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Creators/Authors contains: "Sharma, Anjali"

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  1. Abstract Scaling up electric vehicles (EVs) provides an avenue to mitigate both carbon emissions and air pollution from road transport. The benefits of EV adoption for climate, air quality, and health have been widely documented. Yet, evidence on the distribution of these impacts has not been systematically reviewed, despite its central importance to ensure a just and equitable transition. Here, we perform a systematic review of recent EV studies that have examined the spatial distribution of the emissions, air pollution, and health impacts, as an important aspect of the equity implications. Using the Context-Interventions-Mechanisms-Outcome framework with a two-step search strategy, we narrowed down to 47 papers that met our inclusion criteria for detailed review and synthesis. We identified two key factors that have been found to influence spatial distributions. First, the cross-sectoral linkages may result in unintended impacts elsewhere. For instance, the generation of electricity to charge EVs, and the production of batteries and other materials to manufacture EVs could increase the emissions and pollution in locations other than where EVs are adopted. Second, since air pollution and health are local issues, additional location-specific factors may play a role in determining the spatial distribution, such as the wind transport of pollution, and the size and vulnerability of the exposed populations. Based on our synthesis of existing evidence, we highlight two important areas for further research: (1) fine-scale pollution and health impact assessment to better characterize exposure and health disparities across regions and population groups; and (2) a systematic representation of the EV value chain that captures the linkages between the transport, power and manufacturing sectors as well as the regionally-varying activities and impacts. 
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  2. Objective:While modern antiretroviral therapy (ART) is highly effective and safe, depressive symptoms have been associated with certain ART drugs. We examined the association between common ART regimens and depressive symptoms in women with HIV (WWH) with a focus on somatic vs. nonsomatic symptoms. Design:Analysis of longitudinal data from the Women's Interagency HIV Study. Methods:Participants were classified into three groups based on the frequency of positive depression screening (CES-D ≥16): chronic depression (≥50% of visits since study enrollment), infrequent depression (<50% of visits), and never depressed (no visits). Novel Bayesian machine learning methods building upon a subset-tree kernel approach were developed to estimate the combined effects of ART regimens on depressive symptoms in each group after covariate adjustment. Results:The analysis included 1538 WWH who participated in 12 924 (mean = 8.4) visits. The mean age was 49.9 years, 72% were Black, and 14% Hispanic. In the chronic depression group, combinations including tenofovir alafenamide and cobicistat-boosted elvitegravir and/or darunavir were associated with greater somatic symptoms of depression, whereas those combinations containing tenofovir disoproxil fumarate and efavirenz or rilpivirine were associated with less somatic depressive symptoms. ART was not associated with somatic symptoms in the infrequent depression or never depressed groups. ART regimens were not associated with nonsomatic symptoms in any group. Conclusions:Specific ART combinations are associated with somatic depressive symptoms in WWH with chronic depression. Future studies should consider specific depressive symptoms domains as well as complete drug combinations when assessing the relationship between ART and depression. 
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  6. Cognitive complications persist in antiretroviral therapy(ART)-treated people with HIV. However, the pattern and severity of domain- specific cognitive performance is variable and may be exacerbated by ART-mediated neurotoxicity. 929 women with HIV(WWH) from the Women’s Interagency HIV Study who were classified into subgroups based on sociodemographic and longitudinal behavioral and clinical data using semi-parametric latent class trajectory modelling. Five subgroups were comprised of: 1) well-controlled HIV with vascular comorbidities(n = 116); 2) profound HIV legacy effects(CD4 nadir <250 cells/μL; n = 275); 3) primarily <45 year olds with hepatitis C(n = 165); 4) primarily 35–55 year olds(n = 244), and 5) poorly-controlled HIV/substance use(n = 129). Within each subgroup, we fitted a constrained continuation ratio model via penalized maximum likelihood to examine adjusted associations between recent ART agents and cognition. Most drugs were not associated with cognition. However, among the few drugs, non- nucleoside reverse transcriptase inhibitor (NNRTIs) and protease inhibitors(PIs) were most commonly associated with cognition, followed by nucleoside reverse transcriptase inhibitors(NRTIs) and integrase inhibitors(IIs). Directionality of ART-cognition associa- tions varied by subgroup. Better psychomotor speed and fluency were associated with ART for women with well-controlled HIV with vascular comorbidities. This pattern contrasts women with profound HIV legacy effects for whom poorer executive function and fluency were associated with ART. Motor function was associated with ART for younger WWH and primarily 35–55 year olds. Memory was associated with ART only for women with poorly-controlled HIV/substance abuse. Findings demonstrate interindividual variability in ART-cognition associations among WWH and highlight the importance of considering sociodemographic, clinical, and behavioral factors as an underlying contributors to cognition. 
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