Society for Ambulatory Assessment

Fourth quarter 2010 (October to December)

Abramson, J. L., Lewis, C., & Murrah, N. V. (2011). Body mass index, leptin, and ambulatory blood pressure variability in healthy adults. Atherosclerosis, 214, 456-461.

OBJECTIVE: To investigate the association between body mass index (BMI) and 24-h ambulatory blood pressure (ABP) variability, and to assess whether leptin might act as a mediator of this association. METHODS: A cross-sectional study in healthy, normotensive men and women (n = 156). BMI was derived from direct height and weight measurements made on each participant. All participants underwent 24-h ABP monitoring, and two measures of ABP variability were derived–the weighted standard deviation (wSD) and the average real variability (ARV). Plasma leptin was measured using an enzyme lined immunosorbant assay. RESULTS: In linear regression models adjusted for demographic factors, glucose, creatinine, lipids, and mean ABP, BMI showed positive and statistically significant associations with diastolic wSD, and systolic and diastolic ARV. For those in the low, intermediate, and high BMI groups, mean values for diastolic wSD were 7.7, 7.9, and 8.5 mmHg, respectively (p = .02); mean values of systolic ARV were 8.2, 8.2, and 9.0 mmHg, respectively (p=.02); and mean values of diastolic ARV were 6.7, 7.0, and 7.5 mmHg, respectively (p = .01). Similarly, leptin showed positive and statistically significant associations with measures of wSD and ARV. When BMI was entered as an ordinal variable in regression models for wSD and ARV, adjustment for leptin attenuated significant ordinal BMI coefficients by as much as 60%, suggesting a mediating role for leptin. CONCLUSION: In healthy adults, BMI and leptin show positive associations with ABP variability, and leptin may play a mediating role in this association

Antonicelli, R., Mazzanti, I., Abbatecola, A. M., & Parati, G. (2010). Impact of home patient telemonitoring on use of beta-blockers in congestive heart failure. Drugs Aging, 27, 801-805.

INTRODUCTION: Congestive heart failure (CHF), which typically affects older people, is characterized by high short- and mid-term mortality rates. However, despite accumulating evidence showing that administration of beta-blockers (beta-adrenoceptor antagonists) can improve the clinical status of CHF patients, use of these agents in adequate dosages in this setting is not routine. One reason for this appears to be a concern about a possible risk of bradyarrhythmia associated with use of beta-blockers. Telecardiology has recently been investigated as a means of constantly monitoring the heart rate of CHF patients in their homes. Its use may allay concerns about the risk of bradyarrhythmia and facilitate a more widespread use of beta-blockers in this context. OBJECTIVES: The primary objectives of this study were to assess the impact of telemonitoring on patients’ adherence to prescribed therapeutic regimens, particularly beta-blockers, and to explore whether use of home telemonitoring reduces mortality and rate of re-admission to hospital in elderly CHF patients compared with normal specialized CHF team care. METHODS: A total of 57 patients with CHF (31 New York Heart Association [NYHA] class II, 23 NYHA class III and 3 NYHA class IV), with a mean +/- SD age of 78.2 +/- 7.3 years, were randomized to a control group who received standard care, based on routinely scheduled clinic visits, from a team specialized in CHF patient management, or to a home telemonitoring group (TM group), managed by the same specialized CHF team. Patients were followed up over 12 months. RESULTS: Compared with the control group, the TM group had a significant increase in the use of beta-blockers, HMG-CoA reductase inhibitors (statins) and aldosterone receptor antagonists. A reduction in nitrate administration compared with baseline was also seen in the TM group. The 12-month occurrence of the primary combined endpoint of mortality and hospital re-admission for CHF was significantly lower in the TM group than in the control group (p < 0.01). CONCLUSIONS: This study showed that a home-care model including telemonitoring of relevant clinical parameters may provide useful support in the management of patients with CHF. Home telemonitoring in CHF patients was associated with increased use of beta-blockers at appropriate doses, suggesting that this strategy reassured physicians regarding the safety of careful use of these agents in this setting. However, larger studies are required to confirm these findings. Our findings indicate that there is a need to investigate relevant parameters in CHF patients at the point of care (i.e. in patients’ daily lives), which can in turn optimize beta-blocker and other drug therapy.

Arzbaecher, R., Hampton, D. R., Burke, M. C., & Garrett, M. C. (2010). Subcutaneous electrocardiogram monitors and their field of view. J Electrocardiol., 43, 601-605.

Continuous electrocardiogram (ECG) monitoring of cardiac patients on a long-term, even permanent, basis has become possible. Postsurgical cases, those with significant risk factors, or patients with chronic conditions are candidates for these procedures to assess evolving risk factors and detect life-threatening events. A small sensing device can be implanted subcutaneously to assess the ECG, transmitting status and alerts to local caregivers or a remote monitoring service. We and others have shown that a differential electrode pair with only 2- to 3-cm spacing can produce QRS amplitudes greater than 1 mV, sufficient to accurately identify asystole, tachyarrhythmias, and ST-segment changes. Medtronic’s REVEAL and St Jude Medical’s CONFIRM are implantable look recorders (ILRs) with a single pair of subcutaneous electrodes mounted on the surface of the case (6 x 2 x 0.7 cm). They store representative rhythm strips when the heart rate exceeds preset limits or when the patient presses a button on the accompanying actuator. These records may be transferred for physician review during a subsequent office visit. Transoma’s SLEUTH is a similar ILR, except that one of the electrodes is at the end of a 6-cm lead tunneled under the skin and the wider separation may result in a larger ECG amplitude. Instead of storing the records, SLEUTH transmits them through the skin to a home base unit, which sends them via telephone to a monitoring service. Angel Medical’s ALERT system also has a tunneled lead, but one that is introduced pervenously into the right ventricle hoping to detect ST changes in addition to rhythm abnormalities. Advanced multivector ILR devices with integrated event alerting are rapidly approaching commercialization. AJ Medical Devices’ CARDIOALARM (4 x 4 x 0.6 cm) has 4 electrodes at the corners of the square package, arranged as 2 orthogonal recording pairs that can produce a robust signal that is relatively immune to signal fluctuations caused by changes in the direction of cardiac activation and patient’s body position. This permits accurate identification of dramatic changes in the ECG pattern, such as those occurring in ventricular fibrillation and polymorphic tachycardia. Because of this feature, CARDIOALARM can detect cardiac arrest, and its external receiver can alert bystanders to begin cardiopulmonary resuscitation and can automatically summon Emergency Medical Services. In the future, addition of other sensors, integration of data streams via body surface wireless networks, and real-time interpretive algorithms will allow enhanced monitoring systems to more generally assess evolving risks, the impacts of therapeutic interventions, and patient compliance with rehabilitative programs. When coupled to remote medical monitoring services, these devices have the potential to dramatically impact patient outcomes by lessening the diagnostic dependence on symptom recognition and decreasing event response times. Significant cost savings may also be realized through more efficient use of specialist resources, reduction in the number of office visits to physicians, and long-term improvements in patient health. Structural and behavior barriers to adoption need to be addressed for these methods to reach their full potential, addressing patient privacy concerns, adequate reimbursement, and integration into standard care protocols

Badr, H., Laurenceau, J. P., Schart, L., Basen-Engquist, K., & Turk, D. (2010). The daily impact of pain from metastatic breast cancer on spousal relationships: a dyadic electronic diary study. Pain, 151, 644-654.

Women with metastatic breast cancer (MBC) experience high levels of emotional distress and pain. Although individuals often rely on their intimate partners to provide physical and emotional support when they are in pain, the daily impact of pain on the spousal relationship in the context of advanced cancer is unclear. To understand how relationships are affected by pain, 57 MBC patients and their partners completed electronic diary assessments 6 times a day for 14 days. Patients and partners rated the patient’s pain, their own mood (circumplex adjectives), the provision/receipt of social support, and the degree to which cancer interfered with their relationship. Multilevel mediation models with the couple as the unit of analysis were estimated. Partners and patients reported greater relationship interference when patients experienced more pain and less aroused (i.e., more tired, less peppy, less active) mood. Greater tired mood during the day accounted for 17% and 82% of the association between patients’ morning pain and their evening ratings of emotional and physical support from their partners, respectively. Partners did not directly respond to patients’ pain by providing emotional or physical support; however, they were more likely to provide support when patients experienced more tired and less active mood as a consequence of their pain. Results suggest that one way that pain may wear on couples’ relationships is through its adverse effects on patients’ daily mood. They also suggest that partners may base their provision of support on their perception of the adverse effects of pain on patients’ aroused mood

Bailey, C. & Buckley, V. (2011). Recruiting and retaining older persons within a home-based pilot study using movement sensors. Health Soc.Care Community, 19, 98-105.

In this paper, we report on key aspects of recruiting and retaining a small group of community dwelling older adults in to a study, piloting motion sensors in their homes for 8 weeks. This was to further understanding of older adults’ falls at home. We consider our recruitment strategy in terms of informed consent and non-exploitation; planning and explaining, and our retention strategy in terms of communicating and recording and pacing and sharing data. Offering reflective analyses of our challenges and strategies may help develop skills that maximise the involvement of older adults in research, particularly technologies related research, whilst at the same time ensuring inclusive and non-exploitative research relationships

Bassett, D. R., Jr., Wyatt, H. R., Thompson, H., Peters, J. C., & Hill, J. O. (2010). Pedometer-measured physical activity and health behaviors in U.S. adults. Med Sci.Sports Exerc., 42, 1819-1825.

U.S. adults may have lower levels of ambulatory physical activity compared with adults living in other countries. PURPOSE: The purpose of this study was to provide descriptive, epidemiological data on the average number of steps per day estimated to be taken by U.S. adults and to identify predictors of pedometer-measured physical activity on the basis of demographic characteristics and self-reported behavioral characteristics. METHODS: The America On the Move study was conducted in 2003. Individuals (N = 2522) aged 13 yr and older consented to fill out a survey, including 1921 adults aged 18 yr and older. Valid pedometer data were collected on 1136 adults with Accusplit AE120 pedometers. Data were weighted to reflect the general U.S. population according to several variables (age, gender, race/ethnicity, education, income, level of physical activity, and number of 5- to 17-yr-old children in the household). Differences in steps per day between subgroups were analyzed using unpaired t-tests when only two subgroups were involved or one-way ANOVA if multiple subgroups were involved. RESULTS: Adults reported taking an average of 5117 steps per day. Male gender, younger age, higher education level, single marital status, and lower body mass index were all positively associated with steps per day. Steps per day were positively related to other self-reported measures of physical activity and negatively related to self-reported measures on physical inactivity. Living environment (urban, suburban, or rural) and eating habits were not associated with steps per day. CONCLUSIONS: In the current study, men and women living in the United States took fewer steps per day than those living in Switzerland, Australia, and Japan. We conclude that low levels of ambulatory physical activity are contributing to the high prevalence of adult obesity in the United States

Bedford, J. L., Linden, W., & Barr, S. I. (2010). Negative eating and body attitudes are associated with increased daytime ambulatory blood pressure in healthy young women. International Journal of Psychophysiology.

BACKGROUND AND OBJECTIVE: Various psychosocial stressors have been associated with increased ambulatory blood pressure (ABP) and cortisol in middle-aged women. Given that many young women report negative eating/body attitudes, we examined whether these attitudes were associated with cortisol and ABP in a cross-sectional study. METHODS: 120 non-obese, healthy women aged 1935 completed questionnaires, measurement of 24-h urinary free cortisol (UFC), and 12-h daytime ABP. Main and interactive effects of eating/body attitudes (average Z-score of Eating/body attitude questionnaires split at zero) and current weight loss effort (yes/no) were examined by General Linear Modeling adjusted for covariates. RESULTS: Women with negative eating/body attitudes were more likely to report current weight loss attempts (63% versus 21%, p<0.001). Eating/body attitudes or weight loss effort did not have main or interactive effects on age, physical activity level, energy intakes, general stress (average Z-score of psychosocial stress questionnaires) or UFC. Body mass index was higher among those currently trying to lose weight but did not differ by eating/body attitudes. Significant main effects of eating/body attitudes were detected on ABP: diastolic ABP (73.2-¦0.7 versus 70.3-¦0.8mm Hg, p=0.011) and mean arterial pressure (87.3-¦0.7 versus 84.9-¦0.8mm Hg, p=0.032) were higher among women with negative versus neutral/positive eating/body attitudes. There were no weight loss effort main effects for ABP, or weight loss effort-by-Eating/body attitude interactions. CONCLUSION: This exploratory study suggests that more negative eating/body-related attitudes may be modestly associated with higher ABP independent of weight loss effort.

Bianchi, F., Redmond, S. J., Narayanan, M. R., Cerutti, S., & Lovell, N. H. (2010). Barometric pressure and triaxial accelerometry-based falls event detection. IEEE Trans.Neural Syst.Rehabil.Eng, 18, 619-627.

Falls and fall related injuries are a significant cause of morbidity, disability, and health care utilization, particularly among the age group of 65 years and over. The ability to detect falls events in an unsupervised manner would lead to improved prognoses for falls victims. Several wearable accelerometry and gyroscope-based falls detection devices have been described in the literature; however, they all suffer from unacceptable false positive rates. This paper investigates the augmentation of such systems with a barometric pressure sensor, as a surrogate measure of altitude, to assist in discriminating real fall events from normal activities of daily living. The acceleration and air pressure data are recorded using a wearable device attached to the subject’s waist and analyzed offline. The study incorporates several protocols including simulated falls onto a mattress and simulated activities of daily living, in a cohort of 20 young healthy volunteers (12 male and 8 female; age: 23.7 +/-3.0 years). A heuristically trained decision tree classifier is used to label suspected falls. The proposed system demonstrated considerable improvements in comparison to an existing accelerometry-based technique; showing an accuracy, sensitivity and specificity of 96.9%, 97.5%, and 96.5%, respectively, in the indoor environment, with no false positives generated during extended testing during activities of daily living. This is compared to 85.3%, 75%, and 91.5% for the same measures, respectively, when using accelerometry alone. The increased specificity of this system may enhance the usage of falls detectors among the elderly population

Bishop, G. D., Ng, D. P. K., Ngau, F., & Nurbaya, S. (2010). Ethnicity, gender, genotype, and anger as related to nocturnal dipping. Psychophysiology, 47, 1094-1101.

