Affective Theory of Mind in Late Adulthood: The Role of Emotion Complexity and Social Relatedness.

BACKGROUND: Age-related declines in adult affective theory of mind (AToM) have been discovered. However, AToM measures have not accounted for emotional state complexity involved in AToM. Measures have also not accounted for different types of relationships - friends versus strangers - for which AToM is employed, which is important considering the limited social networks of aging adults. OBJECTIVE: We address these issues and examine the emotion complexity, social-relatedness, and contextual relevance in AToM across adult ages (18-89 years) using a new task and two well-established measures. RESULTS: The new task displayed good structural fit and internal construct validity. Overall, an age-related decline in AToM was found along with an interaction between age and emotion complexity. For all ages, AToM performance was best for complex emotions. However, as age increased, there was more rapid decline in AToM for more complex emotions than for less complex ones. Surprisingly, AToM performance for strangers was better than for social companions. CONCLUSION: The findings suggest age-related AToM declines are more nuanced than previously understood given that adult age differences are related to emotional state complexity. They indicate that the emotion complexity levels of basic, complex, and self-conscious should be included in AToM assessments. Implications for AToM tasks and development are discussed.

Local and distant brain control in melanoma and NSCLC brain metastases with concurrent radiosurgery and immune checkpoint inhibition.

INTRODUCTION: The treatment of brain metastases with stereotactic radiosurgery (SRS) in combination with immune checkpoint inhibitors (ICI) has become more common in recent years, but there is a lack of prospective data on cancer control outcomes when these therapies are administered concurrently. METHODS: Data were retrospectively reviewed for patients with non-small cell lung cancer (NSCLC) and melanoma brain metastases treated with SRS at a single institution from May 2008 to January 2017. A parametric proportional hazard model is used to detect the effect of concurrent ICI within 30, 60, or 90 days of ICI administration on local control and distant in-brain control. Other patient and lesion characteristics are treated as covariates and adjusted in the regression. A frailty term is added in the baseline hazard to capture the within-patient correlation. RESULTS: We identified 144 patients with 477 total lesions, including 95 NSCLC patients (66.0%), and 49 (34.0%) melanoma patients. On multivariate analysis, concurrent SRS and ICI (SRS within 30 days of ICI administration) was not associated with local control but was associated with distant brain control. When controlling for prior treatment to lesion, number of lesions, and presence of extracranial metastases, patients receiving this combination had a statistically significant decrease in distant brain failure compared to patients that received non-concurrent ICI or no ICI (HR 0.15; 95% CI 0.05-0.47, p = 0.0011). CONCLUSION: Concurrent ICI can enhance the efficacy of SRS. Prospective studies would allow for stronger evidence to support the impact of concurrent SRS and ICI on disease outcomes.

When a Circle Becomes the Letter O: Young Children's Conceptualization of Learning and Its Relation With Theory of Mind Development.

In two independent yet complementary studies, the current research explored the developmental changes of young children's conceptualization of learning, focusing the role of knowledge change and learning intention, and its association with their developing theory of mind (ToM) ability. In study 1, 75 children between 48 and 86 months of age (M = 65.45, SD = 11.45, 36 girls) judged whether a character with or without a genuine knowledge change had learned. The results showed that younger children randomly attributed learning between genuine knowledge change and accidental coincidence that did not involve knowledge change. Children's learning judgments in familiar contexts improved with age and correlated with their ToM understanding. However, the correlation was no longer significant once age was held constant. Another sample of 72 children aged between 40 and 90 months (M = 66.87, SD = 11.83, 31 girls) participated in study 2, where children were asked to judge whether the story protagonists intended to learn and whether they eventually learned. The results suggested that children over-attributed learning intention to discovery and implicit learning. Stories with conflict between the learning intention and outcome appeared to be most challenging for children. Children's intention judgment was correlated with their ToM understanding, and ToM marginally predicted intention judgment when the effect of age was accounted for. The implication of the findings for school readiness was discussed. Training studies and longitudinal designs in the future are warranted to better understand the relation between ToM development and children's learning understanding.

Prediabetes, diabetes, and other CVD-related conditions among Asian populations in Los Angeles County, 2014.

