Society for Ambulatory Assessment

First quarter 2013 (January to March)

al’Absi, M., Khalil, N. S., Al, H. M., Hoffman, R., Fujiwara, K., & Wittmers, L. (2013). Effects of chronic khat use on cardiovascular, adrenocortical, and psychological responses to stress in men and women. Am J Addict., 22, 99-107.

BACKGROUND: Khat is a psychostimulant plant widely used in Africa and its use has been growing rapidly in Europe and North America. OBJECTIVES: We investigated effects of chronic khat (Catha edulis) use on cardiovascular, adrenocortical, and psychological responses to acute stress. METHODS: Chronic khat users and nonusers were compared on physiological measures and mood reports in a cross-sectional, mixed design. Measurements were conducted during 24-hour ambulatory monitoring and during a laboratory session. A total of 152 participants (58 women) were recruited by flyers posted around Sana’a University campus and the surrounding community in Sana’a, Yemen. Salivary cortisol and self-report measures were collected during a 24-hour ambulatory period prior to a lab testing session. In addition, blood pressures (BP), salivary cortisol, and mood measures were assessed during rest and in response to acute mental stress. RESULTS: Khat users exhibited enhanced evening and attenuated morning cortisol levels, reflecting a blunted diurnal pattern of adrenocortical activity compared to nonusers. Khat users reported greater negative affect during the ambulatory period and during the laboratory session. In addition, they exhibited attenuated BP responses to stress. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: These novel results demonstrate altered adrenocortical activity and increased dysphoric mood among khat users. The extent to which these associations are due to effects of chronic khat use per se or instead reflect predisposing risk factors for khat use is yet to be determined

Anastasopoulou, P., Tansella, M., Stumpp, J., Shammas, L., & Hey, S. (2012). Classification of human physical activity and energy expenditure estimation by accelerometry and barometry. Conf.Proc.IEEE Eng Med Biol.Soc., 2012, 6451-6454.

Regular exercise and physical activity are among the most important factors influencing the quality of life and make a significant contribution to the maintenance of health and well-being. The assessment of physical activity via accelerometry has become a promising technique often used as means to objectively measure physical activity. This work proposes a simple and reliable method to assess human physical activity and calculate the energy expenditure (EE) by using an acceleration and an air pressure sensor. Our proposed algorithm differentiates between 7 activities with an average accuracy of 98.2% and estimates the second by second EE with an average percent error of 1.59 +/- 8.20% using a single measurement unit attached to the subject’s hip

Anestis, M. D., Silva, C., Lavender, J. M., Crosby, R. D., Wonderlich, S. A., Engel, S. G. et al. (2012). Predicting nonsuicidal self-injury episodes over a discrete period of time in a sample of women diagnosed with bulimia nervosa: An analysis of self-reported trait and ecological momentary assessment based affective lability and previous suicide attempts. International Journal of Eating Disorders, 45, 808-811.

Objective: To examine the moderating effect of trait affective lability on the relationship between past suicidal behavior and future nonsuicidal self-injury (NSSI). Method: A total of 127 adult females diagnosed with bulimia nervosa took part in this study. We hypothesized that individuals with greater levels of self-reported trait affective lability and a greater number of past suicide attempts would engage in a greater number of NSSI episodes over the course of 2 weeks than would individuals lacking elevations in one or both of those variables, controlling for average level of negative affect and affective lability as measured through ecological momentary assessment (EMA). Results: The two-way interaction of trait affective lability and past suicidal behavior predicted participantsÇÖ number of NSSI episodes during the course of the study. Discussion: Interaction of self-reported trait affective lability and past suicidal behavior may exhibit clinical utility in the prediction of patientsÇÖ imminent risk of engaging in NSSI.

Armey, M. F. (2012). Ecological momentary assessment and intervention in nonsuicidal self-injury: A novel approach to treatment. Journal of Cognitive Psychotherapy, 26, 299-317.

This study provides an introduction to ecological momentary assessment (EMA) methods and the potential use of ecological momentary intervention (EMI) for nonsuicidal self-injury (NSSI). The novel use of EMA and EMI are discussed within the context of the emotion regulation function of NSSI, the ability of these approaches to complement established treatments (i.e., cognitive behavior therapy & dialectical behavior therapy), and the specific areas in which an EMI treatment approach can augment traditional treatment. Based on established EMA findings in general and specific applications of EMA to the NSSI, a model EMI for NSSI is proposed

Ayabe, M., Kumahara, H., Morimura, K., & Tanaka, H. (2013). Epoch length and the physical activity bout analysis: an accelerometry research issue. BMC Res Notes, 6, 20.

BACKGROUND: The purpose of the present investigation was to compare the bouts of daily physical activity (PA) determined by three different accelerometer epoch lengths under free-living conditions. METHODS: One hundred thirty-four adults (50 +/- 7 years) wore an accelerometer (Lifecorder) for 7 consecutive days under free-living conditions in order to determine the time spent in physical activity of light intensity (LPA), moderate intensity (MPA), vigorous intensity (VPA), moderate to vigorous intensity (MVPA), and the total physical activity (TPA; sum of LPA, MPA and VPA). Additionally, all PA was divided according to the bout durations (sporadic, > 3 min, > 5 min, and > 10 min). These indices of PA were analyzed using three different epoch lengths (4 sec, 20 sec and 60 sec) derived from the accelerometer. RESULTS: The LPA significantly increased in association with increases in the epoch length (48.7 +/- 15.9 to 178.7 +/- 62.6 min/day, p < 0.05). The amount of sporadic VPA determined by the shortest epoch length (2.9 +/- 5.2 min/day) was significantly longer than the two remaining epoch lengths (1.1 +/- 2.4 to 0.9 +/- 2.5 min/day, p < 0.05). The times of the MVPA bouts lasting longer than 3 minutes determined using the 4-second epoch length (2.6 +/- 5.4 to 7.7 +/- 10.0 min/day) were significantly shorter than those determined using the other two settings (6.5 +/- 10.5 to 13.8 +/- 13.8 min/day, p < 0.05). The frequencies of the MVPA bouts lasting longer than 10 minutes determined using the 4-second epoch length (0.2 +/- 0.3 bouts/day) were significantly lower than those determined using the other two settings (0.3 +/- 0.4 bouts/day, p < 0.05). CONCLUSION: The epoch length setting of the accelerometer affects the estimation of the PA bouts under free-living conditions in middle-aged to older adults

Ayubi, S. U. & Parmanto, B. (2012). PersonA: Persuasive social network for physical Activity. Conf.Proc.IEEE Eng Med Biol.Soc., 2012, 2153-2157.

Advances in physical activity (PA) monitoring devices provide ample opportunities for innovations in the way the information produced by these devices is used to encourage people to have more active lifestyles. One such innovation is expanding the current use of the information from self-management to social support. We developed a Persuasive social network for physical Activity (PersonA) that combines automatic input of physical activity data, a smartphone, and a social networking system (SNS). This paper describes the motivation for and overarching design of the PersonA and its functional and non-functional features. PersonA is designed to intelligently and automatically receive raw PA data from the sensors in the smartphone, calculate the data into meaningful PA information, store the information on a secure server, and show the information to the users as persuasive and real-time feedbacks or publish the information to the SNS to generate social support. The implementation of self-monitoring, social support, and persuasive concepts using currently available technologies has the potential for promoting healthy lifestyle, greater community participation, and higher quality of life. We also expect that PersonA will enable health professionals to collect in situ data related to physical activity. The platform is currently being used and tested to improve PA level of three groups of users in Pittsburgh, PA, USA

Barkley, J. E., Salvy, S. J., & Roemmich, J. N. (2012). The effect of simulated ostracism on physical activity behavior in children. Pediatrics, 129, e659-e666.

Objectives: To assess the effects of simulated ostracism on childrenÇÖs physical activity behavior, time allocated to sedentary behavior, and liking of physical activity. Methods: Nineteen children (11 boys, 8 girls; age 11.7 -¦ 1.3 years) completed 2 experimental sessions. During each session, children played a virtual ball-toss computer game (Cyberball). In one session, children played Cyberball and experienced ostracism; in the other session, they were exposed to the inclusion/control condition. The order of conditions was randomized. After playing Cyberball, children were taken to a gymnasium where they had free-choice access to physical and sedentary activities for 30 minutes. Children could participate in the activities, in any pattern they chose, for the entire period. Physical activity during the free-choice period was assessed via accelerometery and sedentary time via observation. Finally, children reported their liking for the activity session via a visual analog scale. Results: Children accumulated 22% fewer (P < .01) accelerometer counts and 41% more (P < .04) minutes of sedentary activity in the ostracized condition (8.9[sup]e+4[/sup] -¦ 4.5[sup]e+4[/sup] counts, 11.1 -¦ 9.3 minutes) relative to the included condition (10.8[sup]e+4[/sup] -¦ 4.7[sup]e+4[/sup] counts, 7.9 -¦ 7.9 minutes). Liking (8.8 -¦ 1.5 cm included, 8.1 -¦ 1.9 cm ostracized) of the activity sessions was not significantly different (P > .10) between conditions. Conclusions: Simulated ostracism elicits decreased subsequent physical activity participation in children. Ostracism may contribute to childrenÇÖs lack of physical activity.

Barnes, V. A., Johnson, M. H., Williams, R. B., & Williams, V. P. (2012). IMPACT OF WILLIAMS LIFESKILLS TRAINING ON ANGER, ANXIETY AND AMBULATORY BLOOD PRESSURE IN ADOLESCENTS. Transl.Behav.Med, 2, 401-410.

The Williams LifeSkills(R) (WLS) anger and stress management workshop provides training in strategies to cope with stressful situations and build supportive relationships. The purpose of this study was to determine the impact of school-based Williams LifeSkills training on anger, anxiety and blood pressure in adolescents. 159 adolescents (mean age+/-SD=15.7+/-1.4 years) were randomized to WLS (n=86) or control (CTL, n=73) groups. The WLS group engaged in twelve 50-min WLS training sessions conducted by teachers at school. Anger-in and anxiety scores decreased and anger control scores increased in the WLS group across the six-month follow-up period compared to the CTL group (group x visit, ps<0.05). Daytime diastolic BP was lower across the follow-up in the WLS group (p=0.08). DBP was significantly lower across the follow-up period in the WLS group among those with higher SBP at baseline (p=0.04). These findings demonstrate beneficial impact of WLS upon self-reported anger-in, anger-control, anxiety levels and ambulatory DBP in the natural environment in healthy normotensive youth

Basen-Engquist, K., Carmack, C. L., Li, Y., Brown, J., Jhingran, A., Hughes, D. C. et al. (2013). Social-Cognitive Theory Predictors of Exercise Behavior in Endometrial Cancer Survivors. Health Psychology.

Objective: This study evaluated whether social-cognitive theory (SCT) variables, as measured by questionnaire and ecological momentary assessment (EMA), predicted exercise in endometrial cancer survivors. Method: One hundred posttreatment endometrial cancer survivors received a 6-month home-based exercise intervention. EMAs were conducted by using hand-held computers for 10- to 12-day periods every 2 months. Participants rated morning self-efficacy and positive and negative outcome expectations by using the computer, recorded exercise information in real time and at night, and wore accelerometers. At the midpoint of each assessment period, participants completed SCT questionnaires. Using linear mixed-effects models, the authors tested whether morning SCT variables predicted minutes of exercise that day (Question 1) and whether exercise minutes at time point Tj could be predicted by questionnaire measures of SCT variables from time point Tj-1 (Question 2). Results: Morning self-efficacy significantly predicted that day’s exercise minutes (p < .0001). Morning positive outcome expectations were also associated with exercise minutes (p = .0003), but the relationship was attenuated when self-efficacy was included in the model (p = .4032). Morning negative outcome expectations were not associated with exercise minutes. Of the questionnaire measures of SCT variables, only exercise self-efficacy predicted exercise at the next time point (p = .003). Conclusions: The consistency of the relationship between self-efficacy and exercise minutes over short (same day) and longer (Tj to Tj-1) time periods provides support for a causal relationship. The strength of the relationship between morning self-efficacy and exercise minutes suggest that real-time interventions that target daily variation in self-efficacy may benefit endometrial cancer survivors’ exercise adherence.

Bassi, M., Ferrario, N., Ba, G., Delle, F. A., & Vigano, C. (2012). Quality of experience during psychosocial rehabilitation: a real-time investigation with experience sampling method. Psychiatr.Rehabil.J, 35, 447-453.

OBJECTIVE: This study aimed to identify contextual and clinical factors contributing to the quality of experience of people participating in psychosocial rehabilitation activities (RA) and to investigate the association of RA with optimal experience or flow, a state characterized by the perception of high challenges and high skills, deep concentration, positive affect, clear goals, control and autonomous motivation, which contributes to individuals’ well-being. METHOD: Twenty-seven people at an Italian psychiatric rehabilitation center provided real-time information on daily activities and associated experience through experience sampling method. Multilevel models were calculated to assess the factors contributing to participants’ quality of experience. RESULTS: Analyses showed that situation-contingent factors-type of activity and relationship between perceived challenges and skills-predicted participants’ quality of experience over and above the clinical factors taken into account in this study: level of global functioning (GAF), rehabilitation duration, and type of setting (residential vs. semi-residential). In addition, RA were prominently associated with optimal experience. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Results suggest the importance for people involved in rehabilitation programs to engage in challenging tasks, favoring both the onset of positive and complex experiences and skill development. Findings further show the usefulness of real-time assessment methods in monitoring the rehabilitation process

Bassi, M. & Fave, A. D. (2012). Optimal experience among teachers: New insights into the work paradox. Journal of Psychology: Interdisciplinary and Applied, 146, 533-557.

Several studies highlighted that individuals perceive work as an opportunity for flow or optimal experience, but not as desirable and pleasant. This finding was defined as the work paradox. The present study addressed this issue among teachers from the perspective of self-determination theory, investigating work-related intrinsic and extrinsic motivation, as well as autonomous and controlled behavior regulation. In Study 1, 14 teachers were longitudinally monitored with Experience Sampling Method for one work week. In Study 2, 184 teachers were administered Flow Questionnaire and Work Preference Inventory, respectively investigating opportunities for optimal experience, and motivational orientations at work. Results showed that work-related optimal experiences were associated with both autonomous regulation and with controlled regulation. Moreover, teachers reported both intrinsic and extrinsic motivation at work, with a prevailing intrinsic orientation. Findings provide novel insights on the work paradox, and suggestions for teachersÇÖ well-being promotion.

Ben-Zeev, D., Frounfelker, R., Morris, S. B., & Corrigan, P. W. (2012). Predictors of Self-Stigma in Schizophrenia: New Insights Using Mobile Technologies. J Dual Diagn., 8, 305-314.

Self-stigma has significant negative impact on the recovery of individuals with severe mental illness, but its varying course is not well understood. Individual levels of self-stigma may vary over time and fluctuate in response to both external/contextual (i.e., location, activity, social company) and internal (i.e., psychiatric symptoms, mood) factors. The aim of this study was to examine the relationship between self-stigmatizing beliefs and these factors, as they occur in the daily life of individuals with schizophrenia. Mobile technologies were used to longitudinally track momentary levels of self-stigma, psychotic symptoms, negative affect, positive affect, activity, and immediate social and physical environment in twenty-four individuals with schizophrenia, multiple times daily, over a one-week period. Multilevel modeling showed that participants’ current activity was associated with changes in self-stigma (chi2= 10.53, p <0.05), but immediate location and social company were not. Time-lagged analyses found that increases in negative affect (beta=0.11, p<0.01) and psychotic symptom severity (beta=0.16, p<0.01) predicted increases in the intensity of self-stigmatizing beliefs. Psychotic symptoms were found to be both an antecedent and a consequence (beta=0.08, p<0.01) of increased self-stigma. Our findings support a framework for understanding self-stigma as an experience that changes based on alterations in internal states and external circumstances. Mobile technologies are an effective methodology to study self-stigma and have potential to be used to deliver clinical interventions

Bless, J. J., Westerhausen, R., Arciuli, J., Kompus, K., Gudmundsen, M., & Hugdahl, K. (2013). “Right on all Occasions?” – On the Feasibility of Laterality Research Using a Smartphone Dichotic Listening Application. Front Psychol., 4, 42.

Most psychological experimentation takes place in laboratories aiming to maximize experimental control; however, this creates artificial environments that are not representative of real-life situations. Since cognitive processes usually take place in noisy environments, they should also be tested in these contexts. The recent advent of smartphone technology provides an ideal medium for such testing. In order to examine the feasibility of mobile devices (MD) in psychological research in general, and laterality research in particular, we developed a MD version of the widely used speech laterality test, the consonant-vowel dichotic listening (DL) paradigm, for use with iPhones/iPods. First, we evaluated the retest reliability and concurrent validity of the DL paradigm in its MD version in two samples tested in controlled, laboratory settings (Experiment 1). Second, we explored its ecological validity by collecting data from the general population by means of a free release of the MD version (iDichotic) to the iTunes App Store (Experiment 2). The results of Experiment 1 indicated high reliability (r(ICC) = 0.78) and validity (r(ICC) = 0.76-0.82) of the MD version, which consistently showed the expected right ear advantage (REA). When tested in real-life settings (Experiment 2), participants (N = 167) also showed a significant REA. Importantly, the size of the REA was not dependent on whether the participants chose to listen to the syllables in their native language or not. Together, these results establish the current MD version as a valid and reliable method for administering the DL paradigm both in experimentally controlled as well as uncontrolled settings. Furthermore, the present findings support the feasibility of using smartphones in conducting large-scale field experiments

Blood, E. A. & Shrier, L. A. (2013). The temporal relationship between momentary affective states and condom use in depressed adolescents. Archives of Sexual Behavior.

Depressed adolescents are more likely to engage in sexual risk behaviors than their non-depressed peers. The objectives of this study were (1) to examine whether affective states predicted subsequent condom use, directly or indirectly through contextual factors and (2) to compare results obtained from structural equation models versus non-linear mixed effects models. This study used ecological momentary assessment to collect data on in-the-moment affective states and sexual behavior from 51 depressed adolescents (7 male, 44 female) aged 15Çô22-áyears. The association between positive and negative affect and condom use during a subsequent sex event was explored using several structural equation models and non-linear mixed effects models. Potential mediation by substance use before sex, partner type, reason for sex, and who wanted sex was examined. Neither positive nor negative affect was directly associated with condom use in any models; however, negative affect was associated with increased likelihood of sex with a non-main partner, which, in turn, was associated with increased condom use. Both structural equation models and non-linear mixed effects models successfully modeled the relationship between affect and condom use in momentary data while correctly accounting for the correlation of multiple observations from the same individual. The benefit of structural equation modeling was the ability to directly model the mediation of this effect by contextual factors. In this sample of depressed adolescents, negative and positive affect did not appear to be directly predictive of condom use during a subsequent sex event, although may indirectly affect condom use through sex with a non-main partner.

Bolkhovsky, J. B., Scully, C. G., & Chon, K. H. (2012). Statistical analysis of heart rate and heart rate variability monitoring through the use of smart phone cameras. Conf.Proc.IEEE Eng Med Biol.Soc., 2012, 1610-1613.

Video recordings of finger tips made using a smartphone camera contain a pulsatile component caused by the cardiac pulse equivalent to that present in a photoplethysmographic signal. By performing peak detection on the pulsatile signal it is possible to extract a continuous heart rate signal. We performed direct comparisons between 5-lead electrocardiogram based heart rate variability measurements and those obtained from an iPhone 4s and Motorola Droid derived pulsatile signal to determine the accuracy of heart rate variability measurements obtained from the smart phones. Monitoring was performed in the supine and tilt positions for independent iPhone 4s (2 min recordings, n=9) and Droid (5 min recordings, n=13) experiments, and the following heart rate and heart rate variability parameters were estimated: heart rate, low frequency power, high frequency power, ratio of low to high frequency power, standard deviation of the RR intervals, and root mean square of successive RR-differences. Results demonstrate that accurate heart rate variability parameters can be obtained from smart phone based measurements

Bracht, T., Federspiel, A., Schnell, S., Horn, H., Hofle, O., Wiest, R. et al. (2012). Cortico-cortical white matter motor pathway microstructure is related to psychomotor retardation in major depressive disorder. PLoS One, 7, e52238.

Alterations of brain structure and function have been associated with psychomotor retardation in major depressive disorder (MDD). However, the association of motor behaviour and white matter integrity of motor pathways in MDD is unclear. The aim of the present study was to first investigate structural connectivity of white matter motor pathways in MDD. Second, we explore the relation of objectively measured motor activity and white matter integrity of motor pathways in MDD. Therefore, 21 patients with MDD and 21 healthy controls matched for age, gender, education and body mass index underwent diffusion tensor imaging and 24 hour actigraphy (measure of the activity level) the same day. Applying a probabilistic fibre tracking approach we extracted connection pathways between the dorsolateral prefrontal cortex (dlPFC), the rostral anterior cingulate cortex (rACC), the pre-supplementary motor area (pre-SMA), the SMA-proper, the primary motor cortex (M1), the caudate nucleus, the putamen, the pallidum and the thalamus. Patients had lower activity levels and demonstrated increased mean diffusivity (MD) in pathways linking left pre-SMA and SMA-proper, and right SMA-proper and M1. Exploratory analyses point to a positive association of activity level and mean-fractional anisotropy in the right rACC-pre-SMA connection in MDD. Only MDD patients with low activity levels had a negative linear association of activity level and mean-MD in the left dlPFC-pre-SMA connection. Our results point to structural alterations of cortico-cortical white matter motor pathways in MDD. Altered white matter organisation of rACC-pre-SMA and dlPFC-pre-SMA pathways may contribute to movement initiation in MDD

Bracht, T., Schnell, S., Federspiel, A., Razavi, N., Horn, H., Strik, W. et al. (2013). Altered cortico-basal ganglia motor pathways reflect reduced volitional motor activity in schizophrenia. Schizophr.Res, 143, 269-276.

Little is known about the neurobiology of hypokinesia in schizophrenia. Therefore, the aim of this study was to investigate alterations of white matter motor pathways in schizophrenia and to relate our findings to objectively measured motor activity. We examined 21 schizophrenia patients and 21 healthy controls using diffusion tensor imaging and actigraphy. We applied a probabilistic fibre tracking approach to investigate pathways connecting the dorsolateral prefrontal cortex (dlPFC), the rostral anterior cingulate cortex (rACC), the pre-supplementary motor area (pre-SMA), the supplementary motor area proper (SMA-proper), the primary motor cortex (M1), the caudate nucleus, the striatum, the pallidum and the thalamus. Schizophrenia patients had lower activity levels than controls. In schizophrenia we found higher probability indices forming part of a bundle of interest (PIBI) in pathways connecting rACC, pre-SMA and SMA-proper as well as in pathways connecting M1 and pre-SMA with caudate nucleus, putamen, pallidum and thalamus and a reduced spatial extension of motor pathways in schizophrenia. There was a positive correlation between PIBI and activity level in the right pre-SMA-pallidum and the left M1-thalamus connection in healthy controls, and in the left pre-SMA-SMA-proper pathway in schizophrenia. Our results point to reduced volitional motor activity and altered motor pathway organisation in schizophrenia. The identified associations between the amount of movement and structural connectivity of motor pathways suggest dysfunction of cortico-basal ganglia pathways in the pathophysiology of hypokinesia in schizophrenia. Schizophrenia patients may use cortical pathways involving the supplementary motor area to compensate for basal ganglia dysfunction

Brans, K., Van, M., I, Rime, B., & Verduyn, P. (2013). The relation between social sharing and the duration of emotional experience. Cogn Emot..

