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.     

General estimators for the reliability of qualitative data

We study a proportional reduction in loss (PRL) measure for the reliability of categorical data and consider the general case in which each ofN judges assigns a subject to one ofK categories. This measure has been shown to be equivalent to a measure proposed by Perreault and Leigh for a special case when there are two equally competent judges, and the correct category has a uniform prior distribution. We consider a general framework where the correct category is assumed to have an arbitrary prior distribution, and where classification probabilities vary by correct category, judge, and category of classification. In this setting, we consider PRL reliability measures based on two estimators of the correct category—the empirical Bayes estimator and an estimator based on the judges' consensus choice. We also discuss four important special cases of the general model and study several types of lower bounds for PRL reliability.Bruce Cooil is Associate Professor of Statistics, and Roland T. Rust is Professor and area head for Marketing, Owen Graduate School of Management, Vanderbilt University. The authors thank three anonymous reviewers and an Associate Editor for their helpful comments and suggestions. This work was supported in part by the Dean's Fund for Faculty Research of the Owen Graduate School of Management, Vanderbilt University.     

Risky choice as a function of amount and variance in food supply.

In Experiment 1, 4 rats earned their daily food ration by choosing on a trials basis between a "risky" and a "riskless" lever. The risky lever produced either 15 45-mg food pellets or no pellets, and on average provided five pellets per choice. The riskless lever always produced three pellets. Across conditions, the number of trials per session was varied. Body weight and choice of the risky lever decreased as the number of trials per session decreased, even though body weight could only be defended by increased choice of the risky lever. In Experiment 2, trials per session were fixed, but the number of pellets delivered by the risky and riskless levers was either at the same level as in Experiment 1 or tripled from those levels. Now choice of the risky lever was inversely related to the size of reinforcement and to body weight. The results of these experiments show that risk aversion covaries with the amount of food available in a session and the daily variance in the amount of food earned.     

Aversive potency of urine from dominant and subordinate male laboratory mice (Mus musculus): Resolution of a conflict

The present study assessed the aversive potency of urine collected from male albino mice that had been clearly identified as dominants/winners or subordinates/losers of paired aggression tests and then housed either individually or in a quasi-paired situation in which only a wire-mesh divider separated the two mice. This divider permitted constant visual, olfactory, auditory, and some tactile contact. The responses of individually tested, group-housed males were recorded when half of the substrate in a test box was treated with either water or one of the four urine types; the other half remained untreated. Significant preferences for the untreated half were found when the urine of winners or losers housed in individual metabolism cages or that of pair-housed dominants was used as the test stimulus. On the other hand, neither water nor the urine of cohabiting subordinate males was avoided. The present findings confirmed our earlier reports that the urine of dominant male mice was aversive, whereas that of their cohabiting subordinate partners was not. They also identified Sawyer's [1978] procedure of housing winners and losers in individual cages, with the consequent interruption of social contact as the likely reason for his failure to replicate our reports that subordinate male urine lacked aversive properties. The territorial implications of the aversive factor and other urinary signals are discussed.     

Estimating the imputed social cost of errors of measurement

If a loss function is available specifying the social cost of an error of measurement in the score on a unidimensional test, an asymptotic method, based on item response theory, is developed for optimal test design for a specified target population of examinees. Since in the real world such loss functions are not available, it is more useful to reverse this process; thus a method is developed for finding the loss function for which a given test is an optimally designed test for the target population. An illustrative application is presented for one operational test.This work was supported in part by contract N00014-80-C-0402, project designation NR 150-453 between the Office of Naval Research and Educational Testing Service. Reproduction in whole or in part is permitted for any purpose of the United States Government.     

An exploratory study of psychodynamic therapists’ working with people with multiple sclerosis

There is little published on working psychodynamically with chronic illness and even less on the clinical insights of therapists working with people with multiple sclerosis. The objective of this study was to consider therapists’ reflections on the impact of multiple sclerosis on the internal worlds of clients with multiple sclerosis. I would also like to think about the challenges multiple sclerosis presents and how these challenges are worked with therapeutically. Finally, the impact of my multiple sclerosis diagnosis upon the research interviews was considered. Twelve counsellors / psychotherapists who had experience of working with clients with multiple sclerosis were interviewed. Data was analysed thematically and the findings revealed a number of significant themes. Denial appeared significant both for those with multiple sclerosis and those therapists working with them. Therapists also identified that people with multiple sclerosis hold a range of conscious and unconscious feelings in relation to their multiple sclerosis. Also, the meanings and impact of multiple sclerosis are broad and idiosyncratic. Therapists also faced a number of challenges in their work with people with multiple sclerosis: powerful countertransference feelings which could disable the therapy, embodied countertransference, the tendency to make generalisations, the physical reality of multiple sclerosis and its impact upon continuity, therapists’ unconscious phantasy and associations which if unaddressed could impact their ability to work with illness and the pressure multiple sclerosis placed on therapeutic boundaries. Therapists within the study recognised the need to work with both the physical reality of multiple sclerosis, as well as its psychological impact while at the same time keeping themselves open to powerful countertransference feelings and using them in the service of the therapy. The study has implications for theory, practice and future research.     

