Society for Ambulatory Assessment

Third quarter 2015 (July to September)

Abrams, Paul; Paty, Jean; Martina, Reynaldo; Newgreen, Donald T.; van Maanen, Rob; Paireddy, Asha et al. (2015): Electronic bladder diaries of differing duration versus a paper diary for data collection in overactive bladder. In: Neurourology and urodynamics. DOI: 10.1002/nau.22800.

AIMS: This observational study compared data values, reliability, consistency and compliance collected by electronic and paper diaries of differing durations. METHODS: Subjects >/=18 years with overactive bladder (OAB) on stable antimuscarinic treatment for >/=12 weeks were assigned to one of five, 15-week diary schedules in this randomized, parallel-group observational study. Sample size was sufficient to assess reliability and consistency of diary data with adequate precision. Reliability was assessed via intraclass correlation coefficients, variability with ANCOVAs, and consistency using Cronbach’s alpha. RESULTS: Demographic characteristics of randomized subjects were representative of OAB trial populations. For mean volume voided, reliability was comparable across diary groups. For incontinence, reliability improved with increasing diary duration. For micturition frequency, electronic 7-day diary results had highest reliability and lowest variability. Lowest overall reliability was observed in the 3-day paper diary. Consistency was highest in the electronic continuous groups; Cont A (daily measurements throughout the study period [fully Continuous]) and Cont B (daily measurements for some but not all endpoints of interest [Partially Continuous]). Compliance was generally high; across groups >/=90% of diaries had at least one entry per day. There was no significant change in average micturition frequency with diary duration, suggesting no diary fatigue. One-third of subjects in the electronic Cont B group also reported micturitions as incontinence when they only needed to report incontinence; they also reported lowest satisfaction with the study. The electronic 7-day and electronic Cont A schedules (who reported incontinence and micturitions throughout the study) had lowest residual errors. CONCLUSIONS: For future OAB trials, 7-day or continuous electronic diaries may improve accuracy and reliability of micturition and incontinence frequency data compared with shorter collection periods and paper diaries. Neurourol. Urodynam. (c) 2015 Wiley Periodicals, Inc.

Abroms, Lorien; Hershcovitz, Ronit; Boal, Ashley; Levine, Hagai (2015): Feasibility and acceptability of a text messaging program for smoking cessation in Israel. In: Journal of Health Communication 20 (8), S. 903–909. DOI: 10.1080/10810730.2015.1018585.

Text messaging programs on mobile phones have been shown to promote smoking cessation. This study investigated whether a text-messaging program for smoking cessation, adapted from QuitNowTXT, is feasible in Israel and acceptable to Israeli smokers. Participants (N = 38) were given a baseline assessment, enrolled in the adapted text messaging program, and followed-up with at 2 weeks and 4 weeks after their quit date. The authors used an intent-to-treat analysis and found that 23.7% of participants reported having quit smoking at the 4-week follow-up. Participants sent an average of 12.9 text replies during the study period, and the majority reported reading most or all of the texts. However, 34.2% of participants had unsubscribed by the 4-week follow-up. Moderate levels of satisfaction were reported; more than half agreed that they would recommend the program. Suggestions for improvement included adding advice by an expert counselor, website support, and increased customization. Results indicate that a text messaging smoking cessation program developed by modifying the content of QuitNowTXT is feasible and could be acceptable to smokers in Israel. The experience adapting and pilot testing the program can serve as a model for using QuitNowTXT to develop and implement such programs in other countries.

Adamson, Gregory T.; Draper, Lauren R.; Broom, Matthew A. (2014): Text4Peds: Feasibility of an Educational Text-Messaging Program for Pediatrics Residents. In: Journal of graduate medical education 6 (4), S. 746–749. DOI: 10.4300/JGME-D-13-00469.1.

BACKGROUND: There is an ongoing effort to maximize educational material provided to residents who are in a time-constrained work environment. Mobile technology, principally smartphone applications and online modules, has shown educational promise. INTERVENTION: We developed a text-messaging program, Text4Peds, to assist residents with preparation for their pediatric board examinations. Goals were to assess (1) the feasibility of texting educational messages to residents, and (2) resident satisfaction and perceived usefulness of a texting program. METHODS: We conducted a prospective study of pediatrics and combined internal medicine-pediatrics residents. Messages derived from the most missed pediatric in-training examination questions were sent daily to residents. After 3 months, residents completed surveys that gauged their perception on the educational value of the text messages and the effect on their pediatric board preparation. Feasibility of the system was assessed as a total percentage of messages successfully received by residents. RESULTS: Of 55 residents, 35 (64%) participated in the program. Of 2534 messages sent out to participants, 2437 (96.2%) were delivered successfully. Positive comments cited the texting of board facts as a quick, helpful, daily study tool. Residents liked that messages were sent at 2:00 pm, and most felt that 1 to 5 messages per week was appropriate. Drawbacks included character restrictions of messages, content limitations, and the lack of a question-answer format. CONCLUSIONS: An educational text message-based program was successfully implemented in our residency program. Messages were delivered with a high success rate, and residents found educational value in the messages.

Albright, Karen; Krantz, Mori J.; Backlund Jarquín, Paige; DeAlleaume, Lauren; Coronel-Mockler, Stephanie; Estacio, Raymond O. (2015): Health promotion text messaging preferences and acceptability among the medically underserved. In: Health Promotion Practice 16 (4), S. 523–532. DOI: 10.1177/1524839914566850.

The Colorado Healthy Heart Solutions program uses community health workers to provide health promotion and navigation services for participants in medically underserved, predominantly rural areas who are at risk for developing cardiovascular disease. A text messaging program designed to increase participant engagement and adherence to lifestyle changes was pilot tested with English- and Spanish-speaking participants. Preimplementation focus groups with participants informed the development of text messages that were used in a 6-week pilot program. Postimplementation focus groups and interviews then evaluated the pilot program. Participants reported a preference for concise messages received once daily and for positive messages suggesting specific actions that could be feasibly accomplished within the course of the day. Participants also consistently reported the desire for clarity in message delivery and content, indicating that the source of the messages should be easy to recognize, messages should state clearly when participants were expected to respond to the messages, and any responses should be acknowledged. Links to other websites or resources were generally viewed as trustworthy and acceptable, but were preferred for supplementary material only. These results may inform the development of future chronic disease management programs in underserved areas or augment existing programs using text messaging reinforcement.

Alshamsi, Aamena; Pianesi, Fabio; Lepri, Bruno; Pentland, Alex; Rahwan, Iyad (2015): Beyond Contagion: Reality Mining Reveals Complex Patterns of Social Influence. In: PLoS ONE 10 (8), S. e0135740. DOI: 10.1371/journal.pone.0135740.

Contagion, a concept from epidemiology, has long been used to characterize social influence on people’s behavior and affective (emotional) states. While it has revealed many useful insights, it is not clear whether the contagion metaphor is sufficient to fully characterize the complex dynamics of psychological states in a social context. Using wearable sensors that capture daily face-to-face interaction, combined with three daily experience sampling surveys, we collected the most comprehensive data set of personality and emotion dynamics of an entire community of work. From this high-resolution data about actual (rather than self-reported) face-to-face interaction, a complex picture emerges where contagion (that can be seen as adaptation of behavioral responses to the behavior of other people) cannot fully capture the dynamics of transitory states. We found that social influence has two opposing effects on states: adaptation effects that go beyond mere contagion, and complementarity effects whereby individuals’ behaviors tend to complement the behaviors of others. Surprisingly, these effects can exhibit completely different directions depending on the stable personality or emotional dispositions (stable traits) of target individuals. Our findings provide a foundation for richer models of social dynamics, and have implications on organizational engineering and workplace well-being.

Beckjord, Ellen; Shiffman, Saul (2014): Background for Real-Time Monitoring and Intervention Related to Alcohol Use. In: Alcohol research : current reviews 36 (1), S. 9–18.

Real-time assessment, known as ecological momentary assessment (EMA), and real-time intervention (ecological momentary intervention [EMI]) can significantly extend the reach and impact of interventions to help individuals reduce their drinking behavior. For EMA, the user provides information on the variable of interest (e.g., drinking or craving) via a mobile device.This data reporting can occur either at pre-specified times or in certain high-risk situations.The primary benefits of EMA include external validity, minimized recall bias, and the ability to capture dynamic patterns in human behavior. EMI refers to interventions that are delivered via mobile devices at the time when the user needs it (i.e., in a high-risk situation). Key constructs of EMI are what interventions are delivered and when they are delivered.The timing of the EMI often is determined by the user’s EMA reports. Both EMA and EMI have been studied in people with alcohol use disorders. EMA and EMI often are used in conjunction with each other because EMA can help inform the optimal timing of EMI and help tailor its content. Further development of high-impact, algorithm-driven, technology-mediated real-time intervention may help reduce drinking and promote positive health behavior change.

Beldad, Ardion; Kusumadewi, Margareta Citra (2015): Here’s my location, for your information: The impact of trust, benefits, and social influence on location sharing application use among Indonesian university students. In: Computers in Human Behavior 49, S. 102–110. DOI: 10.1016/j.chb.2015.02.047.

As mobile phones have become nearly ubiquitous, mobile phone applications are also becoming almost indispensable. Applications that enable people to share location information are becoming increasingly popular. What remains unknown, however, are the factors that influence the use of a location sharing application (LSA). A paper-based survey was implemented with 655 students of six universities in Yogyakarta, Indonesia to test the hypotheses proposed for the study. Results of hierarchical regression analysis reveal that students’ use of a specific LSA could be attributed to the two types of benefits of using the app (impression management and entertainment) and to competence-based trust in LSA and to their trust in their LSA network members. Furthermore, the impact of social influence on LSA use is also statistically significant.

Ben-Zeev, Dror; Scherer, Emily A.; Wang, Rui; Xie, Haiyi; Campbell, Andrew T. (2015): Next-generation psychiatric assessment: Using smartphone sensors to monitor behavior and mental health. In: Psychiatric Rehabilitation Journal 38 (3), S. 218–226. DOI: 10.1037/prj0000130.

Objective: Optimal mental health care is dependent upon sensitive and early detection of mental health problems. We have introduced a state-of-the-art method for the current study for remote behavioral monitoring that transports assessment out of the clinic and into the environments in which individuals negotiate their daily lives. The objective of this study was to examine whether the information captured with multimodal smartphone sensors can serve as behavioral markers for one’s mental health. We hypothesized that (a) unobtrusively collected smartphone sensor data would be associated with individuals’ daily levels of stress, and (b) sensor data would be associated with changes in depression, stress, and subjective loneliness over time. Method: A total of 47 young adults (age range: 19–30 years) were recruited for the study. Individuals were enrolled as a single cohort and participated in the study over a 10-week period. Participants were provided with smartphones embedded with a range of sensors and software that enabled continuous tracking of their geospatial activity (using the Global Positioning System and wireless fidelity), kinesthetic activity (using multiaxial accelerometers), sleep duration (modeled using device-usage data, accelerometer inferences, ambient sound features, and ambient light levels), and time spent proximal to human speech (i.e., speech duration using microphone and speech detection algorithms). Participants completed daily ratings of stress, as well as pre- and postmeasures of depression (Patient Health Questionnaire-9; Spitzer, Kroenke, & Williams, 1999), stress (Perceived Stress Scale; Cohen et al., 1983), and loneliness (Revised UCLA Loneliness Scale; Russell, Peplau, & Cutrona, 1980). Results: Mixed-effects linear modeling showed that sensor-derived geospatial activity (p < .05), sleep duration (p < .05), and variability in geospatial activity (p < .05), were associated with daily stress levels. Penalized functional regression showed associations between changes in depression and sensor-derived speech duration (p < .05), geospatial activity (p < .05), and sleep duration (p < .05). Changes in loneliness were associated with sensor-derived kinesthetic activity (p < .01). Conclusions and Implications for Practice: Smartphones can be harnessed as instruments for unobtrusive monitoring of several behavioral indicators of mental health. Creative leveraging of smartphone sensing could provide novel opportunities for close-to-invisible psychiatric assessment at a scale and efficiency that far exceeds what is currently feasible with existing assessment technologies.

Bond, Dale S.; Buse, Dawn C.; Lipton, Richard B.; Thomas, J. Graham; Rathier, Lucille; Roth, Julie et al. (2015): Clinical pain catastrophizing in women with migraine and obesity. In: Headache: The Journal of Head and Face Pain 55 (7), S. 923–933. DOI: 10.1111/head.12597.

Objective/Background - Obesity is related to migraine. Maladaptive pain coping strategies (eg, pain catastrophizing) may provide insight into this relationship. In women with migraine and obesity, we cross‐sectionally assessed: (1) prevalence of clinical catastrophizing; (2) characteristics of those with and without clinical catastrophizing; and (3) associations of catastrophizing with headache features. Methods - Obese women migraineurs seeking weight loss treatment (n = 105) recorded daily migraine activity for 1 month via smartphone and completed the Pain Catastrophizing Scale (PCS). Clinical catastrophizing was defined as total PCS score ≥ 30. The six‐item Headache Impact Test (HIT‐6), 12‐item Allodynia Symptom Checklist (ASC‐12), Headache Management Self‐Efficacy Scale (HMSE), and assessments for depression (Centers for Epidemiologic Studies Depression Scale) and anxiety (seven‐item Generalized Anxiety Disorder Scale) were also administered. Using PCS scores and body mass index (BMI) as predictors in linear regression, we modeled a series of headache features (ie, headache days, HIT‐6, etc) as outcomes. Results - One quarter (25.7%; 95% confidence interval [CI] = 17.2‐34.1%) of participants met criteria for clinical catastrophizing: they had higher BMI (37.9 ± 7.5 vs 34.4 ± 5.7 kg/m², P = .035); longer migraine attack duration (160.8 ± 145.0 vs 97.5 ± 75.2 hours/month, P = .038); higher HIT‐6 scores (68.7 ± 4.6 vs 64.5 ± 3.9, P < .001); more allodynia (7.0 ± 4.1 vs 4.5 ± 3.5, P < .003), depression (25.4 ± 12.4 vs 13.3 ± 9.2, P < .001), and anxiety (11.0 ± 5.2 vs 5.6 ± 4.1, P < .001); and lower self‐efficacy (80.1 ± 25.6 vs 104.7 ± 18.9, P < .001) compared with participants without clinical catastrophizing. The odds of chronic migraine were nearly fourfold greater in those with (n = 8/29.6%) vs without (n = 8/10.3%) clinical catastrophizing (odds ratio = 3.68; 95%CI = 1.22‐11.10, P = .021). In all participants, higher PCS scores were related to more migraine days (β = 0.331, P = .001), longer attack duration (β = 0.390, P < .001), higher HIT‐6 scores (β = 0.425, P < .001), and lower HMSE scores (β = −0.437, P < .001). Higher BMI, but not higher PCS scores, was related to more frequent attacks (β = −0.203, P = .044). Conclusions - One quarter of participants with migraine and obesity reported clinical catastrophizing. These individuals had more frequent attacks/chronicity, longer attack duration, higher pain sensitivity, greater headache impact, and lower headache management self‐efficacy. In all participants, PCS scores were related to several migraine characteristics, above and beyond the effects of obesity. Prospective studies are needed to determine sequence and mechanisms of relationships between catastrophizing, obesity, and migraine.

Bond, Dale S.; Thomas, J. Graham; O’Leary, Kevin C.; Lipton, Richard B.; Peterlin, B. Lee; Roth, Julie et al. (2015): Objectively measured physical activity in obese women with and without migraine. In: Cephalalgia 35 (10), S. 886–893. DOI: 10.1177/0333102414562970.

Aim: The aim of this article is to cross-sectionally compare objectively measured physical activity (PA) levels and their association with migraine characteristics in obese women with and without migraine. Methods: Obese women seeking weight loss treatment were divided into migraine (n = 25) and control (n = 25) groups matched by age and body mass index (BMI). Participants wore the SenseWear Armband monitor for seven days to objectively evaluate daily light-(LPA) and moderate-to-vigorous intensity PA (MVPA). Migraine diagnosis was confirmed by a neurologist using ICHD-3-beta criteria. Migraine characteristics were tracked daily using a smartphone-based diary over a four-week period immediately preceding the objective PA assessment. Results: Migraine participants spent 57.9 fewer minutes/day in LPA (141.1 ± 56.4 vs. 199.1 ± 87.7, p = 0.019) and 24.5 fewer minutes/day in MVPA (27.8 ± 17.0 vs. 52.3 ± 26.0, p < 0.001), compared to controls. Migraine participants reported 4.8 ± 3.1 migraine days/month (mean duration = 17.1 ± 8.9 hours; mean maximum pain severity = 6.4 ± 1.7 on a 0–10 scale). Higher BMI (p < 0.05), but not migraine characteristics, were related to lower total PA. Additionally, total objectively measured PA was not associated with how often PA was reported to exacerbate migraine attacks during the four-week diary assessment. Conclusions: Obese women with migraine spent nearly 1.5 hours/day less in PA compared to controls; however, lower PA was not related to migraine characteristics. Further research is needed to identify PA barriers and effective interventions in obese women with migraine.

Borrelli, Belinda; Bartlett, Yvonne Kiera; Tooley, Erin; Armitage, Christopher J.; Wearden, Alison (2015): Prevalence and Frequency of mHealth and eHealth Use Among US and UK Smokers and Differences by Motivation to Quit. In: Journal of medical Internet research 17 (7), S. e164. DOI: 10.2196/jmir.4420.

BACKGROUND: Both mHealth and eHealth interventions for smoking cessation are rapidly being developed and tested. There are no data on use of mHealth and eHealth technologies by smokers in general or by smokers who are not motivated to quit smoking. OBJECTIVE: The aims of our study were to (1) assess technology use (eg, texting, social media, Internet) among smokers in the United States and United Kingdom, (2) examine whether technology use differs between smokers who are motivated to quit and smokers who are not motivated to quit, (3) examine previous use of technology to assist with smoking cessation, and (4) examine future intentions to use technology to assist with smoking cessation. METHODS: Participants were 1000 adult smokers (54.90%, 549/1000 female; mean age 43.9, SD 15.5 years; US: n=500, UK: n=500) who were recruited via online representative sampling strategies. Data were collected online and included demographics, smoking history, and frequency and patterns of technology use. RESULTS: Among smokers in general, there was a high prevalence of mobile and smartphone ownership, sending and receiving texts, downloading and using apps, using Facebook, and visiting health-related websites. Smokers who were unmotivated to quit were significantly less likely to own a smartphone or handheld device that connects to the Internet than smokers motivated to quit. There was a significantly lower prevalence of sending text messages among US smokers unmotivated to quit (78.2%, 179/229) versus smokers motivated to quit (95.0%, 229/241), but no significant differences between the UK groups (motivated: 96.4%, 239/248; unmotivated: 94.9%, 223/235). Smokers unmotivated to quit in both countries were significantly less likely to use a handheld device to read email, play games, browse the Web, or visit health-related websites versus smokers motivated to quit. US smokers had a high prevalence of app downloads regardless of motivation to quit, but UK smokers who were motivated to quit had greater prevalence of app downloads than smokers unmotivated to quit. US smokers were significantly more likely to have a Facebook account (87.0%, 435/500) than UK smokers (76.4%, 382/500), but smokers unmotivated to quit in both countries used Facebook less frequently than smokers motivated to quit. Smokers who were unmotivated to quit were less likely to have used eHealth or mHealth platforms to help them quit smoking in the past and less likely to say that they would use them for smoking cessation in the future. CONCLUSIONS: Although smokers unmotivated to quit make less use of technology than smokers motivated to quit, there is sufficient prevalence to make it worthwhile to develop eHealth and mHealth interventions to encourage cessation. Short and low-effort communications, such as text messaging, might be better for smokers who are less motivated to quit. Multiple channels may be required to reach unmotivated smokers.

