Unraveling the interplay between math anxiety and math achievement.

A robust association exists between math anxiety and math achievement, with higher levels of anxiety correlating with lower achievement. Understanding this relationship is crucial due to the importance of math proficiency at individual and societal levels. In this review, we explore two prominent theories: Reduced Competency Theory, which suggests that initial low math achievement leads to math anxiety, and Processing Efficiency Theory, which suggests that math anxiety impairs performance by diverting cognitive resources. While these theories are supported by empirical evidence, they do not fully explain the mediators linking math anxiety and achievement. We propose 'math avoidance' as a critical mediator, suggesting that avoidance behaviors, formed through conditioning, create a feedback loop that exacerbates math anxiety and reduces proficiency.

Concurrent Targeting of HDAC and PI3K to Overcome Phenotypic Heterogeneity of Castration-resistant and Neuroendocrine Prostate Cancers.

Castration-resistant prostate cancer (CRPC) consists of multiple phenotypic subtypes including androgen receptor (AR)-active prostate cancer (ARPC) and neuroendocrine prostate cancer (NEPC). Tumor cells with these phenotypes can coexist between metastases within a patient and within an individual tumor. Treatments that are effective across CRPC subtypes are currently lacking. Histone deacetylation is crucial for the regulation of chromatin structure and maintenance of cancer cell state and activation of the PI3K/AKT/mTOR signaling cascade is a tumor growth-promoting pathway. We therefore investigated combined targeting of histone deacetylase (HDAC) and PI3K using a rationally designed dual inhibitor, fimepinostat, in CRPC subtypes in vitro and in vivo. Dual HDAC1/2 and PI3K/AKT pathway inhibition by fimepinostat led to robust tumor growth inhibition in both ARPC and NEPC models including cell line- and patient-derived xenografts. HDAC1/2 inhibition combined with PI3K/AKT inhibition was more effective than targeting each pathway alone, producing growth inhibitory effects through cell-cycle inhibition and apoptosis. Molecular profiling revealed on-target effects of combined HDAC1/2 and PI3K/AKT inhibition independent of tumor phenotype. Fimepinostat therapy was also associated with the suppression of lineage transcription factors including AR in ARPC and Achaete-scute homolog 1 (ASCL1) in NEPC. Together, these results indicate that fimepinostat represents a novel therapeutic that may be effective against both ARPC and NEPC through CRPC subtype-dependent and -independent mechanisms. SIGNIFICANCE: CRPC is a heterogeneous disease constituting multiple phenotypic subtypes that often co-occur within tumors or across metastases in patients. Existing targeted therapies for CRPC do not take this into account. Here we show that fimepinostat, a dual HDAC1/2 and PI3K/AKT inhibitor investigated clinically in other cancer types but not prostate cancer, may overcome this heterogeneity by effectively inhibiting both ARPC and NEPC subtypes of CRPC.

Effects of school-level and area-level socio-economic factors on elementary school student COVID-19 infections: a population-based observational study.

OBJECTIVES: To estimate the variability of the cumulative incidence of SARS-CoV-2 infections among elementary school students attributable to individual schools and/or their geographic areas, and to ascertain whether socio-economic characteristics of school populations and/or geographic areas may be predictive of this variability. DESIGN: Population-based observational study of SARS-CoV-2 infections among elementary school children. SETTING: 3994 publicly funded elementary schools in 491 forward sortation areas (designated geographic unit based on first three characters of Canadian postal code), Ontario, Canada, September 2020 to April 2021. PARTICIPANTS: All students attending publicly funded elementary schools with a positive molecular test for SARS-CoV-2 reported by the Ontario Ministry of Education. MAIN OUTCOME MEASURES: Cumulative incidence of laboratory-confirmed elementary school student SARS-CoV-2 infections in Ontario, 2020-21 school year. RESULTS: A multilevel modelling approach was used to estimate the effects of socio-economic factors at the school and area levels on the cumulative incidence of elementary school student SARS-CoV-2 infections. At the school level (level 1), the proportion of the student body from low-income households was positively associated with cumulative incidence (ß=0.083, p<0.001). At the area level (level 2), all dimensions of marginalisation were significantly related to cumulative incidence. Ethnic concentration (ß=0.454, p<0.001), residential instability (ß=0.356, p<0.001) and material deprivation (ß=0.212, p<0.001) were positively related, while dependency (ß=-0.204, p<0.001) was negatively related. Area-related marginalisation variables explained 57.6% of area variability in cumulative incidence. School-related variables explained 1.2% of school variability in cumulative incidence. CONCLUSIONS: The socio-economic characteristics of the geographic area of schools were more important in accounting for the cumulative incidence of SARS-CoV-2 elementary school student infections than individual school characteristics. Schools in marginalised areas should be prioritised for infection prevention measures and education continuity and recovery plans.

