Society for Ambulatory Assessment

Fourth quarter 2007 (October to December)

Armeli S., Dehart T., Tennen H. (Oct 2007). Daily interpersonal stress and the stressor – vulnerability model of alcohol use. Journal of Social & Clinical Psychology, Vol 26(8): 896-921.

We used an experience sampling design to examine the within-person, within-day associations among interpersonal stress, negative affect, and alcohol use, and how these associations varied as a function of alcohol-outcome expectancies (AOEs), avoidance coping style, sex, and neuroticism. Ninety-eight community adult drinkers who wanted to reduce their alcohol consumption (49 women) reported for 21 days on their interpersonal stress and affect (three times per day), and alcohol use (as it occurred) using hand-held computers. Several individual difference factors interacted with daytime interpersonal stress and afternoon negative affect in predicting nighttime alcohol use, with individuals high in careless unconcern AOEs or low in impairment AOEs demonstrating stronger positive associations between daytime stress and negative affect and nighttime drinking. Daytime drinking and individual difference factors also interacted in predicting nighttime interpersonal stress, with individuals high in careless unconcern AOEs or those low in impairment AOEs or avoidance coping style demonstrating the strongest positive associations between daytime drinking and nighttime stress. The interactive effects in predicting drinking outcomes were generally limited to days on which some interpersonal stress occurred.

Bailes F. (Oct 2007). The prevalence and nature of imagined music in the everyday lives of music students. Psychology of Music, Vol 35(4): 555-570.

‘Musical imagery’ is the experience of imagining music in the ‘mind’s ear’. A study was conducted to explore the prevalence and nature of musical imagery for music students in everyday life, using experience-sampling methods (ESM). As a group, music students reported that imagining music was a very frequent form of musical experience. Participants reported individual variation in their imagery experience but also common differences between the strength of imagery for different musical dimensions. For instance, melody and lyrics were rated as being more vivid components of the image than timbre and expression. Another clear pattern was the influence of hearing music on musical imagination, one indicator being that 58 percent of sampled episodes described having heard or performed the music recently as a possible reason for currently imagining it.

Boggia J., Li Y., Thijs L., Hansen T.W., Kikuya M., Björklund-Bodegård K., Richart T., Ohkubo T., Kuznetsova T., Torp-Pedersen C., Lind L., Ibsen H., Imai Y., Wang J., Sandoya E., O’Brien E., Staessen J.A. International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes (IDACO) investigators. (Oct 2007). Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet. 370(9594): 1219-29.

BACKGROUND: Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the prognostic significance of the ambulatory blood pressure during night and day and of the night-to-day blood pressure ratio. METHODS: We did 24-h blood pressure monitoring in 7458 people (mean age 56.8 years [SD 13.9]) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay, and China. We calculated multivariate-adjusted hazard ratios for daytime and night-time blood pressure and the systolic night-to-day ratio, while adjusting for cohort and cardiovascular risk factors. FINDINGS: Median follow-up was 9.6 years (5th to 95th percentile 2.5-13.7). Adjusted for daytime blood pressure, night-time blood pressure predicted total (n=983; p<0.0001), cardiovascular (n=387; p<0.01), and non-cardiovascular (n=560; p<0.001) mortality. Conversely, adjusted for night-time blood pressure, daytime blood pressure predicted only non-cardiovascular mortality (p<0.05), with lower blood pressure levels being associated with increased risk. Both daytime and night-time blood pressure consistently predicted all cardiovascular events (n=943; p<0.05) and stroke (n=420; p<0.01). Adjusted for night-time blood pressure, daytime blood pressure lost prognostic significance only for cardiac events (n=525; p> or =0.07). Adjusted for the 24-h blood pressure, night-to-day ratio predicted mortality, but not fatal combined with non-fatal events. Antihypertensive drug treatment removed the significant association between cardiovascular events and the daytime blood pressure. Participants with systolic night-to-day ratio value of 1 or more were older, at higher risk of death, and died at an older age than those whose night-to-day ratio was normal (> or =0.80 to <0.90). INTERPRETATION: In contrast to commonly held views, daytime blood pressure adjusted for night-time blood pressure predicts fatal combined with non-fatal cardiovascular events, except in treated patients, in whom antihypertensive drugs might reduce blood pressure during the day, but not at night. The increased mortality in patients with higher night-time than daytime blood pressure probably indicates reverse causality. Our findings support recording the ambulatory blood pressure during the whole day.

Buckingham B., Beck R.W., Tamborlane W.V., Xing D., Kollman C., Fiallo-Scharer R., Mauras N., Ruedy K.J., Tansey M., Weinzimer S.A., Wysocki T., Diabetes Research in Children Network (DirecNet) Study Group. (Oct 2007). Continuous glucose monitoring in children with type 1 diabetes.J Pediatr. 151(4):388-93.

OBJECTIVE: To examine the feasibility of daily use of a continuous glucose monitor, the FreeStyle Navigator Continuous Glucose Monitoring System (“Navigator”), in children with type 1 diabetes (T1D). STUDY DESIGN: After a masked Navigator was used for 4 to 7 days to establish a baseline level of glycemic control, 30 insulin pump users with T1D (average age 11.2 years) were asked to use the Navigator daily for 13 weeks. RESULTS: Subjects averaged 149 h/wk of Navigator use during the first 4 weeks, which decreased slightly to 134 h/wk during weeks 9 to 13 (P = .006). Mean hemoglobin A1c improved from 7.1% at baseline to 6.8% at 13 weeks (P = .02), and the percentage of glucose values between 71 and 180 mg/dL increased from 52% to 60% (P = .01). Subjects and parents reported high satisfaction with the Navigator on the Continuous Glucose Monitor Satisfaction Scale. Two subjects had severe skin reactions related to sensor mount adhesive. CONCLUSION: This study indicates that incorporating real-time continuous glucose monitoring into the daily treatment of children with T1D is feasible. The results provide a compelling rationale for conducting a randomized trial of daily use of a continuous glucose monitor in children with T1D.

Clarkson G.P. & Hodgkinson, G.P. (2007). What can occupational stress diaries achieve that questionnaires can’t? Personnel Review, Vol 36(5): 684-700.

Purpose: The paper aims to demonstrate the efficacy of the qualitative occupational stress diary as a means by which to attain additional depth of insight into the way people experience stress, to foster individual reflection and self-assessment, and as an aid to the development of context sensitive interventions. Design/methodology/approach: Using a free response format, a critical incident diary was completed by 15 clerical workers, employed in a higher education organisation, over five consecutive working days. Findings: The factors constituting causes and consequences of occupational stress were cognitively framed differently from one day to the next and it is unlikely that these insights would have been attained had we employed a series of preformed quantitative response scales. The diary facilitated self-reflection and was reported to have cathartic qualities. Research implications/limitations: There is a need for context specific, tailored intervention measures. Accumulation of corroborating descriptions of how people respond to specific stressors will contribute to the development of such measures. The work reported now needs to be extended to larger groups and over longer periods to identify the most frequently used coping strategies, and which are most efficacious in a given situation. Practical implications: The qualitative occupational stress diary is a simple but powerful self-reflective tool, which may lead to therapeutic outcomes. Originality/value: A growing number of researchers are critical of the practical influence of quantitative measures of occupational stress and coping. The study illustrates how the qualitative occupational stress diary might usefully complement traditional methods for research and intervention purposes.

Corder K., Brage S., Mattocks C., Ness A., Riddoch C., Wareham N.J., Ekelund U. (Dec 2007). Comparison of Two Methods to Assess PAEE during Six Activities in Children. Med Sci Sports Exerc. 39(12):2180-8.

PURPOSE:: The purpose of this study was to compare the accuracy of physical activity energy expenditure (PAEE)-prediction models using accelerometry alone (ACC) and accelerometry combined with heart rate monitoring (HR+ACC) to estimate PAEE during six common activities in children (lying, sitting, slow and brisk walking, hop-scotch, running). Three PAEE-prediction models derived using the current data, and five previously published prediction models were cross-validated to estimate PAEE in this sample. METHODS:: PAEE was assessed using ACC, HR+ACC, and indirect calorimetry during six activities in 145 children (12.4 +/- 0.2 yr). One ACC and two HR+ACC PAEE-prediction models were derived using linear regression on data from the current study. These three new models were cross-validated using a jackknife approach, and a modified Bland-Altman method was used to assess the validity of all eight models. RESULTS: PAEE predictions using the one ACC and two HR+ACC models derived in the current study correlated strongly with measured values (RMSE = 97.3-118.0 J.min.kg). All five previously published models agreed well overall (RMSE = 115.6-245.3 J.min.kg), but systematic error was present for most of these, to a greater extent for ACC. CONCLUSIONS:: ACC and HR+ACC can both be used to predict overall PAEE during these six activities in children; however, systematic error was present in all predictions. Although both ACC and HR+ACC provide accurate predictions of overall PAEE, according to the activities in this study, PAEE-prediction models using HR+ACC may be more accurate and widely applicable than those based on accelerometry alone.

Denchev S.V., Simova I.I., Matveev M.G. (Oct 2007). Evaluation of the SCHILLER BR-102 plus noninvasive ambulatory blood pressure monitor according to the International Protocol introduced by the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. Blood Press Monit. 12(5):329-33.

OBJECTIVE: To evaluate the SCHILLER BR-102 plus (Schiller AG, Baar, Switzerland) noninvasive ambulatory blood pressure recorder according to the International Protocol for validation of blood pressure measuring devices in adults introduced by the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. METHOD: One SCHILLER BR-102 plus blood pressure recorder was tested by a validation team, consisting of three persons: two observers (nurses) and a doctor, acting as supervisor and ‘expert’. The European Society of Hypertension International Protocol comprises two phases. Fifteen participants were recruited for the first phase and, following a successful test, a further 18 persons (giving a total of 33) were recruited additionally. For phase 1, five of the 15 participants had systolic blood pressure and diastolic blood pressure in each of the ranges: low, medium and high. For phase 2, 11 of the 33 participants (including the first 15 participants) had systolic blood pressure and diastolic blood pressure in each of the ranges. The mercury standard for validation was preferred over the optional Sphygmocorder. Because the SCHILLER BR-102 plus has the oscillometric method as backup to the basic auscultatory measurement, both systems of measurement were subjected to individual validations. RESULTS: Results obtained show that the SCHILLER BR-102 plus noninvasive ambulatory blood pressure recorder meets all the requirements specified in the International Protocol for both oscillometric and auscultatory methods. CONCLUSION: On the basis of these results, the SCHILLER BR-102 plus can be recommended for ambulatory blood pressure measurement in clinical practice using both auscultatory and oscillometric modes.

de Jonge P., Mangano D., Whooley M.A. (Nov 2007). Differential association of cognitive and somatic depressive symptoms with heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study. Psychosom Med. 69(8):735-9.

OBJECTIVE: To determine if depression associated with low heart rate variability (HRV) in patients post myocardial infarction (MI), but not in patients with stable coronary heart disease (CHD), may be the result of differential associations of somatic and cognitive depressive symptoms with HRV. METHODS: To examine the association of somatic and cognitive depressive symptoms with 24-hour HRV, we performed a cross-sectional study of 863 outpatients with stable CHD. The severity of somatic and cognitive depressive symptoms was determined using factor analysis of items of the Patient Health Questionnaire (PHQ-9). Time-domain (SDNN, SDANN) and frequency-domain (VLF, LF, HF, WBF) indices of HRV were derived using ambulatory monitoring. RESULTS: Unadjusted analyses revealed that somatic symptom scores were significantly associated with HRV (r = -.09 for SDNN; r = -.08 for SDANN; r = -.08 for LnVLF; r = -.08 for LnLF; r = -.10 for LnHF; r = -.08 for LnWBF). After adjustment for demographic variables, comorbidities, and lifestyle factors, somatic symptom scores were no longer associated with lower HRV, with the possible exception of LnWBF (r = -.06). Cognitive depressive symptom scores were not associated with HRV using either unadjusted or adjusted analyses. CONCLUSIONS: We found that somatic depressive symptoms were associated with lower HRV, although cognitive depressive symptoms were not. The inverse association of somatic symptoms with HRV was largely explained by differences in comorbidities and lifestyle factors. These results suggest that individual symptoms of depression may have differential associations with HRV.

Ebner-Priemer U.W. & Kubiak T. (2007). Psychological and psychophysiological ambulatory monitoring: A review of hardware and software solutions. European Journal of Psychological Assessment, Vol 23(4): 238-247. Special issue: Advances in the methodology of ambulatory assessment.

Ambulatory assessment targets capturing psychological, behavioral, and physiological data in “real time” using in-field data acquisition systems. Although ambulatory assessment research has flourished particularly in the last decades, overviews on hardware and software solutions for monitoring are scarce, and–if found–are often outdated. In this review, we give an overview of current software and hardware solutions, focusing on multichannel systems for physiological data acquisition and hand-held computer based “experience sampling” systems. We aim at offering the reader guidance with regard to their choice of psychological and physiological monitoring solutions, giving special emphasis to key features relevant for different research questions.