Bos, Fionneke M.; Schoevers, Robert A.; aan het Rot, Marije (2015):  Experience sampling and ecological momentary assessment studies in psychopharmacology: A systematic review. In: European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology. DOI: 10.1016/j.euroneuro.2015.08.008.

Experience sampling methods (ESM) and ecological momentary assessment (EMA) offer insight into daily life experiences, including symptoms of mental disorders. The application of ESM/EMA in psychopharmacology can be a valuable addition to more traditional measures such as retrospective self-report questionnaires because they may help reveal the impact of psychotropic medication on patients’ actual experiences. In this paper we systematically review the existing literature on the use of ESM/EMA in psychopharmacology research. To this end, we searched the PsycInfo and Medline databases for all available ESM/EMA studies on the use of psychotropic medication in patients with DSM-III-R and DSM-IV disorders. Dissertations were excluded. We included 18 studies that applied ESM/EMA to study the effects of medication on patients with major depressive disorder, substance use disorder, attention-deficit hyperactivity disorder, psychotic disorder, and anxiety disorder. We found that ESM/EMA may allow researchers and clinicians to track patients during different phases of treatment: before treatment to predict outcome, during treatment to examine the effects of treatment on symptoms and different aspects of daily life experience, and after treatment to detect vulnerability for relapse. Moreover, ESM/EMA can potentially help determine how long and in what contexts medications are effective. Thus, ESM/EMA may benefit both researchers and clinicians and might prove to be an effective tool for improving the treatment of psychiatric patients.

Bosman, Renske C.; Jung, Sophie E.; Miloserdov, Kristina; Schoevers, Robert A.; aan het Rot, Marije (2015): Daily symptom ratings for studying premenstrual dysphoric disorder: A review. In: Journal of affective disorders 189, S. 43–53. DOI: 10.1016/j.jad.2015.08.063.

BACKGROUND: To review how daily symptom ratings have been used in research into premenstrual dysphoric disorder (PMDD), and to discuss opportunities for the future. METHODS: PsycINFO and Medline were systematically searched, resulting in the inclusion of 75 studies in which (1) participants met the diagnostic criteria for late luteal phase dysphoric disorder (LLPDD) or PMDD and (2) diaries were used to study LLPDD/PMDD. RESULTS: To date, diaries have been used to gain insight into the aetiology and phenomenology of PMDD, to examine associated biological factors, and to assess treatment efficacy. We found low consistency among the diaries used, and often only part of the menstrual cycle was analysed instead of the whole menstrual cycle. We also observed that there was substantial variability in diagnostic procedures and criteria. LIMITATIONS: This review excluded diary studies conducted in women with premenstrual syndrome, women seeking help for premenstrual complaints without a clear diagnosis, and women without premenstrual complaints. CONCLUSIONS: Prospective daily ratings of symptoms and related variables provide a valuable and important tool in the study of PMDD. This paper addresses some options for improving the use of diaries and proposes the use of experience sampling and ecological momentary assessment to investigate within-person variability in symptoms in more detail.

Bromberg, Maggie H.; Connelly, Mark; Anthony, Kelly K.; Gil, Karen M.; Schanberg, Laura E. (2015): Prospective Mediation Models of Sleep, Pain and Daily Function in Children with Arthritis using Ecological Momentary Assessment. In: The Clinical journal of pain. DOI: 10.1097/AJP.0000000000000298.

OBJECTIVES: Sleep is an emerging area of concern in children with juvenile idiopathic arthritis (JIA). Research shows the presence of poor sleep quality and related adverse outcomes in pediatric pain populations, including JIA, but few studies have examined the prospective patterns of association between sleep and associated outcomes. This prospective study evaluated the direction and magnitude of associations between subjective sleep characteristics (sleep quality, difficulty initiating sleep, and sleep duration), pain intensity, and functional limitations in children with JIA. We hypothesized that pain intensity would partially mediate the relationship between sleep and functional limitations. METHODS: Children and adolescents with JIA (n=59, age range=8-18) recruited during clinic visits, completed smartphone-based diaries for one month. Subjective sleep characteristics were reported each morning; pain and functioning were assessed three times daily. RESULTS: As hypothesized, the associations between sleep quality and functional limitations and between difficulty initiating sleep and functional limitations were partially mediated by pain intensity, at any given moment (z=-3.27, P=0.001, z=2.70, P<0.05). Mediation was not detected in a model testing the association between sleep duration, pain intensity, and functional limitations (z=-0.58, P=0.56). DISCUSSION: Results suggest that sleep is integral to understanding the momentary association between pain intensity and functioning in children with JIA.

Brondolo, Elizabeth; Monge, Angela; Agosta, John; Tobin, Jonathan N.; Cassells, Andrea; Stanton, Cassandra; Schwartz, Joseph (2015): Perceived ethnic discrimination and cigarette smoking: Examining the moderating effects of race/ethnicity and gender in a sample of Black and Latino urban adults. In: Journal of Behavioral Medicine 38 (4), S. 689–700. DOI: 10.1007/s10865-015-9645-2.

Perceived ethnic discrimination has been associated with cigarette smoking in US adults in the majority of studies, but gaps in understanding remain. It is unclear if the association of discrimination to smoking is a function of lifetime or recent exposure to discrimination. Some sociodemographic and mood-related risk factors may confound the relationship of discrimination to smoking. Gender and race/ethnicity differences in this relationship have been understudied. This study examines the relationship of lifetime and recent discrimination to smoking status and frequency, controlling for sociodemographic and mood-related variables and investigating the moderating role of race/ethnicity and gender. Participants included 518 Black and Latino(a) adults from New York, US. Lifetime and past week discrimination were measured with the Perceived Ethnic Discrimination Questionnaire-Community Version. Ecological momentary assessment methods were used to collect data on smoking and mood every 20 min throughout one testing day using an electronic diary. Controlling for sociodemographic and mood-related variables, there was a significant association of recent (past week) discrimination exposure to current smoking. Lifetime discrimination was associated with smoking frequency, but not current smoking status. The association of recent discrimination to smoking status was moderated by race/ethnicity and gender, with positive associations emerging for both Black adults and for men. The association of lifetime discrimination on smoking frequency was not moderated by gender or race/ethnicity. Acute race/ethnicity-related stressors may be associated with the decision to smoke at all on a given day; whereas chronic stigmatization may reduce the barriers to smoking more frequently.

Brooks, Gabriel C.; Vittinghoff, Eric; Iyer, Sivaraman; Tandon, Damini; Kuhar, Peter; Madsen, Kristine A. et al. (2015): Accuracy and Usability of a Self-Administered 6-Minute Walk Test Smartphone Application. In: Circulation. Heart failure 8 (5), S. 905–913. DOI: 10.1161/CIRCHEARTFAILURE.115.002062.

BACKGROUND: The 6-minute walk test (6MWT) independently predicts congestive heart failure severity, death, and heart failure hospitalizations, but must be administered in clinic by qualified staff on a premeasured course. As part of the Health eHeart Study, we sought to develop and validate a self-administered 6MWT mobile application (SA-6MWTapp) for independent use at home by patients. METHODS AND RESULTS: We performed a validation study of an SA-6MWTapp in 103 participants. In phase 1 (n=52), we developed a distance-estimation algorithm for the SA-6MWTapp by comparing step counts from an Actigraph and measured distance on a premeasured 6MWT course with step counts and estimated distance obtained simultaneously from our SA-6MWTapp (best estimation algorithm, r=0.89 [95% confidence interval 0.78-0.99]). In phase 2, 32 participants (including those with congestive heart failure and pulmonary hypertension) used the SA-6MWTapp independently in clinic, and the distance estimated by the SA-6MWTapp was compared with the measured distance (r=0.83 [95% confidence interval 0.79-0.92]). In phase 3, 19 patients with congestive heart failure and pulmonary hypertension consecutively enrolled from clinic performed 3.2+/-1 SA-6MWTapp tests per week at home over 2 weeks. Distances estimated from the SA-6MWTapp during home 6MWTs were highly repeatable (coefficient of variation =4.6%) and correlated with in-clinic-measured distance (r=0.88 [95% confidence interval 0.87-0.89]). Usability surveys performed during the second (in-clinic) and third (at-home) phases demonstrated that the SA-6MWTapp was simple and easy to use independently. CONCLUSIONS: An SA-6MWTapp is easy to use and yields accurate repeatable measurements in the clinic and at home.

Bucci, Sandra; Barrowclough, Christine; Ainsworth, John; Morris, Rohan; Berry, Katherine; Machin, Matthew et al. (2015): Using mobile technology to deliver a cognitive behaviour therapy-informed intervention in early psychosis (Actissist): study protocol for a randomised controlled trial. In: Trials 16 (1), S. 404. DOI: 10.1186/s13063-015-0943-3.

BACKGROUND: Cognitive behaviour therapy (CBT) is recommended for the treatment of psychosis; however, only a small proportion of service users have access to this intervention. Smartphone technology using software applications (apps) could increase access to psychological approaches for psychosis. This paper reports the protocol development for a clinical trial of smartphone-based CBT. METHODS/DESIGN: We present a study protocol that describes a single-blind randomised controlled trial comparing a cognitive behaviour therapy-informed software application (Actissist) plus Treatment As Usual (TAU) with a symptom monitoring software application (ClinTouch) plus TAU in early psychosis. The study consists of a 12-week intervention period. We aim to recruit and randomly assign 36 participants registered with early intervention services (EIS) across the North West of England, UK in a 2:1 ratio to each arm of the trial. Our primary objective is to determine whether in people with early psychosis the Actissist app is feasible to deliver and acceptable to use. Secondary aims are to determine whether Actissist impacts on predictors of first episode psychosis (FEP) relapse and enhances user empowerment, functioning and quality of life. Assessments will take place at baseline, 12 weeks (post-treatment) and 22-weeks (10 weeks post-treatment) by assessors blind to treatment condition. The trial will report on the feasibility and acceptability of Actissist and compare outcomes between the randomised arms. The study also incorporates semi-structured interviews about the experience of participating in the Actissist trial that will be qualitatively analysed to inform future developments of the Actissist protocol and app. DISCUSSION: To our knowledge, this is the first controlled trial to test the feasibility, acceptability, uptake, attrition and potential efficacy of a CBT-informed smartphone app for early psychosis. Mobile applications designed to deliver a psychologically-informed intervention offer new possibilities to extend the reach of traditional mental health service delivery across a range of serious mental health problems and provide choice about available care. TRIAL REGISTRATION: ISRCTN34966555 . Date of first registration: 12 June 2014.

Burbank, Allison J.; Lewis, Shannon D.; Hewes, Matthew; Schellhase, Dennis E.; Rettiganti, Mallikarjuna; Hall-Barrow, Julie et al. (2015): Mobile-based asthma action plans for adolescents. In: Journal of Asthma 52 (6), S. 583–586. DOI: 10.3109/02770903.2014.995307.

Purpose: To examine feasibility and utilization of a mobile asthma action plan (AAP) among adolescents. Methods: Adolescents (aged 12–17 years) with persistent asthma had their personalized AAP downloaded to a smartphone application. Teens were prompted by the mobile application to record either daily symptoms or peak flow measurements and to record medications. Once data were entered, the application provided immediate feedback based on the teen’s AAP instructions. Asthma Control Test (ACT®) and child asthma self-efficacy scores were examined pre- and post-intervention. Results: Adolescents utilized the mobile AAP a median 4.3 days/week. Participant satisfaction was high with 93% stating that they were better able to control asthma by utilizing the mobile AAP. For participants with uncontrolled asthma at baseline, median (interquartile range) ACT scores improved significantly from 16 (5) to 18 (8) [p = 0.03]. Median asthma attack prevention self-efficacy scores improved from 34 (3.5) to 36 (5.3) [p = 0.04]. Conclusions: Results suggest that personalized mobile-based AAPs are a feasible method to communicate AAP instructions to teens.

Camacho, M.; Robertson, M.; Abdullatif, J.; Certal, V.; Kram, Y. A.; Ruoff, C. M. et al. (2015): Smartphone apps for snoring. In: The Journal of laryngology and otology, S. 1–6. DOI: 10.1017/S0022215115001978.

OBJECTIVE: To identify and systematically evaluate user-friendly smartphone snoring apps. METHODS: The Apple iTunes app store was searched for snoring apps that allow recording and playback. Snoring apps were downloaded, evaluated and rated independently by four authors. Two patients underwent polysomnography, and the data were compared with simultaneous snoring app recordings, and one patient used the snoring app at home. RESULTS: Of 126 snoring apps, 13 met the inclusion and exclusion criteria. The most critical app feature was the ability to graphically display the snoring events. The Quit Snoring app received the highest overall rating. When this app’s recordings were compared with in-laboratory polysomnography data, app snoring sensitivities ranged from 64 to 96 per cent, and snoring positive predictive values ranged from 93 to 96 per cent. A chronic snorer used the app nightly for one month and tracked medical interventions. Snoring decreased from 200 to 10 snores per hour, and bed partner snoring complaint scores decreased from 9 to 2 (on a 0-10 scale). CONCLUSION: Select smartphone apps are user-friendly for recording and playing back snoring sounds. Preliminary comparison of more than 1500 individual snores demonstrates the potential clinical utility of such apps; however, further validation testing is recommended.

Chan, Steven; Torous, John; Hinton, Ladson; Yellowlees, Peter (2015): Towards a Framework for Evaluating Mobile Mental Health Apps. In: Telemedicine journal and e-health : the official journal of the American Telemedicine Association. DOI: 10.1089/tmj.2015.0002.

INTRODUCTION: Mobile phones are ubiquitous in society and owned by a majority of psychiatric patients, including those with severe mental illness. Their versatility as a platform can extend mental health services in the areas of communication, self-monitoring, self-management, diagnosis, and treatment. However, the efficacy and reliability of publicly available applications (apps) have yet to be demonstrated. Numerous articles have noted the need for rigorous evaluation of the efficacy and clinical utility of smartphone apps, which are largely unregulated. Professional clinical organizations do not provide guidelines for evaluating mobile apps. MATERIALS AND METHODS: Guidelines and frameworks are needed to evaluate medical apps. Numerous frameworks and evaluation criteria exist from the engineering and informatics literature, as well as interdisciplinary organizations in similar fields such as telemedicine and healthcare informatics. RESULTS: We propose criteria for both patients and providers to use in assessing not just smartphone apps, but also wearable devices and smartwatch apps for mental health. Apps can be evaluated by their usefulness, usability, and integration and infrastructure. Apps can be categorized by their usability in one or more stages of a mental health provider’s workflow. CONCLUSIONS: Ultimately, leadership is needed to develop a framework for describing apps, and guidelines are needed for both patients and mental health providers.

Clasen, Peter C.; Fisher, Aaron J.; Beevers, Christopher G. (2015): Mood-Reactive Self-Esteem and Depression Vulnerability: Person-Specific Symptom Dynamics via Smart Phone Assessment. In: PLoS ONE 10 (7), S. e0129774. DOI: 10.1371/journal.pone.0129774.

Cognitive theories of depression suggest that mood-reactive self-esteem, a pattern of cognitive reactivity where low self-esteem is temporally dependent on levels of sadness, represents vulnerability for depression. Few studies have directly tested this hypothesis, particularly using intensive data collection methods (i.e., experience sampling) required to capture the temporal dynamics of sadness and self-esteem as they unfold naturally, over time. In this study we used participants’ smartphones to collect multiple daily ratings of sadness and self-esteem over three weeks, in the real world. We then applied dynamic factor modeling to explore theoretically driven hypotheses about the temporal dependency of self-esteem on sadness (i.e., mood-reactive self-esteem) and its relationship to indices of depression vulnerability both contemporaneously (e.g., rumination, sad mood persistence) and prospectively (e.g., future symptomatology). In sum, individuals who demonstrated mood-reactive self-esteem reported higher levels of rumination at baseline, more persistent sad mood over three weeks, and increased depression symptoms at the end of three weeks above and beyond a trait-like index of self-esteem. The integration of smartphone assessment and person-specific analytics employed in this study offers an exiting new avenue to advance the study and treatment of depression.

Comulada, W. Scott; Lightfoot, Marguerita; Swendeman, Dallas; Grella, Christine; Wu, Nancy (2015): Compliance to cell phone-based EMA among Latino youth in outpatient treatment. In: Journal of Ethnicity in Substance Abuse 14 (3), S. 232–250. DOI: 10.1080/15332640.2014.986354.

Outpatient treatment practices for adolescent substance users utilize retrospective self-report to monitor drug use. Cell phone-based ecological momentary assessment (CEMA) overcomes retrospective self-report biases and can enhance outpatient treatment, particularly among Latino adolescents, who have been understudied with regard to CEMA. This study explores compliance to text message-based CEMA with youth (n = 28; 93% Latino) in outpatient treatment. Participants were rotated through daily, random, and event-based CEMA strategies for 1-month periods. Overall compliance was high (> 80%). Compliance decreased slightly over the study period and was less during random versus daily strategies and on days when alcohol use was retrospectively reported. Findings suggest that CEMA is a viable monitoring tool for Latino youth in outpatient treatment, but further study is needed to determine optimal CEMA strategies, monitoring time periods, and the appropriateness of CEMA for differing levels of substance use.

Cooper, Ashley R.; Goodman, Anna; Page, Angie S.; Sherar, Lauren B.; Esliger, Dale W.; van Sluijs, Esther Mf et al. (2015): Objectively measured physical activity and sedentary time in youth: the International children’s accelerometry database (ICAD). In: The International Journal of Behavioral Nutrition and Physical Activity 12, S. 113. DOI: 10.1186/s12966-015-0274-5.

BACKGROUND: Physical activity and sedentary behaviour in youth have been reported to vary by sex, age, weight status and country. However, supporting data are often self-reported and/or do not encompass a wide range of ages or geographical locations. This study aimed to describe objectively-measured physical activity and sedentary time patterns in youth. METHODS: The International Children’s Accelerometry Database (ICAD) consists of ActiGraph accelerometer data from 20 studies in ten countries, processed using common data reduction procedures. Analyses were conducted on 27,637 participants (2.8-18.4 years) who provided at least three days of valid accelerometer data. Linear regression was used to examine associations between age, sex, weight status, country and physical activity outcomes. RESULTS: Boys were less sedentary and more active than girls at all ages. After 5 years of age there was an average cross-sectional decrease of 4.2 % in total physical activity with each additional year of age, due mainly to lower levels of light-intensity physical activity and greater time spent sedentary. Physical activity did not differ by weight status in the youngest children, but from age seven onwards, overweight/obese participants were less active than their normal weight counterparts. Physical activity varied between samples from different countries, with a 15-20 % difference between the highest and lowest countries at age 9-10 and a 26-28 % difference at age 12-13. CONCLUSIONS: Physical activity differed between samples from different countries, but the associations between demographic characteristics and physical activity were consistently observed. Further research is needed to explore environmental and sociocultural explanations for these differences.

Crescenzo, Franco de; Licchelli, Serena; Ciabattini, Marco; Menghini, Deny; Armando, Marco; Alfieri, Paolo et al. (2015): The use of actigraphy in the monitoring of sleep and activity in ADHD: A meta-analysis. In: Sleep medicine reviews. DOI: 10.1016/j.smrv.2015.04.002.