People often socially share their emotions to regulate them. Two-mode theory of social sharing states that cognitive sharing will contribute to emotional recovery, whereas socio-affective sharing will only temporarily alleviate emotional distress. Previous studies supporting this theory, measured emotional recovery in terms of residual emotional intensity. Until now, another important time-dynamic aspect of emotions, emotion duration, has been largely ignored. In two experience sampling studies we addressed this gap. In Study 1, participants reported on the duration of anger, fear, and sadness episodes; additionally time-varying information on the occurrence and mode of sharing was collected. This study revealed that sharing led to a shortening in emotion duration, in particular when it was socio-affective in nature. In Study 2 we investigated whether this result could be interpreted in terms of our measure of duration primarily reflecting emotional relief rather than recovery. In this study, the same method as in Study 1 was used; additionally, residual emotional intensity was measured three days after emotion onset. Study 2 largely replicated the findings from Study 1. Furthermore, duration appeared to be empirically distinct from residual intensity. Finally, no relation between sharing and residual intensity was found, even when considering the sharing mode

Brodbeck, J., Bachmann, M. S., & Znoj, H. (2013). Distinct coping strategies differentially predict urge levels and lapses in a smoking cessation attempt. Addict.Behav., 38, 2224-2229.

This study analysed mechanisms through which stress-coping and temptation-coping strategies were associated with lapses. Furthermore, we explored whether distinct coping strategies differentially predicted reduced lapse risk, lower urge levels, or a weaker association between urge levels and lapses during the first week of an unassisted smoking cessation attempt. Participants were recruited via the internet and mass media in Switzerland. Ecological momentary assessment (EMA) with mobile devices was used to assess urge levels and lapses. Online questionnaires were used to measure smoking behaviours and coping variables at baseline, as well as smoking behaviour at the three-month follow-up. The sample consisted of 243 individuals, aged 20 to 40, who reported 4199 observations. Findings of multilevel regression analyses show that coping was mainly associated with a reduced lapse risk and not with lower urge levels or a weaker association between urge levels and lapses. ‘Calming down’ and ‘commitment to change’ predicted a lower lapse risk and also a weaker relation between urge levels and lapses. ‘Stimulus control’ predicted a lower lapse risk and lower urge levels. Conversely, ‘task-orientation’ and ‘risk assessment’ were related to higher lapse risk and ‘risk assessment’ also to higher urge levels. Disengagement coping i.e. ‘eating or shopping’, ‘distraction’, and ‘mobilising social support’ did not affect lapse risk. Promising coping strategies during the initial stage of smoking cessation attempt are targeted directly at reducing the lapse risk and are characterised by engagement with the stressor or one’s reactions towards the stressor and a focus on positive consequences instead of health risks

Bruehl, S., Liu, X., Burns, J. W., Chont, M., & Jamison, R. N. (2012). Associations between daily chronic pain intensity, daily anger expression, and trait anger expressiveness: An ecological momentary assessment study. Pain, 153, 2352-2358.

Links between elevated trait anger expressiveness (anger-out) and greater chronic pain intensity are well documented, but pain-related effects of expressive behaviors actually used to regulate anger when it is experienced have been little explored. This study used ecological momentary assessment methods to explore prospective associations between daily behavioral anger expression and daily chronic pain intensity. Forty-eight chronic low back pain (LBP) patients and 36 healthy controls completed electronic diary ratings of momentary pain and behavioral anger expression in response to random prompts 4 times daily for 7 days. Across groups, greater trait anger-out was associated with greater daily behavioral anger expression (P < 0.001). LBP participants showed higher levels of daily anger expression than controls (P < 0.001). Generalized estimating equation analyses in the LBP group revealed a lagged main effect of greater behavioral anger expression on increased chronic pain intensity in the subsequent assessment period (P < 0.05). Examination of a trait +ù situation model for anger-out revealed prospective associations between elevated chronic pain intensity and later increases in behavioral anger expression that were restricted largely to individuals low in trait anger-out (P < 0.001). Trait+ùsituation interactions for trait anger suppression (anger-in) indicated similar influences of pain intensity on subsequent behavioral anger expression occurring among low anger-in persons (P < 0.001). Overlap with trait and state negative affect did not account for study findings. This study for the first time documents lagged within-day influences of behavioral anger expression on subsequent chronic pain intensity. Trait anger regulation style may moderate associations between behavioral anger expression and chronic pain intensity.

Businelle, M. S., Lam, C. Y., Kendzor, D. E., Cofta-Woerpel, L., McClure, J. B., Cinciripini, P. M. et al. (2013). Alcohol consumption and urges to smoke among women during a smoking cessation attempt. Experimental and Clinical Psychopharmacology, 21, 29-37.

Laboratory and ad libitum smoking studies have indicated that alcohol consumption increases the frequency and intensity of smoking urges. However, few studies have examined the relation between smoking urges and alcohol use in natural settings during a quit attempt. The purpose of this study was to examine the relationships between smoking urge and alcohol use in women who reported drinking on at least one occasion during the first 7 days of a smoking quit attempt (N = 134). Participants were asked to use a palmtop computer to complete assessments that recorded smoking urges and recent alcohol use. Multilevel analyses examined the relation between smoking urge parameters and alcohol use. Smoking urges were higher during assessments where alcohol had been recently consumed compared to assessments where no alcohol had been consumed. Interestingly, the first urge rating of the day was higher and urges were more volatile on days where alcohol would eventually be consumed as compared to days where no alcohol was consumed. A closer examination of urge parameters on drinking days indicated that smoking urge trajectory was significantly flatter and urge volatility was significantly higher following alcohol consumption. However, smoking urge trajectory also flattened later in the day on nondrinking days. The findings suggest that there may be reciprocal relations between smoking urge and alcohol use (e.g., higher initial urges and more volatile urges may increase the likelihood of alcohol use, and alcohol use may impact within-day smoking urge parameters), and these relations could potentially impact smoking cessation and relapse.

Byun, W., Blair, S. N., & Pate, R. R. (2013). Objectively measured sedentary behavior in preschool children: comparison between Montessori and traditional preschools. Int.J Behav.Nutr.Phys.Act., 10, 2.

BACKGROUND: This study aimed to compare the levels of objectively-measured sedentary behavior in children attending Montessori preschools with those attending traditional preschools. METHODS: The participants in this study were preschool children aged 4 years old who were enrolled in Montessori and traditional preschools. The preschool children wore ActiGraph accelerometers. Accelerometers were initialized using 15-second intervals and sedentary behavior was defined as <200 counts/15-second. The accelerometry data were summarized into the average minutes per hour spent in sedentary behavior during the in-school, the after-school, and the total-day period. Mixed linear regression models were used to determine differences in the average time spent in sedentary behavior between children attending traditional and Montessori preschools, after adjusting for selected potential correlates of preschoolers’ sedentary behavior. RESULTS: Children attending Montessori preschools spent less time in sedentary behavior than those attending traditional preschools during the in-school (44.4. min/hr vs. 47.1 min/hr, P = 0.03), after-school (42.8. min/hr vs. 44.7 min/hr, P = 0.04), and total-day (43.7 min/hr vs. 45.5 min/hr, P = 0. 009) periods. School type (Montessori or traditional), preschool setting (private or public), socio-demographic factors (age, gender, and socioeconomic status) were found to be significant predictors of preschoolers’ sedentary behavior. CONCLUSIONS: Levels of objectively-measured sedentary behavior were significantly lower among children attending Montessori preschools compared to children attending traditional preschools. Future research should examine the specific characteristics of Montessori preschools that predict the lower levels of sedentary behavior among children attending these preschools compared to children attending traditional preschools

Byun, W., Liu, J., & Pate, R. R. (2013). Association between objectively measured sedentary behavior and body mass index in preschool children. Int.J Obes.(Lond).

Objective:To determine the association between accelerometry-derived sedentary behavior and body mass index (BMI) z-score in preschool children, and to determine whether the association changed when applying three different accelerometry cutpoints for sedentary behavior.Design and subjects:Cross-sectional design. Data came from two completed studies: Children’s Activity and Movement in Preschool Study (CHAMPS) and the Environmental Determinants of Physical Activity in Preschool Children (EDPAPC) study. Children of ages 3-5 years with complete data on sedentary behavior, BMI z-score, physical activity and other covariates were included in the analyses (N=263 in CHAMPS and N=155 in EDPAPC). Accelerometry data were summarized as time spent in sedentary behavior (min h(-1)) using three different cutpoints developed specifically for preschool children (<37.5, <200 and <373 counts per 15 s). Linear mixed regression models were used to determine the association between time spent in sedentary behavior and BMI z-score; age, gender, race, parental education, preschools and moderate-to-vigorous physical activity (MVPA) were included as covariates.Results:In both CHAMPS and EDPAPC studies, no independent association between time spent in sedentary behavior and BMI z-score was observed after adjusting for MVPA. The observed null association between sedentary behavior and BMI z-score was maintained even with different sedentary behavior cutpoints.Conclusions:Regardless of cutpoints used, accelerometry-derived sedentary behavior was not independently associated with BMI z-score in two independent samples of preschool children. Longitudinal studies addressing this research question are needed.International Journal of Obesity advance online publication, 15 January 2013; doi:10.1038/ijo.2012.222

Cagnacci, A., Ferrari, S., Napolitano, A., Piacenti, I., Arangino, S., & Volpe, A. (2012). Combined oral contraceptive containing drospirenone does not modify 24-h ambulatory blood pressure but increases heart rate in healthy young women: prospective study. Contraception.

BACKGROUND: Hypertension is a primary cardiovascular risk factor. Oral contraceptives (OCs) may increase blood pressure and cardiovascular events. We evaluated whether an OC containing ethynylestradiol (EE) in association with the spironolactone-derived progestin drospirenone (DRSP) influences 24-h ambulatory blood pressure of normotensive women. STUDY DESIGN: Twenty-four-hour blood pressure was measured every 30 min by an ambulatory blood pressure device in 18 normotensive healthy women prior to and after 6 months of use of an OC containing 30 mcg EE and 3 mg DRSP. RESULTS: OC induced no modification in 24-h, nighttime and daytime blood pressure. Heart rate increased about 4 beats/min in the 24-h (p<.05) and daytime (p<.02) measurements. CONCLUSIONS: In normotensive women, an OC containing 30 mcg EE plus 3 mg DRSP does not modify blood pressure, and significantly increases 24-h and daytime heart rate. These data suggest a neutral effect on hypertension-associated cardiovascular risk and point out an unreported effect on heart rate of which cause and effect require further evaluation

Carter, T., O’Neill, S., Johns, N., & Brady, R. R. (2013). Contemporary Vascular Smartphone Medical Applications. Ann.Vasc.Surg..

BACKGROUND: Use of smartphones and medical mHealth applications (apps) within the clinical environment provides a potential means for delivering elements of vascular care. This article reviews the contemporary availability of apps specifically themed to major vascular diseases and the opportunities and concerns regarding their integration into practice. METHODS: Smartphone apps relating to major vascular diseases were identified from the app stores for the 6 most popular smartphone platforms, including iPhone, Android, Blackberry, Nokia, Windows, and Samsung. Search terms included peripheral artery (arterial) disease, varicose veins, aortic aneurysm, carotid artery disease, amputation, ulcers, hyperhydrosis, thoracic outlet syndrome, vascular malformation, and lymphatic disorders. RESULTS: Forty-nine vascular-themed apps were identified. Sixteen (33%) were free of charge. Fifteen apps (31%) had customer satisfaction ratings, but only 3 (6%) had greater than 100. Only 13 apps (27%) had documented medical professional involvement in their design or content. CONCLUSIONS: The integration of apps into the delivery of care has the potential to benefit vascular health care workers and patients. However, high-quality apps designed by clinicians with vascular expertise are currently lacking and represent an area of concern in the mHealth market. Improvement in the quality and reliability of these apps will require the development of robust regulation

Casaseca-de-la-Higuera, P., Martin-Martinez, D., Alberola-Lopez, S., Andres-de-Llano, J. M., Lopez-Villalobos, J. A., Ramon-Garmendia, L. J. et al. (2012). Automatic diagnosis of ADHD based on multichannel nonlinear analysis of actimetry registries. Conf.Proc.IEEE Eng Med Biol.Soc., 2012, 4204-4207.

Attention-Deficit Hyperactivity Disorder (ADHD) is the most common mental health problem in childhood and adolescence. It is commonly diagnosed by means of subjective methods which tend to overestimate the severity of the pathology. A number of objective methods also exist, but they are either expensive or time-consuming. Some recent proposals based on nonlinear processing of activity registries have deserved special attention. Since they rely on actigraphy measurements, they are both inexpensive and non-invasive. Among these methods, those shown to have higher reliability are based on single-channel complexity assessment of the activity patterns. This way, potentially useful information related to the interaction between the different channels is discarded. In this paper we propose a new methodology for ADHD diagnosis based on joint complexity assessment of multichannel activity registries. Results on real data show that the proposed method constitute a useful diagnostic aid tool reaching 87:10% sensitivity and 84.38% specificity. The combination of ADHD indicators extracted with the proposed method with single-channel complexity-based indices previously proposed lead to sensitivity and specifity values above 90%

Chow, S. M. & Zhang, G. (2013). Nonlinear regime-switching state-space (rsss) models. Psychometrika.

Nonlinear dynamic factor analysis models extend standard linear dynamic factor analysis models by allowing time series processes to be nonlinear at the latent level (e.g., involving interaction between two latent processes). In practice, it is often of interest to identify the phasesÇönamely, latent Ç£regimesÇØ or classesÇöduring which a system is characterized by distinctly different dynamics. We propose a new class of models, termed nonlinear regime-switching state-space (RSSS) models, which subsumes regime-switching nonlinear dynamic factor analysis models as a special case. In nonlinear RSSS models, the change processes within regimes, represented using a state-space model, are allowed to be nonlinear. An estimation procedure obtained by combining the extended Kalman filter and the Kim filter is proposed as a way to estimate nonlinear RSSS models. We illustrate the utility of nonlinear RSSS models by fitting a nonlinear dynamic factor analysis model with regime-specific cross-regression parameters to a set of experience sampling affect data. The parallels between nonlinear RSSS models and other well-known discrete change models in the literature are discussed briefly.

Cippa, M. A., Baumann, C. R., Siccoli, M. M., Bassetti, C. L., Poryazova, R., & Werth, E. (2013). Actigraphic assessment of periodic leg movements in patients with restless legs syndrome. J Sleep Res.

The diagnosis of restless legs syndrome (RLS) relies upon diagnostic criteria which are based on history only, and dopaminergic treatment is not normally the first choice of treatment for all patients. It would be worthwhile to identify patients non-responsive to dopaminergic treatment beforehand, because they may suffer from a restless legs-like syndrome and may require alternative treatment. We included retrospectively 24 adult patients fulfilling the four essential criteria for restless legs and 12 age-matched healthy controls. They were investigated by ambulatory actigraphy from both legs over three nights, and patients started treatment with dopamine agonists after this diagnostic work-up. We examined 12 responders to dopaminergic treatment and 12 non-responders and studied the association between response to dopaminergic treatment and the periodic limb movement index (PLMI) as assessed with actigraphy. Demographic characteristics, excessive daytime sleepiness and fatigue at baseline were similar in all three groups. Baseline RLS severity was similar between responders and non-responders [International Restless Legs Severity Scale (IRLS): 25 +/- 9 and 24 +/- 8]. Group comparisons of PLMI before treatment initiation showed significant differences between the three groups. Post-hoc pairwise comparisons revealed that healthy controls had significantly lower PLMI (4.9 +/- 4.5) than responders (29.3 +/- 22.7) and non-responders (13.3 +/- 11.2). Similarly, the PLMI in responders was lower than in non-responders. PLMI day-to-day variability did not differ between responders and non-responders and there was no correlation between treatment effect, as assessed by the decrease of the IRLS and baseline PLMI. Our retrospective study indicates that actigraphy to assess periodic limb movements may contribute to a better diagnosis of dopamine-responsive restless legs syndrome

Clements, C. M., Buller, M. J., Welles, A. P., & Tharion, W. J. (2012). Real time gait pattern classification from chest worn accelerometry during a loaded road march. Conf.Proc.IEEE Eng Med Biol.Soc., 2012,  364-367.

Accelerometers, whether in smart phones or wearable physiological monitoring systems are becoming widely used to identify movement and activities of free living individuals. Although there has been much work in applying computationally intensive methods to this problem, this paper focuses on developing a real-time gait analysis approach that is intuitive, requires no individual calibration, can be extended to complex gait analysis, and can readily be adopted by ambulatory physiological monitors for use in real time. Chest-mounted tri-axial accelerometry data were collected from sixty-one male U.S. Army Ranger candidates engaged in an 8 or 12 mile loaded (35 Kg packs) timed road march. The pace of the road march was such that volunteers needed to both walk and run. To provide intuitive features we examined the periodic patterns generated from 4s periods of movement from the vertical and longitudinal accelerometer axes. Applying the “eigenfaces” face recognition approach we used Principal Components Analysis to find a single basis vector from 10% of the data (n=6) that could distinguish patterns of walk and run with a classification rate of 95% and 90% (n=55) respectively. Because these movement features are based on a gridded frequency count, the method is applicable for use by body-worn microprocessors

Cliff, D. P., Okely, A. D., Burrows, T. L., Jones, R. A., Morgan, P. J., Collins, C. E. et al. (2013). Objectively measured sedentary behavior, physical activity, and plasma lipids in overweight and obese children. Obesity (Silver.Spring), 21, 382-385.

OBJECTIVE: This study examines the associations between objectively measured sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA), and plasma lipids in overweight and obese children. DESIGN AND METHODS: Cross-sectional analyses were conducted among 126 children aged 5.5-9.9 years. Sedentary behavior, LPA, and MVPA were assessed using accelerometry. Fasting blood samples were analyzed for plasma lipids (high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], and triglycerides [TG]). RESULTS: MVPA was not related to plasma lipids (P > 0.05). Independent of age, sex, energy intake, and waist circumference z-score, sedentary behavior and LPA were associated with HDL-C (beta = -0.23, 95% CI -0.42 to -0.04, P = 0.020; beta = 0.20, 95% CI 0.14 to 0.39, P = 0.036, respectively). The strength of the associations remained after additionally adjusting for MVPA (sedentary behavior: beta = -0.22, 95% CI -0.44 to 0.006, P = 0.056; LPA: beta = 0.19, 95% CI -0.005 to 0.38, P = 0.056, respectively). CONCLUSION: Substituting at least LPA for sedentary time may contribute to the development of healthy HDL-C levels among overweight and obese children, independent of their adiposity. Comprehensive prevention and treatment strategies to improve plasma HDL-C among overweight and obese children should target reductions in total sedentary time and promote the benefits of LPA, in addition to promoting healthy levels of adiposity, healthy dietary behaviors, and MVPA

Comte, M., Hobin, E., Majumdar, S. R., Plotnikoff, R. C., Ball, G. D., & McGavock, J. (2013). Patterns of weekday and weekend physical activity in youth in 2 Canadian provinces. Appl.Physiol Nutr.Metab, 38, 115-119.

Few Canadian children are meeting physical activity (PA) guidelines for optimal growth and health. There is little information describing the patterns of PA among Canadian youth, so it is difficult to determine where the deficits occur. The purpose of this study was to identify subgroups of youth and windows of time characterized by low PA and high sedentary behaviour. We conducted a cross-sectional study of 626 youth (aged 10-15 years) in 2 Canadian provinces. The primary exposure variables included geographic setting (rural vs. urban), sex, and days of the week (weekend days vs. weekdays). The primary outcome measures were minutes of light PA, moderate to vigorous physical activity (MVPA), and sedentary behavior, assessed with accelerometry. Compared with weekdays, MVPA was approximately 30% lower on weekend days (55.8 +/- 23.0 min vs. 38.7 +/- 26.7 min; p < 0.001), whereas light PA was approximately 15% higher. Significantly more youth achieved an average of >60 min of MVPA on weekdays than on weekend days (46% vs. 22%; p < 0.001). Sex-specific differences in MVPA were more pronounced on weekdays than on weekend days ( approximately 13 vs approximately 8 min per day; p < 0.01). Youth in rural settings achieved approximately 9 fewer minutes of MVPA daily than youth in urban settings (p < 0.001). In youth 10 to 15 years of age, daily MVPA is lower and light PA is higher on weekend days than on weekdays. Girls and students living in rural areas were particularly vulnerable to low levels of MVPA

Conroy, D. E., Maher, J. P., Elavsky, S., Hyde, A. L., & Doerksen, S. E. (2013). Sedentary Behavior as a Daily Process Regulated by Habits and Intentions. Health Psychology.

Objective: Sedentary behavior is a health risk but little is known about the motivational processes that regulate daily sedentary behavior. This study was designed to test a dual-process model of daily sedentary behavior, with an emphasis on the role of intentions and habits in regulating daily sedentary behavior. Method: College students (N = 128) self-reported on their habit strength for sitting and completed a 14-day ecological momentary assessment study that combined daily diaries for reporting motivation and behavior with ambulatory monitoring of sedentary behavior using accelerometers. Results: Less than half of the variance in daily sedentary behavior was attributable to between-person differences. People with stronger sedentary habits reported more sedentary behavior on average. People whose intentions for limiting sedentary behavior were stronger, on average, exhibited less self-reported sedentary behavior (and marginally less monitored sedentary behavior). Daily deviations in those intentions were negatively associated with changes in daily sedentary behavior (i.e., stronger than usual intentions to limit sedentary behavior were associated with reduced sedentary behavior). Sedentary behavior also varied within people as a function of concurrent physical activity, the day of week, and the day in the sequence of the monitoring period. Conclusions: Sedentary behavior was regulated by both automatic and controlled motivational processes. Interventions should target both of these motivational processes to facilitate and maintain behavior change. Links between sedentary behavior and daily deviations in intentions also indicate the need for ongoing efforts to support controlled motivational processes on a daily basis.

Corder, K., Crespo, N. C., van Sluijs, E. M. F., Lopez, N. V., & Elder, J. P. (2012). Parent awareness of young children’s physical activity. Preventive Medicine: An International Journal Devoted to Practice and Theory, 55, 201-205.

Objective: Parents who overestimate their child’s physical activity (PA) level may not encourage their children to increase their PA. We assessed parental awareness of child PA, and investigated potential correlates of overestimation. Method: Child PA (accelerometer) and parent-classified child PA [ÇÿactiveÇÖëÑ60 min/day vs. ÇÿinactiveÇÖ b60 min/ day moderate and vigorous PA (MVPA)] were measured over 7 days [n=329, 44% male, 39% Latino;mean (SD) 9.1 (0.7)years] in an obesity prevention study in San Diego (Project MOVE). Agreement between date-matched objective MVPA and parent-classified child PA was assessed; % days parental overestimation was the outcome variable. Associations between parental overestimation and potential correlates were investigated using three-level mixedÇÉeffects linear regression. Results: Children met the PA guidelines on 43% of days. Parents overestimated their children’s PA on 75% of days when children were inactive. Most parents (80%) overestimated their child’s PA on ëÑ1 measurement day. Parental support for child PA (transport, encouragement and participation with child) (p<0.01) was positively associated with higher overestimation. Parents of girls showed more overestimation than parents of boys (p=0.04). Conclusion: Most parents incorrectly classified their child as active when their child was inactive. Strategies addressing parental overestimation may be important in PA promotion.

