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The role of disease perceptions and results sharing in psychological adaptation after genetic susceptibility testing: the REVEAL Study
Ashida, Sato
Koehly, Laura M
Roberts, J Scott
Chen, Clara A
Hiraki, Susan
Green, Robert C
European Journal of Human Genetics
This study evaluates the extent to which psychological adaptation (validated measures of depressive symptoms, anxiety, and test-specific distress) after genetic susceptibility testing is influenced by changes in beliefs about Alzheimer's disease (AD) and sharing of test results with others. Adult children of AD patients (N=269) from a randomized clinical trial involving genetic testing for apolipoprotein E (APOE) provided information before, as well as 6 weeks and 12 months after results disclosure. The levels of adaptation varied highly among participants at 12-month assessment. Participants who learned that they were ɛ4 negative (lower risk) had a reduction in perceived risk and concern about developing AD compared with those who learned that they were ɛ4 positive. Those who received results through an extended educational protocol (three in-person visits) had a larger decline in AD concern than those in a condensed protocol (educational brochure and two in-person visits). Increase in AD concern 6 weeks after disclosure was associated with increase in depression scores (b=0.20, P<0.01) and anxiety levels (b=0.20, P<0.01), and higher distress associated with AD genetic testing (b=0.18, P=0.02) 1 year after testing. Increase in perceived risk (b=0.16, P=0.04) was also associated with higher AD genetic testing distress. Sharing the test results with health professionals and friends (but not family) was associated with decrease in depression (b = −0.11, P = 0.05) and anxiety levels (b=−0.16, P<0.01), respectively after a year. Enhancing discussion with regard to risks and concerns about AD during pretesting counseling and obtaining support through sharing the results after testing may help facilitate test recipients' long-term psychological adaptation.
susceptibility genetic testing; AD; APOE; results disclosure; communication; risk perceptions
Related Articles
Disclosure of APOE Genotype for Risk of Alzheimer's Disease
Green, Robert C.
Roberts, J. Scott
Cupples, L. Adrienne
Relkin, Norman R.
Whitehouse, Peter J.
Brown, Tamsen
Eckert, Susan LaRusse
Butson, Melissa
Sadovnick, A. Dessa
Quaid, Kimberly A.
Chen, Clara
Cook-Deegan, Robert
Farrer, Lindsay A.
Annas, G.
Bhatt, D.
Biesecker, B.
Blacker, D.
Cox, E.
Christensen, K.
Davis, J.G.
Fasaye, G.-A.
Griffith, P.
Hiraki, S.
Juengst, E.
Karlawish, J.
Linnenbringer, E.
Marteau, T.
Neimeister, E.
Obisesan, T.
Petersen, R.
Post, S.
Ravdin, L.
Reilly, R.P.
Roter, D.
Royal, C.
Stern, R.
Topol, E.
Uhlmann, W.
Williams, M.
Wright, L.
The New England journal of medicine
The apolipoprotein E (APOE) genotype provides information on the risk of Alzheimer's disease, but the genotyping of patients and their family members has been discouraged. We examined the effect of genotype disclosure in a prospective, randomized, controlled trial.
We randomly assigned 162 asymptomatic adults who had a parent with Alzheimer's disease to receive the results of their own APOE genotyping (disclosure group) or not to receive such results (nondisclosure group). We measured symptoms of anxiety, depression, and test-related distress 6 weeks, 6 months, and 1 year after disclosure or nondisclosure.
There were no significant differences between the two groups in changes in time-averaged measures of anxiety (4.5 in the disclosure group and 4.4 in the nondisclosure group, P = 0.84), depression (8.8 and 8.7, respectively; P = 0.98), or test-related distress (6.9 and 7.5, respectively; P=0.61). Secondary comparisons between the non-disclosure group and a disclosure subgroup of subjects carrying the APOE ε4 allele (which is associated with increased risk) also revealed no significant differences. However, the ε4-negative subgroup had a significantly lower level of test-related distress than did the ε4-positive subgroup (P=0.01). Subjects with clinically meaningful changes in psychological outcomes were distributed evenly among the nondisclosure group and the ε4-positive and ε4-negative subgroups. Baseline scores for anxiety and depression were strongly associated with post-disclosure scores of these measures (P<0.001 for both comparisons).
The disclosure of APOE genotyping results to adult children of patients with Alzheimer's disease did not result in significant short-term psychological risks. Test-related distress was reduced among those who learned that they were APOE ε4–negative. Persons with high levels of emotional distress before undergoing genetic testing were more likely to have emotional difficulties after disclosure. (ClinicalTrials.gov number, NCT00571025.)
Related Articles
Presymptomatic testing for BRCA1 and BRCA2: how distressing are the pre-test weeks?
Lodder, L
Frets, P
Trijsburg, R
Meijers-Heijboer, E
Klijn, J
Duivenvoorden, H
Tibben, A
Wagner, A
van der Meer, C A
Devilee, P
Cornelisse, C
Niermeijer, M
m other,
Journal of Medical Genetics
Presymptomatic DNA testing for autosomal dominant hereditary breast/ovarian cancer (HBOC) became an option after the identification of the BRCA1 and BRCA2 genes in 1994-1995. Healthy female mutation carriers have a high lifetime risk for breast cancer (56-87%) or ovarian cancer (10-60%) and may opt for intensive breast and ovary surveillance or prophylactic surgery (mastectomy/oophorectomy). We studied general and cancer related distress in 85 healthy women with a 25% or 50% risk of being carrier of a BRCA1/BRCA2 gene mutation and 66 partners in the six to eight week period between genetic counselling/blood sampling and disclosure of the test result. Questionnaire and interview data are analysed. Associations are explored between levels of distress and (1) expected consequences of being identified as a mutation carrier, (2) personality traits, (3) sociodemographic variables, and (4) experiences related to HBOC. Mean pre-test anxiety and depression levels in women at risk of being a carrier and partners were similar to those of a normal Dutch population. In about 25% of those at risk of being a carrier and 10% of the partners, increased to high levels of general and cancer related distress were found. Increased levels of distress were reported by women who (1) anticipated an increase in problems after an unfavourable test outcome, (2) considered prophylactic mastectomy if found to be mutation carrier, (3) had an unoptimistic personality, (4) tended to suppress their emotions, (5) were younger than 40 years, and (6) were more familiar with the serious consequences of HBOC. Recently obtained awareness of the genetic nature of cancer in the family was not predictive of distress. The majority of the women and their partners experienced a relatively calm period before the disclosure of the test result and seemed to postpone distressing thoughts until the week of disclosure of the result. The low distress levels may partly be explained by the use of strategies to minimise the emotional impact of a possibly unfavourable test outcome. However, a minority reported feeling very distressed. Several factors were found to be predictive for increased distress levels. Keywords: genetic testing; cancer; BRCA1/BRCA2; psychological distress
Related Articles
Does Preoperative Psychologic Distress Influence Pain, Function, and Quality of Life After TKA?
Utrillas-Compaired, Alfonso
De la Torre-Escuredo, Basilio J.
Tebar-Martínez, Ana J.
Asúnsolo-Del Barco, Ángel
Clinical Orthopaedics and Related Research
Preoperative psychologic distress is considered to be a risk factor for clinical dissatisfaction stemming from persistent pain and physical limitations after elective orthopaedic procedures such as lower-extremity arthroplasty. However, the degree to which psychologic distress, specifically in the form of anxiety and depression, influences surgical results has been poorly characterized.
We analyzed the effect of preoperative psychologic distress on changes in pain, function, and quality of life 1 year after elective TKA.
In this prospective cohort study, we assessed patients who underwent TKAs in 2009 and 2010. Before surgery, patients completed the Folstein Mini Mental Test, the Hospital Anxiety and Depression Scale (HAD), The Knee Society Score©, the WOMAC quality-of-life questionnaire, and the VAS for pain. The patients were divided into two groups based on the degree of psychologic distress on the HAD Scale, and the groups were compared in terms of the above-listed clinical outcomes tools 1 year after surgery using multivariate linear models. Two hundred sixty-three patients met the inclusion criteria, and 202 (77%) completed the study protocol.
The presence of preoperative psychologic distress did not influence 1-year postoperative pain assessment (average reduction in pain, 40.33; 95% CI, 36.9–43.8; p = 0.18). The only factor influencing change in pain experienced by patients was the preoperative pain recorded (R2 = 0.31; β = −0.82; p < 0.001). The patients experiencing preoperative psychologic distress obtained poorer outcomes in function (R2 = 0.16; β = −5.62; p = 0.001) and quality of life (R2 = 0.09; β = −0.46; p < 0.001) 1 year after receiving TKA.
The presence of preoperative psychologic distress is associated with worse 1-year outcomes for function and quality of life in patients undergoing TKA. Interventions designed to reduce psychologic distress may be indicated for patients to undergo this type of surgery, and incorporation of these data into discussions with patients may facilitate informed and shared decision making regarding the surgical treatment of knee osteoarthritis.
Level of Evidence
Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
Related Articles
Comparing test-specific distress of susceptibility versus deterministic genetic testing for Alzheimer's disease
Cassidy, Michael R.
Roberts, J. Scott
Bird, Thomas D.
Steinbart, Ellen J.
Cupples, L. Adrienne
Chen, Clara A.
Linnenbringer, Erin
Green, Robert C.
Alzheimer's & dementia : the journal of the Alzheimer's Association
Genetic risk for Alzheimer's disease (AD) may be conferred by the susceptibility polymorphism apolipoprotein E (APOE), where the ε4 allele increases the risk of developing late-onset Alzheimer's disease but is not a definitive predictor of the disease, or by autosomal dominant mutations (e.g., the presenilins), which almost inevitably result in early-onset familial Alzheimer's disease. The purpose of this study was to compare the psychological impact of using these two different types of genetic information to disclose genetic risk for AD to family members of affected patients.