Scene-dependent, feedforward eye gaze metrics can differentiate technical skill levels of trainees in laparoscopic surgery.

INTRODUCTION: In laparoscopic surgery, looking in the target areas is an indicator of proficiency. However, gaze behaviors revealing feedforward control (i.e., looking ahead) and their importance have been under-investigated in surgery. This study aims to establish the sensitivity and relative importance of different scene-dependent gaze and motion metrics for estimating trainee proficiency levels in surgical skills. METHODS: Medical students performed the Fundamentals of Laparoscopic Surgery peg transfer task while recording their gaze on the monitor and tool activities inside the trainer box. Using computer vision and fixation algorithms, five scene-dependent gaze metrics and one tool speed metric were computed for 499 practice trials. Cluster analysis on the six metrics was used to group the trials into different clusters/proficiency levels, and ANOVAs were conducted to test differences between proficiency levels. A Random Forest model was trained to study metric importance at predicting proficiency levels. RESULTS: Three clusters were identified, corresponding to three proficiency levels. The correspondence between the clusters and proficiency levels was confirmed by differences between completion times (F2,488 = 38.94, p < .001). Further, ANOVAs revealed significant differences between the three levels for all six metrics. The Random Forest model predicted proficiency level with 99% out-of-bag accuracy and revealed that scene-dependent gaze metrics reflecting feedforward behaviors were more important for prediction than the ones reflecting feedback behaviors. CONCLUSION: Scene-dependent gaze metrics revealed skill levels of trainees more precisely than between experts and novices as suggested in the literature. Further, feedforward gaze metrics appeared to be more important than feedback ones at predicting proficiency.

Modeling of older adults' driving exposure and avoidance using objective driving data in a naturalistic driving study.

Older adults in the United States rely heavily on driving their own vehicles to commute to work, shop for groceries, and access public services. To effectively help older adults maintain mobility and independence,we need to better understand how thecognitive, visual functioning, and health declines influence their tendency to self-restrict their driving. The objective of this study is to develop a causal model to examine the effects of age, gender, household status (specifically living alone), physical, cognitive, visual abilities, and health status on older adults' driving mobility in terms of driving exposure and avoidance. Driving exposure was measured by actual driving data, whereas driving avoidance was assessed by both self-report data and actual driving exposure to challenging situations. Structural equation modeling was used to analyze data collectedin the Second Strategic Highway Research Program Naturalistic Driving Study for establishing relationships between the selected factors and mobility. The structural equation model included a total of794 participants aged 65 and over (367 or 46.22%femalesand 427 or 53.78% males). Results indicate that poorer health is associated with less driving exposure; deteriorating cognitive and physical capabilities are associated with more self-reported driving avoidance and less actual driving in challenging situations; visual function is associated with self-reported avoidance; living alone is associated with higher driving exposure in general as well as in challenging situations; self-reported driving avoidance of challenging situations has a negative association with actual driving in those same situations. The final model could be applied to predict older adults' mobility changes according to their age, gender, household status, as well as their visual, physical, cognitive and health status.

Numeracy and COVID-19: examining interrelationships between numeracy, health numeracy and behaviour.

