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This paper describes the rationale, design, and methods of the Treatment for Anxiety in Autism Spectrum Disorders study, a three-site randomized controlled trial investigating the relative efficacy of a modular CBT protocol for anxiety in ASD (Behavioral Interventions for Anxiety in Children with Autism) versus standard CBT for pediatric anxiety (the Coping Cat program) and a treatment-as-usual control. The trial is distinct in its scope, its direct comparison of active treatments for anxiety in ASD, and its comprehensive approach to assessing anxiety difficulties in youth with ASD. The trial will evaluate the relative benefits of CBT for children with ASD and investigate potential moderators (ASD severity, anxiety presentation, comorbidity) and mediators of treatment response, essential steps for future dissemination and implementation.

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OBJECTIVE: The incidence of nonmelanoma skin cancer (NMSC) is increasing rapidly worldwide. As NMSC incidence increases, the modalities to treat this condition have become diverse. However, Mohs surgery remains the standard treatment for skin cancer in several particular locations such as the face. The objective of this study is to compare the changes, occurring over a 10-year period, in the characteristics of those cancers that were treated with Mohs micrographic surgery (MMS) at the dermatology clinics of the University of Puerto Rico as well as the modifications in the repair patterns used to close the surgical defects. METHODS: A retrospective chart review of patients treated with MMS at the dermatology of the University of Puerto Rico in the years 2000 and 2010. Variables analyzed include patient demographics, the anatomic site of each patient's lesion, pathology, the preoperative tumor size, the postoperative defect size, and the repair method. RESULTS: Thirty-eight (38) patients in the year 2000 and 55 patients in the year 2010 were treated with MMS, signifying a 44% increase in this kind of treatment over a 10-year period. The 2000 cohort was found to be slightly older (P = 0.22), with no gender predominance (P = 0.44). In both years, the majority of tumors were located on the head and neck region, being the nose the most frequent site of involvement (P = 0.06). Basal cell carcinoma (BCC) was the most common neoplasm (P = 0.65). No statistical difference was found in preoperative tumor sizes (P = 0.27). More stages were required to remove a given tumor completely in the year 2000 (P = 0.025). Postoperative defects were smaller in 2000 (P = 0.027) than they were in 2010. Flap repair was used more often in 2010 (P = 0.001) than in 2000. CONCLUSION: This study shows a trend toward larger defects in a slightly younger population of patients in the 2010 cohort compared to the 2000 cohort. It also demonstrates a reduction in the number of stages required to excise the tumors, and a tendency to reconstruct the surgical defects with flaps. However, the tumor types, preoperative tumor sizes, and anatomic sites of the lesions were all similar in the 2 cohorts.

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BACKGROUND: Melanocytic nevi are well-known, important precursors of melanoma among children and adults. The adolescence period is an important period for nevi formation and evolution. This study provides data of a longitudinal study of nevi in a Hispanic adolescent population. MATERIALS AND METHODS: A cross-sectional survey and 1-year prospective follow-up study was performed on Hispanic students from grades 6 and 7 at a school in Caguas, Puerto Rico (n = 90). The survey was completed by the students and one of their parents. The backs of the children were clinically examined for melanocytic nevi using digital photography and dermoscopy. Follow-up was conducted one year later. RESULTS: The study cohort consisted of 53 (59%) boys and 37 (41%) girls, with an average age of 11.9 years (range 11-13 years). At the beginning of the study, 85% (n = 71/90) of the students presented with melanocytic nevi on their backs. After one year, new nevi were identified in 62% (n = 44/71), and there was a mean increase in nevus count of 1.8 (P < 0.001). A trend toward increased nevus count in lighter skin types was observed (P < 0.001). The predominant dermoscopic pattern was reticular (44%). The globular pattern was found most commonly in children with skin-type II (100%), while the reticular pattern was the most common among skin-types III (32%), IV (56%), and V (45%). CONCLUSIONS: This study supports the utility of digital photography and dermoscopy for the evaluation of melanocytic nevi, providing evidence of the interrelationship between nevus count, dermoscopic pattern, and skin phenotype.

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Cocaine-induced vasculitis is a rare complication found in drug abusers. It occurs due to cocaine adulterated with levamisole. Levamisole was once used as a chemotherapy and immunomodulator for different conditions. One of the side effects of this medication is necrotizing vasculitis which has been reported in the US and Puerto Rico. Here we present another case of cocaine induced vasculitis in Puerto Rico. We describe a 43-year-old female with past medical history of bronchial asthma, migraine, and crack smoking who presented to the emergency room due to blood in her urine for 5 days. She also reported fever, chills, and fatigue. At the physical exam she had a right knee ulcer with swelling erythema, warmth, and pain. Also, she had retiform purpuric plaque lesions in her ears, bilaterally. Eroded plaques with elevated borders at left foot and finger dorsum were also present. Laboratory workup was positive for cocaine. The patient showed leucopenia and microcytic anemia with a normal absolute neutrophil count in her cell blood count. Blood cultures, urine cultures, and ulcer cultures were negative. Urinalysis was positive for proteinuria and hematuria. Also, the patient had positive perinuclear anti-neutrophil cytoplasmic antibody, cytoplasmic anti-neutrophil cytoplasmic antibody, and antinuclear antibody tests and elastase specificity. She showed negative anticardiolipin and lupus anticoagulant antibodies. Her complement levels were decreased. The punch biopsy of her ear showed superficial thrombosis of superficial vascular plexus with perivascular lymphocytic infiltrates and deeper sections showed epidermal necrosis and necrotizing vasculitis. She was started on a high dose of steroids, but could not complete the treatment because she escaped from the hospital before finishing her treatment.

