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Nearly 40% of people with HIV (PWH) experience HIV-associated Neurocognitive Disorder (HAND). In this 3-group efficacy study, 216 PWH 40 + years with HAND or borderline HAND were randomized to either: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73), or (3) 10 h of Internet navigation training (n = 73; contact control group). Participants were administered a measure of SOP [i.e., the Useful Field of View Test (UFOV®)] at baseline, at posttest immediately after training, and at year 1 and year 2 follow up. Intent-to-treat linear mixed-effect models with subject-specific intercept and slope were fitted to estimate between-group mean differences at the follow-up time-points. At the post-intervention time-point, small beneficial SOP training effects were observed for the 10-h group in UFOV® total (d = 0.28, p = 0.002). Effects were of larger magnitude for the 20-h group in these same outcomes [UFOV® total (d = 0.43, p < 0.001)]. These results indicated better benefit with more training. No intervention effect was observed at year 1. At year 2, beneficial effects of small magnitude were observed again in the 10-h group [UFOV® total (d = 0.22, p = 0.253)] with larger small-to-moderate magnitude in the 20-h group [UFOV® total (d = 0.32, p = 0.104)]. This study suggests that SOP training can improve a key indicator of this cognitive performance and that treatment gains are small-to-moderate over a two-year period. Prior literature suggests slower SOP is predictive of impairment in everyday functioning in older PWH; such an approach could potentially improve everyday functioning in PWH., (© 2024. The Author(s).)

Distinctive subpopulations of circulating tumor cells (CTCs) with increased motility are considered to possess enhanced tumor-initiating potential and contribute to metastasis. Single-cell analysis of the migratory CTCs may increase our understanding of the metastatic process, yet most studies are limited by technical challenges associated with the isolation and characterization of these cells due to their extreme scarcity and heterogeneity. We report a microfluidic method based on CTCs' chemotactic motility, termed as CTC-Race assay, that can analyze migrating CTCs from metastatic non-small-cell lung cancer (NSCLC) patients with advanced tumor stages and enable concurrent biophysical and biochemical characterization of them with single-cell resolution. Analyses of motile CTCs in the CTC-Race assay, in synergy with other single cell characterization techniques, could provide insights into cancer metastasis.

Abstract: Speed of processing (SOP) cognitive training may improve indicators of the quality of life (QoL) in people living with HIV. In this 2-year, longitudinal, randomized, controlled trial, 216 participants ages 40 years and older with HIV-associated neurocognitive disorder or borderline HIV-associated neurocognitive disorder were assigned to one of three groups: (a) 10 hr of SOP training (n = 70); (b) 20 hr of SOP training (n = 73), or (c) 10 hr of internet navigation control training (a contact control group; n = 73). Participants completed several QoL measures at baseline, posttest, and Year 1 and Year 2 follow-ups. Using linear mixed-effect models, no strong pattern of training effects across QoL outcomes was apparent, with small-magnitude, nonsignificant, between-group differences in depression, locus of control, and Medical Outcomes Study-HIV scales. In conclusion, despite prior work showing some transfer of SOP cognitive training improving QoL, that was not observed. Implications for research and practice are posited., (Copyright © 2024 Association of Nurses in AIDS Care.)

Objective: As people with HIV (PWH) age, they are at-risk of developing cognitive impairments compared to their seronegative counterparts. Although speed of processing (SOP) training may help improve this cognitive ability, less work has examined transfer to other cognitive domains. This study examined the effect of SOP training has on secondary cognitive domains in PWH aged 40+ years., Method: In this 3-group 2-year longitudinal study, 216 PWH with HIV-associated neurocognitive disorder (HAND) or borderline HAND were randomized to either: (1) 10 h of SOP training ( n  = 70); (2) 20 h of SOP training ( n  = 73); or (3) 10 h of an active control training ( n  = 73). Participants completed a comprehensive cognitive battery at baseline, immediately after training, and at 1 and 2 years. This battery yielded global and domain specific T-scores as well as a cognitive impairment variable. Generalized linear mixed-effect models were fitted to estimate between-group mean differences at the follow-up time-points adjusted for baseline., Results: No clinically or statistically significant improvements in any of the cognitive outcomes were observed. A sensitivity analysis was conducted; conclusions replicated those of the main analysis, with two exceptions: Global Function T and Psychomotor Speed T showed relevant training improvements among the intervention groups over the control group at the immediate post time point., Conclusions: Although SOP training has been shown to improve cognitive abilities that correspond to driving and mobility, such training has limited therapeutic utility in improving cognition in other domains in PWH with HAND.

The intersectional risks of children in United States immigrant communities include environmental exposures. Pesticide exposures and their biological outcomes are not well characterized in this population group. We assessed pesticide exposure and related these exposures to DNA double-strand breaks (DSBs) in Latinx children from rural, farmworker families (FW; N  = 30) and from urban, non-farmworker families (NFW; N  = 15) living in North Carolina. DSBs were quantified in hair follicular cells by immunostaining of 53BP1, and exposure to 72 pesticides and pesticide degradation products were determined using silicone wristbands. Cholinesterase activity was measured in blood samples. DSB frequencies were higher in FW compared to NFW children. Seasonal effects were detected in the FW group, with highest DNA damage levels in April-June and lowest levels in October-November. Acetylcholinesterase depression had the same seasonality and correlated with follicular DNA damage. Organophosphate pesticides were more frequently detected in FW than in NFW children. Participants with organophosphate detections had increased follicular DNA damage compared to participants without organophosphate detection. Follicular DNA damage did not correlate with organochlorine or pyrethroid detections and was not associated with the total number of pesticides detected in the wristbands. These results point to rural disparities in pesticide exposures and their outcomes in children from vulnerable immigrant communities. They suggest that among the different classes of pesticides, organophosphates have the strongest genotoxic effects. Assessing pesticide exposures and their consequences at the individual level is key to environmental surveillance programs. To this end, the minimally invasive combined approach used here is particularly well suited for children., Supplementary Information: The online version contains supplementary material available at 10.1007/s12403-023-00609-1., Competing Interests: Conflicts of InterestK.A.A. has a financial interest in MyExposome, Inc., which is marketing technology related to the research being reported. The terms of this arrangement have been approved by Oregon State University in accordance with its policy on research conflicts of interest. All other authors declare they have no conflict of interest., (© The Author(s) 2023.)