During the COVID-19 pandemic, people across the globe have been exposed to large amounts of statistical data. Previous studies have shown that individuals' mathematical understanding of health-related information affects their attitudes and behaviours. Here, we investigate the relation between (i) basic numeracy, (ii) COVID-19 health numeracy, and (iii) COVID-19 health-related attitudes and behaviours. An online survey measuring these three variables was distributed in Canada, the United States (US) and the United Kingdom (UK) (n = 2032). In line with predictions, basic numeracy was positively related to COVID-19 health numeracy. However, predictions, neither basic numeracy nor COVID-19 health numeracy was related to COVID-19 health-related attitudes and behaviours (e.g. follow experts' recommendations on social distancing, wearing masks etc.). Multi-group analysis was used to investigate mean differences and differences in the strength of the correlation across countries. Results indicate there were no between-country differences in the correlations between the main constructs but there were between-country differences in latent means. Overall, results suggest that while basic numeracy is related to one's understanding of data about COVID-19, better numeracy alone is not enough to influence a population's health-related attitudes about disease severity and to increase the likelihood of following public health advice.

Disentangling the individual and contextual effects of math anxiety: A global perspective.

Math anxiety is a common affective disorder in students that is characterized by intrusive thoughts that disrupt critical cognitive resources required for math problem-solving. Consistent associations between math anxiety and math achievement have been observed across countries and age groups, placing math anxiety among other important correlates of math achievement, such as socioeconomic status and magnitude representation ability. However, studies examining math anxiety's relation to achievement have largely focused on the effect of students' own math anxiety (individual effect), while little is known regarding the effect of math anxiety in students' educational context (contextual effect). Using three international studies of achievement (n = 1,175,515), we estimated both the individual and contextual effects of math anxiety across the globe. Results suggest that while there are consistent individual effects in virtually all countries examined, the contextual effects are varied, with only approximately half of the countries exhibiting a contextual effect. Additionally, we reveal that teacher confidence in teaching math is associated with a reduction of the individual effect, and country's level of uncertainty avoidance is related to a lessening of the contextual effect. Finally, we uncovered multiple predictors of math anxiety; notably, student perception of teacher competence was negative related with math anxiety, and parental homework involvement was positively related with math anxiety. Taken together, these results suggest that there are significant between-country differences in how math anxiety may be related with math achievement and suggest that education and cultural contexts as important considerations in understanding math anxiety's effects on achievement.

Attending Surgeons Demonstrate Greater Correlations of Skill Assessment and Anticipation of Adverse Events Than Residents During Laparoscopic Cholecystectomy.

BACKGROUND: Surgical training includes the development of technical and nontechnical skills. While technical skills are more easily quantified, nontechnical skills such as situation awareness (SA) are more difficult to measure and quantify. This study investigated the relationships between different SA elements and expertise. METHODS: Twenty attending and resident surgeons rated their anticipation of an impending adverse event while watching 20 videos of laparoscopic cholecystectomies with and without adverse events. After watching each video, they assessed surgeon skills and self-assessed their anticipation ratings. All participants answered a general confidence questionnaire before and after the study. RESULTS: Videos with adverse events led to significantly higher anticipation of adverse events (P < 0.001), lower surgeon skill rating (P < 0.001), and higher self-assessment in their anticipation ratings (P < 0.001) across both participant groups. General confidence was significantly lower for residents than that for attending surgeons (P < 0.001). Compared with the residents, attendings exhibited stronger and more stable correlations between measurements of SA. When viewing videos with adverse events, attendings showed significantly higher correlation between anticipation of an impending adverse event and skill assessment of the surgeon (P = 0.005). CONCLUSIONS: This study investigated how different elements of SA and their relationships were influenced by experience. The results indicated that attendings had stronger and more stable correlations between SA elements than residents, demonstrating how measurement correlations could be meaningful and sensitive indicators of expertise and autonomy readiness.

