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As the HIV+ population ages, the risk for and need to screen for HIV-associated neurocognitive disorders (HAND) increases. The aim of this study is to determine the utility and ecological validity of the Montreal Cognitive Assessment (MoCA) among older HIV+ adults. A total of 100 HIV+ older adults aged 50 years or over completed a comprehensive neuromedical and neurocognitive battery, including the MoCA and several everyday functioning measures. The receiver operating characteristic curve indicates ≤26 as the optimal cut-off balancing sensitivity (84.2%) and specificity (55.8%) compared to "gold standard" impairment as measured on a comprehensive neuropsychological battery. Higher MoCA total scores are significantly (p < .01) associated with better performance in all individual cognitive domains except motor abilities, with the strongest association with executive functions (r = -0.49, p

Objective: Research has linked subjective cognitive concerns with emotional functioning, but few studies have examined if there is a dynamic association across time. This study explored whether the association between subjective cognitive concerns, emotional functioning, and quality of life (QoL) is more trait-based (i.e., associated at an average-level) or more state-based (i.e., changes in emotional functioning at one timepoint are related to simultaneous changes in subjective cognitive concerns)., Design and Participants: Participants included 1061 community-dwelling adults aged 50-99 at baseline from the observational Successful Aging Evaluation (SAGE) study in San Diego, California. This study analyzed data collected over eight years., Measurements: Participants completed the Cognitive Failures Questionnaire (CFQ) to assess subjective cognitive concerns yearly. Self-reported emotional functioning (i.e., depression, anxiety, stress symptoms, and resiliency) and QoL were also assessed yearly. Associations between emotional functioning and QoL measures and CFQ scores were analyzed using multilevel modeling., Results: Between-person analyses showed that worse average emotional functioning and QoL were associated with greater average cognitive concerns (ps <0.0001; partial R 2 > 0.28). Within-person analyses indicated that worse emotional functioning and QoL at a given timepoint were significantly associated with greater cognitive concerns at the same timepoint (ps <0.0001; partial R 2 = 0.007-0.017). Within all five examined predictors, stress had the greatest within- and between-person associations with CFQ scores., Discussion: Findings suggest that subjective cognitive concerns are related to trait-like, and to a lesser extent, state-like emotional functioning and QoL. Incorporating assessment of both general and current emotional functioning could refine the use of subjective cognitive concern measures., Competing Interests: DISCLSOURES LMC receives consulting fees from NeuroUX Inc. RCM is a co-founder of NeuroUX and KeyWise AI., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Metastatic breast cancer (MBC) is associated with burdensome side effects, including cognitive changes that require ongoing monitoring. Cognitive ecological momentary assessments (EMAs) allow for assessment of individual cognitive functioning in natural environments and can be administered via smartphones. Accordingly, we sought to establish the feasibility, reliability, and validity of a commercially available cognitive EMA platform., Methods: Using a prospective design, clinical cognitive and psychosocial assessments (cognitive batteries; patient reported outcomes) were collected at baseline, followed by a 28-day daily EMA protocol that included self-ratings for symptoms and mobile cognitive tests (memory, executive functioning, working memory, processing speed). Satisfaction and feedback questions were included in follow-up data collection. Feasibility data were analyzed using mixed descriptive methods. Test-retest reliability was examined using intraclass correlation coefficients (ICCs) for each EMA, and Pearson's correlation were used to evaluate convergent validity between cognitive EMAs and baseline clinical cognitive and psychosocial variables., Results: Fifty-one women with MBC ( n  = 51) completed this EMA study. High satisfaction (median 90%), low burden (median 19%), high adherence rates (mean 94%), and 100% retention rate were observed. ICCs for cognitive tests of working memory, executive function, and processing speed were robust (>0.90) and ICC for memory tests acceptable (>0.66). Other correlational findings indicated strong convergent validity for all cognitive and psychosocial EMAs., Conclusion: Cognitive EMA monitoring for 28 days is feasible and acceptable in women with MBC, with specific cognitive EMAs (mobile cognitive tests; cognitive function self-ratings) demonstrating strong reliability and validity., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RCM is a co-founder of KeyWise AI, Inc. and a co-founder of NeuroUX. The terms of this arrangement have been reviewed and approved by UC San Diego in accordance with its conflict-of-interest policies. AMH was a consultant for Prodeo, Inc. The terms of this arrangement have been reviewed and approved by University of Texas at Austin in accordance with its conflict-of-interest policies., (© The Author(s) 2025.)

Poor introspective accuracy (IA), defined as inaccurate judgments of one's abilities and performance, is a strong and independent predictor of functional impairment in people with psychotic disorders. However, there are currently no treatments that directly target IA in this population as a primary outcome. We describe a protocol for a clinical trial to test a newly developed blended digital intervention, Improving Thinking through Everyday SelfAssessment Training (iTEST), aimed at improving IA in people with psychotic disorders to improve functional outcomes. iTEST involves daily training consisting of feedback on IA in mobile cognitive tests, coupled with individual coaching that applies improved IA to participant-identified recovery goals. Following the NIMH experimental therapeutics paradigm, the first step in the evaluation of iTEST is an open trial in 60 individuals with psychotic disorders to assess 1) feasibility and acceptability, and 2) whether the intervention leads to clinically significant improvement in an objective target: IA on trained tasks along with transfer to an untrained task-based measure of IA. After programming of the mobile intervention and the creation of treatment manuals, enrollment for an open trial started in November 2023 and will be completed by April 2025. If effective, iTEST could be integrated with cognitive training and other rehabilitative interventions to boost the impact on functional outcomes. Trial registration: ClinicalTrials.gov NCT05899348., Competing Interests: Competing interestsDr. Harvey has received consulting fees or travel reimbursements from Alkermes, Bio Excel, Boehringer Ingelheim, Karuna Pharma, Merck Pharma, Minerva Pharma, and Sunovion (DSP) Pharma in the past year. Dr. Harvey receives royalties from the Brief Assessment of Cognition in Schizophrenia (Owned by WCG Verasci, Inc. and contained in the MCCB). Dr. Harvey is chief scientific officer of i-Function, Inc. and Scientific Consultant to EMA Wellness, Inc. Dr. Depp has received consulting fees from WCG Clinical and Boehringer Ingelheim. Dr. Moore is a co-founder of KeyWise AI, Inc. and NeuroUX Inc. No other authors have conflicts of interest to report., (© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2025.)