Ebner-Priemer U.W. & Sawitzki G. (2007). Ambulatory assessment of affective instability in borderline personality disorder: The effect of the sampling frequency. European Journal of Psychological Assessment, Vol 23(4): 238-247. Special issue: Advances in the methodology of ambulatory assessment.

Affective instability is an essential criterion for borderline personality disorder (BPD) but studies using diaries have rendered conflicting results. Discrepant findings may be caused by differences in the time-based design, especially in the diverse length of the time intervals between self-reports. Even though there is consensus that the time-based design should fit the temporal dynamics of the processes of interest, no general conventions exist. We used 24 h ambulatory monitoring to repeatedly assess subjective ratings of distress in 50 BPD-patients and in 50 healthy controls. We investigated if the chosen time-based design with a time interval of 15min between self-reports (1) reveals within subject variability in BPD-patients and (2) taps the process of interest. Using graphical and statistical evaluation, we demonstrate that the time-based design (15 min/24 h) does catch within-person variability in the BPD-patients. Comparison of the original data with randomly distributed data (simulation) and autocorrelation analyses prove that we tapped a specific process and did not randomly pick states of distress. Using increasing lags between self-reports reveals that short intervals, especially, (15min, 30 min) tap a specific process. We recommend using short time intervals to study temporal dynamics of affective instability.

Eisenberger N.I., Gable S.L., Lieberman M.D. (Nov 2007). Functional magnetic resonance imaging responses relate to differences in real-world social experience. Emotion, Vol 7(4): 745-754.

Although neuroimaging techniques have proven powerful in assessing neural responses, little is known about whether scanner-based neural activity relates to real-world psychological experience. A joint functional magnetic resonance imaging (fMRI)/experience-sampling study investigated whether individual differences in neurocognitive reactivity to scanner-based social rejection related to: (a) moment-to-moment feelings of social rejection during real-world social interactions (“momentary social distress”) and (b) the extent to which these momentary feelings corresponded with end-of-day global assessments of social disconnection (“end-of-day social disconnection”). Individuals who showed greater activity in regions associated with affective and pain processing (dorsal anterior cingulate cortex, amygdala, periaqueductal gray) during scanner-based social rejection reported feeling greater momentary social distress during their daily social interactions. In contrast, individuals who showed greater activity in regions associated with memory and self-referential memory encoding (hippocampus, medial prefrontal cortex) showed a stronger correspondence between momentary social distress and end-of-day social disconnection, such that greater momentary social distress was associated with greater end-of-day social disconnection. These findings complement previous work showing a dissociation between momentary and retrospective reports of affect and suggest that these processes rely on dissociable neural systems.

Fagard R.H., Stolarz K., Kuznetsova T., Seidlerova J., Tikhonoff V., Grodzicki T., Nikitin Y., Filipovsky J., Peleska J., Casiglia E., Thijs L., Staessen J.A., Kawecka-Jaszcz K. (Nov 2007). Sympathetic activity, assessed by power spectral analysis of heart rate variability, in white-coat, masked and sustained hypertension versus true normotension. J Hypertens. 25(11):2280-5.

OBJECTIVE: To assess, in a population-based approach, sympathetic nervous system activity by the use of power spectral analysis of heart rate variability, in normotension, white-coat hypertension, masked hypertension and sustained hypertension. METHODS: The electrocardiographic RR interval was registered in the supine and standing positions and the low-frequency and high-frequency components of its variability were quantified. Cut-off values of 140/90 mmHg for conventional blood pressure and 135/85 mmHg for daytime ambulatory blood pressure were used to define the four blood pressure groups. RESULTS: After exclusion of patients with diabetes, myocardial infarction or treated hypertension, 1485 subjects with complete data remained for the analysis in the supine position. Age averaged 39 +/- 14 years; 54% were women. Conventional and ambulatory blood pressure averaged, respectively, 122 +/- 16/79 +/- 11 mmHg and 124 +/- 12/77 +/- 8 mmHg. After adjusting for demographic, anthropometric and lifestyle characteristics, the low-frequency to high-frequency ratio (geometric mean) averaged 0.81 in normotension and was significantly higher in white-coat hypertension (1.11; P < 0.001), based on a higher low-frequency component and a lower high-frequency component (P < 0.01). This ratio was not significantly different between normotension, masked hypertension (0.97) and sustained hypertension (0.93). The adjusted standing-to-supine ratio of the high-frequency component (geometric mean) was significantly higher in sustained hypertension (0.50) than in normotension (0.39; P < 0.01), but not in white-coat (0.40) and masked hypertension (0.45). CONCLUSION: The findings at rest are compatible with increased sympathetic activity and decreased parasympathetic modulation in white-coat hypertension, with normal autonomic cardiac regulation in masked and sustained hypertension. In addition, sustained hypertension is characterized by a blunted decrease of the high-frequency component on standing.

Fahrenberg J., Myrtek M., Pawlik K., Perrez M. (2007). Ambulatory Assessment – Monitoring Behavior in Daily Life Settings: A Behavioral-Scientific Challenge for Psychology. European Journal of Psychological Assessment, Vol 23(4): 206-213. Special issue: Advances in the methodology of ambulatory assessment.

Abstract. Ambulatory assessment refers to the use of computer-assisted methodology for self-reports, behavior records, or physiological measurements, while the participant undergoes normal daily activities. Since the 1980s, portable microcomputer systems and physiological recorders/analyzers have been developed for this purpose. In contrast to their use in medicine, these new methods have hardly entered the domain of psychology. Questionnaire methods are still preferred, in spite of the known deficiencies of retrospective self-reports. Assessment strategies include: continuous monitoring, monitoring with time- and event-sampling methods, in-field psychological testing, field experimentation, interactive assessment, symptom monitoring, and self-management. These approaches are innovative and address ecological validity, context specificity, and are suitable for practical applications. The advantages of this methodology, as well as issues of acceptance, compliance, and reactivity are discussed. Many technical evelopments and research contributions have come from the German-speaking countries and the Netherlands. Nonetheless, the current Decade of Behavior (APA) calls for a more widespread use of such techniques and developments in assessment. This position paper seeks to make the case for this approach by demonstrating the advantages – and in some domains – necessities of ambulatorymonitoringmethodology for a ehavioral science orientation in psychology.

Fanciullo G.J., Cravero J.P., Mudge B.O., McHugo G.J., Baird J.C. (Oct 2007). Development of a New Computer Method to Assess Children’s Pain. Pain Medicine. 8 Supplement 3: 121-128.

Objective. The primary objective of this study was to determine initial psychometric properties and feasibility of a new Computer Face Scale for measuring pediatric pain. Drawbacks to current measurement tools include a lack of continuous variables, suboptimal mode of implementation, and difficulty interpreting results. A computer method of pediatric pain measurement is presented that addresses these problems. Basic psychometric properties, feasibility, and children’s preference when compared with Wong-Baker Faces Scale were determined. Methods. Fifty-four hospitalized, pediatric inpatients were tested using both the Computer Face Scale and the Wong-Baker Faces Scale. An additional 30 children (not hospitalized) were tested using only the Computer Face Scale. Results. Both hospitalized and nonhospitalized children between the ages of 3 and 17 years of age are able to use the Computer Face Scale to express relative amounts of pain/hurt and happiness. The Computer Face Scale shows acceptable psychometric properties and is preferred by most children. Conclusions. The Computer Face Scale offers advantages over traditional pediatric pain measurement tools. The opportunity for real time review, electronic and time-stamped recording, electronic display, and temporal comparisons of reports affords the potential for improvement in pediatric pain assessment and treatment.

Gage W.H., Zabjek K.F., Sibley K.M., Tang A., Brooks D., McIlroy W.E. (Oct 2007). Ambulatory monitoring of activity levels of individuals in the sub-acute stage following stroke: a case series. J Neuroeng Rehabil. 26;4(1):41.

ABSTRACT: BACKGROUND: There is an important need to better understand the activities of individual patients with stroke outside of structured therapy since this activity is likely to have a profound influence on recovery. A case-study approach was used to examine the activity levels and associated physiological load of patients with stroke throughout a day. METHODS: Activities and physiologic measures were recorded during a continuous 8 hour period from 4 individuals in the sub-acute stage following stroke (ranging from 49 to 80 years old; 4 to 8 weeks post-stroke) in an in-patient rehabilitation hospital. RESULTS: Both heart rate (p=0.0207) and ventilation rate (p<0.0001) increased as intensity of activity increased. Results revealed individual differences in physiological response to daily activities, and large ranges in physiological response measures during ‘moderately’ and ‘highly’ therapeutic activities. CONCLUSIONS: Activity levels of individuals with stroke during the day were generally low, though task-related changes in physiologic measures were observed. Large variability in the physiological response to even the activities deemed to be greatest intensity suggests that inclusion of such extended measurement of physiologic measures may improve understanding of physiological profile that could guide elements of the physical therapy prescription.

Glaser J.P., Os J.V., Mengelers R., Myin-Germeys I. (Nov 2007). A momentary assessment study of the reputed emotional phenotype associated with borderline personality disorder. Psychol Med. 30:1-9.

SUMMARY BACKGROUND: Stress is postulated to play an essential role in the expression of core borderline symptoms. However, the phenomenology of stress reactivity in borderline personality disorder remains unclear. The current study investigated the phenomenology of stress sensitivity in borderline personality disorder in the flow of daily life and compared this with stress sensitivity in patients suffering from psychotic disorders, a group so far known to report the largest reactivity to stress.MethodA total of 44 borderline patients, 42 patients with psychotic disorder and 49 healthy controls were studied with the Experience Sampling Method (a structured diary technique assessing current context and mood in daily life) to assess: (1) appraised subjective stress related to daily events and activities; and (2) emotional reactivity conceptualized as changes in positive and negative affect. RESULTS: Multilevel regression analysis revealed that subjects with borderline personality disorder experienced significantly more emotional reactivity to daily life stress compared with both patients with psychosis and healthy controls, as evidenced by a larger increase in negative affect and a larger decrease in positive affect following stress.ConclusionThese results are the first to ecologically validate the incorporation of stress reactive symptoms in the diagnosis of borderline personality disorder. Borderline patients continually react stronger than patients with psychosis and healthy controls to small disturbances that continually happen in the natural flow of everyday life. Altered emotional stress reactivity may define borderline personality disorder.

Gleaves A., Walker C., Grey J. (Dec 2007).Using digital and paper diaries for learning and assessment purposes in higher education: A comparative study of feasibility and reliability. Assessment & Evaluation in Higher Education, Vol 32(6): 631-643.

The incorporation of diaries and journals as learning and assessment vehicles into programmes of study within higher education has enabled the further growth of reflection, creative writing, critical thinking and meta-cognitive processes of students’ learning. However, there is currently little research that aims to compare how different types of diary are used and for what specific learning and teaching purposes, so, with this in mind, a study was carried out to investigate digital diary use within a group of undergraduates, to some of whom the authors allocated Personal Digital Assistants (PDAs), which they used to contribute to a blog (digital diaries), and to some of whom hard-backed format (paper diaries) were given. This paper is the first of two from this study. The findings indicated that whilst students found both forms of diary acceptable and convenient, differences emerged in the way that the diaries were being used on a day-to-day basis, both in the frequency of entry and in the length of entries made. Throughout the study, the digital diaries were used more frequently, although the entries were often brief and incomplete. Conversely, students completing the paper diaries made significantly fewer entries in total, but those that were made were longer and more discursive in nature. Further, it was found that the paper diaries possessed positive qualities related to handling and attractiveness that promoted more prolonged use, whilst the negative qualities of the digital diaries were linked to technical limitations. The implications of this work are considered in relation to more general notions of using dynamic devices to encourage students to engage in reflexive criticism.

Goldstein D.H., Wilson R., VanDenKerkhof E.G. (Oct 2007). Electronic Monitoring in an Acute Pain Management Service. Pain Medicine, Vol 8 Supplement 3: 94-100.

Objectives. This article will address the process involved in the development and implementation of a clinician-driven portable electronic chart on an Acute Pain Management Service (APMS). We describe the latest version of the program and provide 1 year of clinical data. Setting. Tertiary care center in Kingston, Ontario, Canada. Patients. All patients admitted to the APMS between August 1, 2005, and July 31, 2006. Results. A total of 8,726 APMS visits were made to 2,528 patients. Mean length of stay on the Service was 2.3 days. Sixty-one percent of patients reported an active pain score >3/10. Pain scores were highest with hip or knee surgery. Thirty-five percent of patients reported nausea. Conclusions. Executive sponsorship, alignment with institutional priorities, and user input are essential to the development, implementation, adoption, and sustainability of an electronic patient record. Ready access to data at the bedside can improve quality of care, while ongoing, comprehensive data can contribute to Phase IV drug trials. Incorporating both clinical and research outcomes in the database improves data quality and usability, but must be balanced with the impact of clinical time constraints on documentation. Wireless technology and Tablet computers provide portability and adequate screen size for documentation and reviewing of patient data on an acute pain service. It is necessary to provide solutions to process issues, such as printing electronic records during the transition from paper to electronic records.