Kindergarteners' symbolic number abilities predict nonsymbolic number abilities and math achievement in grade 1.

Research has shown that two different, though related, ways of representing magnitude play foundational roles in the development of numerical and mathematical skills: a nonverbal approximate number system and an exact symbolic number system. While there have been numerous studies suggesting that the two systems are important predictors of math achievement, there has been substantial debate regarding whether and how these basic numerical competencies may be developmentally interrelated. Specifically, the causal direction of their relation has been the subject of debate: whether children's approximate number abilities predict later symbolic number abilities (the mapping account) or the other way around (the refinement account). Our sample included 622 kindergarten children (mean age = 62 months, SD = 3.5, 279 females, 75 born outside Canada), whose dot comparison, number comparison, and mixed comparison skills were assessed over three time-points and math achievement assessed over four time-points. We contrasted multiple theoretical predictions of the interrelations between the variables of interest posited by these two developmental accounts using longitudinal random intercept cross-lagged models. Results were most consistent with the refinement account, suggesting that earlier symbolic number ability is consistently the strongest predictor of approximate number ability, mixed-comparison ability, and arithmetic skills. Notably, our results demonstrated that, when individual models are examined in isolation, model fit was adequate or near adequate for all models tested. This highlights the need for future research to contrast competing accounts, as our results suggest the examination of any one account in isolation may not reveal the best fitting developmental model. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining Senior Drivers' Attitudes Toward Advanced Driver Assistance Systems After Naturalistic Exposure.

BACKGROUND AND OBJECTIVES: The increasing number of senior drivers may introduce new road risks due to age-related declines in physical and cognitive abilities. Advanced driver assistance systems (ADAS) have been proposed as solutions to minimize age-related declines, thereby increasing both senior safety and mobility. This study examined factors that influence seniors' attitudes toward adopting ADAS after significant exposure to the technology in naturalistic settings. RESEARCH DESIGN AND METHODS: This study recruited 18 senior drivers aged 70-79 to drive vehicles equipped with ADAS for 6 weeks in their own environments. Afterward, each participant was enrolled in 1 of the 3 focus group sessions to discuss their changes in attitude toward ADAS based on their driving experiences. We applied structural topic modeling (STM) on the focus group transcripts to reveal key topics deemed important to seniors. RESULTS: STM revealed 5 topics of importance for seniors. In order of prevalence, these were (i) safety, (ii) confidence concerning ADAS, (iii) ADAS functionality, (iv) user interface/usability, and (v) non-ADAS-related features. Based on topics and associated keywords, seniors perceived safety improvement with ADAS but expressed concerns about its limitations in coping with adverse driving conditions. Experience and training were suggested for improving seniors' confidence in ADAS. Blind spot alert and adaptive cruise control received the most discussion regarding perceived safety and comfort. DISCUSSION AND IMPLICATIONS: This study indicated that promoting road safety for senior drivers through ADAS is feasible. Acceptance and appropriate use of ADAS may be supported through intuitive and senior-friendly user interfaces, in-depth training programs, and owner's manuals specifically designed and tested for senior drivers.

Targeting RET Kinase in Neuroendocrine Prostate Cancer.

The increased treatment of metastatic castration-resistant prostate cancer (mCRPC) with second-generation antiandrogen therapies (ADT) has coincided with a greater incidence of lethal, aggressive variant prostate cancer (AVPC) tumors that have lost dependence on androgen receptor (AR) signaling. These AR-independent tumors may also transdifferentiate to express neuroendocrine lineage markers and are termed neuroendocrine prostate cancer (NEPC). Recent evidence suggests kinase signaling may be an important driver of NEPC. To identify targetable kinases in NEPC, we performed global phosphoproteomics comparing several AR-independent to AR-dependent prostate cancer cell lines and identified multiple altered signaling pathways, including enrichment of RET kinase activity in the AR-independent cell lines. Clinical NEPC patient samples and NEPC patient-derived xenografts displayed upregulated RET transcript and RET pathway activity. Genetic knockdown or pharmacologic inhibition of RET kinase in multiple mouse and human models of NEPC dramatically reduced tumor growth and decreased cell viability. Our results suggest that targeting RET in NEPC tumors with high RET expression could be an effective treatment option. Currently, there are limited treatment options for patients with aggressive neuroendocrine prostate cancer and none are curative. IMPLICATIONS: Identification of aberrantly expressed RET kinase as a driver of tumor growth in multiple models of NEPC provides a significant rationale for testing the clinical application of RET inhibitors in patients with AVPC.

