Language, ambiguity, and executive functions in adolescents' theory of mind.

Executive functions' (EF) role in adolescents' advanced theory of mind (aToM) was examined. In Study 1, adolescents (N = 189 in 2017, Mage  = 13.1 years, 55.6% female from racially/ethnically diverse schools) completed the Flexibility and Automaticity of Social Cognition task (FASC), and shifting and inhibition measures. Study 2 (N = 289 in 2018 and 2019, Mage  = 15.7 years, 59.9% female, 56.4% Hispanic/Latino) replicated Study 1 in older adolescents using automated scoring of FASC flexibility. Flexibility of social cognition varied based on ambiguity and language use; automaticity of social cognition varied by ambiguity. The role of EF was less conclusive; shifting and inhibition predicted some flexibility and automaticity measures. Ambiguity, language, and EF, particularly shifting, influence aToM into adolescence.

Evaluating the effect of prior authorizations in patients with complex dermatologic conditions.

BACKGROUND: In dermatology, prior authorizations can delay treatment, decrease patient adherence, and deter providers from advocating for their patients. Patients with complex dermatologic conditions, often requiring off-label treatments, may face particularly significant insurance barriers. OBJECTIVE: Evaluate the effect of prior authorizations in patients with complex dermatologic conditions. METHODS: This prospective cohort study assessed patients treated by a dermatologist during 5 months who specialized in complex dermatology. Patients included were older than 18 years, treated at V.P.W.'s rheumatology-dermatology clinic, and prescribed a medication or ordered a diagnostic procedure that elicited an insurance prior authorization. Data on prior authorization outcome, administrative time, and delay to treatment were collected. RESULTS: Of 51 prior authorizations, 51% were initially denied, with systemic medications more likely denied than topical ones (P < .001). Total administrative time spent on 50 prior authorizations tracked was 62.5 hours (median time per prior authorization 30 minutes [interquartile range 17-105 minutes]). Time to access treatment was tracked for 80% of prior authorizations; median delay was 12 days [interquartile range 5.5-23 days]. LIMITATIONS: Single-center, single-provider patient panel. CONCLUSION: Patients with complex dermatologic conditions face a significant barrier to care because of prior authorizations. The administrative burden for provider practices to address these prior authorizations is substantial and may warrant a streamlined system in collaboration with insurers.

Unbearable wearables.

As wearable devices play an increasing role in the management of health and disease, adverse skin reactions to wearables have become more common. However, the management of allergic contact dermatitis is challenging and new treatment options more compatible with wearable devices are needed. In a 40-year-old woman with contact dermatitis to a continuous glucose monitoring device, topical clobetasol propionate 0.05% spray proved to be an effective treatment that was compatible with the application of adhesive wearables. This case demonstrates that spray formulations of topical steroids are a good option for the treatment of dermatitis under wearable devices such as continuous glucose monitors or ostomy appliance.

Developmental Trends in Flexibility and Automaticity of Social Cognition.

Age-related changes in flexibility and automaticity of reasoning about social situations were investigated. Children (N = 101; age range = 7;8-17;7) were presented with the flexibility and automaticity of social cognition (FASC), a new measure of social cognition in which cartoon vignettes of social situations are presented and participants explain what is happening and why. Scenarios vary on whether the scenario is socially ambiguous and whether or not language is used. Flexibility is determined by the number of unique, plausible explanations, and automaticity is indicated by speed of response. Overall, both flexibility and automaticity increased significantly with age. Language and social ambiguity influenced performance. Future work should investigate differences in FASC in older populations and clinical groups.

Preclinical evaluation of the Aurora kinase inhibitors AMG 900, AZD1152-HQPA, and MK-5108 on SW-872 and 93T449 human liposarcoma cells.

