The Relationship between Real-Time EEG Engagement, Distraction and Workload Estimates and Simulator-Based Driving Performance

Identifying potentially impaired drivers is often dependent upon using cognitive testing from a controlled environment (clinic, laboratory) to predict behavior in a dynamic and unpredictable real world driving environment. The goal of this study was to determine the feasibility, and validity, of using a wireless EEG system to ultimately differentiate between impaired and unimpaired drivers. We utilized the B-Alert X10 portable wireless EEG/ECG system and applied previously validated EEG algorithms estimating engagement, workload, and distraction within a sample of normal control (n = 10) and HIV seropositive individuals (n = 14). Participants underwent a 30-minute fully interactive driving simulation. Overall, the HIV+ group evidenced significantly higher distraction during the simulation. When grouped according to poor and good performers on the simulation (regardless of HIV serostatus), those performing worse on the simulation had higher distraction, with a trend for lower workload, levels. We then examined EEG profiles immediately preceding a crash. Prior to a crash, participants evidenced a significant increase in distraction ~ 10-14 seconds leading up to the crash; the greatest increase was seen in the HIV+ group. These preliminary data support the potential utility of using EEG data in patient populations to identify individuals who might be at risk for impaired drivin

Assessing Neuropsychological Performance in a Migrant Farm Working Colonia in Baja California, Mexico: A Feasibility Study

Neuropsychological impairments (NPI) can lead to difficulties in daily functioning and ultimately contribute to poor health outcomes. However, evidence for the feasibility of NPI assessment in resource-limited settings using tests developed in high literacy/high education cultures is sparse. The main objectives were to: (1) determine the feasibility and appropriateness of conducting neuropsychological assessments among a migrant farm worker population in Baja California, Mexico and (2) preliminary describe neuropsychological test performance in this unique population. A neuropsychological test battery was administered to 21 presumably healthy adults (8 men, 13 women) during a two-day international health services and research collaboration. All but one neuropsychological test (i.e. figure learning) was feasible and appropriate to administer to the study population. Contrary to expectations, participants performed better on verbal rather than nonverbal neuropsychological tests. Results support inclusion of neuropsychological tests into future studies among migrant farm worker populations in Baja California, Mexico

In Vivo Evolution of Tumor-Derived Endothelial Cells

The growth of a malignant tumor beyond a certain, limited size requires that it first develop an independent blood supply. In addition to providing metabolic support, this neovasculature also allows tumor cells to access the systemic circulation, thus facilitating metastatic dissemination. The neovasculature may originate either from normal blood vessels in close physical proximity to the tumor and/or from the recruitment of bone marrow-derived endothelial cell (EC) precursors. Recent studies have shown that human tumor vasculature ECs may also arise directly from tumor cells themselves and that the two populations have highly similar or identical karyotypes. We now show that, during the course of serial in vivo passage, these tumor-derived ECs (TDECs) progressively acquire more pronounced EC-like properties. These include higher-level expression of EC-specific genes and proteins, a greater capacity for EC-like behavior in vitro, and a markedly enhanced propensity to incorporate into the tumor vasculature. In addition, both vessel density and size are significantly increased in neoplasms derived from mixtures of tumor cells and serially passaged TDECs. A comparison of early- and late-passage TDECs using whole-genome single nucleotide polymorphism profiling showed the latter cells to have apparently evolved by a process of clonal expansion of a population with a distinct pattern of interstitial chromosomal gains and losses affecting a relatively small number of genes. The majority of these have established roles in vascular development, tumor suppression or epithelial-mesenchymal transition. These studies provide direct evidence that TDECs have a strong evolutionary capacity as a result of their inherent genomic instability. Consequently such cells might be capable of escaping anti-angiogenic cancer therapies by generating resistant populations

Comparative efficacy of aspirin versus direct oral anticoagulants for venous thromboembolism prophylaxis following primary total hip arthroplasty or total knee arthroplasty : A systematic review and meta‐analysis of randomised controlled trials

Introduction: Venous thromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary embolisms (PE), are common after total knee (TKA) and hip arthroplasty (THA). Recent studies suggest that aspirin effectively prevents VTE following major orthopaedic surgery. This meta‐analysis compares randomised controlled trials (RCTs) evaluating aspirin versus direct oral anticoagulants (DOACs) for VTE prevention after primary THA and TKA. Methods: We included RCTs from 2017 to 2023 that looked at aspirin versus DOACs for VTE prophylaxis in primary THA and TKA. A search strategy was conducted which used Boolean operators and MESH terms. Primary outcomes included VTE rates, symptomatic, asymptomatic DVT and PE. Secondary outcomes were mortality and bleeding complications. Statistical analysis was performed using REVMAN software. An odds ratio with a 95% confidence interval was generated for the pooled studies. Heterogeneity was assessed using the I2 variable, and publication bias was evaluated with a funnel plot. Results: Seven RCTs with 3967 patients were included for analysis. Rivaroxaban 10 mg OD was compared to varying doses of aspirin (81–300 mg). There were no significant differences between the groups in the incidence of VTE (OR: 1.21, 95% CI: 0.72–2.01), PE (OR: 1.01, 95% CI: 0.39–2.61), asymptomatic DVT (OR: 1.39, 95% CI: 0.64–3.00), suspected DVT (OR: 1.13, 95% CI: 0.49–2.61) and major bleeding (OR: 0.84, 95% CI: 0.55–1.27). Discussion: Aspirin is as effective as rivaroxaban for primary thromboprophylaxis post‐THA and TKA, without increased incidence of complications. Further research is needed to determine the optimal dosing regimen of aspirin and its long‐term efficacy in preventing VTE. Level of Evidence: Level I

Neurocognitive impairment associated with predominantly early stage HIV infection in Abuja, Nigeria.

Detailed neuropsychological testing was performed on 133 human immunodeficiency virus (HIV) seropositive (SP) and 77 HIV seronegative (SN) individuals, 86 % with early stage HIV infection in Nigeria, to determine the frequency of HIV-related neurocognitive impairment among the HIV-infected group. The tests were administered to assess the following seven ability domains: speed of information processing, attention/working memory, executive functioning, learning, memory, verbal fluency, and motor function motor. Demographically corrected individual test scores and scores for each domain or reflecting a global deficit (a global deficit score, or GDS) were compared for the SP and SN groups. SP participants were older, had fewer years of education, were more likely to be married, differed in ethnicity, and had higher depression scores than SN individuals. Within the seven ability domains, SP performed worse than SN with respect to speed of information processing, executive function, learning, memory, and verbal fluency and also on the global measure. SP were also more frequently impaired on tests of SIP, and there was a borderline increase in the frequency of global impairment. On the individual tests, SP performed worse than SN on four tests that assessed learning, verbal fluency, memory, and motor function (the Timed Gait). SP subjects, however, performed better than SN on the Finger-tapping test, also a motor task. Performance by SP subjects was not associated on the timed gait which showed a borderline statistically significant correlation with CD4 counts. However, there were significant correlations between viral load measurements and individual tests of speed of information processing, executive function, learning, and verbal fluency and with overall executive function and a borderline correlation with the GDS. Depression scores for SP were associated with impairment on only a single test of executive function. These results demonstrate the ability of these assessments to identify areas of impairment that may be specifically linked to a history of HIV infection among individuals in Nigeria. Confirmation of these findings awaits analyses using data from a larger number of control subjects