Distributed situation awareness: a health-system approach to assessing and designing patient flow management.

Patient flow management is a system-wide process but many healthcare providers do not integrate multiple departments into the process to minimise the time between treatments or medical services for maximum patient throughput. This paper presents a case study of applying Distributed Situation Awareness (DSA) to characterise system-wide patient flow management and identify opportunities for improvements in a healthcare system. This case study employed a three-part method of data elicitation, extraction, and representation to investigate DSA. Social, task, and knowledge networks were developed and then combined to characterise patient flow management and identify deficiencies of the command and control centre of a healthcare facility. Social network analysis provided centrality metrics to further characterise patient flow management. The DSA model helped identify design principles and deficiencies in managing patient flow. These findings indicate that DSA is promising for analysing patient flow management from a system-wide perspective. Practitioner summary: This article examines Distribution Situation Awareness (DSA) as an analysis framework to study system-wide patient flow management. The DSA yields social, task, and knowledge networks that can be combined to characterise patient flow and identify deficiencies in the system. DSA appears promising for analysing communication and coordination of complex systems. Abbreviations: CDM: critical decision method; CTaC: carilion transfer and communications center; EAST: event analysis systematic teamwork; ED: emergency department; DES: discrete event simulation; DSA: distributed situation awareness; SA: situation awareness; SNA: social network analysis.

Detecting cognitive hacking in visual inspection with physiological measurements.

Cyber threats are targeting vulnerabilities of human workers performing tasks in manufacturing processes, including visual inspection to bias their decision-making, thereby sabotaging product quality. This article examines the use of priming as a form of "cognitive hacking" to adversely affect quality inspection decisions in manufacturing, and investigates physiological measurements as means to detect such intrusion. In a within-subject design experiment, twenty participants inspected surface roughness of a manufactured component with and without exposure to priming on the display of an inspection logging system. The results show that the presence of primes impacted accuracy on surface roughness, cortical activities at parietal lobe P4, and eye gaze for inspecting components. The experiment provides supporting evidence that basic hacking of a worker display can be an effective method to alter decision making in inspection. The findings also illustrate that cortical activities and eye gaze can be useful indicators of cognitive hacking. A major implication of the study results is that physiological indicators can be effective at revealing unconscious cognitive influence in visual inspection.

Correction: Survival of infants ≤24 months of age with brain tumors: A population-based study using the SEER database.

[This corrects the article DOI: 10.1371/journal.pone.0223051.].

Survival of infants ≤24 months of age with brain tumors: A population-based study using the SEER database.

INTRODUCTION: Brain tumors are the most common solid malignancy and leading cause of cancer-related deaths in infants. Current epidemiological data is limited by low numbers of reported cases. This study used a population-based approach with analysis of contemporary and historical survival curves to provide up-to-date prognostication. METHODS: Observational cohort analysis was performed using the Surveillance, Epidemiology and End Results (SEER) database. Infants with brain tumors diagnosed from 1973 to 2013 were categorized by the most common tumor types (diffuse astrocytic and oligodendroglioma, choroid plexus, embryonal, ependymal, medulloblastoma and pilocytic astrocytoma). The 1, 5 and 10 year survival was stratified by decade, with trends in management and outcomes analyzed. RESULTS: We identified 2996 affected infants satisfying inclusion criteria. All tumor types, except embryonal and choroid plexus, demonstrated improving survival with time. Infants with embryonal tumors showed a decline in survival from the 1970s to 1990s (p = 0.009), whereas infants with choroid plexus tumors had no change in survival. Infants with ependymal tumors experienced the greatest improvement in survival from 1980s to 1990s and 1990s to 2000s (p = 0.0001, p = 0.01), with 5-year survival probability improving from 28% (95% CI 15-42%) in the 1980s to 77% (95% CI 69-83%) the 2000s. The use of radiation declined from 1970 to 2000 for all tumors; however, radiation treatment for embryonal and ependymal subtypes increased after 2000. CONCLUSIONS: While overall survival for infants with brain tumors has improved from the 1970s onwards, not every tumor type has seen a statistically significant change. Given changes in management and survival, prognostication of infants with brain tumor should be updated.

