Psychometric Evaluation of the Insomnia Severity Index in Nurses.

OBJECTIVES: Examine psychometric properties of the Insomnia Severity Index (ISI) in a sample of nurses. METHOD: In a sample of day shift nurses (N = 289), a confirmatory factor analysis (CFA), convergent and discriminant validity analyses, and a test-retest reliability analysis were performed. RESULTS: CFA showed that a two-factor model provided the best fit. The ISI had moderate to poor convergent validity with sleep diary parameters, and moderate convergent validity with the Sleep Condition Indicator (r = -.66), Pittsburgh Sleep Quality Index (r = .66), and PROMIS Sleep-Related Impairment measure (r = .67). The ISI demonstrated good discriminant validity with the measures Composite Scale of Morningness (r = -.27), Nightmares Disorder Index (r = .25), PTSD Checklist for DSM-5 (sleep items removed; r = .32), and Perceived Stress Scale (r = .43). The ISI had weaker discriminant validity with the PHQ-9 (r = .69) and Generalized Anxiety Disorder Screener (r = .51). The ISI demonstrated a good test-retest reliability (ICCs = .74-.88). CONCLUSIONS: The ISI is a psychometrically strong measure for the assessment of insomnia severity in day shift nurses. Overlap with psychological symptoms, primarily anxiety and depression, suggests caution while interpreting these constructs.

Development of New CD38 Targeted Peptides for Cancer Imaging.

PURPOSE: Multiple myeloma (MM) affects over 35,000 patients each year in the US. There remains a need for versatile Positron Emission Tomography (PET) tracers for the detection, accurate staging, and monitoring of treatment response of MM that have optimal specificity and translational attributes. CD38 is uniformly overexpressed in MM and thus represents an ideal target to develop CD38-targeted small molecule PET radiopharmaceuticals to address these challenges. PROCEDURES: Using phage display peptide libraries and pioneering algorithms, we identified novel CD38 specific peptides. Imaging bioconjugates were synthesized using solid phase peptide chemistry, and systematically analyzed in vitro and in vivo in relevant MM systems. RESULTS: The CD38-targeted bioconjugates were radiolabeled with copper-64 (64Cu) with100% radiochemical purity and an average specific activity of 3.3 - 6.6 MBq/nmol. The analog NODAGA-PEG4-SL022-GGS (SL022: Thr-His-Tyr-Pro-Ile-Val-Ile) had a Kd of 7.55 ± 0.291 nM and was chosen as the lead candidate. 64Cu-NODAGA-PEG4-SL022-GGS demonstrated high binding affinity to CD38 expressing human myeloma MM.1S-CBR-GFP-WT cells, which was blocked by the non-radiolabeled version of the peptide analog and anti-CD38 clinical antibodies, daratumumab and isatuximab, by 58%, 73%, and 78%, respectively. The CD38 positive MM.1S-CBR-GFP-WT cells had > 68% enhanced cellular binding when compared to MM.1S-CBR-GFP-KO cells devoid of CD38. Furthermore, our new CD38-targeted radiopharmaceutical allowed visualization of tumors located in marrow rich bones, remaining there for up to 4 h. Clearance from non-target organs occurred within 60 min. Quantitative PET data from a murine disseminated tumor model showed significantly higher accumulation in the bones of tumor-bearing animals compared to tumor-naïve animals (SUVmax 2.06 ± 0.4 versus 1.24 ± 0.4, P = 0.02). Independently, tumor uptake of the target compound was significantly higher (P = 0.003) compared to the scrambled peptide, 64Cu-NODAGA-PEG4-SL041-GGS (SL041: Thr-Tyr-His-Ile-Pro-Ile-Val). The subcutaneous MM model demonstrated significantly higher accumulation in tumors compared to muscle at 1 and 4 h after tracer administration (SUVmax 0.8 ± 0.2 and 0.14 ± 0.04, P = 0.04 at 1 h; SUVmax 0.89 ± 0.01 and 0.09 ± 0.01, P = 0.0002 at 4 h). CONCLUSIONS: The novel CD38-targeted, radiolabeled bioconjugates were specific and allowed visualization of MM, providing a starting point for the clinical translation of such tracers for the detection of MM.