Bishop, Pek, and Ngau (2005) found a significant interaction in Singapore between anger and nocturnal dipping among Indians but not Chinese and Malays. The current study examines the role of 5-HTTLPR genotype in this relationship. Two hundred thirty-one undergraduates participated in up to 4 days of 24-h ambulatory monitoring, completed the State-Trait Anger Expression Inventory, and provided blood samples for genotyping of 5-HTTLPR. Results indicated individuals with two copies of the short allele (SS) showed reduced dipping when they were high in Outward Anger (OA) but increased dipping when they were low in OA. Further, for Indian men only, dipping was reduced for individuals having the SS genotype when they were low on Anger In and increased when they were high on Anger In. These data provide further evidence for the role of 5-HTTLPR in cardiovascular risk as well as ethnic differences in the 5-HTTLPRphenotype relationship. They also provide further evidence for 5-HTTLPR as a plasticity gene.

Bjornson, K., Song, K., Lisle, J., Robinson, S., Killien, E., Barrett, T., & Zhou, C. (2010). Measurement of walking activity throughout childhood: influence of leg length. Pediatr.Exerc.Sci., 22, 581-595.

The aim of this study was to describe walking (stride) activity frequency and intensity in 428 children ages 2-15 years with a single accelerometer-based device. With comparison with published pedometer-determined data, the influence of leg length was examined. Decline in stride frequency and intensity throughout childhood increased with adjustment for leg length. The accelerometer-based device documented higher stride counts than published pedometer-based data with the greatest discrepancy in 4-5 year olds. Recommended walking levels for optimal weight throughout childhood should be examined with knowledge of the device measurement differences and the natural history of walking activity changes with age

Bond, D. S., Jakicic, J. M., Unick, J. L., Vithiananthan, S., Pohl, D., Roye, G. D., Ryder, B. A., Sax, H. C., & Wing, R. R. (2010). Pre- to postoperative physical activity changes in bariatric surgery patients: self report vs. objective measures. Obesity.(Silver.Spring), 18, 2395-2397.

Bariatric surgery patients report significant pre- to postoperative increases in physical activity (PA). However, it is unclear whether objective measures would corroborate these changes. The present study compared self-reported and accelerometer-based estimates of changes in moderate-to-vigorous intensity PA (MVPA) from pre- (pre-op) to 6 months postsurgery (post-op). Twenty bariatric surgery (65% laparoscopic-adjustable gastric banding, 35% gastric bypass) patients (46.2 +/- 9.8 years, 88% female, pre-op BMI = 50.8 +/- 9.7 kg/m(2)) wore RT3 accelerometers as an objective measure of MVPA and completed the Paffenbarger Physical Activity Questionnaire (PPAQ) as a subjective measure before and 6 months after bariatric surgery. Time (min/week) spent in MVPA was calculated for the PPAQ and RT3 (>/= 1-min and >/= 10-min bouts) at pre-op and post-op. Self-reported MVPA increased fivefold from pre-op to post-op (44.6 +/- 80.8 to 212.3 +/- 212.4 min/week; P < 0.005). By contrast, the RT3 showed nonsignificant decreases in MVPA for both >/= 1-min (186.0 +/- 169.0 to 151.2 +/- 118.3 min/week) and >/= 10-min (41.3 +/- 109.3 to 39.8 +/- 71.3 min/week) bouts. At pre-op, the percentage of participants who accumulated >/= 150-min/week of MVPA in bouts >/= 10-min according to the PPAQ and RT3 was identical (10%). However, at post-op, 55% of participants reported compliance with the recommendation compared to 5% based on RT3 measurement (P = 0.002). Objectively-measured changes in MVPA from pre-op to 6 months post-op appear to be much smaller than self-reported changes. Further research involving larger samples is needed to confirm these findings and to determine whether self-report and objective PA measures are differentially associated with surgical weight loss outcomes

Bossenbroek, L., Kosse, N., Ten, H. N., Gordijn, M., Van der Hoeven, J., & De, G. M. (2010). Validation of the DynaPort MiniMod during sleep: a pilot study. Percept.Mot.Skills, 111, 936-946.

To measure activity during sleep, polysomnography and actigraphy are often used. The DynaPort MiniMod measures movement intensity and body position day and night. The goal was to examine the validity of the DynaPort MiniMod in assessing physical activity and body posture during sleep. In Study A, 10 healthy participants slept with the DynaPort MiniMod and the Actiwatch for one night. In Study B, 8 participants suspected of having Obstructive Sleep Apnoea Syndrome slept for one night with the DynaPort MiniMod and underwent complete polysomnography as part of the typical care protocol. In Study A, there was a significant moderate correlation (r = .70) between the movement scores of the Actiwatch and the DynaPort MiniMod. In Study B, a high intraclass correlation (r = .84) between body posture scores of the DynaPort MiniMod and the polysomnography position sensor was observed. The DynaPort MiniMod is a valid measurement device for physical activity during sleep

Brown, D. E., Sievert, L. L., Morrison, L. A., Rahberg, N., & Reza, A. (2011). Relationship between hot flashes and ambulatory blood pressure: the Hilo women’s health study. Psychosom.Med, 73, 166-172.

OBJECTIVES: To examine ambulatory blood pressure (BP) differences between women who report hot flashes (HFs) and those who do not, and to observe whether an objectively measured HF is associated with transient changes in BP. HFs have been associated with elevated BP, but studies have not examined the relationship between objectively measured HFs and blood pressure during normal daily activities. METHODS: A sample of 202 women in Hilo, Hawaii, aged 45 to 55 years, were asked to fill out a questionnaire that included demographic information and an inventory of symptoms. The women underwent simultaneous 24-hour monitoring of ambulatory BP and HFs, at the same time keeping a diary that included mood and HF reports. RESULTS: No significant difference was present in mean BP between women who reported having an HF during the last 2 weeks and those who did not. When measurements controlled for negative mood reports and posture, there was a highly significant elevation in Z scores of systolic BP when a measured, objective HF occurred within 10 minutes before a BP reading, and a significant elevation of Z scores of diastolic BP when a subjectively reported HF occurred within 10 minutes after a BP reading. CONCLUSIONS: These results suggest that objectively measured HFs precede transient elevations of systolic BP, but it is unclear if there is a causal relationship. These results also suggest that women experience subjective HFs within 10 minutes after a transient increase in diastolic BP. Again, the causal relationship is not understood

Buman, M. P., Hekler, E. B., Haskell, W. L., Pruitt, L., Conway, T. L., Cain, K. L., Sallis, J. F., Saelens, B. E., Frank, L. D., & King, A. C. (2010). Objective light-intensity physical activity associations with rated health in older adults. Am J Epidemiol., 172, 1155-1165.

The extent to which light-intensity physical activity contributes to health in older adults is not well known. The authors examined associations between physical activity across the intensity spectrum (sedentary to vigorous) and health and well-being variables in older adults. Two 7-day assessments of accelerometry from 2005 to 2007 were collected 6 months apart in the observational Senior Neighborhood Quality of Life Study of adults aged >65 years in Baltimore, Maryland, and Seattle, Washington. Self-reported health and psychosocial variables (e.g., lower-extremity function, body weight, rated stress) were also collected. Physical activity based on existing accelerometer thresholds for moderate/vigorous, high-light, low-light, and sedentary categories were examined as correlates of physical health and psychosocial well-being in mixed-effects regression models. Participants (N = 862) were 75.4 (standard deviation, 6.8) years of age, 56% female, 71% white, and 58% overweight/obese. After adjustment for study covariates and time spent in moderate/vigorous physical activity and sedentary behavior, low-light and high-light physical activity were positively related to physical health (all P < 0.0001) and well-being (all P < 0.001). Additionally, replacing 30 minutes/day of sedentary time with equal amounts of low-light or high-light physical activity was associated with better physical health (all P < 0.0001). Objectively measured light-intensity physical activity is associated with physical health and well-being variables in older adults

Camburn, E. M., Spillane, J. P., & Sebastian, J. (2010). Assessing the utility of a daily log for measuring principal leadership practice. Educational Administration Quarterly, 46, 707-737.

Purpose: This study examines the feasibility and utility of a daily log for measuring principal leadership practice. Setting and Sample: The study was conducted in an urban district with approximately 50 principals. Approach: The log was assessed against two criteria: (a) Is it feasible to induce strong cooperation and high response rates among principals with a daily instrument? and (b) Can daily logs accurately measure important aspects of principal leadership? The first criterion was assessed through a discussion of data collection procedures and results. The second criterion was assessed through mixed-method analyses comparing daily logs, observations, and an experience-sampling instrument. Results: The authors found that substantial participant contact time and strategic follow-up achieved strong cooperation and yielded high response rates. The accuracy of the log was confirmed through comparisons with an experience-sampling instrument and direct observations. The results also contribute to a broader understanding of how principals allocate their time across leadership domains. Like earlier structured observation studies, the authors found that principals spend more time on management, personnel issues, and student affairs and less time on instructional leadership than advocated by leadership scholars and professional standards. Implications for Research and Practice: Daily logs appear to be a viable means of measuring important aspects of principal practice and overcoming measurement errors associated with one-time surveys that are common in leadership research. Strategies used to maintain high participation rates are discussed in detail, and an example of a districts adaptation of the daily log methodology is provided.

Camilleri, M., Rothman, M., Ho, K. F., & Etropolski, M. (2011). Validation of a bowel function diary for assessing opioid-induced constipation. Am J Gastroenterol., 106, 497-506.

OBJECTIVES: Validated tools to assess opioid-induced constipation (OIC) are needed. The aim of this study was to validate a Bowel Function Diary (BF-Diary) that includes patient-reported outcomes (PROs) associated with OIC. METHODS: In a multicenter, observational study, opioid-naive or recently untreated (>/= 14 days) adults with nonmalignant, chronic pain who were prescribed oral opioid and usual care completed an electronic diary daily for 2 weeks. Test-retest reliability was assessed. Validity was evaluated for two composite end points–number of spontaneous bowel movements (SBM) and complete SBMs (SCBM)–and for other relevant PROs. RESULTS: Of 238 patients (mean age 54 years, 58% women), 63% reported constipation. The intraclass correlation coefficient for numbers of SBM and SCBM, and other BF-Diary PROs was >/= 0.71 for all items except stool consistency. Mean (s.d.) number of SBM per week was significantly less in each week for patients with vs. without constipation (5.6 +/- 4.3 and 7.3 +/- 3.6, respectively over week 1, P=0.0012; similarly, P=0.0096 over week 2). Validity of individual items in the BF-Diary was supported (P<0.05, stool consistency; P<0.0001, all others). CONCLUSIONS: BF-Diary items are generally reliable and valid assessments for OIC research. Specifically, number of SBM is a valid measure for differentiating opioid-treated patients with and without constipation

Campbell, P., Ghuman, N., Wakefield, D., Wolfson, L., & White, W. B. (2010). Long-term reproducibility of ambulatory blood pressure is superior to office blood pressure in the very elderly. J Hum.Hypertens., 24, 749-754.

Although it is known that reproducibility of ambulatory blood pressure (BP) is superior to office BP in middle-aged subjects, little is known in older age groups. Hence, we compared the long-term reproducibility of ambulatory and office BP readings in subjects over the age of 75 years. A cohort of 72 subjects 75-90 years of age (mean, 82 years at baseline) had repeat office and ambulatory BPs 2 years apart under similar conditions. On the same day, patients underwent office BP measurements by a semi-automated device and then by ambulatory BP monitoring. Awake and sleep periods were divided according to a diary kept by each patient. The agreement between studies was assessed using the standard deviation of the differences (SDD) and Bland-Altman plots. There were minimal mean changes in office, 24-h, and awake and sleep mean BP values between baseline and 2 years later. The SDDs between visits were lower for 24-h BP compared with the office BP (11.7/5.9 mm Hg versus 17.8/9.0 mm Hg, P<0.01). The SDD for 24-h BP was also lower than the SDDs for the awake and sleep BP (P<0.05). Nocturnal BPs defined by absolute values were more reproducible than categories of dippers and non-dippers. These data demonstrate that long-term reproducibility of 24-h BP is superior to office measurements for very elderly subjects. In a clinical trial involving this age group, far fewer subjects would be required if 24-h BP was the primary efficacy endpoint rather than the office BP

Carstensen, L. L., Turan, B., Scheibe, S., Ram, N., Ersner-Hershfield, H., Samanez-Larkin, G. R., Brooks, K. P., & Nesselroade, J. R. (2010). Emotional experience improves with age: Evidence based on over 10 years of experience sampling. Psychology and Aging.

Recent evidence suggests that emotional well-being improves from early adulthood to old age. This study used experience-sampling to examine the developmental course of emotional experience in a representative sample of adults spanning early to very late adulthood. Participants (N = 184, Wave 1; N = 191, Wave 2; N = 178, Wave 3) reported their emotional states at five randomly selected times each day for a one week period. Using a measurement burst design, the one-week sampling procedure was repeated five and then ten years later. Cross-sectional and growth curve analyses indicate that aging is associated with more positive overall emotional well-being, with greater emotional stability and with more complexity (as evidenced by greater co-occurrence of positive and negative emotions). These findings remained robust after accounting for other variables that may be related to emotional experience (personality, verbal fluency, physical health, and demographic variables). Finally, emotional experience predicted mortality; controlling for age, sex, and ethnicity, individuals who experienced relatively more positive than negative emotions in everyday life were more likely to have survived over a 13 year period. Findings are discussed in the theoretical context of socioemotional selectivity theory.