Data were compared from two separate protocols. The Risk Evaluation and Education for Alzheimer's Disease (REVEAL) Study is a randomized, multi-site clinical trial that evaluated the impact of susceptibility testing for Alzheimer's disease with APOE in 101 adult children of Alzheimer's disease patients. A separate study, conducted at the University of Washington, assessed the impact of deterministic genetic testing by disclosing presenilin-1, presenilin-2, or TAU genotype to 22 individuals at risk for familial Alzheimer's disease or frontotemporal dementia. In both protocols, participants received genetic counseling and completed the Impact of Event Scale (IES), a measure of test-specific distress. Scores were analyzed at the time point closest to one year post-disclosure at which IES data were available. The role of genetic test result (positive vs. negative) and type of genetic testing (deterministic vs. susceptibility) in predicting log-transformed IES scores was assessed with linear regression, controlling for age, gender, and time from disclosure.
Subjects from the REVEAL Study who learned that they were positive for the susceptibility gene APOE ε4+ experienced similar, low levels of test-specific distress compared to those who received positive results of deterministic testing in the University of Washington study (p= 0.78). APOE ε4+ individuals in the susceptibility protocol experienced more test-specific distress than those who tested ε4− in the same study (p= 0.04); however, among those receiving deterministic test disclosure, the subjects who received positive results did not experience significantly higher levels of distress when compared to those who received negative results (p= 0.88).
The findings of this preliminary study, with limited sample size, suggest that the test-related distress experienced by those receiving positive results for a deterministic mutation is similar to the distress experienced by those receiving positive results from genetic susceptibility testing, and that the majority of participants receiving genotype disclosure do not experience clinically significant distress as indicated by IES scores one year after learning of their test results.
genetic susceptibility testing; deterministic testing; Alzheimer's disease; APOE; genetic counseling
Related Articles
Distress among Women Receiving Uninformative BRCA1/2 Results: 12-month Outcomes
O'Neill, Suzanne C.
Rini, Christine
Goldsmith, Rachel
Valdimarsdottir, Heiddis
Cohen, Lawrence H.
Schwartz, Marc D.
Few data are available regarding the long-term psychological impact of uninformative BRCA1/2 test results. This study examines change in distress from pretesting to 12-months post-disclosure, with medical, family history, and psychological variables, such as pretesting perceived risk of carrying a deleterious mutation prior to testing and primary and secondary appraisals, as predictors.
209 women with uninformative BRCA1/2 test results completed questionnaires at pretesting and 1-, 6-, and 12-months post-disclosure, including measures of anxiety and depression, cancer-specific and genetic testing distress. We used a mixed models approach to predict change in post-disclosure distress.
Distress declined from pretesting to 1-month post-disclosure, but remained stable thereafter. Primary appraisals predicted all types of distress at 1-month post-disclosure. Primary and secondary appraisals predicted genetic testing distress at 1-month as well as change over time. Receiving a variant of uncertain clinical significance (VUCS) and entering testing with a high expectation for carrying a deleterious mutation predicted genetic testing distress that persisted through the year after testing.
As a whole, women receiving uninformative BRCA1/2 test results are a resilient group. For some women, distress experienced in the month after testing does not dissipate. Variables, such as heightened pretesting perceived risk and cognitive appraisals, predict greater likelihood for sustained distress in this group and could be amenable to intervention.
Related Articles
Development of a process to disclose amyloid imaging results to cognitively normal older adult research participants
Harkins, Kristin
Sankar, Pamela
Sperling, Reisa
Grill, Joshua D
Green, Robert C
Johnson, Keith A
Healy, Megan
Karlawish, Jason
Alzheimer's Research & Therapy
The objective of this study was to develop a process to maximize the safety and effectiveness of disclosing Positron Emission Tomography (PET) amyloid imaging results to cognitively normal older adults participating in Alzheimer's disease secondary prevention studies such as the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) Study.
Using a modified Delphi Method to develop consensus on best practices, we gathered and analyzed data over three rounds from experts in two relevant fields: informed consent for genetic testing or human amyloid imaging.
Experts reached consensus on (1) text for a brochure that describes amyloid imaging to a person who is considering whether to undergo such imaging in the context of a clinical trial, and (2) a process for amyloid PET result disclosure within such trials. Recommendations included: During consent, potential participants should complete an educational session, where they receive verbal and written information covering what is known and unknown about amyloid imaging, including possible results and their meaning, implications of results for risk of future cognitive decline, and information about Alzheimer's and risk factors. Participants should be screened for anxiety and depression to determine suitability to receive amyloid imaging information. The person conducting the sessions should check comprehension and be skilled in communication and recognizing distress. Imaging should occur on a separate day from consent, and disclosure on a separate day from imaging. Disclosure should occur in person, with time for questions. At disclosure, investigators should assess mood and willingness to receive results, and provide a written results report. Telephone follow-up within a few days should assess the impact of disclosure, and periodic scheduled assessments of depression and anxiety, with additional monitoring and follow-up for participants showing distress, should be performed.
We developed a document for use with potential study participants to describe the process of amyloid imaging and the implications of amyloid imaging results; and a disclosure process with attention to ongoing monitoring of both mood and safety to receive this information. This document and process will be used in the A4 Study and can be adapted for other research settings.
Related Articles
Hopefulness predicts resilience after hereditary colorectal cancer genetic testing: a prospective outcome trajectories study
Ho, Samuel MY
Ho, Judy WC
Bonanno, George A
Chu, Annie TW
Chan, Emily MS
BMC Cancer
Background -
Genetic testing for hereditary colorectal cancer (HCRC) had significant psychological consequences for test recipients. This prospective longitudinal study investigated the factors that predict psychological resilience in adults undergoing genetic testing for HCRC.
Methods -
A longitudinal study was carried out from April 2003 to August 2006 on Hong Kong Chinese HCRC family members who were recruited and offered genetic testing by the Hereditary Gastrointestinal Cancer Registry to determine psychological outcomes after genetic testing. Self-completed questionnaires were administered immediately before (pre-disclosure baseline) and 2 weeks, 4 months and 1 year after result disclosure. Using validated psychological inventories, the cognitive style of hope was measured at baseline, and the psychological distress of depression and anxiety was measured at all time points.
Results -
Of the 76 participating subjects, 71 individuals (43 men and 28 women; mean age 38.9 ± 9.2 years) from nine FAP and 24 HNPCC families completed the study, including 39 mutated gene carriers. Four patterns of outcome trajectories were created using established norms for the specified outcome measures of depression and anxiety. These included chronic dysfunction (13% and 8.7%), recovery (0% and 4.3%), delayed dysfunction (13% and 15.9%) and resilience (76.8% and 66.7%). Two logistic regression analyses were conducted using hope at baseline to predict resilience, with depression and anxiety employed as outcome indicators. Because of the small number of participants, the chronic dysfunction and delayed dysfunction groups were combined into a non-resilient group for comparison with the resilient group in all subsequent analysis. Because of low frequencies, participants exhibiting a recovery trajectory (n = 3 for anxiety and n = 0 for depression) were excluded from further analysis. Both regression equations were significant. Baseline hope was a significant predictor of a resilience outcome trajectory for depression (B = -0.24, p < 0.01 for depression); and anxiety (B = -0.11, p = 0.05 for anxiety).
Conclusions -
The current findings suggest that hopefulness may predict resilience after HCRC genetic testing in Hong Kong Chinese. Interventions to increase the level of hope may be beneficial to the psychological adjustment of CRC genetic testing recipients.
Related Articles
Genetic testing of newborns for type 1 diabetes susceptibility: a prospective cohort study on effects on maternal mental health
Aas, Kaja K
Tambs, Kristian
Kise, Marit S
Magnus, Per
Rønningen, Kjersti S
BMC Medical Genetics
Concerns about the general psychological impact of genetic testing have been raised. In the Environmental Triggers of Type 1 Diabetes (MIDIA) study, genetic testing was performed for HLA-conferred type 1 diabetes susceptibility among Norwegian newborns. The present study assessed whether mothers of children who test positively suffer from poorer mental health and well-being after receiving genetic risk information about their children.
The study was based on questionnaire data from the Norwegian Mother and Child Cohort (MoBa) study conducted by the Norwegian Institute of Public Health. Many of the mothers in the MoBa study also took part in the MIDIA study, in which their newborn children were tested for HLA-conferred genetic susceptibility for type 1 diabetes. We used MoBa questionnaire data from the 30th week of pregnancy (baseline) and 6 months post-partum (3-3.5 months after disclosure of test results). We measured maternal symptoms of anxiety and depression (SCL-8), maternal self-esteem (RSES), and satisfaction with life (SWLS). The mothers also reported whether they were seriously worried about their child 6 months post-partum. We compared questionnaire data from mothers who had received information about having a newborn with high genetic risk for type 1 diabetes (N = 166) with data from mothers who were informed that their baby did not have a high-risk genotype (N = 7224). The association between genetic risk information and maternal mental health was analysed using multiple linear regression analysis, controlling for baseline mental health scores.
Information on genetic risk in newborns was found to have no significant impact on maternal symptoms of anxiety and depression (p = 0.9), self-esteem (p = 0.2), satisfaction with life (p = 0.2), or serious worry about their child (OR = 0.98, 95% CI 0.64-1.48). Mental health before birth was strongly associated with mental health after birth. In addition, an increased risk of maternal worry was found if the mother herself had type 1 diabetes (OR = 2.39, 95% CI 1.2-4.78).
This study did not find evidence supporting the notion that genetic risk information about newborns has a negative impact on the mental health of Norwegian mothers.
Related Articles
Randomized Controlled Trial of a Psychosocial Telephone Counseling Intervention in BRCA1 and BRCA2 Mutation Carriers
Graves, Kristi D.
Wenzel, Lari
Schwartz, Marc D.
Luta, George
Wileyto, Paul
Narod, Steven
Peshkin, Beth N.
Marcus, Alfred
Cella, David
Emsbo, Susan Powell
Barnes, Denise
Halbert, Chanita Hughes
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Responses following BRCA1/2 genetic testing are relevant for comprehension of risk status and may play a role in risk management decision making. The objective of this study was to evaluate a Psychosocial Telephone Counseling (PTC) intervention delivered to BRCA1/2 mutation carriers following standard genetic counseling (SGC). We examined the impact of the intervention on distress and concerns related to genetic testing.