Menstrual Products: Attitudes About Taxation and Safety.

Background: This study explored factors associated with the differences between women and men in attitudes, norms, and the support of taxation of menstrual products (MPs) and menstrual-adjacent products. It also investigated the use of these products in women. Methods: Young adults from 18 to 30 years of age were recruited via social media, listserve emails, and flyers placed throughout a university campus. Following cognitive interviewing, a survey investigated attitudes, beliefs, and behaviors associated with MPs. Results: Individuals self-identified as men or women. Women (n = 154) had more positive general attitudes, less positive safety attitudes, and less support for taxation of MPs than men (n = 43). Regression analyses indicated that factors, such as race, age, attitudes, norms, and taxation, were associated with product use. Conclusions: Attitudes about safety and taxation differ for men and women. Tax policies and attitude-shifting interventions need to be tailored to their audience, and our study can inform that effort.

Communication with physicians and family about breast Cancer recurrence.

Objective: Adequate physician-patient communication about cancer recurrence is vital to quality of life and to informed decision-making related to survivorship care. The current study was guided by a cognitive-affective framework to examine communication with family and physicians about breast cancer recurrence risk. Methods: A survey of recently-diagnosed, early-stage breast cancer patients in Appalachia investigated physician-patient and familial communication about breast cancer recurrence risk. Results: Over 30% of participants reported not talking to family or physicians about breast cancer recurrence risk. Younger patients reported more conversations, and speaking with physicians was associated with greater perception risk factors associated with recurrence risk. Greater worry about recurrence was associated with more communication with family and plans to talk to family, physicians, and friends about recurrence risk in the future. Conclusion: Additional supports for patients and physicians are needed to improve understanding of breast cancer recurrence risk and risk factors for recurrence. Innovation: Family communication about breast cancer recurrence risk is understudied. The combination of physician and family communication adds novelty to our analysis.

Assessing the impact of the skin cancer awareness now (SCAN!) intervention several months following the intervention.

BACKGROUND: West Virginia (WV) is the third most rural state in the US and has a high incidence of skin cancer. Intervention efforts in WV are impeded by structural barriers, low health literacy, and lack of health care access. Community pharmacies and pharmacists are highly accessible and may be helpful in promoting skin cancer prevention. OBJECTIVE(S): The purpose of the study was to evaluate the impact of the Skin Cancer Awareness Now (SCAN!) pharmacy-based sun-safety intervention at follow-up. METHODS: Surveys assessed SCAN's effect on skin cancer prevention at preintervention and follow-up. The follow-up survey was administered between 8 and 12 months after our initial feasibility study. Questions included demographics, cancer history, cancer worry, knowledge, cancer communication, and skin cancer screening intentions. Multivariate repeated measures ANOVA assessed the change in worry, importance, knowledge, and intentions to be sun safe. RESULTS: Participants (n=56, response rate= 62.2%) had a mean age of 44.7 (standard deviation: 19.3) years. Most were females (87.5%), Whites (92.9%), and 48.2% lived in rural areas. Knowledge and intentions significantly improved over time. At follow-up, participants (41.1%) mentioned that they plan on discussing skin cancer prevention with their pharmacist in the future. CONCLUSION: The SCAN! intervention can be a useful resource for skin cancer prevention in community pharmacy settings. Community pharmacies have the potential to be change agents in skin cancer prevention by providing education on sun protection or detection and by promoting sun-safety behaviors.

Perspectives of patients with advanced or metastatic non-small cell lung cancer on symptoms, impacts on daily activities, and thresholds for meaningful change: a qualitative research study.