Objective: In a 2-group prospective design, this study compared seasonal cholinesterase levels of Latinx children in rural farmworker families and comparable urban children to assess the impact of environmental exposure to cholinesterase-inhibiting insecticides., Methods: Quarterly blood samples and passive dosimeter wristbands were collected over 2 years in 8-year-old children (74 rural, 62 urban). Laboratory analysis assessed total cholinesterase, acetylcholinesterase, and butyrylcholinesterase from blood samples, and insecticides from wristbands., Results: In spring and summer, total cholinesterase and acetylcholinesterase levels were depressed in rural children compared with winter and fall. Butyrylcholinesterase was depressed in rural children in fall compared with spring and summer. Adjustment for insecticide exposure did not affect these associations., Conclusions: Environmental exposures to cholinesterase-inhibiting insecticides have measurable biochemical effects on blood cholinesterases in rural children from farmworker families., Competing Interests: Conflicts of Interests: All authors have declared possible conflicts of interest:, (Copyright © 2023 American College of Occupational and Environmental Medicine.)

Objectives: Processing speed is essential to functional independence in later life, such as driving a vehicle. Few studies have examined processing speed and driving mobility in the context of racial differences and social determinants of health (SDoH). This study characterized the longitudinal association between processing speed and driving mobility, and how it varied by race and SDoH. Methods: Using data from the control arm of the Advanced Cognitive Training in Vital Elderly study ( n = 581, 24.5% Black), multilevel models examined longitudinal associations between processing speed and driving mobility outcomes (driving space, exposure, and difficulty). Race and SDoH moderations were explored. Results: Decline in processing speed measures was associated with increased self-reported driving difficulty, but only for older adults with below-average to average scores for neighborhood and built environments and social community context SDoH domains. Discussion: Findings emphasize the influence of physical and social environmental characteristics on processing speed and driving mobility., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Karlene Ball owns stock in the Visual Awareness Research Group (formerly Visual Awareness, Inc.), and Posit Science, Inc., the companies that market the Useful Field of View Test and speed of processing training software. Posit Science acquired Visual Awareness, and Dr. Ball continues to collaborate on the design and testing of these assessments and training programs as a member of the Posit Science Scientific Advisory Board. The other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators., Methods: An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings., Results: A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions., Discussion: A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities., Highlights: Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues., (© 2023 the Alzheimer's Association.)

Background: Pain is associated with cognitive decline among older adults, but few studies have investigated bidirectional associations between pain and cognitive decline, especially in older Hispanic populations. Our objective was to assess the bidirectional association between pain interference and cognitive performance in a sample of older Puerto Rican adults., Methods: Data came from baseline and 4-year follow-up of the Puerto Rican Elderly: Health Conditions Study, a longitudinal representative study of Puerto Rican older adults aged 60 and older. Pain and cognitive performance were assessed at each wave. A pain interference variable was created using the sum of pain status (yes/no) and pain interference (yes/no; range 0-2). Global cognitive performance was assessed with the Mini-Mental Cabán. We tested bidirectional associations using a path model with concurrent and cross-lagged paths between pain and cognitive performance, adjusting for sociodemographic and health factors (n = 2 349)., Results: Baseline pain interference was not associated with baseline cognitive performance (p = .636) or with cognitive performance at follow-up (p = .594). However, increased pain interference at follow-up was associated with greater cognitive decline at follow-up (β = -0.07, standard error [SE] = 0.02, p = .003). Greater baseline cognitive performance was associated with lower pain interference at follow-up (β = -0.07, SE = 0.02, p = .007)., Conclusions: These findings highlight the importance of worsening pain interference as a potentially modifiable risk factor for cognitive decline, as pain treatment options exist. Additionally, better baseline cognitive performance may be a protective factor for pain, providing further evidence of the dynamic relationship between pain and cognitive performance., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Many people living with human immunodeficiency virus (HIV) (PLWH) experience cognitive decline that impairs everyday functioning. Cognitive training approaches, such as speed of processing (SOP) training, may reduce the impact of HIV-Associated Neurocognitive Disorder (HAND) on everyday functioning. In this experimental design study called the Think Fast Study, 216 participants age 40 and older with HAND or borderline HAND were randomized to one of three groups: (1) 10 h of SOP training ( n  = 70); (2) 20 h of SOP training ( n  = 73); or (3) 10 h of Internet Navigation Control Training (a contact control group; n  = 73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups, which included: (a) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; (b) Timed Instrumental Activities of Daily Living (TIADL) Test; (c) Patient's Assessment of Own Functioning (PAOFI); (d) Medication Adherence Questionnaire (MAQ); and (e) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-h and 20-h training groups had better scores on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen's d ) ranging 0.13-0.41 for MAQ and 0.02-0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. Implications for practice and research are posited.