This review explores the financial consequences that survivors of critical illness often face following hospitalization in an intensive care unit (ICU). As part of the "post-intensive care syndrome" (PICS), these survivors often experience, in addition to physical and emotional challenges of PICS, major financial burdens resulting from their prolonged ICU treatments. The escalating costs of ICU care, coupled with the potential long-term effects on survivors' ability to work and maintain financial stability, have brought financial toxicity to the forefront of health care discussions. The current review examines the causes and consequences of financial toxicity., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Little is known about cancer-related cognitive impairments (CRCI) in women with metastatic breast cancer (MBC). The purpose of this study is to (1) comprehensively describe CRCI and any associated psychosocial and behavioral symptoms, (2) determine observable sociodemographic and clinical risk factors for CRCI, and (3) explore cognitive and psychosocial predictors of quality of life and social functioning in women living with MBC., Methods: Using a cross-sectional design, women with MBC completed assessments (objective and subjective measures of CRCI including 3 open-ended questions, measures of psychosocial and behavioral factors, and assessments of quality of life and social function), and data were analyzed using descriptive statistics, qualitative content analysis, correlation analyses, t tests, analysis of variance, and linear regression models., Results: Data from 52 women were analyzed. 69.2% of the sample reported clinically significant CRCI and 46% of the sample scored < 1 standard deviation below the standardized mean on one or more cognitive tests. Those with triple-negative MBC (compared to HER2+), recurrent MBC (compared to de novo), and no history of chemotherapy had worse subjective CRCI, and those without history of surgery and older age had worse objective CRCI. Subjective CRCI, but not objective CRCI, was significantly associated with quality of life and social functioning., Conclusion: Subjective and objective CRCI are likely a common problem for those with MBC. Subjective CRCI is associated with poorer quality of life and lower social functioning. Healthcare providers should acknowledge cognitive symptoms, continually assess cognitive function, and address associated unmet needs across the MBC trajectory., Competing Interests: Declarations. Conflict of interest: R.C.M. is a co-founder of KeyWise AI, Inc. and a co-founder of NeuroUX. The terms of this arrangement have been reviewed and approved by UC San Diego in accordance with its conflict-of-interest policies. A.M.H is a consultant for Prodeo, Inc. The terms of this arrangement have been reviewed and approved by University of Texas at Austin in accordance with its conflict-of-interest policies. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. The University of Texas at Austin Institutional Review Board reviewed and monitored all study related procedures (STUDY00002393). Consent to participate: Participants provided informed written consent. Consent for publication: Not Applicable., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Repetitive negative thinking (RNT) symptoms, which are characterized by pervasive, uncontrollable negative thoughts, are common in individuals with mood, anxiety, and traumatic stress disorders. Inability to regulate the contents of working memory is a hypothesized etiological factor in RNT, which suggests that training to improve working memory may be beneficial. This study examined the effects of working memory training on resting-state functional connectivity (rsFC) in individuals with elevated RNT and whether such changes would be associated with clinical improvement., Methods: We conducted a secondary analysis of pre-post resting-state data collected as part of a randomized controlled trial (NCT04912089) of working memory training interventions (n = 42) compared with a waitlist control group (n = 23). We hypothesized that individuals who completed training would show increased rsFC between the 2 key intrinsic connectivity networks-the default mode network (posterior cingulate cortex) and the frontoparietal network (dorsolateral prefrontal cortex). We explored whether the magnitude of rsFC change was associated with change in RNT symptom severity., Results: rsFC increased between the posterior cingulate cortex and regions including the frontal and parietal cortex in the training group compared with the waitlist group. Increased connectivity between the posterior cingulate cortex and superior frontal cortex was associated with RNT symptom reduction., Conclusions: These data provide evidence that working memory training can modulate neural circuitry at rest in individuals with RNT. Results are consistent with accounts of working memory training effects on large-scale neurocircuitry changes and suggest that these changes may contribute to clinical promise of this type of intervention on transdiagnostic RNT symptoms., (Published by Elsevier Inc.)

Objective: Identifying persons with HIV (PWH) at increased risk for Alzheimer's disease (AD) is complicated because memory deficits are common in HIV-associated neurocognitive disorders (HAND) and a defining feature of amnestic mild cognitive impairment (aMCI; a precursor to AD). Recognition memory deficits may be useful in differentiating these etiologies. Therefore, neuroimaging correlates of different memory deficits (i.e., recall, recognition) and their longitudinal trajectories in PWH were examined., Design: We examined 92 PWH from the CHARTER Program, ages 45-68, without severe comorbid conditions, who received baseline structural MRI and baseline and longitudinal neuropsychological testing. Linear and logistic regression examined neuroanatomical correlates (i.e., cortical thickness and volumes of regions associated with HAND and/or AD) of memory performance at baseline and multilevel modeling examined neuroanatomical correlates of memory decline (average follow-up = 6.5 years)., Results: At baseline, thinner pars opercularis cortex was associated with impaired recognition ( p = 0.012; p = 0.060 after correcting for multiple comparisons). Worse delayed recall was associated with thinner pars opercularis ( p = 0.001) and thinner rostral middle frontal cortex ( p = 0.006) cross sectionally even after correcting for multiple comparisons. Delayed recall and recognition were not associated with medial temporal lobe (MTL), basal ganglia, or other prefrontal structures. Recognition impairment was variable over time, and there was little decline in delayed recall. Baseline MTL and prefrontal structures were not associated with delayed recall., Conclusions: Episodic memory was associated with prefrontal structures, and MTL and prefrontal structures did not predict memory decline. There was relative stability in memory over time. Findings suggest that episodic memory is more related to frontal structures, rather than encroaching AD pathology, in middle-aged PWH. Additional research should clarify if recognition is useful clinically to differentiate aMCI and HAND.