Liposarcoma is a malignant soft tissue tumor that originates from adipose tissue and is one of the most frequently diagnosed soft tissue sarcomas in humans. There is great interest in identifying novel chemotherapeutic options for treating liposarcoma based upon molecular alterations in the cancer cells. The Aurora kinases have been identified as promising chemotherapeutic targets based on their altered expression in many human cancers and cellular roles in mitosis and cytokinesis. In this study, we investigated the effects of an Aurora kinase A inhibitor (MK-5108), an Aurora kinase B inhibitor (AZD1152-HQPA), and a pan-Aurora kinase inhibitor (AMG 900) on undifferentiated SW-872 and well-differentiated 93T449 human liposarcoma cells. Treatment of the SW-872 and 93T449 cells with MK-5108 (0-1000 nM), AZD1152-HQPA (0-1000 nM), and AMG 900 (0-1000 nM) for 72 h resulted in a dose-dependent decrease in the total viable cell number. Based upon the EC50 values, the potency of the three Aurora kinase inhibitors in the SW-872 cells was as follows: AMG 900 (EC50 = 3.7 nM) > AZD1152-HQPA (EC50 = 43.4 nM) > MK-5108 (EC50 = 309.0 nM), while the potency in the 93T449 cells was as follows: AMG 900 (EC50 = 6.5 nM) > AZD1152-HQPA (EC50 = 74.5 nM) > MK-5108 (EC50 = 283.6 nM). The percentage of polyploidy after 72 h of drug treatment (0-1000 nM) was determined by propidium iodide staining and flow cytometric analysis. AMG 900 caused a significant increase in polyploidy starting at 25 nM in the SW-872 and 93T449 cells, and AZD1152-HQPA caused a significant increase starting at 100 nM in the SW-872 cells and 250 nM in the 93T449 cells. The Aurora kinase A inhibitor MK-5108 did not significantly increase the percentage of polyploid cells at any of the doses tested in either cell line. The expression of Aurora kinase A and B was evaluated in the SW-872 cells versus differentiated adipocytes and human mesenchymal stem cells by real-time RT-PCR and Western blot analysis. Aurora kinase A and B mRNA expression was significantly increased in the SW-872 cells versus the differentiated adipocytes and human mesenchymal stem cells. Western blot analysis revealed a ~ 48 kDa immunoreactive band for Aurora kinase A that was not present in the differentiated adipocytes or the human mesenchymal stem cells. A ~ 39 kDa immunoreactive band for Aurora kinase B was detected in the SW-872 cells, differentiated adipocytes, and human mesenchymal stem cells. A smaller immunoreactive band for Aurora kinase B was detected in the SW-872 cells but not in the differentiated adipocytes and human mesenchymal stem cells, and this may reflect the expression of a truncated splice variant of Aurora kinase B that has been associated with poor patient prognosis. The 93T449 cells demonstrated decreased expression of Aurora kinase A and B mRNA and protein compared to the SW-872 cells, and also expressed the truncated form of Aurora kinase B. The results of these in vitro studies indicate that Aurora kinase inhibitors should be further investigated as possible chemotherapeutic agents for human liposarcoma.

Reliability and validity of advanced theory-of-mind measures in middle childhood and adolescence.

Although theory-of-mind (ToM) development is well documented for early childhood, there is increasing research investigating changes in ToM reasoning in middle childhood and adolescence. However, the psychometric properties of most advanced ToM measures for use with older children and adolescents have not been firmly established. We report on the reliability and validity of widely used, conventional measures of advanced ToM with this age group. Notable issues with both reliability and validity of several of the measures were evident in the findings. With regard to construct validity, results do not reveal a clear empirical commonality between tasks, and, after accounting for comprehension, developmental trends were evident in only one of the tasks investigated. Statement of contribution What is already known on this subject? Second-order false belief tasks have acceptable internal consistency. The Eyes Test has poor internal consistency. Validity of advanced theory-of-mind tasks is often based on the ability to distinguish clinical from typical groups. What does this study add? This study examines internal consistency across six widely used advanced theory-of-mind tasks. It investigates validity of tasks based on comprehension of items by typically developing individuals. It further assesses construct validity, or commonality between tasks.

Creating 21st-Century Laboratories and Classrooms for Improving Population Health: A Call to Action for Academic Medical Centers.

Academic medical centers (AMCs) in the United States built world-class infrastructure to successfully combat disease in the 20th century, which is inadequate for the complexity of sustaining and improving population health. AMCs must now build first-rate 21st-century infrastructure to connect combating disease and promoting health. This infrastructure must acknowledge the bio-psycho-social-environmental factors impacting health and will need to reach far beyond the AMC walls to foster community "laboratories" that support the "science of health," complementary to those supporting the "science of medicine"; cultivate community "classrooms" to stimulate learning and discovery in the places where people live, work, and play; and strengthen bridges between academic centers and these community laboratories and classrooms to facilitate bidirectional teaching, learning, innovation, and discovery.Private and public entities made deep financial investments that contributed to the AMC disease-centered approach to clinical care, education, and research in the 20th century. Many of these same funders now recognize the need to transform U.S. health care into a system that is accountable for population health and the need for a medical workforce equipped with the skills to measure and improve health. Innovative ideas about communities as centers of learning, the importance of social factors as major determinants of health, and the need for multidisciplinary perspectives to solve complex problems are not new; many are 20th-century ideas still waiting to be fully implemented. The window of opportunity is now. The authors articulate how AMCs must take bigger and bolder steps to become leaders in population health.

Aminophylline in bradyasystolic cardiac arrest.

A short cut review was carried out to establish whether aminophylline improved return of spontaneous circulation rates and eventual outcome in bradyasystolic cardiac arrest. A total of 1154 papers were found using the reported searches, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these four papers are summarised in table 4. It is concluded that aminophylline offers no benefit in this situation.