lian Inheritance in Mank: http://www.ncbi.nlm.nih.gov/ Omim/) is a reputable catalogue of human genetic disorders. Two other sites providing teaching and learning resources include http://www.nchpeg.org and http:// genes-r-us.uthscsa.edu/resources/genetics/primary_care. htm. Computer-based decision making is another option to consider in the rapidly progressing field of molecular genetics and genomics. An example of this is shown in a pilot study utilizing 36 UK general practitioners. Patients with a positive family history of breast cancer were assessed using the traditional pen-and-paper approach vs. a computerized pedigree drawing package or a computerized decision support package. Perhaps not surprisingly, decision making was superior with the latter option.
tion. The first three require societally determined standards to ensure that DNA tests are used appropriately, particularly when resources are limited. To complicate this further, there are likely to be tensions between industry and the publicly funded health and research organizations. This union is of mutual benefit and is needed to provide expensive resources for many of the large gene discovery and genomics enterprises (an example of this is the microarray study described earlier). However, as industry has greater involvement in clinical genetics, there is the potential for more extensive (but not necessarily relevant) DNA testing. In this environment, health professionals can also be bypassed by direct company-to-consumer advertising and DNA testing.
Issues with more implicit legal implications arise when there are threats to privacy/confidentiality raised by the specter of DNA tests identifying information on individuals for which consent has not been given. Related to this is the potential for DNA information to lead to discrimination or stigmatization because an individual has a particular DNA change, which either has the propensity for developing into disease at some time in the future, or, even more complex, is associated with a behavioral trait. Because of the community's fear that these may occur, there is often pressure for new laws to be passed. In some circumstances, a law may be necessary, but rapid changes occurring in genetics/genomics make legal options less than ideal because laws can be inflexible. Hence, alternative approaches such as education should be tried, as many of the problems that arise do so because of ignorance.
From the clinical perspective, the ethical, social, and legal issues add another layer of complexity when dealing with molecular genetics/genomics. The concepts of informed consent and duty of care are well established and provide health professionals with broad guidelines for clinical consultation. However, molecular genetics (and particularly genomics) adds new dimensions: 1) knowledge is often changing; and 2) effects can be far-reaching (i.e., results for a patient will have implications for other family members). In this environment, continuity of care and long-term follow-up become particularly important.
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The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.