Cognitive impairment is a core feature of schizophrenia and a key determinant of functional outcome. Although conventional paper-and-pencil based cognitive assessments used in schizophrenia remained relatively static during most of the 20th century, this century has witnessed the emergence of innovative digital technologies that aim to enhance the ecological validity of performance-based assessments. This narrative review provides an overview of new technologies that show promise for enhancing the ecological validity of cognitive and functional assessments. We focus on 2 approaches that are particularly relevant for schizophrenia research: (1) digital functional capacity tasks, which use simulations to measure performance of important daily life activities (e.g., virtual shopping tasks), delivered both in-person and remotely, and (2) remote device-based assessments, which include self-administered cognitive tasks (e.g., processing speed test) or functionally-focused surveys regarding momentary activities and experiences (e.g., location, social context), as well as passive sensor-based metrics (e.g., actigraphy measures of activity), during daily life. For each approach, we describe the potential for enhancing ecological validity, provide examples of select measures that have been used in schizophrenia research, summarize available data on their feasibility and validity, and consider remaining challenges. Rapidly growing evidence indicates that digital technologies have the potential to enhance the ecological validity of cognitive and functional outcome assessments, and thereby advance research into the causes of, and treatments for, functional disability in schizophrenia., (© The Author(s) 2024. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.)

Background: Mobile cognitive testing is growing in popularity, with numerous advantages over traditional cognitive testing; however, the field lacks studies that deeply examine mobile cognitive test data from general adult samples., Objective: This study characterized performance for a suite of 8 mobile cognitive tests from the NeuroUX platform in a sample of US adults across the adult lifespan., Methods: Overall, 393 participants completed 8 NeuroUX cognitive tests and a brief ecological momentary assessment survey once per day on their smartphones for 10 consecutive days; each test was administered 5 times over the testing period. The tests tapped the domains of executive function, processing speed, reaction time, recognition memory, and working memory. Participants also completed a poststudy usability feedback survey. We examined alternate form test-retest reliability; practice effects; and associations between scores (averages and intraindividual variability) and demographics as well as test-taking context (ie, smartphone type, being at home vs not at home, and being alone vs not alone)., Results: Our final sample consisted of 393 English-speaking US residents (aged 20-79 y; female: n=198, 50.4%). Of the 367 participants who provided responses about their race and ethnicity, 258 (70.3%) were White. Of the 393 participants, 181 (46.1%) were iOS users, and 212 (53.9%) were Android users. Of 12 test scores derived from the 8 tests, 9 (75%) showed good to excellent test-retest reliability (intraclass correlation coefficients >0.76). Practice effects (ie, improvements in performance) were observed for 4 (33%) of the 12 scores. Older age was associated with worse performance on most of the test scores (9/12, 75%) and greater within-person variability for nearly all reaction time scores (3/4, 75%). Relationships with smartphone type showed better performance among iOS users and those with newer Android software versions compared to those with older software. Being at home (vs not at home) was associated with better performance on tests of processing speed. Being alone (vs not alone) was associated with better performance on tests of recognition and working memory. Poststudy feedback indicated that participants found NeuroUX easy to learn and use, an enjoyable experience, and an app that would be helpful in understanding their thinking skills. Only 4.2% (16/379) endorsed privacy concerns, and 77.3% (293/379) reported that they would be willing to share their results with their health care provider. Older age-but not other demographics-was associated with finding the tests more challenging., Conclusions: In a sample of adults across a wide age range, this study characterized features that are particularly important for the interpretation of remote, repeated mobile cognitive testing performance, including test-retest reliability, practice effects, smartphone type, and test-taking context. These data enhance the understanding and application of mobile cognitive testing, paving the way for improved clinical decision-making, personalized interventions, and advancements in cognitive research., (©Emily W Paolillo, Jessica Bomyea, Colin A Depp, Ashley M Henneghan, Anunay Raj, Raeanne C Moore. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.11.2024.)

Objective : HIV/AIDS disproportionately affects Black and Latino people in the United States, yet there is a lack of research on predictors of neurocognitive outcomes in these groups. We examined neurocognitive performance and its key predictors across White, Black, and Latino people with HIV (PWH). Method : Participants included 586 PWH of White, Black, and Latino (English- and Spanish-speaking) background. Neurocognition was assessed via demographically-adjusted Fluid Cognition Composite T-scores from the NIH-Toolbox cognition battery, and individual tests comprising this composite. Predictors examined included sociodemographic and HIV disease characteristics, and medical, psychiatric and substance comorbidities. Results : Compared to White PWH, English-speaking Latino PWH had lower T-scores on the Fluid Cognition Composite, as well as Flanker Inhibition and Picture Sequence Memory tests. While there were no other significant group differences on Fluid Cognition, both Latino PWH language groups performed worse than Black PWH on Flanker Inhibition, and Black PWH performed worse than White PWH on List Sorting. Separate multivariable linear regression models by ethnic/racial/language group showed that significant correlates of worse Fluid Cognition included depressive symptoms among White PWH; hepatitis C co-infection among Black PWH; hypertension among English-speaking Latino PWH; and higher estimated duration of HIV disease and depressive symptoms in Spanish-speaking Latino PWH. Conclusions : Findings suggest worse neurocognition among English-speaking Latino PWH compared to Whites. Predictors of neurocognitive function among PWH differ across ethnic/racial and language groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in developing targeted culturally-relevant interventions aimed at ameliorating neurocognitive dysfunction among diverse PWH.

There is a broad consensus that the commonly used clinician-administered rating scales for assessment of negative symptoms share significant limitations, including (1) reliance upon accurate self-report and recall from the patient and caregiver; (2) potential for sampling bias and thus being unrepresentative of daily-life experiences; (3) subjectivity of the symptom scoring process and limited sensitivity to change. These limitations led a work group from the International Society of CNS Clinical Trials and Methodology (ISCTM) to initiate the development of a multimodal negative symptom instrument. Experts from academia and industry reviewed the current methods of assessing the domains of negative symptoms including diminished (1) affect; (2) sociality; (3) verbal communication; (4) goal-directed behavior; and (5) Hedonic drives. For each domain, they documented the limitations of the current methods and recommended new approaches that could potentially be included in a multimodal instrument. The recommended methods for assessing negative symptoms included ecological momentary assessment (EMA), in which the patient self-reports their condition upon receipt of periodic prompts from a smartphone or other device during their daily routine; and direct inference of negative symptoms through detection and analysis of the patient's voice, appearance or activity from audio/visual or sensor-based (eg, global positioning systems, actigraphy) recordings captured by the patient's smartphone or other device. The process for developing an instrument could resemble the NIMH MATRICS process that was used to develop a battery for measuring cognition in schizophrenia. Although the EMA and other digital measures for negative symptoms are at relatively early stages of development/maturity and development of such an instrument faces substantial challenges, none of them are insurmountable., (© The Author(s) 2024. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.)

