New procedures for genetic testing and counselling of patients with breast or ovarian cancer

The aim of this PhD project was to evaluate alternative procedures for genetic testing and counselling of patients newly diagnosed with breast or ovarian cancer, in order to meet the expected increasing need of this health service. We performed a prospective study, the DNA-BONus study, in which we consecutively offered BRCA testing and familial risk assessment to unselected patients with newly diagnosed breast (N=893) or ovarian (N=122) cancer between September 2012 and February 2015, without formal pre-test genetic counselling. Out of the 488 patients who underwent genetic testing 7 of 405 patients (2%) with breast cancer and 19 of 83 patients (22%) with ovarian cancer carried a germline pathogenic BRCA variant (Paper I). All carriers fulfilled at least one of the Norwegian BRCA test criteria (Paper I). There was a significant decline in the mean levels of anxiety symptoms (Paper I) and cancer related psychological distress (Paper II) from inclusion to six months after dissemination of the BRCA test result. Predictors of increased distress were young age, short time since diagnosis, low level of perceived social support, high level of decisional conflict, diagnosis of ovarian cancer, and living with a partner (Paper II). By investigating RNA splicing, we showed that the intronic BRCA1 c.5407-25T>A variant leads to partial skipping of exon 22, resulting in the truncated protein p.Gly1803GlnfsTer11. Combined with allele frequency data and clinical information from 20 families, this indicated that BRCA1 c.5407-25T>A is a likely pathogenic variant with reduced penetrance (Paper III). In conclusion, the current thesis showed that a simplified procedure for BRCA testing was accepted and overall well tolerated by women newly diagnosed with breast or ovarian cancer. However, we also identified more vulnerable subgroups that may need more counselling and support to benefit from diagnostic BRCA testing. Testing of large groups of individuals with low a priori risk of carrying a germline BRCA pathogenic variant, like unselected patients with breast cancer in our study, may lead to detection of more DNA variants with reduced penetrance

Anonymity, Faceprints, and the Constitution

Part I defines anonymity and explains that respect for the capacity to remain physically and psychologically unknown to the government traces back to the Founding. With the advent and expansion of new technologies such as facial recognition technology (“FRT”), the ability to remain anonymous has eroded, leading to a litany of possible harms. Part II reviews the existing Fourth and First Amendment doctrine that is available to stave off ubiquitous government surveillance and identifies anonymity as a constitutional value that warrants more explicit doctrinal protection. Although the Fourth Amendment has been construed to excise surveillance of public and third-party information from its scope, the Court’s recent jurisprudence indicates a growing recognition that constitutional doctrine is out of step with modern surveillance technologies. The Supreme Court has expressly recognized a First Amendment right to anonymous speech, which should be taken into account in assessing the constitutionality of government surveillance systems under the Fourth Amendment. This Part accordingly draws a distinction between cases that arose in the pre-digital age, in which content was often collected through physical trespass or eavesdropping, and those arising in the digital age, in which correlations among disparate points of “big data” are used to make predictions. Part III argues that Fourth and First Amendment doctrine should be reconciled to address the manipulation — versus acquisition — of FRT data to derive new information about individuals which is exceedingly intimate and otherwise out of the government’s reach. This Part suggests that this qualitative shift in information gathering is constitutionally significant under existing doctrine. Part III also offers guidelines gleaned from the intersection of First and Fourth Amendment jurisprudence for consideration by lower courts and legislators as they address the threat of limitless surveillance which big data and new technologies present

Anonymity, Faceprints, and the Constitution

Part I defines anonymity and explains that respect for the capacity to remain physically and psychologically unknown to the government traces back to the Founding. With the advent and expansion of new technologies such as facial recognition technology (“FRT”), the ability to remain anonymous has eroded, leading to a litany of possible harms. Part II reviews the existing Fourth and First Amendment doctrine that is available to stave off ubiquitous government surveillance and identifies anonymity as a constitutional value that warrants more explicit doctrinal protection. Although the Fourth Amendment has been construed to excise surveillance of public and third-party information from its scope, the Court’s recent jurisprudence indicates a growing recognition that constitutional doctrine is out of step with modern surveillance technologies. The Supreme Court has expressly recognized a First Amendment right to anonymous speech, which should be taken into account in assessing the constitutionality of government surveillance systems under the Fourth Amendment. This Part accordingly draws a distinction between cases that arose in the pre-digital age, in which content was often collected through physical trespass or eavesdropping, and those arising in the digital age, in which correlations among disparate points of “big data” are used to make predictions. Part III argues that Fourth and First Amendment doctrine should be reconciled to address the manipulation — versus acquisition — of FRT data to derive new information about individuals which is exceedingly intimate and otherwise out of the government’s reach. This Part suggests that this qualitative shift in information gathering is constitutionally significant under existing doctrine. Part III also offers guidelines gleaned from the intersection of First and Fourth Amendment jurisprudence for consideration by lower courts and legislators as they address the threat of limitless surveillance which big data and new technologies present

