“Should parental refusals of newborn screening be accepted?”

For over four decades, knowledge that symptoms of some inherited diseases can be prevented or reduced via early detection and treatment in newborns has underpinned state-funded screening programs in most developed countries. 1 Conditions for which newborn screening is now a recognized preventative public health initiative include phenylketonuria (PKU), congenital hypothyroidism (CHT), and, more recently, cystic fibrosis (CF) and sickle cell disorder (SCD). The use of tandem mass spectrometry to detect conditions such as amino-acidopathies and fatty-acid oxidation defects is also becoming increasingly prevalent. 2 The early identification of children who are at risk for these conditions can have very positive implications. To take the most significant example, a child born with mutations that would otherwise lead to symptoms of PKU will have a vastly different kind of life if the condition is detected in early infancy rather than later. The introduction of a modified diet at this time, although cumbersome, will prevent the onset of severe mental impairment, allowing the child to lead a virtually normal life. 3 Although clinical indications are sometimes more contentious when justifying screening for other conditions, by and large newborn screening is clinically valid and carries only minimal risk. However, it is sometimes declined by parents, presenting healthcare professionals with an ethical, legal, and practical dilemma. Consider the following scenario: Emma and Tom both work as pediatricians in a large city hospital. They have recently had their third child, a daughter named Clare. During a postnatal visit to their home by a midwife, Emma indicates that she and Tom do not want Clare to have any newborn screening. Emma reports there is no family history of any of the diseases being screened for, and she feels strongly that the probability Clare will have any of the conditions is so low that it cannot justify subjecting her to an invasive test. This scenario gives rise to three issues, each addressed below. First, is Emma and Tom’s refusal of newborn screening for Clare justifiable? Second, should the law ever mandate newborn screening over parental objections? Third, howshould such refusals be managed in practice? Using the example of PKU screening, it is argued that although refusals are often difficult to defend, legal intervention is unjustified as a means of compelling parents to allow their infant to be screened. Nevertheless, the state may be justified in exercising some degree of “influence” over parental decisionmaking, via the practices of health professionals involved in newborn screening.This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

Implicit measures of association in psychopathology research

Studies obtaining implicit measures of associations in Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision; American Psychiatric Association, 2000) Axis I psychopathology are organized into three categories: (a) studies comparing groups having a disorder with controls, (b) experimental validity studies, and (c) incremental and predictive validity studies. In the first category, implicit measures of disorder-relevant associations were consistent with explicit beliefs for some disorders (e.g., specific phobia), but for other disorders evidence was either mixed (e.g., panic disorder) or inconsistent with explicit beliefs (e.g., pain disorder). For substance use disorders and overeating, expected positive and unexpected negative associations with craved substances were found consistently. Contrary to expectation, implicit measures of self-esteem were consistently positive for patients with depressive disorder, social phobia, and body dysmorphic disorder. In the second category, short-term manipulations of disorder-relevant states generally affected implicit measures as expected. Therapeutic interventions affected implicit measures for one type of specific phobia, social phobia, and panic disorder, but not for alcohol use disorders or obesity. In the third category, implicit measures had predictive value for certain psychopathological behaviors, sometimes moderated by the availability of cognitive resources (e.g., for alcohol and food, only when cognitive resources were limited). The strengths of implicit measures include (a) converging evidence for dysfunctional beliefs regarding certain disorders and consistent new insights for other disorders and (b) prediction of some psychopathological behaviors that explicit measures cannot explain. Weaknesses include (a) that findings were inconsistent for some disorders, raising doubts about the validity of the measures, and (b) that understanding of the concept "implicit" is incomplete

Impaired subjective self-control in alcohol use: An ecological momentary assessment study

Background: While both theory and empirical findings have supported impaired self-control as a crucial factor in understanding problem drinking, little is known about the relationship of self-control and drinking in naturalistic settings. The present study uses Ecological Momentary Assessment (EMA) to examine the predictive relationships between impaired subjective self-control, craving and alcohol use in everyday life. Methods: A sample of 172 regular drinkers responded on their smartphone to three random prompts each day for seven days in which amount of perceived self-control and craving were measured with self-report. In the meantime, participants were instructed to initiate an EMA report when they started drinking alcohol. Results: Findings supported the hypotheses that impaired self-control and higher craving levels were prospectively related to the likelihood that people will drink. That is, on random assessments that preceded drinking (i.e., were within two hours of drinking), perceived self-control was lower and craving was higher compared to random assessments that were not followed by drinking. Additionally, during drink consumption, impaired self-control and craving were associated with a higher amount of expected alcohol consumption. Findings further indicated that subjective self-control acted as a moderator of the relationship between craving and alcohol consumption during drinking occasions. Conclusions: By using a smartphone mobile application, this study showed that impaired subjective self-control and cravin

Magnetic transition and spin dynamics in the triangular Heisenberg antiferromagnet α-KCrO2

We present the results of muon-spin relaxation measurements on the triangular lattice Heisenberg antiferromagnet α -KCrO 2 . We observe sharp changes in behavior at an ordering temperature of T c =23 K, with an additional broad feature in the muon-spin relaxation rate evident at T=13 K, both of which correspond to features in the magnetic contribution to the heat capacity. This behavior is distinct from both the Li- and Na-containing members of the series. These data may be qualitatively described with the established theoretical predictions for the underlying spin system