Background: Organophosphate and pyrethroid insecticides can affect children's neurodevelopment and increase inflammation. Limited evidence exists among adolescents and on whether inflammation may mediate pesticide-neurobehavior associations. We examined the associations between insecticide metabolite concentrations and neurobehavior among adolescents in Ecuadorian agricultural communities., Methods: We included 520 participants aged 11-17 years. We measured urinary insecticide metabolites (mass spectrometry) and neurobehavior (NEPSY-II). Associations were adjusted for socio-demographic and anthropometric characteristics. The associations of insecticide mixtures with neurobehavior were evaluated using PLS regression, and mediation by inflammatory biomarkers (TNF-α, IL-6, CRP, SAA, sICAM-1, sVCAM-1 and sCD-14) was conducted., Results: Among organophosphates, para-nitrophenol (PNP) and 3,5,6-Trichloro-2-pyridinol (TCPy) were inversely associated with Social Perception (score difference per 50% increase [β 50% ] = -0.26 [95%CI: - 1.07, -0.20] and -0.10 [-0.22, 0.01], respectively). PNP and TCPy also had significant inverse associations with Attention/Inhibitory Control at concentrations >60 th percentile (β 50% = -0.26 [95%CI: -0.51, -0.01] and β 50% = -0.22 [95%CI: -0.43, -0.00], respectively). The pyrethroid, 3-phenoxybenzoic acid (3-PBA), was inversely associated with Language (β 50% = -0.13 [95%CI: -0.19, -0.01]) and had a negative quadratic association with Attention/Inhibitory Control. The neonicotinoid 5-Hydroxy imidacloprid (OHIM) was positively associated with Memory/Learning (β 50% = 0.20 [95%CI: 0.04, 0.37]). Mixtures of all insecticides were significantly negatively related to all domains, except for Memory/Learning, which was positively associated. No mediation by inflammatory markers on these associations was observed., Conclusions: Concurrent organophosphate, pyrethroid, and the mixtures of all metabolites were associated with lower performance in all domains except for Memory/Learning. Neonicotinoids were positively associated with Memory/Learning and Social Perception scores.

Phytophthora sansomeana is an emerging oomycete pathogen causing root rot in many agricultural species including soybean. However, as of now, only one potential resistance gene has been identified in soybean, and our understanding of how genetic and epigenetic regulation in soybean contributes to responses against this pathogen remains largely unknown. In this study, we performed whole genome bisulfite sequencing (WGBS) on two soybean lines, Colfax (resistant) and Williams 82 (susceptible), in response to P. sansomeana at two time points: 4 and 16 hours post-inoculation to compare their methylation changes. Our findings revealed that there were no significant changes in genome-wide CG, CHG (H = A, T, or C), and CHH methylation. However, we observed local methylation changes, specially an increase in CHH methylation around genes and transposable elements (TEs) after inoculation, which occurred earlier in the susceptible line and later in the resistant line. After inoculation, we identified differentially methylated regions (DMRs) in both Colfax and Williams 82, with a predominant presence in TEs. Notably, our data also indicated that more TEs exhibited changes in their methylomes in the susceptible line compared to the resistant line. Furthermore, we discovered 837 DMRs within or flanking 772 differentially expressed genes (DEGs) in Colfax and 166 DMRs within or flanking 138 DEGs in Williams 82. These DEGs had diverse functions, with Colfax primarily showing involvement in metabolic process, defense response, plant and pathogen interaction, anion and nucleotide binding, and catalytic activity, while Williams 82 exhibited a significant association with photosynthesis. These findings suggest distinct molecular responses to P. sansomeana infection in the resistant and susceptible soybean lines., Competing Interests: Conflicts of interest The authors declare no conflicts of interests., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Genetics Society of America.)

One of humanity's greatest strengths lies in our ability to collaborate to achieve more than we can alone. Just as collaboration can be an important strength, humankind's inability to detect deception is one of our greatest weaknesses. Recently, our struggles with deception detection have been the subject of scholarly and public attention with the rise and spread of misinformation online, which threatens public health and civic society. Fortunately, prior work indicates that going beyond the individual can ameliorate weaknesses in deception detection by promoting active discussion or by harnessing the "wisdom of crowds." Can group collaboration similarly enhance our ability to recognize online misinformation? We conducted a lab experiment where participants assessed the veracity of credible news and misinformation on social media either as an actively collaborating group or while working alone. Our results suggest that collaborative groups were more accurate than individuals at detecting false posts, but not more accurate than a majority-based simulated group, suggesting that "wisdom of crowds" is the more efficient method for identifying misinformation. Our findings reorient research and policy from focusing on the individual to approaches that rely on crowdsourcing or potentially on collaboration in addressing the problem of misinformation., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

Negative symptoms are a source of disability in schizophrenia, but criteria for identifying patients for clinical trials are in flux. Minimum severity for negative symptoms is paired with a definition of minimal psychosis to identify predominant negative symptoms. Two previous successful negative symptoms treatment studies used very different severity and selection criteria. We compared the prevalence of participants meeting those two criteria in a large outpatient sample of participants with schizophrenia. Data from 867 outpatients with schizophrenia who participated in one of four NIMH-funded studies were analyzed. Common data elements included diagnoses, the PANSS, and an assessment of everyday functioning. We compared previous criterion for premoninant negative symptoms based on low levels of agitation and psychosis and different cut-offs for negative symptoms severity. 57 % of the participants met the agitation-based criteria for low scores and 33 % met the psychosis-based criteria. 18 % met total PANSS score ≥ 20 and 8 % met ≥24 prominent negative symptoms criteria. 14 % met low agitation and PANSS≥20 and 2 % met the low psychosis and negative symptoms ≥24 criteria. Participants who met all predominant criteria had more impairments in social functioning (all p < .001, all d > 0.37). Criteria for predominant negative symptoms from previous clinical trials identify widely different numbers of cases, with criteria for negative symptom severity and low symptoms both impacting. All criteria yield the expected profile of relatively specific social deficits. Even in unselected populations who participated in complex research protocols, 14 % meet low- agitation based criteria for predominant negative symptoms and many more participants would be expected to meet criteria with enrichment for the presence of negative symptoms., Competing Interests: Declaration of competing interest Dr. Raeanne C. Moore is a co-founder of KeyWise AI, Inc. and a consultant for NeuroUX. Drs. Davidson, Saoud, and Kuchibhatla are full time employees of Minerva Neurosciences. Dr. Harvey has received consulting fees or travel reimbursements from Alkermes, Boehringer Ingelheim, Karuna Therapeutics, Minerva Neurosciences, Roche Pharma, and Sunovion Pharma. He receives royalties from tWCG Endpoint Solutions, Inc., for the Brief Assessment of Cognition in Schizophrenia, which is contained in the MATRICS Consensus Cognitive Battery. He is chief scientific officer of i-Function, Inc.. Dr. Pinkham has served as a consultant for Roche Pharma. The other authors have no potential Biomedical Conflicts of Interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