“And Yet It Moves”—The First Amendment and Certainty

Surprisingly few, if any, works on the First Amendment have explored the relation between free speech and certainty. The same holds true for decisional law. While this relationship is inherent in much free speech theory and doctrine, its treatment has nonetheless been rather opaque. In what follows, the author teases out— philosophically, textually, and operationally—the significance of that relationship and what it means for our First Amendment jurisprudence. In the process, he examines how the First Amendment operates to counter claims of certainty and likewise how it is employed to demand a degree of certainty from those who wish to cabin free speech rights. Drawing its satirical title from words purportedly spoken by Galileo when he was persecuted by ecclesiastical inquisitors for defending the heliocentric theory of Copernicus, the Essay argues that many free speech theories (from Milton to Meiklejohn and beyond) have the net effect of constricting our First Amendment freedoms based on uncertain claims to normative benefits and equally uncertain claims of societal harm. In this general sense, many free speech theorists might be viewed as the descendants (albeit kinder ones) of Galileo’s ecclesiastical detractors insofar as they invoke their own certainty of morals (or normative theories) or alleged harms to trump actual facts in order to censor speech. This problem is compounded when First Amendment lawyers must disingenuously pigeonhole their client’s speech into the doctrinal boxes compatible with normative theories. In the duplicitous course of things, bawdy comedy becomes political action, erotic sexual expression becomes self-realization, offensive speech becomes cultural criticism, and imagistic commercial expression becomes consumer information. Strange as it is, in such circumstances falsity is necessarily called into the service of placing a normative face on aberrant expression. By way of a bold counter to all such theories, and duly mindful of the role of real harm in the working scheme of things, the author advances a view of the First Amendment premised less on certainty (and its conceptual cousin, normativity) than on risk—real and substantial risks, properly comprehended. Thus understood, the very idea of risk deserves to be an accepted and preferred part of the calculus of decision-making, be it judicial, legislative or executive. Hence, at the philosophical level, a risk-free First Amendment is a contradiction while at the operational level it is a formula for suppression. Undaunted by the specter of criticism of his own experimental views on the matter, the author invites the kind of First Amendment risk-taking once roundly championed by Justice Louis Brandeis—a brand of freedom though uncertain of its success is nevertheless hopeful of its attainment

Care to explain?:A critical epistemic in/justice based analysis of legal explanation obligations and ideals for ‘AI’-infused times

Fundamental legal explanation rights are seen to be in peril because of the use of inscru-table computational methods in decision making across important domains such as health care, welfare, and the judiciary. New technology-oriented explanation rules are created in response to this. As part of such rules, human explainers are tasked with re-humanizing the automated decisional processes. By providing their explainees with meaningful information, explainers are expected to help protect these decision subjects from AI-related harms such as wrongful discrimination, and to sustain their ability to participate in decision making about them in responsible ways.De Groot questions the merits, and the ideas behind these legislative approaches. Harms that are typically ascribed to the use of algorithms and modern ‘AI’ are not so different in character from harms that existed long before the ‘digital revolution.’ If explanation rights have a role to play as a tool against what De Groot describes as knowledge related wrong-doing, law has something to answer for since its explanation rules have thus far underserved those in less privileged societal positions; before and after decisions were automated.To conduct this critical questioning this thesis approaches explanation as a form of knowledge making. It builds a ‘re-idealized’ model of explanation duties based on val-ues described in the philosophical fields of epistemic justice and injustice. Starting from critical insights with regard to responsibly informed interaction in situations of social-informational inequality, the model relates duties of explanation care to different phases of an explanation cycle. The model is then applied in an analysis of the main explanation rules for administrative and medical decision making in The Netherlands. In ‘technology and regulation’ discus-sions, both domains are appealed to as benchmarks for the dignified treatment of ex-plainees. The analysis however teases out how the paradigms ignore important dimen-sions of decision making, and how explainers are not instructed to engage with explain-ees in ways that allow to fundamentally respect them as knowers and rights holders. By generating conceptual criticism and making practical, detailed points, the thesis demon-strates work that can be done to improve explanation regulation moving forward.<br/

Making Big Data Useful for Health Care: A Summary of the Inaugural MIT Critical Data Conference

With growing concerns that big data will only augment the problem of unreliable research, the Laboratory of Computational Physiology at the Massachusetts Institute of Technology organized the Critical Data Conference in January 2014. Thought leaders from academia, government, and industry across disciplines--including clinical medicine, computer science, public health, informatics, biomedical research, health technology, statistics, and epidemiology--gathered and discussed the pitfalls and challenges of big data in health care. The key message from the conference is that the value of large amounts of data hinges on the ability of researchers to share data, methodologies, and findings in an open setting. If empirical value is to be from the analysis of retrospective data, groups must continuously work together on similar problems to create more effective peer review. This will lead to improvement in methodology and quality, with each iteration of analysis resulting in more reliability

Psychological Profiling of Criminals in Violent Crime Investigations in Nigerian Criminal Justice System

The Nigerian criminal justice system is not entirely ignorant or unaware of the use and the merits of the application of criminal profiling as a tool in crime investigation. The technique was introduced to help law enforcement agencies solve serious crimes such as serial rape or murder and to a lesser extent arson and property crime. At the heart of profiling lies the belief that by combining psychological principles with crime scene analysis, it is possible to identify the likely characteristics of a perpetrator. However, criminal profiling in Nigeria has not nearly reached the level of recognition, functionality, or institutionalization that it has attained in other jurisdictions. This study aims to examine the feasibility and the practicality of offender profiling in a criminal investigation of violent crimes with a particular focus on the Nigerian criminal justice system. It will also give an expository critique of the loopholes and impediments in the Nigerian criminal justice system and ways criminal profiling can fill up these holes. The research methods employed in this study include a combination of both primary and secondary sources. The work highlighted the effectiveness of this field and thus concluded that criminal investigative analysis should be effectively immersed into the justice system and should also receive as much recognition as it has in other jurisdictions especially in the United States and in major parts of Europe. Keywords: Criminal Profiling, Crime Investigation, Violent Crime, Criminal Justice System