Chen, B. R., Patel, S., Buckley, T., Rednic, R., McClure, D. J., Shih, L., Tarsy, D., Welsh, M., & Bonato, P. (2011). A web-based system for home monitoring of patients with Parkinson’s disease using wearable sensors. IEEE Trans.Biomed.Eng, 58, 831-836.

This letter introduces MercuryLive, a platform to enable home monitoring of patients with Parkinson’s disease (PD) using wearable sensors. MercuryLive contains three tiers: a resource-aware data collection engine that relies upon wearable sensors, web services for live streaming and storage of sensor data, and a web-based graphical user interface client with video conferencing capability. Besides, the platform has the capability of analyzing sensor (i.e., accelerometer) data to reliably estimate clinical scores capturing the severity of tremor, bradykinesia, and dyskinesia. Testing results showed an average data latency of less than 400 ms and video latency of about 200 ms with video frame rate of about 13 frames/s when 800 kb/s of bandwidth were available and we used a 40% video compression, and data feature upload requiring 1 min of extra time following a 10 min interactive session. These results indicate that the proposed platform is suitable to monitor patients with PD to facilitate the titration of medications in the late stages of the disease

Colvin, P. J. & Mermelstein, R. J. (2010). Adolescents smoking outcome expectancies and acute emotional responses following smoking. Nicotine & Tobacco Research, 12, 1203-1210.

Introduction: Magnitude of mood change following smoking may be an important reinforcing effect in smoking escalation in adolescent smokers. This study used ecological momentary assessments (EMA) of adolescent smokers reports of mood during smoking events to examine (a) whether global reports of negative affect (NA) expectancies were associated with in-the-moment magnitude of negative and positive mood change following smoking, (b) the possibility of a reciprocal feedback loop between global NA expectancies and acute mood change following smoking, and (c) whether this relationship generalizes to other expectancies and mood change. Methods: Participants were 234 9th and 10th graders (54% female) who recorded at least one smoking event during 7 days of EMA data collection. Results: Global reports of NA expectancies were significantly associated with the in-the-moment magnitude of changes in mood following smoking. Specifically, higher NA expectancies were associated with greater decreases in negative and greater increases in positive mood. Additionally, mood change following smoking predicted changes in NA expectancies but only for adolescents who continued to smoke 6 months later. The reciprocal feedback loop between expectancies and mood change was only present in adolescent smokers who continued to smoke over time. Findings indicated that this relationship is specific to NA expectancies and negative and positive mood change. Conclusions: These results highlight the importance of considering NA expectancies and mood changes following smoking in adolescent smokers. Assessing expectancies about NA relief may provide an opportunity for identifying and intervening on adolescents who may be most at risk for continuing to smoke.

Crisco, J. J., Fiore, R., Beckwith, J. G., Chu, J. J., Brolinson, P. G., Duma, S., McAllister, T. W., Duhaime, A. C., & Greenwald, R. M. (2010). Frequency and location of head impact exposures in individual collegiate football players. Journal of Athletic Training, 45, 549-559.

Context: Measuring head impact exposure is a critical step toward understanding the mechanism and prevention of sport-related mild traumatic brain (concussion) injury, as well as the possible effects of repeated subconcussive impacts. Objective: To quantify the frequency and location of head impacts that individual players received in 1 season among 3 collegiate teams, between practice and game sessions, and among player positions. Design: Cohort study. Setting: Collegiate football field. Patients or Other Participants: One hundred eighty-eight players from 3 National Collegiate Athletic Association football teams. Intervention(s): Participants wore football helmets instrumented with an accelerometer-based system during the 2007 fall season. Main Outcome Measure(s): The number of head impacts greater than 10g and location of the impacts on the player’s helmet were recorded and analyzed for trends and interactions among teams (A, B, or C), session types, and player positions using Kaplan-Meier survival curves. Results: The total number of impacts players received was nonnormally distributed and varied by team, session type, and player position. The maximum number of head impacts for a single player on each team was 1022 (team A), 1412 (team B), and 1444 (team C). The median number of head impacts on each team was 4.8 (team A), 7.5 (team B), and 6.6 (team C) impacts per practice and 12.1 (team A), 14.6 (team B), and 16.3 (team C) impacts per game. Linemen and linebackers had the largest number of impacts per practice and per game. Offensive linemen had a higher percentage of impacts to the front than to the back of the helmet, whereas quarterbacks had a higher percentage to the back than to the front of the helmet. Conclusions: The frequency of head impacts and the location on the helmet where the impacts occur are functions of player position and session type. These data provide a basis for quantifying specific head impact exposure for studies related to understanding the biomechanics and clinical aspects of concussion injury, as well as the possible effects of repeated subconcussive impacts in football.

Dasgupta, K., Joseph, L., Pilote, L., Strachan, I., Sigal, R. J., & Chan, C. (2010). Daily steps are low year-round and dip lower in fall/winter: findings from a longitudinal diabetes cohort. Cardiovasc.Diabetol., 9, 81.

BACKGROUND: Higher walking levels lead to lower mortality in type 2 diabetes, but inclement weather may reduce walking. In this patient population, we conducted a longitudinal cohort study to objectively quantify seasonal variations both in walking and in two vascular risk factors associated with activity levels, hemoglobin A1C and blood pressure. METHODS: Between June 2006 and July 2009, volunteer type 2 diabetes patients in Montreal, Quebec, Canada underwent two weeks of pedometer measurement up to four times over a one year follow-up period (i.e. once/season). Pedometer viewing windows were concealed (snap-on cover and tamper proof seal). A1C, blood pressure, and anthropometric parameters were also assessed. Given similarities in measures for spring/summer and fall/winter, and because not all participants completed four assessments, spring and summer values were collapsed as were fall and winter values. Mean within-individual differences (95% confidence intervals) were computed for daily steps, A1C, and systolic and diastolic blood pressure, by subtracting spring/summer values from fall/winter values. RESULTS: Among 201 participants, 166 (82.6%) underwent at least one fall/winter and one spring/summer evaluation. Approximately half were women, the mean age was 62.4 years (SD 10.8), and the mean BMI was 30.1 kg/m2 (SD 5.7). Step counts averaged at a sedentary level in fall/winter (mean 4,901 steps/day, SD 2,464) and at a low active level in spring/summer (mean 5,659 steps/day, SD 2,611). There was a -758 (95% CI: -1,037 to -479) mean fall/winter to spring/summer within-individual difference. There were no significant differences in A1C or in anthropometric parameters. Systolic blood pressure was higher in fall/winter (mean 137 mm Hg, SD 16) than spring/summer (133 mm Hg, SD 14) with a mean difference of 4.0 mm Hg (95% CI: 2.3 to 5.7). CONCLUSIONS: Daily step counts in type 2 diabetes patients are low, dipping lower during fall/winter. In this medication-treated cohort, A1C was stable year-round but a fall/winter systolic blood pressure increase was detected. Our findings signal a need to develop strategies to help patients increase step counts year-round and prevent both reductions in step counts and increases in blood pressure during the fall and winter

Delfino, R. J., Gillen, D. L., Tjoa, T., Staimer, N., Polidori, A., Arhami, M., Sioutas, C., & Longhurst, J. (2011). Electrocardiographic ST-segment depression and exposure to traffic-related aerosols in elderly subjects with coronary artery disease. Environ.Health Perspect., 119, 196-202.

BACKGROUND: Air pollutants have not been associated with ambulatory electrocardiographic evidence of ST-segment depression >/= 1 mm (probable cardiac ischemia). We previously found that markers of primary (combustion-related) organic aerosols and gases were positively associated with circulating biomarkers of inflammation and ambulatory blood pressure in the present cohort panel study of elderly subjects with coronary artery disease. OBJECTIVES: We specifically aimed to evaluate whether exposure markers of primary organic aerosols and ultrafine particles were more strongly associated with ST-segment depression of >/= 1 mm than were secondary organic aerosols or PM2.5 (particulate matter with aerodynamic diameter </= 2.5 microm) mass. METHODS: We evaluated relations of air pollutants to ambulatory electrocardiographic evidence of cardiac ischemia over 10 days in 38 subjects without ST depression on baseline electrocardiographs. Exposures were measured outdoors in retirement communities in the Los Angeles basin, including daily size-fractionated particle mass and hourly markers of primary and secondary organic aerosols and gases. Generalized estimating equations were used to estimate odds of hourly ST-segment depression (>/= 1 mm) from hourly air pollution exposures and to estimate relative rates of daily counts of ST-segment depression from daily average exposures, controlling for potential confounders. RESULTS: We found significant positive associations of hourly ST-segment depression with markers of combustion-related aerosols and gases averaged 1-hr through 3-4 days, but not secondary (photochemically aged) organic aerosols or ozone. The odds ratio per interquartile increase in 2-day average primary organic carbon (5.2 microg/m3) was 15.4 (95% confidence interval, 3.5-68.2). Daily counts of ST-segment depression were consistently associated with primary combustion markers and 2-day average quasi-ultrafine particles < 0.25 microm. CONCLUSIONS: Results suggest that exposure to quasi-ultrafine particles and combustion-related pollutants (predominantly from traffic) increase the risk of myocardial ischemia, coherent with our previous findings for systemic inflammation and blood pressure

Depp, C. A., Mausbach, B., Granholm, E., Cardenas, V., Ben-Zeev, D., Patterson, T. L., Lebowitz, B. D., & Jeste, D. V. (2010). Mobile interventions for severe mental illness: Design and preliminary data from three approaches. Journal of Nervous and Mental Disease, 198, 715-721.

Mobile devices can be used to deliver psychosocial interventions, yet there is little prior application in severe mental illness. We provide the rationale, design, and preliminary data from 3 ongoing clinical trials of mobile interventions developed for bipolar disorder or schizophrenia. Project 1 used a personal digital assistant to prompt engagement in personalized self-management behaviors based on real-time data. Project 2 employed experience sampling through text messages to facilitate case management. Project 3 was built on group functional skills training for schizophrenia by incorporating between-session mobile phone contacts with therapists. Preliminary findings were of minimal participant attrition, and no broken devices; yet, several operational and technical barriers needed to be addressed. Adherence was similar to that reported in nonpsychiatric populations, with high participant satisfaction. Therefore, mobile devices seem feasible and acceptable in augmenting psychosocial interventions for severe mental illness, with future research in establishing efficacy, cost effectiveness, and ethical and safety protocols.

Dockray, S., Grant, N., Stone, A. A., Kahneman, D., Wardle, J., & Steptoe, A. (2010). A comparison of affect ratings obtained with ecological momentary assessment and the day reconstruction method. Social Indicators Research, 99, 269-283.

Measurement of affective states in everyday life is of fundamental importance in many types of quality of life, health, and psychological research. Ecological momentary assessment (EMA) is the recognized method of choice, but the respondent burden can be high. The day reconstruction method (DRM) was developed by Kahneman and colleagues (Science, 2004, 306, 17761780) to assess affect, activities and time use in everyday life. We sought to validate DRM affect ratings by comparison with contemporaneous EMA ratings in a sample of 94 working women monitored over work and leisure days. Six EMA ratings of happiness, tiredness, stress, and anger/frustration were obtained over each 24 h period, and were compared with DRM ratings for the same hour, recorded retrospectively at the end of the day. Similar profiles of affect intensity were recorded with the two techniques. The between-person correlations adjusted for attenuation ranged from 0.58 (stress, working day) to 0.90 (happiness, leisure day). The strength of associations was not related to age, educational attainment, or depressed mood. We conclude that the DRM provides reasonably reliable estimates both of the intensity of affect and variations in affect over the day, so is a valuable instrument for the measurement of everyday experience in health and social research.

Emaus, A., Degerstr+©m, J., Wilsgaard, T., Hansen, B. r. H., Dieli-Conwright, C. M., Furberg, A. S., Pettersen, S. A., Andersen, L. B., Eggen, A. E., Bernstein, L., & Thune, I. (2010). Does a variation in self-reported physical activity reflect variation in objectively measured physical activity, resting heart rate, and physical fitness? Results from the Troms+© study. Scandinavian Journal of Public Health, 38, 105-118.

Aims: To study the association between self-reported physical activity (PA) and objectively measured PA, resting heart rate, and physical fitness. Methods: During 200708, 5017 men and 5607 women aged 3069 years attended the sixth survey of the Troms+© study. Self-reported PA during leisure-time and work were assessed and resting heart ratewas measured. In a sub-study, the activity study, PA (Actigraph LLC) and physical fitness (VO[sub]2max[/sub]) were objectively measured among 313 healthy men and women aged 4044 years. Results: Self-reported leisure PA was significantly correlated with VO[sub]2max[/sub] (ml/kg/min) (women 0.40, p < 0.001, men 0.44 p < 0.001) and moderate-to-vigorous PA(42000 counts/min) (women 0.28, p < 0.01, men 0.25, p < 0.01). The intra-class correlation coefficient between self-reported leisure PA and overall PA (counts/min) measured by accelerometer was 0.62 (95% CI 0.51, 0.71) for women and 0.59 (95% CI 0.47, 0.69) for men, and for VO[sub]2max[/sub] the intra-class correlation coefficient was 0.86 (95% CI 0.81, 0.90) for both sexes. Among all participants, an inverse doseresponse relationship was observed between self-reported leisure PA and resting heart rate for both men and women (p < 0.0001). More women than men met the international recommendations of 10,000 step counts/day (27% vs. 22%) and the recommendation of at least 30 minutes/day of moderate-to-vigorous intensities (30% vs. 22 %). Conclusions: The Troms+© physical activity questionnaire has acceptable validity and provides valid estimates of high-intensity leisure activity. However, these results underscore the need for collecting objectively PA measurements in large epidemiological studies.

Feinstein, J. S., Adolphs, R., Damasio, A., & Tranel, D. (2011). The human amygdala and the induction and experience of fear. Curr.Biol, 21, 34-38.