Patients and Methods
This prospective randomized clinical trial included 90 BRCA1/2 mutation carriers. We measured anxiety, depression, and genetic testing distress outcomes at intervention baseline and 6- and 12-months following disclosure. We evaluated the effects of SGC versus SGC plus PTC on psychological outcomes using intention-to-treat analyses through Generalized Estimating Equations.
At 6 months, PTC reduced depressive symptoms (Z = −2.25, P = .02) and genetic testing distress (Z = 2.18, P = .02) compared to standard genetic counseling. Further, women in the intervention condition reported less clinically-significant anxiety at 6 months (χ21 = 4.11, P = .04) than women who received SGC. We found no differences in outcomes between the intervention groups at the 12-month follow-up.
As an adjunct to SGC, psychosocial telephone counseling delivered following disclosure of positive BRCA1/2 test results appears to offer modest benefits for distress and anxiety. These results build upon a growing literature of psychosocial interventions for BRCA1/2 carriers and, given the potential impact of affect on risk management decision making, suggest that some carriers may derive benefits from adjuncts to traditional genetic counseling.
Psychosocial intervention; BRCA1/2 mutation carriers; telephone counseling
Related Articles
Predictive genetic testing in children and adults: a study of emotional impact
Michie, S
Bobrow, M
Marteau, T
Journal of Medical Genetics
AIM—To determine whether, following predictive genetic testing for familial adenomatous polyposis (FAP), children or adults receiving positive results experience clinically significant levels of anxiety or depression, and whether children receiving positive results experience higher levels of anxiety or depression than adults receiving positive results. DESIGN—Two studies, one cross sectional and one prospective. SAMPLE—208 unaffected subjects (148 adults and 60 children) at risk for FAP who have undergone genetic testing since 1990. MAIN MEASURES—Dependent variables: anxiety, depression; independent variables: test results, demographic measures, psychological resources (optimism, self-esteem). RESULTS—Study 1. In children receiving positive results, mean scores for anxiety and depression were within the normal range. There was a trend for children receiving positive results to be more anxious and depressed than those receiving negative results. In adults, mean scores for anxiety were within the normal range for those receiving negative results, but were in the clinical range for those receiving positive results, with 43% (95% CI 23-65) of the latter having scores in this range. Regardless of test result, adults were more likely to be clinically anxious if they were low in optimism or self-esteem. Children receiving positive or negative results did not experience greater anxiety or depression than adults. Study 2. For children receiving a positive test result, mean scores for anxiety, depression, and self-esteem were unchanged over the year following the result, while mean anxiety scores decreased and self-esteem increased after receipt of a negative test result over the same period of time. CONCLUSION—Children, as a group, did not show clinically significant distress over the first year following predictive genetic testing. Adults were more likely to be clinically anxious if they received a positive result or were low in optimism or self-esteem, with interacting effects. The association between anxiety, self-esteem, and optimism suggests that counselling should be targeted, not only at those with positive test results, but also at those low in psychological resources. Keywords: genetic testing; children; familial adenomatous polyposis; emotional impact
Related Articles
Breathlessness With Pulmonary Metastases: A Multimodal Approach
Brant, Jeannine M.
Journal of the advanced practitioner in oncology
Case Study
Sarah is a 58-year-old breast cancer survivor, social worker, and health-care administrator at a long-term care facility. She lives with her husband and enjoys gardening and reading. She has two grown children and three grandchildren who live approximately 180 miles away.
One morning while showering, Sarah detected a painless quarter-sized lump on her inner thigh. While she thought it was unusual, she felt it would probably go away. One month later, she felt the lump again; she thought that it had grown, so she scheduled a visit with her primary care physician. A CT scan revealed a 6.2-cm soft-tissue mass in the left groin. She was referred to an oncologic surgeon and underwent an excision of the groin mass. Pathology revealed a grade 3 malignant melanoma. She was later tested and found to have BRAF-negative status. Following her recovery from surgery, Sarah was further evaluated with an MRI scan of the brain, which was negative, and a PET scan, which revealed two nodules in the left lung.
As Sarah had attended a cancer support group during her breast cancer treatment in the past, she decided to go back to the group when she learned of her melanoma diagnosis. While the treatment options for her lung lesions included interleukin-2, ipilimumab (Yervoy), temozolomide, dacarbazine, a clinical trial, or radiosurgery, Sarah's oncologist felt that ipilimumab or radiosurgery would be the best course of action. She shared with her support group that she was ambivalent about this decision, as she had experienced profound fatigue and nausea with chemotherapy during her past treatment for breast cancer. She eventually opted to undergo stereotactic radiosurgery.
After the radiosurgery, Sarah was followed every 2 months. She complained of shortness of breath about 2 weeks prior to each follow-up visit. Each time her chest x-ray was normal, and she eventually believed that her breathlessness was anxiety-related. Unfortunately, Sarah's 1-year follow-up exam revealed a 2 cm × 3 cm mass in her left lung, for which she had a surgical wedge resection. Her complaints of shortness of breath increased following the surgery and occurred most often with anxiety, heat, and gardening activities, especially when she needed to bend over. Sarah also complained of a burning "pins and needles" sensation at the surgical chest wall site that was bothersome and would wake her up at night.
Sarah met with the nurse practitioner in the symptom management clinic to discuss her concerns. Upon physical examination, observable signs of breathlessness were lacking, and oxygen saturation remained stable at 94%, but Sarah rated her breathlessness as 7 on the 0 to 10 Borg scale. The nurse practitioner prescribed duloxetine to help manage the surgical site neuropathic pain and to assist with anxiety, which in turn could possibly improve Sarah's breathlessness. Several nonpharmacologic modalities for breathlessness were also recommended: using a fan directed toward her face, working in the garden in the early morning when the weather is cooler, gardening in containers that are at eye level to avoid the need to bend down, and performing relaxation exercises with pursed lip breathing to relieve anxiety-provoked breathlessness. One month later, Sarah reported relief of her anxiety; she stated that the fan directed toward her face helped most when she started to feel "air hungry." She rated her breathlessness at 4/10 on the Borg scale.
Sarah's chest x-rays remained clear for 6 months, but she developed a chronic cough shortly before the 9-month exam. An x-ray revealed several bilateral lung lesions and growth in the area of the previously resected lung nodule. Systemic therapy was recommended, and she underwent two cycles of ipilimumab. Sarah's cough and breathlessness worsened, she developed colitis, and she decided to stop therapy after the third cycle. In addition, her coughing spells triggered bronchospasms that resulted in severe anxiety, panic attacks, and air hunger. She rated her breathlessness at 10/10 on the Borg scale during these episodes. She found communication difficult due to the cough and began to isolate herself. She continued to attend the support group weekly but had difficulty participating in conversation due to her cough.
Sarah was seen in the symptom management clinic every 2 weeks or more often as needed. No acute distress was present at the beginning of each visit, but when Sarah began to talk about her symptoms and fear of dying, her shortness of breath and anxiety increased. The symptom management nurse practitioner treated the suspected underlying cause of the breathlessness and prescribed oral lorazepam (0.5 to 1 mg every 6 hours) for anxiety and codeine cough syrup for the cough. Opioids were initiated for chest wall pain and to control the breathlessness. Controlled-release oxycodone was started at 10 mg every 12 hours with a breakthrough pain (BTP) dose of 5 mg every 2 hours as needed for breathlessness or pain. Sarah noted improvement in her symptoms and reported a Borg scale rating of 5/10. Oxygen therapy was attempted, but subjective improvement in Sarah's breathlessness was lacking.
Sarah's disease progressed to the liver, and she began experiencing more notable signs of breathlessness: nasal flaring, tachycardia, and restlessness. Opioid doses were titrated over the course of 3 months to oxycodone (40 mg every 12 hours) with a BTP dose of 10 to 15 mg every 2 hours as needed, but her breathlessness caused significant distress, which she rated 8/10. The oxycodone was rotated to IV morphine continuous infusion with patient-controlled analgesia (PCA) that was delivered through her implantable port. This combination allowed Sarah to depress the PCA as needed and achieve immediate control of her dyspneic episodes. Oral lorazepam was also continued as needed.
Sarah's daughter moved home to take care of her mother, and hospice became involved for end-of-life care. As Sarah became less responsive, nurses maintained doses of morphine for control of pain and breathlessness and used a respiratory distress observation scale to assess for breathlessness since Sarah could no longer self-report. A bolus PCA dose of morphine was administered by Sarah's daughter if her mother appeared to be in distress. Sarah died peacefully in her home without signs of distress.
Related Articles
Psychological functioning before predictive testing for Huntington's disease: the role of the parental disease, risk perception, and subjective proximity of the disease
Decruyenaere, M.
Evers-Kiebooms, G.
Boogaerts, A.
Cassiman, J. J.
Cloostermans, T.
Demyttenaere, K.
Dom, R.
Fryns, J. P.
Journal of Medical Genetics
BACKGROUND—Psychometric testing of participants in predictive DNA testing for Huntington's disease (HD) has shown that 15% of the subjects at risk for HD had at least mild depression or a high score for general anxiety or both in the pre-test period. The main aim of the study was the delineation of variables associated with pre-test distress of applicants for predictive testing for HD. Based on theoretical considerations, four specific hypotheses were tested regarding the role of (1) the test participant's age at the (perceived) parental onset of HD, (2) the affected parent's sex, (3) the perception of the risk for HD, and (4) the subjective proximity of the disease. Secondly, these four variables were used in multiple regression analyses to select the best predictors of pre- and post-test psychological functioning (one year after the test). Increasing the understanding of pre- and post-test distress is important for developing better counselling and support strategies for test applicants. METHODS—Data were collected by means of clinical interviews and psychometric questionnaires during the pre- and post-test (one year after the test) counselling sessions for predictive testing for HD. RESULTS—We found significant associations of the participant's age at the parental onset, the subjective proximity of the disease onset, and the perceived risk with pre-test psychometric measures of psychological functioning. Multiple regression analyses showed that the best predictors of pre-test functioning were the perceived proximity of the disease onset and its interaction with risk perception. Regarding post-test functioning, none of the proposed variables had a unique contribution beyond that accounted for by pre-test psychological functioning. CONCLUSIONS—Test participants who are close to the perceived age of onset of HD and who have a pessimistic risk perception should be given special attention during pre-test counselling because of their possible negative affective condition at that time. Pre-test psychological measures were the best predictors of post-test distress, irrespective of the test result. Suggestions for future longitudinal research are formulated. This kind of research should enable clinical geneticists and mental health professionals to refine the pre- and post-test counselling strategies for predictive DNA testing, not only for HD, but also for other incurable late onset disorders. Keywords: Huntington's disease; predictive DNA testing; psychological distress
Related Articles
Women's Satisfaction with Genetic Counseling for Hereditary Breast-Ovarian Cancer
Tercyak, Kenneth P.
