Current accounts of the development of scientific reasoning focus on individual children's ability to coordinate the collection and evaluation of evidence with the creation of theories to explain the evidence. This observational study of parent -child interactions in a children's museum demonstrated that parents shape and support children's scientific thinking in everyday, nonobligatory activity. When children engaged an exhibit with parents, their exploration of evidence was observed to be longer, broader, and more focused on relevant comparisons than children who engaged the exhibit without their parents.Parents were observed to talk to children about how to select and encode appropriate evidence and how to make direct comparisons between the most informative kinds of evidence. Parents also sometimes assumed the role of explainer by casting children's experience in causal terms, connecting the experience to prior knowledge, or introducing abstract principles. We discuss these findings with respect to two dimensions of children's scientific thinking: developments in evidence collection and developments in theory construction.

This paper argues that planning entails distributed, mutual contributions of individuals, their social partners, and their community institutions. We suggest that these mutually involved contributions can be viewed through shifts in focus of analysis, contrasting with analyses of cognitive development that treat individuals as though they exist apart from their social and cultural worlds.We illustrate this argument with a study examining the distributed nature of planning to remember in a complex everyday task. We investigated the personal, interpersonal, and institutional cognitive contributions of 16 Girl Scouts, their mothers and customers and other companions, and institutions (the national organization and the cookie company) in keeping track of deliveries and planning collection of money in Girl Scout cookie sales and deliveries. The article also discusses an analytic methodology (Functional Pattern Analysis) for abstracting findings from the details of rich ethnographic data.Individual scouts, their mothers, customers, and the scouting organization and cookie company all played significant roles in keeping track of progress. In particular, tools and supports provided by the cookie company played a key role in organizing the cognitive tasks, and the scouts collaborated in planning with other people (usually their mothers and customers). Our findings illustrate the importance of examining contributions beyond those of the individual, while still recognizing the active roles of individuals in thinking. We argue that conceiving of individual, interpersonal, and institutional/cultural contributions as mutually constituting aspects of cognitive activities supports this aim beyond the usual focus on separate individual and 'external' factors. Individuals, Partners, Institutions 267This article makes the argument that the distributed, mutual contributions of individuals, their partners, and community institutions to planning can be studied with analyses that focus on one or another of these contributions, keeping key aspects of the others part of the analysis. This contrasts with common approaches that treat these contributions as independent factors or entities that can be understood without regard to each other. We illustrate our argument with a study of planning to remember during cookie sales and delivery by Girl Scouts, their mothers and customers and other companions, and the national scouting organization and the cookie baking company. We also use the observations to illustrate a method of qualitative data analysis that involves successive abstraction from ethnographic details of complex everyday activity to create generalities across specific cases.Sociocultural theory suggests that the study of cognitive activity requires analysis of the mutual contributions of individuals, their partners, and the community/ institutional traditions in which people participate. Usually, however, the development of planning has been studied with individuals doing set problems in laboratories, with little attention to contr...