Objective: To assess the prevalence of four common health conditions related to cardiovascular disease risk among Asians in Los Angeles County. Methods: A survey of Asians in Los Angeles County was conducted utilizing purposive sampling to recruit from the region's Service Planning Areas 3 and 4; these underserved areas contain high density of Asian populations. Descriptive and multivariable regression analyses were performed to explore and describe potential associations between self-reported diagnoses of prediabetes, diabetes, hypertension, and high cholesterol and body mass index (measured with non-Asian versus Asian cut points) by race/ethnicity (Chinese/Filipino/Korean/Taiwanese/Thai/Vietnamese). Results: The survey response rate was nearly 60%. The analysis included 1,377 Asians, self-identified as either Chinese (n = 700), Filipino (n = 69), Korean (n = 339), Taiwanese (n = 48), Thai (n = 115), or Vietnamese (n = 106). Results showed that, in comparison to other Asians, Filipinos had the highest risks for two of the four conditions described. Other results by subgroup affirmed a similar heterogeneous pattern of Asian health locally. Conclusions: These and other results from the survey point to potential gaps in healthcare needs of Asians, and to opportunities where local public health efforts could help increase these populations' access to cardiovascular disease-related health and social services.

Self-Reported Interest to Participate in a Health Survey if Different Amounts of Cash or Non-Monetary Incentive Types Were Offered.

The objective of this study was to assess monetary and non-monetary factors that can influence the decision to participate in a future health survey. A questionnaire was administered to eligible, low-income participants (n = 1502) of the 2012 Los Angeles County Health and Nutrition Examination Survey (LAHANES-II). Multivariable regression analyses were performed to describe factors potentially associated with future intent to participate in similar survey designs. The results of the survey suggest that, overall, female participants had a greater interest in participating under a variety of incentive scenarios. Compared to the 25-34 age group, older participants (35-44, 45-84) reported more interest to participate if $10 cash [prepaid gift/debit card], a coupon for product/travel, or a small item [e.g., granola bar, t-shirt, pen] was offered, whereas younger participants (18-24) reported greater interest for $25 cash or a coupon for product/travel. Non-Whites, when compared to Whites/Non-Hispanics, reported greater interest to participate if any of the incentives was offered. High school graduates, when compared to those with some college education, reported greater interest to participate if $10 cash, a small item, or a lottery ticket was offered. Presence of two or more chronic conditions increased interest while concerns about participation in LAHANES-II was associated with reduced interest to participate in future health-related surveys. The results suggest that both incentives and non-monetary considerations (e.g., personal concerns about participating and individual level characteristics) can influence the decision to participate in health-related surveys and offer insights into strategies that can improve response rates for these assessments that are often used to inform community planning.

When preferences are in the way: Children's predictions of goal-directed behaviors.

Across three studies, we examined 4- to 7-year-olds' predictions of goal-directed behaviors when goals conflict with preferences. In Study 1, when presented with stories in which a character had to act against basic preferences to achieve an interpersonal goal (e.g., playing with a partner), 6- and 7-year-olds were more likely than 4- and 5-year-olds to predict the actor would act in accordance with the goal to play with the partner, instead of fulfilling the basic preference of playing a favored activity. Similar results were obtained in Study 2 with scenarios that each involved a single individual pursuing intrapersonal goals that conflicted with his or her basic preferences. In Study 3, younger children's predictions of goal-directed behaviors did not increase for novel goals and preferences, when the influences of their own preferences, future thinking, or a lack of impulse control were minimized. The results suggest that between ages 4 and 7, children increasingly integrate and give more weight to other sources of motivational information (e.g., goals) in addition to preferences when predicting people's behaviors. This increasing awareness may have implications for children's self-regulatory and goal pursuit behaviors. (PsycINFO Database Record

Brainstem metastases treated with Gamma Knife stereotactic radiosurgery: the Indiana University Health experience.

Brainstem metastases offer a unique challenge in cancer treatment, yet stereotactic radiosurgery (SRS) has proven to be an effective modality in treating these tumors. This report discusses the clinical outcomes of patients with brainstem metastases treated at Indiana University with Gamma Knife (GK) radiosurgery from 2008 to 2016. 19 brainstem metastases from 14 patients who had follow-up brain imaging were identified. Median tumor volume was 0.04 cc (range: 0.01-2.0 cc). Median prescribed dose was 17.5 Gy to the 50% isodose line (range: 14-22 Gy). Median survival after GK SRS treatment to brainstem lesion was 17.2 months (range: 2.8-45.6 months). The experience at Indiana University confirms the safety and efficacy of range of GK SRS prescription doses (14-22 Gy) to brainstem metastases.

Not just numeracy and literacy: Theory of mind development and school readiness among low-income children.