DeMarco, Tiffani A.
Mars, Bryn D.
Peshkin, Beth N.
American journal of medical genetics. Part A
Women who participate in BRCA1/2 cancer genetic counseling do so for a variety of reasons, including learning quantitative risk information about their chances of developing hereditary breast-ovarian cancer at some point during their lifetimes. For these women, obtaining pre-test and disclosure genetic counseling with a professional affords them numerous potential benefits, including adequate preparation for, and accurate interpretation of, their test results. In consequence, women commonly report being highly satisfied with their cancer genetic counseling experience, even if the information learned through testing suggests they are at increased cancer risk. This occurrence raises an interesting question, namely what are the psychological aspects of satisfaction with genetic counseling for hereditary breast-ovarian cancer in women? To answer this question, we administered the Genetic Counseling Satisfaction Scale (GCSS) to a convenience sample of 61 women participating in BRCA1/2 pre-test genetic counseling, and re-administered the GCSS to approximately one-third of these women at disclosure. Available psychological data included personality, distress, and family functioning. In bivariate analyses, optimism and family functioning were positively associated with pre-test satisfaction. With respect to satisfaction at disclosure, general and cancer-specific distress were negatively associated with satisfaction. Our findings suggest that psychological aspects of satisfaction with cancer genetic counseling vary, with individual differences and family functioning playing a role at pre-test, and distress playing a role at disclosure. The implications for future research and clinical practice are discussed.
hereditary breast and ovarian cancer; genetic counseling; genetic testing; satisfaction; psychology
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Periodic health examination, 1996 update: 1. Prenatal screening for and diagnosis of Down syndrome. Canadian Task Force on the Periodic Health Examination.
Dick, P T
CMAJ: Canadian Medical Association Journal
OBJECTIVE: To make recommendations to physicians providing prenatal care on (1) whether prenatal screening for and diagnosis of Down syndrome (DS) is advisable and (2) alternative screening and diagnosis manoeuvres. OPTIONS: "Triple-marker" screening of maternal serum levels of alpha-fetoprotein, human chorionic gonadotropin and unconjugated estriol; fetal ultrasonographic examination; amniocentesis; and chorionic villus sampling (CVS). OUTCOMES: Accuracy of detection of DS in fetuses, and risks to the mother, including psychologic distress, and to the fetus from the screening and diagnostic interventions. EVIDENCE: A MEDLINE search for relevant articles published from Jan. 1, 1966, to Mar. 31, 1994, with the use of MeSH terms "Down syndrome," "prenatal diagnosis," "screening," "prevention," "amniocentesis," "chorionic villus sampling," "ultrasonography," "anxiety," "depression" and "psychological stress" and a manual search of bibliographies, recent issues of key journals and Current Contents. VALUES: The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. A high value was placed on providing pregnant women with the opportunity to determine whether they are carrying a fetus with DS and to make choices concerning the termination of the pregnancy. The economic issues involved are complex and were not considered. BENEFITS, HARMS AND COSTS: Triple-marker screening identifies an estimated 58% of fetuses with DS, but it has an estimated rate of true-positive results of 0.1% and of false-positive results of 3.7% (given a risk cut-off of one chance in 190 of DS). These rates vary with maternal age and the risk cut-off chosen. Women with a known risk of having a fetus with DS (e.g., those who have had a previous child with DS) may benefit from a reduction in anxiety after confirmation that their fetus does not have DS. Screening allows women at low risk of having a child with DS to detect fetuses with the syndrome, but may cause psychologic distress if there is a false-positive screening test result. Up to 20% of women with positive results of screening tests may decline to undergo a subsequent amniocentesis. Amniocentesis and CVS are very accurate in diagnosing DS in fetuses and have a very low rate of serious complications for the mother. Amniocentesis is associated with a 1.7% rate of fetal loss when it is performed after 16 weeks' gestation, whereas the rate among controls is 0.7% (for a difference of 1%, 95% confidence interval 0.3% to 1.5%). CVS entails a greater risk of fetal loss than amniocentesis (odds ratio 1.32, 95% confidence interval 1.11 to 1.57). There is little evidence from controlled trials of significant associations between amniocentesis or CVS and neonatal morbidity or malformations; however, samples have been too small to show differences in rare outcomes. Results from some case-control studies suggest that CVS increases the risk of transverse limb deficiency. Costs were not considered because they are beyond the scope of this review. RECOMMENDATIONS: There is fair evidence to offer triple-marker screening through a comprehensive program to pregnant women under 35 years of age (grade B recommendation). Women given detailed information about serum-marker screening show more satisfaction with the screening than those not given this information. There is fair evidence to offer amniocentesis or CVS to pregnant women 35 years of age and older and to women with a history of a fetus with DS or of a chromosome 21 anomaly (grade B recommendation). Information on the limitations and advantages of each procedure should be offered. Triple-marker screening may be offered as an alternative to CVS or amniocentesis to pregnant women over 35. VALIDATION: Recommendations concerning prenatal diagnosis are similar to those of the US Preventive Services Task Force, the Society of Obstetricians and Gynaecologists of Canada, the Canadian College of Medical Geneticists and the Cochrane Pregnancy and Childbirth Group. No previous specific recommendations concerning triple-maker screening exist. SPONSORS: These guidelines were developed and endorsed by the Canadian Task Force on the Periodic Health Examination, which is funded by Health Canada and the National Health Research and Development Program.
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Psychological impact of human papillomavirus testing in women with borderline or mildly dyskaryotic cervical smear test results: cross sectional questionnaire study
Maissi, Esther
Marteau, Theresa M
Hankins, Matthew
Moss, Sue
Legood, Rosa
Gray, Alastair
BMJ : British Medical Journal
Objective To describe the psychological impact on women of being tested for human papillomavirus (HPV) when smear test results are borderline or mildly dyskaryotic.
Design Cross sectional questionnaire study.
Setting Two centres participating in an English pilot study of HPV testing in women with borderline or mildly dyskaryotic smear test results.
Participants Women receiving borderline or mildly dyskaryotic smear test results tested for HPV and found to be HPV positive (n = 536) or HPV negative (n = 331); and women not tested for HPV with borderline or mildly dyskaryotic smear results (n = 143) or normal smear results (n = 366).
Main outcome measures State anxiety, distress, and concern about test result, assessed within four weeks of receipt of results.
Results Women with borderline or mildly dyskaryotic smear results who were HPV positive were more anxious, distressed, and concerned than the other three groups. Three variables independently predicted anxiety in HPV positive women: younger age (β = -0.11, P = 0.03), higher perceived risk of cervical cancer (β = 0.17, P < 0.001), and reporting that they did not understand the meaning of test results (β = 0.17, P = 0.001). Testing HPV negative was not reassuring: among women with abnormal smear test results, those who were HPV negative were no less anxious than those who were not tested for HPV.
Conclusions Informing women more effectively about the meaning of borderline or mildly dyskaryotic smear test results and HPV status, in particular about the absolute risks of cervical cancer and the prevalence of HPV infection, may avoid some anxiety for those who are HPV positive while achieving some reassurance for those who test HPV negative.
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Psychological impact of genetic testing for Huntington's disease: an update of the literature
Meiser, B.
Dunn, S.
Journal of Neurology, Neurosurgery, and Psychiatry
Genetic testing has been available for Huntington's disease for longer than any other adult onset genetic disorder. The discovery of the genetic mutation causing Huntington's disease made possible the use of predictive testing to identify currently unaffected carriers. Concerns have been raised that predictive testing may lead to an increase in deaths by suicide among identified carriers, and these concerns set in motion research to assess the psychological impact of predictive testing for Huntington's disease. This review article provides an overview of the literature and draws implications for clinical practice. About 10%-20% of people at risk request testing when approached by registries or testing centres. Most of the evidence suggests that non-carriers and carriers differ significantly in terms of short term, but not long term, general psychological distress. Adjustment to results was found to depend more on psychological adjustment before testing than the testing result itself. Although risk factors for psychological sequelae have been identified, few adverse events have been described and no obvious contraindications for testing people at risk have been identified. The psychological impact of testing may depend on whether testing was based on linkage analysis or mutation detection. Cohorts enrolled in mutation detection programmes have higher levels of depression before and after testing, compared with people who sought genetic testing when linkage analysis was available. There is evidence that people who choose to be tested are psychologically selected for a favourable response to testing. The impact of testing on people in settings where less intensive counselling protocols and eligibility criteria are used is unknown, and genetic testing is therefore best offered as part of comprehensive specialist counselling.
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The Early Psychological Impacts of the Deepwater Horizon Oil Spill on Florida and Alabama Communities
Grattan, Lynn M.
Roberts, Sparkle
Mahan, William T.
McLaughlin, Patrick K.
Otwell, W. Steven
Morris, J. Glenn
Environmental Health Perspectives
Although public concern has focused on the environmental impact of the Deepwater Horizon oil spill, the public health impact on a broad range of coastal communities is minimally known.
We sought to determine the acute level of distress (depression, anxiety), mechanisms of adjustment (coping, resilience), and perceived risk in a community indirectly impacted by the oil spill and to identify the extent to which economic loss may explain these factors.
