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Schwebel DC, Johnston A, McDaniel D, Severson J, He Y, McClure LA. Teaching children pedestrian safety in virtual reality via smartphone: a noninferiority randomized clinical trial. J Pediatr Psychol 2024:jsae020. [PMID: 38637283 DOI: 10.1093/jpepsy/jsae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE To evaluate whether child pedestrian safety training in a smartphone-based virtual reality (VR) environment is not inferior to training in a large, semi-immersive VR environment with demonstrated effectiveness. METHODS Five hundred 7- and 8-year-old children participated; 479 were randomized to one of two conditions: Learning to cross streets in a smartphone-based VR or learning in a semi-immersive kiosk VR. The systems used identical virtual environments and scenarios. At baseline, children's pedestrian skills were assessed in both VR systems and through a vehicle approach estimation task (judging speed/distance of oncoming traffic on monitor). Training in both conditions comprised at least six 30-min sessions in the randomly assigned VR platform and continued for up to 25 visits until adult-level proficiency was obtained. Following training and again 6 months later, children completed pedestrian safety assessments identical to baseline. Three outcomes were considered from assessments in each VR platform: Unsafe crossings (collisions plus close calls), time to contact (shortest time between child and oncoming simulated traffic), and missed opportunities (unselected safe opportunities to cross). RESULTS Participants achieved adult-level street-crossing skill through VR training. Training in a smartphone-based VR system was generally not inferior to training in a large semi-immersive VR system. There were no adverse effects. CONCLUSIONS Seven- and 8-year-old children can learn pedestrian safety through VR-based training, including training in a smartphone-based VR system. Combined with recent meta-analytic results, the present findings support broad implementation and dissemination of child pedestrian safety training through VR, including smartphone-based VR systems.
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Affiliation(s)
- David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anna Johnston
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dominique McDaniel
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, United States
| | - Joan Severson
- Digital Artefacts, LLC, Iowa City, IA, United States
| | - Yefei He
- Digital Artefacts, LLC, Iowa City, IA, United States
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, United States
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Rubin LH, Du Y, Sweeney SE, O’Toole R, Harrington CK, Jenkins K, Lesniak WG, Veenhuis RT, Dastgheyb R, Severson J, Fan H, Holt DP, Hall AW, Dannals RF, Horti AG, Pomper MG, Coughlin JM. Pilot imaging of the colony stimulating factor 1 receptor in the brains of virally-suppressed individuals with HIV. AIDS 2023; 37:1419-1424. [PMID: 37070549 PMCID: PMC10330113 DOI: 10.1097/qad.0000000000003572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Neuroimmune activation is a putative driver of cognitive impairment in people with HIV (PWH), even in the age of modern antiretroviral therapy. Nevertheless, imaging of the microglial marker, the 18 kDa translocator protein (TSPO), with positron emission tomography (PET) in treated PWH has yielded inconclusive findings. One potential reason for the varied TSPO results is a lack of cell-type specificity of the TSPO target. DESIGN [ 11 C]CPPC, 5-cyano- N -(4-(4-[ 11 C]methylpiperazin-1-yl)-2-(piperidin-1-yl)phenyl) furan-2-carboxaminde, is a radiotracer for use with PET to image the colony stimulating factor 1 receptor (CSF1R). The CSF1R is expressed on microglia and central nervous system macrophages, with little expression on other cell types. We used [ 11 C]CPPC PET in virally-suppressed- (VS)-PWH and HIV-uninfected individuals to estimate the effect sizes of higher CSF1R in the brains of VS-PWH. METHODS Sixteen VS-PWH and 15 HIV-uninfected individuals completed [ 11 C]CPPC PET. [ 11 C]CPPC binding (V T ) in nine regions was estimated using a one-tissue compartmental model with a metabolite-corrected arterial input function, and compared between groups. RESULTS Regional [ 11 C]CPPC V T did not significantly differ between groups after age- and sex- adjustment [unstandardized beta coefficient ( B ) = 1.84, standard error (SE) = 1.18, P = 0.13]. The effect size was moderate [Cohen's d = 0.56, 95% confidence interval (CI) -0.16, 1.28), with strongest trend of higher V T in VS-PWH in striatum and parietal cortex (each P = 0.04; Cohen's d = 0.71 and 0.72, respectively). CONCLUSIONS A group difference in [ 11 C]CPPC V T was not observed between VS-PWH and HIV-uninfected individuals in this pilot, although the observed effect sizes suggest the study was underpowered to detect regional group differences in binding.
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Affiliation(s)
- Leah H. Rubin
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Molecular and Comparative Pathobiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Yong Du
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Shannon Eileen Sweeney
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Riley O’Toole
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Courtney K. Harrington
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Katelyn Jenkins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Wojciech G. Lesniak
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Rebecca T. Veenhuis
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Molecular and Comparative Pathobiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Hong Fan
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Daniel P. Holt
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrew W. Hall
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Robert F. Dannals
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrew G. Horti
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Martin G. Pomper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Molecular and Comparative Pathobiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jennifer M. Coughlin
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Adams JL, Kangarloo T, Tracey B, O'Donnell P, Volfson D, Latzman RD, Zach N, Alexander R, Bergethon P, Cosman J, Anderson D, Best A, Severson J, Kostrzebski MA, Auinger P, Wilmot P, Pohlson Y, Waddell E, Jensen-Roberts S, Gong Y, Kilambi KP, Herrero TR, Ray Dorsey E. Using a smartwatch and smartphone to assess early Parkinson's disease in the WATCH-PD study. NPJ Parkinsons Dis 2023; 9:64. [PMID: 37069193 PMCID: PMC10108794 DOI: 10.1038/s41531-023-00497-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/27/2023] [Indexed: 04/19/2023] Open
Abstract
Digital health technologies can provide continuous monitoring and objective, real-world measures of Parkinson's disease (PD), but have primarily been evaluated in small, single-site studies. In this 12-month, multicenter observational study, we evaluated whether a smartwatch and smartphone application could measure features of early PD. 82 individuals with early, untreated PD and 50 age-matched controls wore research-grade sensors, a smartwatch, and a smartphone while performing standardized assessments in the clinic. At home, participants wore the smartwatch for seven days after each clinic visit and completed motor, speech and cognitive tasks on the smartphone every other week. Features derived from the devices, particularly arm swing, the proportion of time with tremor, and finger tapping, differed significantly between individuals with early PD and age-matched controls and had variable correlation with traditional assessments. Longitudinal assessments will inform the value of these digital measures for use in future clinical trials.