As the number of older people with HIV (PWH) grows, accidental falls and their associated negative health outcomes are of increasing concern. Fall risk can be measured using novel screening tools such as evaluating postural stability using force plate technology. The aims of this study were to test this technology to assess fall risk among older PWH. In a cross-sectional, observational study of people without HIV (PWoH) with a range of fall risk, participants underwent balance assessment using the validated BTrackS balance plate. Postural stability was compared by HIV serostatus. Multivariable linear regressions were used to examine the relationship between postural stability and validated measures of fall risk balance and frailty status. Among 34 PWH and 30 PWoH, all ≥50 years, postural stability was worse among PWH (35.4 cm vs. 28.3 cm, p = .07). In multivariable models, worse postural stability was associated with reporting a fall in the past 6 months (β = 0.32, p = .004), worse fall efficacy (β = 0.45, p < .001), and being frail or prefrail (β = 0.26, p = .027). In multivariable models stratified by HIV serostatus, worse postural stability was significantly associated with worse fall efficacy (β = 0.53, p < .01) and lower balance confidence (β = -0.33, p = . 04) among PWH but not PWoH. Among older PWH and PWoH, worse postural stability was associated with validated measures of fall risk, including history of falls and poorer fall efficacy. Assessment of postural sway is a promising objective screening test for fall risk among older PWH.

Background: Paranoia is a spectrum of fear-related experiences that spans diagnostic categories and is influenced by social and cognitive factors. The extent to which social media and other types of media use are associated with paranoia remains unclear., Objective: We aimed to examine associations between media use and paranoia at the within- and between-person levels., Methods: Participants were 409 individuals diagnosed with schizophrenia spectrum or bipolar disorder. Measures included sociodemographic and clinical characteristics at baseline, followed by ecological momentary assessments (EMAs) collected 3 times daily over 30 days. EMA evaluated paranoia and 5 types of media use: social media, television, music, reading or writing, and other internet or computer use. Generalized linear mixed models were used to examine paranoia as a function of each type of media use and vice versa at the within- and between-person levels., Results: Of the 409 participants, the following subgroups reported at least 1 instance of media use: 261 (63.8%) for using social media, 385 (94.1%) for watching TV, 292 (71.4%) for listening to music, 191 (46.7%) for reading or writing, and 280 (68.5%) for other internet or computer use. Gender, ethnoracial groups, educational attainment, and diagnosis of schizophrenia versus bipolar disorder were differentially associated with the likelihood of media use. There was a within-person association between social media use and paranoia: using social media was associated with a subsequent decrease of 5.5% (fold-change 0.945, 95% CI 0.904-0.987) in paranoia. The reverse association, from paranoia to subsequent changes in social media use, was not statistically significant. Other types of media use were not significantly associated with paranoia., Conclusions: This study shows that social media use was associated with a modest decrease in paranoia, perhaps reflecting the clinical benefits of social connection. However, structural disadvantage and individual factors may hamper the accessibility of media activities, and the mental health correlates of media use may further vary as a function of contents and contexts of use., (© Vincent Paquin, Robert A Ackerman, Colin A Depp, Raeanne C Moore, Philip D Harvey, Amy E Pinkham. Originally published in JMIR Mental Health (https://mental.jmir.org).)

Model species continue to underpin groundbreaking plant science research. At the same time, the phylogenetic resolution of the land plant tree of life continues to improve. The intersection of these 2 research paths creates a unique opportunity to further extend the usefulness of model species across larger taxonomic groups. Here we promote the utility of the Arabidopsis thaliana model species, especially the ability to connect its genetic and functional resources, to species across the entire Brassicales order. We focus on the utility of using genomics and phylogenomics to bridge the evolution and diversification of several traits across the Brassicales to the resources in Arabidopsis, thereby extending scope from a model species by establishing a "model clade." These Brassicales-wide traits are discussed in the context of both the model species Arabidopsis and the family Brassicaceae. We promote the utility of such a "model clade" and make suggestions for building global networks to support future studies in the model order Brassicales., Competing Interests: Conflict of interest statement. None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of American Society of Plant Biologists.)

Neurocognitive impairment and metabolic syndrome (MetS) are prevalent in persons with HIV (PWH). We examined disparities in HIV-associated neurocognitive function between Hispanic and non-Hispanic White older PWH, and the role of MetS in explaining these disparities. Participants included 116 community-dwelling PWH aged 50-75 years enrolled in a cohort study in southern California [58 Hispanic (53% Spanish speaking) and 58 age-comparable non-Hispanic White; overall group: age: M  = 57.9, standard deviation ( SD ) = 5.7; education (years): M  = 13, SD  = 3.4; 83% male, 58% AIDS, 94% on antiretroviral therapy]. Global neurocognition was derived from T-scores adjusted for demographics (age, education, sex, ethnicity, language) on a battery of 10 cognitive tests. MetS was ascertained via standard criteria that considered central obesity, and fasting elevated triglycerides, low high-density lipoprotein cholesterol and elevated glucose, or medical treatment for these conditions. Covariates examined included sociodemographic, psychiatric, substance use and HIV disease characteristics. Compared with non-Hispanic Whites, Hispanics showed worse global neurocognitive function (Cohen's d  = 0.56, p  < 0.05) and had higher rates of MetS (38% vs. 56%, p  < 0.05). A stepwise regression model including ethnicity and significant covariates showed Hispanic ethnicity was the sole significant predictor of worse global neurocognition ( B  = -3.82, SE  = 1.27, p  < 0.01). A model also including MetS showed that both Hispanic ethnicity ( B  = -3.39, SE  = 1.31, p  = 0.01) and MetS ( B  = -2.73, SE  = 1.31, p  = 0.04) were independently associated with worse neurocognition. In conclusion, findings indicate that increased MetS is associated with worse neurocognitive function in both Hispanic and non-Hispanic White older PWH, but does not explain neurocognitive disparities. MetS remains an important target for intervention efforts to ameliorate neurocognitive dysfunction among diverse older PWH.