Half of people with human immunodeficiency virus (HIV) have HIV-associated neurocognitive disorder (HAND). Fortunately, cognitive training programs can improve function across cognitive domains, which may translate to everyday functioning. The Training on Purpose (TOPS) Study was designed to reverse HAND by targeting cognitive training to specific cognitive impairments that contributed to the diagnosis. A secondary aim of TOPS was to determine whether such cognitive training improved subjective and objective everyday functioning. In this two-group pre-post experimental design study, 109 adults with HAND were randomized to either: (1) a no-contact control group (no training) or (2) the Individualized-Targeted Cognitive Training group. Each participant received approximately 10 hours of cognitive training in two selected cognitive domains based on her/his individual baseline cognitive performance. Thus, 20 hours of individualized training on these two cognitive domains occurred over a course of 12 weeks in 1-2 hour sessions. Specific to the secondary aim of TOPS, measures of everyday functioning were administered before and after cognitive training to examine transfer effects. The analyses revealed that in general, speed of processing training produced benefits in everyday functioning as measured by the medication adherence visual analogue scale and the Timed Instrumental Activities of Daily Living test. Inconsistent findings were found for the other seven cognitive training protocols in either improving everyday functioning or reducing perceived everyday functioning; however, there may be other contributing factors that obscured such effects needing further research. This study demonstrated that some training protocols vary in efficacy in altering both objective and subjective everyday functioning ability.

Cognitive impairment is known to increase with aging in people living with HIV (PLWH). Impairment in cognitive domains required for safe driving may put PLWH at risk for poor driving outcomes, decreased mobility, and health-related quality of life (HRQoL). This study described the driving behaviors of middle-aged and older PLWH and examined correlations between driving behaviors and cognitive functioning (Aim 1), and driving behaviors and HRQoL domains (Aim 2). A sample of 260 PLWH ages 40 and older completed a comprehensive assessment including a battery of cognitive tests, an HRQoL measure, and a measure of self-reported driving habits. Associations between driving habits, cognitive function, and HRQoL domains were examined. While 212 (81.54%) participants reported currently driving, only 166 (63.85%) possessed a driver's license. Several significant correlations emerged between driving habits and both cognitive and HRQoL variables, with a general pattern suggesting that current greater driving exposure was associated with better cognitive functioning and HRQoL. Given consistent associations that emerged between the social functioning HRQoL domain and several driving habits, multivariable regression was conducted to examine the unique association between an index of greater driving exposure (i.e., days driven per week) and social functioning, adjusting for potential confounders (race, income, education, depression, and global cognition). Results showed that more days driven per week was a significant, independent correlate of higher social functioning. Understanding the factors underlying driving behaviors in PLWH may contribute to interventions to promote better mobility and improved access to care.

This study examined whether pain is associated with subjective memory problems or cognition in Puerto Rican older adults. Participants came from the Puerto Rican Elderly Health Conditions (PREHCO) study, aged 60 and over ( n  = 2,144). Analyses examined concurrent and longitudinal associations of pain with subjective memory problems and cognition using a cognitive screener. Overall, participants with pain were more likely to report concurrent subjective memory problems than those without pain. Older adults with pain also exhibited slightly lower concurrent cognition. Novel pain was associated with cognitive decline and greater likelihood of incident subjective memory problems at follow-up. Persistent pain was only related to incident subjective memory problems at follow-up. Pain is associated with cognitive decline and subjective memory problems in older Puerto Ricans. Future studies should implement more in-depth neuropsychological assessments and examine the potential role of barriers to pain management in this population.

Cognitive reserve has shown evidence of mitigating HIV-related effects on cognition in people living with HIV (PWH). In a sample of adults residing in the Deep South, an underrepresented subgroup in the neuroAIDS literature, we assessed the association between HIV serostatus and age on processing speed, visual attention, executive function, and episodic memory and the attenuating effect of cognitive reserve. Adults ( n  = 138; 72 PWH; M age = 58.7 years, SD  = 7.9 years; 75% nonwhite race) were recruited from a university clinic and the community. Verbal abilities served as a proxy for cognitive reserve. Regressions accounting for race, alcohol usage, and depressive symptoms were conducted for each cognitive outcome. Indirect effects were tested using the PROCESS macro. Being HIV seropositive was associated with worse executive function ( b  = -1.04, SE = 0.38, p  = .007) and episodic memory ( b  = -39.94, SE = 12.54, p  = .002) performance. Every year of age above the mean and nonwhite race was associated with worse cognitive performance ( p s < .05). The addition of cognitive reserve to the model attenuated the HIV serostatus associations with executive function (BC 95% CI -0.770, -0.001) along with most associations between race and cognitive outcomes. Age associations remained for all cognitive outcomes ( p s < .05). Findings highlight the importance of including verbal ability proxies of cognitive reserve when assessing cognition in PWH. Highlighting modifiable cognitive processes, such as cognitive reserve, will further the development of targeted cognitive interventions in this at-risk population.

Access to reliable transportation is a social determinant of health imperative for disease management for those aging with HIV/AIDS. To what degree transportation barriers are associated with health-related quality of life (HRQOL) in middle-aged and older people living with HIV (PWH) in the Deep South region of the United States is presently unknown. PWH (n = 261, age range = 39 to 73 years old, 80.1% African American, 64.4% male) were recruited from an academic medical center in the Deep South. Variables included sociodemographics, HIV characteristics, depressive symptoms, HRQOL, and perceived transportation barriers. Spearman rho correlations and linear regressions accounting for covariates were conducted. After accounting for covariates, greater perceived transportation barriers were associated with worse health perceptions, pain, social functioning, health distress, and health transitions. Access to reliable transportation is a key factor in improving health for PWH. Considerations for healthcare and traffic safety are discussed., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Abstract: HIV-associated neurocognitive disorder (HAND) is experienced by 30% to 50% of people living with HIV (PLWH), potentially affecting their quality of life (QoL). In the Training on Purpose Study, we investigated whether targeted cognitive training can improve QoL in PLWH with HAND. Using a two-group experimental design, we randomized 109 adults with HAND to either (a) the Individualized-Targeted Cognitive Training group or (b) a no-contact control group. Those in the training group were assigned 10 hr of cognitive training per two selected cognitive domains (20 hr total) for which impairment was observed. Overall, two patterns emerged. First, significant improvements in measures of everyday cognitive complaints, depression, and mental health were consistently observed after the completion of many cognitive training protocols. Second, immediate and delayed spatial learning and memory training resulted in more significant indicators of QoL improvements compared with the other cognitive domain trainings. The findings suggest that some types of cognitive training may have advantages over others in improving aspects of QoL., (Copyright © 2021 Association of Nurses in AIDS Care.)