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Affiliation(s)
- Jamie L Adams
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
| | | | | | - Patricio O'Donnell
- Takeda Pharmaceuticals, Cambridge, MA, USA
- Sage Therapeutics, Seattle, WA, USA
| | | | | | - Neta Zach
- Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Robert Alexander
- Takeda Pharmaceuticals, Cambridge, MA, USA
- Banner Health, Phoenix, AZ, USA
| | | | | | | | | | | | - Melissa A Kostrzebski
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Peggy Auinger
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Wilmot
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Yvonne Pohlson
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Emma Waddell
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Stella Jensen-Roberts
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Yishu Gong
- Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Krishna Praneeth Kilambi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Massachusetts Institute of Technology, Boston, MA, USA
| | | | - E Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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Page LL, Kahn CJ, Severson J, Kramer AF, McAuley E, Ehlers DK. Physical activity and cognitive function: A comparison of rural and urban breast cancer survivors. PLoS One 2023; 18:e0284189. [PMID: 37053178 PMCID: PMC10101459 DOI: 10.1371/journal.pone.0284189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE Increasing evidence suggests rural breast cancer survivors (BCS) may experience greater burden in symptoms known to be associated with cancer-associated cognitive decline (CACD). Yet, little is known about CACD in rural BCS. This study (1) examined differences in cognitive function, moderate-to-vigorous physical activity (MVPA), and other CACD correlates and (2) tested the effects of MVPA on cognitive function in rural versus urban BCS. METHODS Rural and urban BCS (N = 80), matched on age, education, and time since diagnosis from a larger study, completed cognitive tasks assessing processing speed (Trails-B, Mazes, Task-Switch) and working memory (spatial working memory) and questionnaires assessing subjective memory impairment (SMI), MVPA, and CACD correlates (i.e., sleep quality, fatigue, anxiety/depression). Some participants (n = 62) wore an accelerometer to objectively estimate MVPA. Multiple linear regression and multivariate analysis of covariance were used to test study aims. RESULTS Rural BCS (n = 40, M = 61.1±8.4 years-old) performed significantly slower on Trails-B (p<0.01) compared with urban BCS (n = 40, M = 61.0±8.2 years-old) and engaged in less objectively-estimated daily MVPA (mean difference = 13.83±4.73 minutes; p = 0.01). No significant differences in SMI, self-reported MVPA, or CACD correlates were observed (all p>0.28). Regression models did not reveal a significant interaction between MVPA and cognitive performance (all p>0.1); however, estimated marginal means models indicated that the effect of MVPA on processing speed was evident only among rural BCS (Trails-B, p = 0.04; Mazes, p = 0.03). CONCLUSIONS Findings suggest rural BCS may suffer greater CACD and engage in less MVPA. Additional research is warranted to further examine CACD and more effectively promote MVPA in rural BCS.
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Affiliation(s)
- Lindsey L Page
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Christina J Kahn
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Joan Severson
- Digital Artefacts, LLC, Iowa City, IA, United States of America
| | - Arthur F Kramer
- Northeastern University, Boston, MA, United States of America
- University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Diane K Ehlers
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States of America
- Mayo Clinic Arizona, Scottsdale, AZ, United States of America
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Marcotte TD, Umlauf A, Grelotti DJ, Sones EG, Sobolesky PM, Smith BE, Hoffman MA, Hubbard JA, Severson J, Huestis MA, Grant I, Fitzgerald RL. Driving Performance and Cannabis Users' Perception of Safety: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:201-209. [PMID: 35080588 PMCID: PMC8792796 DOI: 10.1001/jamapsychiatry.2021.4037] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Expanding cannabis medicalization and legalization increases the urgency to understand the factors associated with acute driving impairment. OBJECTIVE To determine, in a large sample of regular cannabis users, the magnitude and time course of driving impairment produced by smoked cannabis of different Δ9-tetrahydrocannabinol (THC) content, the effects of use history, and concordance between perceived impairment and observed performance. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled parallel randomized clinical trial took place from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California San Diego. Cannabis users were recruited for this study, and analysis took place between April 2020 and September 2021. INTERVENTIONS Placebo or 5.9% or 13.4% THC cannabis smoked ad libitum. MAIN OUTCOMES AND MEASURES The primary end point was the Composite Drive Score (CDS), which comprised key driving simulator variables, assessed prior to smoking and at multiple time points postsmoking. Additional measures included self-perceptions of driving impairment and cannabis use history. RESULTS Of 191 cannabis users, 118 (61.8%) were male, the mean (SD) age was 29.9 (8.3) years, and the mean (SD) days of use in the past month was 16.7 (9.8). Participants were randomized to the placebo group (63 [33.0%]), 5.9% THC (66 [34.6%]), and 13.4% THC (62 [32.5%]). Compared with placebo, the THC group significantly declined on the Composite Drive Score at 30 minutes (Cohen d = 0.59 [95% CI, 0.28-0.90]; P < .001) and 1 hour 30 minutes (Cohen d = 0.55 [95% CI, 0.24-0.86]; P < .001), with borderline differences at 3 hours 30 minutes (Cohen d = 0.29 [95% CI, -0.02 to 0.60]; P = .07) and no differences at 4 hours 30 minutes (Cohen d = -0.03 [95% CI, -0.33 to 0.28]; P = .87). The Composite Drive Score did not differ based on THC content (likelihood ratio χ24 = 3.83; P = .43) or use intensity (quantity × frequency) in the past 6 months (likelihood ratio χ24 = 1.41; P = .49), despite postsmoking blood THC concentrations being higher in those with the highest use intensity. Although there was hesitancy to drive immediately postsmoking, increasing numbers (81 [68.6%]) of participants reported readiness to drive at 1 hour 30 minutes despite performance not improving from initial postsmoking levels. CONCLUSIONS AND RELEVANCE Smoking cannabis ad libitum by regular users resulted in simulated driving decrements. However, when experienced users control their own intake, driving impairment cannot be inferred based on THC content of the cigarette, behavioral tolerance, or THC blood concentrations. Participants' increasing willingness to drive at 1 hour 30 minutes may indicate a false sense of driving safety. Worse driving performance is evident for several hours postsmoking in many users but appears to resolve by 4 hours 30 minutes in most individuals. Further research is needed on the impact of individual biologic differences, cannabis use history, and administration methods on driving performance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02849587.
