Search

Background: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared with unassisted clinical examinations. Because no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy., Methods: A 2-phase modified Delphi method was used to develop 2 proficiency standards. In the study's first phase, a focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list and determined whether each diagnosis was reflective of a foundational or intermediate proficiency or neither., Results: Of the 35 initial panelists, 5 PCPs were lost to follow-up or withdrew; 30 completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses and associated features., Conclusions: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early cancer detection., Competing Interests: Conflict of interest: None., (© Copyright by the American Board of Family Medicine.)

Butte, Montana is part of the largest superfund site in the continental United States. Open-pit mining continues in close proximity to Butte's urban population. This study seeks to establish baseline metal concentrations in the hair and blood of individuals living in Butte, MT and possible routes of exposure. Volunteers from Butte (n=116) and Bozeman (n=86) were recruited to submit hair and blood samples and asked to complete a lifestyle survey. Elemental analysis of hair and blood samples was performed by ICP-MS. Three air monitors were stationed in Butte to collect particulate and filters were analyzed by ICP-MS. Soil samples from the yards of Butte volunteers were quantified by ICP-MS. Hair analysis revealed concentrations of Al, As, Cd, Cu, Mn, Mo, and U to be statistically elevated in Butte's population. Blood analysis revealed that the concentration of As was also statistically elevated in the Butte population. Multiple regression analysis was performed for the elements As, Cu, and Mn for hair and blood samples. Soil samples revealed detectable levels of As, Pb, Cu, Mn, and Cd, with As and Cu levels being higher than expected in some of the samples. Air sampling revealed consistently elevated As and Mn levels in the larger particulate sampled as compared to average U.S. ambient air data., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Targeted inhibition of Rho-associated kinase (ROCK)2 downregulates the proinflammatory T cell response while increasing the regulatory arm of the immune response in animals models of autoimmunity and Th17-skewing human cell culture in vitro. In this study, we report that oral administration of a selective ROCK2 inhibitor, KD025, reduces psoriasis area and severity index scores by 50% from baseline in 46% of patients with psoriasis vulgaris, and it decreases epidermal thickness as well as T cell infiltration in the skin. We observed significant reductions of IL-17 and IL-23, but not IL-6 and TNF-α, whereas IL-10 levels were increased in peripheral blood of clinical responders after 12 wk of treatment with KD025. Collectively, these data demonstrate that an orally available selective ROCK2 inhibitor downregulates the Th17-driven autoimmune response and improved clinical symptoms in psoriatic patients via a defined molecular mechanism that involves concurrent modulation of cytokines without deleterious impact on the rest of the immune system., (Copyright © 2017 by The American Association of Immunologists, Inc.)

We studied developmental trends in 5 important reasoning tasks that are critical components of the operational definition of rational thinking. The tasks measured denominator neglect, belief bias, base rate sensitivity, resistance to framing, and the tendency toward otherside thinking. In addition to age, we examined 2 other individual difference domains that index cognitive sophistication: cognitive ability (intelligence and executive functioning) and thinking dispositions (actively open-minded thinking, superstitious thinking, and need for cognition). All 5 reasoning domains were consistently related to cognitive sophistication regardless of how it was indexed (age, cognitive ability, thinking dispositions). The implications of these findings for taxonomies of developmental trends in rational thinking tasks are discussed., (PsycINFO Database Record (c) 2014 APA, all rights reserved.)

Background: Both performance-based and rating measures are commonly used to index executive function in clinical and neuropsychological assessments. They are intended to index the same broad underlying mental construct of executive function. The association between these two types of measures was investigated in the current article., Method and Results: We examined the association between performance-based and rating measures of executive function in 20 studies. These studies included 13 child and 7 adult samples, which were derived from 7 clinical, 2 nonclinical, and 11 combined clinical and nonclinical samples. Only 68 (24%) of the 286 relevant correlations reported in these studies were statistically significant, and the overall median correlation was only .19., Conclusions: It was concluded that performance-based and rating measures of executive function assess different underlying mental constructs. We discuss how these two types of measures appear to capture different levels of cognition, namely, the efficiency of cognitive abilities and success in goal pursuit. Clinical implications of using performance-based and rating measures of executive function are discussed, including the use of these measures in assessing ADHD., (© 2012 The Authors. Journal of Child Psychology and Psychiatry © 2012 Association for Child and Adolescent Mental Health.)