Using a community-based participatory model, we performed standardized assessments of psychological distress (mood, anxiety), coping, resilience, neurocognition, and perceived risk on residents of fishing communities who were indirectly impacted (n = 71, Franklin County, Florida) or directly exposed (n = 23, Baldwin County, Alabama) to coastal oil. We also compared findings for participants who reported income stability (n = 47) versus spill-related income loss (n = 47).
We found no significant differences between community groups in terms of psychological distress, adjustment, neurocognition, or environmental worry. Residents of both communities displayed clinically significant depression and anxiety. Relative to those with stable incomes, participants with spill-related income loss had significantly worse scores on tension/anxiety, depression, fatigue, confusion, and total mood disturbance scales; had higher rates of depression; were less resilient; and were more likely to use behavioral disengagement as a coping strategy.
Current estimates of human health impacts associated with the oil spill may underestimate the psychological impact in Gulf Coast communities that did not experience direct exposure to oil. Income loss after the spill may have a greater psychological health impact than the presence of oil on the immediately adjacent shoreline.
disasters; environmental epidemiology; occupational health; petroleum products; risk perception
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Short-term psychological impact of the BRCA1/2 test result in women with breast cancer according to their perceived probability of genetic predisposition to cancer
Brédart, A
Kop, J L
DePauw, A
Caron, O
Sultan, S
Leblond, D
Fajac, A
Buecher, B
Gauthier-Villars, M
Noguès, C
Flahault, C
Stoppa-Lyonnet, D
Dolbeault, S
British Journal of Cancer
The effect of BRCA1/2 gene test result on anxiety, depression, cancer-related thought intrusion or avoidance and perceived control over cancer risk was assessed in breast cancer (BC) patients, according to their perceived probability of genetic predisposition to cancer.
Two hundred and forty-three (89% response rate) women with BC completed questionnaires after an initial genetic counselling visit (T1), of which 180 (66%) completed questionnaires again after receiving the BRCA1/2 results (T2). The discrepancy between women's perceived probability of cancer genetic predisposition at T1 and the geneticist's computed estimates was assessed.
In all, 74% of women received a negative uninformative (NU), 11% a positive BRCA1/2 and 15% an unclassified variant (UV) result. On hierarchical regression analysis, in women with a positive BRCA1/2 result (vs NU or UV), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted lower levels of anxiety at T2 (β=−0.28; P<0.01), whereas in women receiving a UV result (vs NU or positive BRCA1/2), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted higher levels of anxiety (β=0.20; P<0.01), depression (β=0.19; P<0.05) and intrusion (β=0.18; P<0.05) at T2.
The type of BRCA1/2 test result differently affects distress according to women's perceived probability of genetic predisposition before testing.
BRCA1/2 testing; anxiety; depression; stress reactions; perceived probability of genetic predisposition to cancer
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When Do HIV-Infected Women Disclose Their HIV Status to Their Male Partner and Why? A Study in a PMTCT Programme, Abidjan
Brou, Hermann
Djohan, Gérard
Becquet, Renaud
Allou, Gérard
Ekouevi, Didier K
Viho, Ida
Leroy, Valériane
Desgrées-du-Loû, Annabel
PLoS Medicine
In Africa, women tested for HIV during antenatal care are counselled to share with their partner their HIV test result and to encourage partners to undertake HIV testing. We investigate, among women tested for HIV within a prevention of mother-to-child transmission of HIV (PMTCT) programme, the key moments for disclosure of their own HIV status to their partner and the impact on partner HIV testing.
Methods and Findings
Within the Ditrame Plus PMTCT project in Abidjan, 546 HIV-positive and 393 HIV-negative women were tested during pregnancy and followed-up for two years after delivery. Circumstances, frequency, and determinants of disclosure to the male partner were estimated according to HIV status. The determinants of partner HIV testing were identified according to women's HIV status. During the two-year follow-up, disclosure to the partner was reported by 96.7% of the HIV-negative women, compared to 46.2% of HIV-positive women (χ2 = 265.2, degrees of freedom [df] = 1, p < 0.001). Among HIV-infected women, privileged circumstances for disclosure were just before delivery, during early weaning (at 4 mo to prevent HIV postnatal transmission), or upon resumption of sexual activity. Formula feeding by HIV-infected women increased the probability of disclosure (adjusted odds ratio 1.54, 95% confidence interval 1.04–2.27, Wald test = 4.649, df = 1, p = 0.031), whereas household factors such as having a co-spouse or living with family reduced the probability of disclosure. The proportion of male partners tested for HIV was 23.1% among HIV-positive women and 14.8% among HIV-negative women (χ2 = 10.04, df = 1, p = 0.002). Partners of HIV-positive women who were informed of their wife's HIV status were more likely to undertake HIV testing than those not informed (37.7% versus 10.5%, χ2 = 56.36, df = 1, p < 0.001).
In PMTCT programmes, specific psychosocial counselling and support should be provided to women during the key moments of disclosure of HIV status to their partners (end of pregnancy, weaning, and resumption of sexual activity). This support could contribute to improving women's adherence to the advice given to prevent postnatal and sexual HIV transmission.
In a mother-to-child HIV prevention program in Côte d'Ivoire, Annabel Desgrées-du-Loû and colleagues identify three junctures at which women tend to disclose their HIV status to partners.
Editors' Summary
Since the first reported case of AIDS (acquired immunodeficiency syndrome) in 1981, the number of people infected with the human immunodeficiency virus (HIV), which causes AIDS, has risen steadily. By the end of 2006, nearly 40 million people were infected, 25 million of them in sub-Saharan Africa. HIV is most often spread by having unprotected sex with an infected partner. In Africa, most sexual transmission of HIV is between partners in stable relationships—many such couples do not adopt measures that prevent viral transmission, such as knowing the HIV status of both partners and using condoms if one partner is HIV-positive. HIV can also pass from a mother to her baby during pregnancy, labor, or delivery, or through breastfeeding. Mother-to-child transmission (MTCT) of HIV can be reduced by giving anti-HIV drugs to the mother during pregnancy and labor and to her newborn baby, and by avoiding breastfeeding or weaning the baby early.
Why Was This Study Done?
Many African countries have programs for prevention of MTCT (PMTCT) that offer pregnant women prenatal HIV counseling and testing. As a result, women are often the first member of a stable relationship to know their HIV status. PMTCT programs advise women to disclose their HIV test result to their partner and to encourage him to have an HIV test. But for many women, particularly those who are HIV-positive, talking to their partner about HIV/AIDS is hard because of fears of rejection (which could mean loss of housing and food) or accusations of infidelity. Knowing more about when women disclose their HIV status and what makes them decide to do so would help the people running PMTCT programs to support women during the difficult process of disclosure. In this study, the researchers have investigated when and why women participating in a PMTCT research project in Abidjan (Côte d'Ivoire) told their partner about their HIV status and the impact this disclosure had on their partner's uptake of HIV testing.
What Did the Researchers Do and Find?
At regular follow-up visits, the researchers asked women in the Abidjan PMTCT project whether they had told their partners their HIV status and whether they were breast-feeding or had resumed sexual activity. Nearly all the women who tested negative for HIV, but slightly fewer than half of the HIV-positive (infected) women had told their partner about their HIV status by two years after childbirth. Two-thirds of the HIV-positive women who disclosed their status did so before delivery. Other key times for disclosure were at early weaning (4 months after birth) for women who breast-fed their babies, and when sexual activity resumed. HIV-positive women who bottle fed their babies from birth were more likely to tell their partners of their status than women who breast-fed. Factors that prevented women disclosing their HIV status included living in a polygamous relationship or living separately from their partners. Finally, the researchers report that the partners of HIV-positive women who disclosed their HIV status were about three times more likely to take an HIV test than the partners of HIV-positive women who did not disclose.
What Do These Findings Mean?
These findings identify three key times when women who have had an HIV test during pregnancy are likely to disclose their HIV status to their partner. The main one is before delivery and relates, in part, to how the mother plans to feed her baby. To bottle feed in Abidjan, women need considerable support from their partners and this may be the impetus for disclosing their HIV status. Disclosure at early weaning may reflect the woman's need to enlist her partner's support for this unusual decision—the normal time for weaning in Abidjan is 17 months. Finally, disclosure when sexual activity resumes may be necessary so that the woman can explain why she wants to use condoms. Although these findings need confirmation in other settings, targeting counseling and support within PMTCT programs to these key moments might help HIV-positive women to tell their partners about their status. This, hopefully, would help to reduce sexual transmission of HIV within stable relationships in sub-Saharan Africa.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040342.
Information is available from the US National Institute of Allergy and Infectious Diseases on HIV infection and AIDS and on HIV infection in women
HIV InSite has comprehensive information on all aspects of HIV/AIDS
Women Children and HIV provides extensive information on prevention of mother-to-child transmission of HIV in developing countries
Information is available from Avert, an international AIDS charity, on HIV and AIDS in Africa and on HIV and AIDS prevention
AIDSinfo, a service of the US Department of Health and Human Services provideshealth information for HIV-positive pregnant women (in English and Spanish)
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Deaf Genetic Testing and Psychological Well-Being in Deaf Adults
Palmer, Christina G.S.
Boudreault, Patrick
Baldwin, Erin E.
Fox, Michelle
Deignan, Joshua L.
Kobayashi, Yoko
Sininger, Yvonne
Grody, Wayne
Sinsheimer, Janet S.