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Affiliation(s)
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego
| | - David J. Grelotti
- Department of Psychiatry, University of California San Diego, San Diego
| | - Emily G. Sones
- Department of Psychiatry, University of California San Diego, San Diego
| | - Philip M. Sobolesky
- Department of Pathology, University of California San Diego, San Diego,Department of Pathology and Laboratory Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Breland E. Smith
- Department of Pathology, University of California San Diego, San Diego,LetsGetChecked Labs, Monrovia, California
| | - Melissa A. Hoffman
- Department of Pathology, University of California San Diego, San Diego,Vividion Therapeutics, San Diego, California
| | - Jacqueline A. Hubbard
- Department of Pathology, University of California San Diego, San Diego,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Marilyn A. Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego
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Rubin LH, Severson J, Marcotte TD, Savin MJ, Best A, Johnson S, Cosman J, Merickel M, Buchholz A, Del Bene VA, Eldred L, Sacktor NC, Fuchs JB, Althoff KN, Moore RD. Tablet-Based Cognitive Impairment Screening for Adults With HIV Seeking Clinical Care: Observational Study. JMIR Ment Health 2021; 8:e25660. [PMID: 34499048 PMCID: PMC8461534 DOI: 10.2196/25660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/15/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neurological complications including cognitive impairment persist among people with HIV on antiretrovirals; however, cognitive screening is not routinely conducted in HIV clinics. OBJECTIVE Our objective for this study was 3-fold: (1) to determine the feasibility of implementing an iPad-based cognitive impairment screener among adults seeking HIV care, (2) to examine the psychometric properties of the tool, and (3) to examine predictors of cognitive impairment using the tool. METHODS A convenience sample of participants completed Brain Baseline Assessment of Cognition and Everyday Functioning (BRACE), which included (1) Trail Making Test Part A, measuring psychomotor speed; (2) Trail Making Test Part B, measuring set-shifting; (3) Stroop Color, measuring processing speed; and (4) the Visual-Spatial Learning Test. Global neuropsychological function was estimated as mean T score performance on the 4 outcomes. Impairment on each test or for the global mean was defined as a T score ≤40. Subgroups of participants repeated the tests 4 weeks or >6 months after completing the first test to evaluate intraperson test-retest reliability and practice effects (improvements in performance due to repeated test exposure). An additional subgroup completed a lengthier cognitive battery concurrently to assess validity. Relevant factors were abstracted from electronic medical records to examine predictors of global neuropsychological function. RESULTS The study population consisted of 404 people with HIV (age: mean 53.6 years; race: 332/404, 82% Black; 34/404, 8% White, 10/404, 2% American Indian/Alaskan Native; 28/404, 7% other and 230/404, 58% male; 174/404, 42% female) of whom 99% (402/404) were on antiretroviral therapy. Participants completed BRACE in a mean of 12 minutes (SD 3.2), and impairment was demonstrated by 34% (136/404) on Trail Making Test A, 44% (177/404) on Trail Making Test B, 40% (161/404) on Stroop Color, and 17% (67/404) on Visual-Spatial Learning Test. Global impairment was demonstrated by 103 out of 404 (25%). Test-retest reliability for the subset of participants (n=26) repeating the measure at 4 weeks was 0.81 and for the subset of participants (n=67) repeating the measure almost 1 year later (days: median 294, IQR 50) was 0.63. There were no significant practice effects at either time point (P=.20 and P=.68, respectively). With respect for validity, the correlation between global impairment on the lengthier cognitive battery and BRACE was 0.63 (n=61; P<.001), with 84% sensitivity and 94% specificity to impairment on the lengthier cognitive battery. CONCLUSIONS We were able to successfully implement BRACE and estimate cognitive impairment burden in the context of routine clinic care. BRACE was also shown to have good psychometric properties. This easy-to-use tool in clinical settings may facilitate the care needs of people with HIV as cognitive impairment continues to remain a concern in people with HIV.
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Affiliation(s)
- Leah H Rubin
- Johns Hopkins University, Baltimore, MD, United States
| | | | | | | | - Allen Best
- Digital Artefacts LLC, Iowa City, IA, United States
| | | | | | | | | | | | - Lois Eldred
- Johns Hopkins University, Baltimore, MD, United States
| | - Ned C Sacktor
- Johns Hopkins University, Baltimore, MD, United States
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Schwebel DC, Long DL, Gowey M, Severson J, He Y, Trullinger K. Study protocol: developing and evaluating an interactive web platform to teach children hunting, shooting and firearms safety: a randomized controlled trial. BMC Public Health 2021; 21:308. [PMID: 33549072 PMCID: PMC7866873 DOI: 10.1186/s12889-021-10345-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Firearms injuries present a major pediatric public health challenge in the United States. This study protocol describes research to develop and then conduct a randomized clinical trial to evaluate ShootSafe, an interactive, engaging, educational website to teach children firearms safety. ShootSafe has three primary goals: (a) teach children basic knowledge and skills needed to hunt, shoot, and use firearms safely; (b) help children learn and hone critical cognitive skills of impulse control and hypothetical thinking needed to use firearms safely; and (c) alter children's perceptions about their own vulnerability and susceptibility to firearms-related injuries, the severity of those injuries, and their perceived norms about peer behavior surrounding firearms use. ShootSafe will accomplish these goals through a combination of interactive games plus short, impactful testimonial videos and short expert-led educational videos. METHODS Following website development, ShootSafe will be evaluated through a randomized controlled trial with 162 children ages 10-12, randomly assigning children to engage in ShootSafe or an active control website. Multiple self-report, computer-based, and behavioral measures will assess functioning at baseline, immediately following training, and at 4-month follow-up. Four sets of outcomes will be considered: firearms safety knowledge; cognitive skills in impulse control and hypothetical thinking; perceptions about firearms safety; and simulated behavior when handling, storing and transporting firearms. Training in both conditions will comprise two 45-min sessions. DISCUSSION If results are as hypothesized, ShootSafe offers potential as a theory-based program to teach children firearms safety in an accessible, engaging and educational manner. Translation into practice is highly feasible. TRIAL REGISTRATION The study protocol was registered on 11/10/20 at clinicaltrials.gov ( NCT04622943 ).
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Affiliation(s)
- David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, AL, 35294, USA.
| | - D Leann Long
- Department of Biostatistics, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, USA
| | - Marissa Gowey
- Department of Pediatrics, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, AL, 35294, USA
| | | | - Yefei He
- Digital Artefacts, Iowa City, IA, USA
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8
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Hanson LL, Severson J, Kramer AF, McAuley E, Ehlers DK. Differences in cognition and physical activity in younger vs older breast cancer survivors. Psychooncology 2020; 29:1228-1231. [PMID: 32281167 DOI: 10.1002/pon.5388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Lindsey L Hanson
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Arthur F Kramer
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Kinesiology and Community Health, Univerity of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, Univerity of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Diane K Ehlers
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Ehlers DK, Fanning J, Sunderlage A, Severson J, Kramer AF, McAuley E. Influence of sitting behaviors on sleep disturbance and memory impairment in breast cancer survivors. Cancer Med 2020; 9:3417-3424. [PMID: 32202706 PMCID: PMC7221435 DOI: 10.1002/cam4.3008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/25/2020] [Indexed: 01/09/2023] Open
Abstract
Background The purpose was to prospectively examine the effects of sedentary behaviors on subjective memory impairment in breast cancer survivors (BCS) and the extent to which sleep disturbances mediated this pathway. Methods BCS (N = 380; Mage = 57.38 ± 9.25 years) completed questionnaires assessing demographics, health history, sitting behaviors, sleep disturbance, subjective memory impairment, and moderate‐to‐vigorous physical activity (MVPA) at baseline and 6‐month follow‐up. A subsample (N = 300) wore an accelerometer to objectively estimate sedentary time and MVPA. Structural equation modeling was used to test direct and indirect effects of self‐reported and objectively estimated sedentary behaviors on memory impairment (through sleep disturbance) across time. Models were adjusted for demographic, clinical, and MVPA covariates. Results At baseline, more total daily sitting (γ = 0.23), occupational sitting (γ = 0.11), television viewing (γ = 0.15), and computer use (γ = 0.22) were associated with greater sleep disturbance, which was associated with greater memory impairment (γ = −0.22). Indirect effects of self‐reported sitting on memory were significant. At follow‐up, increased total daily sitting (γ = 0.08) and computer use (γ = 0.14) predicted increased sleep disturbance, which predicted increased memory impairment (γ = −0.09). The indirect path from increased computer use to memory impairment was significant (β = −0.01). In the accelerometer subsample, greater daily sedentary time at baseline was associated with less sleep disturbance (γ = −0.14) and memory impairment (indirect effect: β = 0.03). Conclusions Findings provide early evidence that sedentary contexts may differentially influence sleep disturbance and memory impairment in BCS. Computer use and television viewing may pose the strongest risks to cognitive health. Disparate findings between objective and subjective sedentary measures warrant further research.