Competing Interests: We declare we have no competing interests.

Federal reporting of crash fatalities has limited age-by-sex stratification, but both age and sex are associated with driving reduction and cessation. We described older driver fatal crash involvement and fatalities using Fatality Analysis Reporting System data to calculate rates (per 100,000 licensed drivers, per 100,000 population) with age-by-sex stratifications. Nationally from 2000 through 2017, 110,422 drivers 65+ were involved in crashes resulting in at least one death within 30 days, and 67,843 of these older drivers died. Involvement and fatality rates per 100,000 licensed drivers in 2017 were lowest for females 65-69 (7.7 and 3.6, respectively) and highest for males age 85+ (34.3 and 25.5, respectively). Females had lower driver fatal crash involvement and fatality rates throughout the lifespan, even when rates generally decreased over time. Elaborating fatal crash trends and rates by age and sex helps to differentiate the public health burden of older driver crashes and fatalities.

Objective: Older persons with human immunodeficiency virus (HIV) (PWH) are particularly susceptible to life-space restrictions. The aims of this study included: 1) using global positioning system (GPS) derived indicators as an assessment of time spent at home among older adults with and without HIV; 2) using ecological momentary assessment (EMA) to examine real-time relationships between life-space, mood (happiness, sadness, anxious), fatigue, and pain; and 3) determining if number of daily social interactions moderated the effect of life-space on mood., Methods: Eighty-eight older adults (PWH n = 54, HIV-negative n = 34) completed smartphone-based EMA surveys assessing mood, fatigue, pain, and social interactions four times per day for two weeks. Participants' smartphones were GPS enabled throughout the study. Mixed-effects regression models analyzed concurrent and lagged associations among life-space and behavioral indicators of health., Results: PWH spent more of their time at home (79% versus 70%, z = -2.08; p = 0.04) and reported lower mean happiness (3.2 versus 3.7; z = 2.63; p = 0.007) compared to HIV-negative participants. Controlling for covariates, more daily social interactions were associated with higher ratings of real-time happiness (b = 0.12; t = 5.61; df = 1087.9; p< 0.001). Similar findings were seen in lagged analyses: prior day social interactions (b = 0.15; t = 7.3; df = 1024.9; p < 0.0001) and HIV status (b = -0.48; t = -2.56; df = 1026.8; p = 0.01) attenuated the effect of prior day time spent at home on happiness., Conclusion: Accounting for engagement in social interactions reduced the significant effect of time spent at home and lower happiness. Interventions targeting social isolation within the context of constricted life-space may be beneficial for increasing positive mood in older adults, and especially relevant to older PWH., (Copyright © 2020 American Association for Geriatric Psychiatry. All rights reserved.)

Rapid and label-free separation of target cells from biological samples provided unique opportunity for disease diagnostics and treatment. However, even with advanced technologies for cell separation, the limited throughput, high cost and low separation resolution still prevented their utility in separating cells with well-defined physical features from a large volume of biological samples. Here we described an ultrahigh-throughput microfluidic technology, termed as inertial-ferrohydrodynamic cell separation (inertial-FCS), that rapidly sorted through over 60 milliliters of samples at a throughput of 100 000 cells per second in a label-free manner, differentiating the cells based on their physical diameter difference with ∼1-2 μm separation resolution. Through the integration of inertial focusing and ferrohydrodynamic separation, we demonstrated that the resulting inertial-FCS devices could separate viable and expandable circulating tumor cells from cancer patients' blood with a high recovery rate and high purity. We also showed that the devices could enrich lymphocytes directly from white blood cells based on their physical morphology without any labeling steps. This label-free method could address the needs of high throughput and high resolution cell separation in circulating tumor cell research and adoptive cell transfer immunotherapy.

Introduction: Adolescent drivers are often the focus of traffic safety legislation as they are at increased risk for crash-related injury and death. However, the degree to which adolescents support distracted driving laws and factors contributing to their support are relatively unknown. Using a large, nationally weighted sample of adolescent drivers in the United States, we assessed if perceived threat from other road users' engagement in distracted driving, personal engagement in distracted driving behaviors, and the presence of state distracted driving laws was associated with support for distracted driving laws., Methods: The sample included 3565 adolescents (aged 16-18) who participated in the Traffic Safety Culture Index survey from 2011 to 2017. A modified Poisson regression model with robust errors was fit to the weighted data to examine support for distracted driving laws. Models included age, gender, year, state distracted driving laws, personal engagement in distracted driving behavior, and perceived threat from other road users' engaging in distracted driving., Results: Approximately 87% of adolescents supported a law against texting and emailing compared to 66% who supported a universal handheld cellphone law. Support for distracted driving legislation was associated with greater perceived threat of other road users engaging in distracted driving while accounting for personal engagement in distracted driving, state distracted driving laws, and developmental covariates., Discussion: Greater understanding of the factors behind legislative support is needed. Public health interventions focused on effectively translating the risks of cellphone use while driving and effective policy will further improve the traffic safety culture.

We establish the status of the Weyl double copy relation for radiative solutions of the vacuum Einstein equations. We show that all type N vacuum solutions, which describe the radiation region of isolated gravitational systems with appropriate falloff for the matter fields, admit a degenerate Maxwell field that squares to give the Weyl tensor. The converse statement also holds, i.e., if there exists a degenerate Maxwell field on a curved background, then the background is type N. This relation defines a scalar that satisfies the wave equation on the background. We show that for nontwisting radiative solutions, the Maxwell field and the scalar also satisfy the Maxwell equation and the wave equation on Minkowski spacetime. Hence, nontwisting solutions have a straightforward double copy interpretation.

