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ABSTRACT IMPACT: The knowledge acquired from my research can inform the development of early diagnostic methods for HIV-associated neurocognitive disorders. OBJECTIVES/GOALS: In the era of combination antiretroviral therapy (cART), the prevalence of HIV-associated neurocognitive disorders (HAND) remains high but the neural mechanisms are unclear. We examined whether older people with HIV (PWH) with minimal cognitive impairment have reduced functional connectivity in frontostriatal circuits compared to controls. METHODS/STUDY POPULATION: 99 PWH (mean age 56.6 years, 75% male, 62% Black, mean duration of HIV-infection 26.2 years ±9.3, 90% viral load <50 copies, 98% on stable cART) and 38 demographically-comparable controls (mean age 54.5 years, 71% male, 58% Black) participated in a cross-sectional study. A 7-domain neuropsychological battery and an Activities of Daily Living index were used to determine HAND diagnoses: 32 PWH met criteria for asymptomatic to mild HAND. Motor skill was assessed using the Grooved Pegboard Test by measuring performance speed. Structural MRI and resting-state functional MRI were collected. Seed-to-voxel analyses were conducted using 4 distinct regions in the striatum as seed regions. We used a voxel threshold of p<0.001 and cluster threshold of p<0.05 (FDR-corrected) after controlling for demographic variables. RESULTS/ANTICIPATED RESULTS: Compared to controls, PWH had lower resting state functional connectivity between the default mode region of the striatum (i.e., medial caudate) and bilateral superior frontal gyrus, supplementary motor cortex and paracingulate gyrus (p<0.05; cluster size: 567 voxels). Also, compared to controls, PWH had reduced resting state functional connectivity between the motor division of the striatum (i.e., posterior putamen) and anterior cingulate cortex and left supplementary motor cortex (p<0.05, cluster size: 405 voxels). Performance speed on the Grooved Pegboard motor test negatively correlated with functional connectivity between the motor region of the striatum and supplementary motor frontal regions in all participants (Spearman’s rho=-0.18, p=0.04). DISCUSSION/SIGNIFICANCE OF FINDINGS: Our results support the hypothesis that frontostriatal abnormalities are widely present in PWH and might play a key role in HAND development. Our data suggest that dysfunction within the frontostriatal circuits may be involved in motor impairment in PWH, and ongoing inflammation may contribute to motor impairment and frontostriatal injury.
Background: Carbapenemase-producing Enterobacterales (CPE) have rapidly become a global health concern and are associated with substantial morbidity and mortality due to limited treatment options. Travel to endemic areas, especially healthcare exposure in these areas, is an important risk factor for acquisition. We describe the evolving epidemiology, molecular features, and outcomes of CPE in Canada through surveillance by the Canadian Nosocomial Infection Surveillance Program (CNISP). Methods: CNISP has conducted surveillance for CPE among inpatients and outpatients of all ages since 2010. Participating acute-care facilities submit eligible specimens to the National Microbiology Laboratory for detection of carbapenemase production, and epidemiological data are collected. Incidence rates per 10,000 patient days are calculated based on inpatient data. Results: In total, 59 CNISP hospitals in 10 Canadian provinces representing 21,789 beds and 6,785,013 patient days participated in this surveillance. From 2010 to 2018, 118 (26%) CPE-infected and 547 (74%) CPE-colonized patients were identified. Few pediatric cases were identified (n = 18). Infection incidence rates remain low and stable (0.02 per 10,000 patient days in 2010 to 0.03 per 10,000 patient days in 2018), and colonization incidence rates have increased by 89% over the surveillance period. Overall, 92% of cases were acquired in a healthcare facility: 61% (n = 278) in a Canadian healthcare facility and 31% (n = 142) in a healthcare facility outside Canada. Of the 8% of cases not acquired in a healthcare facility, 50% (16 of 32) reported travel outside of Canada in the 12 months prior to positive culture. The distribution of carbapenemases varied by region; New Delhi metallo-B-lactamase (NDM) was dominant (59%) in western Canada and Klebsiella pneumoniae carbapenemase (KPC) (66%) in central Canada. NDM and class D carbapenemase OXA-48 were more commonly identified among those who traveled outside of Canada, whereas KPC was more commonly identified among patients without travel. In addition, 30-day all-cause mortality was 14% (25 of 181) among CPE infected patients and 32% (14 of 44) among those with bacteremia. Conclusions: CPE rates remain low in Canada; however, national surveillance data suggest that the increase in CPE in Canada is now being driven by local nosocomial transmission as well as travel and healthcare within endemic areas. Changes in screening practices may have contributed to the increase in colonizations; however, these data are currently lacking and will be collected moving forward. These data highlight the need to intensify surveillance and coordinate infection control measures to prevent further spread of CPE in Canadian acute-care hospitals.
Susy Hota reports contracted research for Finch Therapeutics. Allison McGeer reports funds to her institution for projects for which she is the principal investigator from Pfizer and Merck, as well as consulting fees from the following companies: Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.