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Research has shown that attention can be abnormally drawn to salient threat- or trauma-related information in individuals with posttraumatic stress and related psychological symptoms. The nature of this attentional bias is thought to derive from capture of attention toward potential threat overpowering the volitional, goal-directed attentional system. However, it is unclear whether this pattern of attentional dysregulation generalizes to salient, but non-emotional types of information. Using a well-established and sensitive measure of attentional capture, the current study demonstrates that posttraumatic psychological symptom severity is associated with the capture of attention by visually salient, non-emotional distractors. Specifically, during visual search for a unique shape, the presence of a task-irrelevant but salient color singleton disrupted search efficiency, and this disruption was correlated with both posttraumatic stress disorder (PTSD) and depression symptom severity as assessed by self-report. These findings suggest that posttraumatic stress and depression may be characterized as involving a general alteration of the balance between salience-based and goal-directed attentional systems.

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Individuals are consistently better at recognizing own-race faces compared to other-race faces (other-race effect, ORE). One popular hypothesis is that this recognition memory ORE is caused by differential own- and other-race holistic processing, the simultaneous integration of part and configural face information into a coherent whole. Holistic processing may create a more rich, detailed memory representation of own-race faces compared to other-race faces. Despite several studies showing that own-race faces are processed more holistically than other-race faces, studies have yet to link the holistic processing ORE and the recognition memory ORE. In the current study, we sought to use a more valid method of analyzing individual differences in holistic processing by using regression to statistically remove the influence of the control condition (part trials in the part-whole task) from the condition of interest (whole trials in the part-whole task). We also employed regression to separately examine the two components of the ORE: own-race advantage (regressing other-race from own-race performance) and other-race decrement (regressing own-race from other-race performance). First, we demonstrated that own-race faces were processed more holistically than other-race faces, particularly the eye region. Notably, using regression, we showed a significant association between the own-race advantage in recognition memory and the own-race advantage in holistic processing and that these associations were weaker when examining the other-race decrement. We also demonstrated that performance on own- and other-race faces across all of our tasks was highly correlated, suggesting that the differences we found between own- and other-race faces are quantitative rather than qualitative. Together, this suggests that own- and other-race faces recruit largely similar mechanisms, that own-race faces more thoroughly engage holistic processing, and that this greater engagement of holistic processing is significantly associated with the own-race advantage in recognition memory.

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Although holistic processing is thought to underlie normal face recognition ability, widely discrepant reports have recently emerged about this link in an individual differences context. Progress in this domain may have been impeded by the widespread use of subtraction scores, which lack validity due to their contamination with control condition variance. Regressing, rather than subtracting, a control condition from a condition of interest corrects this validity problem by statistically removing all control condition variance, thereby producing a specific measure that is uncorrelated with the control measure. Using 43 participants, we measured the relationships amongst the Cambridge Face Memory Test (CFMT) and two holistic processing measures, the composite task (CT) and the part-whole task (PW). For the holistic processing measures (CT and PW), we contrasted the results for regressing vs. subtracting the control conditions (parts for PW; misaligned congruency effect for CT) from the conditions of interest (wholes for PW; aligned congruency effect for CT). The regression-based holistic processing measures correlated with each other and with CFMT, supporting the idea of a unitary holistic processing mechanism that is involved in skilled face recognition. Subtraction scores yielded weaker correlations, especially for the PW. Together, the regression-based holistic processing measures predicted more than twice the amount of variance in CFMT (R(2)=.21) than their respective subtraction measures (R(2)=.10). We conclude that holistic processing is robustly linked to skilled face recognition. In addition to confirming this theoretically significant link, these results provide a case in point for the inappropriateness of subtraction scores when requiring a specific individual differences measure that removes the variance of a control task.

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Because holistic processing is a hallmark of normal face recognition, we ask whether such processing is reduced in developmental prosopagnosia (DP), and, if so, what the sources are of this deficit. Existing literature provides a mixed picture, with face inversion effects showing consistent holistic processing deficits but unable to locate their source and with some composite face studies showing reduced holistic processing and some not. We addressed this issue more thoroughly with a very large sample of DPs (N = 38) performing the part-whole task, a well-accepted measure of holistic processing that allows for the separate evaluation of individual face parts. Contrary to an expected overall reduction in holistic processing, we found an intact holistic advantage for the mouth and a complete absence of a holistic advantage for the eye region. Less severely impaired prosopagnosics showed significantly more holistic processing of the mouth, suggesting that holistic processing can aid them in recognizing faces.

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