Introduction: Advanced or metastatic non-small cell lung cancer (NSCLC) is associated with significant symptom burden. It is important to understand the impact of these disease-and treatment-related symptoms on patients' daily lives and explore from a patient perspective what constitutes a meaningful change in NSCLC symptoms. Methods: Patient experience of advanced or metastatic NSCLC was explored in this prospective, non-interventional qualitative research study recruiting patients from the United States (US). Interviews were conducted to explore the most important symptoms, daily life impacts, and patients' perspectives of what constitutes meaningful change when considering their current symptoms versus 6-12 months prior, based on the Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Change (PGI-C) items. Results: Between February and April 2022, 19 US-based patients with Stage IV NSCLC were recruited; 95% were female, 63% were White, 79% had been diagnosed >1 year prior, and 63% were receiving targeted therapy. Over half the patients indicated their most important symptoms were fatigue, shortness of breath, and cough. Patient differentiation between whether symptoms were disease- or treatment-related lacked concordance, and often patients were unable to distinguish the two. The most frequently mentioned impacts of these symptoms on patients' daily lives were difficulty walking, sleep disturbance, anxiety/depression, impact on relationships, and difficulty doing daily tasks. Most patients considered a one-point change on the PGI-S or PGI-C to be meaningful based on rating their symptom severity at the time of the interview compared with 6-12 months before the interview. Conclusion: Based on their own symptom experience, patients with advanced or metastatic NSCLC indicated a one-point threshold for meaningful change, whether improvement or worsening. This suggests a one-point change on the PGI-S or PGI-C may be a potential anchor for patient-reported outcome (PRO) endpoints used in clinical trials. It is important to use PRO instruments that capture the symptoms and impacts identified as most important to patients. These findings highlight the importance of using qualitative methods to assess disease-related symptoms, treatment-related side effects, and the impacts on daily life for patients with advanced or metastatic NSCLC, underscoring how qualitative assessments can complement quantitative PRO instruments for evaluating clinical trials.

Experience of Daily Life with Generalized Myasthenia Gravis: A Qualitative Investigation and Assessment of Instrument Content Validity.

INTRODUCTION: Generalized myasthenia gravis (gMG) is a rare autoimmune disease. Symptoms of gMG are diverse, and understanding of their impact on patients is limited. This qualitative study aimed to provide an in-depth exploration of patients' daily experiences of gMG. METHODS: Published qualitative studies were reviewed to identify the most important signs, symptoms, and functional impacts related to the patient experience in gMG. Semi-structured hybrid concept elicitation interviews (allowing spontaneous generation of disease concepts) and cognitive debriefing interviews (assessing the validity of existing disease assessments) were conducted with clinicians and adult patients with gMG. Signs, symptoms, and impacts were reviewed to understand which were most salient (i.e., reported by at least 50% of patients, with disturbance rating 5 or higher [10-point numeric scale]); concept saturation was also assessed. The disease conceptual model was updated. Existing clinical outcomes assessments (COAs) that capture how patients feel, function, and survive were assessed. RESULTS: Interviews with patients (n = 24) identified seven new signs and symptoms and 37 new impacts compared with the literature. Concept saturation was reached. Signs and symptoms identified by patients as most important (salient) were shortness of breath, general fatigue, muscle weakness of arms, legs, and neck, dysphonia, dysarthria, trouble swallowing liquids, choking, and heat sensitivity. Patient-identified salient impacts were work life, depression, difficulty walking, grooming hair, showering, and brushing teeth, eating, personal relationships, family life, and participating in social activities. Clinicians considered ocular, respiratory, swallowing, speech/talking, and extremity function as key clinical manifestations of gMG. Patients and clinicians found clinical outcome assessments (COAs) to be conceptually relevant and comprehensive. CONCLUSION: This research provides a holistic understanding of gMG signs, symptoms, and impacts experienced by patients, as observed by patients and clinicians. The conceptual model of gMG highlights the range of signs, symptoms, and impacts that adult patients with gMG experience in their everyday lives, emphasizing the humanistic impact and unmet needs.

The experience of patients with acute myeloid leukemia in remission post-transplant.

