Are providers prepared for genomic medicine: interpretation of Direct-to-Consumer genetic testing (DTC-GT) results and genetic self-efficacy by medical professionals.

BACKGROUND:Precision medicine is set to deliver a rich new data set of genomic information. However, the number of certified specialists in the United States is small, with only 4244 genetic counselors and 1302 clinical geneticists. We conducted a national survey of 264 medical professionals to evaluate how they interpret genetic test results, determine their confidence and self-efficacy of interpreting genetic test results with patients, and capture their opinions and experiences with direct-to-consumer genetic tests (DTC-GT). METHODS:Participants were grouped into two categories, genetic specialists (genetic counselors and clinical geneticists) and medical providers (primary care, internists, physicians assistants, advanced nurse practitioners, etc.). The survey (full instrument can be found in the Additional file 1) presented three genetic test report scenarios for interpretation: a genetic risk for diabetes, genomic sequencing for symptoms report implicating a potential HMN7B: distal hereditary motor neuropathy VIIB diagnosis, and a statin-induced myopathy risk. Participants were also asked about their opinions on DTC-GT results and rank their own perceived level of preparedness to review genetic test results with patients. RESULTS:The rates of correctly interpreting results were relatively high (74.4% for the providers compared to the specialist's 83.4%) and age, prior genetic test consultation experience, and level of trust assigned to the reports were associated with higher correct interpretation rates. The self-selected efficacy and the level of preparedness to consult on a patient's genetic results were higher for the specialists than the provider group. CONCLUSION:Specialists remain the best group to assist patients with DTC-GT, however, primary care providers may still provide accurate interpretation of test results when specialists are unavailable

Frequency effect on streaming phenomenon induced by Rayleigh surface acoustic wave in microdroplets

Acoustic streaming of ink particles inside a water microdroplet generated by a surface acoustic wave(SAW) has been studied numerically using a finite volume numerical method and these results have been verified using experimental measurements. Effects of SAW excitation frequency, droplet volume, and radio-frequency (RF) power are investigated, and it has been shown that SAW excitation frequency influences the SAWattenuation length, lSAW , and hence the acoustic energy absorbed by liquid. It has also been observed that an increase of excitation frequency generally enhances the SAW streaming behavior. However, when the frequency exceeds a critical value that depends on the RF power applied to the SAW device, weaker acoustic streaming is observed resulting in less effective acoustic mixing inside the droplet. This critical value is characterised by a dimensionless ratio of droplet radius to SAWattenuation length, i.e., Rd/lSAW . With a mean value of Rd/lSAW  ≈ 1, a fast and efficient mixing can be induced, even at the lowest RF power of 0.05 mW studied in this paper. On the other hand, for the Rd/lSAW ratios much larger than ∼1, significant decreases in streaming velocities were observed, resulting in a transition from regular (strong) to irregular (weak) mixing/flow. This is attributed to an increased absorption rate of acoustic wave energy that leaks into the liquid, resulting in a reduction of the acoustic energy radiated away from the SAW interaction region towards the droplet free surface. It has been demonstrated in this study that a fast and efficient mixing process with a smaller RF power could be achieved if the ratio of Rd/lSAW  ≤ 1 in the SAW-droplet based microfluidics

Enhanced stability and efficiency in hole-transport-layer-free CsSnI3 perovskite photovoltaics

Photovoltaics based on tin halide perovskites have not yet benefitted from the same intensive research effort that has propelled lead perovskite photovoltaics to >20% power conversion efficiency, due to the susceptibility of tin perovskites to oxidation, the low energy of defect formation and the difficultly in forming pin-hole free films. Here we report CsSnI3 perovskite photovoltaic devices without a hole-selective interfacial layer that exhibit a stability 10 times greater than devices with the same architecture using methylammonium lead iodide perovskite, and the highest efficiency to date for a CsSnI3 photovoltaic: 3.56%. The latter results in large part from a high device fill-factor, achieved using a strategy that removes the need for an electron blocking layer or an additional processing step to minimise the pinhole density in the perovskite film, based on co-depositing the perovskite precursors with SnCl2. These two findings raise the prospect that this class of lead-free perovskite photovoltaic may yet prove viable for applications

Relations of Social Maturity, Executive Function, and Self-Efficacy Among Deaf University Students