Journal of genetic counseling
Limited data suggest that enhanced self-knowledge from genetic information related to non-medical traits can have a positive impact on psychological well-being. Deaf individuals undertake genetic testing for deaf genes to increase self-knowledge. Because deafness is considered a non-medical trait by many individuals, we hypothesized that deaf individuals receiving a genetic explanation for why they are deaf will experience increased psychological well-being. We report results from a prospective, longitudinal study to determine the impact of genetic testing (GJB2, Cx26; GJB6, Cx30) on perceived personal control (PPC), anxiety, and depression in deaf adults (N=209) assessed following pre-test genetic counseling as well as 1-month and 6-months following test result disclosure. Participants were classified as Cx positive (n=82) or Cx negative/inconclusive (n=127). There was significant evidence for Cx group differences in PPC and anxiety over time (PPC: Cx group*time interaction p=0.0007; anxiety: Cx group*time interaction p=0.002), where PPC scores were significantly higher, and anxiety scores were significantly lower for the Cx positive group relative to the negative/inconclusive group following test result disclosure. Compared to pre-test, PPC scores increased at 1-month (p=0.07) and anxiety scores decreased at 6-months for the Cx positive group (p=0.03). In contrast, PPC scores decreased (p=0.009, p<0.0001) and anxiety scores increased (p=0.09, p=0.02) for the Cx negative/inconclusive group at 1- and 6-months post test result disclosure. Genetic testing for deaf genes affects the psychological well-being of deaf individuals. Increasing deaf adults' access to genetic testing may potentially enhance self-knowledge and increase psychological well-being for those who receive a genetic explanation, which could offer downstream health benefits.
Genetic testing; deafness; deaf; sign language; hearing loss; psychological distress; perceived personal control; anxiety; depression; well-being
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Biobank Participants' Preferences for Disclosure of Genetic Research Results: Perspectives From the OurGenes, OurHealth, OurCommunity Project
Allen, Nicole L.
Karlson, Elizabeth W.
Malspeis, Susan
Lu, Bing
Seidman, Christine E.
Lehmann, Lisa Soleymani
Mayo Clinic proceedings
To assess biobank participants' preferences for disclosure of genetic research results. Patients and Methods: We conducted a cross-sectional survey of participants in the OurGenes, OurHealth, OurCommunity biobank. Respondents were surveyed about preferences for disclosure, importance of disclosure, communication of results with practitioners, and sharing of results after respondents' death. Multivariate regression analysis was used to assess independent sociodemographic and clinical predictors of disclosure preferences. Data collection occurred from June 6, 2011, to June 25, 2012.
Among 1154 biobank participants, 555 (48%) responded. Most thought that research result disclosure was important (90%). Preference for disclosure varied, depending on availability of disease treatment (90% vs. 64%, P<.001), high vs. low disease risk (79% vs. 66%, P<.001), and serious vs. mild disease (83% vs. 68%, P<.001). More than half of respondents (57%) preferred disclosure even when there is uncertainty about the results' meaning, and 87% preferred disclosure if the disease is highly heritable. Older age was positively associated with interest in disclosure, whereas female sex, nonwhite race, diabetes mellitus, and depression and/or anxiety were negatively associated with disclosure. More than half of respondents (52%) would want their results returned to their nearest biological relative after death.
OurGenes biobank participants report strong preferences for disclosure of research results, and most would designate a relative to receive results after death. Participant preferences for serious vs. mild disease, high vs. low disease risk, and availability of disease treatment differed significantly. Future research should consider family members' preferences for receiving research results from enrolled research participants.
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The influence of acculturation and breast cancer-specific distress on perceived barriers to genetic testing for breast cancer among women of African descent
Sussner, Katarina M.
Thompson, Hayley S.
Jandorf, Lina
Edwards, Tiffany A.
Forman, Andrea
Brown, Karen
Kapil-Pair, Nidhi
Bovbjerg, Dana H.
Schwartz, Marc D.
Valdimarsdottir, Heiddis B.
Rising health disparities are increasingly evident in relation to use of genetic services (including genetic counseling and testing) for breast cancer risk, with women of African descent less likely to use genetic services compared with Whites. Meanwhile, little is known regarding potential within-group acculturation and psychological differences underlying perceived barriers to genetic testing among women of African descent.
Hypothesized contributions of acculturation factors and breast cancer-specific distress to perceived barriers to genetic testing were examined with a statistical analysis of baseline data from 146 women of African descent (56% US born and 44% foreign born) meeting genetic breast cancer risk criteria and participating in a larger longitudinal study that included the opportunity for free genetic counseling and testing. Perceived barriers assessed included: (1) anticipation of negative emotional reactions, (2) stigma, (3) confidentiality concerns, (4) family-related worry, and (5) family-related guilt associated with genetic testing.
In multivariate analyses, being foreign born was a significant predictor of anticipated negative emotional reactions about genetic testing (β= 0.26; SE=0.11; p = 0.01). Breast cancer-specific distress scores (avoidance symptoms) were positively related to anticipated negative emotional reactions (β = 0.02; SE= 0.005; p = <0.0001), confidentiality concerns (β = 0.02; SE = 0.01; p = 0.02), and family-related guilt (β = 0.02; SE=0.01; p = 0.0009) associated with genetic testing.
Results suggest an influence of acculturation and breast cancer-specific distress on perceived barriers to genetic testing among women of African descent. The potential utility of culturally tailored genetic counseling services taking into account such influences and addressing emotional and psychological concerns of women considering genetic testing for breast cancer should be investigated.
cancer; oncology; genetic testing; breast; African
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Information Needs of Mothers Regarding Communicating BRCA1/2 Cancer Genetic Test Results to their Children
Tercyak, Kenneth P.
Peshkin, Beth N.
DeMarco, Tiffani A.
Patenaude, Andrea Farkas
Schneider, Katherine A.
Garber, Judy E.
Valdimarsdottir, Heiddis B.
Schwartz, Marc D.
Genetic testing
Mothers who participate in genetic testing for hereditary breast/ovarian cancer risk must decide if, when, and how to ultimately share their BRCA1 and BRCA2 (BRCA1/2) test results with their minor-age children. One of the primary aides for mothers in making this decision is cancer genetic counseling. However, counseling is limited in how well it can educate mothers about such decisions without the availability of resources that are specific to family communication and genetic testing per se. In an effort to fill this gap and identify mothers most likely to benefit from such resources, surveys were conducted with 187 mothers undergoing BRCA1/2 testing who had children 8-21 years-old. Data were collected weeks after genetic testing but prior to mothers' learning of their test results; quantitative assessments of informational resource needs (i.e., speaking with previous BRCA1/2 testing participants who are parents regarding their experiences, reading educational literature about options and what to expect, speaking with a family counselor, attending a family support group, and self-nominated other resources), testing motivations, decision making vigilance, and decisional conflict regarding communicating test results to children were included. Mothers' most-to-least frequently cited information resource needs were: literature (93.4%), family counseling (85.8%), prior participants (79.0%), support groups (53.9%), and other (28.9%; e.g., pediatricians and psychologists). Seventy-eight percent of mothers were interested in accessing 3 or more resources. In multivariate regression analyses, testing motivations (β=0.35, p=.03), decision making vigilance (β=0.16, p=.00) and decisional conflict (β=0.10, p=.00) were associated with mothers' need level; mothers with a greater interest in testing to learn about their children's risks, those with more vigilant decision making styles, and those with higher decisional conflict had the greatest need. In conjunction with enhanced genetic counseling focusing on family disclosure, educational literature and psychosocial support may promote improved outcomes.
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The association between history of diabetic foot ulcer, perceived health and psychological distress: the Nord-Trøndelag Health Study
Iversen, Marjolein M
Midthjell, Kristian
Tell, Grethe S
Moum, Torbjørn
Østbye, Truls
Nortvedt, Monica W
Uhlving, Sverre
Hanestad, Berit R
BMC Endocrine Disorders
While the adverse impact of a history of a foot ulcer on physical health among persons with diabetes is well known, little is known about the association between foot ulcer, perceived health and psychological distress. Results from various studies are difficult to compare as different study designs, samples and/or different questionnaires have been used. The aim of this study was to compare levels of anxiety and depression, psychological well-being and perceived health between persons with diabetes, with or without a history of foot ulcer, and persons without diabetes in a large study of community-dwelling individuals.
This study included 65,126 persons, of whom 63,632 did not have diabetes, 1,339 had diabetes without a history of foot ulcer and 155 had diabetes and a history of foot ulcer. Levels of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Psychological well-being was measured on a four-item scale, and perceived health was measured with a one-item question. We investigated whether levels of anxiety, depression, psychological well-being and perceived health were different in the three study groups using multiple regression models controlling for demographic factors, body mass index, smoking and cardiovascular conditions. Separate multivariate analyses comparing the two diabetes samples were additionally adjusted for diabetes-specific variables.
A history of foot ulcer was significantly associated with more depressive symptoms, poorer psychological well-being and poorer perceived health compared to participants without diabetes. In multivariate analyses, perceived health and psychological well-being were significantly poorer among those with a history of foot ulcer compared to those without diabetes. Among persons with diabetes, perceived health was significantly worse among those with a history of foot ulcer. After multivariate adjustment, levels of anxiety and depression and psychological well-being did not differ between the two diabetes groups.
Perceived health and psychological well-being were significantly poorer among participants with diabetes and a history of foot ulcer compared to those without diabetes. Among people with diabetes, a history of foot ulcer had significant negative impact on perceived health but did not independently contribute to psychological distress.