Response times (RTs) to ecological momentary assessment (EMA) items often decrease after repeated EMA administration, but whether this is accompanied by lower response quality requires investigation. We examined the relationship between EMA item RTs and EMA response quality. In one data set, declining response quality was operationalized as decreasing correspondence over time between subjective and objective measures of blood glucose taken at the same time. In a second EMA study data set, declining response quality was operationalized as decreasing correspondence between subjective ratings of memory test performance and objective memory test scores. We assumed that measurement error in the objective measures did not increase across time, meaning that decreasing correspondence across days within a person could be attributed to lower response quality. RTs to EMA items decreased across study days, while no decrements in the mean response quality were observed. Decreasing EMA item RTs across study days did not appear problematic overall., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AS is a senior scientist with the Gallup Organization and a consultant for HRA Pharma. RCM is a co-founder of KeyWise AI, Inc. and NeuroUX Inc. The other authors have no conflicts of interest to declare.

Spinal cord injury (SCI) leads to significant sublesional bone loss and high fracture rates. While loss of mechanical loading plays a significant role in SCI-induced bone loss, animal studies have demonstrated mechanical loading alone does not fully account for loss of bone following SCI. Indeed, we have shown that bone loss occurs below the level of an incomplete moderate contusion SCI, despite the resumption of weight-bearing and stepping. As systemic factors could also impact bone after SCI, bone alterations may also be present in bone sites above the level of injury. To examine this, we assessed bone microarchitecture and bone turnover in the supralesional humerus in male and female rats at two different ages following a moderate contusion injury in both sub-chronic (30 days) and chronic (180 days) time points after injury. At the 30-day timepoint, we found that both young and adult male SCI rats had decrements in trabecular bone volume at the supralesional proximal humerus (PH), while female SCI rats were not different from age-matched shams. At the 180-day timepoint, there were no statistical differences between SCI and sham groups, irrespective of age or sex, at the supralesional proximal humerus. At the 30-day timepoint, all SCI rats had lower BFR and higher osteoclast-covered trabecular surfaces in the proximal humerus compared to age-matched sham groups generally matching the pattern of SCI-induced changes in bone turnover seen in the sublesional proximal tibia. However, at the 180-day timepoint, only male SCI rats had lower BFR at the supralesional proximal humerus while female SCI rats had higher or no different BFR than their age-matched counterparts. Overall, this preclinical study demonstrates that a moderate contusion SCI leads to alterations in bone turnover above the level of injury within 30-days of injury; however male SCI rats maintained lower BFR in the supralesional humerus into long-term recovery. These data further highlight that bone loss after SCI is not driven solely by disuse. Additionally, these data allude to potential systemic factors exerting influence on bone following SCI and highlight the need to consider treatments for SCI-induced bone loss that impact both sublesional and systemic factors., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Authors. Published by Elsevier Inc.)

Introduction: People with serious mental illness (SMI; schizophrenia, schizoaffective disorder, bipolar disorder) are at increased risk of suicidal ideation (SI). Over-attribution of social threat, or attributing threatening emotions to neutral faces, may contribute to social isolation through increased social avoidance and decreased social approach motivation. These factors are related to suicide, as well as perceived burdensomeness (PB) and thwarted belongingness (TB). This study examined how over-attribution of threat relates to PB, TB, and social motivations., Method: N = 273 participants with SMI were assessed for current SI and behavior, and were stratified into SI (N = 130) vs. non-SI (N = 143) groups. Participants completed smartphone surveys (via ecological momentary assessments [EMA]) 3×/day for 10 days. They also completed the Mobile Ecological Test of Emotion Recognition (METER) 1×/day. Linear mixed models and multi-level mediation tested the relationships between over-attribution of threat, METER performance, PB/TB, and social motivations., Results: Participants with and without SI did not significantly differ in over-attribution of threat or METER performance. In separate models, there was a relationship of over-attribution of threat with increased PB (B = 1.00, SE = 0.21, t = 4.72, p < .001), reduced social approach motivation (B = -0.74, SE = 0.22, t = -3.33, p < .001), and increased social avoidance (B = 0.90, SE = 0.24, t = 3.70, p < .001), all significant when adjusting for facial affect recognition ability. A model examining social motivations as a mediator between over-attribution of threat and PB/TB was not significant., Conclusion: These results suggest that over-attribution of threat relates to interpersonal constructs related to SI irrespective of facial affect abilities. This study may inform understanding of social cognitive processes related to suicide in SMI., Competing Interests: Declaration of competing interest Dr. Harvey has received consulting fees or travel reimbursements from Alkermes, Bio Excel, Boehringer Ingelheim, Karuna Pharma, Merck Pharma, Minerva Pharma, and Sunovion (DSP) Pharma in the past year. Dr. Harvey receives royalties from the Brief Assessment of Cognition in Schizophrenia (Owned by WCG Verasci, Inc. and contained in the MCCB). Dr. Harvey is chief scientific officer of i-Function, Inc. and Scientific Consultant to EMA Wellness, Inc. Dr. Depp has received consulting fees from WCG Clinical and Boehringer Ingelheim. Dr. Granholm has received consulting fees and travel reimbursements from Boehringer Ingelheim in the past year and is co-founder with equity interest in Granholm Consulting and BioSignal Solutions entities. Dr. Moore is a co-founder of KeyWise AI, Inc. and NeuroUX Inc. No other authors have conflicts of interest to report., (Copyright © 2024. Published by Elsevier B.V.)

