Counseling Customers: Emerging Roles for Genetic Counselors in the Direct-to-Consumer Genetic Testing Market

Individuals now have access to an increasing number of internet resources offering personal genomics services. As the direct-to-consumer genetic testing (DTC GT) industry expands, critics have called for pre- and post-test genetic counseling to be included with the product. Several genetic testing companies offer genetic counseling. There has been no examination to date of this service provision, whether it meets critics’ concerns and implications it may have for the genetic counseling profession. Considering the increasing relevance of genetics in healthcare, the complexity of genetic information provided by DTC GT, the mediating role of the internet in counseling, and potential conflicts of interest, this is a topic which deserves further attention. In this paper we offer a discourse analysis of ways in which genetic counseling is represented on DTC GT websites, blogs and other online material. This analysis identified four types of genetic counseling represented on the websites: the integrated counseling product; discretionary counseling; independent counseling; and product advice. Genetic counselors are represented as having the following roles: genetics educator; mediator; lifestyle advisor; risk interpreter; and entrepreneur. We conclude that genetic counseling as represented on DTC GT websites demonstrates shifting professional roles and forms of expertise in genetic counseling. Genetic counselors are also playing an important part in how the genetic testing market is taking shape. Our analysis offers important and timely insights into recent developments in the genetic counseling profession, which have relevance for practitioners, researchers and policy makers concerned with the evolving field of personal genomics. Keywords Genetic counseling Internet Direct-to-consumer genetic testing Discourse analysis

The application of structural reliability techniques to plume impingement loading of the Space Station Freedom Photovoltaic Array

A new aerospace application of structural reliability techniques is presented, where the applied forces depend on many probabilistic variables. This application is the plume impingement loading of the Space Station Freedom Photovoltaic Arrays. When the space shuttle berths with Space Station Freedom it must brake and maneuver towards the berthing point using its primary jets. The jet exhaust, or plume, may cause high loads on the photovoltaic arrays. The many parameters governing this problem are highly uncertain and random. An approach, using techniques from structural reliability, as opposed to the accepted deterministic methods, is presented which assesses the probability of failure of the array mast due to plume impingement loading. A Monte Carlo simulation of the berthing approach is used to determine the probability distribution of the loading. A probability distribution is also determined for the strength of the array. Structural reliability techniques are then used to assess the array mast design. These techniques are found to be superior to the standard deterministic dynamic transient analysis, for this class of problem. The results show that the probability of failure of the current array mast design, during its 15 year life, is minute

Screening and Assessment in TANF/Welfare-to-Work: Ten Important Questions TANF Agencies and Their Partners Should Consider

Changes to the welfare system brought about by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), and state and local welfare reform efforts, carry serious implications for Temporary Assistance to Needy Families (TNF) recipients with disabilities and barriers to employment. Specifically, work participation and time limit requirements are two key provisions of the federal welfare law which provided a new sense of urgency encouraging states to develop strategies to assist clients with their transistions from welfare to work. As a first step in this process, TANF agencies are considering strategies to identify the barriers that are inhibiting or prohibiting this transition. PRWORA offers unprecedented flexibility to develop such strategies and design programs and services to assist with the transition from welfare to work. This paper is merely a first step in considering some of the many challenges associated with identifying unobserved barriers to employment

The prevention and treatment of childhood obesity.

The effectiveness of interventions used in the prevention and treatment of childhood obesity published in a recent issue of Effective Heath Care is reviewed