Attention deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. There is an increasing need to find objective measures and markers of the disorder in order to assess the efficacy of the therapies and to improve follow-up strategies. Actigraphy is an objective method for recording motor activity and sleep parameters that has been used in many studies in ADHD. Our meta-analysis aimed to assess the current evidence on the role of actigraphy in both the detection of changes in motor activity and in sleep patterns in ADHD. A systematic review was carried out to find studies comparing children with unmedicated ADHD versus controls, using actigraphic measures as an outcome. The primary outcome measures were “sleep duration” and daytime “activity mean”. As secondary outcome measures we analyzed “sleep onset latency”, “sleep efficiency” and “wake after sleep onset”. Twenty-four studies comprising 2179 children were included in this review. We show evidence that ADHD compared to typically developing children present a higher mean activity during structured sessions, a similar sleep duration, and a moderately altered sleep pattern. This study highlights the role of actigraphy as an objective tool for the ambulatory monitoring of sleep and activity in ADHD.

Dirk, Judith; Schmiedek, Florian (2015): Fluctuations in Elementary School Children’s Working Memory Performance in the School Context. In: Journal of Educational Psychology. DOI: 10.1037/edu0000076.

Children experience good and bad days in their performance. Although this phenomenon is well-known to teachers, parents, and students it has not been investigated empirically. We examined whether children’s working memory performance varies systematically from day to day and to which extent fluctuations at faster timescales (i.e., occasions, moments) contribute to daily WM fluctuations in the school context. In an ambulatory assessment study, Grade 3 and Grade 4 students (8 to 11 years old; N = 110) completed WM tasks on smartphones 3 times a day in school and at home for 4 weeks. Results showed substantial within-person fluctuations in children’s daily WM performance. Across task conditions, day-to-day, occasion-to-occasion, and moment-to-moment variability accounted for roughly the same extent of observed day-to-day variability with large individual differences in the amount of reliable fluctuations at the different timescales. Grade 3 students were more variable than were Grade 4 students at the faster timescales, more variable WM performance at all timescales was related to lower school achievement, and more day-to-day variability was associated with lower fluid intelligence. These findings build the foundation for research on the antecedents and consequences of children’s fluctuating cognitive resources. Theories about cognitive development and learning should consider performance fluctuations across and within days to understand the processes underlying long-term changes. Educational practice may be informed by the substantial WM fluctuations at all timescales and adopt interventions that increase children’s attentional focus and self-regulation.

Dong, Yuntao; Liao, Hui; Chuang, Aichia; Zhou, Jing; Campbell, Elizabeth M. (2015): Fostering employee service creativity: Joint effects of customer empowering behaviors and supervisory empowering leadership. In: Journal of Applied Psychology 100 (5), S. 1364–1380. DOI: 10.1037/a0038969.

Integrating insights from the literature on customers’ central role in service and the literature on employee creativity, we offer theoretical and empirical account of how and when customer empowering behaviors can motivate employee creativity during service encounters and, subsequently, influence customer satisfaction with service experience. Using multilevel, multisource, experience sampling data from 380 hairstylists matched with 3550 customers in 118 hair salons, we found that customer empowering behaviors were positively related to employee creativity and subsequent customer satisfaction via employee state promotion focus. Results also showed that empowering behaviors from different agents function synergistically in shaping employee creativity: supervisory empowering leadership strengthened the indirect effect of customer empowering behaviors on employee creativity via state promotion focus.

Doyle, Colleen; Werner, Elizabeth; Feng, Tianshu; Lee, Seonjoo; Altemus, Margaret; Isler, Joseph R.; Monk, Catherine (2015): Pregnancy distress gets under fetal skin: Maternal ambulatory assessment & sex differences in prenatal development. In: Developmental Psychobiology 57 (5), S. 607–625. DOI: 10.1002/dev.21317.

Prenatal maternal distress is associated with an at‐risk developmental profile, yet there is little fetal evidence of this putative in utero process. Moreover, the biological transmission for these maternal effects remains uncertain. In a study of n = 125 pregnant adolescents (ages 14–19), ambulatory assessments of daily negative mood (anger, frustration, irritation, stress), physical activity, blood pressure, heart rate (every 30 min over 24 hr), and salivary cortisol (six samples) were collected at 13–16, 24–27, 34–37 gestational weeks. Corticotropin‐releasing hormone, C‐reactive protein, and interleukin 6 from blood draws and 20 min assessments of fetal heart rate (FHR) and movement were acquired at the latter two sessions. On average, fetuses showed development in the expected direction (decrease in FHR, increase in SD of FHR and in the correlation of movement and FHR (“coupling”)). Maternal distress characteristics were associated with variations in the level and trajectory of fetal measures, and results often differed by sex. For males, greater maternal 1st and 2nd session negative mood and 2nd session physical activity were associated with lower overall FHR (p < .01), while 1st session cortisol was associated with a smaller increase in coupling (p < .01), and overall higher levels (p = .05)—findings suggesting accelerated development. For females, negative mood, cortisol, and diastolic blood pressure were associated with indications of relatively less advanced and accelerated outcomes. There were no associations between negative mood and biological variables. These data indicate that maternal psychobiological status influences fetal development, with females possibly more variously responsive to different exposures.

Edmondson, Donald; Arndt, Jamie; Alcantara, Carmela; Chaplin, William; Schwartz, Joseph E. (2015): Self-Esteem and the Acute Effect of Anxiety on Ambulatory Blood Pressure. In: Psychosomatic medicine 77 (7), S. 833–841. DOI: 10.1097/PSY.0000000000000219.

OBJECTIVES: Recent research suggests that self-esteem may be associated with improved parasympathetic nervous system functioning. This study tested whether high self-esteem is associated with decreased ambulatory systolic blood pressure (ASBP) reactivity to anxiety in healthy adults during the waking hours of a normal day. METHODS: Each of 858 participants completed a short version of the Rosenberg Self-Esteem Scale and then wore an ABP monitor that took two blood pressure readings per hour for 24 hours. Immediately after each blood pressure reading, participants completed an electronic diary report that included an anxiety rating on a 100-point visual analog scale. Using multilevel models, we assessed the association of momentary anxiety, high trait self-esteem, and their interaction on momentary ASBP, with adjustment for age, sex, race, ethnicity, and body mass index. Sensitivity analyses were conducted examining psychological factors associated with self-esteem: sense of mastery, optimism, social support, and depressive symptoms. RESULTS: On average, a 1-point increase in cube root-transformed anxiety was associated with a 0.80-mm Hg (standard error = 0.09, p < .001) increase in ASBP, and the interaction of high self-esteem and momentary anxiety was significant, such that this effect was 0.48 (standard error = 0.20, p = .015) less in individuals with high self-esteem compared with all others. Results for self-esteem remained significant when adjusting for sex and psychological factors. CONCLUSIONS: Momentary increases in anxiety are associated with acute increases in ASBP, and high self-esteem buffers the effect of momentary anxiety on blood pressure. Thus, high self-esteem may confer cardiovascular benefit by reducing the acute effects of anxiety on systolic blood pressure.

Edwards, Clementine J.; Cella, Matteo; Tarrier, Nicholas; Wykes, Til (2015): Investigating the empirical support for therapeutic targets proposed by the temporal experience of pleasure model in schizophrenia: A systematic review. In: Schizophrenia Research. DOI: 10.1016/j.schres.2015.08.013.

BACKGROUND: Anhedonia and amotivation are substantial predictors of poor functional outcomes in people with schizophrenia and often present a formidable barrier to returning to work or building relationships. The Temporal Experience of Pleasure Model proposes constructs which should be considered therapeutic targets for these symptoms in schizophrenia e.g. anticipatory pleasure, memory, executive functions, motivation and behaviours related to the activity. Recent reviews have highlighted the need for a clear evidence base to drive the development of targeted interventions. OBJECTIVE: To review systematically the empirical evidence for each TEP model component and propose evidence-based therapeutic targets for anhedonia and amotivation in schizophrenia. METHOD: Following PRISMA guidelines, PubMed and PsycInfo were searched using the terms “schizophrenia” and “anhedonia”. Studies were included if they measured anhedonia and participants had a diagnosis of schizophrenia. The methodology, measures and main findings from each study were extracted and critically summarised for each TEP model construct. RESULTS: 80 independent studies were reviewed and executive functions, emotional memory and the translation of motivation into actions are highlighted as key deficits with a strong evidence base in people with schizophrenia. However, there are many relationships that are unclear because the empirical work is limited by over-general tasks and measures. CONCLUSIONS: Promising methods for research which have more ecological validity include experience sampling and behavioural tasks assessing motivation. Specific adaptations to Cognitive Remediation Therapy, Cognitive Behavioural Therapy and the utilisation of mobile technology to enhance representations and emotional memory are recommended for future development.

Ehlers, Diane K.; Huberty, Jennifer; Buman, Matthew; Hooker, Steven; Todd, Michael; Vreede, Gert-Jan de (2015): A Novel, Inexpensive Use of Smartphone Technology for Ecological Momentary Assessment in Middle-Aged Women. In: Journal of physical activity & health. DOI: 10.1123/jpah.2015-0059.

BACKGROUND: Commercially available mobile and Internet technologies present a promising opportunity to feasibly conduct ecological momentary assessment (EMA). The purpose of this study was to describe a novel EMA protocol administered on middle-aged women’s smartphones via text messaging and mobile Internet. METHODS: Women (N=9; M age=46.2 +/- 8.2 years) received 35 text message prompts to a mobile survey assessing activity, self-worth, and self-efficacy over 14 days. Prompts were scheduled and surveys were administered using commercial, Internet-based programs. Prompting was tailored to each woman’s daily wake/sleep schedule. Women concurrently wore a wrist-worn accelerometer. Feasibility was assessed via survey completion, accelerometer wear, participant feedback, and researcher notes. RESULTS: Of 315 prompted surveys, 287 responses were valid (91.1%). Average completion time was 1.52 +/- 1.03 minutes. One participant’s activity data were excluded due to accelerometer malfunction, resulting in complete data from eight participants (n=252 [80.0%] valid observations). Women reported the survey was easily and quickly read/completed. However, most thought the accelerometer was inconvenient. CONCLUSIONS: High completion rates and perceived usability suggest capitalizing on widely available technology and tailoring prompting schedules may optimize EMA in middle-aged women. However, researchers may need to carefully select objective monitors to maintain data validity while limiting participant burden.

Fairclough, Stuart J.; Boddy, Lynne M.; Mackintosh, Kelly A.; Valencia-Peris, Alexandra; Ramirez-Rico, Elena (2015): Weekday and weekend sedentary time and physical activity in differentially active children. In: Journal of Science and Medicine in Sport 18 (4), S. 444–449. DOI: 10.1016/j.jsams.2014.06.005.

Objectives: To investigate whether weekday–weekend differences in sedentary time and specific intensities of physical activity exist among children categorised by physical activity levels. Design: Cross-sectional observational study. Methods: Seven-day accelerometer data were obtained from 810 English children (n =420 girls) aged 10–11 years. Daily average minday−1 spent in moderate to vigorous physical activity were calculated for each child. Sex-specific moderate to vigorous physical activity quartile cut-off values categorised boys and girls separately into four graded groups representing the least (Q1) through to the most active (Q4) children. Sex- and activity quartile-specific multilevel linear regression analyses analysed differences in sedentary time, light physical activity, moderate physical activity, vigorous physical activity, and moderate to vigorous physical activity between weekdays and weekends. Results: On weekdays Q2 boys spent longer in light physical activity (p < 0.05), Q1 (p < 0.001), Q2 boys (p < 0.01) did significantly more moderate physical activity, and Q1–Q3 boys accumulated significantly more vigorous physical activity and moderate to vigorous physical activity than at weekends. There were no significant differences in weekday and weekend sedentary time or physical activity for Q4 boys. On weekdays Q2 and Q3 girls accumulated more sedentary time (p < 0.05), Q1 and Q2 girls did significantly more moderate physical activity (p < 0.05), and Q1–Q3 girls engaged in more vigorous physical activity (p < 0.05) and more moderate to vigorous physical activity (p < 0.01) than at weekends. Q4 girls’ sedentary time and physical activity varied little between weekdays and weekends. Conclusions: The most active children maintained their sedentary time and physical activity levels at weekends, while among less active peers weekend sedentary time and physical activity at all intensities was lower. Low active children may benefit most from weekend intervention strategies.

Fairclough, Stuart J.; Noonan, Robert; Rowlands, Alex V.; van Hees, Vincent; Knowles, Zoe; Boddy, Lynne M. (2015): Wear Compliance and Activity in Children Wearing Wrist and Hip-Mounted Accelerometers. In: Medicine and science in sports and exercise. DOI: 10.1249/MSS.0000000000000771.

PURPOSE: This study aimed to (i) explore children’s compliance to wearing wrist and hip-mounted accelerometers, (ii) compare children’s physical activity (PA) derived from wrist and hip raw accelerations, and (iii) examine differences in raw and counts PA measured by hip-worn accelerometry. METHODS: One hundred and twenty nine 9-10 y old children wore a wrist-mounted GENEActiv accelerometer (GAwrist) and a hip-mounted ActiGraph GT3X+ accelerometer (AGhip) for 7 d. Both devices measured raw accelerations and the AGhip also provided counts-based data. RESULTS: More children wore the GAwrist than the AGhip regardless of wear time criteria applied (p<.001 - .035). Raw data signal vector magnitude (SVM; r = .68), moderate PA (MPA; r = .81), vigorous PA (VPA; r = .85), and moderate-to-vigorous PA (MVPA; r = .83) were strongly associated between devices (p<.001). GAwrist SVM (p = .001), MPA (p = .037), VPA (p = .002), and MVPA (p = .016) were significantly greater than AGhip. According to GAwrist raw data, 86.9% of children engaged in at least 60 min MVPA[BULLET OPERATOR]d, compared to 19% for AGhip. ActiGraph MPA (raw) was 42.00 +/- 1.61 min[BULLET OPERATOR]d compared to 35.05 +/- 0.99 min[BULLET OPERATOR]d (counts) (p=.02). Actigraph VPA was 7.59 +/- 0.46 min[BULLET OPERATOR]d (raw) and 37.06 +/- 1.85 min[BULLET OPERATOR]d (counts; p=.19). CONCLUSION: In children accelerometer wrist placement promotes superior compliance than the hip. Raw accelerations were significantly higher for GAwrist compared to AGhip, possibly due to placement location and technical differences between devices. AGhip PA calculated from raw accelerations and counts differed substantially, demonstrating that PA outcomes derived from cutpoints for raw output and counts cannot be directly compared.

Faurholt-Jepsen, M.; Frost, M.; Ritz, C.; Christensen, E. M.; Jacoby, A. S.; Mikkelsen, R. L. et al. (2015): Daily electronic self-monitoring in bipolar disorder using smartphones – the monarca I trial: A randomized, placebo-controlled, single-blind, parallel group trial. In: Psychological Medicine. DOI: 10.1017/S0033291715000410.

Background The number of studies on electronic self-monitoring in affective disorder and other psychiatric disorders is increasing and indicates high patient acceptance and adherence. Nevertheless, the effect of electronic self-monitoring in patients with bipolar disorder has never been investigated in a randomized controlled trial (RCT). The objective of this trial was to investigate in a RCT whether the use of daily electronic self-monitoring using smartphones reduces depressive and manic symptoms in patients with bipolar disorder. Method A total of 78 patients with bipolar disorder according to ICD-10 criteria, aged 18–60 years, and with 17-item Hamilton Depression Rating Scale (HAMD-17) and Young Mania Rating Scale (YMRS) scores ≤17 were randomized to the use of a smartphone for daily self-monitoring including a clinical feedback loop (the intervention group) or to the use of a smartphone for normal communicative purposes (the control group) for 6 months. The primary outcomes were differences in depressive and manic symptoms measured using HAMD-17 and YMRS, respectively, between the intervention and control groups. Results Intention-to-treat analyses using linear mixed models showed no significant effects of daily self-monitoring using smartphones on depressive as well as manic symptoms. There was a tendency towards more sustained depressive symptoms in the intervention group (B = 2.02, 95% confidence interval −0.13 to 4.17, p = 0.066). Sub-group analysis among patients without mixed symptoms and patients with presence of depressive and manic symptoms showed significantly more depressive symptoms and fewer manic symptoms during the trial period in the intervention group. Conclusions These results highlight that electronic self-monitoring, although intuitive and appealing, needs critical consideration and further clarification before it is implemented as a clinical tool.

Faurholt-Jepsen, Maria; Ritz, Christian; Frost, Mads; Mikkelsen, Rie Lambaek; Margrethe Christensen, Ellen; Bardram, Jakob et al. (2015): Mood instability in bipolar disorder type I versus type II-continuous daily electronic self-monitoring of illness activity using smartphones. In: Journal of affective disorders 186, S. 342–349. DOI: 10.1016/j.jad.2015.06.026.

BACKGROUND: A substantial proportion of patients with bipolar disorder remain symptomatic during inter-episode periods, and mood instability is associated with high risk of relapse and hospitalization. Few studies have investigated long-term daily illness activity and none has compared bipolar type I and II using daily data. The objectives were to investigate differences in daily illness activity between bipolar disorder type I and II. METHODS: A smartphone-based system for self-monitoring was developed. A total of 33 patients treated in a mood clinic used the system for daily self-monitoring during a median period of 310 days [IQR 189; 437]. Data presented summarize over 8500 observations. RESULTS: Patients with bipolar disorder type II (n=20), compared to patients with bipolar disorder type I (n=13), experienced a significant lower mean level of mood on a scale from -3; +3 (-0.54 (95% CI: -0.74; -0.35) versus -0.19 (95% CI: -0.35; -0.02), p=0.02), less time euthymic (51.0% (95% CI: 36.4; 65.7) versus 74.5% (95% CI: 62.4; 86.7), p=0.03) and a higher proportion of time with depressive symptoms (45.1% (95% CI: 30.6; 59.5) versus 18.8% (95% CI: 6.9; 30.7), p=0.01). The proportion of time spent with (hypo)manic symptoms did not differ (2.7% (95% CI: 0.1; 5.5) versus 5.5% (95% CI: 3.1; 7.8), p=0.17). LIMITATIONS: Patients received different types, doses and combinations of psychopharmacological treatment. CONCLUSION: Euthymia was obtained for a substantial proportion of time in patients with bipolar disorder type I, but despite on-going treatment only for half of the time for patients with bipolar disorder type II. This emphasizes the need for improving treatment strategies for bipolar disorder type II.

Faurholt-Jepsen, Maria; Vinberg, Maj; Frost, Mads; Christensen, Ellen Margrethe; Bardram, Jakob E.; Kessing, Lars Vedel (2015): Smartphone data as an electronic biomarker of illness activity in bipolar disorder. In: Bipolar Disorders. DOI: 10.1111/bdi.12332.

