Genetic counseling and testing for hereditary breast and ovarian cancer now includes practitioners from multiple healthcare professions, specialties, and settings. This study examined whether ...non‐genetics professionals (NGPs) perform guideline‐based patient intake and informed consent before genetic testing. NGPs offering BRCA testing services in Florida (n = 386) were surveyed about clinical practices. Among 81 respondents (response rate = 22%), approximately half reported: sometimes scheduling a separate session for pre‐test counseling lasting 11–30 min prior to testing, discussing familial implications of testing, benefits and limitations of risk management options, and discussing the potential psychological impact and insurance‐related issues. Few constructed a three‐generation pedigree, discussed alternative hereditary cancer syndromes, or the meaning of a variant result. This lack of adherence to guideline‐based practice may result in direct harm to patients and their family members. NGPs who are unable to deliver guideline adherent cancer genetics services should focus on identification and referral of at‐risk patients to in person or telephone services provided by genetics professionals.
Individuals often tend to irrationally blame victims for their plight. This research incorporated a bounded rationality framework to examine first-person perspectives (rather than third-person) of ...both victims’ and nonvictims’ perceptions and judgments of acquaintance and stranger sexual violence. Upon completing individual difference measures, including a just-world belief assessment, participants (N = 296) were randomly assigned to read a scenario in which the vignette victim was either acquainted with or had no prior relationship with the perpetrator. Then, taking the perspective of the vignette victim, participants offered four judgments: the likelihood of reporting the crime, self-blame, perceived control, and sympathy expected from others. Results showed that instances of acquaintance sexual violence were judged more negatively than instances of stranger sexual violence. Moreover, participants who had previously experienced sexual violence reported more negative judgments than nonvictims (except for sympathy expected from others). An exploratory path analysis indicated that as nonvictims’, but not victims’, just-world beliefs became stronger, they indicated a higher willingness to report the crime, perceived more control over the situation, and expected more sympathy from others. We end with a discussion of how the present research can advance our understanding of sexual violence by using a bounded rationality framework and discuss the practical implications that the observed effects have for professionals in the legal system, outside observers, and victims themselves.
A binder free thick film sulfur cathode based on a carbon structure with carbon nano tubes (CNT) is introduced. The sulfur mass can be varied between 3 and 20 mg cm−2 electrode leading to sulfur ...loads that are several times as high as in slurry electrodes. The electrode structure and thickness is examined by SEM, the surface area measured by BET and the in-plane conductivity is determined by a modified 4-point measurement. The achieved capacities for these extremely high sulfur loads are around 900 mAh g−1 sulfur at a current of 0.64 mA cm−2 electrode.
Additionally the price of future Li–S cells (18650), both conventional sulfur slurry cathode and here introduced binder free CNT sulfur cathode were calculated and compared with a lithium-ion system (NCA-graphite).
► Binder free sulfur cathodes based on CNT for Li–S batteries. ► High sulfur loads. ► Influence of electrode surface and structure on electrochemical performance. ► Costs calculation for 18650 cell.
Highlights • CDC has messages and materials to support physicians’ HPV vaccine recommendations. • Many physicians were unaware of the CDC’s resources, suggesting suboptimal reach. • Most physicians ...reported favorable views of the CDC’s messages. • Physicians requested additional information about HPV vaccine safety and efficacy.
Studies indicate variant of uncertain significance (VUS) results are challenging for genetic counselors and patients, often resulting in negative patient outcomes. Genetic counselors' current ...practices regarding VUS are unknown. This study utilized a national survey of genetic counselors (n = 932) to examine current practices and confidence related to disclosing BRCA VUS results and reclassification information. For participants (n = 398), descriptive statistics were calculated regarding patient demographic characteristics, practices and confidence, and cross tabulation was used to identify participant's actions when receiving a reclassified VUS. Upon receiving a BRCA VUS report, the majority reported providing patients with information about the frequency with which their VUS was seen and patient ancestry, but a minority discussed DNA banking. Most were confident in their understanding of, and ability to explain, VUS results to patients, but felt less confident about achieving high levels of patient understanding. Upon reclassification, the majority reported calling the patient and mailing the results, but when the reclassification was deleterious, the majority also met with the patient face‐to‐face. Given the lack of standard professional guidelines about informing patients of initial and reclassified VUS results, this overview provides important insight into genetic counselors' current practices and confidence.
Section Editor:
Aad Tibben, email: a.tibben@lumc.nl
According to the European Pharmacopoeia monograph 1038 (Praeparationes homoeopathicae), homeopathic preparations are produced by successive dilution and succussion steps. Dilution levels beyond ...Avogadro's limit, however, render specific effects implausible according to standard scientific knowledge. Accordingly, we were interested in a critical empirical investigation of preparations produced according to this monograph.
Within a precursor study we developed a bioassay based on a fingerprint metabolomic analysis of Lepidium sativum seeds germinated in vitro in either homeopathic preparations or controls in a blinded and randomized assignment. Results of the precursor study were not consistent with the hypothesis that the effects of a Stannum metallicum 30x preparation are identical to placebo.