Progress to date has varied between different sub-disciplines and this final chapter will touch on common themes throughout. Psychology as a discipline has much to gain from the digital age, especially following the mass adoption of smartphohes. Software development is an entire discipline within itself, but even comparatively simple smartphone apps that collect minimal data can be highly revealing of everyday behaviour. However, we face numerous challenges that go beyond technological development. Some of these issues pretain to theorising and replication, while others concern the scientific climate in which we operate. Most of these issues are not unique to research involving new technology, but they become more apparent as the speed of innovation accelerates. As a result, we appear to carry very little understanding forward to the next mass-adopted innovation.
By reflecting on past successes and failures, this chapter provides guidance on how psychological research can become more productive and break free from tired cycles of research. More importantly, if psychological science can re-align existing priorities and embrace the digital age, it has nothing to lose and everything to gain.
Smartphones and associated wearable devices have gained a greater prominence directly within health psychology. Not only can such devices track health and answer a variety of research questions in relation to physical and mental health, but real-time feedback can also be augmented to support subsequent behaviour change interventions. There are literally 1000s of smartphone health apps that aim to change behaviour. Hence, health psychologists have been heavily involved with the design and testing of interventions (Ellis and Piwek, 2018). In addition, there are increasing numbers of interdisciplinary groups who focus on such interventions. However, while the research landscape is now littered with many well-publicised successes and failures, very little is known when it comes to understanding why such results are occurring even for users who engage with a long-term smartphone/wearable intervention. Despite having plenty of scope for development, progress has stalled because existing adaptations continue to be poorly designed from both a theoretical and patient perspective.
With these issues in mind, this chapter points towards where psychological research is using smartphone sensing methods that can quantify health related behaviours on a larger scale. It also considers how psychology can make a key contribution in the future. For example, while the process of behaviour change remains complex, additional research is urgently needed to understand how individuals, devices, and related technologies can be designed and implemented if interventions are to become widespread across healthcare systems in the future (Piwek et al., 2016; Ellis and Piwek, 2018)
Psychological concerns around the impact of smartphone use tends to overshadow all other threats and concerns around digital spaces. This chapter critically considers research that has associated smartphone use with negative traits and behavioural outcomes. In contrast to other areas of smartphone research, and while many prominent academics have argued that smartphone data have a great deal to offer as a research tool in psychology, comparatively little research utilises objective smartphone usage data in relation to potential harms (Andrews et al., 2015). For example, the majority of existing research tends to rely on self-report alone when to quantifying ‘addictive’ behaviour. A frank discussion regarding similar issues of measurement would help the field move forward more quickly, improve its visibility and generate additional impact from a policy and practitioner perspective.
This chapter provides a timely narrative and critically considers where smartphone research within psychology has advanced in a variety of innovative ways, but also where it is has been slower to innovate both theoretically and methodologically. While some progress has been made regarding the genuine impacts of general technology use, this chapter will conclude by reminding readers that smartphone addiction provides an excellent example of where the field has to embrace the abilities of other disciplines if it is to make additional progress.
Cognitive science has often considered the impact of new technology on childhood development and the ability of digital devices to disrupt attention and cognitive processes. In contrast, the same area has successfully implemented smartphones into existing research practices, which perhaps reflects the methodological training many psychologists working within cognition and perception receive as part of their doctoral studies. For example, standard psychophysical experiments and reaction time tasks have been ported to a variety of smartphones using their built-in web-browser. This has been extended to include the large-scale gamification of traditional cognitive tests (Wilmer, Sherman and Chein, 2017). Combining advanced graphical abilities, a number of cognitive tasks have been validated to assess working memory, attention and decision-making abilities (Paletta, 2014).
This chapter points towards a future whereby cognitive psychology could become the first sub-discipline within psychology to develop a complete portable laboratory. This would, in turn, reveal any casual links between technology use and cognitive functioning which continues to allude existing research paradigms
Social interaction and the subsequent generation of interpersonal relationships appear to be inherently linked to emotional well-being. Smartphones have increased an individual’s social footprint while remaining the primary way in which people communicate with each other via social media, phone calls and text messages. However, many researchers have questioned if the same technology is simultaneously preventing us from developing meaningful relationships?
At the same time, other research has started to focus on a variety of popular smartphone applications that have changed the way modern relationships are formed and maintained (e.g., Tinder, Snaphat). This work typically considers a participants’ own experience or data derived directly from applications themselves (Davidson, Joinson and Jones, 2018). However, it is also possible to explore real-wold social interaction via the variety of on-board sensors, which can also reveal group dynamics within the real-world (Piwek, Ellis and Andrews, 2016). For example, Bluetooth and location data derived from appropriate sensors can be used to infer when someone is meeting with others who are also running similar software of their device. This has also been referred to as Social fMRI whereby researchers can quantify social mechanisms in the real world (Aharony et al., 2011).
Smartphones can also generate data within other domains that psychology could take advantage of in the future including “smart cities.” For example, tracking and understanding individuals’ mobility using GPS location can allow for the forecasting of future movements. While smartphones have dramatically changed how large sections of society form and develop new relationships, this chapter points towards how the same technology can be leveraged further to understand how relationships and groups rapidly shift between offline and online contexts in the digital age.