Background: Distracted driving among teens is a public health and safety concern. Most states in the U.S. have sought to restrict cellphone use while driving by enacting laws. This study examines the difference in prevalence of self-reported calling while driving (CWD) between states with different cellphone bans., Methods: Demographics and CWD data were extracted from state Youth Risk Behavior Surveys (YRBS) from 14 states in 2013, 2015, 2017, and 2019. The state YRBS is conducted every 2 years with a representative sample of 9th through 12th grade students attending public school. States were grouped by type of cellphone law(s): no ban (the absence of both handheld calling ban and young driver ban), young driver ban (a ban on all forms of cellphone use while driving, for young drivers only), or concurrent ban (a young driver ban plus a ban on handheld calling for all drivers irrespective of age). Poisson regression models with robust variance were used to estimate prevalence ratios comparing CWD prevalence across ban types., Results: In total, 157,423 high school students participated in the surveys, and 65,044 (45%) participants reached the minimum age to obtain an intermediate license and drove during the 30 days prior the survey. Approximately 53% of participants reported CWD at least once during the previous 30 days, and the percentages varied widely by states (range: 51-55%). Compared to students from states with no ban, those from states with concurrent bans were 19%(95% CI: 14-24%) less likely to engage in CWD. Students in states with concurrent bans were 23% less likely to engage in CWD compared to students in states with young driver bans (95% CI:17-27%)., Conclusions: Engaging in CWD is common among teen drivers. The concurrent implementation of a handheld calling ban and a young driver ban was associated with a lower prevalence of CWD.

Metabolic syndrome (MetS), a constellation of related metabolic risk factors, is a common comorbidity associated with cognitive difficulty in people living with HIV (PLWH). Neurobehavioral disturbances (e.g., behavioral manifestations of frontal-subcortical dysfunction) are also prevalent in HIV, yet the role MetS might play in HIV-associated neurobehavioral disturbances is unknown. Thus, we examined the link between MetS and neurobehavioral disturbances in PLWH. Participants included 215 adults (117 PLWH, 98 HIV-uninfected), aged 36 to 65 years, from a cohort study at the University of California San Diego. Using the Frontal Systems Behavior Scale, we captured neurobehavioral disturbances (apathy, disinhibition, and executive dysfunction). MetS was defined by the National Cholesterol Education Program's Adult Treatment Panel-III criteria. Covariates examined included demographic, neurocognitive impairment, and psychiatric characteristics. When controlling for relevant covariates, both HIV serostatus and MetS were independently associated with greater apathy and executive dysfunction. HIV, but not MetS, was associated with greater disinhibition. The present findings suggest an additive effect of HIV and MetS on specific neurobehavioral disturbances (apathy and executive dysfunction), underscoring the importance of identifying and treating both HIV and MetS to lessen central nervous system burden among PLWH.

Objective: To assess the longitudinal association between fall history reported at a driver's license screening visit and the likelihood of subsequent vehicle crashes. Method: A total of 1,127 older adults were recruited from Maryland State Motor Vehicle Administration sites and interviewed annually over 15 years. Results: Individuals who reported a previous fall were more likely to be female, perform worse on physical functioning and divided attention tasks, and report more situational driving avoidance compared with non-fallers at baseline. Females who reported a fall at baseline had a 2.6× greater likelihood of subsequently reporting a crash over the 15 years than males. Among those who reported a fall at baseline, greater weekly driving exposure over the 15 years was associated with a 23% higher likelihood of a subsequent crash. Discussion: These findings support the utility of investigating nontraditional driver screening methods to identify drivers who may be at increased risk of future driving difficulties.

We outline a proof of the stability of a massless neutral scalar field ψ in the background of a wide class of four dimensional asymptotically flat rotating and "electrically charged" solutions of supergravity, and the low energy limit of string theory, known as STU metrics. Despite their complexity, we find it possible to circumvent the difficulties presented by the existence of ergo regions and the related phenomenon of superradiance in the original metrics by following a strategy due to Whiting, and passing to an auxiliary metric admitting an everywhere lightlike Killing field and constructing a scalar field ψ (related to a possible unstable mode ψ by a nonlocal transformation) which satisfies the massless wave equation with respect to the auxiliary metric. By contrast with the case for ψ, the associated energy density of ψ is not only conserved but is also non-negative.

Introduction: The quasi-induced exposure (QIE) method has been widely implemented into traffic safety research. One of the key assumptions of QIE method is that not-at-fault drivers represent the driving population at the time of a crash. Recent studies have validated the QIE representative assumption using not-at-fault drivers from three-or-more vehicle crashes (excluding the first not-at-fault drivers; D3&#95;other) as the reference group in single state crash databases. However, it is unclear if the QIE representativeness assumption is valid on a national scale and is a representative sample of driving population in the United States. The aims of this study were to assess the QIE representativeness assumption on a national scale and to evaluate if D3&#95;other could serve as a representative sample of the U.S. driving population., Method: Using the Fatality Analysis Reporting System (FARS) and the National Occupant Protection Use Survey (NOPUS), distributions of driver gender, age, vehicle type, time, and roadway type among the not-at-fault drivers in clean two-vehicle crashes, the first not-at-fault drivers in three-or-more-vehicle crashes, and the remaining not-at-fault drivers in three-or-more vehicle crashes were compared to the driver population observed in NOPUS., Results: The results showed that with respect to driver gender, vehicle type, time, and roadway type, drivers among D3&#95;other did not show statistical significant difference from NOPUS observations. The age distribution of D3&#95;other driver was not practically different to NOPUS observations., Conclusions: Overall, we conclude that D3&#95;other drivers in FARS represents the driving population at the time of the crash. Practical applications: Our study provides a solid foundation for future studies to utilize D3&#95;other as the reference group to validate the QIE representativeness assumption and has potential to increase the generalizability of future FARS studies., (Copyright © 2019 National Safety Council and Elsevier Ltd. All rights reserved.)