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text: Mary and Kelly, you're both solid gold on your backup strategies. I might add one item, which would give you even more space, and that is, to compress files or directories and just store the compressed files for expansion or extraction when you need them. Unfortunately, neither SmartSync nor Synchro Magic are capable of compressing before backing up, or using a compression program such as WinRAR or PKZIP to do it for you. The ideal software solution would be to take a program like SmartSync or Synchro Magic and add on a feature that could use an external file compression program with user-supplied parameters to do exactly what I just explained. For example, I'm an Agent user, not an Outlook user, and Agent does not name its database files where it holds messages with real names like Outbox.DBS. Instead, they're all eight-digit numbers and some extension (I can't remember offhand and am too lazy to look at this hour), but what I would prefer is to compress the entire folder where all the message files and database master file reside, rather than copying the individual files, which can get pretty big if I leave a lot of messages hanging around. The problem with doing things this way is that you don't have any control of deleting old or non-existent files unless you re-create the entire archive, which, of course, you could very easily do by deleting the old one first, then make the new one in its place. If you're handy with writing batch programs, you could certainly whip one up to do this for you, then stick it in the Windows Task Scheduler to run before SmartSync or Synchro Magic runs. Of course, they could run concurrently, but that presents problems of its own. Firstly, any archive (.ZIP, .RAR, .ARJ, etc.) should be as contiguous as possible. If there are two job writing to the backup disk running concurrently, files will be fragmented. Of course, you could defragment the drive on occasion, but this presents its own possibilities for problems, such as, what if the system crashes in the middle of the defrag? THen you're truly and totally left holding a very empty, very unuseable backup drive! The other problem with running jobs simultaneously is, of course, performance. Windows is not a multi-threaded multi-tasking operating system, as much as Microsoft or others would like you to think it is. What makes it appear to be multi-tasking is its speed (such as that is). However, given what backup jobs do, which is mainly read a lot and write a lot, having two of them running concurrently could actually take longer than running them back-to-back. The other thing which neither of your otherwise excellent messages addressed is the subject of recovering or re-creating a system disk or boot drive. It's potentially a three-part problem, and unfortunately I can only help with a solution for one of these parts. 1. Partitioning: Normally, when an internal drive is purchased, it comes with formatting characteristics on it which mark the boundaries where the drive writing assembly can be positioned to write on the physical surface of the disk. However, different operating systems and file systems have different rules about how that data is to be physically laid down on the platter inside the box. You've no doubt heard of such units of measure called blocks, tracks, sectors and cylinders. Some of these are combinations of units of others, but there is usually one standard measure, the sector I believe it is, which is common to all drives. When a disk is purchased, there's usually a piece of paper or a sticker attached to the outside of the disk which tells how many sectors it contains. Each operating system formats the sector differently, holding a different number of actual bytes of information. All the sectors available for writing on a disk comprise yet another unit of measurement called a partition. By default and definition, since new disks have no other formatting on them, they come from the factory with one unformatted partition which takes up all the useable space on the drive. The problem is, with large drives being, well, large as they are, lots of folks like to break them up into multiple partitions. Take a 200GB drive, for instance. It might be broken up into two or more partitions of differing sizes--40GB for a boot and software drive, 60GB for office stuff, 100GB for audio projects, and bingo, there's your 200GB drive. Of course, each of these so-called logical drives can be managed as if they are three separate physical drives, but what happens when the real physical drive--the 200GB disk in my example--needs to be replaced in case of failure or you simply want one of a different size? What's out there to re-partition, or reset the boundaries between logical drives? The de facto standard for drive partition management is called (what else?) Partition Magic, and last I saw of it, was not very accessible. It also did not have a feature in it which I would think would be something pretty standard given what else the program does--the ability to save partition information in a file on a floppy or CD and use it to partition a disk automatically at another time without having to answer a lot of questions. Somebody please correct me on this if I'm wrong, or if there's another, better, utility than Partition Magic that's come along recently. It would be great to just boot a floppy diskette or a CD-ROM, have it play a short musical sequence to let you know it was ready to go to restore your partitions, you press ENTER, off it goes, and plays another musical sequence to let you know it was successful, or not. If it wasn't successful, of course you'd need to get someone to read the screen for you, but if you were running it on an already running system, using the new drive as a secondary or slave drive, you could read it yourself if your operating system and speech programs were already up and running. 2. Using a Drive Imager: So now we've got our new disk drive re-partitioned (if we needed to do so) and we have it installed back into the master position on the drive chain. And now what? Now is when we break out our specially-prepared re-imaging CD's which we've previously made with a program such as Driveimage. The nice thing about Driveimage is that it can be used with speech to prepare the setup for exactly what you want imaged, then it reboots, does its thing, then reboots again and your speech comes back. When done, you have a bunch of CD's (or now, of course, you can use DVD's as long as you have a DVD drive that can be booted, which most can these days) that you use to re-create that all-important boot partition. In fact, if you're fortunate enough to be able to have a running system on which you can run your partitioner (should you need one) and your drive imager, that's the best of both worlds, but the program called Driveimage is pretty automated--you boot, press Enter a few times to bypass the usuall warning screens reminding you of what you're about to do, then off it goes, you change CD's or DVD's when it tells you to and opens the drawer for you, and when it's done, your system is back. When you use a drive imager, it's very important not to pick up every single thing on the drive and image it. For instance, in the above example of a 40GB boot partition, suppose you had 15GB of data (documents, email, whatever) which you normally back up daily, weekly, etc. You don't need to include those directories in your imaging process. It just takes too long to create and restore. Better to image a drive with as few data files as possible, then restore them separately after your system is back up and running with your preferred access methodology software (speech, Braille, lp, etc.) 3. The JAWS Problem: I've not had Driveimage long enough to know the answer to this one, but it seems to me, knowing what I know about how JAWS authorization works, that Driveimage might thing the JAWS key file is bad data because of the scheme HJ/FS used in its creation, having to do with non-standard sector sizes and such. Be forewarned, I have not tested this yet, but your JAWS may not be authorized after a system restore using any one of the various drive-imaging programs out there. Check with the manufacturer of the one you want to test out before buying (they usually give you a couple test-images to try before you buy the software) to find out if they can handle non-standard sector sized files. If they can, you may have hit a good one. But of course you won't really know until after the test restore is done and your copy of JAWS either works or doesn't. I hope this addition to Mary and Kelly's thoughts and techniques was helpful. BACKUP is very important, now so more than ever, since our systems are now larger and more complex and, perforce, more difficult to rebuild after diasaster. -- Steve Matzura Master of Disaster (Recovery)

subset: commoncrawl


text:
Product Details
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text:
Gozh'ga is a she-troll. I know because she is bigger than the other two, and often berates and belittles Umook and Droog whenever they attempt to mate with her, or eat her food. She is a wrinkled behemoth of a troll with empty, worm-ridden eye sockets.
What she lacks in sight, she makes up for with her wart-ridden nose. Her sense of smell is extraordinary. I was present when she once sniffed at the air suddenly and excitedly, then proceeded to sketch crude human-like figures in the dirt, indicating travelers and pointing in a direction. The trolls seemed excited.
*Three* full days later an unfortunate band of adventurers stumbled upon the troll lair. The trolls were ready for them, and the awful screams that night, did not last long. Not only had Gozh'ga sensed the group many miles away, but she seemed to know that they were traveling in this exact direction. There was no reason to start the hunt.
Once Gozh'ga had eyes, but as I watched from a bluff spell-bound one night, she plucked them out one after the other and ate them, much to the delight of Umook and Droog, who leapt up and down, like two idiots at their first fare.
Go to Comment
Several weeks later, something interesting occurred. I was watching the troll relieve herself one morning, riveted to the scene, when suddenly to my horror, two bulbous, gloopy eyes sprouted, one ripping through the flesh of each cheek of her desiccated backside. These are truly remarkable creatures.
I sometimes call him "Droog the Last" because he always is. The runt of the foursome, Droog is often submissive to the other three. Last to attack during the hunt, last to feed back at the troll lair. He is easily recognizable by his two extended members(!) which I have never witnessed in flaccid states. I have colleagues that would no doubt jape at being envious of Droog's predicament, but I digress. Why Gozh'ga refuses to mate with Droog despite his twin ever-ready phalluses, remains a mystery.
Go to Comment
Droog seems to prefer eating animals to humanoids. The other three trolls are the opposite, they will listlessly chew on snakes and hedgehogs, but positively animate whenever two-legged prey appears on the menu. At these times Droog looks almost sullen, and withdraws to his pit gnawing on his own arm. Droog will sometimes try to keep food alive for a while, and play with prey like a cat. It almost seems as if he is desirous of acquiring a pet. I watched him once drag a dwarf around by the neck on a chain for three weeks everywhere he went, though he forgot to feed him, until Warp'raa at last, came over, ripped the dwarf's head off and ate it. Droog ate the rest, whimpering solemnly.
Go to Comment
Heh, wise Gyma has touched upon the crux of what I was going for...Some combination of the banal, apologetic, self-important, desentisized news reporting on mass beheadings, Sharkweek jumping the shark ("Oy, watch as I swim with these misunderstood, gentle giants---Gaaaaaack---Dead.), Gorillas in the Mist ("Wow, he just sits there. Amazing! Wait, look, he just picked his ass with his finger and tasted it! I think he liked it. What incredible creatures, I'm in awe!), ecological ultra-liberal-terrorists, and the reality tv trainwreck.
Go to Comment
that last plot hook tittilates me :) What could be so bad-assed that the trolls are running? :)
Go to Comment
Aaarg, I wish I'd thought of that! They kill diggers, that's brilliant! And miners makes sense too. I may have to add that. I'm rusty.
Go to Comment
yep, yep, you and axle are right! Will edit this to change from stabby, stabby, bash.
I know when to call spade a spade.
Go to Comment
Please don't think I am troweling here.... But from the description of their animation and origin it sounds like they might seek to stop diggers, so undead mages or other ground dwelling super beings won't be disturbed. These could be funny antagonists for miners and grave diggers.


text:
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The stock of DXP Enterprises Inc (NASDAQ:DXPE) is a huge mover today! About 218,786 shares traded hands. DXP Enterprises Inc (NASDAQ:DXPE) has risen 30.17% since April 27, 2016 and is uptrending. It has outperformed by 24.94% the S&P500.
The move comes after 5 months positive chart setup for the $562.99 million company. It was reported on Nov, 30 by Barchart.com. We have $34.69 PT which if reached, will make NASDAQ:DXPE worth $28.15 million more.
Analysts await DXP Enterprises Inc (NASDAQ:DXPE) to report earnings on February, 24.
According to Zacks Investment Research, "DXP Enterprises Inc. is a leading supplier of maintenance, repair and operating products, equipment and services to industrial customers. The company offers its customers a single source of supply on an efficient and competitive basis by being a first-tier distributor which purchases its products directly from the manufacturer. The company also provides value-added services such as system design, fabrication, installation, repair and maintenance for its customers."