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Adalimumab is widely used in the treatment of immune-mediated inflammatory diseases. It is the highest-spend drug in the National Health Service, costing more than £400 million annually. In 2018, adalimumab biosimilars became available, leading to substantial cost savings. However, patient tolerability of biosimilars remains underexplored. We evaluated the tolerability of adalimumab biosimilar therapy (Idacio®) in patients who were switched from Humira® in a large dermatology and rheumatology tertiary centre. We identified all patients issued with a prescription of Humira by dermatology [psoriasis and hidradenitis suppurativa (HS)] or rheumatology (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Behçet disease) and analysed the number who switched to Idacio between January 2021 and March 2022. Patient electronic records were reviewed up to October 2022 to identify patients who switched back to the originator product and the documented reason for the switch. The primary outcome was the numbers of patients who were switched back from the biosimilar to the originator product. Of 769 patients issued with a prescription of Humira, 694 were switched to Idacio during the study period. Of these, 134 (19.3%) switched back to the originator product, 102 of whom (76.1%) remained on this during follow-up. The highest proportion of individuals switching back to the originator product was observed in the HS population (26.7%). The most common reasons for switching back were patient-reported loss of disease control (n = 63; 47.0%), injection pain (n = 51; 38.1%) or both (n = 10; 7.5%). The median time to switch back was 197 days (interquartile range 138–280). Of 694 patients prescribed Idacio, 32 (4.6%) were switched to an alternative biologic agent during the study period. Our experience with previous biosimilar switches within rheumatology and dermatology (etanercept, rituximab and infliximab) has resulted in few patients requiring a switch back to the originator. Our data indicate that around one in five patients in our study population switched back to the originator product. The higher proportion of patients citing injection pain may relate to the citrate excipient content or larger injection volume of the biosimilar Idacio. Loss of efficacy with time is well established with adalimumab, in part due to antidrug antibodies, and cannot be specifically attributed to the biosimilar. Switching may alter a patient’s confidence in the drug, which is particularly important when it may be a first-line therapy or the only approved biologic for a condition. Data on switch-back rates for other adalimumab biosimilars is required to understand how generalizable our findings are and the potential economic implications.

Background/Aims In England, patients with rheumatoid arthritis (RA) with Moderate Disease Activity (MDAS), assessed by the DAS28 measure, had been unable to access effective therapies. We and others have reported that this group has persistent active disease, progressive joint damage, poor function and quality of life for years. In 2021 NICE published Technology Appraisals, 676, 715 and 744, which provided these patients with access to effective advanced therapies. We audited our response to these new standards from their approval in 2021. Methods Virtual Biologics Clinic (VBC) electronic records were analysed for details of patients with RA with DAS28 scores ≥3.2 to ≤ 5.1 who were approved for advanced therapies and their response to therapy. Response is reported as those who achieved DAS28 remission or low disease activity (LDAS), the usual goals of therapy for treat to target in patients with RA. Adverse events and reasons for adopting oral therapies were recorded. Results Local approval was granted for filgotinib in May 2021, adalimumab, etanercept and infliximab in October 2021, and upadacitinib in February 2022. From May 2021 until 30 August 2022, 49 patients with MDAS status RA have been approved by our VBC process. Of these, 3 declined advanced therapy after approval, 25 started adalimumab, 14 filgotinib, 4 etanercept, 1 certolizumab pegol (planned pregnancy) and 2 with a mixed RA/CTD diagnosis, rituximab. The mean DAS28 score was 4.32, range 3.22-5.1, with 20 having a DAS28 score >4.5. 29 patients had failed two DMARDS, 18 triple therapy and 2 patients failed 4 DMARDs. Most patients starting filgotinib strongly preferred oral therapy and one was a frequent traveller. Of the 18 patients receiving TNFi therapy who had at least 3 months therapy for initial disease response assessment, 8 achieved DAS 28 remission, 5 LDAS, 3 unchanged and 2 primary failure. In the 11 patients receiving filgotinib for at least three months, 7 achieved DAS28 remission, 2 LDAS, 1 primary failure and I was lost to follow-up. No patients stopped for adverse events to date. Conclusion Our preliminary data describing the use of advanced therapies in this previously under-treated group of patients with RA, show that good responses occur in many. A high percentage achieve remission, the primary goal of treat-to target guided therapy in RA. Disclosure F. Humby: Honoraria; Galapagos, Roche. Grants/research support; Pfizer. S. Subesinghe: None. A. Cope: Honoraria; Abbvie. B. Menon: None. R. Byng-Maddock: None. N. Ladha Hassan: None. L. Blackler: Honoraria; Abbvie, Novartis, UCB. Z. Mckee: None. K. Topping: None. L. Marsh: None. T. Garrood: Honoraria; UCB. Grants/research support; Galapagos, Pfizer. N. Ng: None. B.W. Kirkham: Honoraria; Abbvie, Galapagos, Janssen, Lilly, Novartis, PfizerUCB. Grants/research support; Lilly, Novartis.