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Affiliation(s)
| | | | | | | | - Arthur F Kramer
- University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Northeastern University, Boston, MA, USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
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10
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Ehlers DK, Fanning J, Salerno EA, Aguiñaga S, Cosman J, Severson J, Kramer AF, McAuley E. Replacing sedentary time with physical activity or sleep: effects on cancer-related cognitive impairment in breast cancer survivors. BMC Cancer 2018; 18:685. [PMID: 29940894 PMCID: PMC6019533 DOI: 10.1186/s12885-018-4603-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/18/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence suggests reallocating daily sedentary time to physical activity or sleep confers important health benefits in cancer survivors. Despite emerging research suggesting physical activity as a treatment for cancer-related cognitive impairment (CRCI), little is known about the interactive effects of behaviors across the 24-h period. The present purpose was to examine the cognitive effects of reallocating sedentary time to light-intensity physical activity, moderate-to-vigorous physical activity (MVPA), or sleep in breast cancer survivors. METHODS Breast cancer survivors (N = 271, Mage = 57.81 ± 9.50 years) completed iPad-based questionnaires and cognitive tasks assessing demographics, health history, executive function, and processing speed (Task-Switch, Trail Making). Participants wore an accelerometer for seven consecutive days to measure their sedentary, physical activity, and sleep behaviors. Single effects (each behavior individually) and partition (controlling for other behaviors) models were used to examine associations among behaviors and cognitive performance. Isotemporal substitution models were used to test the cognitive effects of substituting 30 min of sedentary time with 30 min of light-intensity activity, MVPA, and sleep. RESULTS MVPA was associated with faster Task-switch reaction time in the partition models (stay: B = - 35.31, p = 0.02; switch: B = - 48.24, p = 0.004). Replacing 30 min of sedentary time with 30 min of MVPA yielded faster reaction times on Task-Switch stay (B = - 29.37, p = 0.04) and switch (B = - 39.49, p = 0.02) trials. In Trails A single effects models, sedentary behavior was associated with faster completion (B = - 0.97, p = 0.03) and light-intensity activity with slower completion (B = 1.25, p = 0.006). No single effects were observed relative to Trails B completion (all p > 0.05). Only the effect of MVPA was significant in the partition models (Trails A: B = - 3.55, p = 0.03; Trails B: B = - 4.46, p = 0.049). Replacing sedentary time with light-intensity activity was associated with slower Trails A (B = 1.55 p = 0.002) and Trails B (B = 1.69, p = 0.02) completion. Replacing light activity with MVPA yielded faster Trails A (B = - 4.35, p = 0.02) and Trails B (B = - 5.23, p = 0.03) completion. CONCLUSIONS Findings support previous research suggesting MVPA may be needed to improve cognitive function in breast cancer survivors. Trails findings underscore the need to dissect sedentary contexts to better understand the impact of daily behavioral patterns on CRCI. Additional research investigating the cognitive impacts of behaviors across the 24-h period is warranted. TRIAL REGISTRATION This study is registered with United States ClinicalTrials.gov ( NCT02523677 ; 8/14/2015).
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Affiliation(s)
| | - Jason Fanning
- Wake Forest School of Medicine, Winston-Salem, NC USA
| | | | - Susan Aguiñaga
- University of Illinois at Urbana-Champaign, Urbana, IL USA
| | | | | | - Arthur F. Kramer
- University of Illinois at Urbana-Champaign, Urbana, IL USA
- Northeastern University, Boston, MA USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL USA
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11
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Schwebel DC, Wu Y, Li P, Severson J, He Y, Xiang H, Hu G. Featured Article: Evaluating Smartphone-Based Virtual Reality to Improve Chinese Schoolchildren's Pedestrian Safety: A Nonrandomized Trial. J Pediatr Psychol 2018; 43:473-484. [PMID: 29216384 PMCID: PMC5961228 DOI: 10.1093/jpepsy/jsx147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/15/2022] Open
Abstract
Objective This nonrandomized trial evaluated whether classroom-based training in a smartphone-based virtual reality (VR) pedestrian environment (a) teaches schoolchildren to cross streets safely, and (b) increases their self-efficacy for street-crossing. Methods Fifty-six children, aged 8-10 years, attending primary school in Changsha, China participated. Baseline pedestrian safety assessment occurred in the VR environment and through unobtrusive observation of a subsample crossing a street for 11 days outside school. Self-efficacy was assessed through both self-report and observation. Following baseline, children engaged in the VR for 12 days in their classrooms, honing complex cognitive-perceptual skills required to engage safely in traffic. Follow-up assessment replicated baseline. Results Probability of crash in the VR decreased posttraining (0.40 vs. 0.09), and observational data found the odds of looking at oncoming traffic while crossing the first lane of traffic increased (odds ratio [OR] = 2.4). Self-efficacy increases occurred in self-report (proportional OR = 4.7 crossing busy streets) and observation of following crossing-guard signals (OR = 0.2, first lane). Conclusions Pedestrian safety training via smartphone-based VR provides children the repeated practice needed to learn the complex skills required to cross streets safely, and also helps them improve self-efficacy to cross streets. Given rapid motorization and global smartphone penetration, plus epidemiological findings that about 75,000 children die annually worldwide in pedestrian crashes, smartphone-based VR could supplement existing policy and prevention efforts to improve global child pedestrian safety.
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Affiliation(s)
| | - Yue Wu
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University
| | - Peng Li
- Department of Biostatistics, University of Alabama at Birmingham
| | | | | | - Henry Xiang
- Center for Pediatric Trauma Research, Nationwide Children’s Hospital
- The Ohio State University
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University
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12
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Aguiñaga S, Ehlers DK, Cosman J, Severson J, Kramer AF, McAuley E. Effects of physical activity on psychological well-being outcomes in breast cancer survivors from prediagnosis to posttreatment survivorship. Psychooncology 2018; 27:1987-1994. [PMID: 29740914 DOI: 10.1002/pon.4755] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 04/05/2018] [Accepted: 04/24/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effects of physical activity from prediagnosis to posttreatment survivorship on the psychological well-being (PWB) outcomes of fatigue, depression, anxiety, and quality of life (QoL) in breast cancer survivors (BCS). METHODS Participants (N = 387) completed a questionnaire battery by using an iPad-based platform. Measures included self-reported PA (before diagnosis and currently) and perceptions of fatigue, depression, anxiety, and QoL. Multivariate analysis of covariance was used to examine differences in PWB among BCS categorized into 1 of 4 physical activity levels: (a) low-active prediagnosis, low-active currently (low-active maintainers; n = 128); (b) low-active prediagnosis, active currently (increasers; n = 74); (c) active prediagnosis, low-active currently (decreasers; n = 52); and (d) active prediagnosis, active currently (high-active maintainers; n = 136). Participants were classified as active (≥24 units) or low-active (<24 units) by using Godin Leisure-Time Exercise Questionnaire cut-points for health benefits. RESULTS Fatigue and depression were lowest, and QoL was highest among women in the high-active maintainers category, followed by the increasers, low-active maintainers, and decreasers. No differences in anxiety were observed across categories. Women in the high-active maintainers category differed significantly in fatigue, depression, and QoL from both low-active categories (low-active maintainers and decreasers), P ≤ .001. Women in the increasers category also differed significantly in fatigue, depression, and QoL from the decreasers, P ≤ .01. CONCLUSION Low physical activity during survivorship was associated with greater fatigue and depression and lower QoL. IMPLICATIONS FOR CANCER SURVIVORS Efforts to help increase or maintain high levels of physical activity may be critical to helping BCS maintain their PWB.