OBJECTIVES: Objective methods are lacking for continuous monitoring of illness activity in bipolar disorder. Smartphones offer unique opportunities for continuous monitoring and automatic collection of real-time data. The objectives of the paper were to test the hypotheses that (i) daily electronic self-monitored data and (ii) automatically generated objective data collected using smartphones correlate with clinical ratings of depressive and manic symptoms in patients with bipolar disorder. METHODS: Software for smartphones (the MONARCA I system) that collects automatically generated objective data and self-monitored data on illness activity in patients with bipolar disorder was developed by the authors. A total of 61 patients aged 18-60 years and with a diagnosis of bipolar disorder according to ICD-10 used the MONARCA I system for six months. Depressive and manic symptoms were assessed monthly using the Hamilton Depression Rating Scale 17-item (HDRS-17) and the Young Mania Rating Scale (YMRS), respectively. Data are representative of over 400 clinical ratings. Analyses were computed using linear mixed-effect regression models allowing for both between individual variation and within individual variation over time. RESULTS: Analyses showed significant positive correlations between the duration of incoming and outgoing calls/day and scores on the HDRS-17, and significant positive correlations between the number and duration of incoming calls/day and scores on the YMRS; the number of and duration of outgoing calls/day and scores on the YMRS; and the number of outgoing text messages/day and scores on the YMRS. Analyses showed significant negative correlations between self-monitored data (i.e., mood and activity) and scores on the HDRS-17, and significant positive correlations between self-monitored data (i.e., mood and activity) and scores on the YMRS. Finally, the automatically generated objective data were able to discriminate between affective states. CONCLUSIONS: Automatically generated objective data and self-monitored data collected using smartphones correlate with clinically rated depressive and manic symptoms and differ between affective states in patients with bipolar disorder. Smartphone apps represent an easy and objective way to monitor illness activity with real-time data in bipolar disorder and may serve as an electronic biomarker of illness activity.

Firth, Joseph; Cotter, Jack; Torous, John; Bucci, Sandra; Firth, Josh A.; Yung, Alison R. (2015): Mobile Phone Ownership and Endorsement of “mHealth” Among People With Psychosis: A Meta-analysis of Cross-sectional Studies. In: Schizophrenia bulletin. DOI: 10.1093/schbul/sbv132.

There is currently growing interest in using mobile phones to support the treatment of psychotic disorders, such as schizophrenia. However, the widespread implementation of these interventions will ultimately depend upon patients’ access to mobile devices and their willingness to engage with mobile health (“mHealth”). Thus, we conducted a systematic review and meta-analysis to assess mobile phone ownership and interest in mHealth among patients with psychosis. An electronic search of Ovid MEDLINE, Embase, PsycINFO, CENTRAL, AMED, Health Technology Assessment Database, and Health Management Information Consortium Database was conducted, using search terms synonymous with mobile phones and psychotic disorders. The initial literature search yielded 2572 results. Fifteen studies matched eligibility criteria, reporting data from 12 independent samples of psychiatric patients (n = 3227). Data pertaining to mobile phone ownership, usage, and opinions on mHealth among patients with psychotic disorders were extracted from these studies, and meta-analytic techniques were applied. The overall mobile phone ownership rate was 66.4% (95% CI = 54.1%-77.6%). However, we found strong statistical evidence that mobile phone ownership has been significantly increasing since 2007, and the rate among patients surveyed in the last 2 years was 81.4% (n = 454). Furthermore, in surveys of mHealth acceptability, the majority of patients responded in favor of using mobile phones to enhance contact with services and support self-management. Considering the increasing availability of mobile phones and the broad acceptability of mHealth among patients, there is now a need to develop and evaluate mHealth interventions to enhance healthcare services for people with psychosis.

Franklin, Michael S.; Smallwood, Jonathan; Zedelius, Claire M.; Broadway, James M.; Schooler, Jonathan W. (2015): Unaware yet reliant on attention: Experience sampling reveals that mind-wandering impedes implicit learning. In: Psychonomic bulletin & review. DOI: 10.3758/s13423-015-0885-5.

Although implicit learning has been widely studied, controversy remains regarding its reliance on attentional resources. A central issue in this controversy is the question of how best to manipulate attention. The usual approach of comparing implicit learning in a serial reaction time (SRT) task under single- versus dual-task conditions is known to be problematic, because the secondary task may not only divert attention away from the primary task, but also interfere with the implicit-learning process itself. To address this confound, in the present study we used an experience-sampling instead of a dual-task approach. We assessed lapses of attention (mind-wandering) with experience-sampling thought probes during a standard implicit-learning SRT task. The results revealed a significant negative correlation between mind-wandering and implicit learning. Thus, greater task focus was associated with improved implicit sequence learning. This result suggests that, at least in the context of this SRT task, optimal implicit learning relies on attention.

Frost, Allison; Hoyt, Lindsay T.; Chung, Alissa Levy; Adam, Emma K. (2015): Daily life with depressive symptoms: Gender differences in adolescents’ everyday emotional experiences. In: Journal of Adolescence 43, S. 132–141. DOI: 10.1016/j.adolescence.2015.06.001.

Depression is a prevalent and debilitating illness facing many adolescents, especially adolescent girls, whose risk for this disorder is approximately twice that of boys. Many studies have identified mechanisms that place girls at higher risk for depression during adolescence. Few, however, have examined differences in the everyday emotional experiences of boys and girls with varying levels of depressive symptoms. Using the Experience Sampling Method, this study investigated the roles of gender and depressive symptomatology in the emotional experiences of a community sample of youth (11–18 year-olds) from the Sloan 500 Family Study. Females with higher levels of depressive symptoms were more likely than females with fewer depressive symptoms and all males to experience strong negative emotions and to attribute the cause of these emotions to other people. These results suggest that emotional reactivity in interpersonal contexts is especially important to understand gender differences in the daily experience of depressive symptoms.

Fukuoka, Yoshimi; Gay, Caryl L.; Joiner, Kevin L.; Vittinghoff, Eric (2015): A novel diabetes prevention intervention using a mobile app: A randomized controlled trial with overweight adults at risk. In: American Journal of Preventive Medicine 49 (2), S. 223–237. DOI: 10.1016/j.amepre.2015.01.003.

Introduction: Mobile phone technology may be a cost-effective and convenient way to deliver proven weight-loss interventions and thereby prevent or delay onset of type 2 diabetes. The purpose of this study was to examine the feasibility and efficacy of a diabetes prevention intervention combined with a mobile app and pedometer in English-speaking overweight adults at risk for type 2 diabetes. Design: RCT. Participants: Participants included 61 overweight adults with a mean age (SD) of 55.2 (9.0) years. Seventy-seven percent were women, 48% were racial/ethnic minorities, and baseline BMI was 33.3 (6.0). Intervention: The curriculum was adapted from the Diabetes Prevention Program, with the frequency of in-person sessions reduced from 16 to six sessions and group exercise sessions replaced by a home-based exercise program. A study-developed mobile phone app and pedometer augmented the intervention and provided self-monitoring tools. Main outcome measure: Weight loss. Results: Data were collected in 2012 and 2013 and were analyzed in 2014. In intention-to-treat analyses, the intervention group (n = 30) lost an average of 6.2 (5.9) kg (–6.8% [5.7%]) between baseline and 5-month follow-up compared to the control group’s (n = 31) gain of 0.3 (3.0) kg (0.3% [5.7%]) (p < 0.001). The intervention group’s steps per day increased by 2,551 (4,712) compared to the control group’s decrease of 734 (3,308) steps per day (p < 0.001). In comparison, the intervention group had greater reductions in hip circumference (p < 0.001); blood pressure (p < 0.05); and intake of saturated fat (p = 0.007) and sugar-sweetened beverages (p = 0.02). The intervention had no significant effect on fasting lipid or glucose levels. Conclusions: The significant weight loss resulting from this modified combined mobile app and pedometer intervention for overweight adults warrants further investigation in a larger trial.

Fuller-Tyszkiewicz, Matthew; McCabe, Marita; Skouteris, Helen; Richardson, Ben; Nihill, Kristy; Watson, Brittany; Solomon, Daniel (2015): Does body satisfaction influence self-esteem in adolescents’ daily lives? An experience sampling study. In: Journal of Adolescence 45, S. 11–19. DOI: 10.1016/j.adolescence.2015.08.009.

This study examined, within the context of the Contingencies of Self-Worth model, state-based associations between self-esteem and body satisfaction using the experience sampling method. One hundred and forty-four adolescent girls (mean age = 14.28 years) completed up to 6 assessments per day for one week using Palm Digital Assistants, in addition to baseline measures of trait body satisfaction and self-esteem. Results showed considerable variation in both state-based constructs within days, and evidence of effects of body satisfaction on self-esteem, but not vice versa. Although these state-based associations were small in size and weakened as the time lag between assessments increased for the sample as a whole, individual differences in the magnitude of these effects were observed and predicted by trait self-esteem and body satisfaction. Collectively, these findings offer support for key tenets of the Contingencies of Self-Worth model.

Furnari, Melody; Epstein, David H.; Phillips, Karran A.; Jobes, Michelle L.; Kowalczyk, William J.; Vahabzadeh, Massoud et al. (2015): Some of the people, some of the time: field evidence for associations and dissociations between stress and drug use. In: Psychopharmacology 232 (19), S. 3529–3537. DOI: 10.1007/s00213-015-3998-7.

RATIONALE: Stress’s role in drug use is supported by retrospective interview and laboratory studies, but prospective data confirming the association in daily life are sparse. OBJECTIVES: This study aims to assess the relationship between drug use and stress in real time with ambulatory monitoring. METHODS: For up to 16 weeks, 133 outpatients on opiate agonist treatment used smartphones to report each time they used drugs or felt more stressed than usual. They rated stress-event severity on a 10-point scale and as a hassle, day spoiler, or more than a day spoiler. For analysis, stress reports made within 72 h before a reported use of cocaine or opioid were binned into 24-h periods. RESULTS: Of 52 participants who reported stress events in the 72-h timeframe, 41 reported stress before cocaine use and 26 before opioid use. For cocaine use, the severity of stressors, rated numerically (r effect = 0.42, CL95 0.17-0.62, p = 0.00061) and percent rated as “more than a day spoiler” (r effect = 0.34, CL95 0.07-0.56, p = 0.0292)], increased linearly across the three days preceding use. The number of stressors did not predict cocaine use, and no measure of stress predicted opioid use. In ecological momentary assessment (EMA) from the whole sample of 133, stress and drug use occurred independently and there was no overall relationship. CONCLUSIONS: EMA did not support the idea that stress is a necessary or sufficient trigger for cocaine or heroin use after accounting for the base rates of stress and use. But EMA did show that stressful events can increase in severity in the days preceding cocaine use.

Gill, Shubhroz; Panda, Satchidananda (2015): A Smartphone App Reveals Erratic Diurnal Eating Patterns in Humans that Can Be Modulated for Health Benefits. In: Cell metabolism. DOI: 10.1016/j.cmet.2015.09.005.

A diurnal rhythm of eating-fasting promotes health, but the eating pattern of humans is rarely assessed. Using a mobile app, we monitored ingestion events in healthy adults with no shift-work for several days. Most subjects ate frequently and erratically throughout wakeful hours, and overnight fasting duration paralleled time in bed. There was a bias toward eating late, with an estimated <25% of calories being consumed before noon and >35% after 6 p.m. “Metabolic jetlag” resulting from weekday/weekend variation in eating pattern akin to travel across time zones was prevalent. The daily intake duration (95% interval) exceeded 14.75 hr for half of the cohort. When overweight individuals with >14 hr eating duration ate for only 10-11 hr daily for 16 weeks assisted by a data visualization (raster plot of dietary intake pattern, “feedogram”) that we developed, they reduced body weight, reported being energetic, and improved sleep. Benefits persisted for a year.

Gilliland, Jason; Sadler, Richard; Clark, Andrew; O’Connor, Colleen; Milczarek, Malgorzata; Doherty, Sean (2015): Using a Smartphone Application to Promote Healthy Dietary Behaviours and Local Food Consumption. In: BioMed research international 2015, S. 841368. DOI: 10.1155/2015/841368.

Smartphone “apps” are a powerful tool for public health promotion, but unidimensional interventions have been ineffective at sustaining behavioural change. Various logistical issues exist in successful app development for health intervention programs and for sustaining behavioural change. This study reports on a smartphone application and messaging service, called “SmartAPPetite,” which uses validated behaviour change techniques and a behavioural economic approach to “nudge” users into healthy dietary behaviours. To help gauge participation in and influence of the program, data were collected using an upfront food survey, message uptake tracking, experience sampling interviews, and a follow-up survey. Logistical and content-based issues in the deployment of the messaging service were subsequently addressed to strengthen the effectiveness of the app in changing dietary behaviours. Challenges included creating relevant food goal categories for participants, providing messaging appropriate to self-reported food literacy and ensuring continued participation in the program. SmartAPPetite was effective at creating a sense of improved awareness and consumption of healthy foods, as well as drawing people to local food vendors with greater frequency. This work serves as a storehouse of methods and best practices for multidimensional local food-based smartphone interventions aimed at improving the “triple bottom line” of health, economy, and environment.

Goedhart, Geertje; Kromhout, Hans; Wiart, Joe; Vermeulen, Roel (2015): Validating self-reported mobile phone use in adults using a newly developed smartphone application. In: Occupational and environmental medicine. DOI: 10.1136/oemed-2015-102808.

OBJECTIVE: Interpretation of epidemiological studies on health effects from mobile phone use is hindered by uncertainties in the exposure assessment. We used a newly developed smartphone application (app) to validate self-reported mobile phone use and behaviour among adults. METHODS: 107 participants (mean age 41.4 years) in the Netherlands either downloaded the software app on their smartphone or were provided with a study smartphone for 4 weeks. The app recorded the number and duration of calls, text messages, data transfer, laterality and hands-free use. Self-reported mobile phone use was collected before using the app and after 6 months through an interviewer-administered questionnaire. RESULTS: The geometric mean ratios (GMR, 95% CI) and Spearman correlations (r) of self-reported (after 6 months) versus recorded number and duration of calls were: GMR=0.65 (0.53 to 0.80), r=0.53; and GMR=1.11 (0.86 to 1.42), r=0.57 respectively. Participants held the phone on average for 86% of the total call time near the head. Self-reported right side users held the phone for 70.7% of the total call time on the right side of the head, and left side users for 66.2% on the left side of the head. The percentage of total call time that the use of hands-free devices (headset, speaker mode, Bluetooth) was recorded increased with increasing frequency of reported hands-free device usage. DISCUSSION: The observed recall errors and precision of reported laterality and hands-free use can be used to quantify and improve radiofrequency exposure models based on self-reported mobile phone use.

Goedhart, Geertje; Vrijheid, Martine; Wiart, Joe; Hours, Martine; Kromhout, Hans; Cardis, Elisabeth et al. (2015): Using software-modified smartphones to validate self-reported mobile phone use in young people: A pilot study. In: Bioelectromagnetics 36 (7), S. 538–543. DOI: 10.1002/bem.21931.

A newly developed smartphone application was piloted to characterize and validate mobile phone use in young people. Twenty-six volunteers (mean age 17.3 years) from France, Spain, and the Netherlands used a software-modified smartphone for 4 weeks; the application installed on the phone recorded number and duration of calls, data use, laterality, hands-free device usage, and communication system used for both voice calls and data transfer. Upon returning the phone, participants estimated their mobile phone use during those 4 weeks via an interviewer-administered questionnaire. Results indicated that participants on average underestimated the number of calls they made, while they overestimated total call duration. Participants held the phone for about 90% of total call time near the head, mainly on the side of the head they reported as dominant. Some limitations were encountered when comparing reported and recorded data use and speaker use. When applied in a larger sample, information recorded by the smartphone application will be very useful to improve radiofrequency (RF) exposure modeling from mobile phones to be used in epidemiological research. Bioelectromagnetics. 36:538-543, 2015. (c) 2015 Wiley Periodicals, Inc.

Goetz, Thomas; Becker, Eva S.; Bieg, Madeleine; Keller, Melanie M.; Frenzel, Anne C.; Hall, Nathan C. (2015): The Glass Half Empty: How Emotional Exhaustion Affects the State-Trait Discrepancy in Self-Reports of Teaching Emotions. In: PLoS ONE 10 (9), S. e0137441. DOI: 10.1371/journal.pone.0137441.

Following from previous research on intensity bias and the accessibility model of emotional self-report, the present study examined the role of emotional exhaustion in explaining the discrepancy in teachers’ reports of their trait (habitual) versus state (momentary, “real”) emotions. Trait reports (habitual emotions, exhaustion) were assessed via trait questionnaires, and state reports (momentary emotions) were assessed in real time via the experience sampling method by using personal digital assistants (N = 69 high school teachers; 1,089 measures within teachers). In line with our assumptions, multi-level analyses showed that, as compared to the state assessment, teachers reported higher levels of habitual teaching-related emotions of anger, anxiety, shame, boredom, enjoyment, and pride. Additionally, the state-trait discrepancy in self-reports of negative emotions was accounted for by teachers’ emotional exhaustion, with high exhaustion levels corresponding with a greater state-trait discrepancy. Exhaustion levels did not moderate the state-trait discrepancy in positive emotions indicating that perceived emotional exhaustion may reflect identity-related cognitions specific to the negative belief system. Implications for research and educational practice are discussed.

Goh, Zen; Ilies, Remus; Wilson, Kelly Schwind (2015): Supportive supervisors improve employees’ daily lives: The role supervisors play in the impact of daily workload on life satisfaction via work–family conflict. In: Journal of Vocational Behavior 89, S. 65–73. DOI: 10.1016/j.jvb.2015.04.009.

This article presents a multilevel approach that uncovers how day-to-day variations in workload influence life satisfaction by creating work–family conflict, as well as the role supportive supervisors play in influencing these daily relationships. In this experience-sampling study, 135 employees responded to 2 daily surveys (one at work and one at home) for 5days and a one-time post-study survey. With a total of 810 surveys, hierarchical linear modeling revealed that employees’ daily perceived workload positively predicted daily work–family conflict, which in turn negatively predicted daily life satisfaction. Importantly, we found support for a cross-level interaction where supervisor work–family specific support (measured once in the post-study survey) negatively moderated the relationship between daily workload and work–family conflict, attesting the importance of supervisory support in reducing daily interference between work and family.

Graham-Engeland, Jennifer E.; Zawadzki, Matthew J.; Slavish, Danica C.; Smyth, Joshua M. (2015): Depressive symptoms and momentary mood predict momentary pain among rheumatoid arthritis patients. In: Annals of Behavioral Medicine. DOI: 10.1007/s12160-015-9723-2.

Background: Although a relationship between mood and pain has been established cross-sectionally, little research has examined this relationship using momentary within-person data.Purpose: We examined whether baseline depressive symptoms and within-person levels of negative and positive mood predicted momentary pain among 31 individuals with rheumatoid arthritis (RA).Methods: Depressive symptomatology was measured at baseline. Mood and RA symptoms were self-reported via ecological momentary assessment five times a day for seven consecutive days. Analyses controlled for gender, age, weekend day, time of day, and experiences of stress.Results: Greater momentary positive mood was associated with less momentary pain and fewer arthritis-related restrictions; negative mood was associated with more restrictions. Greater depressive symptomatology also predicted more pain and restrictions, an effect which was not accounted for by mood.Conclusions: Results suggest that both depression and mood are uniquely associated with momentary pain; as such, multi-component interventions may provide optimal disease management.

Greenfield, Thomas K.; Bond, Jason; Kerr, William C. (2014): Biomonitoring for Improving Alcohol Consumption Surveys: The New Gold Standard? In: Alcohol research : current reviews 36 (1), S. 39–45.

To assess alcohol consumption levels in large populations, researchers often rely on self-report measures. However, these approaches are associated with several limitations, particularly underreporting. Use of noninvasive biomonitoring approaches may help validate self-report alcohol consumption measurements and thus improve their accuracy. Two such devices currently are available, the WrisTASTM and SCRAMTM devices, both of which measure alcohol vapors emitted through the skin after alcohol consumption. Several studies assessing the utility of the WrisTASTM bracelet in determining alcohol consumption levels noted that it was associated with relatively high failure rates. The SCRAMTM is an ankle bracelet intended for court-ordered alcohol monitoring. In studies, its sensitivity exceeded that of the WrisTASTM and increased with increasing blood alcohol concentrations. Although early studies also identified some equipment concerns with the SCRAMTM, studies of its ability to detect moderate and heavy drinking recently have yielded good results. Biomonitoring devices already are valuable tools and with further improvements may become even more useful in both research and practical applications.

