Companion: A Pilot Randomized Clinical Trial to Test an Integrated Two-Way Communication and Near-Real-Time Sensing System for Detecting and Modifying Daily Inactivity among Adults >60 Years-Design and Protocol.

Supervised personal training is most effective in improving the health effects of exercise in older adults. Yet, low frequency (60 min, 1-3 sessions/week) of trainer contact limits influence on behavior change outside sessions. Strategies to extend the effect of trainer contact outside of supervision and that integrate meaningful and intelligent two-way communication to provide complex and interactive problem solving may motivate older adults to "move more and sit less" and sustain positive behaviors to further improve health. This paper describes the experimental protocol of a 16-week pilot RCT (N = 46) that tests the impact of supplementing supervised exercise (i.e., control) with a technology-based behavior-aware text-based virtual "Companion" that integrates a human-in-the-loop approach with wirelessly transmitted sensor-based activity measurement to deliver behavior change strategies using socially engaging, contextually salient, and tailored text message conversations in near-real-time. Primary outcomes are total-daily and patterns of habitual physical behaviors after 16 and 24 weeks. Exploratory analyses aim to understand Companion's longitudinal behavior effects, its user engagement and relationship to behavior, and changes in cardiometabolic and cognitive outcomes. Our findings may allow the development of a more scalable hybrid AI Companion to impact the ever-growing public health epidemic of sedentariness contributing to poor health outcomes, reduced quality of life, and early death.

Influence of Opioid Prescription Policy on Overdoses and Related Adverse Effects in a Primary Care Population.

BACKGROUND: In response to the opioid epidemic, many states have enacted policies limiting opioid prescriptions. There is a paucity of evidence of the impact of opioid prescribing interventions in primary care populations, including whether unintended consequences arise from limiting the availability of prescribed opioids. OBJECTIVE: Our aim was to compare changes in opioid overdose and related adverse effects rate among primary care patients following the implementation of state-level prescribing policies. DESIGN: A cohort of primary care patients within an interrupted time series model. PARTICIPANTS: Electronic medical record data for 62,776 adult (18+ years) primary care patients from a major medical center in Vermont from January 1, 2016, to June 30, 2018. INTERVENTIONS: State-level opioid prescription policy changes limiting dose and duration. MAIN MEASURES: Changes in (1) opioid overdose rate and (2) opioid-related adverse effects rate per 100,000 person-months following the July 1, 2017, prescription policy change. KEY RESULTS: Among primary care patients, there was no change in opioid overdose rate following implementation of the prescribing policy (incidence rate ratio; IRR: 0.64, 95% confidence interval; CI: 0.22-1.88). There was a 78% decrease in the opioid-related adverse effects rate following the prescribing policy (IRR: 0.22, 95%CI: 0.09-0.51). This association was moderated by opioid prescription history, with decreases observed among opioid-naïve patients (IRR: 0.18, 95%CI: 0.06-0.59) and among patients receiving chronic opioid prescriptions (IRR: 0.17, 95%CI: 0.03-0.99), but not among those with intermittent opioid prescriptions (IRR: 0.51, 95%CI: 0.09-2.82). CONCLUSIONS: Limiting prescription opioids did not change the opioid overdose rate among primary care patients, but it reduced the rate of opioid-related adverse effects in the year following the state-level policy change, particularly among patients with chronic opioid prescription history and opioid-naïve patients. Limiting the quantity and duration of opioid prescriptions may have beneficial effects among primary care patients.

Push and pushback: Control behavior as a precipitant of verbal and violent disputes.

We examine to what extent control behavior precipitates disputes involving adversaries in different social relationships. We hypothesize that disputes between intimate partners and illegal business partners are more likely than other disputes to involve control because they involve a higher level of interdependence between the participants. A sample of male inmates (n = 479) and nonoffenders (n = 206) were asked whether control behaviors (e.g., verbal commands) precipitated their most recent disputes (n = 1184). Bivariate probit regression models allowed us to examine mutual control as well as unilateral control. Disputes between intimate partners were more likely than disputes between adversaries in other relationships to be precipitated by mutual control, but not unilateral or one-sided control by men. Disputes between illegal business partners also predicted mutual control, but not unilateral control. Discussions of the motives for violence would benefit from consideration of the classic social psychological literature on power and influence.

The interpersonal context of depression and violent behavior: A social psychological interpretation.

Depression is a particularly prevalent form of psychopathology affecting millions of individuals worldwide. It is associated with a variety of adverse social and behavioral outcomes. Numerous observational studies have found that depressed individuals have significantly elevated rates of interpersonal violence. As of now, the social mechanisms that explain the association between depression and violence remain understudied and not well understood. Drawing on the aggression and social psychology literatures, we argue that depressed actors suffer skills deficits and exhibit hostile communication styles that provoke grievances and disputes. We suggest that, because of these interpersonal tendencies, depression increases involvement in verbal disputes, and that frequent participation in verbal disputes foments social contexts where interpersonal violence is more common. Findings from a series of regression models based on a nationally representative sample of 2171 respondents offer support for our assumptions. The study suggests a consideration of interpersonal dynamics, particularly verbal disputes, might unlock clues about the association between depression and violence involvement.