Crooke, A. H., Reid, S. C., Kauer, S. D., McKenzie, D. P., Hearps, S. J., Khor, A. S. et al. (2013). Temporal mood changes associated with different levels of adolescent drinking: Using mobile phones and experience sampling methods to explore motivations for adolescent alcohol use. Drug Alcohol Rev..

INTRODUCTION AND AIMS: Alcohol use during adolescence is associated with the onset of alcohol use disorders, mental health disorders, substance abuse as well as socially and physically damaging behaviours, the effects of which last well into adulthood. Nevertheless, alcohol use remains prevalent in this population. Understanding motivations behind adolescent alcohol consumption may help in developing more appropriate and effective interventions. This study aims to increase this understanding by exploring the temporal relationship between mood and different levels of alcohol intake in a sample of young people. DESIGN AND METHODS: Forty-one secondary school students used a purpose-designed mobile phone application to monitor their daily mood and alcohol use for 20 random days within a 31 day period. Generalised estimating equations were used to examine the relationship between differing levels of alcohol consumption (light, intermediate and heavy) and positive and negative mood three days before and after drinking episodes. RESULTS: While there was no relationship between light and heavy drinking and positive mood, there was an increase in positive mood before and after the drinking event for those that drank intermediate amounts. No statistically significant relationships were found between negative mood and any of the three drinking categories. DISCUSSION AND CONCLUSION: Adolescents who drank in intermediate amounts on a single drinking occasion experienced an increase in positive mood over the three days leading up to and three days following a drinking event. These findings contribute to an understanding of the motivations that underpin adolescent alcohol use, which may help inform future interventions

de, N. A., Seto, E., Donaire-Gonzalez, D., Mendez, M., Matamala, J., Nieuwenhuijsen, M. J. et al. (2013). Improving estimates of air pollution exposure through ubiquitous sensing technologies. Environ.Pollut., 176, 92-99.

Traditional methods of exposure assessment in epidemiological studies often fail to integrate important information on activity patterns, which may lead to bias, loss of statistical power, or both in health effects estimates. Novel sensing technologies integrated with mobile phones offer potential to reduce exposure measurement error. We sought to demonstrate the usability and relevance of the CalFit smartphone technology to track person-level time, geographic location, and physical activity patterns for improved air pollution exposure assessment. We deployed CalFit-equipped smartphones in a free-living population of 36 subjects in Barcelona, Spain. Information obtained on physical activity and geographic location was linked to space-time air pollution mapping. We found that information from CalFit could substantially alter exposure estimates. For instance, on average travel activities accounted for 6% of people’s time and 24% of their daily inhaled NO. Due to the large number of mobile phone users, this technology potentially provides an unobtrusive means of enhancing epidemiologic exposure data at low cost

Diana, C., Cristina, B., Azucena, G. P., Luis, F., & Ignacio, M. (2012). Experience-sampling methodology with a mobile device in fibromyalgia. Int.J Telemed.Appl., 2012, 162673.

This work describes the usability studies conducted in the development of an experience-sampling methodology (ESM) system running in a mobile device. The goal of the system is to improve the accuracy and ecology in gathering daily self-report data in individuals suffering a chronic pain condition, fibromyalgia. The usability studies showed that the developed software to conduct ESM with mobile devices (smartphones, cell phones) can be successfully used by individuals with fibromyalgia of different ages and with low level of expertise in the use of information and communication technologies. 100% of users completed the tasks successfully, although some have completely illiterate. Also there seems to be a clear difference in the way of interaction obtained in the two studies carried out

Diener, E. & Tay, L. (2013). Review of the day reconstruction method (drm). Social Indicators Research.

The Day Reconstruction Method (DRM) for assessing daily experience and subjective well-being is reviewed. The DRM is a promising method as it assesses feelings within situations and activities, and therefore goes beyond asking who is happy to asking when they are happy. The technique might be less burdensome on respondents than experience-sampling, and might reduce memory biases that are inherent in global recall of feelings. However, evidence for the validity and reliability of the DRM is limited and is not entirely supportive. Research is needed on the psychometrics of the DRM, for example by comparing it to mobile phone assessments and other forms of experience-sampling, as well as to global reports of feelings in situations. Conceptual issues with computing overall subjective well-being by weighting a respondentÇÖs activity scores by the time spent in them are discussed. Despite the promises of the DRM, the many unresolved issues with it and the alternative of using on-line electronic experience-sampling techniques suggest that more research is needed before the value of the DRM is established.

Duncan, G. E., Lester, J., Migotsky, S., Higgins, L., & Borriello, G. (2013). Measuring slope to improve energy expenditure estimates during field-based activities. Appl.Physiol Nutr.Metab, 38, 352-356.

This technical note describes methods to improve activity energy expenditure estimates by using a multi-sensor board (MSB) to measure slope. Ten adults walked over a 4-km (2.5-mile) course wearing an MSB and mobile calorimeter. Energy expenditure was estimated using accelerometry alone (base) and 4 methods to measure slope. The barometer and global positioning system methods improved accuracy by 11% from the base (p < 0.05) to 86% overall. Measuring slope using the MSB improves energy expenditure estimates during field-based activities

Ebner-Priemer, U. W., Koudela, S., Mutz, G., & Kanning, M. (2012). Interactive Multimodal Ambulatory Monitoring to Investigate the Association between Physical Activity and Affect. Front Psychol., 3, 596.

Although there is a wealth of evidence that physical activity has positive effects on psychological health, a large proportion of people are inactive. Data regarding counts, steps, and movement patterns are limited in their ability to explain why people remain inactive. We propose that multimodal ambulatory monitoring, which combines the assessment of physical activity with the assessment of psychological variables, helps to elucidate real world physical activity. Whereas physical activity can be monitored continuously, psychological variables can only be assessed at discrete intervals, such as every hour. Moreover, the assessment of psychological variables must be linked to the activity of interest. For example, if an inactive and overweight person is physically active once a week, psychological variables should be assessed during this episode. Linking the assessment of psychological variables to episodes of an activity of interest can be achieved with interactive monitoring. The primary aim of our interactive multimodal ambulatory monitoring approach was to intentionally increase the number of e-diary assessments during “active” episodes. We developed and tested an interactive monitoring algorithm that continuously monitors physical activity in everyday life. When predefined thresholds are surpassed, the algorithm triggers a signal for participants to answer questions in their electronic diary. Using data from 70 participants wearing an accelerative device for 24 h each, we found that our algorithm quadrupled the frequency of e-diary assessments during the activity episodes of interest compared to random sampling. Multimodal interactive ambulatory monitoring appears to be a promising approach to enhancing our understanding of real world physical activity and movement

El-Gayar, O., Timsina, P., Nawar, N., & Eid, W. (2013). Mobile applications for diabetes self-management: status and potential. J Diabetes Sci Technol., 7, 247-262.

BACKGROUND: Advancements in smartphone technology coupled with the proliferation of data connectivity has resulted in increased interest and unprecedented growth in mobile applications for diabetes self-management. The objective of this article is to determine, in a systematic review, whether diabetes applications have been helping patients with type 1 or type 2 diabetes self-manage their condition and to identify issues necessary for large-scale adoption of such interventions. METHODS: The review covers commercial applications available on the Apple App Store (as a representative of commercially available applications) and articles published in relevant databases covering a period from January 1995 to August 2012. The review included all applications supporting any diabetes self-management task where the patient is the primary actor. RESULTS: Available applications support self-management tasks such as physical exercise, insulin dosage or medication, blood glucose testing, and diet. Other support tasks considered include decision support, notification/alert, tagging of input data, and integration with social media. The review points to the potential for mobile applications to have a positive impact on diabetes self-management. Analysis indicates that application usage is associated with improved attitudes favorable to diabetes self-management. Limitations of the applications include lack of personalized feedback; usability issues, particularly the ease of data entry; and integration with patients and electronic health records. CONCLUSIONS: Research into the adoption and use of user-centered and sociotechnical design principles is needed to improve usability, perceived usefulness, and, ultimately, adoption of the technology. Proliferation and efficacy of interventions involving mobile applications will benefit from a holistic approach that takes into account patients’ expectations and providers’ needs

Ellis-Davies, K., Sakkalou, E., Fowler, N. C., Hilbrink, E. E., & Gattis, M. (2012). CUE: The continuous unified electronic diary method.  Behavior Research Methods, 44, 1063-1078.

In the present article, we introduce the continuous unified electronic (CUE) diary method, a longitudinal, event-based, electronic parent report method that allows real-time recording of infant and child behavior in natural contexts. Thirty-nine expectant mothers were trained to identify and record target behaviors into programmed handheld computers. From birth to 18 months, maternal reporters recorded the initial, second, and third occurrences of seven target motor behaviors: palmar grasp, rolls from side to back, reaching when sitting, pincer grip, crawling, walking, and climbing stairs. Compliance was assessed as two valid entries per behavior: 97 % of maternal reporters met compliance criteria. Reliability was assessed by comparing diary entries with researcher assessments for three of the motor behaviors: palmar grasp, pincer grip and walking. A total of 81 % of maternal reporters met reliability criteria. For those three target behaviors, age of emergence was compared across data from the CUE diary method and researcher assessments. The CUE diary method was found to detect behaviors earlier and with greater sensitivity to individual differences. The CUE diary method is shown to be a reliable methodological tool for studying processes of change in human development.

Evenson, K. R., Wen, F., Hillier, A., & Cohen, D. A. (2013). Assessing the Contribution of Parks to Physical Activity using GPS and Accelerometry. Med Sci Sports Exerc.

Purpose: Parks offer a free option for physical activity in many communities. How much time people spend using parks and the contribution that parks makes to their physical activity is not known. This study describes patterns of park use and physical activity among a diverse adult sample.Methods: From five US states, 238 adults enrolled in or near 31 study parks. Participants wore a global positioning system (GPS) monitor (Qstarz BT-Q1000X) and an ActiGraph accelerometer (GT1M) concurrently for three weeks. Parks were mapped from local and national park shape files. Park visits and travel to and from the parks were derived from the objective data.Results: Participants visited parks a median of 2.3 times/week and park visits lasted a median of 42.0 minutes. Overall, participants engaged in a median of 21.7 minutes/day of moderate activity and 0.1 minutes/day of vigorous activity, with an average of 8.2% of all moderate and 9.4% of all vigorous activity occurring within the parks. Among those with at least one park visit (n=218), counts per minute, moderate, moderate to vigorous physical activity (MVPA), number and time in MVPA bouts/day, and sedentary behavior were all higher on days when a park was visited compared to days when a park was not visited. Considering several definitions of active travel, walking or bicycling to and from the park added an additional 3.7 to 6.6 mean minutes of MVPA per park visit.Conclusion: Parks contributed as a place and destination for physical activity, but were underutilized. One of the next steps in this line of inquiry is to understand characteristics of parks used more often as a place and destination for physical activity

Fanning, J., Mullen, S. P., & McAuley, E. (2012). Increasing physical activity with mobile devices: A meta-analysis. Journal of Medical Internet Research, 14, 61-71.

Background: Regular physical activity has established physical and mental health benefits; however, merely one quarter of the U.S. adult population meets national physical activity recommendations. In an effort to engage individuals who do not meet these guidelines, researchers have utilized popular emerging technologies, including mobile devices (ie, personal digital assistants [PDAs], mobile phones). This study is the first to synthesize current research focused on the use of mobile devices for increasing physical activity. Objective: To conduct a meta-analysis of research utilizing mobile devices to influence physical activity behavior. The aims of this review were to: (1) examine the efficacy of mobile devices in the physical activity setting, (2) explore and discuss implementation of device features across studies, and (3) make recommendations for future intervention development. Methods: We searched electronic databases (PubMed, PsychINFO, SCOPUS) and identified publications through reference lists and requests to experts in the field of mobile health. Studies were included that provided original data and aimed to influence physical activity through dissemination or collection of intervention materials with a mobile device. Data were extracted to calculate effect sizes for individual studies, as were study descriptives. A random effects meta-analysis was conducted using the Comprehensive Meta-Analysis software suite. Study quality was assessed using the quality of execution portion of the Guide to Community Preventative Services data extraction form. Results: Four studies were of Ç£goodÇØ quality and seven of Ç£fairÇØ quality. In total, 1351 individuals participated in 11 unique studies from which 18 effects were extracted and synthesized, yielding an overall weight mean effect size of g = 0.54 (95% CI = 0.17 to 0.91, P = .01). Conclusions: Research utilizing mobile devices is gaining in popularity, and this study suggests that this platform is an effective means for influencing physical activity behavior. Our focus must be on the best possible use of these tools to measure and understand behavior. Therefore, theoretically grounded behavior change interventions that recognize and act on the potential of smartphone technology could provide investigators with an effective tool for increasing physical activity.

Fisher, C. D., Minbashian, A., Beckmann, N., & Wood, R. E. (2013). Task appraisals, emotions, and performance goal orientation. J Appl.Psychol., 98, 364-373.

We predict real-time fluctuations in employees’ positive and negative emotions from concurrent appraisals of the immediate task situation and individual differences in performance goal orientation. Task confidence, task importance, positive emotions, and negative emotions were assessed 5 times per day for 3 weeks in an experience sampling study of 135 managers. At the within-person level, appraisals of task confidence, task importance, and their interaction predicted momentary positive and negative emotions as hypothesized. Dispositional performance goal orientation was expected to moderate emotional reactivity to appraisals of task confidence and task importance. The hypothesized relationships were significant in the case of appraisals of task importance. Those high on performance goal orientation reacted to appraisals of task importance with stronger negative and weaker positive emotions than those low on performance goal orientation.

Gamaldo, C. E., Spira, A. P., Hock, R. S., Salas, R. E., McArthur, J. C., David, P. M. et al. (2013). Sleep, function and hiv: A multi-method assessment. AIDS and Behavior.

Amongst HIV+ individuals, sleep complaints have been recognized as common and debilitating; but have rarely been formally assessed or compared to controls using validated sleep tools. In this study we conducted structured interview for sleep disorders, polysomnography, 2-week home (ambulatory) monitoring and validated sleep/functional questionnaires. 56-á% (14/25) of HIV+ participants and 0-á% (0/19) of controls fulfilled the diagnostic criteria for insomnia. Insomnia severity scores were correlated with fatigue and anxiety symptoms. Sleep latency on 2-week actigraphy was significantly longer (P-á=-á0.027) for HIV+ participants and associated with lower MOS-HIV scores. Sleep quality was significantly reduced in HIV+ participants based on validated questionnaires of overall sleep quality (P-á=-á0.0017) and insomnia related symptoms (P-á<-á0.001) even after adjusting for education and affective symptoms. HIV+ individuals are suffering with under-diagnosed sleep disorders that are negatively impacting quality of life and functional capabilities. Further studies aimed at improving recognition of sleep disorders and implementation of efficacious medical and behavioral treatment could improve functioning and disease management.

Gastin, P. B., McLean, O., Spittle, M., & Breed, R. V. (2013). Quantification of tackling demands in professional Australian football using integrated wearable athlete tracking technology. J Sci Med Sport.

OBJECTIVES: To describe and quantify the frequency, velocity and acceleration at impact during tackling in Australian football using a combination of video and athlete tracking technology. DESIGN: Quasi-experimental. METHODS: Data was collected from twenty professional Australian Football League players during four in-season matches. All tackles made by the player and those against the player were video-coded and time stamped at the point of contact and then subjectively categorised into low, medium and high intensity impact groups. Peak GPS and acceleration data were identified at the point of contact. Two-way analysis of variance was used to assess differences (p<0.05) between tackle type (made and against) and tackle intensity. RESULTS: A total of 173 tackles made and 179 tackles against were recorded. Significant differences were found between all tackle intensity groups. Peak velocity was significantly greater in high (19.5+/-6.1kmh(-1)) compared to medium (13.4+/-5.8kmh(-1)) and low intensity (11.3+/-5.0kmh(-1)) tackles. Peak Player Load, a modified vector magnitude of tri-axial acceleration, was significantly greater in high (7.5+/-1.7a.u.) compared to medium (4.9+/-1.5a.u.) and low intensity (4.0+/-1.3a.u.) tackles. CONCLUSIONS: High intensity tackles, although less frequent, are significantly greater in speed of movement immediately prior to contact and in the resultant impact acceleration compared to tackles of lower intensity. Differences in accelerometer data between tackles observed to be progressively greater in intensity suggest a level of ecological validity and provide preliminary support for the use of accelerometers to assess impact forces in contact invasion sports

Geisler, F. C., Kubiak, T., Siewert, K., & Weber, H. (2013). Cardiac vagal tone is associated with social engagement and self-regulation.  Biol.Psychol..

The polyvagal theory (Porges, 2007) represents a biobehavioral model that relates autonomic functioning to self-regulation and social engagement. The aim of the two presented studies was to test the proposed association of cardiac vagal tone (CVT), assessed via resting high-frequency heart rate variability (respiratory sinus arrhythmia, RSA), with coping, emotion-regulation, and social engagement in young adults. In Study 1 (retrospective self-report), RSA was positively associated with engagement coping (situation control, response control, positive self-instructions, social-support seeking) and aspects of social well-being. In Study 2 (ecological momentary assessment), for 28 days following the initial assessment, RSA predicted less use of disengagement strategies (acceptance and avoidance) for regulating negative emotions and more use of socially adaptive emotion-regulation strategies (i.e., social-support seeking as a reaction to sadness and making a concession as a reaction to anger caused by others). Furthermore, RSA was higher in participants who reported no anger episodes compared to those who reported at least one anger episode and was positively associated with reported episodes of negative emotions. Results support the association proposed by the PVT between CVT and self-regulatory behavior, which promotes social bonds

Giesbrecht, G. F., Campbell, T., Letourneau, N., & Kaplan, B. J. (2013). Advancing gestation does not attenuate biobehavioural coherence between psychological distress and cortisol. Biol.Psychol., 93, 45-51.

BACKGROUND: Despite little evidence to suggest that HPA axis responses to psychological provocation are attenuated during pregnancy, it is widely held that dampening of the HPA axis response to psychological distress serves a protective function for the mother and fetus. The current study was designed to assess changes in biobehavioral coherence between psychological distress and cortisol over the course of pregnancy. METHODS: Ambulatory assessment of ecologically relevant psychological distress and salivary cortisol were repeated in all three trimesters for 82 pregnant women. Samples were collected 5 times per day over the course of 2days in each trimester. RESULTS: Psychological distress and cortisol were positively associated, beta=.024, p<.01, indicating that increases in psychological distress were associated with increases in cortisol. Gestational age did not moderate this association, beta=.0009, p=.13, suggesting that negative psychological experiences remain potent stimuli for the HPA axis during pregnancy. CONCLUSION: Biobehavioral coherence between ecologically relevant experiences of psychological distress and cortisol is not attenuated with advancing gestation

Giesbrecht, G. F., Granger, D. A., Campbell, T., & Kaplan, B. (2013). Salivary alpha-amylase during pregnancy: Diurnal course and associations with obstetric history, maternal demographics, and mood. Developmental Psychobiology, 55, 156-167.

Diurnal patterns of salivary alpha amylase (sAA) in pregnant women have not previously been described. The current study employed ecological momentary assessment to examine the association between the diurnal sAA, obstetric history, maternal demographics, and mood during pregnancy. Saliva was self-collected by 83 pregnant women (89% White, age 25.3Çô43.0 years; mean gestational age 21.9 weeks, range 6Çô37 weeks; gravida 1Çô6) at home over three days. Results indicated that current pregnancy (gestational age and fetal sex) and maternal demographics were not related to diurnal sAA. In contrast, a history of previous miscarriage (Parameter = êÆ.17; SE = .05; p < .05) was associated with an atypical diurnal pattern. Even after accounting for obstetric history, trait anxiety (Parameter = .16; SE = .04; p < .001) was associated with increased sAA over the day while chronic levels of fatigue (Parameter -+ .06; SE = .03; p < .05) were associated with decreased sAA. In a separate model, we also tested the time varying covariation of sAA and mood. The effects of momentary mood were in contrast to those for trait mood. Both momentary depression (Parameter = .22; SE = .09; p < .01) and vigour/positive mood (Parameter = .12; SE = .04; p < .001) were associated with momentary increases in sAA while momentary anxiety and fatigue were not related to sAA. The findings suggest that basal sAA during pregnancy is sensitive to emotional arousal. Evaluating diurnal patterns of sAA holds promise for advancing understanding of how emotional arousal during pregnancy may affect fetal development.

Gould, L. F., Hussong, A. M., & Hersh, M. A. (2012). Emotional distress may increase risk for self-medication and lower risk for mood-related drinking consequences in adolescents. The International Journal of Emotional Education, 4, 6-24.

The current study examines indicators of emotional distress and coping that may define sub-populations of adolescents at risk for two potential affect-related mechanisms underlying substance misuse: self-medication and mood-related drinking consequences. Although theory and empirical evidence point to the salience of affect-related drinking to current and future psychopathology, we have little knowledge of whether or for whom such mood-related processes exist in adolescents because few studies have used methods that optimally match the phenomenon to the level of analysis. Consequently, the current study uses multi-level modeling in which daily reports of negative mood and alcohol use are nested within individuals to examine whether adolescents with more emotional distress and poorer coping skills are more likely to evidence self-medication and mood-related drinking consequences. Seventy-five adolescents participated in a multi-method, multi-reporter study in which they completed a 21-day experience sampling protocol assessing thrice daily measures of mood and daily measures of alcohol use. Results indicate that adolescents reporting greater anger are more likely to evidence self-medication. Conversely, adolescents displaying lower emotional distress and more active coping are more likely to evidence mood-related drinking consequences. Implications for identifying vulnerable sub-populations of adolescents at risk for these mechanisms of problematic alcohol use are discussed. (

Granholm, E., Ben-Zeev, D., Fulford, D., & Swendsen, J. (2013). Ecological momentary assessment of social functioning in schizophrenia: Impact of performance appraisals and affect on social interactions. Schizophrenia Research.

Research concerning the complex interplay between factors that contribute to poor social functioning in schizophrenia has been hampered by limitations of traditional measures, most notably the ecological validity and accuracy of retrospective self-report and interview measures. Computerized Ecological Momentary Assessment (EMAc) permits the real-time assessment of relationships between daily life experiences, thoughts, feelings, and behaviors. In the current study, EMAc was used to record daily social interactions, subjective performance appraisals of these interactions (e.g., Ç£I succeeded/failedÇØ; Ç£I was liked/rejectedÇØ), and affect in 145 individuals with schizophrenia or schizoaffective disorder. Participants completed electronic questionnaires on a personal digital assistant (PDA) four times per day for one week. Time-lagged multilevel modeling of the data revealed that more positive interaction appraisals at any point in a day were associated with greater positive affect which, in turn, was a strong predictor of more social interactions over subsequent hours. Social functioning, therefore, was linked to positive performance beliefs about social interactions that were associated with greater positive affect. The findings suggest a useful treatment target for cognitive behavioral therapy and other psychosocial interventions that can be used to challenge defeatist beliefs and increase positive affect to enhance social functioning in schizophrenia.

Gurrin, C., Qiu, Z., Hughes, M., Caprani, N., Doherty, A. R., Hodges, S. E. et al. (2013). The smartphone as a platform for wearable cameras in health research. Am J Prev.Med, 44, 308-313.