Goodrich S., Orr W.C. (Dec 2007). An investigation of the validity of the Lifeshirt in comparison to standard polysomnography in the detection of obstructive sleep apnea. Sleep Med. 14.

BACKGROUND: Due to the cost and waiting times for traditional sleep studies, there is great interest in finding alternatives for the diagnosis of sleep apnea. Several alternatives exist, including ambulatory devices. Our laboratory utilized one such device, a form-fitting vest called the Lifeshirt, and compared its accuracy to that of polysomnography (PSG). METHODS: PSG was performed with simultaneous utilization of the Lifeshirt on 50 individuals who met screening criteria for obstructive sleep apnea. Participants came to the sleep laboratory approximately 2h before their normal bedtime. A sleep technician prepared each participant for PSG and Lifeshirt monitoring. “Lights Out” occurred when the participant was ready for bed, and time in bed was standardized to approximately 7h. PSGs were scored by experienced personnel in our laboratory, while Lifeshirt data were sent electronically to the Lifeshirt manufacturer for analysis. The major variable that was compared between PSG and Lifeshirt was the apnea hypopnea index (AHI), or the number of apneas and hypopneas per hour. Due to incomplete data on two participants, analyses were completed on 48 individuals. RESULTS: Sensitivity of the Lifeshirt ranged from .85 (AHI of 5) to 1.00 (AHI of 25). Specificity ranged from .67 to 1.00. Using the Bland-Altman technique of determining agreement, the mean difference between the AHI of the Lifeshirt and PSG was 1.02 (+/-16.36). When these values are plotted, every case falls within the limits of agreement, with one exception. CONCLUSIONS: The Lifeshirt compared favorably with PSG and could be used with considerable confidence for the screening of patients with suspected obstructive sleep apnea.

Granholm E., Loh C., Swendsen J. (Oct 2007). Feasibility and Validity of Computerized Ecological Momentary Assessment in Schizophrenia. Schizophr Bull. 10; Epub ahead of print

Background: Computerized Ecological Momentary Assessment (EMAc) techniques permit the assessment of daily life behaviors and experiences. The present investigation examined the feasibility and validity of this assessment methodology in outpatients with schizophrenia. Methods: Outpatients with schizophrenia or schizoaffective disorder (n = 54) received a battery of standard laboratory clinical and functional outcome measures and then completed electronic questionnaires on a personal digital assistant (PDA) microcomputer 4 times per day for 1 week. Results: Generally good compliance (87%) with EMAc was found, and participants rated their experience with the study positively. The data collected in daily life demonstrated expected patterns across the assessment week and were significantly associated with scores from standard laboratory instruments measuring similar constructs. Conclusions: EMAc is a feasible and valid approach to data collection in community-dwelling people with schizophrenia, and it may provide important information that is inaccessible via standard clinical and functional outcome measures administered in the laboratory.

Heapy A., Sellinger J., Higgins D., Chatkoff D., Bennett T.C., Kerns R.D. (Oct 2007). Using Interactive Voice Response to Measure Pain and Quality of Life. Pain Medicine, Vol 8 Supplement 3: 145-154.

Objectives. To describe the feasibility of using Interactive Voice Response (IVR) technology to collect daily, prospective data about pain and quality of life in a randomized clinical trial of transdermal fentanyl (TDF). Design. This article focuses on the use of IVR technology within a larger study that compared the relative efficacy of TDF to short-acting opioids for treating chronic noncancer pain. IVR allows individuals to call into a telephone system to answer questions using  the telephone keypad. Participants. Forty-six participants consented to be in the study and made at least one IVR phone call. Thirty-one participants completed the study. All participants were veterans from the VA Connecticut Healthcare System, and all reported chronic pain that had previously been treated with short-acting oral opioids. Outcome Measures. Participant adherence with calling into the IVR system was assessed via frequency counts of the number of calls placed vs the number of expected calls. Participants provided data about average pain, pain interference, medication adherence and side effects, satisfaction with pain control, and sleep quality. Results. Participants who completed the study made 84.6% of the 1302 expected calls into the IVR system, and an additional 4% of missed calls were obtained through follow-up. Proportion of completed calls declined slightly across the three call-in intervals, but  remained high (from 87.5% to 81.3%). Conclusions. These data suggest that IVR is an effective way to collect prospective treatment data. Detailed discussion of additional benefits and potential drawbacks to the use of IVR technology is provided.

Hedeker D., Mermelstein R.J., Demirtas H. (Oct 2007). An Application of a Mixed-Effects Location Scale Model for Analysis of Ecological Momentary Assessment (EMA) Data. Biometrics. 26. Epub ahead of print

For longitudinal data, mixed models include random subject effects to indicate how subjects influence their responses over repeated assessments. The error variance and the variance of the random effects are usually considered to be homogeneous. These variance terms characterize the within-subjects (i.e., error variance) and between-subjects (i.e., random-effects variance) variation in the data. In studies using ecological momentary assessment (EMA), up to 30 or 40 observations are often obtained for each subject, and interest frequently centers around changes in the variances, both within and between subjects. In this article, we focus on an adolescent smoking study using EMA where interest is on characterizing changes in mood variation. We describe how covariates can influence the mood variances, and also extend the standard mixed model by adding a subject-level random effect to the within-subject variance specification. This permits subjects to have influence on the mean, or location, and variability, or (square of the) scale, of their mood responses. Additionally, we allow the location and scale random effects to be correlated. These mixed-effects location scale models have useful applications in many research areas where interest centers on the joint modeling of the mean and variance structure.

Hermida R.C., Ayala D.E., Fernández J.R., Calvo C. (Oct 2007). Chronotherapy Improves Blood Pressure Control and Reverts the Nondipper Pattern in Patients With Resistant Hypertension. Hypertension. 29. Epub ahead of print

Therapeutic strategies in resistant hypertension include adding another drug or changing drugs in search for a better synergic combination. Most patients, however, receive all of their drugs in a single morning dose. We have evaluated the impact on the circadian pattern of blood pressure on modifying the time of treatment without increasing the number of prescribed drugs. We studied 250 hypertensive patients who were receiving 3 antihypertensive drugs in a single morning dose. Patients were randomly assigned to 1 of 2 groups according to the modification in their treatment strategy: changing 1 of the drugs but keeping all 3 in the morning or the same approach but administering the new drug at bedtime. Blood pressure was measured for 48 hours before and after 12 weeks of treatment. There was no effect on ambulatory blood pressure when all of the drugs were taken on awakening. The baseline prevalence of nondipping (79%) was slightly increased after treatment (86%; P=0.131). The ambulatory blood pressure reduction was statistically significant (9.4/6.0 mm Hg for systolic/diastolic blood pressure; P<0.001) with 1 drug at bedtime. This reduction was larger in the nocturnal than in the diurnal mean of blood pressure. Thus, whereas only 16% of the patients in this group were dippers at baseline, 57% were dippers after therapy (P<0.001). Results indicate that, in resistant hypertension, time of treatment may be more important for blood pressure control and for the proper modeling of the circadian blood pressure pattern than just changing the drug combination.

Hernández-del Rey R., Martin-Baranera M., Sobrino J., Gorostidi M., Vinyoles E., Sierra C., Segura J., Coca A., Ruilope L.M., Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators. (Dec 2007). Reproducibility of the circadian blood pressure pattern in 24-h versus 48-h recordings: the Spanish Ambulatory Blood Pressure Monitoring Registry. J Hypertens. 25(12):2406-12.

OBJECTIVES: To assess the reproducibility of the circadian blood pressure (BP) pattern over a 48-h period by comparing the first 24 h of ambulatory blood pressure monitoring (ABPM) with the following 24 h and with the mean over 48 h. PATIENTS AND METHODS: Patients undergoing 48-h ABPM within the National ABPM Registry of the Spanish Society of Hypertension, based on 800 Spacelabs 90207 monitors distributed throughout Spain in hypertension units and primary healthcare centres, were included. Between June 2004 and September 2005, 611 valid 48-h ABPM recordings were obtained, 235 corresponded to patients without antihypertensive treatment. RESULTS: The percentages of patients classified as non-dipper for the first 24 h, the second 24 h and the 48-h average were 47, 50 and 48%, respectively. When the first and second 24-h periods were compared, 147 (24%) subjects switched from dipper (D) to non-dipper (ND) or vice-versa. When the first 24-h period was compared to the 48-h average, 66 (11%) subjects switched patterns. The proportions were similar separately for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and between treated and untreated patients. In subjects with poor ABPM reproducibility, night-to-day ratios were of an intermediate value between those of subjects always classified as D or ND. CONCLUSION: Categorization of D or ND based on a single 24-h ABPM is moderately reproducible, since one out of every five patients change profile over the following 24 h. Nevertheless, the use of 48-h ABPM in clinical practice should be assessed according to cost-effectiveness criteria. Night-to-day ratios may be helpful in identifying patients with a stable profile.

Houtveen J.H., van Doornen L.J. (Oct 2007). Medically unexplained symptoms and between-group differences in 24-h ambulatory recording of stress physiology. Biol Psychol. 76(3):239-49.

People with medically unexplained symptoms (MUS) often have a comorbid history of stress and negative affect. Although the verbal-cognitive and (peripheral) physiological stress systems have shown a great degree of independence, at the same time it is claimed that chronic stress and negative affect can result in a disregulated physiological stress system, which may lead to MUS. Previous studies could not demonstrate a straightforward between subject relationship between MUS and stress physiology, supporting the view of independence. The aim of the current study was to further explore this relationship using an improved methodology based on ecologically valid 24-h real-life ambulatory recordings. Seventy-four participants (19 male; 55 female) with heterogeneous MUS were compared with 71 healthy controls (26 male; 45 females). Momentary experienced somatic complaints and mood, heart rate, cardiac autonomic activity, respiration and saliva cortisol were monitored using electronic diary and ambulatory registration devices. Participants with MUS reported much more momentary complaints and negative affect as compared to controls. Although MUS seemed to be associated with elevated heart rate and reduced low and very-low frequency heart period variability, these effects disappeared after controlling for differences in sports behaviour. No group differences were found for cardiac autonomic activity, respiration, end-tidal CO(2) and saliva cortisol. Our 24-h real-life ambulatory study did not support the existence of a connection between MUS and disregulated peripheral stress physiology. Future studies may instead focus on central measures to reveal potential abnormalities such as deviant central processing of visceral signals in MUS patients.

Jokerst N.M., Brooke M.A., Cho S.Y., Shang A.B. (Dec 2007). Chip-scale sensor system integration for portable health monitoring. Anesth Analg. 105(6 Suppl):S42-7.

The revolution in integrated circuits over the past 50 yr has produced inexpensive computing and communications systems that are powerful and portable. The technologies for these integrated chip-scale sensing systems, which will be miniature, lightweight, and portable, are emerging with the integration of sensors with electronics, optical systems, micromachines, microfluidics, and the integration of chemical and biological materials (soft/wet material integration with traditional dry/hard semiconductor materials). Hence, we stand at a threshold for health monitoring technology that promises to provide wearable biochemical sensing systems that are comfortable, inauspicious, wireless, and battery-operated, yet that continuously monitor health status, and can transmit compressed data signals at regular intervals, or alarm conditions immediately. In this paper, we explore recent results in chip-scale sensor integration technology for health monitoring. The development of inexpensive chip-scale biochemical optical sensors, such as microresonators, that are customizable for high sensitivity coupled with rapid prototyping will be discussed. Ground-breaking work in the integration of chip-scale optical systems to support these optical sensors will be highlighted, and the development of inexpensive Si complementary metal-oxide semiconductor circuitry (which makes up the vast majority of computational systems today) for signal processing and wireless communication with local receivers that lie directly on the chip-scale sensor head itself will be examined.

Kikuchi H., Yoshiuchi K., Ohashi K., Yamamoto Y., Akabayashi A. (Nov 2007). Tension-type headache and physical activity: an actigraphic study. Cephalalgia, 27(11): 1236-1243.

There have been some studies on the relationship between tension-type headache (TTH) and physical activity. However, most previous studies were not prospective and assessed physical activity by questionnaire. Therefore, this study was aimed to investigate the relationship between TTH intensity and physical activity prospectively utilizing computerized ecological momentary assessment and actigraphy. Thirty-one TTH patients wore watch-type computers equipped with actigraphy inside for 1 week to record momentary headache intensity and physical activity. Multilevel modelling was used to investigate the effect of headache intensity on the simultaneous and subsequent activity level. There were significant negative associations between headache intensity and the simultaneous and subsequent activity level, and activity level was significantly reduced at headache exacerbations. These results provide objective and quantitative evidence suggesting that TTH negatively affects physical activity.

Kubiak T. & Jonas C. (2007). Applying Circular Statistics to the Analysis of Monitoring Data: Patterns of Social Interactions and Mood. European Journal of Psychological Assessment, Vol 23(4): 238-247. Special issue: Advances in the methodology of ambulatory assessment.