Although clinical observations suggest that humans with amygdala damage have abnormal fear reactions and a reduced experience of fear, these impressions have not been systematically investigated. To address this gap, we conducted a new study in a rare human patient, SM, who has focal bilateral amygdala lesions. To provoke fear in SM, we exposed her to live snakes and spiders, took her on a tour of a haunted house, and showed her emotionally evocative films. On no occasion did SM exhibit fear, and she never endorsed feeling more than minimal levels of fear. Likewise, across a large battery of self-report questionnaires, 3 months of real-life experience sampling, and a life history replete with traumatic events, SM repeatedly demonstrated an absence of overt fear manifestations and an overall impoverished experience of fear. Despite her lack of fear, SM is able to exhibit other basic emotions and experience the respective feelings. The findings support the conclusion that the human amygdala plays a pivotal role in triggering a state of fear and that the absence of such a state precludes the experience of fear itself

Gardner, A. W., Parker, D. E., Montgomery, P. S., Khurana, A., Ritti-Dias, R. M., & Blevins, S. M. (2010). Gender differences in daily ambulatory activity patterns in patients with intermittent claudication. J Vasc.Surg., 52, 1204-1210.

OBJECTIVES: To compare the pattern of daily ambulatory activity in men and women with intermittent claudication, and to determine whether calf muscle hemoglobin oxygen saturation (StO2) is associated with daily ambulatory activity. METHODS: Forty men and 41 women with peripheral arterial disease limited by intermittent claudication were assessed on their community-based ambulatory activity patterns for 1 week with an ankle-mounted step activity monitor and on calf muscle StO2 during a treadmill test. RESULTS: Women had lower adjusted daily maximal cadence (mean+/-SE) for 5 continuous minutes of ambulation (26.2+/-1.2 strides/min vs 31.0+/-1.2 strides/min; P=.009), for 1 minute of ambulation (43.1+/-0.9 strides/min vs 47.2+/-0.9 strides/min; P=.004), and for intermittent ambulation determined by the peak activity index (26.3+/-1.2 strides/min vs 31.0+/-1.2 strides/min; P=.009). Women also had lower adjusted time to minimum calf muscle StO2 during exercise (P=.048), which was positively associated with maximal cadence for 5 continuous minutes (r=0.51; P<.01), maximal cadence for 1 minute (r=0.42; P<.05), and peak activity index (r=0.44; P<.05). These associations were not significant in men. CONCLUSION: Women with intermittent claudication ambulate slower in the community setting than men, particularly for short continuous durations of up to 5 minutes and during intermittent ambulation at peak cadences. Furthermore, the daily ambulatory cadences of women are correlated with their calf muscle StO2 during exercise, as women who walk slower in the community setting reach their minimum calf muscle StO2 sooner than those who walk at faster paces. Women with intermittent claudication should be encouraged to not only walk more on a daily basis, but to do so at a pace that is faster than their preferred speed

Hamed, N. S. & Abd-elwahab, M. S. (2011). Pedometer-based gait training in children with spastic hemiparetic cerebral palsy: a randomized controlled study. Clin Rehabil., 25, 157-165.

OBJECTIVE: To study the effect of pedometer-based gait training on changing gait parameters in children with spastic hemiparetic cerebral palsy. DESIGN: Two group randomized controlled trial with pre-treatment and post-treatment measures. SETTING: Rehabilitation clinics. SUBJECTS: Thirty spastic hemiparetic children with cerebral palsy of both sexes (13 females and 17 males) ranging in age from six to eight years old with mean age 7.05 +/- 0.78 years. INTERVENTIONS: Children were randomized equally to receive pedometer-based gait training or a traditional gait training programme three times per week for three successive months. MAIN MEASURES: Assessment was done before and after three months of treatment application using 3D motion analysis system with six pro-reflex cameras to evaluate spatiotemporal gait parameters. The primary outcome measure was the walking velocity while the secondary outcome measures were stride length, cadence and cycle duration. RESULTS: There was a high statistically significant improvement in favour of the study group more than the control group concerning all the measured gait parameters. T-test results showed that velocity was 0.68 +/- 0.09 m/sec (0.26 +/- 0.07 change score) for study group and 0.42 +/- 0.11 m/sec (0.06 +/- 0.05 change score) for control group (t = 6.2) (P < 0.0001) while cadence was much less significant 124.3 +/- 4.3 step/min (-5.8 +/- 2.1 change score) for study group and 128.7 +/- 4.1 step/min (-0.86 +/- 0.05 change score) for control group (t = 2.8) (P < 0.008). CONCLUSION: Pedometer-based gait training is a useful tool that can be used in improving gait parameters in children with spastic hemiparetic cerebral palsy

Hanlon, E. & Bir, C. (2010). Validation of a wireless head acceleration measurement system for use in soccer play. J Appl.Biomech., 26, 424-431.

Soccer heading has been studied previously with conflicting results. One major issue is the lack of knowledge regarding what actually occurs biomechanically during soccer heading impacts. The purpose of the current study is to validate a wireless head acceleration measurement system, head impact telemetry system (HITS) that can be used to collect head accelerations during soccer play. The HIT system was fitted to a Hybrid III (HIII) head form that was instrumented with a 3-2-2-2 accelerometer setup. Fifteen impact conditions were tested to simulate impacts commonly experienced during soccer play. Linear and angular acceleration were calculated for both systems and compared. Root mean square (RMS) error and cross correlations were also calculated and compared for both systems. Cross correlation values were very strong with r = .95 +/- 0.02 for ball to head forehead impacts and r = .96 +/- 0.02 for head to head forehead impacts. The systems showed a strong relationship when comparing RMS error, linear head acceleration, angular head acceleration, and the cross correlation values

Harms, H., Amft, O., & Tr, S. G. (2010). Estimating posture-recognition performance in sensing garments using geometric wrinkle modeling. IEEE Trans.Inf.Technol.Biomed., 14, 1436-1445.

A fundamental challenge limiting information quality obtained from smart sensing garments is the influence of textile movement relative to limbs. We present and validate a comprehensive modeling and simulation framework to predict recognition performance in casual loose-fitting garments. A statistical posture and wrinkle-modeling approach is introduced to simulate sensor orientation errors pertained to local garment wrinkles. A metric was derived to assess fitting, the body-garment mobility. We validated our approach by analyzing simulations of shoulder and elbow rehabilitation postures with respect to experimental data using actual casual garments. Results confirmed congruent performance trends with estimation errors below 4% for all study participants. Our approach allows to estimate the impact of fitting before implementing a garment and performing evaluation studies with it. These simulations revealed critical design parameters for garment prototyping, related to performed body posture, utilized sensing modalities, and garment fitting. We concluded that our modeling approach can substantially expedite design and development of smart garments through early-stage performance analysis

Hasler, B. P. & Troxel, W. M. (2010). Couples’ nighttime sleep efficiency and concordance: evidence for bidirectional associations with daytime relationship functioning. Psychosom.Med, 72, 794-801.

OBJECTIVE: To examine prospectively the directionality of the association between daily relationship functioning and nightly sleep quality and the association between couples’ relationship functioning and concordance in sleep-wake rhythms. Emerging evidence suggests the existence of bidirectional links between sleep and relational processes in dyads, but to date, this research has been primarily cross sectional. METHODS: Sleep was measured via both diaries and wrist actigraphy for 7 days in 29 heterosexual cosleeping couples. Ecological momentary assessment methods were used to characterize daily relationship functioning. Dyadic, multilevel analyses were used to examine the degree to which nightly sleep efficiency or within-couple concordance in sleep timing predicted the next day’s relational functioning and vice versa. RESULTS: In the first set of analyses, for men, higher diary-based sleep efficiency predicted less negative partner interaction the following day. For women, less negative partner interaction during the day predicted greater actigraphy-based sleep efficiency that night. Furthermore, if women reported more positive and less negative daytime partner interaction during the day, this also predicted higher diary-based sleep efficiency for their male partners that night. In the second set of analyses, among females only, lower diary- or actigraphy-based sleep onset concordance respectively predicted less positive and more negative partner interactions the next day. CONCLUSIONS: Bidirectional associations seem to exist between sleep parameters and interpersonal interaction and may represent a novel pathway linking close relationships with physical and mental health

Heavey, C. L., Hurlburt, R. T., & Lefforge, N. L. (2010). Descriptive experience sampling: A method for exploring momentary inner experience. Qualitative Research in Psychology, 7, 345-368.

Descriptive Experience Sampling (DES) is a method developed to provide high fidelity accounts of pristine inner experience. A DES investigator gives a subject a random beeper to take into her natural environments. When the beep sounds, the subject jots down notes about her ongoing experience. The subject repeats this process, typically collecting about six moments of experience in a sampling day. Within 24 hours the investigator interviews the subject. During this expositional interview subject and investigator collaborate to develop high fidelity accounts of each sampled moment of experience. This process is repeated over a number of days until an idiographic description of the subjects inner experience has been developed. DES is open-ended, qualitative, and minimally retrospective. Because of the close examination of brief moments of experience, DES is capable of providing highly detailed accounts of inner experience. We summarize some important DES results and contrast DES with the methods of van Manen and Moustakas.

Hurst, J. R., Donaldson, G. C., Quint, J. K., Goldring, J. J., Patel, A. R., & Wedzicha, J. A. (2010). Domiciliary pulse-oximetry at exacerbation of chronic obstructive pulmonary disease: prospective pilot study. BMC Pulm.Med, 10, 52.

BACKGROUND: The ability to objectively differentiate exacerbations of chronic obstructive pulmonary disease (COPD) from day-to-day symptom variations would be an important development in clinical practice and research. We assessed the ability of domiciliary pulse oximetry to achieve this. METHODS: 40 patients with moderate-severe COPD collected daily data on changes in symptoms, heart-rate (HR), oxygen saturation (SpO2) and peak-expiratory flow (PEF) over a total of 2705 days. 31 patients had data suitable for baseline analysis, and 13 patients experienced an exacerbation. Data were expressed as multiples of the standard deviation (SD) observed from each patient when stable. RESULTS: In stable COPD, the SD for HR, SpO2 and PEF were approximately 5 min(-1), 1% and 10l min(-1). There were detectable changes in all three variables just prior to exacerbation onset, greatest 2-3 days following symptom onset. A composite Oximetry Score (mean magnitude of SpO2 fall and HR rise) distinguished exacerbation onset from symptom variation (area under receiver-operating characteristic curve, AUC = 0.832, 95%CI 0.735-0.929, p = 0.003). In the presence of symptoms, a change in Score of >/=1 (average of >/=1SD change in both HR and SpO2) was 71% sensitive and 74% specific for exacerbation onset. CONCLUSION: We have defined normal variation of pulse oximetry variables in a small sample of patients with COPD. A composite HR and SpO2 score distinguished exacerbation onset from symptom variation, potentially facilitating prompt therapy and providing validation of such events in clinical trials

Hurum, H., Sulheim, D., Thaulow, E., & Wyller, V. B. (2011). Elevated nocturnal blood pressure and heart rate in adolescent chronic fatigue syndrome. Acta Paediatr., 100, 289-292.

AIM: To compare ambulatory recordings of heart rate (HR) and blood pressure in adolescents with chronic fatigue syndrome (CFS) and healthy controls. We hypothesized both HR and blood pressure to be elevated among CFS patients. METHODS: Forty-four CFS patients aged 12-18 years were recruited from our paediatric outpatient clinic. The controls were 52 healthy adolescents having similar distribution of age and gender. 24-h ambulatory blood pressure and HR were recorded using a validated, portable oscillometric device. RESULTS: At night (sleep), HR, mean arterial blood pressure and diastolic blood pressure were significantly higher in CFS patients as compared with controls (p < 0.01). During daytime, HR was significantly higher among CFS patients (p < 0.05), whereas blood pressures were equal among the two groups. CONCLUSIONS: The findings support previous experimental evidence of sympathetic predominance of cardiovascular control in adolescent CFS patients. Also, the findings prompt increased focus on cardiovascular risk assessment and suggest a possible target for therapeutic intervention

Jablonski, I. (2011). Wearable interrupter module for home-based applications in a telemedical system dedicated to respiratory mechanics measurements. IEEE Trans.Biomed.Eng, 58, 785-789.

The mobile interrupter module, dedicated to the enhanced interrupter (EIT) measurement of respiratory mechanics in a home environment and capable of cooperation with a telemedical system, is presented. Characterized by noninvasiveness and minimal requirements regarding patient cooperation, the EIT algorithm is especially suitable for newborns, preschool children, and patients suffering from respiratory muscle impairment. Furthermore, this device enables access to raw data–without initial preprocessing–in a fully flexible measurement protocol (which is not available in any commercial apparatus), and the EIT procedure improves insight (the number and precision of assessed parameters) into the physiological system with respect to the classical occlusive methods

Karpettas, N., Kollias, A., Vazeou, A., & Stergiou, G. S. (2010). Office, ambulatory and home blood pressure measurement in children and adolescents. Expert.Rev.Cardiovasc.Ther., 8, 1567-1578.

There is an increasing interest in pediatric hypertension, the prevalence of which is rising in parallel with the obesity epidemic. Traditionally the assessment of hypertension in children has relied on office blood pressure (BP) measurements by the physician. However, as in adults, office BP might be misleading in children mainly due to the white coat and masked hypertension phenomena. Thus, out-of-office BP assessment, using ambulatory or home monitoring, has gained ground for the accurate diagnosis of hypertension and decision-making. Ambulatory monitoring is regarded as indispensable for the evaluation of pediatric hypertension. Preliminary data support the usefulness of home monitoring, yet more evidence is needed. Office, ambulatory and home BP normalcy tables providing thresholds for diagnosis have been published and should be used for the assessment of elevated BP in children

Kimhy, D., Delespaul, P., Ahn, H., Cai, S., Shikhman, M., Lieberman, J. A., Malaspina, D., & Sloan, R. P. (2010). Concurrent measurement of “real-world” stress and arousal in individuals with psychosis: assessing the feasibility and validity of a novel methodology. Schizophr.Bull., 36, 1131-1139.

