In Search of New Perspectives in Cancer Genetics Services: Exploring Use of Genetic Counseling Among a Group of Young Breast Cancer Survivors

Breast cancer associated with mutations in the breast cancer genes BRCA1 and BRCA2 often occurs at an earlier age and individuals with a mutation have increased risk for developing breast, ovarian, and other cancers. The cancers may be more difficult to treat, have higher rates of recurrence, and have poor outcomes. Genetic counseling can facilitate informed decision-making about risk-reducing strategies that have shown to be effective but carry their own risks. However, genetic counseling use is low, even among individuals considered high risk for having a BRCA mutation. The reason for this is not clear. Existing knowledge is limited by 1) inconsistent findings, 2) potential bias from highly selected samples (e.g., recruited only African American women, or only Hispanic women, or patients at a cancer risk evaluation clinic at an academic facility), 3) inadequate representation of rural populations, 4) small sample sizes, and 5) cross-sectional design. This dissertation describes a secondary analysis of existing data from a group of young breast cancer survivors identified using a state cancer registry. Of 859 participants, 281 (32.7%) used genetic counseling. Of 546 participants who did not use genetic counseling, 357 (65.4%) reported that “No one ever suggested it.” In fact, genetic counseling is recommended for all participants in this study due to their personal diagnosis of breast cancer at age younger than 50. There was no significant difference in genetic counseling use between medically served and underserved participants (=.05, p=.32). However, the analysis was underpowered and this finding should be interpreted with caution. Variables that showed positive associations with counseling use could be interpreted as facilitators and were the same for served and underserved groups: perceived positive consequences for family, perceived positive consequences for self, and provider recommended. The associations were moderate to strong with Pearson’s r>.50. Variables that showed negative associations could be interpreted as barriers. The strongest associations were still weak with Pearson’s r<-.25. These were: perceived negative consequences to self (among served) and convenience factors (among underserved). Logistic regression was done using data from the entire sample. The following were significant and increased odds of using genetic counseling: having an additional risk factor (OR=2.292; 95% CI=1.604-3.275; p=.000), income (OR=1.356; 95% CI=1.091-1.686; p=.006). Knowledge of breast cancer genetics also showed increased odds of using genetic counseling (OR=1.208; 95% CI=1.137-1.282; p=.000) but because 32.7% of participants already received genetic counseling at the time of the study, the knowledge score may be an outcome of genetic counseling rather than a predictor. Motivation to comply with healthcare provider showed lower odds of using genetic counseling (OR=.360; 95% CI=.162-.803; p=.013). Challenges in operationalizing variables due to being a secondary analysis led to exclusion of some variables from analyses and were a limitation of the study. Triandis’s model of interpersonal behavior still shows promise as a framework for guiding research on the predictors (barriers and facilitators) of cancer genetic counseling use. To prevent worsening disparities in the context of having a heritable mutation for cancer, additional work needs to ensure equitable opportunity to use genetic counseling. Prospective studies might oversample for rural populations and individuals of racial and ethnic minority background. Integration into the health care system, measured by regular use of preventive health services, may be a helpful criterion for determining underserved status in the context of the specialized health service of cancer genetic counseling.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/145950/1/cherylsl_1.pd

Fantasy Versus Fairy Tale: How Modern Fairy Tale Variants Measure up to One of the Greatest Literary Traditions of All Time.

This thesis will examine both the history of the fairy tale and the modern adaptations of these popular stories in order to illustrate how fairy tales have evolved into their modern counterparts. The implications and circumstances of several recent variants are questioned and compared to a concise definition of the fairy tale. It is determined that, although the modern versions resemble classic fairy tales, they are not a detriment to the tradition of the tales, and may, in fact, begin their own literary tradition

Diet and subsistence patterns in the later iron age of South Africa : an analysis of stable carbon and nitrogen isotopes and the incidence of dental caries