The current study investigated the role of theory of mind development in school readiness among 120 low-income preschool and kindergarten children. A short-term longitudinal design was used to examine relations among theory of mind, the understanding of teaching, and learning behaviors and their collective role in children's literacy and numeracy skills at school entry. Results replicate differences in theory of mind development among low-income children as compared to typically studied, higher-income samples. Theory of mind and the combination of several sociocognitive variables successfully predicted concurrent relations with academic outcomes. Children's understanding of teaching predicted changes in literacy scores over time. Results are discussed in the context of what is known about theory of mind and sociocognitive development in school readiness. (PsycINFO Database Record

Community Emergency Response Team (CERT) Training of High-Risk Teens in the Community of Watts, South Los Angeles, 2013-2014.

The Community Emergency Response Team (CERT) concept was initially developed for adult members of the community to help prepare for disasters and minimize damage when disasters occur. CERTs also served as a tool for building community capacity and self-sufficiency by supporting a diverse group of people working together in dealing with challenges affecting their communities. The novel approach to CERTs described here sought to involve high-risk youth from low-socioeconomic status communities in CERTs and first aid and cardiopulmonary resuscitation (CPR) training to help them build ties with communities, stay off the streets, and become leaders in the community. It also helped to provide different perspectives on life, while building more resilient communities better prepared to minimize damage when a disaster strikes. After the successful launch of the first high-risk teen CERT cohort in Watts (27 CERT-trained and 14 first aid/CPR-trained), the project was expanded to other community groups and organizations. Seven additional cohorts underwent CERT and first aid/CPR training in 2013 through 2014. This initiative increased CERT visibility within South Los Angeles. New partnerships were developed between governmental, nongovernmental, and community-based organizations and groups. This model can be used to expand CERT programs to other communities and organizations by involving high-risk teens or other high-risk groups in CERT training. (Disaster Med Public Health Preparedness. 2017;11:605-609).

Community-based Flu Outreach Clinics in South Los Angeles: Client Satisfaction and Experiences.

OBJECTIVE: This study sought to better understand and improve influenza vaccination in low-income populations regardless of their health insurance/immigration status. It assessed client satisfaction and experiences with services provided at community-based "flu outreach" clinics in South Los Angeles. The clinics represent a community-public agency partnership-a model of vaccine delivery that was relatively novel to the region. DESIGN AND SAMPLE: During 2011-2012, a self-administered questionnaire was distributed to clients of the local health department's 39 flu outreach clinics in South Los Angeles. MEASURES: The study utilized a 10-item satisfaction scale and survey questions that gauged client history and experiences with present and prior vaccinations. RESULTS: Of 4,497 adults who were eligible, 3,860 completed the survey (participation rate = 86%). More than 90% were satisfied with their experiences at the clinics. Younger adults were significantly more likely than adults aged 65+ to report not having been vaccinated in the previous year (p < .05). No statistical differences were observed by gender or race/ethnicity. CONCLUSIONS: High satisfaction with flu outreach services in South Los Angeles suggests that this model for vaccine delivery could lead to meaningful client experience of care. Local health departments could capitalize on this model to improve preventive services delivery for the underserved.

Children with autism are impaired in the understanding of teaching.

Children learn novel information using various methods, and one of the most common is human pedagogical communication or teaching - the purposeful imparting of information from one person to another. Neuro-typically developing (TD) children gain the ability to recognize and understand teaching as a core method for acquiring knowledge from others. However, it is not known when children with Autism Spectrum Disorder (ASD) acquire the ability to recognize and understand teaching. This study (total N = 70) examined whether children with ASD recognize the two central elements that define teaching: (1) that teaching is an intentional activity; and (2) that teaching requires a knowledge difference between teacher and learner. Theory of mind understanding was also tested. Compared to individually matched TD children, high cognitively functioning children with ASD were impaired in their comprehension of both components of teaching understanding, and their performance was correlated with theory of mind understanding. These findings could have broad implications for explaining learning in children with autism, and could help in designing more effective interventions, which could ultimately lead to improved learning outcomes for everyday life skills, school performance, health, and overall well-being.

Cognitive universals and cultural variation in teaching.

We address three issues: (1) There is a need for a comprehensive multidisciplinary understanding of teaching; (2) teaching is a natural cognitive ability for humans; and (3) there is a need to incorporate the mentalistic and cultural approaches to teaching. We suggest certain research studies that can help deepen our understanding of the cognition of teaching.

Prevalence and circulation patterns of variant, atypical and resistant HIV in Los Angeles County (2007-2009).