BACKGROUND: Psychosis has been repeatedly suggested to be affected by increases in stress and arousal. However, there is a dearth of evidence supporting the temporal link between stress, arousal, and psychosis during “real-world” functioning. This paucity of evidence may stem from limitations of current research methodologies. Our aim is to the test the feasibility and validity of a novel methodology designed to measure concurrent stress and arousal in individuals with psychosis during “real-world” daily functioning. METHOD: Twenty patients with psychosis completed a 36-hour ambulatory assessment of stress and arousal. We used experience sampling method with palm computers to assess stress (10 times per day, 10 AM –> 10 PM) along with concurrent ambulatory measurement of cardiac autonomic regulation using a Holter monitor. The clocks of the palm computer and Holter monitor were synchronized, allowing the temporal linking of the stress and arousal data. We used power spectral analysis to determine the parasympathetic contributions to autonomic regulation and sympathovagal balance during 5 minutes before and after each experience sample. RESULTS: Patients completed 79% of the experience samples (75% with a valid concurrent arousal data). Momentary increases in stress had inverse correlation with concurrent parasympathetic activity (rho = -.27, P < .0001) and positive correlation with sympathovagal balance (rho = .19, P = .0008). Stress and heart rate were not significantly related (rho = -.05, P = .3875). CONCLUSION: The findings support the feasibility and validity of our methodology in individuals with psychosis. The methodology offers a novel way to study in high time resolution the concurrent, “real-world” interactions between stress, arousal, and psychosis. The authors discuss the methodology’s potential applications and future research directions

Kruger, A. & Edelmann-Nusser, J. (2010). Application of a full body inertial measurement system in alpine skiing: a comparison with an optical video based system. J Appl.Biomech., 26, 516-521.

This study aims at determining the accuracy of a full body inertial measurement system in a real skiing environment in comparison with an optical video based system. Recent studies have shown the use of inertial measurement systems for the determination of kinematical parameters in alpine skiing. However, a quantitative validation of a full body inertial measurement system for the application in alpine skiing is so far not available. For the purpose of this study, a skier performed a test-run equipped with a full body inertial measurement system in combination with a DGPS. In addition, one turn of the test-run was analyzed by an optical video based system. With respect to the analyzed angles, a maximum mean difference of 4.9 degrees was measured. No differences in the measured angles between the inertial measurement system and the combined usage with a DGPS were found. Concerning the determination of the skier’s trajectory, an additional system (e.g., DGPS) must be used. As opposed to optical methods, the main advantages of the inertial measurement system are the determination of kinematical parameters without the limitation of restricted capture volume, and small time costs for the measurement preparation and data analysis

Kuppens, P., Oravecz, Z., & Tuerlinckx, F. (2010). Feelings change: accounting for individual differences in the temporal dynamics of affect. J Pers.Soc.Psychol., 99, 1042-1060.

People display a remarkable variability in the patterns and trajectories with which their feelings change over time. In this article, we present a theoretical account for the dynamics of affect (DynAffect) that identifies the major processes underlying individual differences in the temporal dynamics of affective experiences. It is hypothesized that individuals are characterized by an affective home base, a baseline attractor state around which affect fluctuates. These fluctuations vary as the result of internal or external processes to which an individual is more or less sensitive and are regulated and tied back to the home base by the attractor strength. Individual differences in these 3 processes–affective home base, variability, and attractor strength–are proposed to underlie individual differences in affect dynamics. The DynAffect account is empirically evaluated by means of a diffusion modeling approach in 2 extensive experience-sampling studies on people’s core affective experiences. The findings show that the model is capable of adequately capturing the observed dynamics in core affect across both large (Study 1) and shorter time scales (Study 2) and illuminate how the key processes are related to personality and emotion dispositions. Implications for the understanding of affect dynamics and affective dysfunctioning in psychopathology are also discussed

Lam, J., Barr, R. G., Catherine, N., Tsui, H., Hahnhaussen, C. L., Pauwels, J., & Brant, R. (2010). Electronic and paper diary recording of infant and caregiver behaviors. Journal of Developmental and Behavioral Pediatrics, 31, 685-693.

Objectives: To assess (1) preference of parental use of an electronic diary (e-diary) over a paper diary to record continuous infant and caregiver behaviors over 7 days; (2) whether e-diary recordings would differ in systematic ways from those obtained by paper diaries, and (3) frequency of diary entries when parents provide entries when convenient. Methods: Mothers of normal newborns were randomized at 5 weeks infant age to a paper diary first (n = 34) or e-diary first (n = 35) group. With 3 days between, mothers completed 7-day recordings on both the paper Babys Day Diary and an analogous personal digital assistant e-diary for infant (sleep, awake alert, feeding, fussing, crying, inconsolable crying) and caregiver (carrying/ holding, moving) behaviors, and completed post diary ease-of-use ratings and post study preference ratings. Results: Mothers found e-diaries less bothersome but similarly disruptive and enjoyable to paper diaries. At study end, more found e-diaries easier to use, less bothersome and more efficient. E-diary behaviors were consistently more frequent, but rarely different in duration, then paper diary behaviors. Time-stamped e-diary entries (1) generally declined across weeks, (2) were higher if e-diaries were used first, and (3) settled at a modal 2 to 3 entries/day by the second week. Conclusions: For behavioral recording of infant and caregiver behaviors, mothers generally expressed more approval for e-diaries than paper diaries, but neither was considered onerous. E-diaries consistently report more frequent but similar durations of behaviors. If recording when convenient, daily diary entries trend toward 2 to 3 entries a day. The e-diary results provide convergent evidence that paper diary recordings of common infant and caregiver behavior durations provide good estimates of durations, but that behavioral frequencies may be underestimated.

Lataster, T., Collip, D., Lardinois, M., van Os, J., & Myin-Germeys, I. (2010). Evidence for a familial correlation between increased reactivity to stress and positive psychotic symptoms. Acta Psychiatrica Scandinavica, 122, 395-404.

Objective: This study tested the hypothesis that stress-reactivity may represent an intermediary phenotype underlying positive psychotic symptoms. It was examined whether: (i) stress-reactivity clusters within families of psychotic patients and (ii) stress-reactivity in relatives cosegregates with positive symptoms in patients. Method: The sample consisted of 40 patients and 47 siblings of these patients. The Experience Sampling Method (ESMa structured diary technique) was used to measure stress-reactivity. Positive symptoms in patients were measured with the Comprehensive Assessment of Symptoms and History. Results: Within-trait, cross-sib associations showed a significant association between stress-reactivity in the patient and stress-reactivity in their siblings. Significant cross-trait, cross-sib associations were established showing a significant association between positive psychotic symptoms in the patient and stress-reactivity in the sibling. Conclusion: The findings show familial clustering of increased stress-reactivity, suggesting common aetiological influences, probably both genetic and environmental, underlying stress-reactivity in the siblings and patients. In addition, the results underscore the hypothesis that increased stress-reactivity is an unconfounded mechanism of risk underlying the positive symptoms of psychotic disorders.

LeBlanc, A. G. & Janssen, I. (2010). Difference between self-reported and accelerometer measured moderate-to-vigorous physical activity in youth. Pediatr.Exerc.Sci., 22, 523-534.

We examined differences between objective (accelerometer) and subjective (selfreport) measures of moderate-to-vigorous physical activity (MVPA) in youth. Participants included 2761 youth aged 12-19 years. Within each sex and race group, objective and self-reported measures of MVPA were poorly correlated (R(2) = .01-.10). Self-reported MVPA values were higher than objective values (median: 42.4 vs. 15.0 min/d). 65.4% of participants over-reported their MVPA by (3)5 min/d. The difference between self-reported and objective measures was not influenced by sex, age, or race. There was, however, a systematic difference such that inactive participants over-reported their MVPA to the greatest extent

Lee, J. A., Cho, S. H., Lee, Y. J., Yang, H. K., & Lee, J. W. (2010). Portable activity monitoring system for temporal parameters of gait cycles. J Med Syst., 34, 959-966.

A portable and wireless activity monitoring system was developed for the estimation of temporal gait parameters. The new system was built using three-axis accelerometers to automatically detect walking steps with various walking speeds. The accuracy of walking step-peak detection algorithm was assessed by using a running machine with variable speeds. To assess the consistency of gait parameter analysis system, estimated parameters, such as heel-contact and toe-off time based on accelerometers and footswitches were compared for consecutive 20 steps from 19 individual healthy subjects. Accelerometers and footswitches had high consistency in the temporal gait parameters. The stance, swing, single-limb support, and double-limb support time of gait cycle revealed ICCs values of 0.95, 0.93, 0.86, and 0.75 on the right and 0.96, 0.86, 0.93, 0.84 on the left, respectively. And the walking step-peak detection accuracy was 99.15% (+/-0.007) for the proposed method compared to 87.48% (+/-0.033) for a pedometer. Therefore, the proposed activity monitoring system proved to be a reliable and useful tool for identification of temporal gait parameters and walking pattern classification

Luckmann, R. & Vidal, A. (2010). Design of a handheld electronic pain, treatment and activity diary. J Biomed.Inform., 43, S32-S36.

Effective tools for recording and analyzing data on patients’ pain experience, use of pain treatments, and physical function are needed to improve communication between providers and patients with noncancer chronic pain. A handheld electronic diary (HED) that can be used throughout the day may provide more useful and accurate information about pain, treatments, and function than available paper and on-line diaries that are designed to be used once daily, weekly or less often. Based on user-specified requirements we designed and built a prototype HED with 7 modules. Diary queries are followed by multiple choice responses customized to the patients’ expected responses. Usability testing confirmed user comprehension and acceptability of the queries, response sets, and interface

Macdonell, K. E., Naar-King, S., Murphy, D. A., Parsons, J. T., & Huszti, H. (2011). Situational temptation for HIV medication adherence in high-risk youth. AIDS Patient Care STDS., 25, 47-52.

Abstract This study explored the role of situational temptation, a component of self-efficacy, in adolescent and young adult (ages 16-24) HIV medication adherence by assessing participants’ perceptions of their temptation to miss medications in various situations (e.g., when medication causes physical side effects, when there is fear of disclosure of HIV status). Youth (n = 186; 83% African American) were participants in a multisite clinical trial examining the efficacy of a motivational intervention. Data were collected using computer-assisted personal interviewing. Youth believed the most tempting reasons or situations that might lead them to miss their HIV medications to be symptoms (if the medicine caused you to have other physical symptoms) and sick (if the medicine made you sick to your stomach or made you throw up or if it tasted bad), but these were not significantly associated with nonadherence. This suggests disconnection between youths’ expectations of temptation and actual tempting situations associated with nonadherence. Situational temptations associated with nonadherence included lack of social support, needing a break from medications, and not seeing a need for medications. Interventions to improve adherence should consider perceptions of HIV medications, particularly the benefits of taking medications and expectations of physical symptoms. Interventionists and clinicians should consider situations that may tempt youth to miss doses of medication and help youth gain insight into these temptations. Emerging methods, such as Ecological Momentary Assessment (e.g., daily diaries, cell phone text messaging), may be useful in gaining insight into the day-to-day experience of youth living with HIV

McMurdo, M. E., Sugden, J., Argo, I., Boyle, P., Johnston, D. W., Sniehotta, F. F., & Donnan, P. T. (2010). Do pedometers increase physical activity in sedentary older women? A randomized controlled trial. J Am Geriatr.Soc., 58, 2099-2106.

OBJECTIVES: To determine the effectiveness of a behavior change intervention (BCI) with or without a pedometer in increasing physical activity in sedentary older women. DESIGN: Prospective randomized controlled trial. SETTING: Primary care, City of Dundee, Scotland. PARTICIPANTS: Two hundred four sedentary women aged 70 and older. INTERVENTIONS: Six months of BCI, BCI plus pedometer (pedometer plus), or usual care. MEASUREMENTS: Primary outcome: change in daily activity counts measured by accelerometry. Secondary outcomes: Short Physical Performance Battery, health-related quality of life, depression and anxiety, falls, and National Health Service resource use. RESULTS: One hundred seventy-nine of 204 (88%) women completed the 6-month trial. Withdrawals were highest from the BCI group (15/68) followed by the pedometer plus group (8/68) and then the control group (2/64). After adjustment for baseline differences, accelerometry counts increased significantly more in the BCI group at 3 months than in the control group (P = .002) and the pedometer plus group (P = .04). By 6 months, accelerometry counts in both intervention groups had fallen to levels that were no longer statistically significantly different from baseline. There were no significant changes in the secondary outcomes. CONCLUSION: The BCI was effective in objectively increasing physical activity in sedentary older women. Provision of a pedometer yielded no additional benefit in physical activity, but may have motivated participants to remain in the trial

McParlin, C., Robson, S. C., Tennant, P. W., Besson, H., Rankin, J., Adamson, A. J., Pearce, M. S., & Bell, R. (2010). Objectively measured physical activity during pregnancy: a study in obese and overweight women. BMC Pregnancy Childbirth, 10, 76.