Patterns of psychological variables in time have been of interest to research from the beginning. This is particularly true for ambulatory monitoring research, where large (cross-sectional) time-series datasets are often the matter of investigation. Common methods for identifying cyclic variations include spectral analyses of time-series data or time-domain based strategies, which also allow for modeling cyclic components. Though the prerequisites of these sophisticated procedures, such as interval-scaled time-series variables, are seldom met, their usage is common. In contrast to the time-series approach, methods from a different field of statistics, directional or circular statistics, offer another opportunity for the detection of patterns in time, where fewer prerequisites have to be met. These approaches are commonly used in biology or geostatistics. They offer a wide range of analytical strategies to examine “circular data,” i.e., data where period of measurement is rotationally invariant (e.g., directions on the compass or daily hours ranging from 0 to 24, 24 being the same as 0). In psychology, however, circular statistics are hardly known at all. In the present paper, we intend to give a succinct introduction into the rationale of circular statistics and describe how this approach can be used for the detection of patterns in time, contrasting it with time-series analysis. We report data from a monitoring study, where mood and social interactions were assessed for 4 weeks in order to illustrate the use of circular statistics. Both the results of periodogram analyses and circular statistics-based results are reported. Advantages and possible pitfalls of the circular statistics approach are highlighted concluding that ambulatory assessment research can benefit from strategies borrowed from circular statistics.

Kudielka B.M., Hawkley L.C., Adam E.K. (Sep-Oct 2007). Compliance with ambulatory saliva sampling in the Chicago Health, Aging, and Social Relations Study and associations with social support. Annals of Behavioral Medicine, Vol 34(2): 209-216.

Background: Noncompliance with instructed saliva sampling times in ambulatory settings can compromise resulting Cortisol findings. Purpose and Methods: Here, the impact of noncompliance on the Cortisol awakening response (CAR), an established marker for hypothalamic-pituitary-adrenal axis activity, was examined over 3 sampling days in middle- and older-age participants in the Chicago Health, Aging, and Social Relations Study. Results: Noncompliant participants had a significantly lower Cortisol rise after awakening (assessed by an awakening sample and a 30-min after awakening sample) on 2 of the 3 sampling days (Day 1, ns; Days 2 & 3, ps < .02). Furthermore, social support measured by the Interpersonal Support Evaluation List correlated negatively with the number of “noncompliant” samples (r = -.19, p < .05), indicating that participants reporting more social support had more “compliant” samples. Conclusion: The results confirm that nonadherence to saliva sampling in ambulatory settings can exert a significant impact on the resulting CAR. Furthermore, the data raise the idea that the extent of nonadherence might be systematically associated with psychosocial factors like social support. For future studies on the relationship between CAR and psychological factors, we therefore recommend controlling for saliva sampling adherence because noncompliance might be systematically associated with the phenomenon being investigated.

Marceau L.D., Link C., Jamison R.N., Carolan S. (Oct 2007). Electronic diaries as a tool to improve pain management: is there any evidence? Pain Med. 8 Suppl 3:101-9.

OBJECTIVE: Chronic pain is a common and costly syndrome which affects approximately one in three US adults. Factors such as shortened length of the medical visit, increased availability of technological approaches to care, and a more informed patient all suggest that a new paradigm is required for chronic pain management. Although much has been written about the use of electronic diaries in clinical trials, little has been presented about the use of these diaries in clinic practice and their potential for changing pain behavior. The intent of this preliminary study is to measure accessibility and usability of a software program designed for use on a personal digital assistant and to discuss how the software program may impact clinic practice and patient behavior. METHODS: We present the results of a preliminary, randomized, comparison, crossover trial of 36 chronic pain patients who were asked to monitor their pain, mood, activity interference, medication use, and pain location on either a paper or electronic diary for 2 weeks. Patients in the electronic diary condition were able to observe changes in their ratings over time and view them on a secure web site. RESULTS: No differences were found between paper and electronic tracking on pain descriptors, pain interference, mood, or helpfulness of medication. Similar to past findings, patients found the electronic diary easier to use (P < 0.0001) and would continue using it (P < 0.05) over paper if given the choice. Importantly, patients using the electronic diary reported more frequently that a provider suggested medication change (P < 0.05) based on feedback from the electronic diary. One trend requiring further investigation is that electronic diary users reported that the diary enabled them and their doctor to make care adjustments according to changes in pain status. CONCLUSION: This study goes beyond previous research on preference and data quality to investigate how the information provided may affect patient and physician perspectives toward pain management. Although not the initial intent of this study, findings indicate that electronic tracking may provide information which can affect management decisions. A follow-up study is ongoing to investigate these initial results. If found to be true, electronic monitoring may have broad implications for health care, policy, and improvement in quality of care for chronic pain sufferers in the future.

Mcentegart D. (Oct 2007). Letter to editor discussing an article by Burton et al. Journal of Psychosomatic Research 63(4): 453.

Letter to the editor discussing an article by Burton et al. The letter writer states that the authors restrict their article to discussion of “handheld computer technology… electronic diaries… users enter data via a touch screen and a stylus.” There is no discussion of the use of the telephone as an alternative convenient handheld device. Interactive voice response (IVR) methodology has been used in hundreds of studies to collect symptom information directly from patients.

Mehl M.R., Holleran S.E. (2007). An Empirical Analysis of the Obtrusiveness of and Participants’ Compliancewith the Electronically Activated Recorder (EAR). European Journal of Psychological Assessment, Vol 23(4): 248-257. Special issue: Advances in the methodology of ambulatory assessment.

In this article, the authors provide an empirical analysis of the obtrusiveness of and participants’ compliance with a relatively new psychological ambulatory assessment method, called the electronically activated recorder or EAR. The EAR is a modified portable audio-recorder that periodically records snippets of ambient sounds from participants’ daily environments. In tracking moment-to-moment ambient sounds, the EAR yields an acoustic log of a person’s day as it unfolds. As a naturalistic observation sampling method, it provides an observer’s account of daily life and is optimized for the assessment of audible aspects of participants’ naturally-occurring social behaviors and interactions. Measures of self-reported and behaviorally-assessed EAR obtrusiveness and compliance were analyzed in two samples. After an initial 2-h period of relative obtrusiveness, participants habituated to wearing the EAR and perceived it as fairly unobtrusive both in a short-term (2 days, N = 96) and a longer-term (10–11 days, N = 11) monitoring. Compliance with the method was high both during the short-term and longer-term monitoring. Somewhat reduced compliance was identified over the weekend; this effect appears to be specific to student populations. Important privacy and data confidentiality considerations around the EAR method are discussed.

Moore H.J., Ells L.J., McLure S.A., Crooks S., Cumbor D., Summerbell C.D., Batterham A.M. (Nov 2007). The development and evaluation of a novel computer program to assess previous-day dietary and physical activity behaviours in school children: The Synchronised Nutrition and Activity Program (SNAP). Br J Nutr. 28. Epub ahead of print

Self-report recall questionnaires used to measure physical activity and dietary intake in children can be labour intensive and monotonous and tend to focus on either dietary intake or physical activity. The web-based software, Synchronised Nutrition and Activity ProgramTM (SNAPTM), was developed to produce a novel, simple, quick and engaging method of assessing energy balance-related behaviours at a population level, combining principles from new and existing 24 h recall methodologies, set within a user-friendly interface. Dietary intake was measured using counts for twenty-one food groups and physical activity levels were measured in min of moderate to vigorous physical activity (MVPA). A combination of the mean difference between methods, type II regression and non-parametric limits of agreement techniques were used to examine the accuracy and precision of SNAPTM. Method comparison analyses demonstrated a good agreement for both dietary intake and physical activity behaviours. For dietary variables, accuracy of SNAPTM (mean difference) was within +/- 1 count for the majority of food groups. The proportion of the sample with between-method agreement within +/- 1 count ranged from 0.40 to 0.99. For min of MVPA, there was no substantial fixed or proportional bias, and a mean difference between methods (SNAPTM – accelerometry) of – 9 min. SNAPTM provides a quick, accurate, low-burden, cost-effective and engaging method of assessing energy balance behaviours at a population level. Tools such as SNAPTM, which exploit the popularity, privacy and engagement of the computer interface, and linkages with other datasets, could make a substantial contribution to future public health monitoring and research.

Mudge S., Stott N.S., Walt S.E. (Dec 2007). Criterion validity of the StepWatch Activity Monitor as a measure of walking activity in patients after stroke. Arch Phys Med Rehabil. 88(12):1710-5.

OBJECTIVES: To test the validity of the StepWatch Activity Monitor (SAM) in subjects with stroke against 2 criterion standards, 3-dimensional gait analysis (3-DGA) and footswitches in a variety of indoor and outdoor walking conditions, including different speeds and different terrains, and to test the accuracy of the SAM when worn on the paretic limb. DESIGN: Criterion standard validation study. SETTING: Gait laboratory and outside course. PARTICIPANTS: Twenty-five participants with physical disability after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The total step count measured simultaneously by SAM and either 3-DGA or footswitches for both paretic and nonparetic limbs. RESULTS: The total step count measured by the SAM and 3-DGA was highly correlated (nonparetic limb, r=.959; paretic limb, r=.896). The 95% limits of agreement (LOA) (derived from Bland-Altman analysis) between the SAM and 3-DGA were within +/-10 steps for SAMs worn on either the nonparetic or paretic limb. The total step count measured simultaneously by the SAM and footswitches was also highly correlated for each limb (nonparetic, r=.999; paretic, r=.963). The 95% LOA between the SAM and footswitches were +/-9 steps on the nonparetic limb but higher at +/-57 steps on the paretic limb. Further analysis showed that the measurement differences occurred during the outdoor component of the combined walk. The 95% LOA between footswitches on both limbs were not more than +/-9 steps for walking, suggesting that the error was accounted for by the SAM on the paretic limb, which both over- and underread the total step count in the outdoor walking conditions. CONCLUSIONS: Criterion validity of the SAM to measure steps in both clinical and natural environments has been established when used on the nonparetic limb. However, more errors are apparent when the SAM is worn on the paretic limb while walking over a variety of outdoor terrains. Validation is recommended before use in patients with neurologic conditions affecting bilateral legs because there may be more error, particularly in outdoor activities.

Nezlek, J. B., Schütz, A., & Sellin, I. (2007). Self-presentational success in daily social interaction. Self and Identity, 6, 361-379.

In a study on self-presentation in everyday social encounters, 100 undergraduate students described their social interactions for two weeks using a variant of the Rochester Interaction Record. For each interaction, participants described their self-presentational goals and perceived success in achieving these goals. A series of multilevel random coefficient modeling analyses found that wanting to be liked was a particularly important goal. Moreover, goals and perceived success depended strongly on the type of situation people were in. For example, people wanted to appear competent during work-related interactions but interesting and attractive during romantic interactions. Overall, participants were relatively satisfied with their self-presentations. Self-presentational goals were more important in interactions with close others (family and friends) than with strangers or acquaintances. Furthermore, interactions with close others were considered especially successful. Participants felt least successful about their self-presentational performance during work related interactions and most successful about their performance during romantic interactions. Overall, social goals were more important than performance goals, and more of the variance in aspirations and perceived success was within-person (i.e., across interactions) than between-persons.

Nijsen T.M., Cluitmans P.J., Arends J.B., Griep P.A. (Nov 2007).Detection of subtle nocturnal motor activity from 3-D accelerometry recordings in epilepsy patients. IEEE Trans Biomed Eng. 54(11):2073-81.

This paper presents a first step towards reliable detection of nocturnal epileptic seizures based on 3-D accelerometry (ACM) recordings. The main goal is to distinguish between data with and without subtle nocturnal motor activity, thus reducing the amount of data that needs further (more complex) analysis for seizure detection. From 15 ACM signals (measured on five positions on the body), two features are computed, the variance and the jerk. In the resulting 2-D feature space, a linear threshold function is used for classification. For training and testing, the algorithm ACM data along with video data is used from nocturnal registrations in seven mentally retarded patients with severe epilepsy. Per patient, the algorithm detected 100% of the periods of motor activity that are marked in video recordings and the ACM signals by experts. From all the detections, 43%-89% was correct (mean =65%). We were able to reduce the amount of data that need to be analyzed considerably. The results show that our approach can be used for detection of subtle nocturnal motor activity. Furthermore, our results indicate that our algorithm is robust for fluctuations across patients. Consequently, there is no need for training the algorithm for each new patient.