The symptoms of acute myeloid leukemia (AML) and its treatment can negatively impact patient functioning and quality of life. Through concept elicitation interviews, we sought to evaluate the experience of patients with AML in remission following hematopoietic stem cell transplant (HSCT). Thirty patients with AML in remission post-HSCT, and eight clinicians with experience treating such patients, were asked to identify symptoms and impacts associated with AML and/or its treatment. The findings were used to develop an AML conceptual disease model to reflect the experience of these patients. We identified five symptoms and six impacts that were salient to patients with AML in remission post-HSCT. Although clinician and patient perspectives largely aligned, emotional and cognitive impacts were most important to patients, whereas clinicians focused on physical impacts. This model could be used to ensure patient-reported outcome measures included in clinical trials are reflective of the post-HSCT AML patient experience.

A Projectile Concussive Impact Model Produces Neuroinflammation in Both Mild and Moderate-Severe Traumatic Brain Injury.

Traumatic brain injury (TBI) is a major cause of death and disability and is experienced by nearly 3 million people annually as a result of falls, vehicular accidents, or from being struck by or against an object. While TBIs can range in severity, the majority of injuries are considered to be mild. However, TBI of any severity has the potential to have long-lasting neurological effects, including headaches, cognitive/memory impairments, mood dysfunction, and fatigue as a result of neural damage and neuroinflammation. Here, we modified a projectile concussive impact (PCI) model of TBI to deliver a closed-head impact with variable severity dependent on the material of the ball-bearing projectile. Adult male Sprague Dawley rats were evaluated for neurobehavioral, neuroinflammatory, and neural damage endpoints both acutely and longer-term (up to 72 h) post-TBI following impact with either an aluminum or stainless-steel projectile. Animals that received TBI using the stainless-steel projectile exhibited outcomes strongly correlated to moderate-severe TBI, such as prolonged unconsciousness, impaired neurobehavior, increased risk for hematoma and death, as well as significant neuronal degeneration and neuroinflammation throughout the cortex, hippocampus, thalamus, and cerebellum. In contrast, rats that received TBI with the aluminum projectile exhibited characteristics more congruous with mild TBI, such as a trend for longer periods of unconsciousness in the absence of neurobehavioral deficits, a lack of neurodegeneration, and mild neuroinflammation. Moreover, alignment of cytokine mRNA expression from the cortex of these rats with a computational model of neuron-glia interaction found that the moderate-severe TBI produced by the stainless-steel projectile strongly associated with the neuroinflammatory state, while the mild TBI existed in a state between normal and inflammatory neuron-glia interactions. Thus, these modified PCI protocols are capable of producing TBIs that model the clinical and experimental manifestations associated with both moderate-severe and mild TBI producing relevant models for the evaluation of the potential underlying roles of neuroinflammation and other chronic pathophysiology in the long-term outcomes associated with TBI.

Systematic review and meta-analysis of randomized controlled trials of interventions addressing caregiver distress and burden among cancer caregivers.

Objective: Informal caregivers (ICs) are vital to supportive cancer care and assisting cancer patients, but this caregiving burden is associated with significant distress. While addressing caregiving, it is important to explore if the caregivers are receiving care they need. Evaluating interventions that address burden and distress is integral to targeting ICs needs. This study evaluated interventions addressing IC burden and distress. Methods: Randomized control trials (RCT) assessing interventions for IC burden and distress and exploring supportive care as an adjunct to the intervention were included. Six electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through October 2021. Effect sizes were estimated, and risk of bias was assessed. Results: Of 678 studies, 11 were included. Most ICs were spouses, females, and white. Interventions included educational programs, cognitive behavioral treatment, and a telephone support program. Five studies utilized behavioral theories and seven included supportive care. Pooled results showed no significant effect on reducing caregiver distress (ES, -0.26, p<0.001). Conclusions: Caring for the caregiver with interventions for reducing burden and distress are not efficacious. Innovative, well-designed, more pragmatic RCTs are needed. Innovation: This study exclusively focused on interventions and supportive care needs for reducing distress and burden among cancer ICs.