In the present study we investigated the reproducibility of these effects after scrutinizing and optimizing experimental procedures. Ten independent experiments were performed in a blinded and randomized assignment in two independent laboratories. Additionally, 10 systematic negative water control experiments were performed in both laboratories to critically assess the stability of the experimental set-up.
The effects of the Stannum metallicum 30x treatment were reproduced. The systematic negative control experiments did not yield false-positive results, indicating a stable experimental set-up.
We thus repeatedly observed biological effects conflicting with the assumption that Stannum metallicum 30x is identical to placebo. We therefore wish to discuss whether these findings are to be considered a scientific anomaly or whether they might stimulate further investigations to clarify whether application of the European Pharmacopoeia monograph 1038 may result in pharmaceutical preparations with specific effects.
Graphical abstract Display omitted
Being a victim of a violent crime is a traumatic experience. Sexual victimization, in particular, may be powerful enough to change presumably stable worldviews like just world beliefs. Across two ...large samples, we examined the influence of sexual victimization on just world beliefs. Results of Study 1 (N = 727) indicated that victims of sexual aggression had significantly lower levels of just world beliefs compared to nonvictims. Other researchers have claimed that sexual aggression is a uniquely intense traumatic event. Therefore, in a second study, we examined (a) whether just world belief endorsement was associated with the frequency of victimization, and (b) whether sexual aggression was unique in its effect on just world belief endorsement compared to other crimes such as physical assault. Results of Study 2 (N = 2,011) indicated that multiple incidents of victimization did not meaningfully impact just world beliefs compared to a single instance and just world belief endorsement was not significantly different across victims of sexual aggression, robbery, physical assault, or arson. An exploratory analysis, however, indicated there was a significant difference in victims’ behavior such that victims of sexual aggression were the least likely to have reported the crime. We end with a discussion of how the present research can advance our understanding of just world belief ideology and discuss the practical implications for professionals working with and studying victims of violent crimes.
False confessions are a contributing factor in almost 30% of DNA exonerations in the United States. Similar problems have been documented all over the world. We present a novel framework to highlight ...the processes through which innocent people, once misidentified as suspects, experience cumulative disadvantages that culminate in pernicious consequences. The cumulative-disadvantage framework details how the innocent suspect’s naivete and the interrogator’s presumption of guilt trigger a process that can lead to false confession, the aftereffects of which spread to corrupt evidence gathering, bias forensic analysis, and virtually ensure wrongful convictions at trial or through pressured false guilty pleas. The framework integrates nascent research underscoring the enduring effects of the accumulated disadvantages postconviction and even after exoneration. We synthesize findings from psychological science, corroborating naturalistic evidence, and relevant legal precedents to explain how an innocent suspect’s disadvantages can accumulate through the actions of law enforcement, forensic examiners, prosecutors, defense attorneys, judges, juries, and appeals courts. We conclude with prescribed research directions that can lead to empirically driven reforms to address the gestalt of the multistage process.
Victims of sexual violence are often punished by the legal system when their version of the incident—or fact finders' perception of their version—violates expected sexual violence schemas. We ...investigated the influence of sexual violence schemas on mock jurors' ability to accurately recognize facts presented in a hypothetical case. Participants (N = 155) read a vignette depicting one of four scenarios: expectancy consistent, expectancy inconsistent, no detail control, or no crime control condition. Participants then indicated whether certain evidence (e.g., victim‐perpetrator relationship) was presented, and if so, what the correct information was. Although participants generally demonstrated accurate recognition of the case evidence, errors were more likely to be made when the vignette was inconsistent with expected sexual violence schemas. We end with a discussion of how the present research can advance our understanding of the underlying cognitive mechanisms of victim blaming and the practical implications for the legal system.
Oral appliances (OAs) are first-line therapy for mild-to-moderate obstructive sleep apnea (OSA) and are being used with increasing frequency. Additionally, best practice of OA titration is unknown. ...We describe the experience of patients treated with an OA, identify factors that predict treatment success with an OA, and offer a protocol for OA titration.
Wece:ke retrospectively studied patients seen in a dental sleep clinic between 2002 and 2006. Patients selected for OA treatment underwent baseline polysomnography, were individually fit with an OA, and were instructed to titrate it at home until symptom resolution or discomfort. During follow-up polysomnography, additional titration was performed as needed. Primary outcome was successful treatment, defined as apnea-hypopnea index (AHI) <10 events per hour and AHI decrease at least 50% from baseline. Logistic regression models were created to identify associations between patient characteristics and successful treatment. Overall differences in AHI at baseline, after home titration, and after final titration were compared using Kruskal-Wallis test, and post hoc comparisons were performed with sign tests, with Bonferroni corrections.
Of 57 subjects treated with an OA, 37 subjects (64.9%) were successfully treated with OA therapy. Of the 49 subjects for whom data were available for AHI after home titration, 27 subjects (55%) achieved successful treatment of OSA by self-titration, without need for further titration during follow-up polysomnography.
A majority of subjects, regardless of OSA severity, are successfully treated with an OA. Men and younger patients were found to be the best responders. The titration protocol for an OA offers a beneficial initial step in the treatment of OSA.
PDF