This study explored possible associations of social maturity, executive function (EF), self-efficacy, and communication variables among deaf university students, both cochlear implant (CI) users and nonusers. Previous studies have demonstrated differences between deaf and hearing children and young adults in EF and EF-related social and cognitive functioning. EF differences also have been demonstrated between hearing children and deaf children who use CIs. Long-term influences of cochlear implantation in the social domain largely have not been explored, but were examined in the present study in terms of social maturity, as it might be related to EF and communication variables. Replicating and extending recent findings, social maturity was found to be related to somewhat different aspects of EF in CI users, deaf nonusers, and hearing students, but unrelated to hearing status, CI use, or deaf students' use of sign language versus spoken language. Self-efficacy proved a predictor of self-reported socially mature and immature behaviours for all groups. Individuals' beliefs about their parents' views of such behaviours was a potent predictor of behaviours for deaf CI users and those deaf students who reported sign language as their best form of communication

Are providers prepared for genomic medicine: interpretation of Direct-to-Consumer genetic testing (DTC-GT) results and genetic self-efficacy by medical professionals

Background: Precision medicine is set to deliver a rich new data set of genomic information. However, the number of certified specialists in the United States is small, with only 4244 genetic counselors and 1302 clinical geneticists. We conducted a national survey of 264 medical professionals to evaluate how they interpret genetic test results, determine their confidence and self-efficacy of interpreting genetic test results with patients, and capture their opinions and experiences with direct-to-consumer genetic tests (DTC-GT). Methods: Participants were grouped into two categories, genetic specialists (genetic counselors and clinical geneticists) and medical providers (primary care, internists, physicians assistants, advanced nurse practitioners, etc.). The survey (full instrument can be found in the Additional file 1) presented three genetic test report scenarios for interpretation: a genetic risk for diabetes, genomic sequencing for symptoms report implicating a potential HMN7B: distal hereditary motor neuropathy VIIB diagnosis, and a statin-induced myopathy risk. Participants were also asked about their opinions on DTC-GT results and rank their own perceived level of preparedness to review genetic test results with patients. Results: The rates of correctly interpreting results were relatively high (74.4% for the providers compared to the specialist’s 83.4%) and age, prior genetic test consultation experience, and level of trust assigned to the reports were associated with higher correct interpretation rates. The self-selected efficacy and the level of preparedness to consult on a patient’s genetic results were higher for the specialists than the provider group. Conclusion: Specialists remain the best group to assist patients with DTC-GT, however, primary care providers may still provide accurate interpretation of test results when specialists are unavailable

Examining Measurement Reactivity in Daily Diary Data On Substance Use: Results From a Randomized Experiment

The debate about whether measurement reactivity exists in daily diary research on substance use is still unsettled due to the issues of study design and statistical methodology. This study proposes a time-varying effect model (TVEM) that characterizes the trajectory of substance use behaviors with nonparametric functions determined by the data rather than imposes presumed parametric functions. It also allows researchers to investigate the effect of measurement reactivity on not only the likelihood of using substances but also the amount of substance use. The TVEM was applied to analyze diary data on alcohol and marijuana use collected from an experiment, which randomized 307 participants in Michigan into daily and weekly assessment schedules during 2014-2016. This study found short-term measurement reactivity on alcohol use, but did not find a significant reactivity effect on marijuana use. The daily group had smaller odds of abstinence from drinking but lower expected drinking quantity in the first week of assessment, which dissipated by the second week. The results indicate that although daily self-monitoring could have short-term reactivity on substance use behaviors that tend to fluctuate across days, such as alcohol use, it does not affect substance use behaviors that are quite consistent, such as marijuana use. Our findings imply that although daily monitoring of drinking may motivate people to reduce the quantity consumed once they start to drink, it may also arouse their desire to start drinking. Yet, both effects tend to last only one week, as participants accommodate to the monitoring by the second week

Integration of Electrodeposited Ni-Fe in MEMS with Low-Temperature Deposition and Etch Processes

This article presents a set of low-temperature deposition and etching processes for the integration of electrochemically deposited Ni-Fe alloys in complex magnetic microelectromechanical systems, as Ni-Fe is known to suffer from detrimental stress development when subjected to excessive thermal loads. A selective etch process is reported which enables the copper seed layer used for electrodeposition to be removed while preserving the integrity of Ni-Fe. In addition, a low temperature deposition and surface micromachining process is presented in which silicon dioxide and silicon nitride are used, respectively, as sacrificial material and structural dielectric. The sacrificial layer can be patterned and removed by wet buffered oxide etch or vapour HF etching. The reported methods limit the thermal budget and minimise the stress development in Ni-Fe. This combination of techniques represents an advance towards the reliable integration of Ni-Fe components in complex surface micromachined magnetic MEMS