People with serious mental illness have challenged self-awareness, including momentary monitoring of performance. A core feature of this challenge is in the domain of using external information to guide behavior, an ability that is measured very well by certain problem-solving tasks such as the Wisconsin Card Sorting Test (WCST) . We used a modified WCST to examine correct sorts and accuracy decisions regarding the correctness of sort. Participants with schizophrenia (n = 99) or bipolar disorder (n = 76) sorted 64 cards and then made judgments regarding correctness of each sort prior to feedback. Time series analyses examined the course of correct sorts and correct accuracy decisions by examining the momentary correlation and lagged correlation on the next sort. People with schizophrenia had fewer correct sorts, fewer categories, and fewer correct accuracy decisions (all p<.001). Positive response biases were seen in both groups. After an incorrect sort or accuracy decision, the groups were equally likely to be incorrect on the next sort or accuracy decision. Following correct accuracy decisions, participants with bipolar disorder were significantly (p=.003) more likely to produce a correct sort or accuracy decision. These data are consistent with previous studies implicating failures to consider external feedback for decision making. Interventions aimed at increasing consideration of external information during decision making have been developed and interventions targeting use of feedback during cognitive test performance are in development., Competing Interests: Declaration of competing interest Dr. Raeanne C. Moore is a co-founder of KeyWise AI, Inc. and a consultant for NeuroUX. Dr. Harvey has received consulting fees or travel reimbursements from Alkermes, Boehringer Ingelheim, Karuna Therapeutics, Minerva Neuroscience, Roche Pharma, and Sunovion Pharma. He receives royalties from the Brief Assessment of Cognition in Schizophrenia, which is owned by WCG-Endpoint Solutions and is part of the MATRICS Consensus Battery. He is chief scientific officer of iFunction, Inc. Dr. Pinkham has served as a consultant for Roche Pharma. The other authors have no potential Biomedical Conflicts of Interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Repetitive negative thinking (RNT) is a transdiagnostic symptom observed across mood and anxiety disorders and is characterized by frequent, distressing thoughts that are perceived as uncontrollable. Specific forms of RNT have been linked to increased suicide risk. However, most work examining links between RNT and suicide has been conducted within specific disorders and subtypes of RNT (e.g., rumination in individuals with depression). The present study aimed to investigate associations between transdiagnostic RNT and suicidal ideation. We hypothesized RNT would be associated with suicide risk beyond disorder-specific clinical symptoms. Fifty-four participants with mood, anxiety, and/or traumatic stress disorders completed an interview assessing suicidal risk (Columbia-Suicide Severity Rating Scale (C-SSRS)) and self-report questionnaires assessing transdiagnostic RNT, depression, and anxiety. Based on C-SSRS, we divided participants into high or low suicide risk groups. We analyzed the relationship between suicidal risk group and RNT and found that RNT was uniquely associated with suicidal risk group, controlling for depression and anxiety severity. Our results suggest including assessments of RNT may have clinical utility for understanding the degree of suicide risk in individuals and point to the potential utility of including clinical interventions to target this symptom for those at high risk of suicide., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Raeanne C. Moore reports a relationship with KeyWise Inc. that includes: equity or stocks. Raeanne C. Moore reports a relationship with NeuroUX Inc. that includes: equity or stocks. Dr. Raeanne C. Moore is a co-founder and has equity interest in KeyWise, Inc. and NeuroUX Inc. The terms of these arrangements have been reviewed and approved by the University of California San Diego in accordance with its conflict of interest policies. No other authors declare that they have competing interests., (Copyright © 2024. Published by Elsevier B.V.)

Background and Hypothesis: People with serious mental illness (SMI; psychotic and affective disorders with psychosis) are at an increased risk of suicide, yet there is limited research on the correlates of suicide in SMI. Social cognitive impairments are common among people with SMI and several studies have examined social cognition and suicidal ideation (SI) and behavior. This systematic review aims to evaluate the links between various domains of social cognition, SI, and suicidal behavior in SMI., Study Design: Electronic databases (PubMed and PsycInfo) were searched through June 2023. Records obtained through this search ( N  = 618) were screened by 2 independent reviewers according to inclusion criteria. Relevant data were extracted, and study quality was assessed., Study Results: Studies ( N  = 16) from 12 independent samples were included in the systematic review ( N  = 2631, sample sizes ranged from N  = 20 to N  = 593). Assessments of social cognition and SI and behavior varied widely between studies. Broadly, effects were mixed. Better emotion recognition of negative affect was linked to SI and a history of suicide attempts, though there is little consistent evidence for the relationship of emotion recognition and SI or behavior. On the other hand, better theory of mind ability was linked to SI and a history of suicide attempts. Furthermore, negative attributional bias was linked to current SI, but not a history of SI or attempt., Conclusions: This review suggests mixed associations between social cognition, SI, and behavior in SMI. Future research should evaluate additional mediators and moderators of social cognition and suicide, employing prospective designs., (© The Author(s) 2024. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.)

The goal of this overview is to help clinicians develop basic proficiency with the terminology of deep learning and understand its fundamentals and early applications. We describe what machine learning and deep learning represent and explain the underlying data science principles. We also review current promising applications and identify ethical issues that bear consideration. Deep Learning is a new type of machine learning that is remarkably good at finding patterns in data, and in some cases generating realistic new data. We provide insights into how deep learning works and discuss its relevance to geriatric psychiatry., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

People with schizophrenia-spectrum and bipolar disorders have difficulty accurately estimating their abilities and skills (impaired introspective accuracy [IA]) and tend to over- or underestimate their performance. This discrepancy between self-reported and objective task performance has been identified as a significant predictor of functional impairment. Yet, the factors driving this discrepancy are currently unclear. To date, the relationships between sleep quality and IA have not been examined. The current study aimed to explore the relationships between sleep quality and IA in participants diagnosed with schizophrenia (SCZ; n = 36), schizoaffective disorder (SCZ-A; n = 55), and bipolar disorder with psychotic features (BP; n = 87). Participants completed tasks of emotion recognition, estimated their performance on the tasks (used to calculate IA), and provided confidence ratings for their accuracy judgments. Participants also self-reported their sleep quality. These results suggest significantly greater discrepancies between self-reported and actual task scores for those with SCZ and SCZ-A compared to participants with BP. For those with SCZ, lower confidence on the tasks and underestimation of abilities were associated with lower sleep quality, while for those with SCZ-A, lower sleep quality was associated with higher confidence and overestimation of performance. Results suggest differential relationships between diagnostic groups. Future research is needed to further explore the factors driving these differing relationships, particularly the contrasting relationships between SCZ and SCZ-A.