Gruber, June; Mennin, Douglas S.; Fields, Adam; Purcell, Amanda; Murray, Greg (2015): Heart rate variability as a potential indicator of positive valence system disturbance: A proof of concept investigation. In: International journal of psychophysiology : official journal of the International Organization of Psychophysiology. DOI: 10.1016/j.ijpsycho.2015.08.005.

One promising avenue toward a better understanding of the pathophysiology of positive emotional disturbances is to examine high-frequency heart rate variability (HRV-HF), which has been implicated as a potential physiological index of disturbances in positive emotional functioning. To date, only a few psychopathology relevant studies have systematically quantified HRV-HF profiles using more ecologically valid methods in everyday life. Using an experience-sampling approach, the present study examined both mean levels and intra-individual variability of HRV-HF - as well as comparison measures of cardiovascular arousal, sympathetic activity, and gross somatic movement - in everyday life, using ambulatory psychophysiological measurement across a six-day consecutive period among a spectrum of community adult participants with varying degrees of positive valence system disturbance, including adults with bipolar I disorder (BD; n=21), major depressive disorder (MDD; n=17), and healthy non-psychiatric controls (CTL; n=28). Groups did not differ in mean HRV-HF, but greater HRV-HF instability (i.e., intra-individual variation in HRV-HF) was found in the BD compared to both MDD and CTL groups. Subsequent analyses suggested that group differences in HRV-HF variability were largely accounted for by variations in clinician-rated manic symptoms. However, no association was found between HRV-HF variability and dimensional measures of positive affectivity. This work provides evidence consistent with a quadratic relationship between HRV-HF and positive emotional disturbance and represents a valuable step toward developing a more ecologically valid model of positive valence system disturbances and their underlying psychophysiological mechanisms within an RDoC framework.

Haaren, Birte von; Haertel, Sascha; Stumpp, Juergen; Hey, Stefan; Ebner-Priemer, Ulrich (2015): Reduced emotional stress reactivity to a real-life academic examination stressor in students participating in a 20-week aerobic exercise training: A randomised controlled trial using Ambulatory Assessment. In: Psychology of Sport and Exercise 20, S. 67–75. DOI: 10.1016/j.psychsport.2015.04.004.

Objectives: To examine if a preventive 20-week aerobic exercise intervention (AET) can improve emotional stress reactivity during real-life stress. Design: Randomised controlled trial; within-subject design. Method: Sixty-one inactive students were randomly assigned to a waiting control and an AET group. To capture the situation-specific, intra-individual data in real life, electronic diaries were used. Participants reported their moods and perceived stress (PS) repeatedly over two days during their daily routines pre- and post-intervention. The pre-intervention baseline assessment was scheduled at the beginning of the semester, and the post-intervention assessment was scheduled at a real-life stressful episode, an academic examination. For the aerobic fitness assessment, both groups completed a cardiopulmonary exercise test on the treadmill before and after the intervention. Multilevel models (MLMs) were conducted to compare within- and between-subject associations. Results: Significant emotional stress reactivity was evident in both groups during all assessment periods. However, participants in the AET group showed lower emotional stress reactivity compared with their control counterparts after the 20-week training programme during the real-life stress episode (the academic examination). Conclusions: AET conferred beneficial effects on emotional stress reactivity during an academic examination, which is likely an extremely stressful real-life situation for students. AET appears to be a promising strategy against the negative health effects of accumulated emotional stress reactivity.

Hare, Dougal J.; Wood, Christopher; Wastell, Sarah; Skirrow, Paul (2015): Anxiety in Asperger’s syndrome: Assessment in real time. In: Autism 19 (5), S. 542–552. DOI: 10.1177/1362361314531340.

Anxiety is a major problem for many people with Asperger’s syndrome who may have qualitatively different fears from a non-Asperger’s syndrome population. Research has relied on measures developed for non-Asperger’s syndrome populations that require reporting past experiences of anxiety, which may confound assessment in people with Asperger’s syndrome due to problems with autobiographical memory as are often reported in this group. Experience sampling methodology was used to record real-time everyday experiences in 20 adults with Asperger’s syndrome and 20 neurotypical adults. Within-subject analysis was used to explore the phenomenology of thoughts occurring in people with Asperger’s syndrome when they were anxious. Comparisons were made with the group that did not have Asperger’s syndrome. The Asperger’s syndrome group were significantly more anxious than the comparison group. Factors associated with feelings of anxiety in the Asperger’s syndrome group were high levels of self-focus, worries about everyday events and periods of rumination lasting over 10 min. People in the Asperger’s syndrome group also had a tendency to think in the image form, but this was not associated with feelings of anxiety. The results are discussed with reference to psychological models of Asperger’s syndrome, cognitive models of anxiety and implications for psychological therapy for this group.

Haynos, Ann F.; Crosby, Ross D.; Engel, Scott G.; Lavender, Jason M.; Wonderlich, Stephen A.; Mitchell, James E. et al. (2015): Initial test of an emotional avoidance model of restriction in anorexia nervosa using ecological momentary assessment. In: Journal of Psychiatric Research 68, S. 134–139. DOI: 10.1016/j.jpsychires.2015.06.016.

It has been hypothesized that restrictive eating allows individuals with anorexia nervosa (AN) to avoid contact with negative emotions; however, this presumption has not been directly tested. In this study, we conducted an initial investigation examining whether restrictive eating serves an emotional avoidance function among individuals with AN. Females with AN (n = 118) reported on negative and positive affect, anxiety/tension, and eating behaviors at multiple time points daily over a 2-week period using ecological momentary assessment methodology. Affective patterns were compared using generalized estimating equation models between days in which participants reported either: (1) relatively high restriction (without binge eating); (2) relatively low restriction (without binge eating); (3) binge eating; or (4) no restriction or binge eating. We hypothesized that, if restriction were functioning to avoid negative affect, average negative affect and anxiety/tension, as well as average negative and positive affect liability, would be lower and average positive affect would be higher on days characterized by high levels of restriction compared to other eating patterns. Contrary to hypotheses: (1) average negative affect, anxiety/tension, and positive affect were not significantly different between days characterized by high restriction and those characterized by low or no restriction; (2) Negative affect and anxiety/tension liability were higher on days characterized by high restriction compared to no restriction or binge eating days; (3) Anxiety/tension liability was higher on days characterized by high versus low levels of restriction. This patterns of findings does not support an avoidance model of restrictive eating for individuals with AN.

Heller, Aaron S.; Fox, Andrew S.; Wing, Erik K.; McQuisition, Kaitlyn M.; Vack, Nathan J.; Davidson, Richard J. (2015): The neurodynamics of affect in the laboratory predicts persistence of real-world emotional responses. In: The Journal of Neuroscience 35 (29), S. 10503–10509. DOI: 10.1523/JNEUROSCI.0569-15.2015.

Failure to sustain positive affect over time is a hallmark of depression and other psychopathologies, but the mechanisms supporting the ability to sustain positive emotional responses are poorly understood. Here, we investigated the neural correlates associated with the persistence of positive affect in the real world by conducting two experiments in humans: an fMRI task of reward responses and an experience-sampling task measuring emotional responses to a reward obtained in the field. The magnitude of DLPFC engagement to rewards administered in the laboratory predicted reactivity of real-world positive emotion following a reward administered in the field. Sustained ventral striatum engagement in the laboratory positively predicted the duration of real-world positive emotional responses. These results suggest that common pathways are associated with the unfolding of neural processes over seconds and with the dynamics of emotions experienced over minutes. Examining such dynamics may facilitate a better understanding of the brain-behavior associations underlying emotion.

Henao, Maria Paula; Bewtra, Meenakshi; Osterman, Mark T.; Aberra, Faten N.; Scott, Frank I.; Lichtenstein, Gary R. et al. (2015): Measurement of Inflammatory Bowel Disease Symptoms: Reliability of an Abbreviated Approach to Data Collection. In: Inflammatory bowel diseases 21 (10), S. 2262–2271. DOI: 10.1097/MIB.0000000000000496.

BACKGROUND: The Crohn’s Disease Activity Index (CDAI) and Mayo score for ulcerative colitis (UC) require symptom recall and/or use of a symptom diary. We examined patients’ abilities to recall their symptoms and the day-to-day variability of symptoms. METHODS: Patients with UC or CD completed a questionnaire including items from the short CDAI (sCDAI) and the 6-point Mayo score. Patients were randomized to receive a follow-up questionnaire testing recall of the bowel symptom items between 1 and 7 days later. In a second study, patients completed a 7-day electronic diary recording their symptoms. sCDAI and 6-point Mayo scores were computed. Analyses estimated daily variability in the indices and misclassification rates when using fewer than 7 days of data. RESULTS: 100%, 82%, and 90% of CD participants recalled the same disease activity status (i.e., active versus remission) as reported on the initial survey when the follow-up questionnaire was administered 1 to 2, 3 to 5, and 6 to 8 days later, respectively. Compared with using 7 days of data, when using only day 7 data, 3.7% of patients with CD were misclassified as active or inactive. Disease activity was misclassified in 2.8%, 4.9%, and 3.3% of patients by using the last 2, 3, or 4 days, respectively. Results were similar for patients with UC. CONCLUSIONS: Patients with CD and UC demonstrated good recall of bowel symptoms for up to 8 days. Additionally, bowel symptoms have relatively little variability within a 7-day period allowing for accurate computation of the sCDAI and 6-point Mayo score using 1 to 3 days of data.

Heron, Kristin E.; Mason, Tyler B.; Sutton, Tiphanie G.; Myers, Taryn A. (2015): Evaluating the real-world predictive validity of the Body Image Quality of Life Inventory using Ecological Momentary Assessment. In: Body image 15, S. 105–108. DOI: 10.1016/j.bodyim.2015.07.004.

Perceptions of physical appearance, or body image, can affect psychosocial functioning and quality of life (QOL). The present study evaluated the real-world predictive validity of the Body Image Quality of Life Inventory (BIQLI) using Ecological Momentary Assessment (EMA). College women reporting subclinical disordered eating/body dissatisfaction (N=131) completed the BIQLI and related measures. For one week they then completed five daily EMA surveys of mood, social interactions, stress, and eating behaviors on palmtop computers. Results showed better body image QOL was associated with less negative affect, less overwhelming emotions, more positive affect, more pleasant social interactions, and higher self-efficacy for handling stress. Lower body image QOL was marginally related to less overeating and lower loss of control over eating in daily life. To our knowledge, this is the first study to support the real-world predictive validity of the BIQLI by identifying social, affective, and behavioral correlates in everyday life using EMA.

Hofmann, Wilhelm; Finkel, Eli J.; Fitzsimons, Gráinne M. (2015): Close relationships and self-regulation: How relationship satisfaction facilitates momentary goal pursuit. In: Journal of Personality and Social Psychology 109 (3), S. 434–452. DOI: 10.1037/pspi0000020.

In the new millennium, scholars have built a robust intersection between close-relationships research and self-regulation research. However, virtually no work has investigated how the most basic and broad indicator of relationship quality, relationship satisfaction, affects self-regulation and vice versa. In the present research, we show that higher relationship satisfaction promotes a motivational mind-set that is conducive for effective self-regulation, and thus for goal progress and performance. In Study 1—a large-scale, intensive experience sampling project of 115 couples (total N = 230)—we closely tracked fluctuations in state relationship satisfaction (SRS) and 4 parameters of effective self-regulation according to our conceptual model. Dyadic process analyses showed that individuals experiencing higher SRS than they typically do exhibited higher levels of (a) perceived control, (b) goal focus, (c) perceived partner support, and (d) positive affect during goal pursuit than they typically exhibit. Together, these 4 self-regulation-relevant variables translated into higher rates of daily progress on specific, idiographic goals. In Study 2 (N = 195), we employed a novel experimental manipulation of SRS, replicating the link between SRS and parameters of effective self-regulation. Taken together, these findings suggest that momentary increases in relationship satisfaction may benefit everyday goal pursuit through a combination of cognitive and affective mechanisms, thus further integrating relationship research with social–cognitive research on goal pursuit.

Huang, Jason L.; Chiaburu, Dan S.; Zhang, Xin-an; Li, Ning; Grandey, Alicia A. (2015): Rising to the challenge: Deep acting is more beneficial when tasks are appraised as challenging. In: Journal of Applied Psychology 100 (5), S. 1398–1408. DOI: 10.1037/a0038976.

Cumulative research indicates that deep acting has a nonsignificant relationship with employee exhaustion, despite arguments that deep acting can be beneficial. To illuminate when deep acting leads to more positive employee outcomes, we draw on the resource conservation perspective to propose a within-individual model of deep acting that focuses on service employees’ daily fluctuation of emotional labor and emotional exhaustion. Specifically, we propose that the ongoing experience of felt challenge is a within-person boundary condition that moderates deep acting’s relationship with emotional exhaustion, and model emotional exhaustion as a mediating mechanism that subsequently predicts momentary job satisfaction and daily customer conflict handling. Using an experience sampling design, we collected data from 84 service employees over a 3-week period. Deep acting was less emotionally exhausting for service providers when they saw their tasks as more challenging. Furthermore, emotional exhaustion mediated the deep acting by felt challenge interaction effect on momentary job satisfaction and daily customer conflict handling. The findings contribute to a better understanding of the deep acting experience at work, while highlighting customer conflict handling as a key behavioral outcome of emotional labor.

Huang, Jurong; Ding, Hang; McBride, Simon; Ireland, David; Karunanithi, Mohan (2015): Use of Smartphones to Estimate Carbohydrates in Foods for Diabetes Management. In: Studies in health technology and informatics 214, S. 121–127.

Over 380 million adults worldwide are currently living with diabetes and the number has been projected to reach 590 million by 2035. Uncontrolled diabetes often lead to complications, disability, and early death. In the management of diabetes, dietary intervention to control carbohydrate intake is essential to help manage daily blood glucose level within a recommended range. The intervention traditionally relies on a self-report to estimate carbohydrate intake through a paper based diary. The traditional approach is known to be inaccurate, inconvenient, and resource intensive. Additionally, patients often require a long term of learning or training to achieve a certain level of accuracy and reliability. To address these issues, we propose a design of a smartphone application that automatically estimates carbohydrate intake from food images. The application uses imaging processing techniques to classify food type, estimate food volume, and accordingly calculate the amount of carbohydrates. To examine the proof of concept, a small fruit database was created to train a classification algorithm implemented in the application. Consequently, a set of fruit photos (n=6) from a real smartphone were applied to evaluate the accuracy of the carbohydrate estimation. This study demonstrates the potential to use smartphones to improve dietary intervention, although further studies are needed to improve the accuracy, and extend the capability of the smartphone application to analyse broader food contents.

Hunter, Emily M.; Wu, Cindy (2015): Give Me a Better Break: Choosing Workday Break Activities to Maximize Resource Recovery. In: The Journal of applied psychology. DOI: 10.1037/apl0000045.

Surprisingly little research investigates employee breaks at work, and even less research provides prescriptive suggestions for better workday breaks in terms of when, where, and how break activities are most beneficial. Based on the effort-recovery model and using experience sampling methodology, we examined the characteristics of employee workday breaks with 95 employees across 5 workdays. In addition, we examined resources as a mediator between break characteristics and well-being. Multilevel analysis results indicated that activities that were preferred and earlier in the work shift related to more resource recovery following the break. We also found that resources mediated the influence of preferred break activities and time of break on health symptoms and that resource recovery benefited person-level outcomes of emotional exhaustion, job satisfaction, and organizational citizenship behavior. Finally, break length interacted with the number of breaks per day such that longer breaks and frequent short breaks were associated with more resources than infrequent short breaks.

Huntley, Geoffrey; Treloar, Hayley; Blanchard, Alexander; Monti, Peter M.; Carey, Kate B.; Rohsenow, Damaris J.; Miranda, Robert (2015): An event-level investigation of hangovers’ relationship to age and drinking. In: Experimental and clinical psychopharmacology 23 (5), S. 314–323. DOI: 10.1037/pha0000037.

Animal and human data suggest that adolescents experience hangover effects that are distinct from adults. The present study used ecological momentary assessment (EMA) methods to examine the temporal relationships between drinking and hangovers, and how this varied by age and sex. We hypothesized that alcohol’s dose-dependent effects on hangover severity are more pronounced among adolescents and young adults than older drinkers. We also explored whether greater hangover severity would lead to a lower likelihood and volume of alcohol use later the same day. Data were pooled from 4 studies of drinkers (N = 274; ages 15 to 66 years) who completed a 4- to 14-day (M = 7.46, SD = 1.13) EMA monitoring period. Each morning, participants recorded how much alcohol they consumed the day before and rated their hangover severity. Participants who consumed a greater quantity of alcohol the prior day reported more severe hangover symptoms; however, there was an interaction between drinking volume and age, such that hangover was more severe among younger drinkers, especially at higher drinking levels. More severe hangover symptoms did not predict the likelihood of drinking later that day; however, on drinking days, more severe hangover symptoms predicted lower quantities of alcohol use later that day. This event-level effect did not vary as a function of age. Study outcomes did not vary by sex. Our findings suggest that younger drinkers experience more severe hangovers, and that greater hangover results in lighter drinking later that same day regardless of age.

Hussain, Muzammil; Al-Haiqi, Ahmed; Zaidan, A. A.; Zaidan, B. B.; Kiah, M L M; Anuar, Nor Badrul; Abdulnabi, Mohamed (2015): The landscape of research on smartphone medical apps: Coherent taxonomy, motivations, open challenges and recommendations. In: Computer methods and programs in biomedicine. DOI: 10.1016/j.cmpb.2015.08.015.

OBJECTIVE: To survey researchers’ efforts in response to the new and disruptive technology of smartphone medical apps, mapping the research landscape form the literature into a coherent taxonomy, and finding out basic characteristics of this emerging field represented on: motivation of using smartphone apps in medicine and healthcare, open challenges that hinder the utility, and the recommendations to improve the acceptance and use of medical apps in the literature. METHODS: We performed a focused search for every article on (1) smartphone (2) medical or health-related (3) app, in four major databases: MEDLINE, Web of Science, ScienceDirect, and IEEE Xplore. Those databases are deemed broad enough to cover both medical and technical literature. RESULTS: The final set included 133 articles. Most articles (68/133) are reviews and surveys that refer to actual apps or the literature to describe medical apps for a specific specialty, disease, or purpose; or to provide a general overview of the technology. Another group (43/133) carried various studies, from evaluation of apps to exploration of desired features when developing them. Few researchers (17/133) presented actual attempts to develop medical apps, or shared their experiences in doing so. The smallest portion (5/133) proposed general frameworks addressing the production or operation of apps. DISCUSSION: Since 2010, researchers followed the trend of medical apps in several ways, though leaving areas or aspect for further attention. Regardless of their category, articles focus on the challenges that hinder the full utility of medical apps and do recommend mitigations to them. CONCLUSIONS: Research on smartphone medical apps is active and various. We hope that this survey contribute to the understanding of the available options and gaps for other researchers to join this line of research.

Jackson, Jonathan; Gouseti, Ioanna (2015): Psychological proximity and the construal of crime: A commentary on ‘Mapping fear of crime as a context‐dependent everyday experience that varies in space and time’. In: Legal and Criminological Psychology 20 (2), S. 212–214. DOI: 10.1111/lcrp.12082.