BACKGROUND: The Microsoft SenseCam, a small camera that is worn on the chest via a lanyard, increasingly is being deployed in health research. However, the SenseCam and other wearable cameras are not yet in widespread use because of a variety of factors. It is proposed that the ubiquitous smartphones can provide a more accessible alternative to SenseCam and similar devices. PURPOSE: To perform an initial evaluation of the potential of smartphones to become an alternative to a wearable camera such as the SenseCam. METHODS: In 2012, adults were supplied with a smartphone, which they wore on a lanyard, that ran life-logging software. Participants wore the smartphone for up to 1 day and the resulting life-log data were both manually annotated and automatically analyzed for the presence of visual concepts. The results were compared to prior work using the SenseCam. RESULTS: In total, 166,000 smartphone photos were gathered from 47 individuals, along with associated sensor readings. The average time spent wearing the device across all users was 5 hours 39 minutes (SD=4 hours 11 minutes). A subset of 36,698 photos was selected for manual annotation by five researchers. Software analysis of these photos supports the automatic identification of activities to a similar level of accuracy as for SenseCam images in a previous study. CONCLUSIONS: Many aspects of the functionality of a SenseCam largely can be replicated, and in some cases enhanced, by the ubiquitous smartphone platform. This makes smartphones good candidates for a new generation of wearable sensing devices in health research, because of their widespread use across many populations. It is envisioned that smartphones will provide a compelling alternative to the dedicated SenseCam hardware for a number of users and application areas. This will be achieved by integrating new types of sensor data, leveraging the smartphone’s real-time connectivity and rich user interface, and providing support for a range of relatively sophisticated applications

Haffey, F., Brady, R. R., & Maxwell, S. (2013). Smartphone apps to support hospital prescribing and pharmacology education: a review of current provision. Br.J Clin.Pharmacol..

AIMS: Junior doctors write the majority of hospital prescriptions but many indicate they feel underprepared to assume this responsibility and around 10% of prescriptions contain errors. Medical smartphone apps are now widely used in clinical practice and present an opportunity to provide support to inexperienced prescribers. This study assesses the contemporary range of smartphone apps with prescribing or related content. METHODS: Six smartphone app stores were searched for apps aimed at the healthcare professional with drug, pharmacology or prescribing content. RESULTS: 306 apps were identified. 34% appeared to be for use within the clinical environment in order to aid prescribing, 14% out with the clinical setting, and 51% of apps were deemed appropriate for both clinical and non-clinical use. Apps with drug reference material, such as textbooks, manuals or medical apps with drug information were the commonest app found (51%), followed by apps offering drug or infusion rate dose calculation (26%). 68% of apps charged for download, with a mean price of pound14.25 per app and a range of pound0.62 – 101.90. CONCLUSIONS: A diverse range of pharmacology-themed apps are available and there is further potential for the development of contemporary apps to improve prescribing performance. Personalised app stores may help universities/healthcare organisations offer high-quality apps to students to aid in pharmacology education. Users of prescribing apps must be aware of the lack of information regarding the medical expertise of app developers; this will enable them to make informed choices about the use of such apps in their clinical practice

Haffey, F., Brady, R. R., & Maxwell, S. (2013). A comparison of the reliability of smartphone apps for opioid conversion. Drug Saf, 36, 111-117.

BACKGROUND: Many medical professionals use smartphone applications (apps) on a daily basis to support clinical decision making. Opioid switching (conversion of one opioid to another at equianalgesic dose) is common in clinical practice and often challenging for doctors. Apps providing an opioid conversion tool can therefore be a useful resource. Despite rapid growth in the use of medical apps, the lack of robust regulation and peer review to ensure the accuracy and reliability of app content is currently an area of concern. METHOD: We searched major online app stores for apps providing an opioid dose conversion tool. We assessed output variability between apps in the dose calculation of seven opioid switches, as well as assessing the level of professional medical involvement in the authorship, creation and design of the apps. RESULTS: Of 23 different apps identified, more than half (n = 12; 52 %) had no stated medical professional involvement and only 11 (48 %) apps provided direct references to primary sources for their opioid conversion ratios. Conversion of 1 mg of oral morphine to oral codeine demonstrated the largest conversion output range (median 6.67 mg, range 3.333-12 mg). Conversion of 1 mg of oral morphine to methadone ranged from 0.05-0.67 mg, with only 44 % of methadone-converting apps (n = 4) commenting that the conversion ratio changes with magnitude of methadone dose. Overall, 35 % of apps (n = 8) did not warn the user about the standard practice of dose reduction when opioid switching. There was a statistically significant difference in the mean conversion output for hydromorphone (oral) between apps with and without medical professional involvement (0.2256 vs 0.2536; p = 0.0377). CONCLUSIONS: There are significant concerns with regard to the reliability of information provided by apps offering opioid dose conversion, with lack of information regarding evidence-based content and peer review in many cases. It is crucial that better regulation of medical apps is instigated in order to ensure that patient safety is maintained

Hebden, L., Balestracci, K., McGeechan, K., Denney-Wilson, E., Harris, M., Bauman, A. et al. (2013). ‘TXT2BFiT’ a mobile phone-based healthy lifestyle program for preventing unhealthy weight gain in young adults: study protocol for a randomized controlled trial. Trials, 14, 75.

BACKGROUND: Despite international efforts to arrest increasing rates of overweight and obesity, many population strategies have neglected young adults as a target group. Young adults are at high risk for unhealthy weight gain which tends to persist throughout adulthood with associated chronic disease health risks. METHODS/DESIGN: TXT2BFiT is a nine month two-arm parallel-group randomized controlled trial aimed at improving weight management and weight-related dietary and physical activity behaviors among young adults. Participants are recruited via general practice (primary medical care) clinics in Sydney, New South Wales, Australia. All participants receive a mailed resource outlining national physical activity and dietary guidelines and access to the study website. Additional resources accessible to the intervention arm via the study website include Smartphone mobile applications, printable handouts, an interactive healthy weight tracker chart, and a community blog. The study consists of two phases: (1) Intensive phase (weeks 1 to 12): the control arm receives four short message service (SMS) text messages; the intervention arm receives eight SMS messages/week tailored to their baseline stage-of-change, one Email/week, and personalized coaching calls during weeks 0, 2, 5, 8, and 11; and (2) Maintenance phase (weeks 14 to 36): the intervention arm receives one SMS message/month, one Email/month and booster coaching calls during months 5 and 8. A sample of N = 354 (177 per arm) is required to detect differences in primary outcomes: body weight (kg) and body mass index (kg/m2), and secondary outcomes: physical activity, sitting time, intake of specific foods, beverages and nutrients, stage-of-change, self-efficacy and participant well-being, at three and nine months. Program reach, costs, implementation and participant engagement will also be assessed. DISCUSSION: This mobile phone based program addresses an important gap in obesity prevention efforts to date. The method of intervention delivery is via platforms that are highly accessible and appropriate for this population group. If effective, further translational research will be required to assess how this program might operate in the broader community. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000924853

Hedeker, D. & Mermelstein, R. J. (2012). Mood changes associated with smoking in adolescents: An application of a mixed-effects location scale model for longitudinal ecological momentary assessment data. In J.R.Harring & G. R. Hancock (Eds.), Advances in longitudinal methods in the social and behavioral sciences (pp. 59-79). Charlotte, NC US: IAP Information Age Publishing.

(from the chapter) In this chapter, the authors extend the mixed-effects location scale model to focus on the variation of mood change that is associated with smoking across measurement waves, and the degree to which subject and wave characteristics influence the variation in mood changes. Also, while Hedeker et al. (2008) only considered random subject intercepts for the one wave of ecological momentary assessment (EMA) data, here the authors allow random subject time trends for the multiple waves of EMA data. The authors further consider a three-level model that treats observations nested within waves within subjects. To aid in making this class of models accessible, sample computer syntax is provided in the Appendix. The data are drawn from a natural history study of adolescent smoking. The number of subjects at each measurement wave equaled 116 (baseline), 91 (6 months), 92 (15 months), and 88 (24 months). The study utilized a multimethod approach to assess adolescents including self-report questionnaires, a week-long time/event sampling method via hand-held computers (EMA), and detailed surveys. Overall, following smoking, adolescents reported higher positive affect and lower negative affect than before their smoking report. Additionally, the analyses indicated an increased consistency of subjective mood responses as a person’s smoking experience increased over time and a diminishing of the mood change associated with smoking. The authors’ data thus provide one of the few ecologically valid examinations of the development of tolerance.

Herber, O. R., Jones, M. C., Smith, K., & Johnston, D. W. (2012). Assessing acute coronary syndrome patients’ cardiac-related beliefs, motivation and mood over time to predict non-attendance at cardiac rehabilitation. Journal of Advanced Nursing, 68, 2778-2788.

Aim: This research protocol describes and justifies a study to assess patientsÇÖ cardiac-related beliefs (i.e. illness representations, knowledge/misconceptions, cardiac treatment beliefs), motivation and mood over time to predict non-attendance at a cardiac rehabilitation programme by measuring weekly/monthly changes in these key variables. Background: Heart disease is the UKÇÖs leading cause of death. Evidence from meta-analyses suggests that cardiac rehabilitation facilitates recovery following acute cardiac events. However, 30Çô60% of patients do not attend cardiac rehabilitation. There is some evidence from questionnaire studies that a range of potentially modifiable psychological variables including patientsÇÖ cardiac-related beliefs, motivation and mood may influence attendance. Design: Mixed-methods. Methods: In this study, during 2012Çô2013, electronic diary data will be gathered weekly/monthly from 240 patients with acute coronary syndrome from discharge from hospital until completion of the cardiac rehabilitation programme. This will identify changes and interactions between key variables over time and their power to predict non-attendance at cardiac rehabilitation. Data will be analysed to examine the relationship between patientsÇÖ illness perceptions, cardiac treatment beliefs, knowledge/misconceptions, mood and non-attendance of the cardiac rehabilitation programme. The qualitative component (face-to-face interviews) seeks to explore why patients decide not to attend, not complete or complete the cardiac rehabilitation programme. Discussion: The identification of robust predictors of (non-)attendance is important for the design and delivery of interventions aimed at optimizing cardiac rehabilitation uptake.

Hershfield, H. E., Scheibe, S., Sims, T. L., & Carstensen, L. L. (2013). When feeling bad can be good: Mixed emotions benefit physical health across adulthood. Social Psychological and Personality Science, 4, 54-61.

Traditional models of emotionÇôhealth interactions have emphasized the deleterious effects of negative emotions on physical health. More recently, researchers have turned to potential benefits of positive emotions on physical health as well. Both lines of research, though, neglect the complex interplay between positive and negative emotions and how this interplay affects physical well-being. Indeed, recent theoretical work suggests that a strategy of “taking the good with the bad” may benefit health outcomes. In the present study, the authors assessed the impact of mixed emotional experiences on health outcomes in a 10-year longitudinal experience-sampling study across the adult life span. The authors found that not only were frequent experiences of mixed emotions (co-occurrences of positive and negative emotions) strongly associated with relatively good physical health, but that increases of mixed emotions over many years attenuated typical age-related health declines.

Ho, V., Simmons, R. K., Ridgway, C. L., van Sluijs, E. M., Bamber, D. J., Goodyer, I. M. et al. (2013). Is wearing a pedometer associated with higher physical activity among adolescents? Prev.Med.

OBJECTIVE: To examine whether wearing a pedometer was associated with higher objectively-measured physical activity (PA) among adolescents independent of other behavior change strategies, and whether this association differed by sex or day of wear. METHOD: In a parallel-group population-based cohort study, 892 adolescents (43.4% male, mean+/-SD age, 14.5+/-0.5years) from Eastern England were recruited. PA was measured (in 2005-2006) by accelerometry over four days; a sub-group (n=345) wore a pedometer coterminously with the accelerometer. Three-level (individual, day of wear and school level) multiple linear regression was used to examine the association between accelerometry (counts/min, cpm) and pedometer wear, stratified by sex and adjusted for weekday/weekend. RESULTS: For the entire cohort, there was a significant decline in cpm over four days (p<0.01). Girls wearing pedometers had higher mean cpm than those not wearing a pedometer, independent of BMI z-score, socio-economic status, weekday/weekend, and school clustering (beta=5.1; 95% CI: 0.8 to 9.5, p=0.02). This association was not seen in boys. CONCLUSION: Pedometer wear was associated with higher PA among adolescent girls, but not boys. Findings may support sex-specific intervention strategies. In addition to pedometer monitoring, additional strategies may be required to promote PA levels, especially among boys

Hodgkinson, J. A., Sheppard, J. P., Heneghan, C., Martin, U., Mant, J., Roberts, N. et al. (2013). Accuracy of ambulatory blood pressure monitors: a systematic review of validation studies. J Hypertens., 31,  239-250.

Abstract: BACKGROUND: Recent research and guidelines recommend the routine use of ambulatory blood pressure monitoring for the diagnosis of hypertension, so accuracy of such monitors is more important than ever. AIM: : To systematically review the literature regarding the accuracy of ambulatory monitors currently in use. METHODS: Medline, Embase, Cinahl, the Cochrane database, Medion and the dabl Educational Trust website were searched until February 2011. No language or publication date limits were applied. Data were extracted separately by two independent reviewers. Methodological quality was assessed by whether a validation protocol had been used and followed correctly. RESULTS: From 5420 journal articles identified, 108 met the inclusion criteria. Excluding studies assessing monitors no longer in use, 40 relevant studies were found using 21 different monitors. Thirty-eight (95%) studies used a validation protocol of which 28 studies assessed a monitor in the general population. Of these, protocols were passed in 24 of 28 studies, but 12 of 24 (50%) found a difference of at least 5 mmHg systolic between the test device and the reference standard for 30% or more of the readings. Of the 10 studies conducted in special population groups (e.g. pregnancy, elderly people), only four devices passed the protocols. Only six (16%) studies correctly adhered to the protocols. CONCLUSION: Published validation studies assessed most ambulatory monitors as accurate, but many failed to adhere to the underlying protocols, undermining this conclusion and peer review standards. Furthermore, most monitors which ‘passed’ validation showed significant variation in blood pressure from the reference standard, highlighting inadequacies in older validation protocols. Future validation studies should use protocols with simpler methodologies but more rigorous accuracy criteria

Huffziger, S., Ebner-Priemer, U., Eisenbach, C., Koudela, S., Reinhard, I., Zamoscik, V. et al. (2013). Induced ruminative and mindful attention in everyday life: An experimental ambulatory assessment study. J Behav.Ther.Exp.Psychiatry, 44, 322-328.

BACKGROUND AND OBJECTIVES: Rumination has been proposed as a risk factor for depression, while mindful attention might be protective. Differential effects of these attention foci have so far only been examined in the laboratory. Therefore, we conducted an experimental ambulatory assessment study using ruminative and mindful attention inductions in everyday life to examine their effects in a natural context. METHODS: Fifty young adults carried palmtops over three weekdays (rumination induction day, mindful attention induction day, noninduction day; randomized cross-over design). Ten times a day, participants rated ruminative self-focus and mood. On the induction days, they were additionally subjected to 3-min inductions of ruminative or mindful attention at each assessment. RESULTS: The two induction modes exhibited differential immediate effects on ruminative self-focus and mood. While induced rumination immediately deteriorated valence and calmness, induced mindful attention specifically enhanced calmness. Depressive symptoms did not moderate these effects. While overall longer term effects of the inductions were missing, the mindful attention day was associated with slightly increasing positive valence over the day. LIMITATIONS: The results need to be replicated in high-risk and patient samples to demonstrate the clinical significance of identified effects. CONCLUSIONS: Results confirm the emotional relevance of rumination and mindful attention in real world settings. Future work may test whether adaptive attention-focusing instructions delivered in daily life can support clinical interventions

Huffziger, S., Ebner-Priemer, U., Koudela, S., Reinhard, I., & Kuehner, C. (2012). Induced rumination in everyday life: Advancing research approaches to study rumination. Personality and Individual Differences, 53, 790-795.

Rumination has been proposed as an important cognitive risk factor for depressive states. Experimental studies in the laboratory have demonstrated negative effects of induced rumination on mood and cognition. However, it is not known whether respective effects can also be generalized to naturalistic contexts. Therefore, the present study transferred rumination inductions to daily life within a novel experimental ambulatory assessment approach. Forty young adults carried palmtop computers for 2 days with ten assessments of momentary ruminative self-focus and mood per day. On one of the 2 days (induction day), participants were subjected to 3-min rumination inductions at each assessment (cross-over design). Analyses revealed that the rumination inductions immediately increased momentary ruminative self-focus and deteriorated positive mood. Higher increases in ruminative self-focus after inductions were linked to stronger reductions in positive mood. Momentary preinduction ruminative self-focus and mood on the induction day did not differ from momentary ruminative self-focus and mood on the noninduction day, indicating a lack of significant longer-term effects over the day. This is the first study revealing immediate effects of induced rumination in daily life, thereby assuring external validity of previous laboratory findings. Future studies could extend this induction approach to further dysfunctional and functional attention foci.

Jacob, E., Duran, J., Stinson, J., Lewis, M. A., & Zeltzer, L. (2013). Remote monitoring of pain and symptoms using wireless technology in children and adolescents with sickle cell disease. Journal of the American Academy of Nurse Practitioners, 25, 42-54.

Purpose: The purpose of this study was to examine (a) symptoms, (b) pain characteristics (intensity, location, quality), (c) pain medications and non-pharmacological strategies used for pain, (d) thoughts and feelings, and (e) healthcare visits. We also examined the relationship between pain and sleep. Data sources: Pain and symptoms were entered on an electronic eÇÉDiary using a smartphone and were remotely monitored by an advanced practice registered nurse (APRN). SixtyÇÉseven children and adolescents (10Çô17 years) reported mild to severe pain at home that did not require healthcare visits. Symptoms reported were (a) general symptoms such as tiredness/fatigue (34.7%), headache (20.8%), yellowing of the eyes (28.4%); (b) respiratory symptoms such as sniffling (32.9%), coughing (19.1%), changes in breathing (10.0%); and (c) musculoskeletal symptoms such as stiffness in joints (15.8%). A significant negative correlation was found between pain and sleep (r = êÆ.387, p = .024). Factors that predict pain included previous history of sickle cell disease (SCD) related events, symptoms, and negative thoughts. Conclusion: Pain and multiple symptoms entered on a webÇÉbased eÇÉDiary were remotely monitored by an APRN and prompted communications, further evaluation, and recommendations. Implications for practice: Remote monitoring using wireless technology may facilitate timely management of pain and symptoms and minimize negative consequences in SCD.

Janney, C. A., Ganguli, R., Richardson, C. R., Holleman, R. G., Tang, G., Cauley, J. A. et al. (2013). Sedentary behavior and psychiatric symptoms in overweight and obese adults with schizophrenia and schizoaffective disorders (WAIST Study). Schizophr.Res, 145, 63-68.

OBJECTIVE: Examine the association between sedentary behavior and psychiatric symptoms among overweight and obese adults with schizophrenia or schizoaffective disorders (SZO/SA). DESIGN: Randomized clinical trial; Weight Assessment and Intervention in Schizophrenia Treatment (WAIST) Study: baseline data collected 2005-2008. SETTING: University of Pittsburgh Medical Center, Pittsburgh, PA, USA. PARTICIPANTS: Community-dwelling adults diagnosed with SZO/SA, with mild symptom severity [Positive and Negative Syndrome Scale (PANSS)<90], who were interested in losing weight, age 18-70years, BMI>27kg/m. MEASUREMENTS: Objectively measured sedentary behavior by accelerometry, and psychopathology assessed by PANSS. Participants wore the actigraphs for 7 consecutive days during their waking hours. Sedentary behavior was defined as </=100 counts per minute during wear-time and excluded sleep and non-wear time. RESULTS: On average, 81% of the participant’s monitoring time or 756min/day was classified as sedentary behavior using accelerometry. No association was observed between sedentary behaviors and PANSS psychiatric symptoms [total (p>/=0.75), positive (p>/=0.81), negative (p>/=0.59) and general psychopathology (p>/=0.65) subscales]. No association was observed between sedentary behaviors and age, race, gender and BMI. CONCLUSION: From a clinical and public health perspective, the amount of time (approximately 13h) and percentage of time (81% excluding non-wear time associated with sleeping) engaged in sedentary behavior among overweight and obese adults in this population is alarming, and points to an urgent need for interventions to decrease sedentary behaviors. The lack of associations between sedentary behavior and psychiatric symptoms may be due to a ceiling effect for sedentary behavior

Johnson, J. A., Miller, M. L., Lynam, D. R., & South, S. C. (2012). Five-factor model facets differentially predict in-the-moment affect and cognitions. Journal of Research in Personality, 46, 752-759.

The facets of the Five-Factor Model (FFM) of personality are presumed to represent distinct, biologically-based tendencies to act, think, and behave; yet they have received little behaviorally-based empirical validation. In this study, FFM facets were used to examine individual differences in affective and cognitive responses to stressors as they are experienced in daily life. Participants (N = 79) completed the NEO-PI-R followed by a week-long experience sampling procedure. As expected, hierarchical linear modeling showed that FFM facets captured affective and cognitive tendencies that were missed at the domain level. They additionally demonstrated convergent and divergent validity in predicting momentary affect. These results provide evidence that facets are distinct, non-interchangeable predictors of daily thoughts and emotions.

Johnston, D. W., Jones, M. C., Charles, K., McCann, S. K., & McKee, L. (2013). Stress in Nurses: Stress-Related Affect and Its Determinants Examined Over the Nursing Day. Ann.Behav.Med.

BACKGROUND: Nurses are a stressed group and this may affect their health and work performance. The determinants of occupational stress in nurses and other occupational groups have almost invariably been examined in between subject studies. PURPOSE: This study aimed to determine if the main determinants of occupation stress, i.e. demand, control, effort and reward, operate within nurses. METHODS: A real time study using personal digital-assistant-based ecological momentary assessment to measure affect and its hypothesised determinants every 90 min in 254 nurses over three nursing shifts. The measures were negative affect, positive affect, demand/effort, control and reward. RESULTS: While the effects varied in magnitude between people, in general increased negative affect was predicted by high demand/effort, low control and low reward. Control and reward moderated the effects of demand/effort. High positive affect was predicted by high demand/effort, control and reward. CONCLUSIONS: The same factors are associated with variations in stress-related affect within nurses as between

Johnston, N. W., Lambert, K., Hussack, P., Gerhardsson, d., V, Higenbottam, T., Lewis, J. et al. (2013). Detection of COPD Exacerbations and Compliance with Patient Reported Daily Symptom Diaries Using a BlackBerry-Based Information System. Chest.