A Bitter Taste Receptor as a Novel Molecular Target on Cancer-Associated Fibroblasts in Pancreatic Ductal Adenocarcinoma.

Cancer-associated fibroblasts (CAFs) execute diverse and complex functions in cancer progression. While reprogramming the crosstalk between CAFs and cancer epithelial cells is a promising avenue to evade the adverse effects of stromal depletion, drugs are limited by their suboptimal pharmacokinetics and off-target effects. Thus, there is a need to elucidate CAF-selective cell surface markers that can improve drug delivery and efficacy. Here, functional proteomic pulldown with mass spectrometry was used to identify taste receptor type 2 member 9 (TAS2R9) as a CAF target. TAS2R9 target characterization included binding assays, immunofluorescence, flow cytometry, and database mining. Liposomes conjugated to a TAS2R9-specific peptide were generated, characterized, and compared to naked liposomes in a murine pancreatic xenograft model. Proof-of-concept drug delivery experiments demonstrate that TAS2R9-targeted liposomes bind with high specificity to TAS2R9 recombinant protein and exhibit stromal colocalization in a pancreatic cancer xenograft model. Furthermore, the delivery of a CXCR2 inhibitor by TAS2R9-targeted liposomes significantly reduced cancer cell proliferation and constrained tumor growth through the inhibition of the CXCL-CXCR2 axis. Taken together, TAS2R9 is a novel cell-surface CAF-selective target that can be leveraged to facilitate small-molecule drug delivery to CAFs, paving the way for new stromal therapies.

Investigating sleep, stress, and mood dynamics via temporal network analysis.

OBJECTIVE/BACKGROUND: Prior research has emphasized the bidirectional relationships between sleep, stress, and affective states, such as depression. Given the inherent variability and fluctuations associated with sleep, assessing how sleep and affective variables function within a dynamic system may help further uncover possible causes and consequences of sleep disturbances, as well as find candidate targets for intervention. To this end, we examined dynamic relationships between self-reported stress, depressed mood, and clinically-relevant sleep parameters via temporal network analysis. METHODS: Participants were 401 nurses (92% female, 78% White, Mage = 39.47 years) who completed 14 days of sleep diaries incorporating self-reported stress and depression, as well as total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. RESULTS AND CONCLUSIONS: Overall, total sleep time emerged as a highly influential variable in the context of "outstrength centrality," meaning total sleep time had numerous outward connections with other variables (e.g., stress and sleep efficiency). The high outstrength centrality of total sleep time suggests this variable is a source of activation within this dynamic system. Conversely, stress showed high "instrength centrality," suggesting this variable was highly impacted by other variables in the system, such as depressed mood and sleep efficiency. These findings emphasize the importance of assessing unfolding sleep processes within a naturalistic setting, and implicate the role of total sleep time in fueling depressed mood and stress. Discussion emphasizes implications of these results for understanding the connections between sleep, stress, and depression as well as clinical relevance of these findings.

A pilot study of home-based genetic testing completion rate in telegenetics cancer clinics in West Virginia Appalachia.

Telegenetics has shifted some genetic testing performance to the patient's own home, with the patient collecting his/her own sample. Little is known regarding the rate of test completion of such home-based genetic testing. This study compared the completion rate of home-based genetic tests before and after a reminder system was implemented. In the pre-reminder group, we reviewed medical records for patients who were seen via telegenetics and agreed to complete genetic testing using an at-home test kit. In the reminder group, a prospective analysis of the genetic test completion rate was performed taking a clinical quality improvement approach where three reminders were provided for patients who had not submitted their at-home genetic testing. Our study included 94 patients' records: 46 pre-reminders and 48 reminders. The lab received 24 patient samples (52.2%) in the pre-reminder group. In the reminder group, 30 patients returned their kits (62.5%). Despite a higher percentage of patients completing their test in the reminder group, there was no statistically significant difference between the pre-reminder and reminder groups. The rate of test completion in our pilot test was statistically similar between the two groups, but the reminder group was trending toward a higher percent of completion which may be clinically meaningful.