The prevalence of transmitted HIV drug resistance (TDR) in Los Angeles County remains unknown, due in part to the absence of reliable genotypic data. The specific objectives of this study are to estimate the prevalence of TDR, to describe the demographic characteristics associated with TDR and to investigate the distribution of HIV-1 subtypes among persons newly diagnosed with HIV in Los Angeles County. From 2007 through 2009, 1,414 sequences were obtained from 7,100 persons newly diagnosed with HIV through HIV resistance surveillance. Overall, 257 (18%) sequences had some genetic evidence of drug resistance. Of these, 122 (9%) exhibited evidence of resistance to non-nucleoside reverse transcriptase inhibitors, 121 (9%) to nucleoside reverse transcriptase inhibitors and 76 (5%) to protease inhibitors. Subtype B was dominant (97%), followed by subtypes C (1.2%), CRF01_AE (0.8%), CRF02_AG (0.4%), A (0.3%), and F (0.1%). With a TDR prevalence of 18%, Los Angeles County ranks high compared with other jurisdictions across the nation. The prevalence of TDR in recent (19%) and long-standing (17%) HIV cases were similar, thus providing additional support for the notion that TDR-associated mutations may persist well beyond the period of recent infection. HIV-1 CRF01_AE, observed historically in central Africa and Asia, was observed to be circulating among men who have sex with men and heterosexuals in Los Angeles County. These findings underscore the need for continued and expanded HIV resistance surveillance to inform healthcare providers, policy makers and at-risk populations of emerging trends in HIV drug resistance.

Using laboratory surveillance data to estimate engagement in care among persons living with HIV in Los Angeles County, 2009.

Poor engagement in HIV care has been associated with delayed access to antiretroviral treatment and increased HIV transmission. Using viral load (VL) results from HIV laboratory surveillance data to conduct longitudinal and cross-sectional analyses, we examined linkage to care, retention in care, and their associated factors in 37,325 persons living with HIV (PLWH) in Los Angeles County (LAC). Linkage to care was considered timely if a VL test result was present ≤3 months of diagnosis. Successful retention in care was defined as having two or more VL test results ≥90 days apart during 2009. Of 6841 persons newly diagnosed with HIV in 2007-2009, 67% were linked to care within 3 months of diagnosis. Factors associated with delayed linkage to care included being African American, Latino, and Asian/Pacific Islander (adjusted hazard ratio [AHR]=0.81; 95% CI=0.75-0.87, AHR=0.83; 95% CI=0.77-0.89, AHR=0.82; 95% CI=0.71-0.94, respectively). Of the 37,325 PLWH, 52% were retained in care during 2009. Factors associated with lack of retention in care included injection drug use (adjusted prevalence ratio [APR]=0.88; 95% CI=0.84-0.93), incarceration at diagnosis (APR=0.56; 95% CI=0.51-0.61), being diagnosed in pre-highly active antiretroviral therapy (HAART) era (APR=0.94; 95% CI=0.92-0.96) or at a public facility (APR=0.97; 95% CI=0.95-1.00), age <45 years (APR=0.87; 95% CI=0.86-0.89), and having concurrent HIV/AIDS diagnoses (APR=0.94; 95% CI=0.92-0.96). This study demonstrates the value of using VL surveillance data to monitor engagement in care among PLWH, and its potential to improve linkage and retention efforts where disparities in care are observed.

Barriers and unmet need for supportive services for HIV patients in care in Los Angeles County, California.

Abstract HIV-infected patients frequently experience depression, drug use, and unstable housing but are often unable to access supportive services to manage these challenges. Data on barriers to needed supportive services are critical to improving patient access. Data from the Medical Monitoring Project (MMP), a national supplemental surveillance system for HIV-infected persons in care, was used to examine barriers to support service use and factors associated with need and unmet need for services. Interview data for 333 patients in care in 2007 and 2008 in Los Angeles County (LAC) showed that 71% (n=236) reported needing at least one supportive service and of these, 35% (n=83) reported at least one unmet need for services (46% Latino; 25% white; 83% male; 92% 30+; 77% gay/bisexual; 40% response rate). The main reasons that supportive services were not accessed included lack of information (47%; do not know where to go or who to call); an agency barrier (33%; system too confusing, wait list too long); or a financial/practical barrier (18%; too expensive, transportation problems). In a logistic regression that included all participants (n=333), African Americans (OR=3.1, 95% CI: 1.1-8.7) and those with incomes less than $10,000 were more likely to have service needs (odds ratio [OR]=3.5; 95% confidence interval [CI]: 1.3-9.3). Among those with at least one service need (n=236), those who were gay or bisexual were more likely to report at least one unmet service need (OR=2.8; 95% CI: 1.3-6.1). Disparities were found for need and unmet need for supportive services by race/ethnicity; income and sexual orientation. The reported reasons that services were not obtained suggest needed improvements in information dissemination on availability and location of HIV support services and more streamlined delivery of services.