BACKGROUND: Paper-based diaries and self-report of symptom worsening in COPD studies may lead to under-detection of exacerbations. Epidemiologically, COPD exacerbations exhibit seasonal patterns peaking at year-end. We examined whether use of a BlackBerry-based daily symptom diary would detect 95% or more of exacerbations and enable characterization of seasonal differences between them. METHODS: Fifty participants with GOLD stage l to lV COPD began a community-based study in December 2007. Another 30 began in December 2008. Participants transmitted daily symptom diaries using a BlackBerry. Alerts were triggered when symptom changes, missed diary transmissions or medical care for a respiratory problem occurred. Participant encounters were initiated if COPD exacerbations were suspected. Participants reported returns to normal breathing using their BlackBerry. RESULTS: Participants transmitted 99.9% of 28,514 possible daily diaries. All 191 (2.5/participant-year) COPD exacerbations meeting Anthonisen criteria were detected. During 148/191 exacerbations (78%; 1.97/participant-year) patients were hospitalized and/or ordered prednisone, an antibiotic or both. Respiratory viruses were detected in 78/191 (41%) of exacerbations. Those coinciding with a respiratory viral infection averaged 12.0 days, those without averaged 8.9 days (P &lt;.04), with no difference in Anthonisen score. Respiratory symptom scores before exacerbations and after normal breathing return showed no differences. Exacerbations were more frequent during the Christmas period than the rest of the year but not than the rest of winter alone. CONCLUSIONS: Smartphone-based collection of COPD symptom diaries enables near complete identification of exacerbations at inception. Exacerbation rates in the Christmas season do not reach levels that necessitate changes in disease management

Kang, B., Moudon, A. V., Hurvitz, P. M., Reichley, L., & Saelens, B. E. (2013). Walking Objectively Measured: Classifying Accelerometer Data with GPS and Travel Diaries. Med Sci Sports Exerc.

PURPOSE: This study developed and tested an algorithm to classify accelerometer data as walking or non-walking using either GPS or travel diary data within a large sample of adults under free-living conditions. METHODS: Participants wore an accelerometer and a GPS unit, and concurrently completed a travel diary for 7 consecutive days. Physical activity (PA) bouts were identified using accelerometry count sequences. PA bouts were then classified as walking or non-walking based on a decision-tree algorithm consisting of 7 classification scenarios. Algorithm reliability was examined relative to two independent analysts’ classification of a 100-bout verification sample. The algorithm was then applied to the entire set of PA bouts. RESULTS: The 706 participants’ (mean age 51 years, 62% female, 80% non-Hispanic white, 70% college graduate or higher) yielded 4,702 person-days of data and had a total of 13,971 PA bouts. The algorithm showed a mean agreement of 95% with the independent analysts. It classified physical activity into 8,170 (58.5 %) walking bouts and 5,337 (38.2%) non-walking bouts; 464 (3.3%) bouts were not classified for lack of GPS and diary data. Nearly 70% of the walking bouts and 68% of the non-walking bouts were classified using only the objective accelerometer and GPS data. Travel diary data helped classify 30% of all bouts with no GPS data. The mean duration of PA bouts classified as walking was 15.2 min (SD=12.9). On average, participants had 1.7 walking bouts and 25.4 total walking minutes per day. CONCLUSIONS: GPS and travel diary information can be helpful in classifying most accelerometer-derived PA bouts into walking or non-walking behavior

Kanning, M. (2012). Using objective, real-time measures to investigate the effect of actual physical activity on affective States in everyday life differentiating the contexts of working and leisure time in a sample with students. Front Psychol., 3, 602.

Multiple studies suggest that physical activity causes positive affective reactions and reduces depressive mood. However, studies and interventions focused mostly on structured activity programs, but rarely on actual physical activity (aPA) in daily life. Furthermore, they seldom account for the context in which the aPA occur (e.g., work, leisure). Using a prospective, real-time assessment design (ambulatory assessment), we investigated the effects of aPA on affective states (valence, energetic arousal, calmness) in real-time during everyday life while controlling for the context. Eighty-seven undergraduates students (Age: M = 24.6; SD = 3.2, females: 54%) participated in this study. aPA was assessed through accelerometers during 24-h. Palmtop devices prompted subjects approximately every 45 min during a 14-h daytime period to assess their affective states and the context. We analyzed within- and between-person effects with hierarchical modeling (HLM 6.0). Multilevel analyses revealed that both aPA and context influenced subsequent affective states. The interaction of aPA and context did predict energetic arousal only. State levels of affects did not differ between men and women. For both men and women, aPA in everyday life has an effect on individual’s affective states. For valence and calmness, it seems to be independent of the context in which the aPA occur. For energetic arousal, men reported to have lower feelings of energy and women reported to have more feelings of energy during leisure time compared to working episodes

Kelly, D. & Caulfield, B. (2012). An investigation into non-invasive physical activity recognition using smartphones. Conf.Proc.IEEE Eng Med Biol.Soc., 2012, 3340-3343.

Technology utilized to automatically monitor Activities of Daily Living (ADL) could be a key component in identifying deviations from normal functional profiles and providing feedback on interventions aimed at improving health. However, if activity recognition systems are to be implemented in real world scenarios such as health and wellness monitoring, the activity sensing modality must unobtrusively fit the human environment rather than forcing humans to adhere to sensor specific conditions. Modern smart phones represent a ubiquitous computing device which has already undergone mainstream adoption. In this paper, we investigate the feasibility of using a modern smartphone, with limited placement constraints, as the sensing modality for an activity recognition system. A dataset of 4 subjects performing 7 activities, using varying sensor placement conditions, is utilized to investigate this. Initial experiments show that a decision tree classifier performs activity classification with precision and recall scores of 0.75 and 0.73 respectively. More importantly, as part of this initial experiment, 3 main problems, and subsequently 3 solutions, relating to unconstrained sensor placement were identified. Using our proposed solutions, classification precision and recall scores were improved by +13% and +14.6% respectively

Kennedy, A. P., Epstein, D. H., Phillips, K. A., & Preston, K. L. (2013). Sex differences in cocaine/heroin users: Drug-use triggers and craving in daily life. Drug Alcohol Depend..

BACKGROUND: Studies of sex differences have shown that men and women with drug-use disorders differ in course and outcome and in cue-induced activation of putative brain “control network” areas. We evaluated sex differences in daily functioning and subjective events related to drug use with ecological momentary assessment (EMA). METHODS: EMA data were collected from cocaine- and heroin-using outpatients (72 men; 42 women) in methadone maintenance in 2-5 randomly prompted (RP) entries per day and in participant-initiated entries for heroin or cocaine use or craving, for up to 25 weeks. Urine drug screens were conducted three times weekly. Data were analyzed via repeated-measures logistic regression, using sex as a predictor of responses. RESULTS: In RP reports, women and men reported significantly different patterns of drug-cue exposure, with women significantly more likely to report having seen cocaine or been tempted to use in the past hour. Women also had higher craving after past-hour exposure to drug cues. In reports of drug use, women, compared to men, were more likely to report that they had used more cocaine than they had meant to, tended to feel guilty more often after drug use, and to have used despite trying not to use. CONCLUSIONS: These findings provide real-time behavioral evidence that women respond differently than men to exposure to drug cues and to drug use, consistent with laboratory and brain-imaging findings. This information may be useful for development of sex-specific treatment strategies

King, A. C., Hekler, E. B., Castro, C. M., Buman, M. P., Marcus, B. H., Friedman, R. H. et al. (2013). Exercise Advice by Humans Versus Computers: Maintenance Effects at 18 Months. Health Psychol..

Objective: An automated telehealth counseling system, aimed at inactive midlife and older adults, was shown previously to achieve 12-month physical activity levels similar to those attained by human advisors. This investigation evaluated the sustained 18-month impacts of the automated advisor compared with human advisors. Methods: Following the end of the 12-month randomized, controlled trial, participants who had been randomized to either the human advisor (n = 73) or automated advisor (n = 75) arms were followed for an additional 6 months. During that period, human or automated advisor-initiated telephone contacts ceased and participants were encouraged to initiate contact with their advisor as deemed relevant. The primary outcome was moderate-to-vigorous physical activity (MVPA), measured using the Stanford Physical Activity Recall and validated during the major trial via accelerometry. Results: The two arms did not differ significantly in 18-month MVPA or the percentage of participants meeting national physical activity guidelines (ps >.50). No significant within-arm MVPA differences emerged between 12 and 18 months. Evaluation of the trajectory of physical activity change across the 18-month study period indicated that, for both arms, the greatest physical activity increases occurred during the first 6 months of intervention, followed by a relatively steady amount of physical activity across the remaining months. Conclusions: The results provide evidence that an automated telehealth advice system can maintain physical activity increases at a level similar to that achieved by human advisors through 18 months. Given the accelerated use of mobile phones in developing countries, as well as industrialized nations, automated telehealth systems merit further evaluation.

Kirwan, M., Duncan, M. J., Vandelanotte, C., & Mummery, W. K. (2012). Using smartphone technology to monitor physical activity in the 10,000 steps program: A matched case-control trial. Journal of Medical Internet Research, 14, 176-185.

Background: Website-delivered physical activity interventions are successful in producing short-term behavior change. However, problems with engagement and retention of participants in these programs prevent long-term behavior change. New ways of accessing online content (eg, via smartphones) may enhance engagement in these interventions, which in turn may improve the effectiveness of the programs. Objective: To measure the potential of a newly developed smartphone application to improve health behaviors in existing members of a website-delivered physical activity program (10,000 Steps, Australia). The aims of the study were to (1) examine the effect of the smartphone application on self-monitoring and self-reported physical activity levels, (2) measure the perceived usefulness and usability of the application, and (3) examine the relationship between the perceived usefulness and usability of the application and its actual use. Methods: All participants were existing members of the 10,000 Steps program. We recruited the intervention group (n = 50) via email and instructed them to install the application on their smartphone and use it for 3 months. Participants in this group were able to log their steps by using either the smartphone application or the 10,000 Steps website. Following the study, the intervention group completed an online questionnaire assessing perceived usability and usefulness of the smartphone application. We selected control group participants (n = 150), matched for age, gender, level of self-monitoring, preintervention physical activity level, and length of membership in the 10,000 Steps program, after the intervention was completed. We collected website and smartphone usage statistics during the entire intervention period. Results: Over the study period (90 days), the intervention group logged steps on an average of 62 days, compared with 41 days in the matched group. Intervention participants used the application 71.22% (2210/3103) of the time to log their steps. Logistic regression analyses revealed that use of the application was associated with an increased likelihood to log steps daily during the intervention period compared with those not using the application (odds ratio 3.56, 95% confidence interval 1.72Çô7.39). Additionally, use of the application was associated with an increased likelihood to log greater than 10,000 steps on each entry (odds ratio 20.64, 95% confidence interval 9.19Çô46.39). Linear regression analysis revealed a nonsignificant relationship between perceived usability (r = .216, P = .21) and usefulness (r = .229, P = .17) of the application and frequency of logging steps in the intervention group. Conclusion: Using a smartphone application as an additional delivery method to a website-delivered physical activity intervention may assist in maintaining participant engagement and behavior change. However, due to study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study.

Kramer, I., Simons, C. J., Wigman, J. T., Collip, D., Jacobs, N., Derom, C. et al. (2013). Time-Lagged Moment-to-Moment Interplay Between Negative Affect and Paranoia: New Insights in the Affective Pathway to Psychosis. Schizophr.Bull.

Evidence suggests that affect plays a role in the development of psychosis but the underlying mechanism requires further investigation. This study examines the moment-to-moment dynamics between negative affect (NA) and paranoia prospectively in daily life. A female general population sample (n = 515) participated in an experience sampling study. Time-lagged analyses between increases in momentary NA and subsequent momentary paranoia were examined. The impact of childhood adversity, stress sensitivity (impact of momentary stress on momentary NA), and depressive symptoms on these time-lagged associations, as well as associations with follow-up self-reported psychotic symptoms (Community Assessment of Psychic Experiences and the Symptom Checklist-90-Revised) were investigated. Moments of NA increase resulted in a significant increase in paranoia over 180 subsequent minutes. Both stress sensitivity and depressive symptoms impacted on the transfer of NA to paranoia. Stress sensitivity moderated the level of increase in paranoia during the initial NA increase, while depressive symptoms increased persistence of paranoid feelings from moment to moment. Momentary paranoia responses to NA increases were associated with follow-up psychotic symptoms. Examination of microlevel momentary experience may thus yield new insights into the mechanism underlying co-occurrence of altered mood states and psychosis. Knowledge of the underlying mechanism is required in order to determine source and place where remediation should occur

Kristjansdottir, O. B., Fors, E. A., Eide, E., Finset, A., Stensrud, T. L., van, D. S. et al. (2013). A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial. J Med Internet Res, 15, e72.

BACKGROUND: Internet-based interventions are increasingly used to support self-management of individuals with chronic illnesses. Web-based interventions may also be effective in enhancing self-management for individuals with chronic pain, but little is known about long-term effects. Research on Web-based interventions to support self-management following participation in pain management programs is limited. OBJECTIVE: The aim is to examine the long-term effects of a 4-week smartphone-intervention with diaries and therapist-written feedback following an inpatient chronic pain rehabilitation program, previously found to be effective at short-term and 5-month follow-ups. METHODS: 140 women with chronic widespread pain, participating in a 4-week inpatient rehabilitation program, were randomized into two groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of one face-to-face individual session and 4 weeks of written communication via a smartphone, consisting of three diaries daily to elicit pain-related thoughts, feelings, and activities, as well as daily personalized written feedback based on cognitive behavioral principles from a therapist. Both groups were given access to an informational website to promote constructive self-management. Outcomes were measured with self-reported paper-and-pencil format questionnaires with catastrophizing as the primary outcome measure. Secondary outcomes included daily functioning and symptom levels, acceptance of pain, and emotional distress. RESULTS: By the 11-month follow-up, the favorable between-group differences previously reported post-intervention and at 5-month follow-up on catastrophizing, acceptance, functioning, and symptom level were no longer evident (P>.10). However, there was more improvement in catastrophizing scores during the follow-up period in the intervention group (M=-2.36, SD 8.41) compared to the control group (M=.40, SD 7.20), P=.045. Also, per protocol within-group analysis showed a small positive effect (Cohen’s d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up. A positive effect (Cohen’s d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group. Small to large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05) from the intervention baseline to the 11-month follow-up. CONCLUSION: The long-term results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. This study provides modest evidence supporting the long-term effect of the intervention. TRIAL REGISTRATION: NCT01236209; (Archived by WebCite at

Kuepper, R., Oorschot, M., Myin-Germeys, I., Smits, M., van, O. J., & Henquet, C. (2013). Is psychotic disorder associated with increased levels of craving for cannabis? An Experience Sampling study. Acta Psychiatr.Scand..

OBJECTIVE: Although cannabis use among individuals with psychotic disorder is considerable, little is known about patterns of use and factors contributing to continuation of use. Therefore, we investigated craving in relation to cannabis use in patients with psychotic disorder and healthy controls. METHOD: The study included 58 patients with non-affective psychotic disorder and 63 healthy controls; all were frequent cannabis users. Craving was assessed with the Obsessive Compulsive Drug Use Scale (OCDUS) for cannabis, as well as in daily life using the Experience Sampling Method (ESM). RESULTS: Patients scored higher on the OCDUS (B = 1.18, P = 0.022), but did not differ from controls in ESM indices of craving (all P > 0.05). In daily life, ESM craving predicted cannabis use and this was stronger in controls (chi(2) = 4.5, P = 0.033; B(controls) = 0.08, P < 0.001; B(patients) = 0.06, P < 0.001). In both groups ESM craving was predicted by negative affect, paranoia, and hallucinations (B(negativeaffect) = 0.12, P = 0.009; B(paranoia) = 0.13, P = 0.013; B(hallucinations) = 0.13, P = 0.028), and followed by an increase in negative affect at non-cannabis-using moments (B = 0.03, P = 0.002). CONCLUSION: The temporal dynamics of craving as well as craving intensity in daily life appear to be similar in patients and controls. Further research is needed to elucidate the inconsistencies between cross-sectional and daily-life measures of craving in psychosis

Kuerbis, A., Armeli, S., Muench, F., & Morgenstern, J. (2012). Motivation and Self-Efficacy in the Context of Moderated Drinking: Global Self-Report and Ecological Momentary Assessment. Psychol.Addict.Behav. .

Despite ample research demonstrating the role of motivation and self-efficacy in predicting drinking in the context of abstinence, little research explicitly explores their role in the context of moderation, and none have utilized daily diary methods. The purpose of this study was to (a) explore the concordance between global self-report and daily diary composite measures of motivation and self-efficacy and (b) compare the ability of each in predicting drinking outcomes in the context of a study of brief AUD treatments focused on controlled drinking. Problem drinkers (N = 89) were assessed, provided feedback about their drinking, and randomly assigned to one of three conditions: two brief AUD treatments or a third group asked to change on their own. Global self-report (GSR) measures were administered at baseline and Week 8 (end of treatment). Daily diary composites (DDC) were created from data collected via an Interactive Voice Recording system during the week prior to baseline and the week prior to Week 8. Findings revealed some concordance between GSR and DDC at both baseline and Week 8, indicating the two methods capture some of the same construct; however, their respective relationships to drinking differed. DDC for both baseline and Week 8 significantly predicted Week 8 drinking outcomes, whereas only change in GSR significantly predicted drinking outcomes. Findings suggest that motivation and self-efficacy are important to moderated drinking, and that both GSR and daily diary methods are useful in understanding mechanisms of change in the context of moderation. Daily diary methods may provide significant advantages. Limitations and arenas for future research are discussed.

Kumpula, M. J. (2012). Motivations for sex and sexual behavior among female college students: An event-level analysis. ProQuest Information & Learning, US.

College-aged women frequently engage in sexual behavior associated with negative physical and psychological outcomes, and understanding factors that promote high-risk sexual behavior is necessary to inform effective interventions. Motivational influences on sexual behavior have been implicated in promoting patterns of sexual risk; however, the precise nature of these relationships is unclear. Event-level associations between motivations for sexual intercourse and sexual risk-taking behavior were examined in an eight-week online electronic diary study from a sample of 241 undergraduate women. Hierarchical linear modeling indicated that situation-specific coping, self-affirmation, and enhancement motives for sex, along with associated contextual and dispositional factors, demonstrated differential influences on indiscriminate sexual behavior and engaging in actions to protect against sexually transmitted diseases and unwanted pregnancy. Women were more likely to engage in sex with a new partner when intercourse was preceded by depressed mood and motivated by a desire to cope with negative emotion. Sexual intercourse resulting from self-affirmation motivation in the context of low self-esteem also was associated with increased likelihood of sex with a new partner, as well as lower probability of condom and contraceptive use. In addition, event-level reports of self-affirmation motives for sex were associated with sex with a less familiar partner when self-esteem ratings were high. Sexual experiences driven by enhancement motives were associated with lower perceived intimacy with a sexual partner, and enhancement motivation interacted with propensity for sensation seeking to predict likelihood of condom use. The results suggest that sexual motivation plays an important role in sexual risk-taking behavior; however, its effects are best understood in the context of other situational and dispositional factors.

Kuppens, P., Champagne, D., & Tuerlinckx, F. (2012). The dynamic interplay between appraisal and core affect in daily life. Frontiers in Psychology, 3.

Appraisals and core affect are both considered central to the experience of emotion. In this study we examine the bidirectional relationships between these two components of emotional experience by examining how core affect changes following how people appraise events and how appraisals in turn change following how they feel in daily life. In an experience sampling study, participants recorded their core affect and appraisals of ongoing events; data were analyzed using cross-lagged multilevel modeling. Valence-appraisal relationships were found to be characterized by congruency: the same appraisals that were associated with a change in pleasure-displeasure (motivational congruency, other-agency, coping potential, and future expectancy), changed themselves as a function of pleasure-displeasure. In turn, mainly secondary appraisals of who is responsible and how one is able to cope with events were associated with changes in arousal, which itself is followed by changes in the future appraised relevance of events. These results integrate core affect and appraisal approaches to emotion by demonstrating the dynamic interplay of how appraisals are followed by changes in core affect which in turn change our basis for judging future events.

Kwapil, T. R., Brown, L. H., Silvia, P. J., Myin-Germeys, I., & Barrantes-Vidal, N. (2012). The expression of positive and negative schizotypy in daily life: An experience sampling study. Psychological Medicine, 42, 2555-2566.

Background: Psychometrically identified positive schizotypy and negative schizotypy are differentially related to psychopathology, personality and social functioning. However, little is known about the experience and expression of schizotypy in daily life and the psychological mechanisms that trigger psychotic-like experiences. Method: The present study employed experience sampling methodology (ESM) to assess positive and negative schizotypy in daily life in a non-clinical sample of 412 young adults. ESM is a structured diary technique in which participants are prompted at random times during the day to complete assessments of their current experiences. Results: As hypothesized, positive schizotypy was associated with increased negative affect, thought impairment, suspiciousness, negative beliefs about current activities and feelings of rejection, but not with social disinterest or decreased positive affect. Negative schizotypy, on the other hand, was associated with decreased positive affect and pleasure in daily life, increased negative affect, and decreases in social contact and interest. Both positive schizotypy and negative schizotypy were associated with the desire to be alone when with others. However, this was moderated by anxiety in positive schizotypy and by diminished positive affect in negative schizotypy Conclusions: The results support the construct validity of a multidimensional model of schizotypy and the ecological validity of the positive and negative schizotypy dimensions. ESM appears to be a promising method for examining the daily life experiences of schizotypic individuals.

Kwon, S., Kim, H., & Park, K. S. (2012). Validation of heart rate extraction using video imaging on a built-in camera system of a smartphone. Conf.Proc.IEEE Eng Med Biol.Soc., 2012, 2174-2177.

As a smartphone is becoming very popular and its performance is being improved fast, a smartphone shows its potential as a low-cost physiological measurement solution which is accurate and can be used beyond the clinical environment. Because cardiac pulse leads the subtle color change of a skin, a pulsatile signal which can be described as photoplethysmographic (PPG) signal can be measured through recording facial video using a digital camera. In this paper, we explore the potential that the reliable heart rate can be measured remotely by the facial video recorded using smartphone camera. First, using the front facing-camera of a smartphone, facial video was recorded. We detected facial region on the image of each frame using face detection, and yielded the raw trace signal from the green channel of the image. To extract more accurate cardiac pulse signal, we applied independent component analysis (ICA) to the raw trace signal. The heart rate was extracted using frequency analysis of the raw trace signal and the analyzed signal from ICA. The accuracy of the estimated heart rate was evaluated by comparing with the heart rate from reference electrocardiogram (ECG) signal. Finally, we developed FaceBEAT, an iPhone application for remote heart rate measurement, based on this study

Landsbergis, P. A., Dobson, M., Koutsouras, G., & Schnall, P. (2013). Job strain and ambulatory blood pressure: a meta-analysis and systematic review. Am J Public Health, 103, e61-e71.

We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985-2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case-control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies. Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association. Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions

Lee, J., Matsumura, K., Yamakoshi, T., Rolfe, P., Tanaka, N., Kim, K. et al. (2013). Validation of normalized pulse volume in the outer ear as a simple measure of sympathetic activity using warm and cold pressor tests: towards applications in ambulatory monitoring. Physiol Meas., 34, 359-375.

Normalized pulse volume (NPV) derived from the ear has the potential to be a practical index for monitoring daily life stress. However, ear NPV has not yet been validated. Therefore, we compared NPV derived from an index finger using transmission photoplethysmography as a reference, with NPV derived from a middle finger and four sites of the ear using reflection photoplethysmography during baseline and while performing cold and warm water immersion in ten young and six middle-aged subjects. The results showed that logarithmically-transformed NPV (lnNPV) during cold water immersion as compared with baseline values was significantly lower, only at the index finger, the middle finger and the bottom of the ear-canal. Furthermore, lnNPV reactivities (DeltalnNPV; the difference between baseline and test values) from an index finger were significantly related to DeltalnNPV from the middle finger and the bottom of the ear-canal (young: r = 0.90 and 0.62, middle-aged: r = 0.80 and 0.58, respectively). In conclusion, these findings show that reflection and transmission photoplethysmography are comparable methods to derive NPV in accordance with our theoretical prediction. NPV derived from the bottom of the ear-canal is a valid approach, which could be useful for evaluating daily life stress

Liao, Y., Intille, S., Wolch, J., Pentz, M. A., & Dunton, G. F. (2013). Understanding the Physical and Social Contexts of Children’s Non-School Sedentary Behavior: An Ecological Momentary Assessment Study. J Phys.Act.Health.