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Affiliation(s)
- Susan Aguiñaga
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Josh Cosman
- Digital Artefacts, Iowa City, IA, USA.,Pfizer Incorporated, Cambridge, MA, USA
| | | | - Arthur F Kramer
- University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Northeastern University, Boston, MA, USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
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13
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Schwebel DC, Severson J, He Y. Using smartphone technology to deliver a virtual pedestrian environment: usability and validation. Virtual Real 2017; 21:145-152. [PMID: 29531502 PMCID: PMC5844485 DOI: 10.1007/s10055-016-0304-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/28/2016] [Indexed: 05/30/2023]
Abstract
Various programs effectively teach children to cross streets more safely, but all are labor- and cost-intensive. Recent developments in mobile phone technology offer opportunity to deliver virtual reality pedestrian environments to mobile smartphone platforms. Such an environment may offer a cost- and labor-effective strategy to teach children to cross streets safely. This study evaluated usability, feasibility, and validity of a smartphone-based virtual pedestrian environment. A total of 68 adults completed 12 virtual crossings within each of two virtual pedestrian environments, one delivered by smartphone and the other a semi-immersive kiosk virtual environment. Participants completed self-report measures of perceived realism and simulator sickness experienced in each virtual environment, plus self-reported demographic and personality characteristics. All participants followed system instructions and used the smartphone-based virtual environment without difficulty. No significant simulator sickness was reported or observed. Users rated the smartphone virtual environment as highly realistic. Convergent validity was detected, with many aspects of pedestrian behavior in the smartphone-based virtual environment matching behavior in the kiosk virtual environment. Anticipated correlations between personality and kiosk virtual reality pedestrian behavior emerged for the smartphone-based system. A smartphone-based virtual environment can be usable and valid. Future research should develop and evaluate such a training system.
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Affiliation(s)
- David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, 1720 2nd Ave. S., HHB 560, Birmingham, AL 35294-1152, USA
| | | | - Yefei He
- Digital Artefacts, LLC, Iowa City, IA, USA
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14
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Ehlers DK, Aguiñaga S, Cosman J, Severson J, Kramer AF, McAuley E. The effects of physical activity and fatigue on cognitive performance in breast cancer survivors. Breast Cancer Res Treat 2017; 165:699-707. [PMID: 28677009 DOI: 10.1007/s10549-017-4363-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
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15
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Clark R, Tahan AC, Watson PD, Severson J, Cohen NJ, Voss M. Aging affects spatial reconstruction more than spatial pattern separation performance even after extended practice. Hippocampus 2017; 27:716-725. [PMID: 28321961 DOI: 10.1002/hipo.22727] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/21/2017] [Accepted: 03/14/2017] [Indexed: 11/11/2022]
Abstract
Although the hippocampus experiences age-related anatomical and functional deterioration, the effects of aging vary across hippocampal-dependent cognitive processes. In particular, whether or not the hippocampus is known to be required for a spatial memory process is not an accurate predictor on its own of whether aging will affect performance. Therefore, the primary objective of this study was to compare the effects of healthy aging on a test of spatial pattern separation and a test of spatial relational processing, which are two aspects of spatial memory that uniquely emphasize the use of multiple hippocampal-dependent processes. Spatial pattern separation supports spatial memory by preserving unique representations for distinct locations. Spatial relational processing forms relational representations of objects to locations or between objects and other objects in space. To test our primary objective, 30 young (18-30 years; 21F) and 30 older participants (60-80 years; 21F) all completed a spatial pattern separation task and a task designed to require spatial relational processing through spatial reconstruction. To ensure aging effects were not due to inadequate time to develop optimal strategies or become comfortable with the testing devices, a subset of participants had extended practice across three sessions on each task. Results showed that older adults performed more poorly than young on the spatial reconstruction task that emphasized the use of spatial relational processing, and that age effects persisted even after controlling for pattern separation performance. Further, older adults performed more poorly on spatial reconstruction than young adults even after three testing sessions each separated by 7-10 days, suggesting effects of aging are resistant to extended practice and likely reflect genuine decline in hippocampal memory abilities.
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Affiliation(s)
- Rachel Clark
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, Iowa
| | - Asli C Tahan
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Patrick D Watson
- Department of Psychology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL
| | | | - Neal J Cohen
- Department of Psychology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL
| | - Michelle Voss
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, Iowa.,Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
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16
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Schwebel DC, Li P, McClure LA, Severson J. Evaluating a Website to Teach Children Safety with Dogs: A Randomized Controlled Trial. Int J Environ Res Public Health 2016; 13:ijerph13121198. [PMID: 27918466 PMCID: PMC5201339 DOI: 10.3390/ijerph13121198] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/03/2016] [Accepted: 11/23/2016] [Indexed: 12/03/2022]
Abstract
Dog bites represent a significant threat to child health. Theory-driven interventions scalable for broad dissemination are sparse. A website was developed to teach children dog safety via increased knowledge, improved cognitive skills in relevant domains, and increased perception of vulnerability to bites. A randomized controlled trial was conducted with 69 children aged 4–5 randomly assigned to use the dog safety website or a control transportation safety website for ~3 weeks. Assessment of dog safety knowledge and behavior plus skill in three relevant cognitive constructs (impulse control, noticing details, and perspective-taking) was conducted both at baseline and following website use. The dog safety website incorporated interactive games, instructional videos including testimonials, a motivational rewards system, and messaging to parents concerning child lessons. Our results showed that about two-thirds of the intervention sample was not adherent to website use at home, so both intent-to-treat and per-protocol analyses were conducted. Intent-to-treat analyses yielded mostly null results. Per-protocol analyses suggested children compliant to the intervention protocol scored higher on knowledge and recognition of safe behavior with dogs following the intervention compared to the control group. Adherent children also had improved scores post-intervention on the cognitive skill of noticing details compared to the control group. We concluded that young children’s immature cognition can lead to dog bites. Interactive eHealth training on websites shows potential to teach children relevant cognitive and safety skills to reduce risk. Compliance to website use is a challenge, and some relevant cognitive skills (e.g., noticing details) may be more amenable to computer-based training than others (e.g., impulse control).
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Affiliation(s)
- David C Schwebel
- UAB Youth Safety Lab, Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Peng Li
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Leslie A McClure
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA.