Low risk sexual and drug-using behaviors among Latina women with AIDS in Los Angeles County.

Latina women represent nearly half of all females diagnosed with AIDS in Los Angeles County, yet little is known about their risk behaviors compared to women of other race/ethnicities. Compared to white and African American women with AIDS, Latinas with AIDS had fewer lifetime male sexual partners (P < .0001); reported fewer sexually transmitted diseases (OR = 0.24; 95% CI: 0.1, 0.5); were less likely to trade sex for drugs/money (OR = 0.18; 95% CI: 0.07, 0.5); and were less likely to report exposure to HIV via injection drug use (OR = 0.3; 95% CI: 0.09, 0.99). Latinas were also more likely to be single mothers (OR = 3.02; 95% CI: 1.4, 6.4); less likely to receive public assistance (OR = 0.33; 95% CI: 0.16, 0.70); were less likely to have completed high-school (OR = 0.11; 95% CI: .04, .31) and were more likely to never have had health insurance (OR = 2.44; 95% CI: 1.15, 5.18). The data demonstrate low-risk behaviors for Latinas and underscores the challenge of delivering effective HIV prevention to women without traditional risk profiles.

Factors associated with late HIV testing for Latinos diagnosed with AIDS in Los Angeles.

Latinos are more likely to test late for HIV infection compared to other racial/ethnic groups in the United States. A population-based interview study was used to examine factors associated with late HIV testing for Latinos diagnosed with AIDS in Los Angeles County (LAC) to develop more effective HIV testing outreach strategies. Latinos testing for HIV within one year of an AIDS diagnosis were considered as late testers, while those diagnosed with AIDS more than one year after an HIV diagnosis were defined as non-late testers. After adjusting for age, education, country of birth, and injection drug use in a logistic regression analysis, completion of the interview in Spanish was the main factor associated with late testing (adjusted Odds Ratio (AOR) = 2.9, 95% Confidence Intervals (CIs): 1.4, 6.0). Latinos testing late for HIV were also more likely to test due to illness (p<0.0001) and less likely to test as part of a clinical screening (p<0.0001). Late testers were more likely to receive their first positive HIV test as a hospital inpatient (p<0.0001) and less likely to test positive at a community health center or public clinic (p=0.05). To accomplish widespread and timely HIV testing for Latinos in LAC, Spanish-language social marketing campaigns are needed and Spanish-speaking patients should be offered HIV testing in all clinical settings.

Young children's recognition of the intentionality of teaching.

Two studies examined the role of intention in preschoolers' understanding of teaching. Three- to 5-year-olds judged stories in which there was an intention to teach or not (teaching vs. imitation) for 4 different learning outcomes (successful, partial, failed, and unknown). They also judged 2 stories with embedded instructional intent (e.g., guided discovery learning) and several standard theory of mind tasks. There was an age-related change in the understanding of teaching. Five-year-olds distinguished teaching from imitation and recognized guided discovery learning. Understanding of imitation and false belief was related. The findings indicate that theory of mind is relevant to other means of knowledge acquisition besides perceptual access and that understanding intention could help young children to recognize instruction and identify its different forms.

Demographic characteristics and sexual behaviors associated with methamphetamine use among MSM and non-MSM diagnosed with AIDS in Los Angeles County.

Demographic and behavioral factors associated with methamphetamine use are presented for 455 men who have sex with men (MSM) and 228 non-MSM diagnosed with AIDS in Los Angeles County (LAC) from 2000 to 2004, as there are limited population-based data for these subgroups. Lifetime methamphetamine use was 35% for MSM, 14% for non-MSM, 50% for white MSM, and 35% for black MSM. Methamphetamine use in the previous 12 months among MSM (11%) and non-MSM (0.4%) was less than lifetime use. Compared to MSM with no history of methamphetamine use in a multivariate analysis, MSM methamphetamine users were more likely to be non-Latino (white or black) (OR = 2.8, 95% CI: 1.6, 4.9) compared to Latino and reported > or = 10 sexual partners in the previous 12 months (OR = 3.1, 95% CI: 1.7, 5.6). These data indicate that methamphetamine has been widely used by both MSM and non-MSM with AIDS in LAC and that lifetime use is associated with sexual risk behaviors among MSM.