Perpetrator characteristics and firearm use in pediatric homicides: Supplementary Homicide Reports - United States, 1976 to 2020.

BACKGROUND: Describe trends in perpetrator characteristics and firearm use in pediatric homicides across the United States. METHODS: Multiply-imputed data from the Federal Bureau of Investigation's 1976-2020 Supplementary Homicide Reports were used to estimate perpetrator characteristics (sex, age, and relationship to victim) and firearm use in pediatric homicides. Descriptive analyses were stratified by victim age group, sex, race, and five-year time periods. RESULTS: Family members were the most common perpetrator of infant and toddler (ages 0-4) and child (ages 5-12) homicides, whereas acquaintances accounted for the majority of adolescent (ages 13-19) homicides. Perpetrator characteristics vary across victim sex and race, particularly among adolescents. Despite overall stability, there were changes in perpetrator characteristics from 1976 to 2020. There was a sustained increase in the proportion of homicides committed with a firearm. In 2016-2020, the proportion of firearm-involved homicides was an all-time high for infant and toddler (14.8%), child (53.1%), and adolescent victims (88.5%). CONCLUSIONS: Policy interventions that improve family stability and well-being may be most effective at preventing infant, toddler, and child homicides, whereas programs that target peer and community relationships, as well as policies that focus on firearm access, may be more crucial for preventing adolescent homicides.

Adolescent Mental Health and Resilience Before and During the COVID-19 Pandemic.

PURPOSE: We aimed to assess levels of depression, anxiety, and resilience factors before and during the COVID-19 pandemic in a school sample of adolescents. We also aimed to examine the compensatory and protective effects of individual, family, and school resilience factors on adolescent mental health. METHODS: We used fall 2019 and fall 2020 survey responses from a cluster randomized controlled trial implemented in 20 schools in a Midwestern county. The sample consisted of 3,085 responses from students in grades 5 and 6. Multilevel mixed-effects models with cluster robust standard errors were used to investigate the associations between exposure to the COVID-19 pandemic, mental health (anxiety, depression), and resilience factors (future orientation, family engagement, and having a caring school adult). RESULTS: Anxiety, but not depression, was higher in fall 2020 compared to fall 2019. Family engagement increased during the pandemic, while future orientation of the student body was lower during that time and the prevalence of having a caring adult at school was unchanged. A positive future orientation was associated with lower levels of anxiety and depression, while having a caring school adult was associated with lower depression. Adolescents with less positive future orientations, low family engagement, and no caring school adults experienced the greatest increases in anxiety. DISCUSSION: Positive future orientations, family engagement, and supportive nonparental adult relationships had compensatory and protective effects on adolescent mental health during the COVID-19 pandemic. Adding these measures to the inventory of modifiable resilience factors during natural disasters may promote healthy adaptation among adolescents.

KovaaK's aim trainer as a reliable metrics platform for assessing shooting proficiency in esports players: a pilot study.

Esports research lacks game-based metrics platforms appropriate for adequately capturing esports performance. The aim of this pilot study was to assess the reliability of the KovaaK's first-person shooter (FPS) aim trainer as a metrics platform for assessing shooting proficiency in esports players. Ten FPS esports players completed two identical experimental trials (T) separated by three to five days. Each trial included four rounds (R) of testing, evaluating four shooting tasks: Micro Flicking, Macro Flicking, Strafe Tracking, and Wall Peeking. Reliability of performance outcomes (e.g., accuracy, headshot accuracy, hits per second, and total shots hit) were assessed using the intraclass correlation coefficient (ICC) and their 95% confidence intervals (CI), and significant differences were identified using repeated-measures analysis of variance (RM-ANOVA). Results indicated excellent, or good to excellent reliability for all outcome variables with the ICC estimates ranging between 0.947-0.995, with lower and upper bound 95% CIs ranging between 0.876-0.988, and 0.984-0.999, respectively. Significant improvements were seen between experimental trials in the Macro Flicking task for accuracy (p = .005) and hits per second (p = .009) only. Significant interactions between trial and round were identified in the Micro Flicking task for accuracy (p = .006), with post hoc analysis showing accuracy was significantly higher in T1R1 compared to T2R1 (87.74 ± 3.13 vs. 85.99 ± 3.05, respectively, p = .02), and in T2R4 compared to T2R2 (87.99 ± 2.89 vs. 84.70 ± 4.25, respectively, p = .049). Significant interactions were also identified in the Strafe Tracking task for headshot accuracy (p = .002), with post hoc analysis showing headshot accuracy was significantly higher in T1R2 compared to T2R2 (78.48 ± 8.15 vs. 76.79 ± 12.16, respectively, p = .003), and in T1R2 compared to T1R1 (78.48 ± 8.15 vs. 73.68 ± 17.94, respectively, p = .023). In summary, this study demonstrates that KovaaK's provides a reliable metrics platform for assessing shooting proficiency in esports, however, some variability in performance was observed.