Fear of crime is a dynamic psychosocial phenomenon, and sophisticated methodologies are necessary in order to explore its multidimensionality and complexity. The experience sampling method (ESM) that is used by Solymosi and colleagues (2015) is a promising methodological way forward in fear of crime research. While acknowledging the advantages of ESM, in this commentary we discuss a potential disadvantage of the method, namely the possibility that ESM can increase the psychological proximity of crime. Drawing upon construal‐level theory of psychological distance, we argue that ESM might sensitize people to think about crime through the lens of personal risk, with a knock‐on effect on the construal of crime.

Jiang, Da; Fung, Helene H.; Sims, Tamara; Tsai, Jeanne L.; Zhang, Fan (2015): Limited Time Perspective Increases the Value of Calm. In: Emotion. DOI: 10.1037/emo0000094.

Previous findings indirectly suggest that the more people perceive their time in life as limited, the more they value calm. No study, however, has directly tested this hypothesis. To this end, using a combination of survey, experience sampling, and experimental methods, we examined the relationship between future time perspective and the affective states that people ideally want to feel (i.e., their “ideal affect”). In Study 1, the more people reported a limited time perspective, the more they wanted to feel calm and experience other low-arousal positive states. In Study 2, participants were randomly assigned to a limited time or an expanded time condition. Participants in the limited time condition reported valuing calm and other low arousal positive states more than those in the expanded time condition. We discuss the implications of these findings for broadening our understanding of the factors that shape how people ideally want to feel, and their consequences for decision making.

Juengst, Shannon B.; Graham, Kristin M.; Pulantara, I. Wayan; McCue, Michael; Whyte, Ellen M.; Dicianno, Brad E. et al. (2015): Pilot feasibility of an mHealth system for conducting ecological momentary assessment of mood-related symptoms following traumatic brain injury. In: Brain injury, S. 1–11.

OBJECTIVE: This study assessed pilot feasibility and validity of a mobile health (mHealth) system for tracking mood-related symptoms after traumatic brain injury (TBI). DESIGN: A prospective, repeated measures design was used to assess compliance with daily ecological momentary assessments (EMA) conducted via a smartphone application over an 8-week period. METHODS: An mHealth system was developed specifically for individuals with TBI and utilized previously validated tools for depressive and anxiety symptoms (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7). Feasibility was assessed in 20 community-dwelling adults with TBI via an assessment of compliance, satisfaction and usability of the smartphone applications. The authors also developed and implemented a clinical patient safety management mechanism for those endorsing suicidality. RESULTS: Participants correctly completed 73.4% of all scheduled assessments, demonstrating good compliance. Daily assessments took <2 minutes to complete. Participants reported high satisfaction with smartphone applications (6.3 of 7) and found them easy to use (6.2 of 7). Comparison of assessments obtained via telephone-based interview and EMA demonstrated high correlations (r = 0.81-0.97), supporting the validity of conducting these assessments via smartphone application in this population. CONCLUSIONS: EMA conducted via smartphone demonstrates initial feasibility among adults with TBI and presents numerous opportunities for long-term monitoring of mood-related symptoms in real-world settings.

Jung, Heajung; Park, In-Jo; Rie, Juil (2015): Future time perspective and career decisions: The moderating effects of affect spin. In: Journal of Vocational Behavior 89, S. 46–55. DOI: 10.1016/j.jvb.2015.04.010.

This study investigated the impact of future time perspective on two career decision-making variables and the role of affect spin as a moderator. 98 Korean undergraduate students completed questionnaires of future time perspective, career decision-making self-efficacy, and career choice anxiety. Using experience sampling method (ESM), we also collected students’ affective experiences during 7 consecutive days and computed affect variability, namely affect spin. Hierarchical regression analyses showed that career decision-making self-efficacy and career choice anxiety were positively predicted by future time perspective and that affect spin moderated the relationship between future time perspective and both career decision-making self-efficacy scale and career choice anxiety respectively. We discussed the implications of the moderating role of affect spin, advantages of the ESM method, and practical suggestions for career counseling and supervision.

Kanning, Martina; Ebner-Priemer, Ulrich; Schlicht, Wolfgang (2015): Using activity triggered e-diaries to reveal the associations between physical activity and affective states in older adult’s daily living. In: The International Journal of Behavioral Nutrition and Physical Activity 12, S. 111. DOI: 10.1186/s12966-015-0272-7.

BACKGROUND: Evidence suggests that older adults show positive affects after participating in exercise bouts. However, it is less clear, if and how physical activities in daily living enhance affective states, too. This is dissatisfying, as most of older adults’ physical activities are part of their daily living. To answer these questions we used activity-triggered e-diaries to investigate the within-subject effects of physical activity on three dimensions of affective states (valence, energetic arousal, calmness) during everyday life. METHODS: Older adults (N = 74) between 50 and 70 years took part in the study during three consecutive days. Physical activity in daily living was objectively assessed using accelerometers. Affects were measured 10 min after a study participant surpassed a predefined threshold for activity or inactivity. The participants were prompted by an acoustic signal to assess their momentary affective states on an e-diary. Data were analyzed with hierarchical multilevel analyses. RESULTS: Whenever older individuals were more physically active, they felt more energized (energetic arousal) and agitated (calmness). However, they did not feel better (valence). Interestingly, body mass index (BMI) and valence were associated in a significant cross-level interaction. BMI acts as a moderating variable in the way that lower BMI scores were associated with higher levels of valence scores after being physically active. CONCLUSIONS: The innovative ambulatory assessment used here affords an interesting insight to the affective effects of daily activity of older adults. These effects are no simple and no linear ones, i.e. physical activity is not associated with positive affects per se as shown several times in experimental studies with single activity bouts. Rather there is a differentiating association seen as an enhanced feeling of energy and agitation, which is not accompanied by a better feeling. Socio-emotional selectivity theory may support the finding that older individuals are emotionally more stable during their day-to-day life, which might explain the non-significant effect on the affect dimension valence.

Kikuchi, Hiroe; Yoshiuchi, Kazuhiro; Ando, Tetsuya; Yamamoto, Yoshiharu (2015): Influence of psychological factors on acute exacerbation of tension-type headache: Investigation by ecological momentary assessment. In: Journal of Psychosomatic Research. DOI: 10.1016/j.jpsychores.2015.06.008.

OBJECTIVE: In this study, we investigated whether psychological factors were associated with subsequent acute exacerbation of tension-type headache (TTH) in a prospective and ecologically valid manner with computerized ecological momentary assessment. METHODS: Eighteen women and five men with TTH wore watch-type computers that acted as an electronic diary for 1week. The subjects recorded momentary headache intensity, psychological stress, anxiety, and depressive mood with a visual analog scale of 0–100 approximately every 6h as well as when waking up, when going to bed, and at acute headache exacerbations. Multilevel logistic regression analysis with acute headache exacerbation occurrence as the outcome was conducted. Person-mean centering was applied to psychological factors to disaggregate between- and within-individual association. RESULTS: Momentary psychological stress was associated with subsequent increase in headache exacerbation within 3h [Odds Ratio (95% CI)=1.32 (1.07, 1.64) for 10-point increments] while the individual mean of psychological stress was not. CONCLUSION: These results support the possibility that psychological stress could trigger acute exacerbations of TTH.

Kim, Jihyun; Hahn, Kim H. Y. (2015): The effects of self-monitoring tendency on young adult consumers’ mobile dependency. In: Computers in Human Behavior 50, S. 169–176. DOI: 10.1016/j.chb.2015.04.009.

Retailing industry has evolved drastically, especially in the past two decades due to the mobile technology. A recent empirical research study proved that the public use of mobile devices can be explained by the extension of the self, Hahn and Kim (2013) suggesting that fashion and appearance related constructs are imperative to understand young adult consumers’ mobile use intentions. With an aim to better understand the consumer’s mobile usage behavior, the researchers adopted psychographic characteristics such as fashion involvement, self-monitoring tendency, and proclivity of experimenting with appearance to gauge the individual consumers’ mobile dependency. Using an online and paper survey, we collected 273 usable responses from college-aged consumers. T-tests revealed that individuals, who had a higher degree of one’s sensitivity of self-monitoring, exhibited a significantly higher mean scores in fashion involvement, experimenting with appearance, and mobile dependency. A similar pattern was found among the ones with higher degree of ability of self-monitoring tendency as well. Discussion and pragmatic implications to the retail industry are provided.

Kim, Miji; Yoshida, Hideyo; Sasai, Hiroyuki; Kojima, Narumi; Kim, Hunkyung (2015): Association between objectively measured sleep quality and physical function among community-dwelling oldest old Japanese: A cross-sectional study. In: Geriatrics & Gerontology International 15 (8), S. 1040–1048. DOI: 10.1111/ggi.12396.

Aim: The present study examined the association between objective measures of sleep quality and performance-based measures of physical function in community-dwelling oldest old Japanese. Methods: This cross-sectional study included 207 community-dwelling adults aged 80 years or older (92 men, 115 women; age 83.5 ± 2.6 years [range 80–95 years]). Participants wore an accelerometer (ActiGraph GT3X +) on their non-dominant wrist for 24 h per day over seven consecutive nights. Sleep parameters included total sleep time, sleep efficiency and wake after sleep onset during the night for a week. Performance-based physical function measures were handgrip strength, knee extension strength, and usual and maximum walking speeds. Multivariable linear regression was carried out to determine the associations between weekly sleep parameter averages and physical function measures. Results: Approximately 24% of participants had a total sleep time of less than 6 h a night, and 13% had greater than 8 h a night. Overall, average daily physical activity was 1771.8 ± 520.6 (counts/min/day). In multiple linear regression, sleep efficiency and wake after sleep onset were significantly associated with maximum walking speed (β = 0.277; 95% confidence interval [CI] 0.103 to 0.351 and β = −0.214; 95% CI −0.339 to −0.082, respectively) and usual walking speed (β = 0.200, 95% CI 0.035 to 0.305 and β = −0.174; 95% CI −0.341 to −0.064, respectively), after adjusting for potential confounding factors including daily physical activity. Both sleep qualities were also independently associated with knee extension strength. However, wake after sleep onset was not associated with handgrip strength. Conclusion: Objectively measured sleep quality was associated with physical function in the oldest old. Further research is required to identify the temporality of associations between sleep and physical function.

Konecny, Tomas; Saxon, Leslie A. (2015): Integration of Smartphone Based Monitoring - No Modality Is an Island, Entire of Itself. In: Journal of cardiovascular electrophysiology. DOI: 10.1111/jce.12844.

It would be difficult to find a statement more befitting the currently evolving epoch of human history characterized by unparalleled global integration and exponentially growing information exchange. Technological advances in wireless communication and mobile computing, that have democratized access to information and transformed the culture of communication, are also redefining the physician-patient relationship. This article is protected by copyright. All rights reserved.

Krane-Gartiser, Karoline; Henriksen, Tone E G; Vaaler, Arne E.; Fasmer, Ole Bernt; Morken, Gunnar (2015): Actigraphically assessed activity in unipolar depression: a comparison of inpatients with and without motor retardation. In: The Journal of clinical psychiatry. DOI: 10.4088/JCP.14m09106.

OBJECTIVE: To compare the activity patterns of inpatients with unipolar depression, who had been divided into groups with and without motor retardation prior to actigraphy monitoring. METHOD: Twenty-four-hour actigraphy recordings from 52 consecutively, acutely admitted inpatients with unipolar depression (ICD-10) were compared to recordings from 28 healthy controls. The patients, admitted between September 2011 and April 2012, were separated into 2 groups: 25 with motor retardation and 27 without motor retardation. Twenty-eight healthy controls were also included. Twenty-four-hour recordings, 9-hour daytime sequences, and 64-minute periods of continuous motor activity in the morning and evening were analyzed for mean activity, variability, and complexity. RESULTS: Patients with motor retardation had a reduced mean activity level (P = .04) and higher intraindividual variability, as shown by increased standard deviation (SD) (P = .003) and root mean square successive difference (RMSSD) (P = .025), during 24 hours compared to the patients without motor retardation. Both patient groups demonstrated significantly lower mean activity compared to healthy controls (P < .001) as well as higher SD (P < .02) and RMSSD (P < .001) and a higher RMSSD/SD ratio (P = .04). In the active morning period, the patients without motor retardation displayed significantly increased complexity compared to motor-retarded patients (P = .006). CONCLUSIONS: The patients with and without motor retardation differ in activity patterns. Findings in depressed inpatients without motor retardation closely resemble those of inpatients with mania.

Krieke, Lian Van Der; Jeronimus, Bertus F.; Blaauw, Frank J.; Wanders, Rob B. K.; Emerencia, Ando C.; Schenk, Hendrika M. et al. (2015): Hownutsarethedutch (hoegekisnl): A crowdsourcing study of mental symptoms and strengths. In: International Journal of Methods in Psychiatric Research. DOI: 10.1002/mpr.1495.

HowNutsAreTheDutch (Dutch: HoeGekIsNL) is a national crowdsourcing study designed to investigate multiple continuous mental health dimensions in a sample from the general population (n = 12,503). Its main objective is to create an empirically based representation of mental strengths and vulnerabilities, accounting for (i) dimensionality and heterogeneity, (ii) interactivity between symptoms and strengths, and (iii) intra‐individual variability. To do so, HowNutsAreTheDutch (HND) makes use of an internet platform that allows participants to (a) compare themselves to other participants via cross‐sectional questionnaires and (b) to monitor themselves three times a day for 30 days with an intensive longitudinal diary study via their smartphone. These data enable for personalized feedback to participants, a study of profiles of mental strengths and weaknesses, and zooming into the fine‐grained level of dynamic relationships between variables over time. Measuring both psychiatric symptomatology and mental strengths and resources enables for an investigation of their interactions, which may underlie the wide variety of observed mental states in the population. The present paper describes the applied methods and technology, and presents the sample characteristics. Copyright © 2015 John Wiley & Sons, Ltd.

Kurka, Jonathan M.; Adams, Marc A.; Todd, Michael; Colburn, Trina; Sallis, James F.; Cain, Kelli L. et al. (2015): Patterns of neighborhood environment attributes in relation to children’s physical activity. In: Health & Place 34, S. 164–170. DOI: 10.1016/j.healthplace.2015.05.006.

Characterizing neighborhood environments in relation to physical activity is complex. Latent profiles of parents’ perceptions of neighborhood characteristics were examined in relation to accelerometer-measured moderate-to-vigorous physical activity (MVPA) among 678 children (ages 6–12) in two US regions. Neighborhood environment profiles derived from walkability, transit access, aesthetics, crime and traffic safety, pedestrian infrastructure, and recreation/park access were created for each region. The San Diego County profile lowest on walkability and recreation/park access was associated with an average of 13 fewer min/day of children’s out-of-school MVPA compared to profiles higher on walkability and recreation/park access. Seattle/King County profiles did not differ on children’s MVPA. Neighborhood environment profiles were associated with children’s MVPA in one region, but results were inconsistent across regions.

Lanaj, Klodiana; Johnson, Russell E.; Lee, Stephanie M. (2015): Benefits of Transformational Behaviors for Leaders: A Daily Investigation of Leader Behaviors and Need Fulfillment. In: The Journal of applied psychology. DOI: 10.1037/apl0000052.

Although a large body of work has examined the benefits of transformational leadership, this work has predominantly focused on recipients of such behaviors. Recent research and theory, however, suggest that there are also benefits for those performing behaviors reflective of transformational leadership. Across 2 experience-sampling studies, we investigate the effects of such behaviors on actors’ daily affective states. Drawing from affective events theory and self-determination theory we hypothesize and find that engaging in behaviors reflective of transformational leadership is associated with improvement in actors’ daily affect, more so than engaging in behaviors reflective of transactional, consideration, initiating structure, and participative leadership. Behaviors reflective of transformational leadership improved actors’ affect in part by fulfilling their daily needs. Furthermore, extraversion and neuroticism moderated these effects such that extraverts benefitted less whereas neurotics benefitted more from these behaviors in terms of affective changes. We consider the theoretical and practical implications of these findings and offer directions for future research.

Lange, Stefanie; Süß, Heinz‐Martin (2015): Experimental evaluation of near‐ and far‐transfer effects of an adaptive multicomponent working memory training. In: Applied Cognitive Psychology 29 (4), S. 502–514. DOI: 10.1002/acp.3126.

An important question in cognitive science today is whether working memory training leads to transfer effects. Training studies reported no transfer as well as far transfer to untrained abilities (e.g., reasoning), but different methodological problems have not allowed reliable conclusions to be drawn. Furthermore, most samples have consisted of young adults, whereas older adults have rarely been included. This study attempted to address these limitations. Ninety‐one older adults were randomly assigned to a training group or an active or passive control group. Short‐term memory, speed, and reasoning were assessed as far‐transfer criteria. In addition, transfer to everyday life was investigated using an ambulatory assessment method. Although there were significant training effects, no transfer effects were found. Instead, the active control group showed the same increase in the near‐transfer tasks (i.e., working memory) as the experimental group indicating that unspecific factors explain the training gains of older adults.

Lavender, Jason M.; Utzinger, Linsey M.; Crosby, Ross D.; Goldschmidt, Andrea B.; Ellison, Jo; Wonderlich, Stephen A. et al. (2015): A naturalistic examination of the temporal patterns of affect and eating disorder behaviors in anorexia nervosa. In: International Journal of Eating Disorders. DOI: 10.1002/eat.22447.

Objective Evidence supports the presence of significant variability in the timing of affective experiences and eating disorder (ED) behaviors across ED populations. This study examined the naturalistic timing of affective states and ED behaviors in anorexia nervosa (AN). Methods Women (N = 118) with full or subthreshold DSM‐IV AN completed 2 weeks of ecological momentary assessment (EMA) involving self‐reports of affect and ED behaviors. Patterns of positive affect, negative affect, and tension/anxiety across hours of the day and days of the week were examined using linear mixed models. Variation in ED behavior occurrence (i.e., binge eating, vomiting, exercise, meal skipping, and self‐weighing) across hours of the day and days of the week was examined using general estimating equations. Results Results revealed significant variation in tension/anxiety across hours of the day; there were no significant associations between time of day and negative or positive affect. All affective variables significantly varied across days of the week, with both negative affect and tension/anxiety highest in the middle of the week and lowest on the weekends. The ED behaviors all significantly varied across hours of the day, with binge eating and vomiting most common in later hours, exercise and self‐weighing most common in earlier hours, and meal skipping most common at times corresponding to breakfast and lunch. ED behaviors did not significantly vary across days of the week. Conclusion The significant patterns of variation in the timing of affective experiences and ED behaviors may have utility in informing theories and interventions for AN. (Int J Eat Disord 2015).

Lindhiem, Oliver; Bennett, Charles B.; Rosen, Dana; Silk, Jennifer (2015): Mobile Technology Boosts the Effectiveness of Psychotherapy and Behavioral Interventions: A Meta-Analysis. In: Behavior modification. DOI: 10.1177/0145445515595198.

We conducted a meta-analysis on the effects of mobile technology on treatment outcome for psychotherapy and other behavioral interventions. Our search of the literature resulted in 26 empirical articles describing 25 clinical trials testing the benefits of smartphone applications, personal digital assistants (PDAs), or text messaging systems either to supplement treatment or substitute for direct contact with a clinician. Overall, mobile technology use was associated with superior treatment outcome across all study designs and control conditions, effect size (ES) = .34, p < .0001. For the subset of 10 studies that looked specifically at the added benefit of mobile technology using a rigorous “Treatment” versus “Treatment + Mobile” design, effect sizes were only slightly more modest (ES = .27) and still significant (p < .05). Overall, the results support the role of mobile technology for the delivery of psychotherapy and other behavioral interventions.