The so-called bias blind spot arises when people report that thinking biases are more prevalent in others than in themselves. Bias turns out to be relatively easy to recognize in the behaviors of others, but often difficult to detect in one's own judgments. Most previous research on the bias blind spot has focused on bias in the social domain. In 2 studies, we found replicable bias blind spots with respect to many of the classic cognitive biases studied in the heuristics and biases literature (e.g., Tversky & Kahneman, 1974). Further, we found that none of these bias blind spots were attenuated by measures of cognitive sophistication such as cognitive ability or thinking dispositions related to bias. If anything, a larger bias blind spot was associated with higher cognitive ability. Additional analyses indicated that being free of the bias blind spot does not help a person avoid the actual classic cognitive biases. We discuss these findings in terms of a generic dual-process theory of cognition.

The Cognitive Reflection Test (CRT; Frederick, 2005) is designed to measure the tendency to override a prepotent response alternative that is incorrect and to engage in further reflection that leads to the correct response. In this study, we showed that the CRT is a more potent predictor of performance on a wide sample of tasks from the heuristics-and-biases literature than measures of cognitive ability, thinking dispositions, and executive functioning. Although the CRT has a substantial correlation with cognitive ability, a series of regression analyses indicated that the CRT was a unique predictor of performance on heuristics-and-biases tasks. It accounted for substantial additional variance after the other measures of individual differences had been statistically controlled. We conjecture that this is because neither intelligence tests nor measures of executive functioning assess the tendency toward miserly processing in the way that the CRT does. We argue that the CRT is a particularly potent measure of the tendency toward miserly processing because it is a performance measure rather than a self-report measure.

The Iowa Gambling Task (IGT) has been used to study decision-making differences in many different clinical and developmental samples. It has been suggested that IGT performance captures abilities that are separable from cognitive abilities, including executive functions and intelligence. The purpose of the current review was to examine studies that have explicitly examined the relationship between IGT performance and these cognitive abilities. We included 43 studies that reported correlational analyses with IGT performance, including measures of inhibition, working memory, and set-shifting as indices of executive functions, as well as measures of verbal, nonverbal, and full-scale IQ as indices of intelligence. Overall, only a small proportion of the studies reported a statistically significant relationship between IGT performance and these cognitive abilities. The majority of studies reported a non-significant relationship. Of the minority of studies that reported statistically significant effects, effect sizes were, at best, small to modest, and confidence intervals were large, indicating that considerable variability in performance on the IGT is not captured by current measures of executive function and intelligence. These findings highlight the separability between decision-making on the IGT and cognitive abilities, which is consistent with recent conceptualizations that differentiate rationality from intelligence., (2010 Elsevier Ltd. All rights reserved.)

In 7 different studies, the authors observed that a large number of thinking biases are uncorrelated with cognitive ability. These thinking biases include some of the most classic and well-studied biases in the heuristics and biases literature, including the conjunction effect, framing effects, anchoring effects, outcome bias, base-rate neglect, "less is more" effects, affect biases, omission bias, myside bias, sunk-cost effect, and certainty effects that violate the axioms of expected utility theory. In a further experiment, the authors nonetheless showed that cognitive ability does correlate with the tendency to avoid some rational thinking biases, specifically the tendency to display denominator neglect, probability matching rather than maximizing, belief bias, and matching bias on the 4-card selection task. The authors present a framework for predicting when cognitive ability will and will not correlate with a rational thinking tendency., ((c) 2008 APA, all rights reserved.)

We conducted a genetic screen for mutations in myospheroid, the gene encoding the Drosophila betaPS integrin subunit, and identified point mutants in all of the structural domains of the protein. Surprisingly, we find that mutations in very strongly conserved residues will often allow sufficient integrin function to support the development of adult animals, including mutations in the ADMIDAS site and in a cytoplasmic NPXY motif. Many mutations in the I-like domain reduce integrin expression specifically when betaPS is combined with activating alphaPS2 cytoplasmic mutations, indicating that integrins in the extended conformation are unstable relative to the inactive, bent heterodimers. Interestingly, the screen has identified alleles that show gain-of-function characteristics in cell culture, but have negative effects on animal development or viability. This is illustrated by the allele mys(b58); available structural models suggest that the molecular lesion of mys(b58), V409>D, should promote the "open" conformation of the beta subunit I-like domain. This expectation is supported by the finding that alphaPS2betaPS (V409>D) promotes adhesion and spreading of S2 cells more effectively than does wild-type alphaPS2betaPS, even when betaPS is paired with alphaPS2 containing activating cytoplasmic mutations. Finally, comparisons with the sequence of human beta8 suggest that evolution has targeted the "mys(b58)" residue as a means of affecting integrin activity.