Improving the Intraoperative Educational Experience: Understanding the Role of Confidence in the Resident-Attending Relationship.

OBJECTIVE: With recent changes to graduate medical education, the balance between resident autonomy and need for supervision impacts the educational and training experience of residents. The objective of this study was to understand the relationship between the confidence of attendings and residents and their different perspectives of perceived educational experience and autonomy in the operating room (OR). We hypothesized that the attending's confidence in the resident would be an important factor in improving the educational experience and resident's autonomy in the OR. DESIGN: Self-reported confidence-rating and operative experience surveys were administered to teams of post-graduate year (PGY 1) through PGY 5 surgical residents and attendings in two temporal sets (Early: Sept-Dec 2015, n = 20; Late: Jan-Apr 2016, n = 22). A second "end-of-year" survey was distributed to residents (n = 9, 37.5% response) and attendings (n = 10, 35% response) asking questions regarding their educational experience and operative experience during the past year. SETTING: Large rural teaching hospital. PARTICIPANTS: Nineteen general surgery residents (PGY 1 - 5) and 14 general surgery attendings. RESULTS: Resident perception of confidence differs from junior to senior residents, and that there was discordance between resident's confidence and skill as perceived by attendings, particularly in senior residents. Results also showed that attending's confidence in residents was positively correlated with attending's perceived educational experience in the OR. Residents and attendings both indicated attending's confidence in residents as an important factor in increasing resident autonomy in the OR, thus the attending's confidence in residents could have a positive impact on resident autonomy and educational experience in the OR. CONCLUSIONS: We have demonstrated a relationship between self-confidence for residents and improved confidence from attendings in residents' capabilities. Based on these findings, we would propose identifying methods to expand resident's awareness of surgical situations and develop attending's confidence in residents.

Eye tracking in surgical education: gaze-based dynamic area of interest can discriminate adverse events and expertise.

BACKGROUND: Eye-gaze metrics derived from areas of interest (AOIs) have been suggested to be effective for surgical skill assessment. However, prior research is mostly based on static images and simulated tasks that may not translate to complex and dynamic surgical scenes. Therefore, eye-gaze metrics must advance to account for changes in the location of important information during a surgical procedure. METHODS: We developed a dynamic AOI generation technique based on eye gaze collected from an expert viewing surgery videos. This AOI updated as the gaze of the expert moved with changes in the surgical scene. This technique was evaluated through an experiment recruiting a total of 20 attendings and residents to view 10 videos associated with and another 10 without adverse events. RESULTS: Dwell time percentage (i.e., gaze duration) inside the AOI differentiated video type (U = 13508.5, p < 0.001) between videos with the presence (Mdn = 16.75) versus absence (Mdn = 19.95) of adverse events. This metric also differentiated participant group (U = 14029.5, p < 0.001) between attendings (Mdn = 15.45) and residents (Mdn = 19.80). This indicates that our dynamic AOIs reflecting the expert eye gaze was able to differentiate expertise, and the presence of unexpected adverse events. CONCLUSION: This dynamic AOI generation technique produced dynamic AOIs for deriving eye-gaze metrics that were sensitive to expertise level and event characteristics.

Human performance measures for the evaluation of process control human-system interfaces in high-fidelity simulations.