Oakes J.M., Forsyth A. & Schmitz K.H. (Dec 2007). The effects of neighborhood density and street connectivity on walking behavior: the Twin Cities walking study. Epidemiol Perspect Innov. 4(1) Epub ahead of print

A growing body of health and policy research suggests residential neighborhood density and street connectivity affect walking and total physical activity, both of which are important risk factors for obesity and related chronic diseases. The authors report results from their methodologically novel Twin Cities Walking Study; a multilevel study which examined the relationship between built environments, walking behavior and total physical activity. In order to maximize neighborhood-level variation while maintaining the exchangeability of resident-subjects, investigators sampled 716 adult persons nested in 36 randomly selected neighborhoods across four strata defined on density and street-connectivity – a matched sampling design. Outcome measures include two types of self-reported walking (from surveys and diaries) and so-called objective 7-day accelerometry measures. While crude differences are evident across all outcomes, adjusted effects show increased odds of travel walking in higher-density areas and increased odds of leisure walking in low-connectivity areas, but neither density nor street connectivity are meaningfully related to overall mean miles walked per day or increased total physical activity. Contrary to prior research, the authors conclude that the effects of density and block size on total walking and physical activity are modest to non-existent, if not contrapositive to hypotheses. Divergent findings are attributed to this study’s sampling design, which tends to mitigate residual confounding by socioeconomic status.

Oishi S., Diener E., Choi D.-W. (Oct 2007). The dynamics of daily events and well-being across cultures: When less is more. Journal of Personality and Social Psychology, Vol 93(4): 685-698.

The authors examined cultural and individual differences in the relation between daily events and daily satisfaction. In a preliminary study, they established cross-cultural equivalence of 50 daily events. In the main study, participants in the United States, Korea, and Japan completed daily surveys on the 50 events and daily satisfaction for 21 days. The multilevel random coefficient model analyses showed that (a) the within-person association between positive events and daily satisfaction was significantly stronger among Asian American, Korean, and Japanese participants than among European American participants and (b) the within-person association between positive events and daily satisfaction was significantly weaker among individuals high in global life satisfaction than among those low in global life satisfaction. The findings demonstrate a weaker effect of positive events on daily well-being among individuals and cultures high in global well-being.

Orrell A., Doherty P., Coulton S., Miles J., Stamatakis E., Lewin R. (Dec 2007). Failure to validate the Health Survey for England physical activity module in a cardiac population. Health Policy. 84(2-3):262-8.

OBJECTIVES: The Health Survey for England physical activity module interview, although not validated, is used as a performance indicator to see if people are achieving current physical activity targets and is the primary source of information for physical activity related policy making. The aim of this study was to assess the validity of the Health Survey for England physical activity module as a measure of physical activity in older adults with coronary heart disease. METHODS: Seventy-two older adults who had experienced a cardiac event completed the Health Survey for England physical activity interview and wore an accelerometer for seven consecutive days. Physical activity classification levels were derived from accelerometry and from the Health Survey for England physical activity interview, together with the number of episodes in which participants were moderately active for 30 min or more. RESULTS: The Health Survey for England physical activity interview exhibited high sensitivity (1.0) and specificity (0.76) for people engaged in high levels of physical activity, moderate sensitivity (0.40) and specificity (0.56) for people engaged in medium levels of physical activity and low sensitivity (0.35) and high specificity (0.92) for people engaged in low levels of physical activity. Compared with the accelerometer, the survey misclassified 63% of participants. CONCLUSIONS: The Health Survey for England physical activity interview misclassified true activity levels in older adults with heart disease by overestimating actual activity in the less active participants. Similar biases on self-report physical activity measures have been demonstrated in the general population, suggesting that the Health Survey for England physical activity module interview may be providing inaccurate information on national activity levels.

Ortega F.B., Ruiz J.R., Sjostrom M. (Nov 2007). Physical activity, overweight and central adiposity in Swedish children and adolescents: the European Youth Heart Study. Int J Behav Nutr Phys Act. 4(1):61 Epub ahead of print

BACKGROUND: The aim of this work was to study the associations of physical activity (PA) and other factors predisposing to overweight, with overweight and central adiposity in children and adolescents. METHODS: A total of 557 Swedish children (9.5+/-0.3 y) and 517 adolescents (15.6+/-0.4 y) from the European Youth Heart Study participated in this study. Logistic regression analyses were used to examine the associations of PA, as measured by accelerometry, and other determinants (i.e. television viewing, birth weight, maternal educational level and parental overweight) with total and central adiposity. Body mass index and waist circumference cut-off values proposed by the IOTF and the Bogalusa Heart Study (i.e. waist measures for predicting risk factors clustering, hereinafter called high-risk waist circumference), respectively, were used. Fatness was estimated from skinfold thicknesses and dichotomized using the 85th sex- and age-specific percentile (high/low). RESULTS: Children and adolescents who had a low level (first tertile) of vigorous PA, were more likely to be overweight (including obesity) and to have a high-risk waist circumference, than those with a high level (third tertile) of vigorous PA. Similarly, those subjects who had a low or middle level (second tertile) of total PA were more likely to be overweight than those who had a high level of total PA. Among the PA variables, only vigorous PA was associated with high total fatness. Birth weight and television viewing, were also associated with higher odds of having a high-risk waist circumference, but these associations were attenuated once either total or vigorous PA variable was included in the model. Those subjects who had two overweight parents were more likely to be overweight and to have a high-risk waist circumference independently of PA variables, compared to those whose parents were not overweight. CONCLUSIONS: Low levels of total PA and especially vigorous PA may play an important role in the development of overweight and excess of central adiposity in children and adolescents, independently of a number of factors such as television viewing and birth weight. In addition, the data suggest that the association between television viewing and central fat deposition could be attenuated if enough vigorous PA is accumulated. Longitudinal and intervention studies are needed to confirm these findings.

Ottaviani C., Shapiro D., Goldstein I.B. (Oct 2007). Vascular profile, delayed recovery, inflammatory process, and ambulatory blood pressure: Laboratory-to-life generalizability. International Journal of Psychophysiology 66(1): 56-65.

Impaired recovery and plasma concentration of intercellular adhesion molecule-1 (sICAM-1) were both highlighted as plausible and more established markers of cardiovascular disease, respectively. Hemodynamic patterns during recovery and their link with circulating levels of sICAM-1 were examined as predictors of 24-h blood pressure (ABP). Impedance cardiography measures and beat-to-beat BP were recorded in 45 healthy subjects during a 10-min baseline, four tasks, and four 10-min recovery periods. sICAM-1 levels at rest were determined by ELISA. ABP measures were obtained combining data from a work and an off day. Hierarchical regressions showed that patterns of compensatory changes in cardiac output and total peripheral resistance during recovery improved the prediction of ABP above and beyond resting and recovery BP, or reactivity hemodynamic patterns. Stress-induced recovery was essentially vascular in nature and a more vascular profile was associated with higher ABP and higher circulating levels of sICAM-1. The results suggest a link between recovery hemodynamics and cardiovascular risk.

Padiyar A., Rahman M. (Nov 2007). Ambulatory blood pressure monitoring: an argument for wider clinical use. Cleve Clin J Med. 74(11):831-8.

Ambulatory blood pressure monitoring predicts cardiovascular risk better than office readings do. It can detect white-coat hypertension, masked hypertension, and normal and aberrant patterns of circadian variation in blood pressure. Though the clinical role of ambulatory blood pressure monitoring is currently limited, its use can be considered in many common clinical situations, eg, resistant hypertension, transplantation, pregnancy, chronic kidney disease, and dialysis. It may help in therapeutic decision-making and save money in the long term.

Pang K.P., Gourin C.G., Terris D.J. (Oct 2007). A comparison of polysomnography and the WatchPAT in the diagnosis of obstructive sleep apnea. Otolaryngol Head Neck Surg. 137(4):665-8.

OBJECTIVE: Our goal was to validate the WatchPAT in the diagnosis of obstructive sleep apnea. STUDY DESIGN: We conducted a prospective, blinded, nonrandomized clinical trial. METHODS: Patients with suspected obstructive sleep apnea scheduled for an overnight level I polysomnogram were offered enrollment in a study to compare the WatchPAT (Itamar Ltd, Israel) device with polysomnography. Patients wore the WatchPAT device simultaneously while undergoing polysomnography during evaluation in the sleep lab. RESULTS: Thirty-seven patients participated in the study. They had a mean age of 50.1 years (range, 31-73 years) and mean body mass index of 34.6 kg/m(2) (range, 21.2-46.8 kg/m(2)). There was high correlation between the polysomnogram and WatchPAT apnea-hypopnea index (r = 0.9288; 95% confidence interval = 0.8579-0.9650, P < 0.0001). The lowest oxygen saturation also showed high correlation (r = 0.989; 95% confidence interval = 0.9773-0.9947, P < 0.0001). The overall polysomnogram and WatchPAT sleep times revealed a correlation of r = 0.5815 (P = 0.005). CONCLUSION: The WatchPAT showed a high correlation with the polysomnogram in apnea-hypopnea index, lowest oxygen saturation, and sleep time. SIGNIFICANCE: It’s use as a reliable tool in the diagnosis of Obstructive Sleep Apnea.

Peters M.L., Crombez G. (Oct 2007). Assessment of Attention to Pain Using Handheld Computer Diaries. Pain Medicine, 8 Supplement 3:110-120.

Objective: We review how handheld computer diaries may be used to measure attention to pain in daily life, and how this method helps in clarifying the relationship between attentional focusing and chronic pain. Results: Signal-contingent sampling of attention to pain and pain intensity with computer diaries has demonstrated that at times when patients report increased attention to pain, they also report higher pain intensity. Time-lagged analyses assessing the temporal precedence of changes in pain and attention using computer diaries demonstrated that this association is bidirectional. One diary study manipulated attention toward or away from pain, but this manipulation proved not successful in changing pain intensity. Conclusion: Signal-contingent sampling of pain and attention within patients has furthered our understanding of how these two constructs are related. Handheld computer diaries offer a flexible tool and have several advantages over traditional self-report questionnaires and paper diaries. Complex sampling schemes, in which the timing of signals, or the content of the questions may depend on previous events or responses, are possible. Future research may focus upon the application of handheld computers to measure pain and attention in therapy outcome studies, and upon the combination of event contingent sampling with time contingent sampling.

Phelan S., Roberts M., Lang W., Wing R.R. (Oct 2007). Empirical evaluation of physical activity recommendations for weight control in women. Med Sci Sports Exerc. 39(10):1832-6.

PURPOSE: Recent recommendations advise 30-60 min of physical activity per day to prevent weight gain and 60-90 min to prevent weight regain. No studies have used objective measures of physical activity to verify these public health recommendations. The purpose of this study was to use objective measures to quantify the amount and intensity of physical activity in a weight-loss-maintainer group and an always-normal-weight group, and, thus,empirically evaluate the recommendations for prevention of weight gain versus regain. METHODS: The weight-loss-maintainer group (N = 135) lost >or= 30.6 kg, maintained >or= 10% weight loss for 14.2 yr, and had a BMI of 22.0 kg.m(-2). The always-normal-weight group (N = 102) had a BMI of 21.1 kg.m(-2) and no history of overweight. Accelerometry was used to assess the amount and intensity of physical activity. RESULTS: The weight-loss-maintainer group spent significantly more minutes per day than the always-normal-weight group in physical activity (58.6 vs 52.1; P = 0.0001), largely because of more time spent in higher-intensity activities (24.4 vs 16.9; P = 0.02). The majority of individuals in the always-normal-weight group engaged in 30-60 min.d(-1) of physical activity, whereas a greater proportion of individuals in the weight-loss-maintainer group engaged in > 60 min (P = 0.002). CONCLUSIONS: Findings support current recommendations that more activity may be needed to prevent weight regain than to prevent weight gain. Including some higher-intensity activity may also be advisable for weight-loss maintenance.

Pieper S., Brosschot J.F., van der Leeden R., Thayer J.F. (Dec 2007). Cardiac effects of momentary assessed worry episodes and stressful events. Psychosom Med. 69(9):901-9.

OBJECTIVE: To hypothesize that increased heart rate (HR) and decreased heart rate variability (HRV) occurs not only during stressful events but also during episodes in which stress is cognitively represented, but not necessarily present, i.e., during worry. METHODS: Ambulatory HR and HRV of 73 female and male teachers were recorded for 4 days, during which they reported, on an hourly basis using computerized diaries, the number and characteristics of worry episodes and stressful events. Multilevel regression models were used, controlling for biobehavioral variables. RESULTS: Compared with neutral periods, worry episodes and stressful events had independent effects on HR (2.00 beats/min and 2.75 beats/min, respectively) and HRV (-1.07 ms and -1.05, respectively). Neither psychological traits nor biobehavioral variables influenced these results. Effects were most pronounced for work-related worry on HR (9.16 beats/min) and HRV (-1.19 ms), and for worry about anticipated future stress on HR (4.79 beats/min). CONCLUSIONS: Worry in daily life might have substantial cardiac effects in addition to the effects of stressful events, especially in the form of work-related and anticipatory stress, the latter being a type of stress that has been largely neglected in stress research.

Plasqui G., Westerterp K.R. (Oct 2007). Physical activity assessment with accelerometers: an evaluation against doubly labeled water. Obesity 15(10):2371-9.