In the era of effective antiretroviral therapy, the number of older people with HIV (PWH) is increasing, and those aging with HIV are experiencing an increasing burden of age-associated comorbidities. Life expectancy among older PWH is approaching that of demographically comparable HIV-uninfected (HIV-) adults. With this changing demographic of PWH come new challenges for researchers and clinicians in how to identify, address, and manage the complex interplay of treated HIV infection and aging-associated factors. In response to these challenges, the annual International Workshop on HIV and Aging was initiated in 2009 as a multidisciplinary platform for scientific discourse on the research and clinical complications arising from the aging population of PWH. The multidisciplinary nature of the workshop has resulted in a wide range of topics addressed over the past 9 years, from basic mechanisms in aging and HIV pathogenesis, to epidemiology of aging within large cohorts, interventions, and implementation of clinical programs. Herein, we summarize the key topics discussed at the 9th Annual International Workshop on HIV and Aging 2018, including "inflammaging," mitochondrial dysfunction, exercise interventions, HIV-associated neurocognitive impairment, metabolic dysfunction, menopause, and polypharmacy. In addition to recent developments in research and clinical care, we discuss open questions and future research directions required to better understand the interaction of HIV and aging.

Objective: Motor-vehicle crashes (MVC) remain a leading cause of preventable injury and death for children aged 0-3 in the United States. Despite advancement in legislation and public awareness there is continued evidence of inappropriate child restraint system (CRS) use among the youngest passengers. The current study focuses on appropriate CRS use from 2011 to 2015 using data from the Fatality Analysis Reporting System (FARS) for children aged 0-3., Methods: Child-, driver-, vehicle-, and trip-related characteristics were investigated within a sample of 648 children from 625 crashes over 5-years in which a child aged 0-3 was fatally injured while unrestrained or wearing an identified CRS type. Multivariable log-binomial regression was used to obtain relative risk., Results: Only 48% of the fatally injured children were appropriately restrained in a CRS. Premature transition to a booster seat and seat belt was evident. The largest proportion of rear-facing restraint use was reported in <1 year olds (40%), with less reported in 1 (11%) and 2 year olds (2%) and no usage in 3 year olds. Younger children were more likely to be in an appropriate CRS, while Black children, driver not restrained in a lap-shoulder belt configuration, and riding in a pickup truck were less likely to be restrained appropriately., Conclusions: Evidence of inappropriate CRS use supports the use of more stringent legislation and parental interventions to communicate best practice recommendations and educate caregivers regarding appropriate child restraint methods. Practical applications: Public health campaigns focused on increasing appropriate restraint use in children are of great importance as optimally restrained children are less likely to sustain injuries, or require crash-related hospitalization compared to unrestrained children. Researchers and practitioners may find these surveillance findings essential when developing education and interventions targeting child-parent dyads at the greatest risk for a MVC-related fatality., (Copyright © 2019 National Safety Council and Elsevier Ltd. All rights reserved.)

Purpose: Distracted driving is a growing global epidemic, with adolescent drivers reporting frequent engagement in distracted driving behaviors. Public health initiatives and legislative efforts designed to decrease the prevalence of these unwanted driving behaviors have demonstrated small, but significant reductions in crash risk. Non-compliance is a known problem among drivers of all ages, but may be especially problematic for novice, adolescent drivers. Using a construct from the Health Belief Model, the relations between demographic factors, perceived threat to safety, and peer influences were investigated with adolescents' support for three types of distracted driving legislation regarding: (a) reading or sending text messages/emails while driving; (b) hand-held cell phone use while driving; and (c) using non-driving-related-in-vehicle (NDIV) technology while driving. Investigating adolescents' perceptions provides an opportunity to understand distracted driving enforcement and legislation., Methods: Three hundred and seventy-nine adolescents aged 15-19 (M = 16.12, SD = 0.56) were recruited from public high schools. Demographics, perceptions, and support regarding distracted driving were assessed using self-report surveys. Statistical analyses included bivariate correlations and adjusted odds ratios to investigate influences of adolescent support for distracted driving legislation., Results: Female adolescents were at 2 times greater odds of supporting a law against texting/emailing while driving compared to male adolescents. Greater perceived threat to safety was associated with all three types of distracted driving legislation (aOR = 1.10, 1.33). Minimal association was found with peer influences., Conclusions: Perceived threat to safety and gender were associated with legislative support in adolescents. Practical application: Interventions and public health campaigns that incorporate elements related to perceived threat may be more successful with female adolescent drivers than male adolescents. Future experimental research will help to determine what factors affect adolescents' perspectives on distracted driving to promote compliance with related legislation., (Copyright © 2018 National Safety Council and Elsevier Ltd. All rights reserved.)

Objective: Walking is integral to transportation and physical activity, but safety is a primary concern for pedestrians due to the increasing number of injuries and deaths per year. To address the need for avenues of pedestrian safety improvements, this study's objective is to determine the association among driver and pedestrian characteristics and behavior, environmental characteristics, and the presence of injury resulting from a pedestrian-vehicle crash. Methods: Pedestrian crashes were examined in Ohio from 2013 to 2017 using state crash records. Descriptive statistics as well as univariate and multivariable analyses were performed to estimate the odds of pedestrian injury. Results: Of the 11,241 pedestrian crashes analyzed, 66% resulted in injury. The odds of pedestrian injury increased when the driver was male, the driver was under the influence of alcohol, the cause of the crash was the pedestrian darting, the pedestrian was struck while in the travel lane, the pedestrian was aged 65 or older, the pedestrian was under the influence of alcohol, or under dark conditions on an unlit roadway. Factors that lowered the odds of injury were pedestrian age 0-4 and vehicle maneuvers other than driving straight ahead, such as backing and turning. Conclusion: These findings identify several factors associated with pedestrian injury, and public health efforts that could influence pedestrian safety are discussed.