Linnemann, Alexandra; Ditzen, Beate; Strahler, Jana; Doerr, Johanna M.; Nater, Urs M. (2015): Music listening as a means of stress reduction in daily life. In: Psychoneuroendocrinology 60, S. 82–90. DOI: 10.1016/j.psyneuen.2015.06.008.

The relation between music listening and stress is inconsistently reported across studies, with the major part of studies being set in experimental settings. Furthermore, the psychobiological mechanisms for a potential stress-reducing effect remain unclear. We examined the potential stress-reducing effect of music listening in everyday life using both subjective and objective indicators of stress. Fifty-five healthy university students were examined in an ambulatory assessment study, both during a regular term week (five days) and during an examination week (five days). Participants rated their current music-listening behavior and perceived stress levels four times per day, and a sub-sample (n=25) additionally provided saliva samples for the later analysis of cortisol and alpha-amylase on two consecutive days during both weeks. Results revealed that mere music listening was effective in reducing subjective stress levels (p=0.010). The most profound effects were found when ‘relaxation’ was stated as the reason for music listening, with subsequent decreases in subjective stress levels (p</=0.001) and lower cortisol concentrations (p</=0.001). Alpha-amylase varied as a function of the arousal of the selected music, with energizing music increasing and relaxing music decreasing alpha-amylase activity (p=0.025). These findings suggest that music listening can be considered a means of stress reduction in daily life, especially if it is listened to for the reason of relaxation. Furthermore, these results shed light on the physiological mechanisms underlying the stress-reducing effect of music, with music listening differentially affecting the physiological stress systems.

Linnemann, Alexandra; Kappert, Mattes B.; Fischer, Susanne; Doerr, Johanna M.; Strahler, Jana; Nater, Urs M. (2015): The effects of music listening on pain and stress in the daily life of patients with fibromyalgia syndrome. In: Frontiers in human neuroscience 9, S. 434. DOI: 10.3389/fnhum.2015.00434.

Music listening is associated with both pain- and stress-reducing effects. However, the effects of music listening in daily life remain understudied, and the psycho-biological mechanisms underlying the health-beneficial effect of music listening remain unknown. We examined the effects of music listening on pain and stress in daily life in a sample of women with fibromyalgia syndrome (FMS; i.e., a condition characterized by chronic pain) and investigated whether a potentially pain-reducing effect of music listening was mediated by biological stress-responsive systems. Thirty women (mean age: 50.7 +/- 9.9 years) with FMS were examined using an ecological momentary assessment design. Participants rated their current pain intensity, perceived control over pain, perceived stress level, and music listening behavior five times per day for 14 consecutive days. At each assessment, participants provided a saliva sample for the later analysis of cortisol and alpha-amylase as biomarkers of stress-responsive systems. Hierarchical linear modeling revealed that music listening increased perceived control over pain, especially when the music was positive in valence and when it was listened to for the reason of ‘activation’ or ‘relaxation’. In contrast, no effects on perceived pain intensity were observed. The effects of music listening on perceived control over pain were not mediated by biomarkers of stress-responsive systems. Music listening in daily life improved perceived control over pain in female FMS patients. Clinicians using music therapy should become aware of the potential adjuvant role of music listening in daily life, which has the potential to improve symptom control in chronic pain patients. In order to study the role of underlying biological mechanisms, it might be necessary to use more intensive engagement with music (i.e., collective singing or music-making) rather than mere music listening.

Liu, Xinghua; Xu, Wei; Wang, Yuzheng; Williams, J. Mark G.; Geng, Yan; Zhang, Qian; Liu, Xin (2015): Can inner peace be improved by mindfulness training: A randomized controlled trial. In: Stress and Health: Journal of the International Society for the Investigation of Stress 31 (3), S. 245–254. DOI: 10.1002/smi.2551.

This article reports a randomized controlled trial to investigate whether mindfulness training can successfully improve inner peace in participants with no known mental disorder. Fifty‐seven participants were randomized to either mindfulness training (n = 29) or wait‐list control (n = 28). The experience sampling method was used to measure the fleeting momentary experience of inner peace in participants. In addition, we used an experimental approach to assessing ability to focus attention: the Meditation Breath Attention Score, as well as the self‐report Five‐Facet Mindfulness Questionnaire (FFMQ). Compared with the wait‐list control group, mindfulness training led to an increase in scores of inner peace, Meditation Breath Attention Score and FFMQ, using analysis of repeated measures analysis of variance. Change in inner peace was not, however, mediated by changes in self‐rated mindfulness (FFMQ) nor by increased attentional focus. The findings provide first evidence suggesting that using mindfulness training improves the participants’ inner peace. The focus here was on the immediate effects and future studies need to use follow‐up.

Marcusson-Clavertz, David; Cardena, Etzel; Terhune, Devin Blair (2015): Daydreaming Style Moderates the Relation Between Working Memory and Mind Wandering: Integrating Two Hypotheses. In: Journal of experimental psychology. Learning, memory, and cognition. DOI: 10.1037/xlm0000180.

Mind wandering-mentation unrelated to one’s current activity and surroundings-is a ubiquitous phenomenon, but seemingly competing ideas have been proposed regarding its relation to executive cognitive processes. The control-failure hypothesis postulates that executive processes prevent mind wandering, whereas the global availability hypothesis proposes that mind wandering requires executive resources, and thus an excess of such resources enables mind wandering. Here, we examined whether these hypotheses could be reconciled by considering the moderating influence of daydreaming style. We expected that executive resources would be positively related to mind wandering in those who typically experience positive mind wandering mentation, but negatively related in those who typically experience negative mentation. One hundred eleven participants reported mind wandering over 4 days using experience sampling and completed the sustained attention to response task (SART), the symmetry span task, and the Stroop task. There was a significant interaction between working memory and negative, but not positive, daydreaming style on mind wandering: Working memory related positively to mind wandering in those with a low negative style, but negatively in those with a high negative style. In contrast, poor Stroop performance significantly predicted increased mind wandering, but only in those with a low positive style. SART responses did not predict mind wandering although the relation was suggestively enhanced as the difficulty of daily life activities increased, indicating that the SART is more generalizable to high-demanding than low-demanding activities. These results suggest that the content and context of mind wandering episodes play important roles in the relation between executive processes and mind wandering.

Mason, Michael; Mennis, Jeremy; Way, Thomas; Campbell, Leah Floyd (2015): Real-Time Readiness to Quit and Peer Smoking within a Text Message Intervention for Adolescent Smokers: Modeling Mechanisms of Change. In: Journal of Substance Abuse Treatment. DOI: 10.1016/j.jsat.2015.07.009.

The psychological construct, readiness to change, is established as a central construct within behavioral change theories such as motivational interviewing (MI). Less is known about the interplay of mechanisms for change within adolescent treatment populations. Understanding the timing and interactive influence that adolescents’ readiness to stop smoking and peer smoking have on subsequent tobacco use is important to advance intervention research. Toward this end, we used ecological momentary assessment (EMA) data from an automated texting smoking intervention randomized controlled trial to model the interactive effects of readiness to stop smoking and friends smoking on adolescent tobacco use. Two hundred adolescents were randomized into experimental treatment or attention control conditions, provided smart phones, and were followed for 6months. African American youth represented the majority of the sample. We collected monthly EMA data for 6months on friends smoking and readiness to stop smoking as well as survey outcome data. We tested a moderated mediation model using bias corrected bootstrapping to determine if the indirect effect of treatment on cigarettes smoked through readiness to stop smoking was moderated by friends smoking. Findings revealed that readiness to stop smoking mediated the effects of treatment on cigarettes smoked for those adolescents with fewer friends smoking, but not for those with more friends smoking. These results support importance of peer-focused interventions with urban adolescents and provide target mechanisms for future research.

McCabe, Kira O.; Fleeson, William (2015): Are Traits Useful? Explaining Trait Manifestations as Tools in the Pursuit of Goals. In: Journal of Personality and Social Psychology. DOI: 10.1037/a0039490.

Traits and motivation mainly have been treated separately for almost a century. The purpose of these studies is to test the proposal that traits and motivation are intricately linked. Specifically, that 1 explanation for traits, at least in terms of their descriptiveness of what people actually do, is the goals people pursue. Study 1 used experience-sampling methodology to show that almost half the variance in extraversion and conscientiousness manifestation was explained by goal pursuit differences. Both why people enacted more of extraversion and/or conscientiousness than others, and why people enacted extraversion and/or conscientiousness at any given moment were explained by the goals people were pursuing at those moments. Study 2 used experimental methodology to show that extraversion and conscientiousness enactment was in fact caused by the goal pursuit. Study 3 employed observer ratings to show that the goal-dependent enactments of traits were observer-verified actual behaviors. In all 3 studies, different goals affected different traits discriminatively. Thus, these findings provided strong evidence for 1 explanation of traits, that they are useful for accomplishing goals. These findings provided 1 answer to long-standing questions about the conceptual relations between traits and motivation. And these findings clarified the meaning and nature of extraversion and conscientiousness by revealing part of what these traits are for.

McCarthy, Margaret; Grey, Margaret (2015): Motion Sensor Use for Physical Activity Data: Methodological Considerations. In: Nursing research 64 (4), S. 320–327. DOI: 10.1097/NNR.0000000000000098.

BACKGROUND: Physical inactivity continues to be a major risk factor for cardiovascular disease, and only one half of adults in the United States meet physical activity (PA) goals. PA data are often collected for surveillance or for measuring change after an intervention. One of the challenges in PA research is quantifying exactly how much and what type of PA is taking place-especially because self-report instruments have inconsistent validity. OBJECTIVE: The purpose is to review the elements to consider when collecting PA data via motion sensors, including the difference between PA and exercise, type of data to collect, choosing the device, length of time to monitor PA, instructions to the participants, and interpretation of the data. METHODS: The current literature on motion sensor research was reviewed and synthesized to summarize relevant considerations when using a motion sensor to collect PA data. RESULTS: Exercise is a division of PA that is structured, planned, and repetitive. Pedometer data include steps taken and calculated distance and energy expenditure. Accelerometer data include activity counts and intensity. The device chosen depends on desired data, cost, validity, and ease of use. Reactivity to the device may influence the duration of data collection. Instructions to participants may vary depending on the purpose of the study. Experts suggest pedometer data be reported as steps-because that is the direct output-and distance traveled and energy expenditure are estimated values. Accelerometer count data may be analyzed to provide information on time spent in moderate or vigorous activity. DISCUSSION: Thoughtful decision making about PA data collection using motion sensor devices is needed to advance nursing science.

McCarthy, Danielle E.; Minami, Haruka; Yeh, Vivian M.; Bold, Krysten W. (2015): An experimental investigation of reactivity to ecological momentary assessment frequency among adults trying to quit smoking. In: Addiction. DOI: 10.1111/add.12996.

Aims Ecological Momentary Assessment (EMA) captures real‐time reports in subjects’ natural environments. This experiment manipulated EMA frequency to estimate effects on abstinence and peri‐cessation subjective experiences. Design In this randomized trial, subjects had an equal chance of being assigned to low‐frequency (once) or high‐frequency (six times) daily EMA for 4 weeks (1 week pre‐ and 3 weeks post‐cessation). Participants completed six office visits over 5 weeks and 6‐ and 12‐week follow‐up telephone interviews. Setting Community participants were recruited from central New Jersey, USA. Participants One hundred and ten adult daily smokers seeking to quit smoking were included in intent‐to‐treat analyses of tobacco abstinence; 94 were available for secondary analyses of peri‐cessation subjective ratings. Measurements Primary outcomes were cessation (abstaining at least 24 hours within 2 weeks of attempting to quit) and prolonged abstinence (no relapse between weeks 2 and 12 post‐quit). Secondary outcomes were mean levels and growth in ratings of cigarette craving, affect and quitting motivation and self‐efficacy. Findings EMA frequency was unrelated to cessation (odds ratio = 1.367, 95% confidence interval = 0.603–3.098) or prolonged abstinence (odds ratio = 1.040, 95% confidence interval = 0.453–2.388) in intent‐to‐treat analyses. High‐frequency EMA was associated with lower craving (B = –0.544, standard error (SE) = 0.183, P = 0.004, anxiety (B = –0.424, SE = 0.170, P = 0.015), anger (B = –0.474, SE = 0.139, P = 0.001), hunger (B = –0.388, SE = 0.170, P = 0.025) and positive affect (B = –0.430, SE = 0.196, P = 0.03). Conclusions In smokers trying to quit, more frequent ecological momentary assessment self‐monitoring results in lower craving, anxiety, anger, hunger and positive affect. It is not clear whether this translates into higher rates of smoking abstinence.

McInerney, Stephen (2015): Can You Diagnose Me Now? A Proposal to Modify FDA’s Regulation of Smartphone Mobile Health Applications with a Pre-Market Notification and Application Database System. In: Food and drug law journal 70 (1), S. 161-85, ii.

Mobile applications provide limitless possibilities for the future of medical care. Yet these changes have also created concerns about patient safety. Under the Federal Food, Drug, and Cosmetic Act (FDCA), the Food and Drug Administration (FDA) has the authority to regulate a much broader spectrum of products beyond traditional medical devices like stethoscopes or pacemakers. The regulatory question is not if FDA has the statutory. authority to regulate health-related software, but rather how it will exercise its regulatory authority. In September 2013, FDA published guidance on Mobile Medical Applications; in it, the Agency limited its oversight to a small subset of medical-related mobile applications, referred to as “mobile medical applications.” For the guidance to be effective, FDA must continue to work directly with all actors-including innovators, doctors, and patients-as the market for mobile health applications continues to develop. This Article argues that FDA should adopt a two-step plan-a pre-market notification program and a mobile medical application database-to aid in the successful implementation of its 2013 guidance. By doing so, FDA will ensure that this burgeoning market can reach its fullest potential.

Mehta, Clare M. (2015): Gender in context: Considering variability in wood and eagly’s traditions of gender identity. In: Sex Roles. DOI: 10.1007/s11199-015-0535-4.

This paper was written in response to Wood and Eagly’s (2015) feminist forum paper that proposes two traditions for gender identity research, a tradition based on gender-typed attributes and a tradition based on gender self-conceptualization. The present paper expands on Wood and Eagly’s (2015) framework by proposing, in line with social constructivist models, that both traditions of gender identity may be variable and context dependent. Specifically, the present paper reviews research conducted in the U.S.A. that suggests that gender-typed attributes and components of gender self-conceptualization may change based on contextual factors such as the gender of people in a person’s immediate context and the salience of gender in a given situation. The paper also reviews ways in which variation in gender-typed attributes and components of gender self-conceptualization has been measured previously, and suggests the use of experience sampling methodology for future research. Finally, the paper encourages researchers to consider Wood and Eagly’s (2015) suggestion of using the principle of compatibility when selecting trait or state measures of gender identity, and proposes that beliefs in gender essentialism (that gender differences are due to innate traits) may be reduced by understanding how contextual factors influence gender identity.

Meredith-Jones, Kim; Williams, Sheila; Galland, Barbara; Kennedy, Gavin; Taylor, Rachael (2015): 24 h Accelerometry: impact of sleep-screening methods on estimates of sedentary behaviour and physical activity while awake. In: Journal of sports sciences, S. 1–7. DOI: 10.1080/02640414.2015.1068438.

Although accelerometers can assess sleep and activity over 24 h, sleep data must be removed before physical activity and sedentary time can be examined appropriately. We compared the effect of 6 different sleep-scoring rules on physical activity and sedentary time. Activity and sleep were obtained by accelerometry (ActiGraph GT3X) over 7 days in 291 children (51.3% overweight or obese) aged 4-8.9 years. Three methods removed sleep using individualised time filters and two methods applied standard time filters to remove sleep each day (9 pm-6 am, 12 am-6 am). The final method did not remove sleep but simply defined non-wear as at least 60 min of consecutive zeros over the 24-h period. Different methods of removing sleep from 24-h data markedly affect estimates of sedentary time, yielding values ranging from 556 to 1145 min/day. Estimates of non-wear time (33-193 min), wear time (736-1337 min) and counts per minute (384-658) also showed considerable variation. By contrast, estimates of moderate-to-vigorous activity (MVPA) were similar, varying by less than 1 min/day. Different scoring methods to remove sleep from 24-h accelerometry data do not affect measures of MVPA, whereas estimates of counts per minute and sedentary time depend considerably on which technique is used.

Merwin, Rhonda M.; Dmitrieva, Natalia O.; Honeycutt, Lisa K.; Moskovich, Ashley A.; Lane, James D.; Zucker, Nancy L. et al. (2015): Momentary Predictors of Insulin Restriction Among Adults With Type 1 Diabetes and Eating Disorder Symptomatology. In: Diabetes care. DOI: 10.2337/dc15-0753.

OBJECTIVE: Individuals with type 1 diabetes who restrict insulin to control weight are at high risk for diabetes-related complications and premature death. However, little is known about this behavior or how to effectively intervene. The aim of the current study was to identify predictors of insulin restriction in the natural environment that might inform new treatment directions. RESEARCH DESIGN AND METHODS: Eighty-three adults with type 1 diabetes and a range of eating disorder symptomatology completed three days of ecological momentary assessment. Participants reported emotions, eating, and insulin dosing throughout the day using their cellular telephone. Linear mixed models were used to estimate the effects of heightened negative affect (e.g., anxiety) before eating and characteristics of the eating episode (e.g., eating a large amount of food) on the risk of insulin restriction. RESULTS: Individuals who reported greater-than-average negative affect (general negative affect and negative affect specifically about diabetes) during the study period were more likely to restrict insulin. Momentary increases in anxiety/nervousness and guilt/disgust with self before eating (relative to an individual’s typical level) further increased the odds of restricting insulin at the upcoming meal. Insulin restriction was more likely when individuals reported that they broke a dietary rule (e.g., “no desserts”). CONCLUSIONS: Results suggest that insulin restriction might be decreased by helping patients with type 1 diabetes respond effectively to heightened negative affect (e.g., anxiety, guilt) and encouraging patients to take a less rigid, punitive approach to diabetes management.

Miskewicz, Kelly; Fleeson, William; Arnold, Elizabeth Mayfield; Law, Mary Kate; Mneimne, Malek; Furr, R. Michael (2015): A contingency-oriented approach to understanding borderline personality disorder: Situational triggers and symptoms. In: Journal of Personality Disorders 29 (4), S. 486–502. DOI: 10.1521/pedi.2015.29.4.486.

This article tested a contingency-oriented perspective to examine the dynamic relationships between in-the-moment borderline personality disorder (BPD) symptom events and in-the-moment triggers. An experience sampling study with 282 adults, including 77 participants with BPD, obtained reports of situational triggers and BPD symptom events five times daily for 2 weeks. Triggers included being rejected, betrayed, abandoned, offended, and disappointed; having one’s self-concept threatened; being in a boring situation; and being alone. BPD was associated with increased situational triggers. Multilevel models revealed significant within-person associations between situational triggers and BPD symptoms for the average participant in the study, with significant individual variance in the strength and direction of trigger-symptom contingencies. Most trigger-symptom contingencies were stronger for individuals with greater borderline symptomatology, suggesting that triggers are meaningfully related to BPD. These findings highlight possible proximal mechanisms that maintain BPD and help explain the course of a disorder often described as chaotic and unpredictable.

Morgenstern, Jon; Kuerbis, Alexis; Muench, Frederick (2014): Ecological Momentary Assessment and Alcohol Use Disorder Treatment. In: Alcohol research : current reviews 36 (1), S. 101–109.