This review focuses on the ability of different accelerometers to assess daily physical activity as compared with the doubly labeled water (DLW) technique, which is considered the gold standard for measuring energy expenditure under free-living conditions. The PubMed Central database (U.S. NIH free digital archive of biomedical and life sciences journal literature) was searched using the following key words: doubly or double labeled or labeled water in combination with accelerometer, accelerometry, motion sensor, or activity monitor. In total, 41 articles were identified, and screening the articles’ references resulted in one extra article. Of these, 28 contained sufficient and new data. Eight different accelerometers were identified: 3 uniaxial (the Lifecorder, the Caltrac, and the CSA/MTI/Actigraph), one biaxial (the Actiwatch AW16), 2 triaxial (the Tritrac-R3D and the Tracmor), one device based on two position sensors and two motion sensors (ActiReg), and the foot-ground contact pedometer. Many studies showed poor results. Only a few mentioned partial correlations for accelerometer counts or the increase in R(2) caused by the accelerometer. The correlation between the two methods was often driven by subject characteristics such as body weight. In addition, standard errors or limits of agreement were often large or not presented. The CSA/MTI/Actigraph and the Tracmor were the two most extensively validated accelerometers. The best results were found for the Tracmor; however, this accelerometer is not yet commercially available. Of those commercially available, only the CSA/MTI/Actigraph has been proven to correlate reasonably with DLW-derived energy expenditure.

Putnam K.M., McSweeney L.B. (Oct 2007). Depressive symptoms and baseline prefrontal EEG alpha activity: A study utilizing Ecological Momentary Assessment. Biol Psychol. Epub ahead of print

Prefrontal cortex (PFC) electroencephalography (EEG) alpha asymmetry has been found in individuals with major depression. However, EEG activity has never been examined in regard to specific depressive symptoms. We examine the relationship between resting baseline PFC alpha activity and both rumination and self-esteem in a depressed outpatient group (N=6) and a healthy control group (N=7) using high-density EEG sampling and multiple longitudinal self report measures, i.e. Ecological Momentary Assessment (EMA). Symptom measures were collected five times daily for 7 days, i.e. 35 assessments. Using a mixed-level analysis, significant GroupxHemisphere interactions for PFC sites and both rumination and self-esteem were found. Within the depressed group, lower bilateral PFC activity predicted higher levels of rumination, and lower right PFC activity predicted higher levels of self-esteem. There were no significant effects for the control group. Results indicate that specific symptoms of depression are uniquely associated with patterns of PFC EEG alpha activity.

Reicherts M., Salamin V., Maggiori C. (2007). The Learning Affect Monitor (LAM): A computer-based system integrating dimensional and discrete assessment of affective states in daily life. European Journal of Psychological Assessment, Vol 23(4): 268-277. Special issue: Advances in the methodology of ambulatory assessment.

The Learning Affect Monitor (LAM) is a new computer-based assessment system integrating basic dimensional evaluation and discrete description of affective states in daily life, based on an autonomous adapting system. Subjects evaluate their affective states according to a tridimensional space (valence and activation circumplex as well as global intensity) and then qualify it using up to 30 adjective descriptors chosen from a list. The system gradually adapts to the user, enabling the affect descriptors it presents to be increasingly relevant. An initial study with 51 subjects, using a 1 week time-sampling with 8 to 10 randomized signals per day, produced n=2,813 records with good reliability measures (e.g., response rate of 88.8%,mean split-half reliability of .86), user acceptance, and usability. Multilevel analyses show circadian and hebdomadal patterns, and significant individual and situational variance components of the basic dimension evaluations. Validity analyses indicate sound assignment of qualitative affect descriptors in the bidimensional semantic space according to the circumplex model of basic affect dimensions. The LAM assessment module can be implemented on different platforms (palm, desk, mobile phone) and provides very rapid and meaningful data collection, preserving complex and interindividually comparable information in the domain of emotion and well-being.

Rheinberg F., Manig Y., Kliegl R. (2007). Flow bei der Arbeit, doch Glück in der Freizeit: Zielausrichtung, Flow und Glücksgefühle. = Flow during work but happiness during leisure time: Goals, flow-experience, and happiness. Zeitschrift für Arbeits- und Organisationspsychologie, Vol 51(3): 105-115.

For a week, data from N = 101 employees with different professions were collected on flow-experience, happiness/satisfaction, and goal adjustment of current activities using the Experience Sampling Method (N = 4603 measurements). The data were analyzed with GLMM. Flow-experience measured with all components (FKS) confirmed the paradox of work (i.e., flow-scores are higher during work, but scores for happiness/satisfaction are higher during leisure time). During work, participants’ activities were more often directed towards reaching goals. The effects of goal adjustment on flow vs. happiness/satisfaction differed significantly. During work, goal adjustment had a strong positive effect on flow, but not on happiness/satisfaction. During leisure time, goal adjustment even had a negative effect on happiness/satisfaction but a positive effect on flow. The paradox of work could be partially attributed to the stronger goal adjustment during work.

Ritzema J., Melton I.C., Richards A.M., Crozier I.G., Frampton C., Doughty R.N., Whiting J., Kar S., Eigler N., Krum H., Abraham W.T., Troughton R.W. (Dec 2007). Direct left atrial pressure monitoring in ambulatory heart failure patients: initial experience with a new permanent implantable device. Circulation. 116(25):2952-9.

BACKGROUND: We describe the first human experience with a permanently implantable, direct left atrial pressure (LAP) monitoring system in ambulatory patients with chronic heart failure. METHODS AND RESULTS: Eight patients with established heart failure and at least 1 heart failure hospitalization or unplanned visit for parenteral therapy in the last year underwent device implantation under fluoroscopic guidance. All subjects received aspirin 150 mg and clopidogrel 75 mg daily. Subjects measured LAP twice daily and attended a clinic regularly for data upload and device calibration. Right heart catheterization was performed at the time of device implantation and at 12 weeks. The device was implanted in all subjects with no procedural complications. At the 12-week follow-up, 87% of device LAP measurements were within +/-5 mm Hg of simultaneous pulmonary capillary wedge pressure readings over a wide range of pressures (1.6 to 71 mm Hg). Net drift corrected by calibration was -0.2+/-1.9 mm Hg/mo. During short-term follow-up, there were no device-related complications or systemic emboli. There were no deaths, no unplanned heart failure clinic visits, and no admissions for heart failure. CONCLUSIONS: Ambulatory monitoring of direct LAP with a new implantable device was well tolerated, feasible, and accurate at a short-term follow-up. Further follow-up and investigation are warranted to evaluate the clinical utility of LAP monitoring in patients with heart failure.

Salarian A., Russmann H., Vingerhoets F.J., Burkhard P.R., Aminian K. (Dec 2007). Ambulatory monitoring of physical activities in patients with Parkinson’s disease. IEEE Trans Biomed Eng. 54(12):2296-9.

A new ambulatory method of monitoring physical activities in Parkinson’s disease (PD) patients is proposed based on a portable data-logger with three body-fixed inertial sensors. A group of ten PD patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) and ten normal control subjects followed a protocol of typical daily activities and the whole period of the measurement was recorded by video. Walking periods were recognized using two sensors on shanks and lying periods were detected using a sensor on trunk. By calculating kinematics features of the trunk movements during the transitions between sitting and standing postures and using a statistical classifier, sit-to-stand (SiSt) and stand-to-sit (StSi) transitions were detected and separated from other body movements. Finally, a fuzzy classifier used this information to detect periods of sitting and standing. The proposed method showed a high sensitivity and specificity for the detection of basic body postures allocations: sitting, standing, lying, and walking periods, both in PD patients and healthy subjects. We found significant differences in parameters related to SiSt and StSi transitions between PD patients and controls and also between PD patients with and without STN-DBS turned on. We concluded that our method provides a simple, accurate, and effective means to objectively quantify physical activities in both normal and PD patients and may prove useful to assess the level of motor functions in the latter.

Santhanam G., Linderman M.D., Gilja V., Afshar A., Ryu S.I., Meng T.H., Shenoy K.V. (Nov 2007). HermesB: a continuous neural recording system for freely behaving primates. IEEE Trans Biomed Eng. 54(11):2037-50.

Chronically implanted electrode arrays have enabled a broad range of advances in basic electrophysiology and neural prosthetics. Those successes motivate new experiments, particularly, the development of prototype implantable prosthetic processors for continuous use in freely behaving subjects, both monkeys and humans. However, traditional experimental techniques require the subject to be restrained, limiting both the types and duration of experiments. In this paper, we present a dual-channel, battery-powered neural recording system with an integrated three-axis accelerometer for use with chronically implanted electrode arrays in freely behaving primates. The recording system called HermesB, is self-contained, autonomous, programmable, and capable of recording broadband neural (sampled at 30 kS/s) and acceleration data to a removable compact flash card for up to 48 h. We have collected long-duration data sets with HermesB from an adult macaque monkey which provide insight into time scales and free behaviors inaccessible under traditional experiments. Variations in action potential shape and root-mean square (RMS) noise are observed across a range of time scales. The peak-to-peak voltage of action potentials varied by up to 30% over a 24-h period including step changes in waveform amplitude (up to 25%) coincident with high acceleration movements of the head. These initial results suggest that spike-sorting algorithms can no longer assume stable neural signals and will need to transition to adaptive signal processing methodologies to maximize performance. During physically active periods (defined by head-mounted accelerometer), significantly reduced 5-25-Hz local field potential (LFP) power and increased firing rate variability were observed. Using a threshold fit to LFP power, 93% of 403 5-min recording blocks were correctly classified as active or inactive, potentially providing an efficient tool for identifying different behavioral contexts in prosthetic applications. These results demonstrate the utility of the HermesB system and motivate using this type of system to advance neural prosthetics and electrophysiological experiments.

Schasfoort F.C., Formanoy M.A., Bussmann J.B., Peters J.W., Tibboel D., Stam H.J. (Oct 2007). Objective and continuous measurement of peripheral motor indicators of pain in hospitalized infants: A feasibility study. Pain. Epub ahead of print

Measurement of pain in pre-verbal infants is complex. Until now, pain behavior has mainly been assessed intermittently using observational tools. Therefore, we determined the feasibility of long-term, objective and continuous measurement of peripheral motor parameters through body-fixed sensors to discriminate between pain and no pain in hospitalized pre-verbal infants. Two pain modes were studied: for procedural pain 10 measurements were performed before, during and after routine heel lances in 9 infants (age range infants: 5-175 days), and for post-operative pain 14 infants (age range 45-400 days) were measured for prolonged periods (mean 7h) using the validated COMFORT-behavior scale as reference method. Several peripheral motor parameters were studied: three body part activity parameters derived from acceleration sensors attached to one arm and both legs, and two muscle activity parameters derived from electromyographic (EMG) sensors attached to wrist flexor and extensor muscles. Results showed that the accelerometry-based parameters legs activity and overall extremity activity (i.e. mean of arm and legs) were significantly higher during heel lance than before or after lance (p0.001), whereas arm activity accelerometry data and wrist muscle activity EMG data showed no significant change. For the post-operative pain measurements, relationships were found between accelerometry-based overall extremity activity and COMFORT-behavior (r=0.76, p<0.001), and between EMG-based wrist flexor activity and COMFORT-behavior (r=0.55, p<0.001, for a subgroup of 7 infants). We conclude that long-term, objective and continuous measurement of peripheral motor parameters is feasible, has high potential, and is promising to assess pain in pre-verbal hospitalized infants.

Shiffman S., Balabanis M.H., Gwaltney C.J. (Dec 2007). Prediction of lapse from associations between smoking and situational antecedents assessed by ecological momentary assessment. Drug and Alcohol Dependence. 91(2-3): 159-168.

Smoking is associated with particular moods and activities, but it is not known whether there are individual differences in these associations and whether these differences are associated with success in smoking cessation. We assessed such associations using ecological momentary assessment: real-world, real-time data, collected by palm-top computer. Two hundred and fourteen smokers participating in a smoking cessation study provided data during ad lib smoking at baseline. Participants recorded moods and activities each time they smoked and, for comparison, at randomly selected non-smoking occasions. Situational associations with smoking were captured by examining the associations between smoking and antecedents considered relevant to lapse risk: negative affect (NA), arousal, socializing with others, the presence of others smoking, and consumption of coffee and alcohol. The associations varied across participants, confirming individual differences in situational smoking associations. Survival analyses revealed that only the NA pattern predicted first lapse. The effect was only seen in EMA assessments of NA smoking, and was not captured by questionnaire measures of negative affect smoking, which did not predict lapse risk. Moreover, the effect was not mediated by nicotine dependence.

Silk J.S., Dahl R.E., Ryan N.D., Forbes E.E., Axelson D.A., Birmaher B., Siegle G.J. (Dec 2007). Pupillary Reactivity to Emotional Information in Child and Adolescent Depression: Links to Clinical and Ecological Measures. Am J Psychiatry. 164(12):1873-1880.