BACKGROUND: Research on children’s sedentary behavior has relied on recall-based self-report or accelerometer methods, which do not assess the context of such behavior. PURPOSE: This study used Ecological Momentary Assessment (EMA) to determine where and with whom children’s sedentary behavior occurs during their non-school time. METHODS: Children (N = 120) ages 9-13 years (51% male, 33% Hispanic) wore mobile phones that prompted surveys (20 total) for four days. Surveys measured current activity (e.g., exercise, watching TV), physical location (e.g., home, outdoors), and social company (e.g., family, friends). RESULTS: Children engaged in a greater percentage of leisure-oriented (e.g., watching TV) than productive (e.g., reading, doing homework) sedentary behavior (70% vs. 30%, respectively). Most of children’s sedentary activity occurred at home (85%). Children’s sedentary activity took place most often with family members (58%). Differences in physical context of sedentary behavior were found for older vs. younger children (p < .05). Type of sedentary behavior differed by gender, racial/ethnic group, and social context (p’s < .05). CONCLUSION: Children may prefer or have greater opportunities to be sedentary in some contexts than others. Research demonstrates the potential for using EMA to capture real-time information about children’s sedentary behavior during their non-school time

Litmanen, T., Lonka, K., Inkinen, M., Lipponen, L., & Hakkarainen, K. (2012). Capturing teacher students’ emotional experiences in context: Does inquiry-based learning make a difference? Instructional Science, 40, 1083-1101.

In the present study teacher studentsÇÖ contextual learning experiences were examined longitudinally in authentic study environments using the contextual activity sampling system, a means of mobile-supported experience sampling. The studentsÇÖ (n = 9) experiences were first recorded during a 2 week period in their first year of study. The same measurements were repeated again for a 2 week follow-up in the second year, accompanied by interviews before and after the follow-up. The first year of study consisted mostly of lectures and ordinary small-group work, whereas the second measurement period ran parallel to the completion of an intensive inquiry-based project, which was the focus of the present study. A multivariate analysis of variance revealed that studying during the inquiry-based period produced stronger experiences of being challenged as well as negative affects than the teacher-centered period. The participantsÇÖ experiences of competence, commitment and positive affects did not differ during the two periods. However, interview data indicated that the participants enjoyed the inquiry-based period and that the work was intensive. Contextual data and interviews were also used to describe studentsÇÖ experiences during one particular study session during the inquiry-based project. The results suggest that negative affects may be an essential part of the process of gradually learning to take responsibility for both individual and collaborative learning processes. Possibilities for using experience-sampling methods to analyze collaborative learning are also discussed.

Loeffler, S. N., Myrtek, M., & Peper, M. (2013). Mood-congruent memory in daily life: Evidence from interactive ambulatory monitoring. Biol.Psychol..

Evidence from the psychological laboratory indicates that emotional states tend to facilitate the encoding and retrieval of stimuli of the same emotional valence. To explore mood-congruent memory and the role of arousal in daily life, we applied a new interactive ambulatory technique. Psychophysiological arousal as indexed by non-metabolic heart rate, self-reported emotions and situational information were assessed during 24-h recordings in 70 healthy participants. The emotional state was used to trigger word list presentations on a minicomputer. Our results show that psychophysiological arousal at the time of encoding enhanced the recall of negative words in negative emotional conditions, whereas low psychophysiological arousal facilitated recall of positive words. In positive contexts, mood congruency was more prominent when arousal was low. These results demonstrate how automated experimentation with an ambulatory technique may help to assess emotional memory in real-world contexts, thus providing new methods for diverse fields of application

Mak, T. N., Prynne, C. J., Cole, D., Fitt, E., Roberts, C., Bates, B. et al. (2012). Assessing eating context and fruit and vegetable consumption in children: New methods using food diaries in the UK National Diet and Nutrition Survey Rolling Programme. The International Journal of Behavioral Nutrition and Physical Activity, 9.

Background: Eating context is the immediate environment of each eating occasion (EO). There is limited knowledge on the effects of the eating context on food consumption in children, due to the difficulty in measuring the multiple eating contexts children experience throughout the day. This study applied ecological momentary assessment using food diaries to explore the relationships between eating context and fruit and vegetable consumption in UK children. Methods: Using 4 d unweighed food diaries, data were collected for 642 children aged 1.5-10y in two years of the UK National Diet and Nutrition Survey (2008Çô2010). Participants recorded all foods and drinks consumed at each EO, where and with whom the food was consumed, whether the TV was on and if eaten at a table. Mixed logistic regression and mixed multinomial logistic regression were used to calculate associations between eating contexts and fruit and vegetables (FV) consumed by quartiles. Results: Of 16,840 EOs, 73% took place at home and 31% with parents only. Frequency of eating alone and with friends increased with age. Compared to eating at home, children aged 1.5-3y were more likely to consume fruit at care outside home (>10-50g OR:2.39; >50-100g OR:2.12); children aged 4-6y were more likely to consume fruit (>50-100g OR:3.53; >100g OR:1.88) and vegetables at school (>30-60g OR:3.56). Compared to eating with parents only, children aged 1.5-3y were more likely to consume fruit with friends (>10-50g OR:2.69; >50-100g OR:3.49), and with carer and other children/others (>10-50g OR:2.25); children aged 4-6y were more likely to consume fruit (>50-100g OR:1.96) and vegetables with friends (>30-60g OR:3.56). Children of all ages were more likely to eat vegetables when the TV was off than on and at a table than not at table. Conclusions: The use of food diaries to capture multiple eating contexts and detailed fruit and vegetable consumption data was demonstrated at a population level. Higher odds of FV consumption were seen from structured settings such as school and care outside home than at home, as well as when eating at a table and the TV off. This study highlights eating contexts where provision of fruit and vegetables could be improved, especially at home. Future research should take eating context into consideration when planning interventions to target childrenÇÖs food consumption and eating behaviour.

Matsumura, K. & Yamakoshi, T. (2013). iPhysioMeter: A new approach for measuring heart rate and normalized pulse volume using only a smartphone. Behav.Res Methods.

Heart rate (HR) and normalized pulse volume (NPV) are physiological indices that have been used in a diversity of psychological studies. However, measuring these indices often requires laborious processes. We therefore developed a new smartphone program, named iPhysioMeter, that makes it possible to measure beat-by-beat HR and ln NPV using only a smartphone. We examined its accuracy against conventional laboratory measures. Mental stress tasks were used to alter HR and ln NPV in 12 participants. Bland-Altman analyses revealed negligible proportional bias for HR and ln NPV or for their change values, expressed as DeltaHR and Deltaln NPV. However, a relatively large fixed bias did emerge for ln NPV, as well as a small one for Deltaln NPV, although both were within the limits of agreement. These findings suggest that iPhysioMeter can yield valid measures of the absolute level of HR and of relative changes in ln NPV

McCabe, K. O. & Fleeson, W. (2012). What is extraversion for? Integrating trait and motivational perspectives and identifying the purpose of extraversion. Psychological Science, 23, 1498-1505.

The purpose of this study was to determine whether the manifestation of extraversion (i.e., acting and being extraverted) in everyday behavior can be explained by intentional (functional) constructs, namely, goals. By using a model in which personality states serve as an outcome of specific, momentary goal pursuit, we were able to identify the function of extraversion states in everyday behavior. Using experience-sampling methodology, we asked participants to describe their state extraversion, goal pursuit, and state affect over 10 days. Results show that 18 selected goals predicted 74% of the variance in state extraversion; both within-person and between-person fluctuations in state extraversion were strongly associated with changes in momentary goal pursuit. We extended findings relating state extraversion and state positive affect, showing that the relationship between goals and positive affect was partially mediated by state extraversion.

McTavish, F. M., Chih, M. Y., Shah, D., & Gustafson, D. H. (2012). How patients recovering from alcoholism use a smartphone intervention.  Journal of Dual Diagnosis, 8, 294-304.

Objective: Mobile technology has the potential to radically improve addiction treatment and continuing care by offering emotional and instrumental support anywhere and just in time. This is particularly important in addiction because timing is critical to preventing relapse. Although most experts consider alcoholism to be a chronic disease, providers do not typically offer ongoing support for relapse prevention after patients complete treatment, even though a central characteristic of alcoholism and other addictive behaviors is their chronically relapsing nature. A-CHESS is a smartphone-based system for preventing relapse to heavy drinking among people leaving active alcohol dependence treatment. A-CHESS is designed to improve competence, social relatedness, and motivation, the three tenets of self-determination theory. This paper reports on the relative impact and use of A-CHESS 4 months after patients entered the study and discusses implications of the results on treating addiction and chronic diseases generally. Methods: A total of 349 individuals with alcohol dependence leaving residential treatment were randomly assigned to either receive A-CHESS + Treatment as usual or treatment as usual (standard aftercare). Patients came from two treatment agencies, one in the Midwest and one in the Northeast. Patients assigned to A-CHESS received a smartphone for 8 months and were followed for 12. The authors analyzed use patterns during the first 4 months of use by those receiving A-CHESS. Results: Participants used A-CHESS heavily and sustained their use over time. Ninety-four percent of A-CHESS participants used the application during the first week after residential treatment. At week 16, almost 80% continued to access A-CHESS. Participants with alcohol and drug dependence showed higher levels of system use than those with alcohol dependence only. Participants with a mental health diagnosis had slightly lower levels of use at the end of the intervention period (week 16), although more than 70% still accessed the system. Conclusions: These findings illustrate that patients with alcohol dependence, alcohol and drug dependence, and mental health issues will use smartphone applications such as A-CHESS for ongoing support, resources, and information, thus extending patient care if given the opportunity. Further analysis is needed to determine whether sustained A-CHESS use improves outcomes.

Melton, B. F., Bigham, L. E., & Bland, H. W. (2013). The feasibility of using video journaling to collect ecological momentary assessment data: Application to health behavior change interventions. Journal of Computing in Higher Education.

The purpose of this research was to evaluate the feasibility of an ecological momentary assessment (EMA) technique in a health behavior change intervention offered within university general health courses. A six-week health behavior change project was used with two groups: video journaling and traditional (pencil and paper) group. Research methodology employed was a quantitative, quasi-experimental, control and experimental group posttest comparison design. Stage of change data and program satisfaction surveys were collected from participants at a midsized southeastern university (n-á=-á72; 36 video and 36 traditional). Participants were selected through non-probability, purposive sampling. Upon completion of the behavior change intervention 88.9-á% (N-á=-á32) of video journaling participants reported being in either the action or maintenance stage of change compared to 63.9-á% (N-á=-á23) of the traditional group. Significant difference was found between the video journaling and traditional groups in levels of satisfaction with the program (M-á=-á3.96, SE-á=-á0.79; M-á=-á3.53, SE-á=-á.53 respectively; t-á=-áêÆ2.74, p-á<-á0.05). EMA techniques using video journaling to aid behavior change interventions among late adolescence showed promise with further research needed to focus on long-term effects of such interventions.

Miller, C. B., Kyle, S. D., Marshall, N. S., & Espie, C. A. (2013). Ecological momentary assessment of daytime symptoms during sleep restriction therapy for insomnia. J Sleep Res.

This study profiles changes in self-reported daytime functioning during sleep restriction therapy (SRT) for insomnia. Ecological momentary assessment (EMA) captured point-in-time symptomatology to map the time-course of symptoms. We hypothesized a deterioration (week 1) followed by improvements at week 3 of therapy relative to baseline. Nine patients with psychophysiological insomnia completed the Daytime Insomnia Symptom Scale (DISS) at rise-time, 12:00 hours, 18:00 hours and bedtime for 1 week before and 3 weeks during SRT. Four validated factors from the DISS were analyzed (alert cognition, positive mood, negative mood and sleepiness/fatigue) across 28 days yielding 17 170 data points. Factors evaluated week (baseline versus weeks 1 and 3) and time of day symptomatology. Insomnia Severity Index scores decreased significantly pre-to-post treatment (mean 18 versus 7). Reflecting acute effects of SRT, significant differences were found for all factors, except negative mood, between baseline and week 1 of SRT, suggesting adverse effects. By week 3, sleepiness/fatigue and negative mood decreased significantly compared to baseline, and positive mood showed a trend towards improvement (P = 0.06). Sleepiness/fatigue displayed a significant week x time of day interaction, explained by a reduction in sleepiness/fatigue at every daytime assessment point (except bedtime, which remained high). A significant interaction for alert cognition was associated with reduction in alertness at bedtime by week 3 and an increase in alertness at rise-time, suggesting that SRT not only improves sleep, but moderates alertness and sleepiness in therapeutic ways. Initial SRT is associated with an increase in sleepiness/fatigue and a decrease in alert cognition

Miranda, R., Ray, L., Blanchard, A., Reynolds, E. K., Monti, P. M., Chun, T. et al. (2013). Effects of naltrexone on adolescent alcohol cue reactivity and sensitivity: an initial randomized trial. Addict.Biol..

Adolescent alcohol use is associated with myriad adverse consequences and contributes to the leading causes of mortality among youth. Despite the magnitude of this public health problem, evidenced-based treatment initiatives for alcohol use disorders in youth remain inadequate. Identifying promising pharmacological approaches may improve treatment options. Naltrexone is an opiate receptor antagonist that is efficacious for reducing drinking in adults by attenuating craving and the rewarding effects of alcohol. Implications of these findings for adolescents are unclear; however, given that randomized trials of naltrexone with youth are non-existent. We conducted a randomized, double-blinded, placebo-controlled cross-over study, comparing naltrexone (50 mg/daily) and placebo in 22 adolescent problem drinkers aged 15-19 years (M = 18.36, standard deviation = 0.95; 12 women). The primary outcome measures were alcohol use, subjective responses to alcohol consumption, and alcohol-cue-elicited craving assessed in the natural environment using ecological momentary assessment methods, and craving and physiological reactivity assessed using standard alcohol cue reactivity procedures. Results showed that naltrexone reduced the likelihood of drinking and heavy drinking (P’s </= 0.03), blunted craving in the laboratory and in the natural environment (P’s </= 0.04), and altered subjective responses to alcohol consumption (P’s </= 0.01). Naltrexone was generally well tolerated by participants. This study provides the first experimentally controlled evidence that naltrexone reduces drinking and craving, and alters subjective responses to alcohol in a sample of adolescent problem drinkers, and suggests larger clinical trials with long-term follow-ups are warranted

Moses, P. C., Pihet, S., Favez, N., & Schoebi, D. (2013). Assessment of Parental Discipline in Daily Life. J Fam.Psychol..

The use of ecological momentary assessment (EMA) for studying parenting has been rare. We examined the psychometric properties and structural validity of an EMA Parenting Scale based on 32 mothers’ reports of their parenting over a period of 10 consecutive days, and explored the acceptance of the scale and compliance with the procedure. The results suggested that the EMA Parenting Scale was well accepted for the assessment of daily parenting, and that it consistently captured the overreactive and lax dimensions of parenting across different episodes of child misbehavior. Moreover, multilevel analyses suggested that the scale was sensitive to change across different parenting episodes, and that it reliably assessed the dimensions at both the personal and situational levels.

Nosen, E. & Woody, S. R. (2013). Brief psycho-education affects circadian variability in nicotine craving during cessation. Drug and Alcohol Dependence.

BACKGROUND: Nicotine cravings are a key target of smoking cessation interventions. Cravings demonstrate circadian variation during abstinence, often peaking during the morning and evening hours. Although some research has also shown diurnal variation in the efficacy of nicotine replacement medications, little research has examined how brief psychosocial interventions affect temporal patterns of craving during abstinence. The present study examined the impact of two brief psycho-education interventions on circadian variations in cravings during a 24-h period. METHOD: 176 adult smokers interested in quitting participated in two lab sessions. During the first session, participants received (a) mindfulness psycho-education that encouraged acceptance of cravings as a normal, tolerable part of quitting that people should not expect to perfectly control, (b) standard cessation psycho-education, or (c) no psycho-education. Half the sample initiated a cessation attempt the following day. Dependent variables were assessed using ecological momentary assessment (24-h of monitoring, immediately after first lab session) and questionnaires four days later. RESULTS: Partially consistent with hypotheses, both forms of psycho-education were associated with differential diurnal variation in cravings during cessation. Relative to those receiving no psycho-education, standard smoking cessation psycho-education decreased morning cravings. Psycho-education encouraging acceptance of cravings was associated with lower craving in both the morning and evening, albeit only among successfully abstinent smokers. CONCLUSIONS: Results demonstrate that brief non-pharmacological interventions can affect circadian craving patterns during smoking cessation. Further investigation of mechanisms of change and of the impact of psycho-education on cessation outcomes is warranted.

Offer, S. (2013). Family time activities and adolescents’ emotional well-being. Journal of Marriage and Family, 75, 26-41.

The literature is divided on the issue of what matters for adolescents’ wellÇÉbeing, with one approach focusing on quality and the other on routine family time. Using the experience sampling method, a unique form of time diary, and survey data drawn from the 500 Family Study (N = 237 adolescents with 8,122 observations), this study examined the association between family time and adolescents’ emotional wellÇÉbeing as a function of the type of activities family members engaged in during their time together. Hierarchical linear model analyses revealed that eating meals together was beneficial to adolescents’ emotional wellÇÉbeing, especially when fathers were present. Family leisure was also beneficial to teens’ wellÇÉbeing. By contrast, productive family time (e.g., homework) was associated with lower emotional wellÇÉbeing, as was maintenance family time (e.g., household chores), but only when adolescents engaged in it with both parents.

Oorschot, M., Lataster, T., Thewissen, V., Lardinois, M., van Os, J., Delespaul, P. A. E. G. et al. (2012). Symptomatic remission in psychosis and real-life functioning. The British Journal of Psychiatry, 201, 215-220.

Background: In 2005 Andreasen proposed criteria for remission in schizophrenia. It is unclear whether these criteria reflect symptom reduction and improved social functioning in daily life. Aims: To investigate whether criteria for symptomatic remission reflect symptom reduction and improved functioning in real life, comparing patients meeting remission criteria, patients not meeting these criteria and healthy controls. Method: The Experience Sampling Method (ESM), a structured diary technique, was used to explore real-life symptoms and functioning in 177 patients with (remitted and non-remitted) schizophrenia spectrum disorders and 148 controls. Results: Of 177 patients, 70 met criteria for symptomatic remission. These patients reported significantly fewer positive and negative symptoms and better mood states compared with patients not in remission. Furthermore, patients in remission spent more time in goal-directed activities and had less preference for being alone when they were with others. However, the patient groups did not differ on time spent in social company and doing nothing, and both the remission and non-remission groups had lower scores on functional outcome measures compared with the control group. Conclusions: The study provides an ecological validation for the symptomatic remission criteria, showing that patients who met the criteria reported fewer positive symptoms, better mood states and partial recovery of reward experience compared with those not in remission. However, remission status was not related to functional recovery, suggesting that the current focus on symptomatic remission may reflect an overly restricted goal.

Palmier-Claus, J. E., Dunn, G., Taylor, H., Morrison, A. P., & Lewis, S. W. (2013). Cognitive-self consciousness and metacognitive beliefs: Stress sensitization in individuals at ultra-high risk of developing psychosis. Br.J Clin.Psychol., 52, 26-41.

Objective: Metacognitive beliefs (MCB) may guide information and attention processes, increasing affective and symptomatic reactions to stressful events. Cognitive self-consciousness (CSC; i.e., a preoccupation with one’s thoughts) may increase awareness of MCB, potentially triggering the onset of psychotic symptoms. This study tested the hypotheses that (1), MCB would moderate affective and symptomatic reactions to stress in individuals at ultra-high risk (UHR) of developing psychosis, and (2), greater CSC would precede worsening in psychotic symptoms in individuals with strong MCB. METHOD: Twenty-seven individuals at UHR of developing psychosis completed a self-report diary when prompted by an electronic wristwatch several times each day for 6 days (experience sampling). RESULTS: MCB moderated the association between affective, but not symptomatic, responses to social stress. CSC preceded the subsequent occurrence of hallucinations in individuals who reported strong beliefs about the need to control their thoughts. CONCLUSIONS: The data suggest that MCB sensitize an individual to social stressors. CSC may represent times where an individual is aware that their thoughts are uncontrollable, and therefore contradicting their MCB, motivating them to make an external attribution. The findings have implications for improving the effectiveness of interventions for people experiencing hallucinations

Palmier-Claus, J. E., Rogers, A., Ainsworth, J., Machin, M., Barrowclough, C., Laverty, L. et al. (2013). Integrating mobile-phone based assessment for psychosis into people’s everyday lives and clinical care: a qualitative study. BMC Psychiatry, 13, 34.

BACKGROUND: Over the past decade policy makers have emphasised the importance of healthcare technology in the management of long-term conditions. Mobile-phone based assessment may be one method of facilitating clinically- and cost-effective intervention, and increasing the autonomy and independence of service users. Recently, text-message and smartphone interfaces have been developed for the real-time assessment of symptoms in individuals with schizophrenia. Little is currently understood about patients’ perceptions of these systems, and how they might be implemented into their everyday routine and clinical care. METHOD: 24 community based individuals with non-affective psychosis completed a randomised repeated-measure cross-over design study, where they filled in self-report questions about their symptoms via text-messages on their own phone, or via a purpose designed software application for Android smartphones, for six days. Qualitative interviews were conducted in order to explore participants’ perceptions and experiences of the devices, and thematic analysis was used to analyse the data. RESULTS: Three themes emerged from the data: i) the appeal of usability and familiarity, ii) acceptability, validity and integration into domestic routines, and iii) perceived impact on clinical care. Although participants generally found the technology non-stigmatising and well integrated into their everyday activities, the repetitiveness of the questions was identified as a likely barrier to long-term adoption. Potential benefits to the quality of care received were seen in terms of assisting clinicians, faster and more efficient data exchange, and aiding patient-clinician communication. However, patients often failed to see the relevance of the systems to their personal situations, and emphasised the threat to the person centred element of their care. CONCLUSIONS: The feedback presented in this paper suggests that patients are conscious of the benefits that mobile-phone based assessment could bring to clinical care, and that the technology can be successfully integrated into everyday routine. However, it also suggests that it is important to demonstrate to patients the personal, as well as theoretical, benefits of the technology. In the future it will be important to establish whether clinical practitioners are able to use this technology as part of a personalised mental health regime

Piasecki, T. M., Alley, K. J., Slutske, W. S., Wood, P. K., Sher, K. J., Shiffman, S. et al. (2012). Low sensitivity to alcohol: Relations with hangover occurrence and susceptibility in an ecological momentary assessment investigation. Journal of Studies on Alcohol and Drugs, 73, 925-932.