BACKGROUND: Obese and overweight women may benefit from increased physical activity (PA) during pregnancy. There is limited published data describing objectively measured PA in such women. METHODS: A longitudinal observational study of PA intensity, type and duration using objective and subjective measurement methods. Fifty five pregnant women with booking body mass index (BMI) >/= 25 kg/m2 were recruited from a hospital ultrasound clinic in North East England. 26 (47%) were nulliparous and 22 (40%) were obese (BMI >/= 30 kg/m2). PA was measured by accelerometry and self report questionnaire at 13 weeks, 26 weeks and/or 36 weeks gestation. Outcome measures were daily duration of light, moderate or vigorous activity assessed by accelerometry; calculated overall PA energy expenditure, (PAEE), and PAEE within four domains of activity based on self report. RESULTS: At median 13 weeks gestation, women recorded a median 125 mins/day light activity and 35 mins/day moderate or vigorous activity (MVPA). 65% achieved the minimum recommended 30 mins/day MVPA. This proportion was maintained at 26 weeks (62%) and 36 weeks (71%). Women achieving more than 30 mins/day MVPA in the first trimester showed a significant reduction in duration of MVPA by the third trimester (11 mins/day, p = 0.003). Walking, swimming and floor exercises were the most commonly reported recreational activities but their contribution to estimated energy expenditure was small. CONCLUSION: Overweight and obese pregnant women can achieve and maintain recommended levels of PA throughout pregnancy. Interventions to promote PA should target changes in habitual activities at work and at home, and in particular walking

Minami, H., McCarthy, D. E., Jorenby, D. E., & Baker, T. B. (2011). An Ecological Momentary Assessment analysis of relations among coping, affect and smoking during a quit attempt. Addiction, 106, 641-650.

AIMS: This study used Ecological Momentary Assessment (EMA) data from smokers trying to quit to assess relations among coping, positive affect, negative affect and smoking. The effects of stress coping on affect and smoking were examined. DESIGN: Data from a randomized clinical trial of smoking cessation treatments were submitted to multi-level modeling to test the effects of coping with stressful events on subsequent affect and smoking. SETTING: Center for Tobacco Research and Intervention, Madison, Wisconsin. PARTICIPANTS: A total of 372 adult daily smokers who reported at least one stressful event and coping episode and provided post-quit data. MEASUREMENTS: Participants’ smoking, coping and affect were assessed in near real time with multiple EMA reports using electronic diaries pre- and post-quit. FINDINGS: Multi-level models indicated that a single coping episode did not predict a change in smoking risk over the next 4 or 48 hours, but coping in men was associated with concurrent reports of increased smoking. Coping predicted improved positive and negative affect reported within 4 hours of coping, but these affective gains did not predict reduced likelihood of later smoking. Pre-quit coping frequency and gender moderated post-quit stress coping relations with later positive affect. Men and those with greater pre-quit coping frequency reported greater gains in positive affect following post-quit coping. CONCLUSIONS: Coping responses early in a quit attempt may help smokers trying to quit feel better, but may not help them stay smoke-free

Mirani, M., Berra, C., Finazzi, S., Calvetta, A., Radaelli, M. G., Favareto, F., Graziani, G., & Badalamenti, S. (2010). Inter-day glycemic variability assessed by continuous glucose monitoring in insulin-treated type 2 diabetes patients on hemodialysis. Diabetes Technol.Ther., 12, 749-753.

BACKGROUND: Type 2 diabetes patients on chronic hemodialysis have a high prevalence of cardiovascular complications and often show a poor glycemic control. Single-spot glycemic measurements are not always meaningful, and the hemoglobin A1c (HbA1c) value does not reflect short-term variations in glucose metabolism in this patient category. Therefore, to better understand their metabolic balance, we studied a group of diabetes patients on hemodialysis by a continuous glucose monitoring (CGM) system. METHODS: Twelve insulin-treated type 2 diabetes patients on hemodialysis were studied by a microdialysis-based subcutaneous glucose sensor over a period of 2 days, including the dialysis day (HD) and the following inter-dialytic period (“free” day [FD]). RESULTS: The mean 24-h glycemic value, the mean amplitude of glucose excursions, and the SD of mean glucose were significantly higher in the HD than the FD (186 +/- 50 vs. 154 +/- 25 mg/dL, P<0.05; 75 +/- 22 vs. 56 +/- 15 mg/dL, P<0.05; and 57 +/- 6 vs. 35 +/- 11 mg/dL, P<0.05, respectively). Considering the 48-h recording, there was a direct correlation between the mean glucose concentration and the HbA1c (r=0.47, P<0.05), whereas no association was observed between the measures of glucose variability and HbA1c. CONCLUSIONS: Insulin-treated diabetes patients on hemodialysis showed different glucose profiles between the HD and the FD. In particular, in the HD they have had an increased glycemic variability, which may represent an adjunctive risk factor for cardiovascular complications. Therefore the use of a CGM system, as a means of assessing the measures of glycemic variability, could improve the management of insulin therapy in these patients

Mitoma, H., Yoneyama, M., & Orimo, S. (2010). 24-hour recording of parkinsonian gait using a portable gait rhythmogram. Intern.Med, 49, 2401-2408.

OBJECTIVE: In the advanced stage of Parkinson’s disease (PD), motor fluctuation is a frequent and a disabling problem. Despite its importance, motor fluctuation has received little scientific analysis probably due to limitation in objective assessment. Here, we focused on gait disorders to estimate motor fluctuation in daily activities. PATIENTS AND METHODS: Using a new device, the portable gait rhythmogram, we recorded gait rhythm continuously over 24 hours in 22 patients with PD and in 11 normal controls, for quantitative evaluation of motor fluctuation. The duration of one gait cycle was measured. RESULTS: Continuous 24-hour recording identified changes in gait rhythm, which correlated with fluctuation of PD symptoms. Different motor fluctuations were observed; a shift to a faster gait cycle was noted in patients with short-step walking, festination or freezing of gait, whereas a shift to a slower gait cycle was observed in patients with bradykinesia or instability. CONCLUSION: Characterization of motor fluctuation using this device could help in the selection of appropriate anti-PD medications

Motl, R. W., Sosnoff, J. J., Dlugonski, D., Suh, Y., & Goldman, M. (2010). Does a waist-worn accelerometer capture intra- and inter-person variation in walking behavior among persons with multiple sclerosis? Med Eng Phys., 32, 1224-1228.

The valid application of accelerometry and interpretation of its output (i.e., counts per unit time) for the measurement of walking behavior in persons with multiple sclerosis (MS) rests upon multiple untested assumptions. This study tested the assumption that a waist-worn accelerometer should capture the intra- and inter-person variation in walking behavior. Twenty-four participants with a neurologist-confirmed diagnosis of MS and who were ambulatory with minimal assistance undertook three 6-min periods of over-ground walking that involved comfortable (CWS) and then slower (SWS) and faster (FWS) walking speeds while wearing ActiGraph, model 7164, accelerometers around the waist and ankle. The experimental manipulation of walking was successful such that the CWS was 76.7+/-13.0m/min (range=55.6-105.14), whereas the SWS and FWS were 64.3+/-12.3m/min (range=44.5-90.1) and 89.1+/-13.8m/min (range=60.9-116.4), respectively. Movement counts from the waist and ankle-worn accelerometer were strongly associated with the manipulation of speed, but the association was stronger for the waist than ankle based on both eta-squared estimates (eta(2) values=.78 and .46) and the average squared multiple correlations from individual regression analyses (R(2) values=.97+/-.04 and .88+/-.21). The bivariate correlation between movement counts from the waist-worn accelerometer and speed of walking (r=.823, p=.001) was large in magnitude and significantly different (z=3.22, p=.001) from that between movement counts from the ankle-worn unit and walking speed (r=.549, p=.001). This study provides novel evidence that an accelerometer worn around the waist captures intra- and inter-person variation in over-ground walking behavior in those with MS

Nichols, J. F., Aralis, H., Merino, S. G., Barrack, M. T., Stalker-Fader, L., & Rauh, M. J. (2010). Utility of the actiheart accelerometer for estimating exercise energy expenditure in female adolescent runners. Int J Sport Nutr Exerc.Metab, 20, 487-495.

There is a growing need to accurately assess exercise energy expenditure (EEE) in athletic populations that may be at risk for health disorders because of an imbalance between energy intake and energy expenditure. The Actiheart combines heart rate and uniaxial accelerometry to estimate energy expenditure above rest. The authors’ purpose was to determine the utility of the Actiheart for predicting EEE in female adolescent runners (N = 39, age 15.7 +/- 1.1 yr). EEE was measured by indirect calorimetry and predicted by the Actiheart during three 8-min stages of treadmill running at individualized velocities corresponding to each runner’s training, including recovery, tempo, and 5-km-race pace. Repeated-measures ANOVA with Bonferroni post hoc comparisons across the 3 running stages indicated that the Actiheart was sensitive to changes in intensity (p < .01), but accelerometer output tended to plateau at race pace. Pairwise comparisons of the mean difference between Actiheart- and criterion-measured EEE yielded values of 0.0436, 0.0539, and 0.0753 kcal x kg-1 x min-1 during recovery, tempo, and race pace, respectively (p < .0001). Bland-Altman plots indicated that the Actiheart consistently underestimated EEE except in 1 runner’s recovery bout. A linear mixed-model regression analysis with height as a covariate provided an improved EEE prediction model, with the overall standard error of the estimate for the 3 speeds reduced to 0.0101 kcal x kg-1 x min-1. Using the manufacturer’s equation that combines heart rate and uniaxial motion, the Actiheart may have limited use in accurately assessing EEE, and therefore energy availability, in young, female competitive runners

O’Connell, K. A., Shiffman, S., & Decarlo, L. T. (2011). Does extinction of responses to cigarette cues occur during smoking cessation? Addiction, 106, 410-417.

AIMS: This study investigated whether Pavlovian extinction occurs during smoking cessation by determining whether experience abstaining from smoking in the presence of cigarette cues leads to decreased probability of lapsing and whether this effect is mediated by craving. DESIGN: Secondary analyses were carried out with data sets from two studies with correlational/observational designs. SETTING: Data were collected in smokers’ natural environments using ecological momentary assessment techniques. PARTICIPANTS: Sixty-one and 207 smokers who were attempting cessation participated. MEASUREMENTS: Multi-level path models were used to examine effects of prior experience abstaining in the presence of available cigarettes and while others were smoking on subsequent craving intensity and the probability of lapsing. Control variables included current cigarette availability, current exposure to others smoking, number of prior lapses and time in the study. FINDINGS: Both currently available cigarettes [odds ratios (OR) = 36.60, 11.59] and the current presence of other smoking (OR = 5.00, 1.52) were powerful predictors of smoking lapse. Repeated exposure to available cigarettes without smoking was associated with a significantly lower probability of lapse in subsequent episodes (OR = 0.44, 0.52). However, exposure to others smoking was not a reliable predictor, being significant only in the smaller study (OR = 0.30). Craving functioned as a mediator between extinction of available cigarettes and lapsing only in the smaller study and was not a mediator for extinction of others smoking in either study. CONCLUSIONS: This study showed that exposure to available cigarettes is a large risk factor for lapsing, but that this risk can also be reduced over time by repeated exposures without smoking. Smoking cessation interventions should attempt to reduce cigarette exposure (by training cigarette avoidance) but recognize the potential advantage of unreinforced exposure to available cigarettes

Oliver, M., Schofield, G. M., Badland, H. M., & Shepherd, J. (2010). Utility of accelerometer thresholds for classifying sitting in office workers. Prev.Med, 51, 357-360.

OBJECTIVE: To investigate the utility of a variety of Actical accelerometer count thresholds for determining sitting time in a sample of office workers. METHODS: Data were collected from 21 participants in Auckland, New Zealand, between December 2009 and January 2010. Participants wore a hip-mounted Actical accelerometer and thigh-mounted activPAL inclinometer (criterion) for a 48-h period. Raw inclinometer and accelerometer data for each 15s epoch of wear time were matched by date and time. Candidate accelerometer count thresholds for sitting classification were compared with the criterion measure using receiver operating characteristic analyses. Agreement in sitting time classification was determined using Bland-Altman methodology. RESULTS: Significant differences in area under the curve (AUC) values by threshold criteria were found (p<0.001). A threshold of 0 counts provided the highest combined sensitivity and specificity (AUC 0.759, 95%CI 0.756, 0.761). The 95% limits of agreement for time spent sitting were wide, at 328min (range -30.8, 297.5). CONCLUSION: A threshold of 0 counts/15s epoch with Actical accelerometers is likely to yield the most accurate quantification of sitting in office-based workers, however the wide limits of agreement found indicate limited utility of this threshold to accurately distinguish sitting time in office-based workers

Piira, O. P., Huikuri, H. V., & Tulppo, M. P. (2011). Effects of emotional excitement on heart rate and blood pressure dynamics in patients with coronary artery disease. Auton.Neurosci, 160, 107-114.

The incidence of adverse cardiovascular events is higher among spectators of exciting sports events, but the mechanistic link between the events is not known. We assessed the heart rate (HR) and blood pressure (BP) dynamics of enthusiastic male ice hockey spectators (60 +/- 9 years) with coronary artery disease (CAD) during Finnish national league ice hockey play-off final matches. Twenty-four-hour ambulatory ECG (n = 55) and BP (n = 17) were recorded at the time of the match and on a control day. Beat-to-beat R-R intervals and BP were recorded during the match and a bicycle exercise at equal HR levels (n = 21). Systolic and diastolic BP were significantly higher 1h before, during, and 1h after the match than on the control day, e.g., the highest systolic BP was 180 +/- 14 vs. 145 +/- 15 and diastolic 103 +/- 13 vs. 82 +/- 11 mmHg (p<0.001 for both). HR was higher throughout the match (p<0.05) and remained elevated 2h after the match (p<0001), and measures of HR variability were decreased during the match (p<0.01). Low-frequency variability in BP was higher during the match than during the exercise test (p<0.01). The results show that cardiac vagal outflow is attenuated and vasomotor sympathetic activity elevated during exciting sports events and BP dynamics differ from those occurring during physical exercise at equal HRs. The autonomic reactions may partly explain the vulnerability to cardiovascular events caused by this type of leisure-time emotional excitement

Pitchford, E. A. & Yun, J. (2010). The accuracy of pedometers for adults with Down syndrome. Adapt.Phys.Activ.Q., 27, 321-336.