OBJECTIVE: Pupil dilation provides a quantitative index of the temporal pattern of brain reactivity to emotional stimuli. Previous reports indicate that depressed adults show sustained pupil dilation to emotional words, but this phenomenon has not been investigated in children. This study investigated pupil dilation in children with depression and examined how differences in pupillary responses to emotional stimuli correlate with self-rated emotional experiences in participants’ natural environments in everyday life. METHOD: Participants were 20 children with major depressive disorder and 22 comparison children ages 8-17. Pupil dilation was measured during a valence identification task. Participants also rated positive and negative affect in their natural environments as part of an ecological momentary assessment protocol. RESULTS: Children showed greater pupil dilation to negative words than to neutral or positive words. Children with major depression had diminished late pupil dilation relative to comparison children 9-12 sec after a negative word was presented. Diminished late pupil dilation to negative words was associated with greater severity of depression and with higher levels of negative affect and lower levels of positive affect in the natural environment. CONCLUSIONS: Depressed children exhibit a dynamic change in cognitive-affective resources devoted to processing negative emotional words, with more dramatic decreases than in comparison children after a negative word is initially processed, a pattern that differs markedly from that observed in depressed adults. Diminished late pupil dilation in children with major depression could be a marker for problems in emotional reactivity and/or regulation associated with pediatric depression.

Smith D.M., Brown S.L., Ubel P.A. (Oct 2007). Mispredictions and misrecollections: Challenges for subjective outcome measurement. Disabil Rehabil. Epub ahead of print

Purpose. To review research from the behavioral sciences that demonstrates how predictions of future events – and memories of past events – are often systematically biased. Method. Description of how these biases present challenges for subjective outcome measurement in rehabilitation settings, and for measuring health utility. Results. Two new techniques for outcome measurement that have been specifically designed to resist these biases – Ecological Momentary Assessment and the Day Reconstruction Method are successful. Conclusion. We propose that these techniques could be adopted for measuring rehabilitation outcomes.

Sonnenschein M., Sorbi M.J., van Doornen L.J., Schaufeli W.B., Maas C.J. (Oct 2007). Electronic diary evidence on energy erosion in clinical burnout. J Occup Health Psychol. 12(4):402-13.

Burnout is generally defined as a state of severe exhaustion. So far, research has predominantly focused on relatively mild burnout in employees able to work despite their complaints. This study examines energy depletion in clinical burnout (e.g., the severest cases on extended sick leave) by comparing the diurnal patterns of fatigue and exhaustion with those of healthy individuals. Sixty clinically burned-out and 40 healthy participants kept an electronic diary for 14 days, 7 times a day, yielding a total of 8,116 diary entries. This study shows that burned-out individuals typically suffer continuously from a severe fatigue throughout the day. The resulting flattened diurnal cycles mark a stable exhaustion that is uncommon in healthy persons. The current results provide novel support for the existence of severe energy erosion in clinical burnout.

Soundy A., Taylor A., Faulkner G., Rowlands A. (Dec 2007). Psychometric properties of the 7-day physical activity recall questionnaire in individuals with severe mental illness. Arch Psychiatr Nurs. 21(6):309-16.

Few self-report measures of physical activity have been validated in individuals with severe mental illness. The purpose of this study was to examine the validity and reliability of a 7-day recall measure (7DR: [Blair, S. N. (1984). How to assess exercise habits and physical fitness. In J. D. Matarazzo, N. E. Miller, & S. M. Weiss, (Eds.), Behavioural health: A handbook of health enhancement and disease prevention (pp. 424-447). New York: Wiley.]) through comparison with RT3 triaxial accelerometry data. Fourteen individuals took part in the study. Validity was considered by Kendall’s tau correlation and (Bland, J. M., & Altman, D. G. (1986). Statistical-methods for assessing agreement between 2 methods of clinical measurement. Lancet, 1(8476), 307-310) limits of agreement and test-retest reliability was measured by ICC. The only significant correlation between measures was total energy expenditure (tau = 0.43). The 7-DR over reported moderate physical activity by 16.9 +/- 52.3 min/day, but under reported vigorous physical activity by -10.4 +/- 24.3 min/day. Test retest ICC was significant for all outcome measures. Overall, the 7-DR was reliable but exhibited questionable validity. The use of self-report questionnaires such as the 7-DR may inaccurately estimate the levels of physical activity in this population, and may not be sensitive to monitoring intervention-related changes in physical activity.

Stabouli S., Kotsis V., Zakopoulos N. (Oct 2007). Ambulatory blood pressure monitoring and target organ damage in pediatrics. J Hypertens. 25(10):1979-86.

The prevalence of hypertension in children and adolescents is rising in association with the increasing rate of childhood obesity, and it is associated with early target organ damage. Published guidelines on high blood pressure in children and adolescents, focused on the early and accurate diagnosis of hypertension, resulted in improved ability to identify children with hypertension. Although auscultation using a mercury sphygmomanometer remains the method of choice for evaluation of hypertension in children, accumulating evidence suggests that ambulatory blood pressure monitoring is a more accurate method for diagnosis, and it is more closely associated with target organ damage. In addition, ambulatory blood pressure monitoring is a valuable tool in the assessment of white-coat hypertension, and masked hypertension in children and adolescents. Masked hypertension in children and adolescents is associated with a similar risk of target organ damage as in established hypertension.

Stergiou G.S., Parati G. (Oct 2007). The optimal schedule for self-monitoring of blood pressure by patients at home. J Hypertens. 25(10):1992-7.

The optimal schedule for home blood pressure monitoring should represent the usual level of home blood pressure, give a reproducible value, and have prognostic ability. Therefore, outcome studies, as well as short-term trials assessing the reproducibility of home blood pressure, its stability over time and its relationship with ambulatory blood pressure should be taken into account. A review of this evidence suggests that the optimal schedule should be based on 12-14 measurements, and even more measurements up to 25 are desirable. Morning and evening measurements should be obtained, with at least duplicate measurements per occasion. Measurements on the initial day should preferably be discarded.

Stevens J., Murray D.M., Baggett C.D., Elder J.P., Lohman T.G., Lytle L.A., Pate R.R., Pratt C.A., Treuth M.S., Webber L.S., Young D.R. (Dec 2007). Objectively assessed associations between physical activity and body composition in middle-school girls: the Trial of Activity for Adolescent Girls. Am J Epidemiol. 166(11):1298-305.

Declining levels of physical activity probably contribute to the increasing prevalence of overweight in US youth. In this study, the authors examined cross-sectional and longitudinal associations between physical activity and body composition in sixth- and eighth-grade girls. In 2003, girls were recruited from six US states as part of the Trial of Activity for Adolescent Girls. Physical activity was measured using 6 days of accelerometry, and percentage of body fat was calculated using an age- and ethnicity-specific prediction equation. Sixth-grade girls with an average of 12.8 minutes of moderate-to-vigorous physical activity (MVPA) per day (15th percentile) were 2.3 times (95% confidence interval: 1.52, 3.44) more likely to be overweight than girls with 34.7 minutes of MVPA per day (85th percentile), and their percent body fat was 2.64 percentage points greater (95% confidence interval: 1.79, 3.50). Longitudinal analyses showed that percent body fat increased 0.28 percentage points less in girls with a 6.2-minute increase in MVPA than in girls with a 4.5-minute decrease (85th and 15th percentiles of change). Associations between MVPA in sixth grade and incidence of overweight in eighth grade were not detected. More population-based research using objective physical activity and body composition measurements is needed to make evidence-based physical activity recommendations for US youth.

Stiglmayr C.E., Ebner-Priemer U.W., Bretz J., Behm R., Mohse M., Lammers C.H., Anghelescu I.G., Schmahl C., Schlotz W., Kleindienst N., Bohus M. (Nov 2007). Dissociative symptoms are positively related to stress in borderline personality disorder. Acta Psychiatr Scand. Epub ahead of print

Objective: According to DSM-IV criteria, dissociative symptoms in borderline personality disorder (BPD) occur in response to stress. Empirical evidence is, however, lacking. Method: Using ambulatory monitoring, we assessed dissociative symptoms and subjective ratings of stress every 60 min for 48 h on a palmtop computer in BPD-patients (n = 51), clinical controls (CC; major depression n = 25; panic disorder n = 26), and healthy controls (HC; n = 40). Data analyses were primarily based on hierarchical linear models. Results: In all groups, states of increased stress were paralleled by increased scores of dissociation, thus confirming the hypothesized association between stress and dissociation. The increase in dissociation was more pronounced in BPD-patients when compared with CC and HC. Additionally, BPD-patients reported heightened dissociative experience compared with CC and HC, even after controlling for stress. Conclusion: Our data suggest that BPD-patients might be prone to dissociation when experiencing stress and are characterized by a generally heightened level of dissociation.

Stone A.A. & Broderick J.E. (Oct 2007). Real-Time Data Collection for Pain: Appraisal and Current Status. Pain Medicine, 8 Supplement 3: 85-S93.

Objective: Real-time data capture (RTDC) techniques have rapidly developed with the advent of computer and information technology. We plan to discuss the use of RTDC in the assessment of pain, including issues pertaining to its rationale, sampling protocols, and our opinion on the current status of the methodology. Design: This is “thought” piece involving no systematic data collection methods. Results: We described the rationale for using RTDC, including issues in recall bias, the desire for detailed information about pain, and the ability to examine within-person associations between pain and other variables. The mechanics of RTDC implementations were discussed with a focus on sampling protocols and data collection methods. The final section concerned the status of RTDC. Current acceptance of RTDC is evaluated and three issues in the science of RTDC were discussed: the interpretation of differences between recall and the average of momentary assessments for the same period; if RTDC is advancing our understanding of pain; and, the issue of what consumers of pain assessments actually desire. RTDC extensions to feedback based on momentary assessments are also discussed. Conclusion: Real-time data collection can be a useful methodology for improving our understanding of pain and especially of its dynamic nature in real-world settings.

Tidey J.W., Monti P.M., Rohsenow D.J., Gwaltney C.J., Miranda R. Jr., McGeary J.E., Mackillop J., Swift R.M., Abrams D.B., Shiffman S., Paty J.A. (Nov 2007). Moderators of Naltrexone’s Effects on Drinking, Urge, and Alcohol Effects in Non-Treatment-Seeking Heavy Drinkers in the Natural Environment. Alcohol Clin Exp Res. Epub ahead of print

Background: Naltrexone (NTX) has proven to be effective with alcoholics in treatment, with most controlled clinical trials showing beneficial effects on heavy drinking rates. However, little is known about the behavioral mechanisms underlying the effects of NTX on drinking, or about patient characteristics that may moderate NTX’s effects on drinking. In this study, ecological momentary assessment (EMA) techniques were used to investigate some of the putative mechanisms of naltrexone’s effects on drinking in heavy drinkers who were not seeking treatment for alcohol problems. Polymorphisms in the D4 dopamine receptor (DRD4) gene and the mu-opiate receptor (OPRM1) gene, family history of alcohol problems, age of onset of alcoholism and gender were explored as potential moderators of NTX’s effects. Methods: After a 1-week placebo lead-in period, heavy drinkers (n = 180), 63% of whom were alcohol-dependent, were randomized to 3 weeks of daily naltrexone (50 mg) or placebo. Throughout the study, participants used EMA on palm-pilot computers to enter, in real time, drink data, urge levels, and subjective effects of alcohol consumption. Results: Naltrexone reduced percentage drinking days in all participants and reduced percent heavy drinking days in DRD4-L individuals; NTX decreased urge levels in participants with younger age of alcoholism onset; NTX increased time between drinks in participants who had more relatives with alcohol problems; and NTX reduced the stimulating effects of alcohol in women. OPRM1 status did not moderate any of NTX’s effects. Conclusions: These results confirm earlier findings of NTX’s effects on drinking and related subjective effects, and extend them by describing individual difference variables that moderate these effects in the natural environment, using data collected in real time.

Török K., Pálfi A., Szelényi Z., Molnár D. (Dec 2007). Circadian variability of blood pressure in obese children. Nutr Metab Cardiovasc Dis. Epub ahead of print

BACKGROUND AND AIMS: The aim of the present study was to evaluate the circadian rhythm of blood pressure pattern in obese children, and to investigate if the lack of normal diurnal rhythm of blood pressure is associated with cardiovascular risk factors. METHODS AND RESULTS: 73 obese children (body weight [mean+/-SD]: 89.0+/-17.8kg; age [mean+/-SD]: 14.2+/-2.3years), 42 dippers and 31 non-dippers were investigated. Following ambulatory blood pressure monitoring (ABPM), physical fitness testing was performed on a treadmill. Physical working capacity at 130, -150, -170beat/min (PWC-130, -150, -170), resting and peak oxygen consumption (VO(2)rest, VO(2)peak) were determined. Forty-two percent of obese children were non-dipper. PWC-130 (74.8+/-48.8 watts; 48.0+/-38.5watts), PWC-150 (132.9+/-52.1watts; 104.2+/-49.3watts), PWC-170 (185.9+/-49.5 watts; 154.9+/-53.4watts) and VO(2)rest, ([mean+/-SD]: 0.29+/-0.08L/min; 0.26+/-0.07L/min), and VO(2) peak (2.77+/-0.61L/min; 2.44+/-0.62L/min) were significantly lower in the non-dipper group, as compared to dippers (p<0.05). The prevalence of hypertension, on the basis of ABPM, was significantly higher in the non-dipper group (45.2% vs 83.9%, p<0.001). This is due to increased prevalence of masked hypertension in the non-dipper group (19.0% vs 32.3%, p<0.001). CONCLUSION: The normal circadian variation of the blood pressure is frequently absent in obese children. Most of the non-dipper obese children are hypertensive, and their physical fitness is decreased.

van der Kuip M., de Meer K., Westerterp K.R., Gemke R.J. (Oct 2007). Physical activity as a determinant of total energy expenditure in critically ill children. Clin Nutr. 26(6):744-51.