Objective: The current investigation tested whether low sensitivity to alcohol, as measured by the Self-Rating of the Effects of Alcohol (SRE) form, is associated with hangover occurrence or resistance, two potentially important predictors of later problematic drinking outcomes. Method: Drinkers who reported using alcohol at least four times in the past month (N = 402) completed the SRE at baseline and used ecological momentary assessment methods with an electronic diary to record drinking behaviors and related experiences over 21 days. Each morning, the diary assessed prior-night drinking behaviors and the presence of current hangover. Results: After adjustments for sex, body weight, age, and smoking status, higher SRE scores (indicating lower alcohol sensitivity) predicted hangover occurrence on postdrinking mornings (odds ratio [OR] = 1.24 per interquartile range [IQR], p = .003). However, when the number of drinks consumed in the drinking episode was covaried, SRE scores were negatively associated with hangover (OR = 0.67 per IQR, p <.001). An interaction between SRE scores and the number of drinks consumed indicated that low-sensitivity drinkers tend to be differentially resistant to hangover at a given number of drinks. Higher SRE scores were associated with consuming more drinks on average (generalized estimating equations coefficient = 2.20 per IQR, p < .001). Conclusions: Individuals lower in alcohol sensitivity appear to be more resistant to hangovers per unit of alcohol. However, they are also more likely to engage in excessive drinking, and this may account for their increased odds of experiencing hangover during an arbitrary monitoring period. Heavy consumption, hangover resistance, and hangover frequency may each be manifestations of low sensitivity to alcohol, an established risk factor for alcohol use disorder.

Plasqui, G., Bonomi, A. G., & Westerterp, K. R. (2013). Daily physical activity assessment with accelerometers: new insights and validation studies. Obes.Rev..

The field of application of accelerometry is diverse and ever expanding. Because by definition all physical activities lead to energy expenditure, the doubly labelled water (DLW) method as gold standard to assess total energy expenditure over longer periods of time is the method of choice to validate accelerometers in their ability to assess daily physical activities. The aim of this paper was to provide a systematic overview of all recent (2007-2011) accelerometer validation studies using DLW as the reference. The PubMed Central database was searched using the following keywords: doubly or double labelled or labeled water in combination with accelerometer, accelerometry, motion sensor, or activity monitor. Limits were set to include articles from 2007 to 2011, as earlier publications were covered in a previous review. In total, 38 articles were identified, of which 25 were selected to contain sufficient new data. Eighteen different accelerometers were validated. There was a large variability in accelerometer output and their validity to assess daily physical activity. Activity type recognition has great potential to improve the assessment of physical activity-related health outcomes. So far, there is little evidence that adding other physiological measures such as heart rate significantly improves the estimation of energy expenditure

Plowman, L. & Stevenson, O. (2012). Using mobile phone diaries to explore children’s everyday lives. Childhood: A Global Journal of Child Research, 19, 539-553.

This article describes a novel approach to experience sampling as a response to the challenges of researching the everyday lives of young children at home. Parents from 11 families used mobile phones to send the research team combined picture and text messages to provide Çÿexperience snapshotsÇÖ of their childÇÖs activities six times on each of three separate days. The article describes how the method aligns with an ecocultural approach, illustrates the variation in childrenÇÖs experiences and provides sufficient detail for researchers to adapt the method for the purposes of collecting data in other contexts. The article summarizes the benefits and shortcomings from the perspectives of families and researchers.

Qin, S. M., Verkasalo, H., Mohtaschemi, M., Hartonen, T., & Alava, M. (2012). Patterns, entropy, and predictability of human mobility and life. PLoS One, 7, e51353.

Cellular phones are now offering an ubiquitous means for scientists to observe life: how people act, move and respond to external influences. They can be utilized as measurement devices of individual persons and for groups of people of the social context and the related interactions. The picture of human life that emerges shows complexity, which is manifested in such data in properties of the spatiotemporal tracks of individuals. We extract from smartphone-based data for a set of persons important locations such as “home”, “work” and so forth over fixed length time-slots covering the days in the data-set (see also [1], [2]). This set of typical places is heavy-tailed, a power-law distribution with an exponent close to -1.7. To analyze the regularities and stochastic features present, the days are classified for each person into regular, personal patterns. To this are superimposed fluctuations for each day. This randomness is measured by “life” entropy, computed both before and after finding the clustering so as to subtract the contribution of a number of patterns. The main issue that we then address is how predictable individuals are in their mobility. The patterns and entropy are reflected in the predictability of the mobility of the life both individually and on average. We explore the simple approaches to guess the location from the typical behavior, and of exploiting the transition probabilities with time from location or activity A to B. The patterns allow an enhanced predictability, at least up to a few hours into the future from the current location. Such fixed habits are most clearly visible in the working-day length

Ramos-Castro, J., Moreno, J., Miranda-Vidal, H., Garcia-Gonzalez, M. A., Fernandez-Chimeno, M., Rodas, G. et al. (2012). Heart rate variability analysis using a seismocardiogram signal. Conf.Proc.IEEE Eng Med Biol.Soc., 2012, 5642-5645.

Seismocardiography is a simple and non invasive method of recording cardiac activity from the movements of the body caused by heart pumping. In this preliminary study we use a smartphone to record this acceleration and estimate the heart rate. We compare the heart rate variability parameters from the seismocardiogram and ECG reference signal. The results show a great similarity and are strongly influenced by the instability in the sampling frequency of the device. The differences between RR series are lower than 10 ms

Rosen, P. J., Epstein, J. N., & Van, O. G. (2013). I know it when I quantify it: ecological momentary assessment and recurrence quantification analysis of emotion dysregulation in children with ADHD. Atten.Defic.Hyperact.Disord..

Two studies examined the feasibility, utility, and validity of Ecological Momentary Assessment (EMA) and Recurrence Quantification Analysis (RQA) in assessing emotion dysregulation in children with Attention-Deficit/Hyperactivity Disorder (ADHD). In Study 1, 11 parents of children with ADHD ages 8-11 completed EMA-based ratings of their children’s mood three times daily for 28 days (84 ratings total) and questionnaires regarding their children’s emotion dysregulation. RQA was used to quantify the temporal patterning of dysregulation of the children’s mood. In Study 2, five children ages 8-11 completed EMA-based ratings of their mood three times daily for 28 days. Results supported the feasibility and validity of the parent report EMA protocol, with greater intensity, variability, and persistent patterning of variability associated with greater emotion dysregulation. Results did not support the validity of the child report protocol, as children were less likely to complete ratings when emotionally distressed and demonstrated substantial response bias

Saeki, K., Obayashi, K., Iwamoto, J., Tanaka, Y., Tanaka, N., Takata, S. et al. (2013). Influence of room heating on ambulatory blood pressure in winter: a randomised controlled study. J Epidemiol.Community Health.

BACKGROUND: Previous studies have proposed that higher blood pressure (BP) in winter is an important cause of increased mortality from cardiovascular disease during the winter. Some observational and physiological studies have shown that cold exposure increases BP, but evidence from a randomised controlled study assessing the effectiveness of intensive room heating for lowering BP was lacking. OBJECTIVES: The present study aimed to determine whether intensive room heating in winter decreases ambulatory BP as compared with weak room heating resulting in a 10 degrees C lower target room temperature when sufficient clothing and bedclothes are available. METHODS: We conducted a parallel group, assessor blinded, simple randomised controlled study with 1:1 allocation among 146 healthy participants in Japan from November 2009 to March 2010. Ambulatory BP was measured while the participants stayed in single experimental rooms from 21:00 to 8:00. During the session, participants could adjust the amount of clothing and bedclothes as required. Compared with the weak room heating group (mean temperature+/-SD: 13.9+/-3.3 degrees C), systolic morning BP (mean BP 2 h after getting out of bed) of the intensive room heating group (24.2+/-1.7 degrees C) was significantly lower by 5.8 mm Hg (95% CI 2.4 to 9.3). Sleep-trough morning BP surges (morning BP minus lowest night-time BP) in the intensive room heating group were significantly suppressed to about two thirds of the values in the weak room heating group (14.3 vs 21.9 mm Hg; p<0.01). CONCLUSIONS: Intensive room heating decreased morning BP and the morning BP surge in winter

Santos, R., Mota, J., Okely, A. D., Pratt, M., Moreira, C., Coelho-E-Silva MJ et al. (2013). The independent associations of sedentary behaviour and physical activity on cardiorespiratory fitness. Br.J Sports Med.

BACKGROUND: During childhood and adolescence, both physical activity (PA) and sedentary behaviour seem to influence cardiorespiratory fitness (CRF); however, the combined association of PA and sedentary behaviour remains to be understood. We analysed the combined association of objectively measured sedentary behaviour and moderate-to-vigorous intensity PA (MVPA) on CRF in Portuguese children and adolescents. METHODS: The sample comprised 2506 Portuguese healthy children and adolescents aged 10-18 years, from a cross-sectional school-based study (2008). PA and sedentary behaviour were assessed with accelerometry. Participants were classified as meeting current PA guidelines for youth versus not meeting, and as low versus high sedentary (according to the median value of sedentary time/day by age and gender), and then grouped as follows: Low active-high sedentary; low active-low sedentary; high active-high sedentary; high active-low sedentary. CRF was assessed with the FITNESSGRAM 20 m shuttle-run test. Binary logistic regression models were constructed to verify the relationship between high CRF and the combined influence of MVPA/sedentary behaviour, adjusting for age, gender, body mass index and accelerometer wear time. RESULTS: Participants classified as high active/low sedentary (OR=1.81; 95% CI 1.21 to 2.69), as well as those classified as low active/low sedentary (OR=1.27; 95% CI 1.01 to 1.61) were more likely to be fit, compared with those from the low-active/high-sedentary group. CONCLUSION: MVPA and sedentary behaviour may act independently in their relation with CRF, and that MVPA levels may not overcome the deleterious influence of high-sedentary time in maximising CRF

Schaefer, C. A., Nace, H., & Browning, R. (2013). Establishing Wrist-Based Cutpoints for the Actical Accelerometer in Elementary School Aged Children. J Phys.Act.Health.

BACKGROUND: The wrist has become a standard location for accelerometry (ACC) data collection, primarily to optimize compliance, yet interpreting wrist ACC data is limited due to a lack of calibration studies. This study aimed to establish cutpoints for a wrist-mounted Actical accelerometer in 6-11 year-old children using two methods. METHODS: Metabolic and ACC data (15 sec epoch) were collected during 8 activities in 22 children ages 6-11. Linear regression (LR) and Receiver Operator Characteristics (ROC) were used to examine the relationship between METs and ACC counts. Cutpoints were established at <1.5, 1.5-3, 3-6 and >/=6 METs for sedentary, light, moderate and vigorous activity, respectively. Cutpoints were applied to a large, multi-day sample of children (n=269) to examine differences in cutpoints on minutes of moderate-vigorous PA (MVPA). RESULTS: LR and ROC yielded moderate cutpoints of 574 and 388, respectively. When applied to the large sample, LR and ROC cutpoints resulted in an estimated 83 and 140 minutes of daily MVPA, respectively. CONCLUSIONS: We have established wrist-mounted Actical cutpoints for children using two methods. The differences in cutpoints and their effect on estimates of MVPA in an independent sample highlight challenges associated with establishing cutpoints, suggesting that standardized calibration procedures be developed

Schnall, R., Okoniewski, A., Tiase, V., Low, A., Rodriguez, M., & Kaplan, S. (2013). Using text messaging to assess adolescents’ health information needs: an ecological momentary assessment. J Med Internet Res, 15, e54.

BACKGROUND: Use of mobile technology has made a huge impact on communication, access, and information/resource delivery to adolescents. Mobile technology is frequently used by adolescents. OBJECTIVE: The purpose of this study was to understand the health information needs of adolescents in the context of their everyday lives and to assess how they meet their information needs. METHODS: We gave 60 adolescents smartphones with unlimited text messaging and data for 30 days. Each smartphone had applications related to asthma, obesity, human immunodeficiency virus, and diet preinstalled on the phone. We sent text messages 3 times per week and asked the following questions: (1) What questions did you have about your health today? (2) Where did you look for an answer (mobile device, mobile application, online, friend, book, or parent)? (3) Was your question answered and how? (4) Anything else? RESULTS: Our participants ranged from 13-18 years of age, 37 (62%) participants were male and 22 (37%) were female. Of the 60 participants, 71% (42/60) participants identified themselves as Hispanic and 77% (46/60) were frequent users of mobile devices. We had a 90% (1935/2150) response rate to our text messages. Participants sent a total of 1935 text messages in response to the ecological momentary assessment questions. Adolescents sent a total of 421 text messages related to a health information needs, and 516 text messages related to the source of information to the answers of their questions, which were related to parents, friends, online, mobile apps, teachers, or coaches. CONCLUSIONS: Text messaging technology is a useful tool for assessing adolescents’ health behavior in real-time. Adolescents are willing to use text messaging to report their health information. Findings from this study contribute to the evidence base on addressing the health information needs of adolescents. In particular, attention should be paid to issues related to diet and exercise. These findings may be the harbinger for future obesity prevention programs for adolescents

Selby, E. A., Franklin, J., Carson-Wong, A., & Rizvi, S. L. (2013). Emotional Cascades and Self-Injury: Investigating Instability of Rumination and Negative Emotion. J Clin.Psychol..

OBJECTIVE: Nonsuicidal self-injury (NSSI) is a public health concern and risk factor for suicide. The Emotional Cascade Model (ECM) proposes that NSSI partially functions as a distraction from cascades of negative affect and rumination. The purpose of this study was to examine the roles of trait rumination, and momentary instability of rumination and negative emotion, in NSSI. METHOD: Experience sampling methods were used to monitor thoughts, emotions, and behaviors in 47 individuals reporting dysregulated behaviors including NSSI. Instability indices were generated for rumination and negative emotion using the momentary assessments. RESULTS: Twenty-five episodes of NSSI were reported during monitoring. Trait rumination prospectively predicted NSSI episodes, and the instability indices interacted to predict NSSI. CONCLUSIONS: Consistent with the ECM, the interaction between rumination instability and negative affect instability during monitoring significantly predicted NSSI, with the strongest effects occurring for sadness and rumination about past. These findings may enhance conceptualization and treatment of patients with NSSI

Selby, E. A., Ribeiro, J. D., & Joiner, T. E. Jr. (2013). What Dreams May Come: Emotional Cascades and Nightmares in Borderline Personality Disorder. Dreaming.

People diagnosed with borderline personality disorder (BPD) have been found to have a number of sleep problems, including frequent and distressing nightmares. The experience of nightmares is likely to worsen emotion dysregulation and decrease coping abilities the subsequent day, making it an important issue for clinicians to address. One recent theoretical model of BPD psychopathology, the Emotional Cascade Model (ECM), may shed light on this phenomenon by characterizing nightmares as the experience of emotional cascades that occur during sleep. A model is presented in which these cascades may carry over from a stressful day and lead to elevated cognitive activity during sleep, as well as nightmare-like phenomena. To test this model we used experience sampling from 47 participants exhibiting dysregulated behaviorsÇö16 of them diagnosed with BPD. Negative emotion, rumination, and number of nightmares were assessed daily across two consecutive weeks. Analyses indicated that the BPD group experienced more frequent nightmares, that BPD diagnosis interacted with baseline trait rumination to prospectively predict number of nightmares reported during monitoring, and daily experience of emotional cascades predicted subsequent number of nightly nightmares. These findings held after controlling for key covariates, including sleep quality and diagnoses of depression and posttraumatic stress disorder. Important clinical interventions consistent with the ECM conceptualization of nightmares are proposed, including the potential for management of daily rumination and negative emotion, imagery rescripting for recurrent or anxiously anticipated nightmares, and potential prescription of prazosin (an alpha1-adrenergic antagonist) for the reduction of nightmares in this group.

Shiffman, S., Ferguson, S. G., Dunbar, M. S., & Scholl, S. M. (2012). Tobacco dependence among intermittent smokers. Nicotine & Tobacco Research, 14, 1372-1381.

Introduction: Intermittent smokers (ITS) are an increasingly prevalent segment of smokers, yet it is unknown whether or how dependence severity may vary across ITS. Methods: Participants were 217 ITS (70 never daily ITS [NITS], 138 converted ITS [CITS], and 9 unknown), who smoked 4-27 days per month, and 197 daily smokers (DS), recruited for a study on smoking patterns. Participants completed questionnaires on dependence (time to first cigarette after waking, Fagerstr+Âm Test of Nicotine Dependence [FTND], Nicotine Dependence Syndrome Scale [NDSS], Wisconsin Inventory of Smoking Dependence Motives [WISDM], and Hooked on Nicotine Checklist [HONC]) and recorded each cigarette in real time over 3 weeks using Ecological Momentary Assessment. Logistic regression assessed differences in dependence between groups (DS vs. ITS; CITS vs. NITS), and least squares regression examined associations between dependence and smoking behavior (mean, maximum cigarettes per day; proportion of days smoked; longest period of abstinence) within ITS. Results: As expected, DS were significantly more dependent than ITS: FTND, NDSS, and WISDM discriminated between ITS and DS with greater than 90% accuracy. Similarly, among ITS, NITS demonstrated lower dependence than CITS. Within ITS, dependence measures also correlated with observed smoking rate and duration of abstinence. Conclusions: The study confirmed that DS are more dependent than ITS and that CITS are more dependent than NITS. Importantly, ITS exhibit features of dependence, and there is meaningful variation in dependence within ITS, suggesting that some aspects of dependence may appear with very infrequent smoking. Future work should examine implications for ITS’ potential progression to daily smoking and cessation outcome.

Smyth, N., Clow, A., Thorn, L., Hucklebridge, F., & Evans, P. (2013). Delays of 5-15min between awakening and the start of saliva sampling matter in assessment of the cortisol awakening response. Psychoneuroendocrinology.

Linking psychosocial measures to the cortisol awakening response (CAR) demands accurate saliva sampling times. Monitoring adherence to the saliva sampling protocol requires electronic monitoring of both awakening and sampling times since self-reported times are inaccurate. Delays greater than 15min between awakening and commencement of saliva sampling reduce CAR magnitude. Less delay has been judged tolerable but remains unexplored for different magnitude measures, and for timing of the CAR peak. Study 1: Fifty healthy females (21+/-4 years) were instructed to collect saliva on four days at 0, 15, 30 and 45min post-awakening (samples 1-4). Both self-reported awakening and sampling times were electronically monitored using actigraphy and track caps. Self-reported awakening was later than actigraph estimated awakening (median difference of 4min). Estimates of CAR magnitude were significantly greater on non-adherent days (delay of 5-15min) compared to adherent days (delay<5min). On non-adherent compared to adherent days cortisol on average peaked earlier, at sample 3 rather than at sample 4. Study 2: Accurately timed cortisol values were obtained in an intensive investigation of 10 participants who collected saliva on 2 days every 5min for 30min post-awakening. Cortisol did not significantly increase until 10min post-awakening, suggesting a time lag may be typical between awakening and observation of a cortisol increase. We conclude that moderate delays between awakening and collection of saliva samples previously considered tolerable result in erroneous estimation of CAR magnitude and timing of the peak. These results are attributed to an approximate 10min time lag between awakening and the start of the cortisol rise. The absence of this latent period in calculations leads to overestimation of the CAR magnitude on moderately non-adherent sampling days. These findings, if more universally generalizable, will further theoretical understanding of the physiology of the CAR, but are methodologically challenging for researchers since self-reported awakening times are not accurate enough to override the concerns raised. However accurate electronic measurement of adherence to protocol would enable sampling delays to be taken into account in computing CAR estimates

Snell, C. (2012). A daily phone diary procedure to assess behavioral engagement in the treatment of adolescent anxiety and depressive disorders. ProQuest Information & Learning, US.

Anxiety and depressive disorders are common conditions for adolescents and are associated with significant impairments in functioning. Cognitive behavior therapy (CBT) is an effective treatment modality for these youth, and the behavioral components of CBT protocols, in particular, are thought to be one of the active mechanisms through which positive symptom changes are produced. However, few procedures are available to measure the behavioral changes taking place in adolescents’ daily lives as they make therapeutic progress. This study examined adolescents’ “behavioral engagement” throughout treatment, a construct defined as time spent in social, athletic and academic activities. Behavioral engagement was measured using the Daily Phone Diary (DPD), a validated measure of daily activities utilized in the child health literature, which employs the principles of Ecological Momentary Assessment (EMA). Twenty-four adolescents reported each activity they engaged in throughout the day, in chronological order, over the past 24 hours. Participants were diverse in their ages, ethnicities, socioeconomic statuses and internalizing disorder diagnoses. Activities were reported during phone calls scheduled before, during, and after treatment using a transdiagnostic formulation of CBT and, for a randomized subset of the sample (N=8), both before and following a Waitlist comparison condition. Results indicated that “behavioral engagement” is a construct that is measurable and that daily phone diaries are an acceptable method of data collection for this population. Based on theoretical and empirical literature, three key categories of activities on the DPD comprised behavioral engagement: (1) Time spent socially engaged with others; (2) Time spent on any physical or athletic activity; and (3) Time doing homework. Results supported good inter-rater reliability and potentially reasonable test-retest reliability; data collection via the DPD was feasible and acceptable in this context. Tests of convergent validity with other measures of anxiety and depressive symptoms suggested that prior to treatment, more time spent in some activity categories was associated with more internalizing symptoms for those with anxiety disorders only, but fewer internalizing symptoms for those with depression as well as anxiety. Tests of convergent validity with other measures of weekly mood were promising. Future studies will explore alternate definitions of behavioral engagement, examine this construct in a larger sample that has completed a full course of CBT, and explore this construct’s potential role as a mediator of clinical improvement.

Sonnentag, S., Binnewies, C., & Ohly, S. (2013). Event-sampling methods in occupational health psychology. In R.R.Sinclair, M. Wang, & L. E. Tetrick (Eds.), Research methods in occupational health psychology: Measurement, design, and data analysis (pp. 208-228). New York, NY US: Routledge/Taylor & Francis Group.

(from the chapter) Over the last decade, researchers have increasingly used the experience sampling method (ESM) as a methodological research strategy to examine a wide variety of research questions in occupational health psychology (OHP) and related fields. This methodological approach is also referred to as event-sampling method, ecological momentary assessment, or diary method. Basically, the ESM approach aims at assessing people’s experiences and behaviors as well as everyday events and situational conditions in situ, or as Bolger at al. stated it: “capturing life as it is lived”. In this chapter, we will use the term ESM for this broader range of approaches that are comprised of event-sampling studies, ecological momentary assessments, and diary studies. This chapter presents an overview of the ESM approach. In the first section, we describe core features of ESM studies. In the second section, we characterize typical research questions to be answered with ESM studies. We provide empirical examples from OHP in order to illustrate how this methodological approach can be used to examine research questions within this specific field. In the third section, we discuss how the ESM approach can advance theory in OHP. We will also address issues where theory development is needed. In the fourth and fifth sections we focus on the more practical side of ESM studies and provide information about how to conduct an ESM study and how to deal with specific challenges inherent in this approach.

Stevens, C. & Bryan, A. D. (2012). Rebranding exercise: There’s an app for that. American Journal of Health Promotion, 27, 69-70.

Historically, the approach of promoting exercise by emphasizing its effects on long-term health has predominated. Despite this tradition, there is no strong empirical support for such an approach. Recent work has argued that exercise suffers from a “branding problem” and efforts to promote exercise may be better served by switching the focus from the long-term benefits of exercise that improve health, to the immediate benefits of exercise that enhance quality of life. One way to disseminate and reinforce this message could be through a smartphone application designed to monitor daily improvements on quality of life constructs correlated with, exercise participation.