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17
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Schwebel DC, Severson J, He Y, McClure LA. Virtual reality by mobile smartphone: improving child pedestrian safety. Inj Prev 2016; 23:357. [PMID: 27585563 DOI: 10.1136/injuryprev-2016-042168] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pedestrian injuries are a leading cause of paediatric injury. Effective, practical and cost-efficient behavioural interventions to teach young children street crossing skills are needed. They must be empirically supported and theoretically based. Virtual reality (VR) offers promise to fill this need and teach child pedestrian safety skills for several reasons, including: (A) repeated unsupervised practice without risk of injury, (B) automated feedback on crossing success or failure, (C) tailoring to child skill levels: (D) appealing and fun training environment, and (E) most recently given technological advances, potential for broad dissemination using mobile smartphone technology. OBJECTIVES AND METHODS Extending previous work, we will evaluate delivery of an immersive pedestrian VR using mobile smartphones and the Google Cardboard platform, technology enabling standard smartphones to function as immersive VR delivery systems. We will overcome limitations of previous research suggesting children learnt some pedestrian skills after six VR training sessions but did not master adult-level pedestrian skills by implementing a randomised non-inferiority trial with two equal-sized groups of children ages 7-8 years (total N=498). All children will complete baseline, postintervention and 6-month follow-up assessments of pedestrian safety and up to 25 30-min pedestrian safety training trials until they reach adult levels of functioning. Half the children will be randomly assigned to train in Google Cardboard and the other half in a semi-immersive kiosk VR. Analysis of Covariance (ANCOVA) models will assess primary outcomes. DISCUSSION If results are as hypothesised, mobile smartphones offer substantial potential to overcome barriers of dissemination and implementation and deliver pedestrian safety training to children worldwide.
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Affiliation(s)
- David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Yefei He
- Digital Artefacts, LLC, Iowa City, Iowa, USA
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18
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Schwebel DC, Combs T, Rodriguez D, Severson J, Sisiopiku V. Community-based pedestrian safety training in virtual reality: A pragmatic trial. Accid Anal Prev 2016; 86:9-15. [PMID: 26479677 DOI: 10.1016/j.aap.2015.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
Child pedestrian injuries are a leading cause of mortality and morbidity across the United States and the world. Repeated practice at the cognitive-perceptual task of crossing a street may lead to safer pedestrian behavior. Virtual reality offers a unique opportunity for repeated practice without the risk of actual injury. This study conducted a pre-post within-subjects trial of training children in pedestrian safety using a semi-mobile, semi-immersive virtual pedestrian environment placed at schools and community centers. Pedestrian safety skills among a group of 44 seven- and eight-year-old children were assessed in a laboratory, and then children completed six 15-minute training sessions in the virtual pedestrian environment at their school or community center following pragmatic trial strategies over the course of three weeks. Following training, pedestrian safety skills were re-assessed. Results indicate improvement in delay entering traffic following training. Safe crossings did not demonstrate change. Attention to traffic and time to contact with oncoming vehicles both decreased somewhat, perhaps an indication that training was incomplete and children were in the process of actively learning to be safer pedestrians. The findings suggest virtual reality environments placed in community centers hold promise for teaching children to be safer pedestrians, but future research is needed to determine the optimal training dosage.
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19
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Babakhanyan I, Sakamoto M, Severson J, Hendrix T, Cosman J, Merickel M, McShea K, O'Carroll V, Marcotte T. C-91Preliminary Test-Retest Reliability and Validity of iPad-Adapted Neuropsychological Measures. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Sakamoto M, Marcotte T, Severson J, Hendrix T, Cosman J, Merickel M, Grant I. B-03 * Development of an iPad-Based Screening Tool for Detection of HIV-Related Neuropsychological Disorders. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
OBJECTIVE Child pedestrian injury is a global public health challenge. This randomized, controlled trial considered comparative efficacy of individualized streetside training, training in a virtual pedestrian environment, training using videos and Web sites, plus no-training control, to improve children's street-crossing ability. METHODS Pedestrian safety was evaluated among 231 7- and 8-year-olds using both streetside (field) and laboratory-based (virtual environment) trials before intervention group assignment, immediately posttraining, and 6 months posttraining. All training groups received 6 30-min sessions. Four outcomes assessed pedestrian safety: start delay (temporal lag before initiating crossing), hits/close calls (collisions/near-misses with vehicles in simulated crossings), attention to traffic (looks left and right, controlled for time), and missed opportunities (safe crossing opportunities that were missed). RESULTS Results showed training in the virtual pedestrian environment and especially individualized streetside training resulted in safer pedestrian behavior postintervention and at follow-up. As examples, children trained streetside entered safe traffic gaps more quickly posttraining than control group children and children trained streetside or in the virtual environment had somewhat fewer hits/close calls in postintervention VR trials. Children showed minimal change in attention to traffic posttraining. Children trained with videos/websites showed minimal learning. CONCLUSION Both individualized streetside training and training within virtual pedestrian environments may improve 7- and 8-year-olds' street-crossing safety. Individualized training has limitations of adult time and labor. Virtual environment training has limitations of accessibility and cost. Given the public health burden of child pedestrian injuries, future research should explore innovative strategies for effective training that can be broadly disseminated.
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Abstract
BACKGROUND Paediatric dog bites are a significant public health problem worldwide. Existing prevention programmes focused on altering children's risky behaviour with pet dogs tend to be atheoretical and only moderately effective. OBJECTIVE Test efficacy of a website to train young children in relevant cognitive skills to be safe with pet dogs in their home. SETTING Birmingham, Alabama, USA. METHODS A randomised trial will be conducted with an expected sample of two groups of 34 children (total N=68) ages 4-6 years. One group will engage in the newly designed website at home for 2 weeks and the other group will engage in a control website on transportation safety for an equivalent amount of time. All participants will complete a battery of laboratory-based tests to assess safety with dogs and cognitive functioning at baseline and postintervention. OUTCOME MEASURES Primary analyses will be conducted through linear mixed models testing change over time. Children's cognitive functioning, knowledge about safety with dogs, and behaviour with dogs in simulation and in vivo will serve as the primary outcomes. CLINICAL TRIAL REGISTRATION This study is exempt from registry at the US government website, http://www.clinicaltrials.gov, based on being a behavioural trial in the early phases of testing.
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Baniqued PL, Kranz MB, Voss MW, Lee H, Cosman JD, Severson J, Kramer AF. Corrigendum: Cognitive training with casual video games: points to consider. Front Psychol 2014; 5:234. [PMID: 24688477 PMCID: PMC3960918 DOI: 10.3389/fpsyg.2014.00234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/02/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Pauline L Baniqued
- Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign Urbana, IL, USA
| | - Michael B Kranz
- Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign Urbana, IL, USA
| | - Michelle W Voss
- Department of Psychology, University of Iowa Iowa City, IA, USA
| | - Hyunkyu Lee
- Brain Plasticity Institute San Francisco, CA, USA
| | - Joshua D Cosman
- Department of Psychology, Vanderbilt University Nashville, TN, USA
| | | | - Arthur F Kramer
- Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign Urbana, IL, USA
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Schwebel DC, McClure LA, Severson J. Usability and Feasibility of an Internet-Based Virtual Pedestrian Environment to Teach Children to Cross Streets Safely. Virtual Real 2014; 18:5-11. [PMID: 24678263 PMCID: PMC3963181 DOI: 10.1007/s10055-013-0238-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Child pedestrian injury is a preventable global health challenge. Successful training efforts focused on child behavior, including individualized streetside training and training in large virtual pedestrian environments, are laborious and expensive. This study considers the usability and feasibility of a virtual pedestrian environment "game" application to teach children safe street-crossing behavior via the internet, a medium that could be broadly disseminated at low cost. Ten 7- and 8-year-old children participated. They engaged in an internet-based virtual pedestrian environment and completed a brief assessment survey. Researchers rated children's behavior while engaged in the game. Both self-report and researcher observations indicated the internet-based system was readily used by the children without adult support. The youth understood how to engage in the system and used it independently and attentively. The program also was feasible. It provided multiple measures of pedestrian safety that could be used for research or training purposes. Finally, the program was rated by children as engaging and educational. Researcher ratings suggested children used the program with minimal fidgeting or boredom. The pilot test suggests an internet-based virtual pedestrian environment offers a usable, feasible, engaging, and educational environment for child pedestrian safety training. If future research finds children learn the cognitive and perceptual skills needed to cross streets safely within it, internet-based training may provide a low-cost medium to broadly disseminate child pedestrian safety training. The concept may be generalized to other domains of health-related functioning such as teen driving safety, adolescent sexual risk-taking, and adolescent substance use.