BACKGROUND & AIMS: For adequate nutritional support of critically ill children, knowledge of the patient’s energy expenditure is required. Steady state measurement by a metabolic monitor are defined as resting energy expenditure and may underestimate total energy expenditure in clinical practise. The aim of this study was to investigate total energy expenditure, resting energy expenditure and the relation with physical activity during critical illness and initial recovery. METHODS: We enrolled 20 patients (0-16yr) with sepsis or following surgery. During the first week following admission, total energy expenditure was measured with doubly labelled water, and compared with daily resting energy expenditure measurements (metabolic monitor). Activity levels were independently determined by tri-axial accelerometry. RESULTS: Resting energy expenditure was not different from Schofield’s predicted basal metabolic rate, but was 20% lower than total energy expenditure (P=0.006). Overall physical activity level (=total energy expenditure divided by resting energy expenditure) was 1.22 (95%CI: 1.08-1.36) and activity related energy expenditure (=total energy expenditure minus resting energy expenditure) was associated with accelerometry recordings (R(2)=0.72, P=0.02). CONCLUSIONS: During the week following pediatric intensive care admission, in the individual critically ill patient, activity related energy expenditure should be taken into account to prevent a negative energy balance.

Verberk W.J., Kroon A.A., Lenders J.W., Kessels A.G., van Montfrans G.A., Smit A.J., van der Kuy P.H., Nelemans P.J., Rennenberg R.J., Grobbee D.E., Beltman F.W., Joore M.A., Brunenberg D.E., Dirksen C., Thien T., de Leeuw P.W. (Dec 2007). Self-measurement of blood pressure at home reduces the need for antihypertensive drugs: a randomized, controlled trial. Hypertension. 50(6):1019-25.

It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure. In the present study, we investigated whether antihypertensive treatment based on self-measurement of blood pressure leads to the use of less medication without the loss of blood pressure control. We randomly assigned 430 hypertensive patients to receive treatment either on the basis of self-measured pressures (n=216) or office pressures (OPs; n=214). During 1-year follow-up, blood pressure was measured by office measurement (10 visits), ambulatory monitoring (start and end), and self-measurement (8 times, self-pressure group only). In addition, drug use, associated costs, and degree of target organ damage (echocardiography and microalbuminuria) were assessed. The self-pressure group used less medication than the OP group (1.47 versus 2.48 drug steps; P<0.001) with lower costs ($3222 versus $4420 per 100 patients per month; P<0.001) but without significant differences in systolic and diastolic OP values (1.6/1.0 mm Hg; P=0.25/0.20), in changes in left ventricular mass index (-6.5 g/m(2) versus -5.6 g/m(2); P=0.72), or in median urinary microalbumin concentration (-1.7 versus -1.5 mg per 24 hours; P=0.87). Nevertheless, 24-hour ambulatory blood pressure values at the end of the trial were higher in the self-pressure than in the OP group: 125.9 versus 123.8 mm Hg (P<0.05) for systolic and 77.2 versus 76.1 mm Hg (P<0.05) for diastolic blood pressure. These data show that self-measurement leads to less medication use than office blood pressure measurement without leading to significant differences in OP values or target organ damage. Ambulatory values, however, remain slightly elevated for the self-pressure group.

Verdejo H.E., Castro P.F., Concepción R., Ferrada M.A., Alfaro M.A., Alcaíno M.E., Deck C.C., Bourge R.C. (Dec 2007). Comparison of a radiofrequency-based wireless pressure sensor to swan-ganz catheter and echocardiography for ambulatory assessment of pulmonary artery pressure in heart failure. J Am Coll Cardiol. 50(25):2375-82.

OBJECTIVES: The goal of this work was to evaluate the accuracy of a new heart failure (HF) sensor (HFS) (Heart Failure Sensor, CardioMEMS Inc., Atlanta, Georgia) pulmonary artery pressure (PAP) monitoring compared with Swan-Ganz (SG) (Hospira, Inc., Lake Forest, Illinois) catheterization and echocardiography (ECHO) in ambulatory HF patients. BACKGROUND: There is an increasing interest in the development of ambulatory monitoring devices aiming to adjust therapy and prevent hospitalizations in HF patients. METHODS: Twelve patients with HF and New York Heart Association functional class II to IV were included in this study. The HFS was deployed into the pulmonary artery under angiography, allowing wireless PAP measurement. Two independent blind operators performed 3 HFS measurements at each visit, with simultaneous ECHO at 2, 14, 30, 60, and 90 days. Swan-Ganz catheterization was performed at 0 and 60 days. Linear regression was used as a measure of agreement. Variability between methods and interobserver variability were evaluated by Bland-Altman analysis. RESULTS: Mean age was 63 +/- 14.6 years. Systolic PAP was 64 +/- 22 mm Hg and 58 +/- 22 mm Hg for HFS and SG, respectively (p < 0.01). Both methods showed a significant correlation (r2 = 0.96 baseline, r2 = 0.90 follow-up, p < 0.01), with a mean difference of 6.2 +/- 4.5 mm Hg. Diastolic PAP was 23 +/- 14 mm Hg and 28 +/- 16 mm Hg for HFS and SG, respectively (r2 = 0.88 baseline, r2 = 0.48 follow-up, p < 0.01), with a mean difference of -1.6 +/- 6.8 mm Hg. Systolic PAP was 60 +/- 20 mm Hg and 62 +/- 12 mm Hg for HFS and ECHO, respectively (r2 = 0.75, p < 0.01), with a mean difference of -2.6 +/- 11 mm Hg. There was no significant interobserver difference. CONCLUSIONS: The HFS provides an accurate method for PAP assessment in the intermediate follow-up of HF patients.

Wang G.L., Li Y., Staessen J.A., Lu L., Wang J.G. (Dec 2007). Anthropometric and lifestyle factors associated with white-coat, masked and sustained hypertension in a Chinese population. J Hypertens. 25(12):2398-405.

OBJECTIVE: We investigated to what extent anthropometric and lifestyle factors contributed to the classification of Chinese individuals into groups with white-coat, masked and sustained hypertension (HT). METHODS: We measured the office and ambulatory blood pressure (BP) in 694 Chinese enrolled in the JingNing population study (45.7% men; mean age, 48.4 years). In multivariate-adjusted analyses, we determined the correlates of both types of BP and the factors contributing to white-coat HT (conventional and daytime BP > or =140/90 and <135/85 mmHg, respectively), masked HT (<140/90 and > or =135/85 mmHg) and sustained HT (> or =140/90 and > or =135/85 mmHg), relative to normotension (<140/90 and <135/85 mmHg). RESULTS: In continuous analyses, the conventional and daytime BPs were positively associated with age, body mass index and urinary sodium, and inversely with urinary potassium. The prevalence of white-coat, masked and sustained HT was 7.8, 10.8, and 35.0%, respectively. In line with the continuous analyses, the risk of sustained hypertension increased with age [odds ratio (OR), 2.11 per 10 years], body mass index (OR, 1.27 per 1 kg/m2) and urinary sodium (OR, 1.18 per 50 mmol/day), but was inversely associated with urinary potassium (OR, 0.34 per 25 mmol/day). Furthermore, the risk of white-coat and masked HT increased with age (OR, 1.79 and 1.40, respectively) and body mass index (OR, 1.14 and 1.12). Women were less likely to have masked hypertension than men (OR, 0.39). CONCLUSIONS: Sex, age, body mass index, and urinary sodium and potassium excretion contribute to the risk of white-coat, masked and sustained HT in Chinese.

Waters A.J., Li Y. (Dec 2007). Evaluating the utility of administering a reaction time task in an ecological momentary assessment study. Psychopharmacology Epub ahead of print

RATIONALE: Cognitive processes underlying drug use have typically been assessed in laboratory settings. More detailed and ecologically valid data may be possible if assessments were conducted in an ecological momentary assessment (EMA) setting. OBJECTIVES: We evaluated the feasibility and utility of administering a reaction time task on a hand-held computer (personal digital assistant, PDA) in an EMA setting. MATERIALS AND METHODS: Twenty-two smokers and 22 non-smokers carried around the PDA for 1 week as they went about their daily lives. They were beeped at random times four times per day (random assessments, RAs). Participants were also instructed to press an “anxiety assessment” (AA) button on the PDA whenever they felt suddenly anxious. At each assessment (RA, AA), participants responded to items assessing subjective, pharmacological, and contextual variables, and subsequently completed a Stroop task (classic-Stroop, emotional-Stroop, or smoking-Stroop task). RESULTS: Participants responded to 81.2% of RAs, completed assessments in an average of 4.44 min, reported no interruptions on the majority of assessments (62.4%), and produced data with adequate reliability. Using generalized estimating equation (GEE) analyses, age was associated with the classic-Stroop effect, state anxiety was associated with the emotional-Stroop effect, and Fagerstrom Test for Nicotine Dependence scores were associated with the smoking-Stroop effect. CONCLUSIONS: The study provided evidence for the feasibility and utility of the approach.

Whalen D.J., Silk J.S., Semel M., Forbes E.E., Ryan N.D., Axelson D.A., Birmaher B., Dahl R.E. (Oct 2007). Caffeine Consumption, Sleep, and Affect in the Natural Environments of Depressed Youth and Healthy Controls. J Pediatr Psychol. Epub ahead of print

OBJECTIVE: Sleep problems are a cardinal symptom of depression in children and adolescents and caffeine use is a prevalent and problematic issue in youth; yet little is known about caffeine use and its effects on sleep in youth with depression. We examined caffeine use and its relation to sleep and affect in youth’s natural environments. METHODS: Thirty youth with major depressive disorder (MDD) and 23 control youth reported on caffeine use, sleep, and affect in their natural environment using ecological momentary assessment at baseline and over 8 weeks, while MDD youth received treatment. RESULTS: Youth with MDD reported more caffeine use and sleep problems relative to healthy youth. Youth with MDD reported more anxiety on days they consumed caffeine. Caffeine use among youth with MDD decreased across treatment, but sleep complaints remained elevated. CONCLUSIONS: Findings suggest that both sleep quality and caffeine use are altered in pediatric depression; that caffeine use, but not sleep problems, improves with treatment; and that caffeine may exacerbate daily anxiety among youth with depression.

Wilhelm P. & Schoebi D. (2007). Assessing mood in daily life: Structural validity, sensitivity to change, and reliability of a short-scale to measure three basic dimensions of mood. European Journal of Psychological Assessment, Vol 23(4): 258-267. Special issue: Advances in the methodology of ambulatory assessment

The repeated measurement of moods in everyday life, as is common in ambulatory monitoring, requires parsimonious scales, which may challenge the reliability of the measures. The current paper evaluates the factor structure, the reliability, and the sensitivity to change of a six-item mood scale designed for momentary assessment in daily life. We analyzed data from 187 participants who reported their current mood four times per day during seven consecutive days using a multilevel approach. The results suggest that the proposed three factors Calmness, Valence, and Energetic arousal are appropriate to assess fluctuations within persons over time. However, calmness and valence are not distinguishable at the between-person level. Furthermore, the analyses showed that two-item scales provide measures that are reliable at the different levels and highly sensitive to change.

Yoshiuchi K., Cook D.B., Ohashi K. (Dec 2007). A real-time assessment of the effect of exercise in chronic fatigue syndrome. Physiology & Behavior. 92(5): 963-968.

Patients with chronic fatigue syndrome (CFS) report substantial symptom worsening after exercise. However, the time course over which this develops has not been explored. Therefore, the objective of this study was to investigate the influence of exercise on subjective symptoms and on cognitive function in CFS patients in natural settings using a computerized ecological momentary assessment method, which allowed us to track the effects of exercise within and across days. Subjects were 9 female patients with CFS and 9 healthy women. A watch-type computer was used to collect real-time data on physical and psychological symptoms and cognitive function for 1week before and 2weeks after a maximal exercise test. For each variable, we investigated temporal changes after exercise using multilevel modeling. Following exercise, physical symptoms did get worse but not until a five-day delay in CFS patients. Despite this, there was no difference in the temporal pattern of changes in psychological symptoms or in cognitive function after exercise between CFS patients and controls. In conclusion, physical symptoms worsened after several days delay in patients with CFS following exercise while psychological symptoms or cognitive function did not change after exercise.

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