A linguistic deficit resulting from right-hemisphere damage

The ability of right-brain-damaged (RBD) subjects to correctly insert a word into a well-formed stimulus sentence was tested. Subjects also performed three evaluative tasks designed to establish their degree of general cognitive impairment. The performance of RBD subjects on these tasks was compared to that of left-brain-damaged (LBD) and non-brain-damaged (NBD) subjects. Although RBD subjects outperformed LBD subjects on the language-related evaluative tasks, the RBD group was significantly more impaired on a subset of the insertion task. This subset included items which required reassignment of the syntactic status of elements in the stimulus sentence in order for the insertion to be carried out. The results of this study permit refinement of the common characterization of RBD individuals as rigid in their interpretation of meaning and indicate right-hemisphere involvement in aspects of the grammar previously thought to be inaccessible to it.     

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.     

Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

Directed forgetting of related words: evidence for the inefficient inhibition hypothesis

Fifth-grade children and college students were asked to remember some words and to forget others in an item-cued-directed-forgetting task. Taxonomically related pairs of words and control pairs that were unrelated in meaning were used as stimuli. Children found it more difficult than did adults to ignore forget-cued words that followed associatively related words that were remember-cued. The results provide support for D. F. Bjorklund and K. K. Harnishfeger's (1990) inefficient inhibition hypothesis (i.e., that the efficiency of inhibitory mechanisms improves as children develop). The results also suggest that the inhibition is occurring primarily in the early stages of processing.     

Does right hemisphere damaged patients' impaired performance on a sentence insertion task indicate a syntactic or a lexical level deficit?

The present paper focuses on two studies, one on English (Schneiderman & Saddy, 1988) and the other on Italian (De Vreese, Neri Rubichi, & Salvioli, 1996), which report on right hemisphere damaged subjects' inability to correctly insert a word or phrase into an already well-formed sentence under certain stimulus conditions. Despite their strikingly similar findings, the results of the studies are interpreted quite differently. Schneiderman & Saddy consider the deficit to be syntactic, while De Vreese et al. view it as occurring at the lexical category or morphological level. An analysis and regrouping of the stimulus items from both studies indicate that a single syntactic interpretation could account for their results. Suggestions are made for further analyses and research to increase our understanding of the syntactic capacities of the intact right hemisphere.     

Electrophysiological evidence for age effects on sensory memory processing of tonal patterns

In older adults, difficulties processing complex auditory scenes, such as speech comprehension in noisy environments, might be due to a specific impairment of temporal processing at early, automatic processing stages involving auditory sensory memory (ASM). Even though age effects on auditory temporal processing have been well-documented, there is a paucity of research on how ASM processing of more complex tone-patterns is altered by age. In the current study, age effects on ASM processing of temporal and frequency aspects of two-tone patterns were investigated using a passive listening protocol. The P1 component, the mismatch negativity (MMN) and the P3a component of event-related brain potentials (ERPs) to tone frequency and temporal pattern deviants were recorded in younger and older adults as a measure of auditory event detection, ASM processing, and attention switching, respectively. MMN was elicited with smaller amplitude to both frequency and temporal deviants in older adults. Furthermore, P3a was elicited only in the younger adults. In conclusion, the smaller MMN amplitude indicates that automatic processing of both frequency and temporal aspects of two-tone patterns is impaired in older adults. The failure to initiate an attention switch, suggested by the absence of P3a, indicates that impaired ASM processing of patterns may lead to less distractibility in older adults. Our results suggest age-related changes in ASM processing of patterns that cannot be explained by an inhibitory deficit.     

The Laboratory-Clinician Team: A Professional Call to Action to Improve Communication and Collaboration for Optimal Patient Care in Chromosomal Microarray Testing