The objective of this study was to examine combination speed of processing (SOP) cognitive remediation therapy (CRT) and transcranial direct stimulation (tDCS) as neurorehabilitation in older HIV+ adults. Thirty-three HIV+ adults aged 50+ completed neurocognitive testing and were randomized to either active (n = 17) or sham (n = 16) tDCS. Both conditions received 10 1-hour sessions of SOP CRT, with either active or sham tDCS for the first 20 minutes. Participants then completed a posttest assessment. Repeated measures analysis of variance examining Time X Condition showed small-to-medium effects in the expected direction for an executive (d = 0.36), and SOP measure (d = 0.49), while medium-to-large effects were observed for an executive/attention (d = 0.60) and oral reading measure (d = 0.75). The only statistically significant interaction was the oral reading measure. Small-to-medium and medium-to-large effects (ds = 0.32, 0.58) were found for two SOP measures in the opposite direction (sham group showing greater improvements). Further trials of CRT and tDCS in this population are needed, including larger samples and a nonactive control and tDCS only condition, as is determination of which parameters of each technique (e.g., tDCS montage, timing of tDCS, domain targeted in CRT, number of sessions) are most effective in improving cognitive outcomes, durability of training gains, and translation to everyday functioning.

Motor vehicle crashes (MVCs) are a leading cause of death among children. Multivariable analyses of age-appropriate child restraint system (CRS) use in the "booster-aged" population are needed. The current study identified factors associated with age-appropriate CRS use in fatal MVCs for children 4 to 7 years old, using 2011 to 2015 data from the Fatality Analysis Reporting System. Of 929 MVC fatalities, 32% of fatally injured children were in an age-appropriate restraint. While age-appropriate CRS use was higher for 4-, 5-, and 6-year-olds relative to 7-year-olds (adjusted relative risk [aRR] = 2.57, 2.51, and 2.18, respectively; p < .01 for each comparison), black children (aRR = 0.62; p < .01) relative to white children, and drivers who had not used a lap-shoulder belt (aRR = 0.40; p < .01) relative to belted drivers were associated with lower levels of age-appropriate CRS use. Our findings underscore the continued importance of communicating best practice guidelines on CRSs to caregivers of young children.

Cognitive impairments seen in people living with HIV (PLWH) are associated with difficulties in everyday functioning, specifically driving. This study utilized speed of processing cognitive remediation therapy (SOP-CRT) with transcranial direct current stimulation (tDCS) to gauge the feasibility and impact on simulated driving. Thirty PLWH ( M age = 54.53, SD = 3.33) were randomly assigned to either: sham tDCS SOP-CRT or active tDCS SOP-CRT. Seven indicators of simulated driving performance and safety were obtained. Repeated measures ANOVAs controlling for driver's license status (valid and current license or expired/no license) revealed a large training effect on average driving speed. Participants who received active tDCS SOP-CRT showed a slower average driving speed ( p = 0.020, d = 0.972) than those who received sham tDCS SOP-CRT. Non-significant small-to-medium effects were seen for driving violations, collisions, variability in lane positioning, and lane deviations. Combination tDCS SOP-CRT was found to increase indices of cautionary simulated driving behavior. Findings reveal a potential avenue of intervention and rehabilitation for improving driving safety among vulnerable at-risk populations, such as those aging with chronic disease.

Acetylcholinesterase (AChE, EC 3.1.1.7) and butyrylcholinesterase (BChE, EC 3.1.1.8) are related enzymes found across the animal kingdom. The critical role of acetylcholinesterase in neurotransmission has been known for almost a century, but a physiological role for butyrylcholinesterase is just now emerging. The cholinesterases have been deliberately targeted for both therapy and toxicity, with cholinesterase inhibitors being used in the clinic for a variety of disorders and conversely for their toxic potential as pesticides and chemical weapons. Non-catalytic functions of the cholinesterases (ChEs) participate in both neurodevelopment and disease. Manipulating either the catalytic activities or the structure of these enzymes can potentially shift the balance between beneficial and adverse effect in a wide number of physiological processes., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This article examined the impact of mobile technology on young pedestrians, bicyclists, and drivers. A systematic search yielded 41 articles meeting inclusion criteria: peer-reviewed, published before February 1, 2016, behavioral outcome related to pedestrian, bicycling, or driving in the presence of mobile technology use, youth sample. Eleven studies were meta-analyzed to evaluate increased risk for crash/near-crash while distracted. Risk of bias and quality of research were assessed. Across methodologies, developmental stages, and type of distracting task, mobile technology use impairs youth safety on the road. Quality of evidence was low (pedestrian) to moderate (driving). Findings are discussed from the perspective of cognitive and visual distractions. Policy and behavioral efforts should continue to reduce mobile technology use in transportation settings., (© 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.)