Caffeine improves the shooting performance and reaction time of first-person shooter esports players: a dose-response study.

Caffeine is recognized as one of the most effective dietary ergogenic aids in sports, yet its evidence-based effectiveness in esports is unclear. This study investigated the effects of two different doses of caffeine on the shooting performance and reaction time of 24 first-person shooter (FPS) esports players (22 men, 2 women; age = 22.29 ± 2.91 years). Participants completed three experimental trials in which they consumed either a water control (CON), a 1 mg·kg-1 BM (CAF1) or a 3 mg·kg-1 BM (CAF3) dose of caffeine. Performance measures (e.g., score, accuracy (%), hit rate (hits/sec), and shots fired) were assessed in a static clicking and reactive tracking style task on the KovaaK's FPS aim trainer. Reaction time was used to assess vigilance on the psychomotor vigilance test (PVT). Performance was measured at four time points in each trial: pre-treatment (PRE), 60 min (POST1), 80 min (POST2), and 100 min (POST3) post-treatment. Significant differences were identified using repeated-measures analysis of variances. Caffeine, irrespective of dose, significantly improved performance compared to CON for static clicking score and hit rate, reactive tracking accuracy, and reaction time on the PVT. Significant interactions between treatment and time were identified and post hoc analyses showed that compared to CON, CAF1 significantly improved static clicking score at POST1 and POST3, static clicking hit rate at POST1, reactive tracking accuracy at POST1, POST2, and POST3, and reaction time on the PVT at POST1 and POST2. Post hoc analysis also showed that compared to CON, CAF3 significantly improved static clicking score, reactive tracking accuracy, and reaction time on the PVT at all time points, in addition to static clicking hit rate at POST1 and POST3. In summary, caffeine supplementation enhances the shooting performance and reaction time of FPS esports players.

Sex-Specific Roles of Hypocretin Receptor Signaling in CRF Neurons on Alcohol Drinking, Anxiety, and BNST Neuronal Excitability.

Alcohol use disorder (AUD) is characterized by compulsive alcohol consumption and negative emotional states during withdrawal, often perpetuating a cycle of addiction through arousal dysfunction. The hypocretin/orexin (Hcrt) neuropeptide system, a key regulator of arousal, has been implicated in these processes, particularly in its interactions with corticotropin-releasing factor (CRF) neurons within the bed nucleus of the stria terminalis (BNST). We investigated the role of Hcrt receptor signaling in CRF neurons in modulating alcohol intake, anxiety behaviors, and BNST excitability, with a focus on sex-specific differences. Using CRF-specific genetic deletion of HcrtR1 and/or HcrtR2 receptors in mice, we found that deletion of HcrtR1 significantly reduced alcohol intake, with sex-specific effects on BNST excitability. CRF-specific HcrtR2 deletion, while not affecting alcohol consumption, decreased baseline anxiety-like behaviors in males relative to females. Moreover, the double deletion of both Hcrt receptors from CRF neurons led to reduced alcohol drinking in males and dampened anxiety behaviors and BNST excitability in both sexes during protracted withdrawal. These findings suggest that Hcrt signaling in CRF neurons plays a critical role in the persistence of excessive alcohol consumption and the development of negative affective states, with distinct contributions from HcrtR1 and HcrtR2. The observed sex-specific differences underscore the need for tailored therapeutic approaches targeting the Hcrt system in the treatment of AUD.

The Disproportionate Mental Health Burden Among Incarcerated Transgender and Gender Diverse People.

This article examines the distribution of self-reported mental health conditions and clinical contact among incarcerated transgender and gender diverse (TGD) individuals compared to cisgender women and men. Data are derived from the 2016 Survey of Prison Inmates. Results indicate that TGD respondents report more mental health symptoms, conditions, and clinical contact than their cisgender counterparts. The findings have important implications for the mental health disadvantages experienced by TGD people currently in prison.

Incarceration exposure and epigenetic aging in neighborhood context.