The history of psychological science appears short when placed alongside physics, chemistry and biology. Nevertheless, the field has consistently evolved in response to new challenges. For example, one of the crucial features of scientific psychology in the twentieth century was grounding itself in objectivity. By changing the subject to the study of behaviour, psychology could be based on scientific laws of behaviour. In contrast, introspection relied exclusively on an observation of one’s mental state. Behaviourism initially helped psychologists better understand learning and behavioural change, but motivations and other mediational processes (e.g., thinking) remained hidden because they were not directly observable (Skinner, 1971). Despite academics arguing that the scientific assessment of behaviour can be yoked to cognition and emotion, behaviourism was never universally accepted, especially in Europe or Canada, because it could only provide a partial account of what it means to be human (Baddeley, 2018; Watson, 1913).
Much of the research discussed previously will have relied on participants consenting to have data collected from their smartphone. However, smartphones continue to pose an inherent security risk within and beyond research. They also provide ways in which criminals can operate and communicate across larger networks. Despite the majority of devices holding large quantities of personal information, many people continue to ignore advice when it comes to securing their device. This is particularly problematic when it comes to carrying out tasks on unsecured networks. Malware can also gain access to a smartphone and compromise its function.
The popularity of smartphones provide another digital outlet for illegal data capture and this chapter will consider why, despite multiple security concerns, the majority of smartphone users and even large organisations are unable to recognise the importance of developing sound security practices. A second stand considers how psychologists and software developers are attempting to improve the security of existing devices and encourage security focused beahviours. While data in the digital age can be tremendously valuable for research purposes, developing good practice remains essential when developing software that collects sensitive data from smartphones and associated devices.
While psychologists agree that individuals differ from each other on a variety of traits (e.g., personality), the theoretical and methodological assumptions used to develop pen and paper psychometric tests have failed to keep pace with recent computational developments that utilise digital traces to infer information about individuals and the world around them. For example, while self-report assessments are designed to predict behaviour in the absence of any real-world measure, digital devices (e.g., smartphones) have facilitated the measurement of many real-world outcomes (Piwek et al., 2016). Even the purchase of a specific device can reveal something about the individual behind the screen (Shaw, Ellis and Ziegler, 2018). Smartphones could therefore lead to a step change in how we study and conceptualise a variety of individual differences. This is particularly pertinent when it comes to understanding personality traits (e.g., levels of extraversion – a measure of sociability) that are automatically deployed in new situations seamlessly and non-consciously (Roberts and Hill, 2017).
A number of studies using smartphones have correlated data from these devices with traditional psychometric tests. However, following a brief review of this work, this chapter will question how much progress has been made in this domain. There remains a general consensus among many social scientists that, while traditional psychometric measures are far from perfect, they are the only option available. This chapter will challenge that assumption however, data derived from smartphone sensing may ultimately support the notion that existing psychometric tools remain valuable and reinforce existing conceptualisations of standard personality models.
Psychologists can now quantify behaviours beyond the laboratory using a mass-adopted, unified system that is primed for data capture a.k.a. smartphones. This is the first book to bring together related areas of smartphone research and point towards how psychology can benefit and engage with these developments in the future. It critically considers how smartphones and related digital devices help answer and generate new research questions for psychological science. The book then guides readers through how smartphones are being used within psychology and social science more broadly. Drawing from examples of both good and bad practice within current research, a new perspective is brought to major themes and debates across behavioural science. In the digital age, smartphones and associated devices will be able to accomplish much more in the near future. Psychology has a key role to play when it comes to balancing this monumental potential with carefully considered research.
The criteria for objective memory impairment in mild cognitive impairment (MCI) are vaguely defined. Aggregating the number of abnormal memory scores (NAMS) is one way to operationalise memory impairment, which we hypothesised would predict progression to Alzheimer’s disease (AD) dementia.
As part of the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing, 896 older adults who did not have dementia were administered a psychometric battery including three neuropsychological tests of memory, yielding 10 indices of memory. We calculated the number of memory scores corresponding to z ≤ −1.5 (i.e., NAMS) for each participant. Incident diagnosis of AD dementia was established by consensus of an expert panel after 3 years.
Of the 722 (80.6%) participants who were followed up, 54 (7.5%) developed AD dementia. There was a strong correlation between NAMS and probability of developing AD dementia (r = .91, p = .0003). Each abnormal memory score conferred an additional 9.8% risk of progressing to AD dementia. The area under the receiver operating characteristic curve for NAMS was 0.87 [95% confidence interval (CI) .81–.93, p < .01]. The odds ratio for NAMS was 1.67 (95% CI 1.40–2.01, p < .01) after correcting for age, sex, education, estimated intelligence quotient, subjective memory complaint, Mini-Mental State Exam (MMSE) score and apolipoprotein E ϵ4 status.
Aggregation of abnormal memory scores may be a useful way of operationalising objective memory impairment, predicting incident AD dementia and providing prognostic stratification for individuals with MCI.