Les vicissitudes du préjudice d’agrément

The fate of the loss of amenity has always been related to the right of recourse of the third-party payers against the person in charge of the damage. The loss of amenity has been recognized by Law of the 27 December 1973. It was at that time that it was excluded from the recourse of the third-party payers. It was not the case of the physiological injuries which had always been submitted to the recourse of the third-party payers. At first, these injuries had included the disorders in the conditions of existence. But in 2005, the Dintilhac nomenclature adopted a restrictive conception of the loss of amenity. This damage is now defined as the impossibility to practice regularly a specific activity of sport or leisure. In addition, the Law of 21 December 2006 imposed on third-party payers to exercise their action only on pecuniary damage. The physiological injuries were therefore excluded from this action. The strict definition of loss of amenity is both adopted in Civil Law and Social law. But in these two areas, the analysis of the judicial practice reveals that it is undermined the right for the full repair of the victims under their loss of amenity. Accordingly, the question of the opportunity to widen once more the definition of the loss of amenity arises today.     

The effect of a psycho-educational intervention on weight management in obese military personnel

Obesity is a serious health problem for many population groups, including military personnel. Model-based health education programs have been shown to be effective in reducing weight. This study assessed the efficacy of an educational intervention based on a trans-theoretical model (TTM) targeting weight loss among active duty military. A single group experimental study using a before-after design was conducted in 49 military personnel with obesity. Constructs such as self-efficacy, decisional balance, stages of change, and processes of change as well as anthropometric measures including weight, waist circumference, and body mass index (BMI) were assessed at three times (baseline, 2 months after the intervention, and 4 months later). The intervention consisted of 10 educational sessions developed based on TTM constructs. At baseline, 30 (61%) and 19 (39%) persons were in the pre-action and action stages, respectively. By 2 months after the intervention, only 24 persons (49%) were in pre-action stages and 25 (51%) were in the action stages. Four months later, one (2%) and 43 (88%) were in pre-action and action stages. The mean changes in self-efficacy (25.7 ± 4.1 to 29.3 ± 2.4), decisional balance (9.2 ± 3.6 to 13.8 ± 1.9), total cognitive (74.7 ± 8.5 to 84.7 ± 6.3), and total behavioral change (60.8 ± 9.8 to 71.7 ± 7.8) were significantly different across the three time points. Reductions in weight (99.8 ± 10.4 to 93.0 ± 9.6), waist circumference (105.9 ± 14.2 to 100.2 ± 13.0), and BMI (32.5 ± 5.2 to 30.3 ± 4.5) from baseline to 4 months after the intervention were also significant (p < 0.05). An educational program based on TTM may be effective in reducing weight among obese military staff.     

Recapturing the power of ritual to enhance community in aging

Ritual returns us to the center of who we are. In times of transition, loss, disconnection, and loneliness, ritual offers transformative power. It can provide a language for expression, stability, serve an integrating force in community, mediate tradition, and offer emotional support. This article explores the need for ritual in coping with late life changes, the relationship of ritual to suffering, value of ritual in storytelling and mourning, and explains the role of witness facilitated through community. Therapeutic functions of ritual are addressed and a framework for ritual design is suggested.     

受助者结果类型对亲社会表现的影响:成人与儿童的对比研究

亲社会表现是指人们在社会交往中表现出来的谦让、帮助、合作、分享等行为,其影响机制受到广泛关注。本文通过两个研究（分别以大学生和二、四、六年级小学生为研究对象）探讨了受助者结果类型（受助者获得积极结果vs.受助者避免消极结果）对亲社会表现的影响。结果显示：（1）受助者避免消极结果条件比受助者获得积极结果条件诱发成人更高的亲社会意愿和行为;（2）六年级儿童帮助他人避免消极结果的亲社会意愿更强、情绪更积极;（3）相对于帮助他人避免消极结果,二年级儿童更倾向于帮助他人获得积极结果。这些结果说明受助者结果类型影响个体的亲社会表现（包括亲社会行为、亲社会意愿、亲社会情绪）,并且这种影响因成人和儿童有所不同：成人和年长儿童表现出亲社会损失规避现象,年幼儿童则表现出相反效应。