Illness representations of vaping associated lung injury (VALI) and E-cigarette use: common sense model of self-regulation driven mixed-method approach.

OBJECTIVE: The study explored differences in illness representations of VALI guided by the Common-Sense Model of Self-Regulation (CSM-SR) among non-patient adults. DESIGN: We employed a cross-sectional concurrent mixed-methods design. In the quantitative analysis, we used multivariate analysis of covariance (MANCOVA). Immersion/crystallization was used to analyze qualitative data. MAIN OUTCOME MEASURES: We measured differences in illness representations of VALI by e-cigarette use status, gender, and urban/rural residence. RESULTS: E-cigarette use was associated with illness representations of VALI. Current e-cigarette users discounted the detrimental nature of VALI, compared to former and never e-cigarette users. Gender and urban/rural residence moderated the association between e-cigarette use and illness representation of VALI. In the qualitative analysis, 49.3% respondents reported components of the timeline (e.g. permanent), identity (e.g. shortness of breath), causes (e.g. THC products), consequences (e.g. life-threatening), cure/control (e.g. stop vaping), and worry (e.g. fearful). CONCLUSION: Perceptions about VALI, such as cure and timeline, were associated with e-cigarettes use. Understanding the context in which adults perceive VALI, such as gender and rurality, may contribute to developing interventions that influence e-cigarette cessation. Future research employing CSM-SR to target strategies for promoting vaping abstinence is warranted.

A Systematic Review of eHealth Interventions to Promote Physical Activity in Adults with Obesity or Overweight.

Use of information and communication technology to improve health, known as eHealth, is an emerging concept in healthcare that may present opportunities to promote physical activity in adults with obesity. The purpose of this research was to systematically review eHealth intervention studies to promote physical activity in adults with obesity. Five electronic databases were used. Two authors screened articles, assessed risk of bias, and extracted data independently. A qualitative data synthesis for summarizing the findings was performed using harvest plots. In the search, 2276 articles were identified, and 18 studies met all inclusion criteria. Study quality ranged from poor to good. The included studies varied in intervention technology (e.g., web-based), physical activity assessment (e.g., device-based), and control group (e.g., wait-list). Behavioral change techniques used in the included studies were consistent with some techniques (e.g., self-monitoring) known as effective in face-to-face interventions, but more efficiently employed in eHealth using information and communication technology. Overall, this systematic review showed that a web-based or physical activity monitor-based eHealth intervention had the potential to effectively promote physical activity in adults with obesity. Some recommendations for future eHealth interventions to promote physical activity in adults with obesity were provided (e.g., use of theory, accelerometers).

Daily reactivity to stress and sleep disturbances: unique risk factors for insomnia.

STUDY OBJECTIVES: To naturalistically measure sleep disturbances following stress exposure (i.e. sleep reactivity) and stress responses following sleep disturbances (i.e. stress reactivity) at the daily level and prospectively examine these reactivity measures as individual risk factors for insomnia. METHODS: The study assessed 392 nurses' sleep and stress for 14 days using daily diaries and actigraphy. Self-reported insomnia symptoms were assessed at the end of the 14 days, as well as 6 and 11 months later. RESULTS: In multilevel modeling, while negative fixed effects indicated that shorter total sleep time (TST) and lower sleep efficiency led to greater stress and vice versa, significant random effects indicated individual variability in sleep reactivity and stress reactivity. In latent score change modeling, greater sleep reactivity (lower diary-determined sleep efficiency following greater stress) and greater stress reactivity (greater stress following shorter diary-determined TST) at baseline were associated with greater insomnia symptoms at 11 months (b = 10.34, p = .026; b = 7.83, p = .03). Sleep reactivity and stress reactivity also interacted to predict insomnia symptoms, such that sleep reactivity was significantly associated with insomnia symptoms for those with high (+1 SD) stress reactivity (b = 17.23, p = .001), but not for those with low (-1 SD) stress reactivity (b = 5.16, p = .315). CONCLUSIONS: Baseline stress reactivity and sleep reactivity independently as well as jointly predict greater insomnia symptoms 11 months later. The findings delineate processes underlying the stress-diathesis model of insomnia and highlight the utility of longitudinal and naturalistic measures of sleep and stress reactivity.