OBJECTIVE: Research has implicated incarceration exposure as a social determinant of health, with recent work suggesting incarceration may trigger a stress response that accelerates physiological deterioration. The objective of the current study is to assess whether neighborhood stressors intensify the health consequences of incarceration exposure. METHODS: We test whether two neighborhood context measures - socioeconomic disadvantage and perceived crime - moderate the association between incarceration exposure and a measure of accelerated epigenetic aging based on the GrimAge index. Our sample included 408 African American young adults from the Family and Community Health study. RESULTS: Results from regression analyses with inverse probability of treatment weights suggest that incarceration exposure and neighborhood disadvantage are independently associated with accelerated biological aging. The results also show that the impact of incarceration exposure on accelerated aging is amplified for individuals in neighborhoods with higher levels of perceived crime. CONCLUSIONS: These findings indicate that the neighborhood contexts where formerly incarcerated individuals return have a substantial impact on their pace of biological aging. Policies aimed at reducing ambient stressors after release may promote healthy aging among formerly incarcerated African American adults.

Losing Years Doing Time: Incarceration Exposure and Accelerated Biological Aging among African American Adults.

Research suggests that incarceration exposure increases the prevalence of morbidity and premature mortality. This work is only beginning to examine whether the stressors of the incarceration experience become biologically embedded in ways that affect physiological deterioration. Using data from a longitudinal sample of 410 African American adults in the Family and Community Health Study and an epigenetic index of aging, this study tests the extent to which incarceration accelerates epigenetic aging and whether experiences with violence moderate this association. Results from models that adjust for selection effects suggest that incarceration exposure predicted accelerated aging, leaving formerly incarcerated African American individuals biologically older than their calendar age. Direct experiences with violence also exacerbated the effects of incarceration. These findings suggest that incarceration possibly triggers a stress response that affects a biological signature of physiological deterioration.

Tattoos do not affect exercise-induced localised sweat rate or sodium concentration.

OBJECTIVES: Skin tattoos have been shown to reduce localised sweat rate and increase sweat sodium concentration ([Na+]) when sweating is artificially stimulated. This study investigated whether similar responses are observed with exercise-induced sweating. DESIGN: Unblinded, within-participant control, single trial. METHODS: Twenty-two healthy individuals (25.1±4.8 y (Mean±SD), 14 males) with a unilateral tattoo ≥11.4cm2 in size, ≥2 months in age, and shaded ≥50% participated in this investigation. Participants undertook 20min of intermittent cycling (4×5min intervals) on a stationary ergometer in a controlled environment (24.6±1.1°C; 64±6% RH). Resultant sweat was collected into absorbent patches applied at two pairs of contralateral skin sites (pair 1: Tattoo vs. Non-Tattoo; pair 2: Control 1 vs. Control 2 (both non-tattooed)), for determination of sweat rate and sweat [Na+]. Paired samples t-tests were used to determine differences between contralateral sites. RESULTS: Tattoo vs. Non-Tattoo: Neither sweat rate (Mean±SD: 0.92±0.37 vs. 0.94±0.43mg·cm-2·min-1, respectively; p=0.693) nor sweat [Na+] (Median(IQR): 37(32-52) vs. 37(31-45) mM·L-1, respectively; p=0.827) differed. Control 1 vs. Control 2: Neither sweat rate (Mean±SD: 1.19±0.53 vs. 1.19±0.53mg·cm-2·min-1, respectively; p=0.917) nor sweat [Na+] (Median(IQR): 29(26-41) vs. 31(25-43)mM·L-1, respectively; p=0.147) differed. The non-significant differences for sweat rate and [Na+] between Tattoo vs. Non-Tattoo were inside the range of the within participant variability (sweat rate CVi=5.4%; sweat [Na+] CVi=4.4%). CONCLUSIONS: Skin tattoos do not appear to alter the rate or [Na+] of exercise-induced sweating. The influence of skin tattoos on localised sweat responses may have previously been over-estimated.

Single-center analysis of living donor nephrectomy: hand-assisted laparoscopic, pure laparoscopic, and traditional open.

CONTEXT: Laparoscopic living donor nephrectomy has been shown to be a safe method for removing kidneys for transplantation, but concerns have been raised regarding safety and long-term kidney function. OBJECTIVE: To compare safety and long-term kidney function in hand-assisted laparoscopic, pure laparoscopic, and traditional open living donor nephrectomy. METHOD: The charts of 48 patients with more than 1 year follow-up were reviewed. Thirty-four consecutive patients underwent laparoscopic live donor nephrectomy, and 14 had open donor nephrectomy. All kidneys functioned immediately at transplantation. In the laparoscopic group, 11 had the pure laparoscopic technique, and 23 patients had hand-assisted laparoscopic nephrectomy. RESULTS: Total operative and warm ischemic times were reduced with the hand-assisted technique when compared with pure laparoscopy. Operative and warm ischemic times were similar in open nephrectomy and hand-assisted laparoscopy. Long-term follow-up of serum creatinine levels revealed no significant differences between the 3 groups. Complication rates in the 3 groups were similar. CONCLUSION: Laparoscopic donor nephrectomy appears to be comparable to open donor nephrectomy in terms of safety and long-term graft function.