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

An introduction to the Cambridge advanced modeller

Complex products and their development processes may be viewed as systems, whose different aspects can be modelled as networks of interactions between elements in different domains. Many approaches have been proposed to explore, support or improve engineering processes by building such models. Developing these approaches, and applying them to problems of realistic complexity, often requires specialised computer software suitable for manipulating large data sets. However, creating suitable tools can be difficult–because software development is time-consuming and requires skills that many researchers and practitioners do not possess. We developed an approach which aims to address this problem by recognising the iterative nature of modelling research and its often tight coupling with prototype software development, and by reducing the effort of software prototyping and revision within this process. The approach is enabled by, and embodied in, the Cambridge Advanced Modeller (CAM)–a configurable software platform we have developed, refined and applied over several years and through a number of research projects

The Herts and Minds study: feasibility of a randomised controlled trial of Mentalizationbased Treatment versus usual care to support the wellbeing of children in foster care

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Background: There is a lack of well-designed randomized controlled trials (RCTs) to investigate the efficacy of psychological therapies for children in foster care with emotional and behavioural difficulties. Mentalization-based therapy (MBT) focuses on supporting the carer-child relationship by promoting reflective capacity. This study examined the feasibility and acceptability of an RCT of MBT, delivered in a family-format, for children who are in foster care in the UK. Method: Herts and Minds was a phase II, blinded feasibility RCT with follow-up of at 12 and 24 weeks post-randomisation. Participants were children (age 5-16) in foster care referred to a targeted mental health service, who had some level of difficulty as identified by the Strengths and Difficulties Questionnaire (SDQ). Aims were to assess: the feasibility of recruitment processes and study uptake; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; establish acceptability and credibility of MBT as an intervention for children in foster care; establish feasibility and acceptability to participants of conducting an RCT; and estimate the likely treatment efficacy effect size. Participants were randomly allocated to either MBT (n = 15) or Usual Clinical Care (UCC) (n = 21) individually or in sibling groups. A range of qualitative and quantitative data was gathered to assess feasibility. Results: Feasibility was established with regard to: capacity to recruit participants to a study; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; acceptability and credibility of MBT; and feasibility and acceptability to participants of conducting an RCT. A number of issues made it difficult to estimate a likely treatment efficacy effect size. Conclusion: With modifications, it is feasible to run an RCT of MBT for children in foster care. Both the therapy and research design were acceptable to participants, but modifications may be needed regarding both the timing of assessments and the identification of appropriate primary outcome measures. Given the lack of evidenced based therapies for this population, such a trial would be a significant contribution to the field. Findings may be useful for other groups planning clinical trials of psychological therapies for children in foster care. Trial registration: ISRCTN 90349442. The trial was retrospectively registered on 6 May 2016.Peer reviewedFinal Published versio

Helical spring holder assembly

A helically-threaded spring holder on which a helically wound spring is mounted has a groove formed in one side of the thread at the end where the spring engages the spring holder. The groove relieves the portion of the side in which it is formed from restricting the spring against axial movement during deflection of the spring. The circumferential length of this groove is chosen to establish the number of spring coils which can be deflected without contacting the side of the thread. The end of the thread is also made rigid to prevent flexing thereof during maximal elongation of the spring

Multi-color carrier-envelope-phase stabilization for high-repetition-rate multi-pulse coherent synthesis

Using a zero-offset carrier-envelope locking technique, we have synthesized an octave-spanning composite frequency comb exhibiting 132-attosecond timing jitter between the constituent pulses over a one-second observation window. In the frequency domain, this composite comb has a modal structure and coherence which are indistinguishable from those of a comb that might be produced by a hypothetical single mode locked oscillator of equivalent bandwidth. The associated phase stability enables the participating multi-color pulse sequences to be coherently combined, representing an example of multi-pulse synthesis using a femtosecond oscillator

A causal look into the quantum Talbot effect

A well-known phenomenon in both optics and quantum mechanics is the so-called Talbot effect. This near field interference effect arises when infinitely periodic diffracting structures or gratings are illuminated by highly coherent light or particle beams. Typical diffraction patterns known as quantum carpets are then observed. Here the authors provide an insightful picture of this nonlocal phenomenon as well as its classical limit in terms of Bohmian mechanics, also showing the causal reasons and conditions that explain its appearance. As an illustration, theoretical results obtained from diffraction of thermal He atoms by both N-slit arrays and weak corrugated surfaces are analyzed and discussed. Moreover, the authors also explain in terms of what they call the Talbot-Beeby effect how realistic interaction potentials induce shifts and distortions in the corresponding quantum carpets.Comment: 12 pages, 6 figure

The Spirit Mercurius of Rabelais

The purpose of this paper is to investigate the presence of salt and Mercurius in Rabelais\u27 Gargantua and Pantagruel. This element and this alchemical personification of the process of transformation will be viewed in light of works of psychoanalysis and alchemical symbolism by C. G. Jung. To broach a study of this type implies an overlap of psychoanalytical theory and critical literary theory. This study is being done in order to ascertain the conscious and subconscious influence of the author

Debris discs around nearby Solar analogues

An unbiased search for debris discs around nearby Sun-like stars is reported. Thirteen G-dwarfs at 12-15 parsecs distance were searched at 850 \umum wavelength, and a disc is confirmed around HD 30495. The estimated dust mass is 0.008 M$_{\oplus}$ with a net limit \la 0.0025 M$_{\oplus}$ for the average disc of the other stars. The results suggest there is not a large missed population of substantial cold discs around Sun-like stars -- HD 30495 is a bright rather than unusually cool disc, and may belong to a few hundred Myr-old population of greater dust luminosity. The far-infared and millimetre survey data for Sun-like stars are well fitted by either steady state or stirred models, provided that typical comet belts are comparable in size to that in the Solar System.Comment: published in MNRA