suggested reformulation of Darwinian evolutionary theory, based on the thermodynamics of self-organizing processes, has strong philosophical implications. My claim is that the main philosophical merit of the thermodynamic approach, made especially clear in J.S. Wicken's work, is its insistence on the law-governed, continuous nature of evolution. I attempt to substantiate this claim following a historical analysis of beginning-of-the-century ideas on evolution and matter-life relationship, in particular, the fitness-of-the-environment-for-life theory of the Harvard physiologist L.J. Henderson. In addition, I point to an epistemological common ground underlying the studies of the “thermodynamics school” and other currently active research groups focusing on the emergence and evolution of biological organization.     

A general linear model for estimating effect size in the presence of publication bias

When the process of publication favors studies with smallp-values, and hence large effect estimates, combined estimates from many studies may be biased. This paper describes a model for estimation of effect size when there is selection based on one-tailedp-values. The model employs the method of maximum likelihood in the context of a mixed (fixed and random) effects general linear model for effect sizes. It offers a test for the presence of publication bias, and corrected estimates of the parameters of the linear model for effect magnitude. The model is illustrated using a well-known data set on the benefits of psychotherapy.Authors' note: The contributions of the authors are considered equal, and the order of authorship was chosen to be reverse-alphabetical.     

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.     

Identification of inconsistent variates in factor analysis

When some of observed variates do not conform to the model under consideration, they will have a serious effect on the results of statistical analysis. In factor analysis the model with inconsistent variates may result in improper solutions. In this article a useful method for identifying a variate as inconsistent is proposed in factor analysis. The procedure is based on the likelihood principle. Several statistical properties such as the effect of misspecified hypotheses, the problem of multiple comparisons, and robustness to violation of distributional assumptions are investigated. The procedure is illustrated by some examples.     

Cultural competency in genetic counseling

Incorporating a cross-cultural curriculum into genetic counseling training programs demonstrates a professional conviction of genetic counselors that cultural issues are important in genetic counseling. Funded by the Special Projects Fund in 1993 from the National Society of Genetic Counselors and the Kitson Fund from the Department of Social, Organizational, and Counseling Psychology, Teachers College, Columbia University, theHandbook of Cross-Cultural Genetic Counseling was developed to provide genetic counseling programs a curriculum to teach cross-cultural genetic counseling. The theoretical rationale for the development of a cultural curriculum is presented. By expanding cultural knowledge, developing an awareness of oneself and others, and increasing the repertoire of culturally relevant counseling skills within a socio-political context, genetic counselors will be able to better serve all clients seeking 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.     

Should a criminal receive a heart transplant? Medical Justice vs. Societal Justice

Should the nation provide expensive care and scarce organs to convicted felons? We distinguish between two fields of justice: Medical Justice and Societal Justice. Although there is general acceptance within the medical profession that physicians may distribute limited treatments based solely on potential medical benefits without regard to nonmedical factors, that does not mean that society cannot impose limits based on societal factors. If a society considers the convicted felon to be a full member, then that person would be entitled to at least a “decent minimum” level of care — which might include access to scarce life-saving organs. However, if criminals forfeit their entitlement to the same level of medical care afforded to all members of society, they still would be entitled to a kind of “rudimentary decent minimum” granted to all persons on simple humanitarian grounds. Almost certainly this entitlement would not include access to organ transplants.