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Baniqued PL, Kranz MB, Voss MW, Lee H, Cosman JD, Severson J, Kramer AF. Cognitive training with casual video games: points to consider. Front Psychol 2014; 4:1010. [PMID: 24432009 PMCID: PMC3882717 DOI: 10.3389/fpsyg.2013.01010] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
Brain training programs have proliferated in recent years, with claims that video games or computer-based tasks can broadly enhance cognitive function. However, benefits are commonly seen only in trained tasks. Assessing generalized improvement and practicality of laboratory exercises complicates interpretation and application of findings. In this study, we addressed these issues by using active control groups, training tasks that more closely resemble real-world demands and multiple tests to determine transfer of training. We examined whether casual video games can broadly improve cognition, and selected training games from a study of the relationship between game performance and cognitive abilities. A total of 209 young adults were randomized into a working memory–reasoning group, an adaptive working memory–reasoning group, an active control game group, and a no-contact control group. Before and after 15 h of training, participants completed tests of reasoning, working memory, attention, episodic memory, perceptual speed, and self-report measures of executive function, game experience, perceived improvement, knowledge of brain training research, and game play outside the laboratory. Participants improved on the training games, but transfer to untrained tasks was limited. No group showed gains in reasoning, working memory, episodic memory, or perceptual speed, but the working memory–reasoning groups improved in divided attention, with better performance in an attention-demanding game, a decreased attentional blink and smaller trail-making costs. Perceived improvements did not differ across training groups and those with low reasoning ability at baseline showed larger gains. Although there are important caveats, our study sheds light on the mixed effects in the training and transfer literature and offers a novel and potentially practical training approach. Still, more research is needed to determine the real-world benefits of computer programs such as casual games.
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Affiliation(s)
- Pauline L Baniqued
- Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign Urbana, IL, USA
| | - Michael B Kranz
- Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign Urbana, IL, USA
| | - Michelle W Voss
- Department of Psychology, University of Iowa Iowa City, IA, USA
| | - Hyunkyu Lee
- Brain Plasticity Institute San Francisco, CA, USA
| | - Joshua D Cosman
- Department of Psychology, Vanderbilt University Nashville, TN, USA
| | | | - Arthur F Kramer
- Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign Urbana, IL, USA
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Abstract
Brain training programs have proliferated in recent years, with claims that video games or computer-based tasks can broadly enhance cognitive function. However, benefits are commonly seen only in trained tasks. Assessing generalized improvement and practicality of laboratory exercises complicates interpretation and application of findings. In this study, we addressed these issues by using active control groups, training tasks that more closely resemble real-world demands and multiple tests to determine transfer of training. We examined whether casual video games can broadly improve cognition, and selected training games from a study of the relationship between game performance and cognitive abilities. A total of 209 young adults were randomized into a working memory-reasoning group, an adaptive working memory-reasoning group, an active control game group, and a no-contact control group. Before and after 15 h of training, participants completed tests of reasoning, working memory, attention, episodic memory, perceptual speed, and self-report measures of executive function, game experience, perceived improvement, knowledge of brain training research, and game play outside the laboratory. Participants improved on the training games, but transfer to untrained tasks was limited. No group showed gains in reasoning, working memory, episodic memory, or perceptual speed, but the working memory-reasoning groups improved in divided attention, with better performance in an attention-demanding game, a decreased attentional blink and smaller trail-making costs. Perceived improvements did not differ across training groups and those with low reasoning ability at baseline showed larger gains. Although there are important caveats, our study sheds light on the mixed effects in the training and transfer literature and offers a novel and potentially practical training approach. Still, more research is needed to determine the real-world benefits of computer programs such as casual games.
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Affiliation(s)
- Pauline L. Baniqued
- Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana ChampaignUrbana, IL, USA,*Correspondence: Pauline L. Baniqued, Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign, 405 North Mathews Avenue, Urbana, IL 61801, USA e-mail:
| | - Michael B. Kranz
- Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana ChampaignUrbana, IL, USA
| | | | - Hyunkyu Lee
- Brain Plasticity InstituteSan Francisco, CA, USA
| | - Joshua D. Cosman
- Department of Psychology, Vanderbilt UniversityNashville, TN, USA
| | | | - Arthur F. Kramer
- Department of Psychology, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana ChampaignUrbana, IL, USA
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Baniqued PL, Lee H, Voss MW, Basak C, Cosman JD, DeSouza S, Severson J, Salthouse TA, Kramer AF. Selling points: What cognitive abilities are tapped by casual video games? Acta Psychol (Amst) 2013; 142:74-86. [PMID: 23246789 DOI: 10.1016/j.actpsy.2012.11.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/02/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022] Open
Abstract
The idea that video games or computer-based applications can improve cognitive function has led to a proliferation of programs claiming to "train the brain." However, there is often little scientific basis in the development of commercial training programs, and many research-based programs yield inconsistent or weak results. In this study, we sought to better understand the nature of cognitive abilities tapped by casual video games and thus reflect on their potential as a training tool. A moderately large sample of participants (n=209) played 20 web-based casual games and performed a battery of cognitive tasks. We used cognitive task analysis and multivariate statistical techniques to characterize the relationships between performance metrics. We validated the cognitive abilities measured in the task battery, examined a task analysis-based categorization of the casual games, and then characterized the relationship between game and task performance. We found that games categorized to tap working memory and reasoning were robustly related to performance on working memory and fluid intelligence tasks, with fluid intelligence best predicting scores on working memory and reasoning games. We discuss these results in the context of overlap in cognitive processes engaged by the cognitive tasks and casual games, and within the context of assessing near and far transfer. While this is not a training study, these findings provide a methodology to assess the validity of using certain games as training and assessment devices for specific cognitive abilities, and shed light on the mixed transfer results in the computer-based training literature. Moreover, the results can inform design of a more theoretically-driven and methodologically-sound cognitive training program.