Effective interventions to support compassionate patient- and self-care requires an understanding of how to best assess compassion. Micro-ecological momentary assessment (micro-EMA), a method in which participants provide brief responses in real-time within their own environments, can capture changes in compassion across time and contexts. This study examined a micro-EMA approach for measuring the temporal dynamics of compassion in medical students during the COVID-19 pandemic. Medical students (N = 47) completed demographic information and self-report questionnaires assessing empathy and compassion for self and others. Participants then completed six bursts of micro-EMA smartphone-delivered surveys. Each burst was 14 days, with 28 days between bursts. During each burst, participants received four daily micro-EMA surveys assessing compassion, stress, positive affect, and negative affect. Dynamic structural equation modeling was used to examine micro-EMA responses. The overall micro-EMA response rate was 83.75%. On average, daily compassion did not significantly change across the academic year. However, there was significant within-person variability in medical students' compassion trajectories over the training year (b = 0.027, p < .01). At concurrent timepoints, micro-EMA assessed compassion was associated with greater happiness (b = 0.142, p < .001) and lower stress (b = -0.052, p < .05) but was not associated with sadness. In lagged analyses, higher micro-EMA assessed compassion predicted higher next day happiness (b = 0.116, p < .01) and vice versa (b = 0.185, p < .01). Results suggest it is feasible to use micro-EMA to assess daily levels of compassion among medical students. Additionally, there is wide variability in day-to-day fluctuations in compassion levels among medical students, with some students showing substantial increases in daily compassion across the training year and others showing decreases. Positive affect as opposed to negative affect may have particularly strong associations with compassion. Further examination of antecedents and consequences of fluctuations in daily compassion could inform potent intervention targets., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Digital health technologies are ubiquitous in the healthcare landscape. Older adults represent an important user group who may benefit from improved monitoring of physical and cognitive health and in-home access to care, but there remain many barriers to widespread use of digital health technologies in gerontology and geriatric medicine. The National Institute on Aging Research Centers Collaborative Network convened a workshop wherein geriatricians and gerontological researchers with expertise related to mHealth and digital health applications shared opportunities and challenges in the application of digital health technologies in aging. Discussion broadly centered on 2 themes: promises and challenges in (i) the use of ecological momentary assessment methodologies in gerontology and geriatric medicine, and (ii) the development of health promotion programs delivered via digital health technologies. Herein, we summarize this discussion and outline several promising areas for future research., Competing Interests: R.C.M. is a cofounder of NeuroUX Inc. and KeyWise, Inc. The terms of these arrangements have been reviewed and approved by the University of California San Diego in accordance with its conflict of interest policies., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Objective: Emotional functioning is linked to HIV-associated neurocognitive impairment, yet research on this association among diverse people with HIV (PWH) is scant. We examined emotional health and its association with neurocognition in Hispanic and White PWH., Methods: Participants included 107 Hispanic (41% primarily Spanish-speakers; 80% Mexican heritage/origin) and 216 White PWH (Overall age: M = 53.62, SD = 12.19; 86% male; 63% AIDS; 92% on antiretroviral therapy). Emotional health was assessed via the National Institute of Health Toolbox (NIHTB)-Emotion Battery, which yields T-scores for three factor-based summary scores (negative affect, social satisfaction, and psychological well-being) and 13 individual component scales. Neurocognition was measured via demographically adjusted fluid cognition T-scores from the NIHTB-cognition battery., Results: 27%-39% of the sample had problematic socioemotional summary scores. Hispanic PWH showed less loneliness, better social satisfaction, higher meaning and purpose, and better psychological well-being than Whites ( ps <.05). Within Hispanics, Spanish-speakers showed better meaning and purpose, higher psychological well-being summary score, less anger hostility, but greater fear affect than English speakers. Only in Whites, worse negative affect (fear affect, perceived stress, and sadness) was associated with worse neurocognition ( p <.05); and in both groups, worse social satisfaction (emotional support, friendship, and perceived rejection) was linked with worse neurocognition ( p <.05)., Conclusion: Adverse emotional health is common among PWH, with subgroups of Hispanics showing relative strengths in some domains. Aspects of emotional health differentially relate to neurocogntition among PWH and cross-culturally. Understanding these varying associations is an important step towards the development of culturally relevant interventions that promote neurocognitive health among Hispanic PWH.

Aim: People with serious mental illness (SMI) are at an increased risk for suicide. Social approach and avoidance motivations are linked to social functioning, and social isolation is a risk factor for suicide. This study uses ecological momentary assessment (EMA) to understand social approach and avoidance motivations in relation to symptoms and suicidal ideation (SI)., Methods: Participants ( N  = 128) diagnosed with schizophrenia, schizoaffective disorder, or a mood disorder with psychotic features completed assessments of SI and symptoms at baseline. They completed EMA surveys 3×/day for 10 days. EMA surveys included questions about approach and avoidance motivations and psychotic symptoms. Participants were split into four groups based on the median scores of approach and avoidance., Results: Participants with SI at baseline had higher mean social avoidance motivation, t (126) = 2.84, p = .003, and lower mean social approach motivation, t (126) = -2.44, p = .008, than participants without baseline SI. Greater baseline positive symptoms were related to greater mean avoidance, r = .231, p = .009, but not approach motivation. The low approach/high avoidance group had significantly higher current SI than those with high approach/low avoidance ( p < .001). Overall, the low approach/high avoidance group reported more EMA-measured voices than the low approach/low avoidance group ( p  < .001) and the high approach/low avoidance group ( p < .001). Similarly, the low approach/high avoidance group reported more EMA-measured suspiciousness than the low approach/low avoidance ( p < .001) and the high approach/low avoidance groups ( p < .001)., Conclusion: The results of this study point to the role of social approach and avoidance motivations in relation to SI and psychotic symptoms. Clinically, exposure therapies and cognitive behavioral therapies may help to address these social approach and avoidance processes linked to SI.

There is growing interest in applications of virtual reality (VR) to improve the lives of older adults, but the limited research on older adults and VR largely treats older adults as a monolith, ignoring the substantial differences across 65 to 100+ year olds that may affect their experience of VR. There are also few existing studies examining the experiences and challenges facing those who facilitate VR for older adults (e.g., caregiving staff). We address these limitations through two studies. In study 1, we explore variation within older adults' experiences with VR through a field study of VR use among a large ( N  = 245) and age-diverse ( M age  = 83.6 years, SD age  = 7.9, range = 65-103 years) sample of nursing home and assisted living facility residents across 10 U.S. states. Age was negatively associated with the extent to which older adults enjoyed VR experiences. However, the negative relationship between age and older adults' attitudes toward VR was significantly less negative than the relationship between age and their attitudes toward other technologies (cell phones and voice assistants). In study 2, we surveyed caregiving staff ( N  = 39) who facilitated the VR experiences for older adult residents and found that the caregiving staff generally enjoyed the activity relative to other activities and felt it to be beneficial to their relationship with residents.