Insitutional Activity: The institutional sentiment decreased to 1.17 in 2016 Q2. Its down 0.02, from 1.19 in 2016Q1. The ratio dived, as 16 funds sold all DXP Enterprises Inc shares owned while 26 reduced positions. 13 funds bought stakes while 37 increased positions. They now own 11.67 million shares or 15.44% more from 10.11 million shares in 2016Q1.
Gam Holdg Ag owns 200,000 shares or 0.05% of their US portfolio. Citigroup, a New York-based fund reported 53,445 shares. Blackrock Institutional Na has 0% invested in the company for 335,307 shares. Schwab Charles Invest Mngmt accumulated 39,148 shares or 0% of the stock. Metropolitan Life Insurance Ny holds 0% of its portfolio in DXP Enterprises Inc (NASDAQ:DXPE) for 10,334 shares. Manufacturers Life Insurance The has invested 0% of its portfolio in DXP Enterprises Inc (NASDAQ:DXPE). Snow Lp has invested 0.09% of its portfolio in DXP Enterprises Inc (NASDAQ:DXPE). King Luther Capital Corp, a Texas-based fund reported 435,375 shares. State Board Of Administration Of Florida Retirement System has 0% invested in the company for 11,751 shares. Prudential accumulated 39,418 shares or 0% of the stock. Stephens Inc Ar reported 62,454 shares or 0.04% of all its holdings. Teachers Advsrs reported 20,565 shares or 0% of all its holdings. Systematic Financial Mngmt Limited Partnership holds 0.02% of its portfolio in DXP Enterprises Inc (NASDAQ:DXPE) for 109,573 shares. Creative Planning has 0% invested in the company for 400 shares. Ameriprise Financial Incorporated has 305,586 shares for 0% of their US portfolio.
Insider Transactions: Since August 3, 2016, the stock had 1 buying transaction, and 5 sales for $2.23 million net activity. 172,746 shares with value of $2.76 million were bought by GMT CAPITAL CORP on Wednesday, August 3. The insider HAMLIN TODD sold 1,500 shares worth $45,120. MESSERSMITH GARY A sold $389,385 worth of stock. Another trade for 1,000 shares valued at $29,800 was made by Jeffery John Jay on Tuesday, August 16.
More notable recent DXP Enterprises Inc (NASDAQ:DXPE) news were published by: Marketwatch.com which released: "/quotes/zigman/3870025/realtime" on June 26, 2009, also Fool.com with their article: "Why DXP Enterprises, Inc.'s Shares Popped 51% Today" published on August 10, 2016, Businesswire.com published: "DXP Enterprises Announces Public Offering of Common Stock" on October 20, 2016. More interesting news about DXP Enterprises Inc (NASDAQ:DXPE) were released by: Businesswire.com and their article: "DXP Enterprises, Inc. Announces Definitive Agreement to Purchase B27, LLC" published on December 09, 2013 as well as Businesswire.com's news article titled: "DXP Enterprises, Inc. Announces Results of Arbitration With ITT Goulds Pump" with publication date: September 24, 2015.
DXPE Company Profile
DXP Enterprises, Inc. (DXP), incorporated on July 26, 1996, is engaged in the business of distributing maintenance, repair and operating (MRO) products, equipment and service to industrial customers. The Firm operates through three divisions: Service Centers, Supply Chain Services and Innovative Pumping Solutions. The Service Centers segment provides MRO products, equipment and services, including technical expertise and logistics capabilities to industrial customers. The Supply Chain Services segment manages all or part of a customer's supply chain, including procurement and inventory management. The Innovative Pumping Solutions segment provides source for engineering, systems design and fabrication. The Firm operates from approximately 190 locations in over 40 states in the United States, approximately 10 provinces in Canada, Dubai and over one state in Mexico.
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Watch Heroes in Blue (1939) Free Online
Heroes in Blue
IMDB Link:
Rating: 4.3/10 (13 votes)
Director: William Watson
Writer: Charles Williams (screenplay), Charles Williams (story "Detective First Class"), Charles W. Curran (story "Detective First Class")
Stars: Bernadene Hayes, Charles Quigley, Dick Purcell, Frank Sheridan
Runtime: 61 min
Rated: APPROVED
Year: 1939
Genre: Action, Adventure, Drama
Quality: HD
Language: English
Released: 07 Nov 1939
|Plot: Gangster Moran gives Joe Murphy several thousand dollars to bet on a horse race, the horse wins and Joe takes off with the money. Moran informs Mike Murphy, Joe's father, that no harm will come to Joe if Mike doesn't interfere with the robbing of stores on his beat. Joe's policeman brother, Terry Murphy, learns of the plot and sets out to free his father and brother of Moran's threats.
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Watch Heroes in Blue (1939) - Alternative Servers
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Katie Brown Workshop
A Perfect ShowerSeries Website »
Episode Guide »
Celebrate life's special moments with simple projects - a flower box invitation and a row of roses - and recipes for turkey sausage skewers, tapenade puff pastries and crab crostini.
CommentsShare your thoughts, questions, and comments on "Katie Brown Workshop" here.
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The 2nd Procurement & Vendor Management Working Group meeting of 2013 took place on 6-7 June and was kindly being hosted by CYTA in Paralimni, Cyprus.
The 2nd meeting of the year was held in Cyprus kindly hosted by CYTA and attended by 10 participants from 6 different companies. Some of the main topics discussed during the meeting included how to define, calculate and report Cost-Savings, Spend Reduction and Cost Avoidance with relation to Procurement, Lessons learned, SW audit experiences , good asset management & Product Liability clauses.
20/10/2016ETIS Community Gathering 2016 press release is out!
18/10/2016New ETIS Strategy officially launched at the 11th Community Gathering in Zagreb
01/06/2017 » 02/06/2017Information Security Working Group June 2017
15/06/2017 » 16/06/2017Digital Sales & Services WG 15-16/06/2017
Sharing knowledge is our strength ...


text:
287-5004 - Analog IR Distance Sensor 5V 40MM - 300MM
High precision IR distance measurement or proximity sensing has never been easier with these SHARP distance sensors. Simply supply 5VDC and Ground, and a it will give a return voltage relative to distance. Available in a variety of ranges, these sensors are high...
Mfr Name: Sharp
Mfr Number: GP2Y0A41SK0F
See all items in Sensors
24-13870 - 1Ft 3.5mm To Dual 1/4In Plugs
Cable Length: 0.3mCable Length - Imperial: 11.81"Cable Length - Metric: 300mmColor: BlackConnector Type A: 3.5mm Stereo PlugConnector Type B: 2x 1/4" Mono Plugs
Mfr Name: Pulse
Mfr Number: PLS00139
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24-13970 - 1Ft RCA Stereo Patch Cable
Cable Assembly Type: Audio / VideoCable Length: 0.3mCable Length - Imperial: 11.81"Cable Length - Metric: 300mmColor: BlackConnector Type A: 2 x Phono PlugsConnector Type B: 2 x Phono Plugs
Mfr Number: PLS00171
See all items in RCA Male to Male
22-16042 - Gearless Ratcheting Screwdriver
Gearless ratcheting screwdriver for a variety of fastening applications Operates with friction rather than teeth for a smoother, non-stepping action.
Mfr Name: Duratool
Mfr Number: D00031
See all items in Bit Handles & Holders
55-5005 - Piezo Siren 12V
Description The 41.P47L120G is a panel/chassis mount siren that uses a trailing lead connection.
Mfr Name: Distributed By MCM
Mfr Number: 41.P47L120G
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555-19385 - One Gallon Water Based Fog Liquid
Fog Liquid
CHAUVET fluids are designed and tested to provide exceptional output from CHAUVET fog, snow, and bubble machines.
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Mfr Number: FJU
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83-16199 - 2 X USB 3.0 Cables to 19Pin Header
Internal USB cables come in handy when hiding USB components. Ideal for custom enclosures
Mfr Name: Akasa
Mfr Number: AK-CBUB12-30BK
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31118 - Phillips Ergo Soft Grip Screwdriver - PH#2 x 300mm
Incredible comfort molded on soft cushioned grips
Made of Wiha premium CRM-72 tool steel
Through hardened for maximum durability
Precision machined exact fit Phillips tip
Hard chromed finish, best wear & corrosion resistance
Size: PH#2 x 300mm
Mfr Name: Wiha
Mfr Number: 31118
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83-15809 - 8 Pin Power Supply Extension
Extends 8 pin power supply connections
8 pin plug to 8 pin socket (splits to 2x 4 pin)
300mm length
Mfr Number: AK-CB8-8-EXT
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22-18980 - 1/4" x 300mm SoftFinish Ergonomic Cushion Grip Bit Holding Handle
1/4" stainless steel magnetic bit holder made of CRM-72 tool steel for long lasting use.
Mfr Number: 38460
82-18725 - 36 Hook Key Storage Cabinet with Combination
Key Cabinet
The Sterling KC36C Combination Locking Key Cabinet is a lockable key cabinet that holds up to 36 keys and has a attractive matte black finish.
Mfr Number: KC36C
See all items in Theft Prevention
83-15716 - GPIO Extender Cable for Raspberry For Raspberry Pi - 12" Long
Give your Pi some reach with this GPIO extender cable, which has two matching connectors on the end of a 12" (300mm) long gray cable. Plug one end into your Pi and the other end will have a boxed male header you can plug in a Pi Plate that is expecting to go onto ...
Mfr Name: Adafruit Industries
Mfr Number: 1337
See all items in GPIO and Ribbon Cables
6631900012E - Ector Assembly Ns-pdp42 Smh250 Smh250 300mm 2.50mm
ECTOR ASSEMBLY NS-PDP42 SMH250 SMH250 300MM 2.50MM Harness,Single
Mfr Name: LG Electronics
Mfr Number: 6631900012E
See all items in LG
EBU39117501 - 30PX30P(300mm)LVDS Cable
30PX30P(300mm)LVDS Cable Main Total Assembly
Mfr Number: EBU39117501
82-19020 - CCTV Warning Sign - 12in x 6in
Video Surveillance Warning sign
Mfr Number: VSA24
See all items in Yard Signs
MCM Electronics has always provided me with quality parts and service for many years. Never a bad experience.