A pilot reverse virtual screening study suggests toxic exposures caused long-term epigenetic changes in Gulf War Illness.

Gulf War Illness (GWI) is a chronic illness that affects upward of 32% of deployed Veterans to the 1991 Gulf War (GW). The symptoms are medically unexplained, ranging across cognitive deficits, fatigue, gastrointestinal problems, and musculoskeletal pain. Research indicates that chemical warfare agents play a key role in the onset and progression of GWI. The Khamisiyah ammunition storage that housed chemical warfare agents such as sarin, an acetylcholinesterase (AChE) inhibitor, was demolished during the GW, releasing toxicants into the atmosphere affecting deployed troops. Exposure to other chemical agents such as pyridostigmine bromide, N,N-diethyl-m-toluamide, permethrin and chlorpyrifos, were also prevalent during the war. These additional chemical agents have also been shown to inhibit AChE. AChE inhibition induces an acetylcholine build-up, disrupting signals between nerves and muscles, which in high doses leads to asphyxiation. Little is known about low dose exposure. As bioactive compounds tend to interact with multiple proteins with various physiological effect, we aimed to identify other potential shared targets to understand the extent in which these chemicals could lead to GWI. We followed a reverse screening approach where each chemical is computationally docked to a library of protein targets. The programs PharmMapper and TargetNet were used for this purpose, and further analyses were conducted to mark significant changes in participants with GWI. Previously published work on DNA methylation status in GWI was reanalyzed focusing specifically on the predicted shared targets indicating significant changes in DNA methylation of the associated genes. Our findings thus suggest that exposure to GWI-related agents may converge on similar targets with roles in inflammation, neurotransmitter and lipid metabolism, and detoxification which may have impacts on neurodegenerative-like disease and oxidative stress in Veterans with GWI.

Factor analysis of the virtual reality Stroop task.

INTRODUCTION: Virtual reality (VR) offers neuropsychologists high dimensional (3D) platforms for administering cognitive tasks that balance experimental control with simulations of naturalistic activities. A virtual reality version of the Stroop task, the Virtual Reality Stroop Task (VRST), was developed that leverages technological advances to enhance the ecological validity of neuropsychological assessments. The high mobility multipurpose wheeled vehicle (HMMWV) version of the VRST includes high arousal (ambush) and low arousal (safe) zones was employed in this study. This version of the VRST contains both cognitive (Stroop) and affective (arousal) components. While the VRST has been shown to have good construct validity, the factor structure has yet to be explored. This study aimed to examine the factor structure of the VRST and compare the results with a lower dimensional (2D) computer-automated Stroop task (i.e., the Automated Neuropsychological Assessment Metrics - ANAM). METHOD: Data was drawn from college-aged students who completed the VRST and ANAM Stroop tasks (N = 115). Factor analyses utilized principal axis factoring (PAF), and output variables included percent of correct responses and response times the VRST and ANAM Stroop tasks. RESULTS: Results indicated that both Stroop tasks had two-factor solutions. Factor one measured response times and factor two measured accuracy. While factors respective of speed and accuracy factors were correlated across assessment modalities, within assessment factor correlations were low. CONCLUSIONS: The factors possibly indicated participants response styles in that they either focus on responding accurately or responding quickly to stimuli. Therefore, including throughput in future research examining either the ANAM Stroop task or VRST may provide useful insight into participant performance. Finally, because similar factor structures were observed for both the VRST and ANAM Stroop task this study provided additional support for the construct validity of a higher dimensional Stroop task, the VRST.