Developmental and individual differences in the tendency to favor analytic responses over heuristic responses were examined in children of two different ages (10- and 11-year-olds versus 13-year-olds), and of widely varying cognitive ability. Three tasks were examined that all required analytic processing to override heuristic processing: inductive reasoning, deductive reasoning under conditions of belief bias, and probabilistic reasoning. Significant increases in analytic responding with development were observed on the first two tasks. Cognitive ability was associated with analytic responding on all three tasks. Cognitive style measures such as actively open-minded thinking and need for cognition explained variance in analytic responding on the tasks after variance shared with cognitive ability had been controlled. The implications for dual-process theories of cognition and cognitive development are discussed.

Much research in the last two decades has demonstrated that human responses deviate from the performance deemed normative according to various models of decision making and rational judgment (e.g., the basic axioms of utility theory). This gap between the normative and the descriptive can be interpreted as indicating systematic irrationalities in human cognition. However, four alternative interpretations preserve the assumption that human behavior and cognition is largely rational. These posit that the gap is due to (1) performance errors, (2) computational limitations, (3) the wrong norm being applied by the experimenter, and (4) a different construal of the task by the subject. In the debates about the viability of these alternative explanations, attention has been focused too narrowly on the model response. In a series of experiments involving most of the classic tasks in the heuristics and biases literature, we have examined the implications of individual differences in performance for each of the four explanations of the normative/descriptive gap. Performance errors are a minor factor in the gap; computational limitations underlie non-normative responding on several tasks, particularly those that involve some type of cognitive decontextualization. Unexpected patterns of covariance can suggest when the wrong norm is being applied to a task or when an alternative construal of the task should be considered appropriate.

Several tasks from the heuristics and biases literature were examined in light of Slovic and Tversky's (1974) understanding/acceptance principle-that the deeper the understanding of a normative principle, the greater the tendency to respond in accord with it. The principle was instantiated both correlationally and experimentally. An individual differences version was used to examine whether individuals higher in tendencies toward reflective thought and in cognitive ability would be more likely to behave normatively. In a second application of the understanding/acceptance principle, subjects were presented with arguments both for and against normative choices and it was observed whether, on a readministration of the task, performance was more likely to move in a normative direction. Several discrepancies between performance and normative models could be explained by the understanding/acceptance principle. However, several gaps between descriptive and normative models (particularly those deriving from some noncausal base rate problems) were not clarified by the understanding/acceptance principle-they could not be explained in terms of varying task understanding or tendencies toward reflective thought. The results demonstrate how the variation and instability in responses can be analyzed to yield inferences about why descriptive and normative models of human reasoning and decision making sometimes do not coincide., (Copyright 1999 Academic Press.)

In two experiments, involving over 900 subjects, we examined the cognitive correlates of the tendency to view P(D/approximately H) and base rate information as relevant to probability assessment. We found that individuals who viewed P(D/approximately H) as relevant in a selection task and who used it to make the proper Bayesian adjustment in a probability assessment task scored higher on tests of cognitive ability and were better deductive and inductive reasoners. They were less biased by prior beliefs and more data-driven on a covariation assessment task. In contrast, individuals who thought that base rates were relevant did not display better reasoning skill or higher cognitive ability. Our results parallel disputes about the normative status of various components of the Bayesian formula in interesting ways. It is argued that patterns of covariance among reasoning tasks may have implications for inferences about what individuals are trying to optimize in a rational analysis (J. R. Anderson, 1990, 1991).