Bibliography: pages 103-116.Current archaeological perspectives on the change in Later Iron Age diet and subsistence patterns and the subsequent affect on the economy, are re-examined using isotopic and caries analyses. Existing perspectives have focused mainly on material archaeological evidence and are not reflective of diet at the individual level. Consequently, the focus of archaeological research has been biased towards the importance of cattle in subsistence patterns and the economy, and the role of agriculture has not been as thoroughly investigated. In order to address this problem the isotopic signatures of 72skeletal remains, and the pattern of carious lesions of 44 of those individuals, were examined. The samples were drawn from different ethnic groups and geographical/climatic regions. Skeletons were analysed for both ᵟ¹³C and ᵟ¹⁵ N values in order to better reflect both the level of cultigen consumption and the relative importance of animal protein in the diet. The results were initially examined at an individual level, within the biomes from which they were drawn, to determine subsistence type. The diets of persons and ethnic groups was then compared to archaeological and ethnographical research. Combination of results demonstrates a trend towards more enriched ᵟ¹³C values over time. Although there were differences between individuals diets, there is an overall increasing consumption (and therefore reliance) on domesticated grains, whilst the consumptive levels of animal protein remain relatively constant over the last 1000 years. Consequently, the context of previously undated skeletal material was founded on the trend towards increasing ᵟ¹³C values during the second millennium. The creation of a set of criteria based on pattern, type and extent on carious lesions, has provided a further means of assessing the carbohydrate intake level of individuals. An increase in both ᵟ¹³C values and the incidence of caries during the 18th century, may reflect the introduction of maize in the interior of South Africa, via Delagoa Bay. It is suggested that population growth and increased demand resulted in maize replacing indigenous African cultigens to become a staple food source after this period. In conclusion it is postulated that further re-examination of the current outlook should be undertaken as it is clear from this study that the Later Iron Age is heterogenous with comparable but distinct dietary levels

Metric Variation on the Arikara Pelvis

Metric variation in the innominates, sacra and articulated pelves of the South Dakota Plains Indian group, the Arikara, are analyzed in an attempt to delineate biological relationships. The specimens examined represent 10 archaeological sites ranging in date from A.D. 1600 to 1832. The following sample sizes for innominate, sacrum and articulated pelvis data sets are employed: 292, 305, and 151, respectively. The data are analyzed utilizing univariate as well as multivariate statistical procedures. The results indicate that consistent within-group patterning exists. Common elements of pelvic structure can therefore be identified. Group analysis results indicate that temporal patterning can be identified on the innominate and articulated pelvis. In general, these results are consistent with those of several Arikara craniometric studies. Several explanations, namely obstetrical significance, demographic age structure differences, and gene flow, for the observed patterning are explored. Neither alone, however, appears to completely explain the patterning noted. An analysis of the patterns of sexual dimorphism expressed in the Arikara groups examined indicates that nutritional factors alone are not responsible for the noted patterning. The results tend to more strongly support a greater genetic component to ranging patterns of Arikara sexual dimorphism and are also consistent with the resent results obtained for the Arikara postcranial skeleton. Future studies employing data from other Plains Indians groups are designed to delineate the environmental and genetic components of variation of the boney pelvis as necessary in order to disprove or substantiate the present results. Data collection for this work was supported by NSF Grant BNS 8102650

Meeting the Needs of the Nontraditional Student:: A Study of the Effectiveness of Synchronous Online Writing Center Tutorials

In the fall of 2007, 3.9 million students took at least one online course, reflecting an online education growth rate of 12.9 percent. Many online students are nontraditional, possessing one or more of the following characteristics: delayed enrollment, part time attendance, full-time worker, financially independent as related to financial aid, dependents other than a spouse, single parent, a GED or did not finish high school. While these students bring diversity and life experience to the classroom, they are often ill-prepared for college writing. Though they need help, hectic schedules make it difficult to meet with a writing consultant. This study investigates whether synchronous writing center tutorials can effectively address this client population's needs. Currently, there is a dearth of scholarship relating to online writing tutorials, particularly synchronous tutorials. This two-year study of 189 face-to-face clients and 90 online clients employs quantitative and qualitative research to determine (1) the demographic profile of online users, (2) reasons clients meet online, (3) help sought online, (4) online client preparation, (5) client perceptions of online sessions, and (6) advantages and disadvantages of online sessions. Data were culled from a client questionnaire, online session logs, and consultant and client interviews. Statistically significant differences in client demographics between face-to-face and online users were found in age, ethnicity, and gender: online clients are younger, are more likely to be white, and are more likely to be male. Clients meet online primarily for convenience; however, there is no correlation between distance from campus and online client usage. There were no significant differences in client preparation. Spelling was the only statistically significant category in help sought: online clients seek more spelling help than their face-to-face counterparts. Face-to-face and online clients both viewed their sessions as successful with no statistically significant difference between the groups. Over one-third of clients reported technical problems during their session, and some clients expressed a preference for the emphatic cues found in face-to-face consultations. Advantages of online sessions included assistance with word processing features, the ability to make revisions to the working document, and the ability to record the session

Family Preservation: The Parents’ Perceptions

This research documents the perspective of 100 parents who had an open case with the Department of Children and Family Service’s (DCFS) regarding their family’s well-being, reasons for referral and satisfaction with services. Two DCFS services, Family Preservation (FP) and routine Family Maintenance (FM) were examined using standardized instruments. Parents’ responses regarding reasons for involvement with the system differed from DCFS administrative data. FP parents had more children, were more likely to be monolingual Spanish speakers, and perceived greater improvement in discipline and emotional care of children and housing than FM parents. FP parents reported being satisfied with services. Implications include supporting community based culturally competent FP programs