The purpose of this study was to examine the accuracy of spring-levered and piezoelectric pedometers for adults with and without Down syndrome (DS). Twenty adults with DS and 24 adults without a disability walked for two minute periods on a predetermined indoor course at a self-selected, slower and faster pace. Pedometer recorded and criterion observed steps were compared to determine pedometer error. There was a significant interaction between pedometer model and walking speed. Piezoelectric pedometers demonstrated significantly less measurement error than spring-levered pedometers, particularly at slower walking speeds. There were also significant differences in pedometer error between adults with and without DS. The study concludes that pedometer measurement error is significantly different for adults with DS but also that piezoelectric pedometers can be used in the future to measure walking activity for adults with and without DS

Proudfoot, J., Parker, G., Hadzi, P. D., Manicavasagar, V., Adler, E., & Whitton, A. (2010). Community attitudes to the appropriation of mobile phones for monitoring and managing depression, anxiety, and stress. J Med Internet Res., 12, e64.

BACKGROUND: The benefits of self-monitoring on symptom severity, coping, and quality of life have been amply demonstrated. However, paper and pencil self-monitoring can be cumbersome and subject to biases associated with retrospective recall, while computer-based monitoring can be inconvenient in that it relies on users being at their computer at scheduled monitoring times. As a result, nonadherence in self-monitoring is common. Mobile phones offer an alternative. Their take-up has reached saturation point in most developed countries and is increasing in developing countries; they are carried on the person, they are usually turned on, and functionality is continually improving. Currently, however, public conceptions of mobile phones focus on their use as tools for communication and social identity. Community attitudes toward using mobile phones for mental health monitoring and self-management are not known. OBJECTIVE: The objective was to explore community attitudes toward the appropriation of mobile phones for mental health monitoring and management. METHODS: We held community consultations in Australia consisting of an online survey (n = 525), focus group discussions (n = 47), and interviews (n = 20). RESULTS: Respondents used their mobile phones daily and predominantly for communication purposes. Of those who completed the online survey, the majority (399/525 or 76%) reported that they would be interested in using their mobile phone for mental health monitoring and self-management if the service were free. Of the 455 participants who owned a mobile phone or PDA, there were no significant differences between those who expressed interest in the use of mobile phones for this purpose and those who did not by gender (chi2(1), = 0.98, P = .32, phi = .05), age group (chi2(4), = 1.95, P = .75, phi = .06), employment status (chi2(2), = 2.74, P = .25, phi = .08) or marital status (chi2(4), = 4.62, P = .33, phi = .10). However, the presence of current symptoms of depression, anxiety, or stress affected interest in such a program in that those with symptoms were more interested (chi(2) (1), = 16.67, P < .001, phi = .19). Reasons given for interest in using a mobile phone program were that it would be convenient, counteract isolation, and help identify triggers to mood states. Reasons given for lack of interest included not liking to use a mobile phone or technology, concerns that it would be too intrusive or that privacy would be lacking, and not seeing the need. Design features considered to be key by participants were enhanced privacy and security functions including user name and password, ease of use, the provision of reminders, and the availability of clear feedback. CONCLUSIONS: Community attitudes toward the appropriation of mobile phones for the monitoring and self-management of depression, anxiety, and stress appear to be positive as long as privacy and security provisions are assured, the program is intuitive and easy to use, and the feedback is clear

Raustorp, A., Boldemann, C., Johansson, M., & M+Ñrtensson, F. (2010). Objectively measured physical activity level during a physical education class: A pilot study with Swedish youth. International Journal of Adolescent Medicine and Health, 22, 469-476.

The aim of this study is to advance our knowledge of the contribution of a typical physical education (PE) class to children’s daily physical activity. Methods: The pilot project is a part of a survey study comprising 11 fourth grader classes (250 pupils). One class of 19 pupils (9 girls) participated in the pilot study. Daily step counts were measured by Yamax pedometers during four consecutive weekdays. During PE class, the participants wore a second pedometer and an Actigraph GT1M accelerometer. Results: The total average step count during PE class was 2512, average 74 steps/ min. The counts for the whole day were 16668, and 19 steps/ min respectively. The total share of moderate-vigorous physical activity (MVPA) of the PE class was 50,4% (52,5% and 48,3 % for boys and girls respectively). There was an inverse correlation between daily mean step count and contribution of PE class step to daily mean step (r = -0.64, p= .003). Conclusion: The contribution of PE class to MVPA was in high in both boys and girls. Considering the suggested independent role of physical fitness for cardiovascular health in children, the PE class must be seen as an important health factor, especially for otherwise inactive children.

Reimuller, A., Shadur, J., & Hussong, A. M. (2010). Parental social support as a moderator of self-medication in adolescents. Addictive Behaviors.

OBJECTIVE: We examined the moderating effects of parenting on the temporal relationship between negative affect and subsequent alcohol use in adolescents as an indicator of self-medication. Specifically, we tested whether youth are more likely to self-medicate if they receive less parental social support. METHOD: We used a multi-method, multi-reporter strategy and an experience sampling paradigm to examine these mechanisms in an elevated-risk sample preparing for the transition to high school. Seventy-one adolescents and their parents completed home-based interviews and adolescents completed a 21-day experience sampling protocol in which they reported their alcohol use daily and their affect thrice daily. RESULTS: Parent-reported family communication, though no other parental support indicators, moderated the relation between daily negative affect and alcohol use. Plotting of interactions showed a greater likelihood of drinking on days characterized by greater negative affect only in adolescents with higher levels of parent-reported family communication. CONCLUSIONS: This study offers tentative support for parental support as a moderator of the relation between daily negative affect and alcohol use. Parental support may be a response to alcohol use and self-medication in teens such that parents become more involved and open in talking with their teens when they notice these patterns of behavior.

Ridgers, N. D., Graves, L. E., Foweather, L., & Stratton, G. (2010). Examining influences on boy’s and girls’ physical activity patterns: the A-CLASS project. Pediatr.Exerc.Sci., 22, 638-650.

Understanding children’s physical activity (PA) patterns and the factors that may influence PA are important for developing interventions within this population. One hundred and ten children aged 9-10 years from 8 schools had their PA patterns assessed over 7 days. Physiological and self-report data were also collected. Multilevel analyses revealed that cardiorespiratory fitness was a consistent, significant and positive predictor of weekday and weekend PA, while the availability of home sedentary activities was a significant but negative predictor of PA. Since a range of variables were associated with PA levels, intervention developers should be cognizant of variables that may influence children’s activity

Rietberg, M. B., van Wegen, E. E., Uitdehaag, B. M., de Vet, H. C., & Kwakkel, G. (2010). How reproducible is home-based 24-hour ambulatory monitoring of motor activity in patients with multiple sclerosis? Arch Phys.Med Rehabil., 91, 1537-1541.

OBJECTIVE: To determine the reproducibility of 24-hour monitoring of motor activity in patients with multiple sclerosis (MS). DESIGN: Test-retest design; 6 research assistants visited the participants twice within 1 week in the home situation. SETTING: General community. PARTICIPANTS: A convenience sample of ambulatory patients (N=43; mean age +/- SD, 48.7+/-7.0y; 30 women; median Expanded Disability Status Scale scores, 3.5; interquartile range, 2.5) were recruited from the outpatient clinic of a university medical center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dynamic activity and static activity parameters were recorded by using a portable data logger and classified continuously for 24 hours. Reproducibility was determined by calculating intraclass correlation coefficients (ICCs) for test-retest reliability and by applying the Bland-Altman method for agreement between the 2 measurements. The smallest detectable change (SDC) was calculated based on the standard error of measurement. RESULTS: Test-retest reliability expressed by the ICC(agreement) was .72 for dynamic activity, .74 for transitions, .77 for walking, .71 for static activity, .67 for sitting, .62 for standing, and .55 for lying. Bland and Altman analysis indicated no systematic differences between the first and second assessment for dynamic and static activity. Measurement error expressed by the SDC was 1.23 for dynamic activity, 66 for transitions, .99 for walking, 1.52 for static activity, 4.68 for lying, 3.95 for sitting, and 3.34 for standing. CONCLUSIONS: The current study shows that with 24-hour monitoring, a reproducible estimate of physical activity can be obtained in ambulatory patients with MS

Ritz, T., Rosenfield, D., & Steptoe, A. (2010). Physical activity, lung function, and shortness of breath in the daily life of individuals with asthma. Chest, 138, 913-918.

BACKGROUND: The effects of physical activity on asthma have been explored extensively. Exercise can trigger later bronchoconstriction in many patients, and deconditioning due to a sedentary lifestyle may be the consequence. However, the immediate effect of physical activity in asthma and health is bronchodilation. To date, little is known about the association between physical activity and lung function in the daily life of asthma patients. METHODS: We studied 20 individuals with asthma and 20 control subjects using an electronic diary of activities and spirometry (peak expiratory flow [PEF], FEV(1)). Participants rated their shortness of breath and their intensity of physical and social activity for the preceding 30 min. Assessments were made over the course of 3 weeks, tid (morning, afternoon, evening/night). RESULTS: Stronger physical activity was concurrently associated with significantly higher lung function. In contrast, it also showed a positive concurrent association with shortness of breath. In prospective cross-lag analyses, lower PEF and FEV(1) earlier in the day predicted lower physical and social activity levels later in the day, but shortness of breath did not. CONCLUSION: The findings show that detrimental effects observed in exercise-induced bronchoconstriction cannot be generalized to physical activity in daily lives of individuals with asthma. Nevertheless, people with asthma still feel more shortness of breath when being more physically active. They adjust their activity levels throughout the day according to their earlier lung function, but this does not fully explain the concurrent positive association of physical activity and lung function

Schoenthaler, A. M., Schwartz, J., Cassells, A., Tobin, J. N., & Brondolo, E. (2010). Daily interpersonal conflict predicts masked hypertension in an urban sample. Am J Hypertens., 23, 1082-1088.

BACKGROUND: Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH. METHODS: Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (</=120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: >/=135 mm Hg or DiaABP: >/=85 mm Hg. Logistic regression was used to examine whether daily interpersonal conflict is an independent predictor of MMH. RESULTS: This form of MMH (i.e., optimal office BP plus elevated ABP) was present in 21% of participants (n = 50). Those with MMH (vs. without) were significantly more likely to be men (P < 0.001). Daily harassment and unfair treatment scores were significant predictors of MMH group status (P < 0.05). Participants with harassment scores >30 were significantly more likely to be in the MMH group. CONCLUSION: MH may be a concern, even for patients with optimal office BP. Evaluating exposure to psychosocial stressors, including routine levels of interpersonal conflict may help to identify those patients who might benefit from further clinical follow-up

Seo, M. G., Bartunek, J. M., & Barrett, L. F. (2010). The role of affective experience in work motivation: Test of a conceptual model. Journal of Organizational Behavior, 31, 951-968.

The purpose of this paper was to contribute to understanding of the crucial role of emotion in work motivation by testing a conceptual model developed by Seo, Barrett, and Bartunek (2004) that predicted the impacts of core affect on three behavioral outcomes of work motivation, generative-defensive orientation, effort, and persistence. We tested the model using an Internet-based investment simulation combined with an experience sampling procedure. Consistent with the predictions of the model, pleasantness was positively related to all three of the predicted indices. For the most part, these effects occurred indirectly via its relationships with expectancy, valence, and progress judgment components. Also as predicted by the model, activation was directly and positively related to effort.

Shin, W., Cha, Y. D., & Yoon, G. (2010). ECG/PPG integer signal processing for a ubiquitous health monitoring system. J Med Syst., 34, 891-898.

A compact ubiquitous-health monitor operated by single 8-bit microcontroller was made. An integer signal processing algorithm for this microcontroller was developed and digital filtering of ECG (electrocardiogram) and PPG (photoplethysmogram) was performed. Rounding-off errors due to integer operation was solved by increasing the number of effective integer digits during CPU operation; digital filter coefficients and data expressed in decimal points were multiplied by a certain number and converted into integers. After filter operation, the actual values were retrieved by dividing with the same number and selecting available highest bits. Our results showed comparable accuracies to those computed by a commercial software. Compared with a floating-point calculation by the same microcontroller, the computation speed became faster by 1.45 approximately 2.0 times depending on various digital filtering cases. Our algorithm was successfully tested for remote health monitoring with multiple users. If our algorithm were not used, our health monitor should have used additional microcontrollers or DSP chip. The proposed algorithm reduced the size and cost of our health monitor substantially

Simons, J. S., Dvorak, R. D., Batien, B. D., & Wray, T. B. (2010). Event-level associations between affect, alcohol intoxication, and acute dependence symptoms: Effects of urgency, self-control, and drinking experience. Addictive Behaviors, 35, 1045-1053.

This study used experience sampling to examine within-person associations between positive affect, anxiety, sadness, and hostility and two outcomes: alcohol intoxication and acute dependence symptoms. We examined the role of urgency, premeditation, and perseverance in predicting the alcohol outcomes and tested whether the affective associations varied as a function of urgency. Participants completed baseline assessments and 21 days of experience sampling on PDAs. Hypotheses were partially confirmed. Positive affect was positively, and sadness inversely, associated with intoxication. Hostility was associated with intoxication for men but not women. Negative urgency moderated the association between anxiety and intoxication, making it stronger. However, positive urgency did not moderate the effect of positive affect. Heavier drinkers exhibited the greatest number of symptoms, yet the association between intoxication and acute signs of alcohol disorder was attenuated among these individuals. Results support the use of experience sampling to study acute signs and symptoms of high risk drinking and dependence.

Simpson, T. L., Galloway, C., Rosenthal, C. F., Bush, K. R., McBride, B., & Kivlahan, D. R. (2011). Daily telephone monitoring compared with retrospective recall of alcohol use among patients in early recovery. Am J Addict., 20, 63-68.