The International Standards for Cytogenomic Arrays (ISCA) Consortium is a worldwide collaborative effort dedicated to optimizing patient care by improving the quality of chromosomal microarray testing. The primary effort of the ISCA Consortium has been the development of a database of copy number variants (CNVs) identified during the course of clinical microarray testing. This database is a powerful resource for clinicians, laboratories, and researchers, and can be utilized for a variety of applications, such as facilitating standardized interpretations of certain CNVs across laboratories or providing phenotypic information for counseling purposes when published data is sparse. A recognized limitation to the clinical utility of this database, however, is the quality of clinical information available for each patient. Clinical genetic counselors are uniquely suited to facilitate the communication of this information to the laboratory by virtue of their existing clinical responsibilities, case management skills, and appreciation of the evolving nature of scientific knowledge. We intend to highlight the critical role that genetic counselors play in ensuring optimal patient care through contributing to the clinical utility of the ISCA Consortium's database, as well as the quality of individual patient microarray reports provided by contributing laboratories. Current tools, paper and electronic forms, created to maximize this collaboration are shared. In addition to making a professional commitment to providing complete clinical information, genetic counselors are invited to become ISCA members and to become involved in the discussions and initiatives within the Consortium.     

Genetic Counseling as a Tool for Type 2 Diabetes Prevention: A Genetic Counseling Framework for Common Polygenetic Disorders

Advances in genetic epidemiology have increased understanding of common, polygenic preventable diseases such as type 2 diabetes. As genetic risk testing based on this knowledge moves into clinical practice, we propose that genetic counselors will need to expand their roles and adapt traditional counseling techniques for this new patient set. In this paper, we present a genetic counseling intervention developed for a clinical trial [Genetic Counseling/Lifestyle Change for Diabetes Prevention, ClinicalTrials.gov identifier: NCT01034319] designed to motivate behavioral changes for diabetes prevention. Seventy-two phenotypically high-risk participants received counseling that included their diabetes genetic risk score, general education about diabetes risk factors, and encouragement to participate in a diabetes prevention program. Using two validated genetic counseling scales, participants reported favorable perceived control and satisfaction with the counseling session. Our intervention represents one model for applying traditional genetic counseling principles to risk testing for polygenetic, preventable diseases, such as type 2 diabetes.     

Awareness of Genetic Counseling and Perceptions of its Purpose: A Survey of the Canadian Public

Genetic counseling can result in better outcomes when clients understand what to expect, and at least theoretically, at some point in their lifespan, anyone could be referred for or benefit from genetic counseling. Thus, in order to identify (and ultimately address) issues around awareness of genetic counseling and perceptions of its purpose, we surveyed the Canadian general population. We acquired 1,000 telephone numbers corresponding to a demographically representative sample of Canada from Survey Sampling International, and invited individuals to participate in a telephone-based survey. We administered a purpose-designed survey (in either French or English) comprising questions regarding: demographics, whether or not the individual had heard of genetic counseling, and 15 Likert scale-rated (strongly disagree—strongly agree) items about the possible purposes of genetic counseling. Responses to these 15 items were used to generate a total “knowledge score”. Of the 1,000 numbers, n?=?372 could not be reached, and the survey was successfully administered to n?=?188 individuals (response rate 30 %). Most respondents (n?=?129, 69 %) had not heard of genetic counseling, and substantial proportions thought that genetic counseling aims to prevent genetic diseases and abnormalities, help couples have children with desirable characteristics, and help people to understand their ancestry. These data could be used to inform the strategy for development of future awareness efforts, and as a baseline from which to measure their effects.     

An approach to families of acting-out adolescents--a case study.

Certain types of acting-out in the adolescent express the feelings of deprivation of the parental pair in a maladaptive aggressive way. Family therapists have attempted to convert the acting-out behavioral disorders into an effective state, i.e., make the family aware of their feelings of deprivation by focusing on the aggressive component. In many instances, the family becomes depressed and then interrupts or terminates treatment. The authors feel that this is due to the therapist's interpretations which bring about the depressive state via guilt provocation. The family understands the interpretations as meaning "You are bad to have your adolescent offspring behave in such a way". The therapist is thus seen as the family's collective super-ego. In order to prevent premature termination, the therapist should instead help the members of the family to become more conscious of their loving, "welfare" feelings for one another. In this way the self-esteem of the family is increased, which then permits more verbal action of aggressive feelings--thus a decrease in the acting-out, and ultimately an increase in the capacity to mourn. It should be pointed out, however, that in certain families, the technique described is not applicable. In these cases, although there is acting-out, the families are unable to draw on sufficient good experiences together which are necessary to elicit positive feeling for one another. The absence of readily available "welfare" feelings is of diagnostic and prognostic significance and differentiates the disorganized, sociopathic or schizophrenic family from the acting-out of parental deprivation as illustrated in this paper.