This paper presents the characterization of nine alleles of myospheroid, which encodes the beta PS subunit of the Drosophila PS integrins. On Southern blots, the mysXB87, mysXN101 and mysXR04 genes yield restriction digest patterns similar to that seen for wild-type chromosomes, however the mys1 and mysXG43 genes contain detectable deletions. mys1, mysXB87 and mysXG43 make little or no stable protein product, and genetically behave as strong lethal alleles. For the mysXN101 mutation, protein product is seen on immunoblots and a reduced amount of beta PS protein is seen at muscle attachment sites of embryos; this mutant protein retains some wild-type function, as revealed by complementation tests with weak alleles. Protein is also seen on immunoblots from mysXR04 embryos, and this allele behaves as an antimorph, being more deleterious in some crosses than the complete deficiency for the locus. mysts2 and mysnj42 are typically lethal in various combinations with other alleles at high temperatures only, but even at high physiological temperatures, neither appears to eliminate gene function completely. The complementation behaviors of mysts1 and mysts3 are quite unusual and suggest that these mutations involve regulatory phenomena. For mysts3, the data are most easily explained by postulating transvection effects at the locus. The results for mysts1 are less straightforward, but point to the possibility of a chromosome pairing-dependent negative interaction.

The purpose of this study was to assess the degree of consistency in student ratings of teacher effectiveness during the first year of medical school. Student ratings of teaching effectiveness represent a commonly used source of information that enters into the academic decision-making process. In medical school, student evaluations often represent a major source of information that is used in promotion and tenure decisions. It is essential that the precision of such ratings be ascertained so that decision-makers will know how much confidence to place in this source of information on teaching effectiveness. In this study, each member of a first-year medical school class was randomly assigned a two-digit identification number at the beginning of the spring semester, 1986. As the semester progressed students were asked to evaluate each full-time teacher in three major courses. Multiple instructors were utilized in each course (n = 10). Each teacher was evaluated immediately after lectures during the first (T1) and second (T2) halves of the course. Students evaluated the teacher a third time (T3) as part of the end-of-semester overall course evaluation. The teachers were evaluated on a short eight-item Likert-type scale that identified several key indicators of effective teaching. Students attached their anonymous identification numbers to individual ratings so that their responses could be matched in the analysis. The results indicate that medical students are only moderately consistent in the extent to which they evaluate teachers. This inconsistency varied by course and by instructors within courses.(ABSTRACT TRUNCATED AT 250 WORDS)

How contract learning may be used in the introduction to clinical medicine is described, with the goal to develop and enhance self-directed learning skills and attitudes of first- and second-year medical students. Essential tasks associated with successful self-directed learning are cited, and the contract method is described as a means for providing medical students with the opportunity to practice these tasks in the study of gerontology. The procedures followed in the implementation of the contract learning method are described, and its impact on both need and to continue learning about ageing and skills in directing independent learning projects are analysed and discussed. In addition, the implications of early preparation for doctor's lifelong learning are discussed.

The anatomy and morphometry of venous values associated with the vasculature of the head of the duckling were studied using vascular corrosion casting and scanning electron microscopy. All valves encountered were bicuspid, and casts typically exhibited slight expansions at valve sinuses and deep slits at the sites of valve leaflets. The locations, numbers, and orientations of endothelial nuclei on all surfaces of the valves were clearly revealed by imprints in the casting resin. Endothelial cell densities were significantly higher on the surfaces of valve leaflets (about 10 cells/1,000 micron2) than on other venous surfaces (about 7 cells/1,000 micron2). Endothelial nuclei on the medial surface of the valve leaflet were oriented parallel to the long axis of the vessel, whereas those on the lateral surface were oriented perpendicular to that axis. The close proximities of valves in some vessels and the presence of anomalies such as the sharing of leaflets by adjacent valves were readily demonstrated with the corrosion-casting techniques. These methods provide a useful means for studying the fine, three-dimensional details of venous valve anatomy.

Several studies have demonstrated that adults display a category effect in visual search paradigms. That is, when searching an array for the presence of a target letter, subjects detect the letter faster when the array is composed of numbers rather than letters, and vice versa. Groups of 8-year-olds, 10-year-olds, and adults searched for the presence of a target in fields of items that were either of the same or a different category (letter or number) than the target. Highly significant category effects were evident in the search times of all 3 age groups. While search times were found to decrease with development, there was no evidence of an increasing effect of category with age. It was concluded that the feature extraction process that mediates the category effect is fully automated by age 8.