Most studies comparing frequent self-monitoring protocols and retrospective assessments of alcohol use find good correspondence, but have excluded participants with significant comorbidity and/or social instability, and some have included abstainers. We evaluated the correspondence between measures of alcohol use based on daily interactive voice response (IVR) telephone monitoring and a 28-day modification of the Form-90 (Form-28). Participants were 25 outpatients with alcohol use disorder and significant PTSD symptomatology . Overall correlations between the IVR and Form-28 on days drinking and total standard drink units (SDUs) were strong for the entire sample and the subsample of drinkers (n = 7). Day-to-day correspondence between IVR and Form-28 was modest, but much stronger for the most recent week assessed than for the prior 3 weeks. Finally, the drinkers reported significantly greater total SDUs and heavy drinking days on the Form-28 than via IVR. The results indicate a need for further refinement of IVR methodology for treatment seeking populations as well as caution when retrospectively assessing drinking over time periods longer than a week among these individuals

Stepp, S. D., Hallquist, M. N., Morse, J. Q., & Pilkonis, P. A. (2010). Multimethod investigation of interpersonal functioning in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment.

Even though interpersonal functioning is of great clinical importance for patients with borderline personality disorder (BPD), the comparative validity of different assessment methods for interpersonal dysfunction has not yet been tested. This study examined multiple methods of assessing interpersonal functioning, including self- and other-reports, clinical ratings, electronic diaries, and social cognitions in three groups of psychiatric patients (N = 138): patients with (1) BPD, (2) another personality disorder, and (3) Axis I psychopathology only. Using dominance analysis, we examined the predictive validity of each method in detecting changes in symptom distress and social functioning 6 months later. Across multiple methods, the BPD group often reported higher interpersonal dysfunction scores compared with other groups. Predictive validity results demonstrated that self-report and electronic diary ratings were the most important predictors of distress and social functioning. Our findings suggest that self-report scores and electronic diary ratings have high clinical utility, because these methods appear most sensitive to change.

Swendsen, J., Ben-Zeev, D., & Granholm, E. (2011). Real-time electronic ambulatory monitoring of substance use and symptom expression in schizophrenia. Am J Psychiatry, 168, 202-209.

OBJECTIVE: Despite evidence demonstrating elevated comorbidity between schizophrenia and substance use disorders, the underlying mechanisms of association remain poorly understood. The brief time intervals that characterize interactions between substance use and psychotic symptoms in daily life are inaccessible to standard research protocols. The authors used electronic personal digital assistants (PDAs) to examine the temporal association of diverse forms of substance use with psychotic symptoms and psychological states in natural contexts. METHOD: Of 199 community-dwelling individuals with schizophrenia or schizoaffective disorder who were contacted to participate in the study, 92% accepted and 73% completed the study. The 145 participants who completed the study provided reports of substance use, psychotic symptoms, mood, and event negativity multiple times per day over 7 consecutive days through PDAs. RESULTS: Participants responded to 72% of the electronic interviews (N=2,737) across daily life contexts. Strong within-day prospective associations were observed in both directions between substance use and negative psychological states or psychotic symptoms, but considerable variation was observed by substance type. Consistent with the notion of self-medication, alcohol use was most likely to follow increases in anxious mood or psychotic symptoms. Cannabis and other illicit substances, demonstrating more complex patterns, were more likely to follow certain psychological states but were also associated with the later onset of psychotic symptoms. CONCLUSIONS: The dynamic interplay of substance use and psychotic symptoms is in many cases consistent with both causal and self-medication mechanisms, and these patterns of association should be considered in the design of treatment and prevention strategies

Timmermans, T., Van Mechelen, I., & Kuppens, P. (2010). The relationship between individual differences in intraindividual variability in core affect and interpersonal behaviour. European Journal of Personality, 24, 623-638.

How people’s feelings and interpersonal behaviour change across time can be represented as movements within a core affect and an interpersonal space. To gain insight into the relationship between affect and behaviour dynamics, the present study examined how individual differences in intraindividual variability in core affect relate to those in interpersonal behaviour, and how both are related to personality traits. In an experience sampling study, 63 participants were asked to monitor their core affect during one week and their interpersonal behaviour during another one. The results demonstrated a fairly consistent correspondence between several indices of people’s variability in core affect and interpersonal behaviour, indicating that emotional lability also signals behavioural volatility and vice versa.

Troughton, R. W., Ritzema, J., Eigler, N. L., Melton, I. C., Krum, H., Adamson, P. B., Kar, S., Shah, P. K., Whiting, J. S., Heywood, J. T., Rosero, S., Singh, J. P., Saxon, L., Matthews, R., Crozier, I. G., & Abraham, W. T. (2011). Direct left atrial pressure monitoring in severe heart failure: long-term sensor performance. J Cardiovasc.Transl.Res., 4, 3-13.

We report the stability, accuracy, and development history of a new left atrial pressure (LAP) sensing system in ambulatory heart failure (HF) patients. A total of 84 patients with advanced HF underwent percutaneous transseptal implantation of the pressure sensor. Quarterly noninvasive calibration by modified Valsalva maneuver was achieved in all patients, and 96.5% of calibration sessions were successful with a reproducibility of 1.2 mmHg. Absolute sensor drift was maximal after 3 months at 4.7 mmHg (95% CI, 3.2-6.2 mmHg) and remained stable through 48 months. LAP was highly correlated with simultaneous pulmonary wedge pressure at 3 and 12 months (r = 0.98, average difference of 0.8 +/- 4.0 mmHg). Freedom from device failure was 95% (n = 37) at 2 years and 88% (n = 12) at 4 years. Causes of failure were identified and mitigated with 100% freedom from device failure and less severe anomalies in the last 41 consecutive patients (p = 0.005). Accurate and reliable LAP measurement using a chronic implanted monitoring system is safe and feasible in patients with advanced heart failure

Vaddiraju, S., Burgess, D. J., Tomazos, I., Jain, F. C., & Papadimitrakopoulos, F. (2010). Technologies for continuous glucose monitoring: current problems and future promises. J Diabetes Sci.Technol., 4, 1540-1562.

Devices for continuous glucose monitoring (CGM) are currently a major focus of research in the area of diabetes management. It is envisioned that such devices will have the ability to alert a diabetes patient (or the parent or medical care giver of a diabetes patient) of impending hypoglycemic/hyperglycemic events and thereby enable the patient to avoid extreme hypoglycemic/hyperglycemic excursions as well as minimize deviations outside the normal glucose range, thus preventing both life-threatening events and the debilitating complications associated with diabetes. It is anticipated that CGM devices will utilize constant feedback of analytical information from a glucose sensor to activate an insulin delivery pump, thereby ultimately realizing the concept of an artificial pancreas. Depending on whether the CGM device penetrates/breaks the skin and/or the sample is measured extracorporeally, these devices can be categorized as totally invasive, minimally invasive, and noninvasive. In addition, CGM devices are further classified according to the transduction mechanisms used for glucose sensing (i.e., electrochemical, optical, and piezoelectric). However, at present, most of these technologies are plagued by a variety of issues that affect their accuracy and long-term performance. This article presents a critical comparison of existing CGM technologies, highlighting critical issues of device accuracy, foreign body response, calibration, and miniaturization. An outlook on future developments with an emphasis on long-term reliability and performance is also presented

van den Berg-Emons RJ, Bussmann, J. B., & Stam, H. J. (2010). Accelerometry-based activity spectrum in persons with chronic physical conditions. Arch Phys.Med Rehabil., 91, 1856-1861.

OBJECTIVES: (1) To give an overview of the impact of a variety of chronic physical conditions on accelerometry-based levels of everyday physical activity and to identify high-risk conditions; and (2) to compare these objectively assessed activity levels with the levels estimated by rehabilitation physicians. INTERVENTIONS: Not applicable. DESIGN: Cross-sectional study. SETTING: Participant’s home environment. PARTICIPANTS: Patients (n=461) with 18 chronic physical (sub)conditions and able-bodied subjects (n=96). MAIN OUTCOME MEASURES: We summarized data on the level of everyday physical activity as objectively measured with an accelerometry-based activity monitor. Thirty-one rehabilitation physicians filled in a questionnaire designed to obtain their estimates of the level of physical activity in patients with the various conditions. RESULTS: Only 4 of the studied conditions had normal activity levels (>/=90% of the able-bodied level). Persons with transtibial amputation (vascular), spinal cord injury, and myelomeningocele (wheelchair dependent) had the lowest levels of activity, less than 40% of the able-bodied level. In general, rehabilitation physicians were aware of the inactive lifestyles, but considerably underestimated the magnitude of inactivity in the high-risk conditions. CONCLUSIONS: This is the first study to provide an objectively assessed activity spectrum in a variety of chronic physical conditions. We hope this study will increase the awareness of health professionals as to which chronic physical conditions are at increased risk for an inactive lifestyle, and will contribute to adaptation of patient management accordingly

Wang, N., Redmond, S. J., Ambikairajah, E., Celler, B. G., & Lovell, N. H. (2010). Can triaxial accelerometry accurately recognize inclined walking terrains? IEEE Trans.Biomed.Eng, 57, 2506-2516.

The standard method for the analysis of body accelerations cannot accurately estimate the energy expenditure (EE) of uphill or downhill walking. The ability to recognize the grade of the walking surface will most likely improve upon the accuracy of the EE estimates for daily physical activities. This paper investigates the benefits of automatic gait analysis approaches including step-by-step gait segmentation and heel-strike recognition of the accelerometry signal in classifying various gradients. Triaxial accelerometry signals were collected from 12 subjects, performing walking on seven different gradient surfaces: 1) 92 m of 0( degrees ) flat ground; 2) 85 m of +/-2.70( degrees ) inclined ramp; 3) 24 m of +/-9.86( degrees ) inclined ramp; and 4) 6-m pitch line of +/-28.03( degrees ) rake of stairway. Validity studies performed on a group of randomly selected healthy subjects showed high agreement scores between the automated heel-strike recognition markers, manual gait annotation markers, and video-based gait-segmentation markers. Thirteen subset features were found using a subset-selection search procedure from 57 extracted features which maximize the classification accuracy, performed with a Gaussian mixture model classifier, as estimated using sixfold cross-validation. An overall walking pattern-recognition accuracy of 82.46% was achieved on seven different inclined terrains using the 13 selected features. This system should, therefore, improve the accuracy of daily EE estimates with accurate measures on terrain inclinations

Weinzimer, S. A. (2010). Analysis: high-tech diabetes technology and the myth of clinical “plug and play”. J Diabetes Sci.Technol., 4, 1465-1467.

In this issue of Journal of Diabetes Science and Technology, Davey and coauthors present encouraging data that even short-term use of a real-time continuous glucose monitor can lead to marked reduction in hypoglycemia exposure. In this analysis, two particular issues will be discussed: the distinction between short- and long-term experiences with sensors and the use of standardized diabetes treatment algorithms for use with continuous glucose monitoring (CGM) devices. An understanding of both of these aspects of CGM devices is necessary for placing clinical diabetes technology products into the context of how they will be used in “real life.”

Wenze, S. J., Gunthert, K. C., & Forand, N. R. (2010). Cognitive reactivity in everyday life as a prospective predictor of depressive symptoms. Cognitive Therapy and Research, 34, 554-562.

We used PDA devices and an experience sampling technique to assess participants negative mood and thoughts as they engaged in their normal daily routines over the course of a week. We then calculated each persons own unique relationship between mood and thoughts, and used this index of cognitive reactivity to predict depressive symptoms at 6-month follow-up. Participants who demonstrated a stronger link between their momentary negative mood and negative cognitions reported more depressive symptoms at follow-up than those who had a weaker relationship between mood and cognitions. Further, this cognitive reactivity index was a better predictor of follow-up depressive symptom scores than initial depressive symptoms, dysfunctional attitudes, average experienced negative mood or thoughts, or variability of negative mood or thoughts. These results are consistent with earlier findings and build on previous research by demonstrating that naturally occurring cognitive reactivity is predictive of future mood disruptions.

Wilczynska, A., De, M. F., Singh, R. B., & Bargiel-Matusiewicz, K. (2010). Heart rate and blood pressure in the context of nutritional and psychological analysis: a case study. Eur J Med Res., 15 Suppl 2, 217-223.

BACKGROUND: The disturbance of circadian variability helps predict, among others, the occurrence of cardiovascular diseases. Circadian Hyper Amplitude Tension (CHAT) is a psychosomatic disorder related to an inappropriate lifestyle (including unbalanced diet, stress-inducing environment/development) and genetic factors. Blood pressure and heart rate are phenotypes characterized by rhythmic fluctuations over time under influence of environmental/developmental (incl. psychosocial) and genetic conditions. These cardio-/cerebro-vascular fluctuations result from otherwise largely distributed internal biological rhythms regulated via complex and intertwined neuro-hormonal systems. OBJECTIVE: The objective of this study was to identify a potential time-structure relationship between blood pressure/heart rate rhythmic fluctuations and nutritional/psychosocial conditions in a 43-year old woman exposed to new nutritional (omega-3 fatty acids supplementation) and psychosocial (divorce) factors. METHOD: The study involved the use of a non-invasive device (ambulatory blood pressure monitor or ABPM, A&D Ltd, Tokyo, Japan) for continuous (24/7) monitoring of heart functions and rhythms between October 2009 and March 2010, at 30-min intervals. As a result, 16 time-structure profiles (Sphygmochron) were obtained from Halberg Chronobiological Center (Minneapolis, MN, USA), each of them containing detailed analysis and interpretation of stacked data spanning 7-14 days. The study also involved a diary of daily nutritional (omega-3 fatty acids) / psychosocial (PANAS) events and their emotional and cognitive components. RESULTS: Both systolic (SBP) and diastolic blood pressure (DBP) steadily decreased during the time of the study. Three periods of elevated variability in SBP (diagnosed as CHAT) and one period of abnormally low DBP were recorded during the 6-month study at the time of negative affects (NA). CONCLUSION: A comparative analysis of diary records (omega-3 fatty acids & PANAS) and cardiovascular responses (Sphygmochron) showed that a person who is professionally and socially active in middle age can actively reduce her SBP/DBP with omega-3 fatty acids intervention. However, the person also displays disturbances in blood pressure variability predicted by the stress-strain hypothesis, whereby states of strain and relaxation are generated by the persons predetermined standards and objectives

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