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Schwebel DC, Gaines J, Severson J. Validation of virtual reality as a tool to understand and prevent child pedestrian injury. Accid Anal Prev 2008; 40:1394-1400. [PMID: 18606271 DOI: 10.1016/j.aap.2008.03.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 01/09/2008] [Accepted: 03/07/2008] [Indexed: 05/26/2023]
Abstract
In recent years, virtual reality has emerged as an innovative tool for health-related education and training. Among the many benefits of virtual reality is the opportunity for novice users to engage unsupervised in a safe environment when the real environment might be dangerous. Virtual environments are only useful for health-related research, however, if behavior in the virtual world validly matches behavior in the real world. This study was designed to test the validity of an immersive, interactive virtual pedestrian environment. A sample of 102 children and 74 adults was recruited to complete simulated road-crossings in both the virtual environment and the identical real environment. In both the child and adult samples, construct validity was demonstrated via significant correlations between behavior in the virtual and real worlds. Results also indicate construct validity through developmental differences in behavior; convergent validity by showing correlations between parent-reported child temperament and behavior in the virtual world; internal reliability of various measures of pedestrian safety in the virtual world; and face validity, as measured by users' self-reported perception of realism in the virtual world. We discuss issues of generalizability to other virtual environments, and the implications for application of virtual reality to understanding and preventing pediatric pedestrian injuries.
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Affiliation(s)
- David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Birmingham, AL 35294, USA.
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Schwebel DC, Ball KK, Severson J, Barton BK, Rizzo M, Viamonte SM. Individual difference factors in risky driving among older adults. J Safety Res 2007; 38:501-9. [PMID: 18023635 PMCID: PMC2186376 DOI: 10.1016/j.jsr.2007.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Revised: 03/22/2007] [Accepted: 04/25/2007] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Motor-vehicle crashes kill roughly 4,500 American adults over the age of 75 annually. Among younger adults, one behavioral factor consistently linked to risky driving is personality, but this predictor has been overshadowed by research on cognitive, perceptual, and motor processes among older drivers. METHOD In this study, a sample of 101 licensed drivers, all age 75 and over, were recruited to complete self-report measures on personality, temperament, and driving history. Participants also completed a virtual environment (VE) course designed to assess risk-taking driving behavior. State records of motor-vehicle crashes were collected. RESULTS Results suggest both a sensation-seeking personality and an undercontrolled temperament are related to risky driving among older adults. Sensation-seeking was particularly related to history of violations and tickets, while temperamental control was more broadly related to a number of risky driving measures. Methodological and crash prevention issues are discussed.
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Affiliation(s)
- David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham AL 35294, USA.
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Schwebel DC, Severson J, Ball KK, Rizzo M. Individual difference factors in risky driving: the roles of anger/hostility, conscientiousness, and sensation-seeking. Accid Anal Prev 2006; 38:801-10. [PMID: 16527223 DOI: 10.1016/j.aap.2006.02.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 11/01/2005] [Accepted: 02/08/2006] [Indexed: 05/07/2023]
Abstract
Motor vehicle crashes claim the lives of more Americans than any other cause of injury. One factor long recognized as relevant to predicting dangerous driver behavior is the driver's personality. This study examines the independent and combined roles of three personality traits--sensation-seeking, conscientiousness, and anger/hostility--in predicting risky driving behavior. Seventy-three participants completed personality and driving history questionnaires, and also engaged in a virtual environment (VE) task designed to assess risk-taking driving behavior. Each facet of personality was correlated to risky driving behavior in independent univariate analyses. In multivariate analyses, sensation-seeking emerged as the best predictor of self-reported driving violations. Anger/hostility and the interactive effect of anger/hostility by sensation-seeking also emerged in a multivariate analysis predicting one measure of self-reported driving violations. No personality trait predicted risky driving in the VE in multivariate analyses. Results are discussed with respect to previous work in the field, challenges involved in measuring the constructs of interest, and implications to prevention.
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Affiliation(s)
- David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd., CH 415, 35294, USA.
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Abstract
BACKGROUND Follicular mycosis fungoides is an unusual variant of mycosis fungoides (MF). Unlike classic MF where atypical lymphocytes show a predilection for the epidermis (epidermotropism), follicular MF displays a malignant lymphocytic infiltrate tropic for hair follicles (folliculotropism). This malignant lymphocytic infiltrate results in follicular disruption typically manifesting clinically as plaques, comedones and follicular papules. METHODS This report describes a 40-year-old patient with follicular MF presenting as nodules on the face and chest. Histologic examination of the patient's biopsy revealed a folliculocentric infiltrate of atypical lymphocytes with sparing of the epidermis. RESULTS AND CONCLUSIONS Our case is discussed in the context of previously reported cases of follicular MF; we also include a review of all cases of follicular MF published to date that meet the strict criterion for this diagnosis.
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Affiliation(s)
- J DeBloom
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
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Abstract
BACKGROUND Human papillomaviruses (HPV) are common human pathogens and are classified into more than 80 different types. These viruses produce benign warts in many cases and aggressive squamous cell carcinomas in other cases. OBJECTIVE The goal of this review is to update the reader on the epidemiology, pathogenesis, and therapy of HPV infections. Nonanogenital warts are transmitted by skin-to-skin contact while anogenital warts are usually transmitted sexually. Both types of warts produce much morbidity but rarely undergo malignant transformation. They are commonly treated with surgical or cytodestructive therapy, but immunomodulatory agents, such as imiquimod, have been proven to be very effective in anogenital warts and are being evaluated in nonanogenital warts. Other types of HPV have marked oncogenic potential such that over 99% of all cervical cancers and over 50% of other anogenital cancers are due to infection with oncogenic HPV. Many cofactors, such as cigarette smoking, genetics, and helper viruses, have potential roles in HPV oncogenesis, but their relative contributions are poorly understood. Other control measures for warts and HPV-associated cancers are under study, but the greatest future potential may be from the development of prophylactic and therapeutic vaccines. CONCLUSIONS Infection with HPV is very prevalent as are the clinical manifestations of this family of pathogens. Improved therapies for warts (e.g., imiquimod) have recently become available. Vaccines for HPV offer hope for future interventions for warts as well as for prevention of anogenital malignancies.
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Affiliation(s)
- J Severson
- Department of Dermatology, University of Texas Medical Branch, Galveston 77058, USA
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Abstract
A 31-year-old man presented with acute pain in his left arm and hemorrhagic vesicles that followed his left 8th cervical nerve. A diagnosis of herpes zoster was made, and the patient was treated with valacyclovir. He refused testing for antibodies to HIV because he denied being at risk. Two months later he returned with postherpetic neuralgia and postherpetic hyperhidrosis in the distribution of the vesicles, which had since resolved. Serology for HIV at this visit was positive, and the patient admitted to having sexual relations with prostitutes. Six months later the patient was being treated with triple antiretroviral therapy, and all signs and symptoms of postherpetic zoster had resolved. This case report documents the need for HIV testing in patients with unusual presentations of herpes zoster even if they initially deny being at risk.
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Affiliation(s)
- K F Chopra
- Department of Dermatology, College of Physicians and Surgeons of Columbia University, New York, New York, USA
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Abstract
Because of its ability to produce two clinically distinct disease entities (chickenpox and shingles), varicella zoster virus (VZV) is an unusual etiologic agent. Although in the past viral exanthems were mostly only of academic interest to the practitioner, the development of antiviral agents and the newly approved varicella (OKA) vaccine have increased the clinical significance. Also, with the increasing seroprevalence of HIV infection, more patients will be stricken with zoster (at a younger age) and disseminated varicella. In this review, the history, incidence, pathogenesis, clinical manifestations, and treatment options (of VZV infection and postherpetic neuralgia) will be discussed.
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Affiliation(s)
- M L McCrary
- Section of Dermatology, Medical College of Georgia, Augusta, USA
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