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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 ofmore »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. As the use of Integrase inhibitor (INSTI)-class antiretroviral medications becomes more common to maintain long-term viral suppression, early reports suggest the potential for CNS side-effects when starting or switching to an INSTI-based regimen. In a population already at higher risk for developing mood and anxiety disorders, these drugs may have significant effects on PTSD scale symptom scores, particularly in women with HIV (WWH). A total of 551 participants were included after completing ≥ 1 WIHS study visits before and after starting/switching to an INSTI-based ART regimen. Of these, 14% were ART naïve, the remainder switched from primarily a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. Using multivariable linear mixed effects models, we compared PTSD Civilian Checklist subscale scores before and after a “start/switch” to dolutegravir (DTG), raltegravir (RAL), or elvitegravir (EVG). Start/switch to EVG improved re-experiencing subscale symptoms (P’s < 0.05). Switching to EVG improved symptoms of avoidance (P = 0.01). Starting RAL improved arousal subscale symptoms (P = 0.03); however, switching to RAL worsened re-experiencing subscale symptoms (P < 0.005). Starting DTG worsened avoidance subscale symptoms (P = 0.03), whereas switching to DTG did not change subscale or overall PTSD symptoms (P’s > 0.08). In WWH, an EVG-based ART regimen is associated with improved PTSD symptoms, in both treatment naïvemore »patients and those switching from other ART. While a RAL-based regimen was associated with better PTSD symptoms than in treatment naïve patients, switching onto a RAL-based regimen was associated with worse PTSD symptoms. DTG-based regimens either did not affect, or worsened symptoms, in both naïve and switch patients. Further studies are needed to determine mechanisms underlying differential effects of EVG, RAL and DTG on stress symptoms in WWH.« less
  3. 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 effectsmore »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.« less