Latino immigrants that work on farms experience chronic exposures to potential neurotoxicants, such as pesticides, as part of their work. For tobacco farmworkers there is the additional risk of exposure to moderate to high doses of nicotine. Pesticide and nicotine exposures have been associated with neurological changes in the brain. Long-term exposure to cholinesterase-inhibiting pesticides, such as organophosphates and carbamates, and nicotine place this vulnerable population at risk for developing neurological dysfunction. In this study we examined whole-brain connectivity patterns and brain network properties of Latino immigrant workers. Comparisons were made between farmworkers and non-farmworkers using resting-state functional magnetic resonance imaging data and a mixed-effects modeling framework. We also evaluated how measures of pesticide and nicotine exposures contributed to the findings. Our results indicate that despite having the same functional connectivity density and strength, brain networks in farmworkers had more clustered and modular structures when compared to non-farmworkers. Our findings suggest increased functional specificity and decreased functional integration in farmworkers when compared to non-farmworkers. Cholinesterase activity was associated with population differences in community structure and the strength of brain network functional connections. Urinary cotinine, a marker of nicotine exposure, was associated with the differences in network community structure. Brain network differences between farmworkers and non-farmworkers, as well as pesticide and nicotine exposure effects on brain functional connections in this study, may illuminate underlying mechanisms that cause neurological implications in later life., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Performing secondary tasks, such as texting while driving, is associated with an increased risk of motor vehicle collisions (MVCs). While cognitive processes, such as executive function, are involved in driving, little is known about the relationship between executive control and willingness to engage in distracted driving. This study investigated the relationship between age, behavioral manifestations of executive function, and self-reported distracted driving behaviors. Executive difficulty (assessed with the BRIEF-A) as well as demographics (age and gender) was considered as possible predictors of engagement in distracted driving behaviors. Fifty-nine young, middle, and older adults self-reported executive difficulty and weekly engagement in distracted driving behaviors. Results revealed that while partially accounted for by age, global executive difficulty was uniquely related to engagement in distracted driving behaviors. Older age was associated with fewer weekly self-reported distracted driving behaviors while higher self-reported executive difficulty was associated with more frequent weekly engagement in distracted behavior. No significant differences were found between young and middle-aged adults on distracted driving behaviors. Findings conclude that distracted driving is a ubiquitous phenomenon evident in drivers of all ages. Possible mechanisms underlying distracted driving behavior could potentially be related to deficits in executive function., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: Motor vehicle collisions (MVCs) are one of the leading causes of injury and death for adolescents. Driving is a complex activity that is highly reliant on executive function (EF) to safely navigate through the environment. Little research has examined the efficacy of using self-reported EF measures for assessing adolescent driving risk. This study examined the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire and performance-based EF tasks as potential predictors of problematic driving outcomes in adolescents., Methods: Forty-six adolescent drivers completed the (1) BRIEF, (2) Trail Making Test, (3) Backwards Digit Span, and (4) self-report on 3 problematic driving outcomes: the number of times of having been pulled over by a police officer, the number of tickets issued, and the number of MVCs., Results: Greater self-reported difficulty with planning and organization was associated with greater odds of having a MVC, whereas inhibition difficulties were associated with greater odds of receiving a ticket. Greater self-reported difficulty across multiple BRIEF subscales was associated with greater odds of being pulled over., Conclusion: Overall findings indicated that the BRIEF, an ecological measure of EF, showed significant association with self-reported problematic driving outcomes in adolescents. No relationship was found between performance-based EF measures and self-reported driving outcomes. The BRIEF could offer unique and quick insight into problematic driving behavior and potentially be an indicator of driving risk in adolescent drivers during clinical evaluations.

Objective: Migrant tobacco farmworkers experience regular occupational exposure to pesticides and nicotine. The present study was designed to determine whether there are differences in brain anatomy between Latino farmworkers and non-farmworkers., Methods: Magnetic resonance brain images were compared between farmworkers and non-farmworkers. In addition, blood cholinesterase activity and urinary cotinine levels were also used to identify associations with pesticide and nicotine exposure., Results: Farmworkers had greater gray matter signal in putamen and cerebellum, and lower gray matter signal in frontal and temporal lobes. Urinary cotinine was associated with the observed differences in brain anatomy, but blood cholinesterase activity was not., Conclusions: Nicotine exposure was associated with neuroanatomical differences between Latino farmworkers and non-farmworkers. Future studies are needed to differentiate iron deposition from brain atrophy and to further assess the potential role of nicotine and pesticide exposure.

For centuries, since the advent of harnessing magnetic and electrical energies, humans have been applying such energies to various body parts, including the brain, with the goal of improving health. Advancements over the past two decades in the production and affordability of such devices that precisely deliver such energies have resulted in novel therapeutic uses. One technique in particular, transcranial Direct Current Stimulation (tDCS), uses electrodes placed on the scalp to deliver a low electrical current to various areas on the surface of the neocortex. Such electrical currents stimulate neurons, which depending on the area of the neocortex it is applied and certain stimulation parameters, can either excite or inhibit certain functions within the brain that may result in alterations in mood, cognition, and behavior. This article provides an overview of this approach, explains how it is used, describes the hypothesized neurobiomechanisms involved, and explores its therapeutic potential. From this overview, implications for nursing practice and innovative uses for nursing research are posited., Competing Interests: The authors report no conflicts of interest with this work.

Objective: This study (1) describes patterns of whole blood total cholinesterase, acetylcholinesterase, and butyrylcholinesterase activities across the agricultural season, comparing farmworkers and nonfarmworkers; and (2) explores differences between farmworkers' and non-farmworkers' likelihood of cholinesterase depression., Methods: Blood samples from 210 Latino male farmworkers and 163 Latino workers with no occupational pesticide exposure collected 8 times across 2 agricultural seasons were analyzed. Mean cholinesterase activity levels and depressions 15% or more were compared by month., Results: Farmworkers had significantly lower total cholinesterase and butyrylcholinesterase activities in July and August and lower acetylcholinesterase activity in August. Farmworkers had significantly greater likelihood of cholinesterase depression for each cholinesterase measure across the agricultural season., Significance: A repeated-measures design across 2 years with a nonexposed control group demonstrated anticholinesterase effects in farmworkers. Current regulations designed to prevent pesticide exposure are not effective.

Extensions of Einstein gravity with higher-order derivative terms arise in string theory and other effective theories, as well as being of interest in their own right. In this Letter we study static black-hole solutions in the example of Einstein gravity with additional quadratic curvature terms. A Lichnerowicz-type theorem simplifies the analysis by establishing that they must have vanishing Ricci scalar curvature. By numerical methods we then demonstrate the existence of further black-hole solutions over and above the Schwarzschild solution. We discuss some of their thermodynamic properties, and show that they obey the first law of thermodynamics.