Stinson, J. N., Jibb, L. A., Nguyen, C., Nathan, P. C., Maloney, A. M., Dupuis, L. L. et al. (2013). Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer. J Med Internet Res, 15, e51.

BACKGROUND: Pain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent’s life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary. OBJECTIVE: Our objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer. METHODS: We used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app. RESULTS: Thematic analysis of usability interviews showed the app to be appealing overall to adolescents. Analyses of both low- and high-fidelity testing resulted in minor revisions to the app to refine the theme and improve its usability. Adolescents resoundingly endorsed the game-based nature of the app and its virtual reward system. The importance of app pain diary questions was established by content validity analysis. Compliance with the app, assessed during feasibility testing, was high (mean 81%, SD 22%) and adolescents from this phase of the study found the app likeable, easy to use, and not bothersome to complete. CONCLUSIONS: A multifaceted usability approach demonstrated how the Pain Squad app could be made more appealing to children and adolescents with cancer. The game-based nature and built-in reward system of the app was appealing to adolescents and may have resulted in the high compliance rates and satisfaction ratings observed during clinical feasibility testing

Straker, L., Campbell, A., Mathiassen, S., Abbott, R. A., Parry, S., & Davey, P. (2013). Capturing the Pattern of Physical Activity and Sedentary Behavior: Exposure Variation Analysis of Accelerometer Data. J Phys.Act.Health.

BACKGROUND: Capturing the complex time pattern of physical activity and sedentary behavior using accelerometry remains a challenge. Research from occupational health suggests Exposure Variation Analysis (EVA) could provide a meaningful tool. This paper 1) explains the application of EVA to accelerometer data, 2) demonstrates how EVA thresholds and derivatives could be chosen and used to examine adherence to physical activity and sedentary behaviour guidelines, and 3) explores the validity of EVA outputs. METHODS: EVA outputs are compared with accelerometer data from 4 individuals (study 1a and1b) and 3 occupational groups (study 2): seated workstation office workers (n=8), standing workstation office workers (n=8) and teachers (n=8). RESULTS: Line graphs and related EVA graphs highlight the use of EVA derivatives for examining compliance with guidelines. EVA derivatives of occupational groups confirm no difference in bouts of activity but clear differences as expected in extended bouts of sedentary behavior and brief bursts of activity, thus providing evidence of construct validity. CONCLUSIONS: EVA offers a unique and comprehensive generic method that is able, for the first time, to capture the time pattern (both frequency and intensity) of physical activity and sedentary behavior, which can be tailored for both occupational and public health research

Stroe-Kunold, E., Wesche, D., Friederich, H. C., Herzog, W., Zastrow, A., & Wild, B. (2012). Temporal relationships of emotional avoidance in a patient with anorexia nervosa–A time series analysis. International Journal of Psychiatry in Medicine, 44, 53-62.

Objective: Anorexia nervosa (AN) is a serious eating disorder marked by self-induced underweight. In patients with AN, the avoidance of emotions appears to be a central feature that is reinforced during the acute state of the disorder. This single case study investigated the role of emotional avoidance of a 25-year-old patient with AN during her inpatient treatment. Method: Throughout the course of 96 days, the patient answered questions daily about her emotional avoidance, pro-anorectic beliefs, perfectionism, and further variables on an electronic diary. The patientÇÖs daily self-assessment of emotional avoidance was described in terms of mean value, range, and variability for the various treatment phases. Temporal relationships between emotional avoidance and further variables were determined using a time series approach (vector autoregressive (VAR) modelling). Results: Diary data reflect that the patientÇÖs ability to tolerate unpleasant emotions appeared to undergo a process of change during inpatient treatment. Results of the time series analysis indicate that the more the patient was able to deal with negative emotions on any one day (tÇô1), the less she would be socially avoidant, cognitively confined to food and eating, as well as feeling less secure with her AN, and less depressive on the following day (t). Conclusions: The findings show that for this patient emotional avoidance plays a central role in the interacting system of various psychosocial variables. Replication of these results in other patients with AN would support the recommendation to focus more on emotional regulation in the treatment of AN.

Tang, N. K. Y., Goodchild, C. E., Sanborn, A. N., Howard, J., & Salkovskis, P. M. (2012). Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: A multilevel daily process study. Sleep: Journal of Sleep and Sleep Disorders Research, 35, 657-687.

Objectives: Because insomnia is a common comorbidity of chronic pain, scientific and clinical interest in the relationship of pain and sleep has surged in recent years. Although experimental studies suggest a sleep-interfering property of pain and a pain-enhancing effect of sleep deprivation/ fragmentation, the temporal association between pain and sleep as experienced by patients is less understood. The current study was conducted to examine the influence of presleep pain on subsequent sleep and sleep on pain reports the next day, taking into consideration other related psychophysiologic variables such as mood and arousal. Design: A daily process study, involving participants to monitor their pain, sleep, mood, and presleep arousal for 1 wk. Multilevel modeling was used to analyze the data. Setting: In the patientsÇÖ natural living and sleeping environment. Patients: One hundred nineteen patients (73.9% female, mean age = 46 years) with chronic pain and concomitant insomnia. Measurement: An electronic diary was used to record patientsÇÖ self-reported sleep quality/efficiency and ratings of pain, mood, and arousal at different times of the day; actigraphy was also used to provide estimates of sleep efficiency. Results: Results indicated that presleep pain was not a reliable predictor of subsequent sleep. Instead, sleep was better predicted by presleep cognitive arousal. Although sleep quality was a consistent predictor of pain the next day, the pain-relieving effect of sleep was only evident during the first half of the day. Conclusions: These findings challenge the often-assumed reciprocal relationship between pain and sleep and call for a diversification in thinking of the daily interaction of these 2 processes.

Udachina, A., Varese, F., Oorschot, M., Myin-Germeys, I., & Bentall, R. P. (2012). Dynamics of self-esteem in ‘poor-me’ and ‘bad-me’ paranoia. Journal of Nervous and Mental Disease, 200, 777-783.

The dynamics of self-esteem and paranoia were examined in 41 patients with past or current paranoia and 23 controls using questionnaires and the Experience Sampling Method (a structured diary technique). For some analyses, patients were further divided into three groups: a) individuals who believed that persecution is underserved (“poor me”; PM), b) individuals who believed that persecution is justified (“bad me”; BM), and c) remitted patients. The results revealed that PM and especially BM patients had highly unstable psychological profiles. Beliefs about deservedness of persecution fluctuated over 6 days. BM beliefs were associated with low self-esteem and depression. Measured concurrently, paranoia predicted lower self-esteem in the BM patients. Prospectively, paranoia predicted lower subsequent self-esteem in BM patients but higher subsequent self-esteem in PM patients. Our results suggest that paranoia can serve a defensive function in some circumstances. The reasons for inconsistencies in self-esteem research in relation to paranoia are discussed.

Van Ryckeghem, D. M., Crombez, G., Goubert, L., De, H. J., Onraedt, T., & Van, D. S. (2013). The predictive value of attentional bias towards pain-related information in chronic pain patients: A diary study. Pain, 154, 468-475.

Theoretical accounts of chronic pain hypothesize that attentional bias towards pain-related information is a maintaining or exacerbating factor, fuelling further pain, disability, and distress. However, empirical research testing this idea is currently lacking. In the present study, we investigated whether attentional bias towards pain-related information predicts daily pain-related outcomes in a sample of chronic pain patients (n=69; M(age)=49.64years; 46 females). During an initial laboratory session, attentional bias to pain-related information was assessed using a modified spatial cueing task. In advance, patients completed a number of self-report measures assessing current pain intensity, current disability, and pain duration. Subsequently, daily pain outcomes (self-reported pain severity, disability, avoidance behaviour, and distractibility) were measured for 2weeks by means of an electronic diary. Results indicated that, although an attentional bias towards pain-related information was associated with the current level of disability and pain severity, it had no additional value above control variables in predicting daily pain severity, avoidance, distractibility, and disability. Attentional bias towards pain-related information did, however, moderate the relationship between daily pain severity and both daily disability and distractibility, indicating that, particularly in those patients with a strong attentional bias, increases in pain were associated with increased disability and distractibility. The use of interventions that diminish attentional bias may therefore be helpful to reduce daily disability and the level of distraction from current tasks despite the presence of pain in chronic pain patients

Vankipuram, M., McMahon, S., & Fleury, J. (2012). ReadySteady: app for accelerometer-based activity monitoring and wellness-motivation feedback system for older adults. AMIA.Annu.Symp.Proc., 2012, 931-939.

Increased physical activity and exercise have been found to reduce falls and decrease mortality and age-related morbidity in older adults. However, a large percentage of this population fail to achieve the necessary levels of activity needed to support health living. In this work, we present a mobile app developed on the iOS platform that monitors activity levels using accelerometry. The data captured by the sensor is utilized to provide real-time motivational feedback to enable reinforcement of positive behaviors in older adults. Pilot experiments (conducted with younger adults) performed to assess validity of activity measurement showed that system accurately measures sedentary, light, moderate and vigorous activities in a controlled lab setting. Pilot tests (conducted with older adults) in the user setting showed that while the app is adept at capturing gross body activity (such as sitting, walking and jogging), additional sensors may be required to capture activities involving the extremities

Vella, E. J., Kamarck, T. W., Flory, J. D., & Manuck, S. (2012). Hostile mood and social strain during daily life: A test of the transactional model. Annals of Behavioral Medicine, 44, 341-352.

Background: Hostility is a multidimensional construct related to cardiovascular (CV) disease risk. Daily hostile mood and social interactions may precipitate stress-related CV responses in hostile individuals. Purpose: Determine whether trait cognitive hostility best predicts daily hostile mood and social interactions relative to other trait hostility factors and explore the temporal links between these daily measures. Methods: One hundred seventy-one participants completed assessments of four trait hostility scales. Participants completed an electronic diary across 3 days, assessing current hostile mood and social interaction quality. Results: Multiple regression analyses revealed both affective and cognitive hostility to be significant predictors of daily hostile mood, and cognitive hostility alone to predict daily social strain. Additional analyses revealed previous social strain to predict elevated subsequent hostile mood. Conclusions: Episodes of social strain may give rise to elevated hostile mood. Trait cognitive hostility may be an important factor in predicting daily social strain.

Walther, S., Ramseyer, F., Horn, H., Strik, W., & Tschacher, W. (2013). Less Structured Movement Patterns Predict Severity of Positive Syndrome, Excitement, and Disorganization. Schizophr.Bull.

Disorganized behavior is a key symptom of schizophrenia. The objective assessment of disorganized behavior is particularly challenging. Actigraphy has enabled the objective assessment of motor behavior in various settings. Reduced motor activity was associated with negative syndrome scores, but simple motor activity analyses were not informative on other symptom dimensions. The analysis of movement patterns, however, could be more informative for assessing schizophrenia symptom dimensions. Here, we use time series analyses on actigraphic data of 100 schizophrenia spectrum disorder patients. Actigraphy recording intervals were set at 2 s. Data from 2 defined 60-min periods were analyzed, and partial autocorrelations of the actigraphy time series indicated predictability of movements in each individual. Increased positive syndrome scores were associated with reduced predictability of movements but not with the overall amount of movement. Negative syndrome scores were associated with low activity levels but unrelated with predictability of movement. The factors disorganization and excitement were related to movement predictability but emotional distress was not. Thus, the predictability of objectively assessed motor behavior may be a marker of positive symptoms and disorganized behavior. This behavior could become relevant for translational research

Wigman, J. T., Collip, D., Wichers, M., Delespaul, P., Derom, C., Thiery, E. et al. (2013). Altered Transfer of Momentary Mental States (ATOMS) as the Basic Unit of Psychosis Liability in Interaction with Environment and Emotions. PLoS One, 8, e54653.

Psychotic disorders are thought to represent altered neural function. However, research has failed to map diagnostic categories to alterations in neural networks. It is proposed that the basic unit of psychotic psychopathology is the moment-to-moment expression of subtle anomalous experiences of subclinical psychosis, and particularly its tendency to persist from moment-to-moment in daily life, under the influence of familial, environmental, emotional and cognitive factors.In a general population twin sample (n = 579) and in a study of patients with psychotic disorder (n = 57), their non-psychotic siblings (n = 59) and unrelated controls (n = 75), the experience sampling paradigm (ESM; repetitive, random sampling of momentary mental states and context) was applied. We analysed, in a within-person prospective design, (i) transfer of momentary anomalous experience at time point () to time point () in daily life, and (ii) moderating effects of negative affect, positive affect, daily stressors, IQ and childhood trauma. Additionally, (iii) familial associations between persistence of momentary anomalous experience and psychotic symptomatology were investigated. Higher level of schizotypy in the twins (but not higher level of psychotic symptoms in patients) predicted more persistence of momentary anomalous experience in daily life, both within subjects and across relatives. Persistence of momentary anomalous experience was highest in patients, intermediate in their siblings and lowest in controls. In both studies, persistence of momentary anomalous experience was moderated by higher levels of negative affect, daily stressors and childhood trauma (only in twins), and by lower levels of positive affect. The study of alterations in the moment-to-moment transfer of subtle anomalous experience of psychosis, resulting in their persistence, helps to explain psychotic and emotional dysregulation tend to cluster in a single phenotype such as schizophrenia, and familial and environmental risks increase the risk of expression of psychosis from, first, subtle momentary anomalous experience to, second, observable clinical symptoms

Wu, W., Dasgupta, S., Ramirez, E. E., Peterson, C., & Norman, G. J. (2012). Classification accuracies of physical activities using smartphone motion sensors. Journal of Medical Internet Research, 14, 168-176.

Background: Over the past few years, the world has witnessed an unprecedented growth in smartphone use. With sensors such as accelerometers and gyroscopes on board, smartphones have the potential to enhance our understanding of health behavior, in particular physical activity or the lack thereof. However, reliable and valid activity measurement using only a smartphone in situ has not been realized. Objective: To examine the validity of the iPod Touch (Apple, Inc.) and particularly to understand the value of using gyroscopes for classifying types of physical activity, with the goal of creating a measurement and feedback system that easily integrates into individualsÇÖ daily living. Methods: We collected accelerometer and gyroscope data for 16 participants on 13 activities with an iPod Touch, a device that has essentially the same sensors and computing platform as an iPhone. The 13 activities were sitting, walking, jogging, and going upstairs and downstairs at different paces. We extracted time and frequency features, including mean and variance of acceleration and gyroscope on each axis, vector magnitude of acceleration, and fast Fourier transform magnitude for each axis of acceleration. Different classifiers were compared using the Waikato Environment for Knowledge Analysis (WEKA) toolkit, including C4.5 (J48) decision tree, multilayer perception, naive Bayes, logistic, k-nearest neighbor (kNN), and meta-algorithms such as boosting and bagging. The 10-fold cross-validation protocol was used. Results: Overall, the kNN classifier achieved the best accuracies: 52.3%Çô79.4% for up and down stair walking, 91.7% for jogging, 90.1%Çô94.1% for walking on a level ground, and 100% for sitting. A 2-second sliding window size with a 1-second overlap worked the best. Adding gyroscope measurements proved to be more beneficial than relying solely on accelerometer readings for all activities (with improvement ranging from 3.1% to 13.4%). Conclusions: Common categories of physical activity and sedentary behavior (walking, jogging, and sitting) can be recognized with high accuracies using both the accelerometer and gyroscope onboard the iPod touch or iPhone. This suggests the potential of developing just-in-time classification and feedback tools on smartphones.

Wuerzner, G., Bochud, M., Zweiacker, C., Tremblay, S., Pruijm, M., & Burnier, M. (2013). Step Count is Associated With Lower Nighttime Systolic Blood Pressure and Increased Dipping. Am J Hypertens., 26, 527-534.

BACKGROUND Higher nighttime blood pressure (BP) and the loss of nocturnal dipping of BP are associated with an increased risk for cardiovascular events. However, the determinants of the loss of nocturnal BP dipping are only beginning to be understood. We investigated whether different indicators of physical activity were associated with the loss of nocturnal dipping of BP. METHODS We conducted a cross-sectional study of 103 patients referred for 24-hour ambulatory monitoring of BP. We measured these patients’ step count (SC), active energy expenditure (AEE), and total energy expenditure simultaneously, using actigraphs. RESULTS In our study population of 103 patients, most of whom were hypertensive, SC and AEE were associated with nighttime systolic BP in univariate (SC, r = -0.28, P < 0.01; AEE, r = -0.20, P = 0.046) and multivariate linear regression analyses (SC, coefficient beta = -5.37, P < 0.001; AEE, coefficient beta = -0.24, P < 0.01). Step count was associated with both systolic (r = 0.23, P = 0.018) and diastolic (r = 0.20, P = 0.045) BP dipping. Nighttime systolic BP decreased progressively across the categories of sedentary, moderately active, and active participants (125mm Hg, 116mm Hg, 112mm Hg, respectively; P = 0.002). The degree of BP dipping of BP increased progressively across the same three categories of activity (respectively 8.9%, 14.6%, and 18.6%, P = 0.002, for systolic BP and respectively 12.8%, 18.1%, and 22.2%, P = 0.006, for diastolic BP). CONCLUSIONS Step count is continuously associated with nighttime systolic BP and with the degree of BP dipping independently of 24-hour mean BP. The combined use of an actigraph for measuring indicators of physical activity and a device for 24-hour measurement of ambulatory BP may help identify patients at increased risk for cardiovascular events in whom increased physical activity toward higher target levels may be recommended

Yu, F., Albers, J., Gao, T., Wang, M., Bilberg, A., & Stenager, E. (2012). A smartphone application of alcohol resilience treatment for behavioral self-control training. Conf.Proc.IEEE Eng Med Biol.Soc., 2012, 1976-1979.

High relapse rate is one of the most prominent problems in addiction treatment. Alcohol Resilience Treatment (ART), an alcohol addiction therapy, is based on Cue Exposure Treatment, which has shown promising results in preliminary studies. ART aims at optimizing the core area of relapse prevention, and intends to improve patients’ capability to withstand craving of alcohol. This method emphasizes the interplay of resilience and resourcefulness. It contains 6 sessions with different topics according to the stage of treatment circuit, and each session consists of 6 steps. Due to the purity and structure of the treatment rationale, it is realistic, reasonable and manageable to transform the method into a smartphone application. An ART app in Android system and an accessory of bilateral tactile stimulation were developed and will be used in a study with behavioral self-control training. This paper presents the design and realization of the smartphone based ART application. The design of a pilot study, which is to examine the benefits of a smartphone application providing behavioral self-control training, is also reported in this paper

Zdziechowska, K., Czy++ak, I., Murawiec, S. +., & Prot, K. (2012). Characteristics of subjects with self reported history of psychosis who were interested in self-assessment of their functional status via online e-diaries. Archives of Psychiatry and Psychotherapy, 14, 31-36.

Aim: To identify a profile of subjects with psychotic symptoms who were interested in selfÇômonitoring of their functional status via an online electronic diary (e-diary). Method: The website was promoted by means of a standard online advertising and positioning methods together with limited traditional advertising activities (an article in press, a radio broadcast). Physicians were not involved in recruitment process. Registered users of the website were offered a simple and convenient self-assessment tool to monitor their functional status in the form of e-diary. E-diaries were designed by psychiatrists for the purpose of self-assessment of mental state, everyday activities, therapy and treatment tolerability, in a registered users group. Results: Over 18 months 450 individuals registered in the after psychotic crisis section of the website. Answering question of how did they found out about the website 86% of users pointed internet as the source of information, 8% Çô friends , 4% Çô their physician, 2% Çô the press. 70% of users, as they reported, were diagnosed with schizophrenia and paranoid disorders, 82% of them were hospitalized due to their condition. The group of users consisted mainly of people in their thirties, who completed their secondary education. 70% of them did not have paid job; majority of them were single (57% of women and as much as 77% of men; p < 0.0001). Despite significant life independence of users, as well as their understanding of the necessity of treatment (97% of registered users received outpatient psychiatric treatment), depressive mood was observed in the group. At registration the WHO-5 Well-being scale was completed by 239 subjects; and as much as 76% of them achieved total score below 13 (Chi2(239.1) = 65, p < 0.0001), what indicates depressive mood and higher risk for developing clinical depression. There were no statistically significant differences between results of men and women. Conclusions: Self-monitoring of functional status via e-diary generated a great deal of interest among younger users with psychotic experiences who received outpatient treatment, mostly singles, often with depressive mood. Self-assessment via e-diaries proved to be manageable and worthwhile. E-diary users were interested in active participation in their treatments, however without being encouraged by their physician, they discontinued regular self-assessment after several entries. Still, they visited other sections that the website, such as: ask a doctor corner, medical library, photo contests section, online chat rooms, and discussion forum they kept in touch, chatted and talked also with persons with no psychic disorders, who registered on the website.

Zhang, S., Wu, Q., van Velthoven, M. H. M. M., Chen, L., Car, J., Rudan, I. et al. (2012). Smartphone versus pen-and-paper data collection of infant feeding practices in rural China. Journal of Medical Internet Research, 14, 156-167.

Background: Maternal, Newborn, and Child Health (MNCH) household survey data are collected mainly with pen-and-paper. Smartphone data collection may have advantages over pen-and-paper, but little evidence exists on how they compare. Objective: To compare smartphone data collection versus the use of pen-and-paper for infant feeding practices of the MNCH household survey. We compared the two data collection methods for differences in data quality (data recording, data entry, open-ended answers, and interrater reliability), time consumption, costs, interviewersÇÖ perceptions, and problems encountered. Methods: We recruited mothers of infants aged 0 to 23 months in four village clinics in Zhaozhou Township, Zhao County, Hebei Province, China. We randomly assigned mothers to a smartphone or a pen-and-paper questionnaire group. A pair of interviewers simultaneously questioned mothers on infant feeding practices, each using the same method (either smartphone or pen-and-paper). Results: We enrolled 120 mothers, and all completed the study. Data recording errors were prevented in the smartphone questionnaire. In the 120 pen-and-paper questionnaires (60 mothers), we found 192 data recording errors in 55 questionnaires. There was no significant difference in recording variation between the groups for the questionnaire pairs (P = .32) or variables (P = .45). The smartphone questionnaires were automatically uploaded and no data entry errors occurred. We found that even after double data entry of the pen-and-paper questionnaires, 65.0% (78/120) of the questionnaires did not match and needed to be checked. The mean duration of an interview was 10.22 (SD 2.17) minutes for the smartphone method and 10.83 (SD 2.94) minutes for the pen-and-paper method, which was not significantly different between the methods (P = .19). The mean costs per questionnaire were higher for the smartphone questionnaire (-Ñ143, equal to US $23 at the exchange rate on April 24, 2012) than for the pen-and-paper questionnaire (-Ñ83, equal to US $13). The smartphone method was acceptable to interviewers, and after a pilot test we encountered only minor problems (eg, the system halted for a few seconds or it shut off), which did not result in data loss. Conclusions: This is the first study showing that smartphones can be successfully used for household data collection on infant feeding in rural China. Using smartphones for data collection, compared with pen-and-paper, eliminated data recording and entry errors, had similar interrater reliability, and took an equal amount of time per interview. While the costs for the smartphone method were higher than the pen-and-paper method in our small-scale survey, the costs for both methods would be similar for a large-scale survey. Smartphone data collection should be further evaluated for other surveys and on a larger scale to deliver maximum benefits in China and elsewhere.

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