We reviewed the available literature on measuring human performance to evaluate human-system interfaces (HSIs), focused on high-fidelity simulations of industrial process control systems, to identify best practices and future directions for research and operations. We searched the available literature and then conducted in-depth review, structured coding, and analysis of 49 articles, which described 42 studies. Human performance measures were classified across six dimensions: task performance, workload, situation awareness, teamwork/collaboration, plant performance, and other cognitive performance indicators. Many studies measured performance in more than one dimension, but few studies addressed more than three dimensions. Only a few measures demonstrated acceptable levels of reliability, validity, and sensitivity in the reviewed studies in this research domain. More research is required to assess the measurement qualities of the commonly used measures. The results can provide guidance to direct future research and practice for human performance measurement in process control HSI design and deployment.

Examining Cybersecurity of Cyberphysical Systems for Critical Infrastructures Through Work Domain Analysis.

OBJECTIVE: The aim of this study was to apply work domain analysis for cybersecurity assessment and design of supervisory control and data acquisition (SCADA) systems. BACKGROUND: Adoption of information and communication technology in cyberphysical systems (CPSs) for critical infrastructures enables automated and distributed control but introduces cybersecurity risk. Many CPSs employ SCADA industrial control systems that have become the target of cyberattacks, which inflict physical damage without use of force. Given that absolute security is not feasible for complex systems, cyberintrusions that introduce unanticipated events will occur; a proper response will in turn require human adaptive ability. Therefore, analysis techniques that can support security assessment and human factors engineering are invaluable for defending CPSs. METHOD: We conducted work domain analysis using the abstraction hierarchy (AH) to model a generic SCADA implementation to identify the functional structures and means-ends relations. We then adopted a case study approach examining the Stuxnet cyberattack by developing and integrating AHs for the uranium enrichment process, SCADA implementation, and malware to investigate the interactions between the three aspects of cybersecurity in CPSs. RESULTS: The AHs for modeling a generic SCADA implementation and studying the Stuxnet cyberattack are useful for mapping attack vectors, identifying deficiencies in security processes and features, and evaluating proposed security solutions with respect to system objectives. CONCLUSION: Work domain analysis is an effective analytical method for studying cybersecurity of CPSs for critical infrastructures in a psychologically relevant manner. APPLICATION: Work domain analysis should be applied to assess cybersecurity risk and inform engineering and user interface design.

The impact of sleep disorders on driving safety-findings from the Second Strategic Highway Research Program naturalistic driving study.

Study Objectives: This study investigated the association between driving safety and seven sleep disorders amongst 3541 participants of the Second Strategic Highway Research Program (SHRP 2) naturalistic driving study. Methods: SHRP 2 collected naturalistic driving data from participants between 16 and 98 years old by instrumenting participants' vehicles. The analyses used logistic regression to determine the likelihood of crash or near-crash involvement, Poisson log-linear regression to assess crash or near-crash rate, and ordinal logistic regression to assess driver maneuver appropriateness and crash or near-crash severity. These analyses did not account for any medical treatments for the sleep disorders. Results: Females with restless legs syndrome/Willis-Ekbom disease (RLS/WED), drivers with insomnia or narcolepsy, are associated with significantly higher risk of crash or near-crash. Drivers with shift work sleep disorder (SWSD) are associated with significantly increased crash or near-crash rate. Females with RLS/WED or sleep apnea and drivers with SWSD are associated with less safe driver maneuver and drivers with periodic limb movement disorder are associated with more severe events. The four analyses provide no evidence of safety decrements associated with migraine. Conclusions: This study is the first examination on the association between seven sleep disorders and different measures of driving risk using large-scale naturalistic driving study data. The results corroborate much of the existing simulator and epidemiological research related to sleep-disorder patients and their driving safety, but add ecological validity to those findings. These results contribute to the empirical basis for medical professionals, policy makers, and employers in making decisions to aid individuals with sleep disorders in balancing safety and personal mobility.