The ability to capture real-time data on human behavior inexpensively, efficiently, and accurately holds promise to transform and broaden our understanding of many areas of health science. One approach to acquiring this type of real-time data is ecological momentary assessment (EMA).This method has been used to collect data in many domains of addiction research, including research on the treatment of alcohol use disorders (AUDs). Empirical evidence supports the hypothesis that use of EMA can improve the quality of AUD treatment research when compared with standard assessment methods because it provides more accurate reporting, allows investigators to examine the dynamic unfolding of the behavior change process at an individual level, and can be used to augment and improve clinical assessment and treatment. Overall, the existing literature provides strong support for the advantages of EMA when combined with standard assessment of addictive behaviors in general. Nevertheless, use of EMA in AUD treatment research thus far has been limited, especially in the area of research on mechanisms of behavior change. Existing research indicates, however, that EMA can be used to deliver tailored feed- back as a novel and potentially transformative approach to improving AUD treatment. This research area clearly warrants additional future efforts.

Nadell, Melanie J.; Mermelstein, Robin J.; Hedeker, Donald; Marquez, David X. (2015): Work and non-work physical activity predict real-time smoking level and urges in young adults. In: Nicotine & Tobacco Research 17 (7), S. 803–809. DOI: 10.1093/ntr/ntu244.

Introduction: Physical activity (PA) and smoking are inversely related. However, evidence suggests that some types of PA, namely work-related PA, may show an opposite effect. Despite growing knowledge, there remains a paucity of studies examining the context of these behaviors in naturalistic settings or in young adults, a high-risk group for escalation. Methods: Participants were 188 young adults (mean age = 21.32; 53.2% female; 91% current smokers) who participated in an electronic diary week to assess daily smoking and urges and a PA recall to examine daily PA. PA was coded into non-work-related and work-related activity to examine differential effects. We considered both participants’ weekly average PA and their daily deviations from their average. Results: Mixed-effects regression models revealed that higher weekly average non-work PA was associated with lower smoking level and urges. Daily deviations in non-work PA did not predict urges; however, increased daily non-work PA relative to participants’ weekly average was associated with lower smoking for females but higher levels for males. Regarding work PA, only higher weekly average work PA was associated with higher smoking level for both genders; work PA did not predict urges. Conclusions: Results extend previous literature by documenting differential associations between non-work and work PA and young adult smoking and suggest that young adults engaged in work PA should be considered a high-risk group for escalation. Findings provide theoretical and clinical implications for the use of PA in intervention and highlight the necessity of considering PA as a multidimensional construct when examining its links to health behavior.

Nam, Yunyoung; Reyes, Bersain; Chon, Ki (2015): Estimation of Respiratory Rates Using the Built-in Microphone of a Smartphone or Headset. In: IEEE journal of biomedical and health informatics. DOI: 10.1109/JBHI.2015.2480838.

This paper proposes accurate respiratory rate estimation using nasal breath sound recordings from a smartphone. Specifically, the proposed method detects nasal airflow using a built-in smartphone microphone or a headset microphone placed underneath the nose. In addition, we also examined if tracheal breath sounds recorded by the built-in microphone of a smartphone placed on the paralaryngeal space can also be used to estimate different respiratory rates ranging from as low as 6 breaths/min to as high as 90 breaths/min. The true breathing rates were measured using inductance plethysmography bands placed around the chest and the abdomen of the subject. Inspiration and expiration were detected by averaging the power of nasal breath sounds. We investigated the suitability of using the smartphone-acquired breath sounds for respiratory rate estimation using two different spectral analyses of the sound envelope signals: the Welch periodogram and the autoregressive spectrum. To evaluate the performance of the proposed methods, data were collected from 10 healthy subjects. For the breathing range studied (6-90 breaths/min), experimental results showed that our approach achieves an excellent performance accuracy for the nasal sound as the median errors were less than 1% for all breathing ranges. The tracheal sound, however, resulted in poor estimates of the respiratory rates using either spectral method. For both nasal and tracheal sounds, significant estimation outliers resulted for high breathing rates when subjects had nasal congestion, which often resulted in the doubling of the respiratory rates. Finally, we show that respiratory rates from the nasal sound can be accurately estimated even if a smartphone?s microphone is as far as 30 cm away from the nose.

Nicholas, Jennifer; Larsen, Mark Erik; Proudfoot, Judith; Christensen, Helen (2015): Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality. In: Journal of medical Internet research 17 (8), S. e198. DOI: 10.2196/jmir.4581.

BACKGROUND: With continued increases in smartphone ownership, researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality. OBJECTIVE: Our aim was to identify the types of apps currently available for BD in the Google Play and iOS stores and to assess their features and the quality of their content. METHODS: A systematic review framework was applied to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS stores for English-language apps developed for people with BD. The comprehensiveness and quality of information was assessed against core psychoeducation principles and current BD treatment guidelines. Management tools were evaluated with reference to the best-practice resources for the specific area. General app features, and privacy and security were also assessed. RESULTS: Of the 571 apps identified, 82 were included in the review. Of these, 32 apps provided information and the remaining 50 were management tools including screening and assessment (n=10), symptom monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82, 22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-practice guidelines. Only a third (10/32, 31%) cited their information source. Neither comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35, 51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%). CONCLUSIONS: In general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles. Apps also fail to provide important information to help users assess their quality, with most lacking source citation and a privacy policy. Therefore, both consumers and clinicians should exercise caution with app selection. While mHealth offers great opportunities for the development of quality evidence-based mobile interventions, new frameworks for mobile mental health research are needed to ensure the timely availability of evidence-based apps to the public.

Nishiguchi, S.; Ito, H.; Yamada, M.; Yoshitomi, H.; Furu, M.; Ito, T. et al. (2015): Self-assessment of Rheumatoid Arthritis Disease Activity Using a Smartphone Application. Development and 3-month Feasibility Study. In: Methods of information in medicine 54 (6). DOI: 10.3414/ME14-01-0106.

BACKGROUND: Rheumatoid arthritis (RA) is a progressive inflammatory disease that causes damage to multiple joints, decline in functional status, and premature mortality. Thus, effective and frequent objective assessments are necessary. Then, we developed a self-assessment system for RA patients based on a smartphone application. OBJECTIVE: The purpose of this study was to investigate the feasibility of a self-assessment system for RA patients using a smartphone application. METHODS: We measured daily disease activity in nine RA patients who used the smartphone application for a period of three months. A disease activity score (DAS28) predictive model was used and feedback comments relating to disease activity were shown to patients via the smartphone application each day. To assess participants’ RA disease activity, the DAS28 based on the C-reactive protein level was measured by a rheumatologist during monthly clinical visits. RESULTS: The disease activity measured by the application correlated well with the patients’ actual disease activity during the 3-month period, as assessed by clinical examination. Furthermore, most participants gave favourable responses to a questionnaire administered at the end of the 3-month period containing questions relating to the ease of use and usefulness of the system. CONCLUSIONS: The results of this feasibility study indicated that the DAS28 predictive model can longitudinally predict DAS28 and may be an acceptable and useful tool for assessment of RA disease activity for both patients and healthcare providers.

O’Reilly, Gillian A.; Huh, Jimi; Schembre, Susan M.; Tate, Eleanor B.; Pentz, Mary Ann; Dunton, Genevieve (2015): Association of usual self-reported dietary intake with ecological momentary measures of affective and physical feeling states in children. In: Appetite 92, S. 314–321. DOI: 10.1016/j.appet.2015.05.032.

Background: Little is known about the relationship between dietary intake and affective and physical feeling states in children. Purpose: The current study used Ecological Momentary Assessment (EMA) to examine how usual dietary intake is cross-sectionally associated with both average affective and physical feeling state ratings and rating variability in children. Methods: Children (N = 110, mean age = 11.0 ± 1.2 years, 52.5% male, 30.1% Hispanic/Latino) completed EMA measures of affective and physical feeling states 3–7 times per day for a full or partial day (weekday evenings and weekend days and evenings) over a 4-day period. Usual intake of pre-selected dietary components was measured prior to the EMA measurement period using the Block Kids Food Screener. Statistical analyses included mixed models and mixed-effects location scale models. Results: Greater usual fiber intake was cross-sectionally associated with higher average positive affect (PA) ratings, lower variability of NA ratings, and higher variability of physical fatigue ratings. Lower usual glycemic load of diet was cross-sectionally associated with lower variability of NA ratings. Lower usual added sugar intake was cross-sectionally associated with higher average physical energy ratings and lower variability of NA ratings. Conclusions: Although temporal precedence was not established by these findings, they indicate that characteristics of children’s usual dietary intake are cross-sectionally associated with both the average and variability of affective and physical feeling states. EMA offers a promising avenue through which to explore the associations between affective states and diet and has the potential to provide insight into nuances of this relationship.

Osipov, Maxim; Behzadi, Yashar; Kane, John M.; Petrides, Georgios; Clifford, Gari D. (2015): Objective identification and analysis of physiological and behavioral signs of schizophrenia. In: Journal of mental health (Abingdon, England), S. 1–7. DOI: 10.3109/09638237.2015.1019048.

BACKGROUND: A patient’s physical activity is often used by psychiatrists to contribute to the diagnostic process for mental disorders. Typically, it is based mostly on self-reports or observations, and hardly ever upon actigraphy. Other signals related to physiology are rarely used, despite the fact that the autonomic nervous system is often affected by mental disorders. AIM: This study attempted to fuse physiological and physical activity data and discover features that are predictive for schizophrenia. METHOD: Continuous simultaneous heart rate (HR) and physical activity recordings were made on 16 individuals with schizophrenia and 19 healthy controls. Statistical characteristics of the recorded data were analyzed, as well as non-linear rest-activity measures and disorganization measures. RESULTS: Four most predictive features for schizophrenia were identified, namely, the standard deviation and mode of locomotor activity, dynamics of Multiscale Entropy change over scales of HR signal and the mean HR. A classifier trained on these features provided a cross-validation accuracy of 95.3% (AUC = 0.99) for differentiating between schizophrenia patients and controls, compared to 78.5 and 85.5% accuracy (AUC = 0.85 and AUC = 0.90) using only the HR or locomotor activity features. CONCLUSION: Physiological and physical activity signals provide complimentary information for assessment of mental health.

Parry, Monica; Nielson, Chantelle A.; Muckle, Fiona; O’Keefe-McCarthy, Sheila; van Lien, Rene; Meijer, Jan H. (2015): A Novel Noninvasive Device to Assess Sympathetic Nervous System Function in Patients With Heart Failure. In: Nursing research 64 (5), S. 351–360. DOI: 10.1097/NNR.0000000000000111.

BACKGROUND: Heart failure is a complex syndrome associated with sympathetic nervous system and renin-angiotensin-aldosterone system hyperactivity. Sympathoinhibition and downregulation of sympathetic activity using medications and exercise training improve outcomes in patients with heart failure. Impedance cardiography provides data on hemodynamic and autonomic function that may assist with safe medication, exercise monitoring, and titration. PURPOSE: The purpose of this pilot study was to evaluate the sensitivity of the Vrije Universiteit Ambulatory Monitoring System (VU-AMS) version 5fs to detect hemodynamic and sympathetic nervous system changes associated with postural shift in persons with heart failure with reduced ejection fraction. METHODS: In this descriptive study, participants (N = 28) were recruited from an outpatient device clinic at a tertiary care hospital in Ontario, Canada. They completed a sit-to-stand posture protocol wearing an ambulatory blood pressure (ABP) and a noninvasive VU-AMS version 5fs impedance cardiography system. RESULTS: Most (n = 18, 64%) participants were eliminated from the final analyses in this sample because of difficulty in Q-onset and B-point identification in peculiar electrocardiogram and impedance cardiogram waveforms. The remaining participants (n = 10) had a mean age of 69 years (SD = 10 years) and responses to a sit-to-stand posture protocol that included a 5% increase in heart rate (p = .001), an 18% decrease in stroke volume (p = .01), and an 8% decrease in left ventricular ejection time (p = .01). Participants had an increased preejection period (11%, p = .01), a drop in cardiac output of 13% (p = .02), and a reduced mean arterial pressure of approximately 4% (p = .09) with standing. DISCUSSION: Although the VU-AMS version 5fs system detected anticipated hemodynamic and sympathetic nervous system changes to postural shift in participants (n = 10), the elimination of 64% (n = 18) of the sample because of scoring difficulties limits the use of this impedance cardiography device using standard scoring algorithms in persons with heart failure with reduced ejection fraction.

Pellegrini, Christine A.; Pfammatter, Angela F.; Conroy, David E.; Spring, Bonnie (2015): Smartphone applications to support weight loss: current perspectives. In: Advanced health care technologies 1, S. 13–22. DOI: 10.2147/AHCT.S57844.

Lower cost alternatives are needed for the traditional in-person behavioral weight loss programs to overcome challenges of lowering the worldwide prevalence of overweight and obesity. Smartphones have become ubiquitous and provide a unique platform to aid in the delivery of a behavioral weight loss program. The technological capabilities of a smartphone may address certain limitations of a traditional weight loss program, while also reducing the cost and burden on participants, interventionists, and health care providers. Awareness of the advantages smartphones offer for weight loss has led to the rapid development and proliferation of weight loss applications (apps). The built-in features and the mechanisms by which they work vary across apps. Although there are an extraordinary number of a weight loss apps available, most lack the same magnitude of evidence-based behavior change strategies typically used in traditional programs. As features develop and new capabilities are identified, we propose a conceptual model as a framework to guide the inclusion of features that can facilitate behavior change and lead to reductions in weight. Whereas the conventional wisdom about behavior change asserts that more is better (with respect to the number of behavior change techniques involved), this model suggests that less may be more because extra techniques may add burden and adversely impact engagement. Current evidence is promising and continues to emerge on the potential of smartphone use within weight loss programs; yet research is unable to keep up with the rapidly improving smartphone technology. Future studies are needed to refine the conceptual model’s utility in the use of technology for weight loss, determine the effectiveness of intervention components utilizing smartphone technology, and identify novel and faster ways to evaluate the ever-changing technology.

Pereira, Sara; Gomes, Thayse Natacha; Borges, Alessandra; Santos, Daniel; Souza, Michele; Dos Santos, Fernanda K et al. (2015): Variability and Stability in Daily Moderate-to-Vigorous Physical Activity among 10 Year Old Children. In: International journal of environmental research and public health 12 (8), S. 9248–9263. DOI: 10.3390/ijerph120809248.

Day-to-day variability and stability of children’s physical activity levels across days of the week are not well understood. Our aims were to examine the day-to-day variability of moderate-to-vigorous physical activity (MVPA), to determine factors influencing the day-to-day variability of MVPA and to estimate stability of MVPA in children. The sample comprises 686 Portuguese children (10 years of age). MVPA was assessed with an accelerometer, and BMI was computed from measured height and weight. Daily changes in MVPA and their correlates (gender, BMI, and maturity) were modeled with a multilevel approach, and tracking was calculated using Foulkes & Davies gamma. A total of 51.3% of boys and 26.2% of girls achieved 60 min/day of MVPA on average. Daily MVPA was lower during the weekend (23.6% of boys and 13.6% of girls comply with the recommended 60 min/day of MVPA) compared to weekdays (60.8% and 35.4%, boys and girls, respectively). Normal weight children were more active than obese children and no effect was found for biological maturation. Tracking is low in both boys (gamma = 0.59 +/- 0.01) and girls (gamma = 0.56 +/- 0.01). Children’s MVPA levels during a week are highly unstable. In summary, boys are more active than girls, maturation does not affect their MVPA, and obese children are less likely to meet 60 min/day of MVPA. These results highlight the importance of providing opportunities for increasing children’s daily MVPA on all days of week, especially on the weekend.

Phillips, Kristina T.; Phillips, Michael M.; Lalonde, Trent L.; Tormohlen, Kayla N. (2015): Marijuana use, craving, and academic motivation and performance among college students: An in-the-moment study. In: Addictive Behaviors 47, S. 42–47. DOI: 10.1016/j.addbeh.2015.03.020.

Introduction: Marijuana is the most commonly used illicit substance in the U.S., with high rates among young adults in the state of Colorado. Chronic, heavy marijuana use can impact cognitive functioning, which has the potential to influence academic performance of college students. It is possible that craving for marijuana may further contribute to diminished cognitive and affective functioning, thus leading to poor outcomes for students. Methods: College student marijuana users (n = 57) were recruited based on heavy use and completed ecological momentary assessment (EMA) via text-messaging. The association between marijuana use and craving in a college setting was explored, as well as how these variables might relate to academic motivation, effort and success. The participants were sent text messages for two weeks, three times per day at random times. Results: A temporal association between craving and marijuana use was found, where momentary craving positively predicted greater marijuana use. Similarly, as craving levels increased, the number of minutes spent studying decreased at the next assessment point. A negative association between momentary craving for marijuana and academic motivation was found in the same moment. Greater academic self-efficacy positively predicted cumulative GPA, while average minutes spent smoking marijuana was negatively related. Conclusions: Using EMA, marijuana craving and use were significantly related. These findings provide further evidence that heavy marijuana use is negatively associated with academic outcomes.

Pickering, Trevor A.; Huh, Jimi; Intille, Stephen; Liao, Yue; Pentz, Mary Ann; Dunton, Genevieve F. (2015): Physical Activity and Variation in Momentary Behavioral Cognitions: An Ecological Momentary Assessment Study. In: Journal of physical activity & health. DOI: 10.1123/jpah.2014-0547.

BACKGROUND: Decisions to perform moderate to vigorous physical activity (MVPA) involve behavioral cognitive processes that may differ within individuals depending on the situation. METHODS: Ecological momentary assessment (EMA) was used to examine the relationships of momentary behavioral cognitions (i.e., self-efficacy, outcome expectancy, intentions) with MVPA (measured by accelerometer). A sample of 116 adults (M=40.3 years, 72.4% female) provided real-time EMA responses via mobile phones across four days. Multilevel models tested whether momentary behavioral cognitions differed across contexts, and were associated with subsequent MVPA. Mixed-effects location scale models examined whether subject-level means and within-subject variances in behavioral cognitions were associated with average daily MVPA. RESULTS: Momentary behavioral cognitions differed across contexts for self-efficacy (p=.007) but not for outcome expectancy (p=.53) or intentions (p=.16). Momentary self-efficacy, intentions, and their interaction predicted MVPA within the subsequent two hours (p’s<.01). Average daily MVPA was positively associated with within-subject variance in momentary self-efficacy and intentions for physical activity (p’s<.05). CONCLUSIONS: While momentary behavioral cognitions are related to subsequent MVPA, adults with higher average MVPA have more variation in physical activity self-efficacy and intentions. Performing MVPA may depend more on how much behavioral cognitions vary across the day than whether they are generally high or low.

Powers, Katherine E.; Chavez, Robert S.; Heatherton, Todd F. (2015): Individual differences in response of dorsomedial prefrontal cortex predict daily social behavior. In: Social cognitive and affective neuroscience. DOI: 10.1093/scan/nsv096.

The capacity to accurately infer the thoughts and intentions of other people is critical for effective social interaction, and neural activity in dorsomedial prefrontal cortex (dmPFC) has long been linked with the extent to which people engage in mental state attribution. In this study, we combined functional neuroimaging and experience sampling methodologies to test the predictive value of this neural response for daily social behaviors. We found that individuals who displayed greater activity in dmPFC when viewing social scenes spent more time around other people on a daily basis. These findings suggest a specific role for the neural mechanisms that support the capacity to mentalize in guiding individuals toward situations containing valuable social outcomes.

Rathbun, Stephen L.; Shiffman, Saul (2015): Mixed effects models for recurrent events data with partially observed time-varying covariates: Ecological momentary assessment of smoking. In: Biometrics. DOI: 10.1111/biom.12416.

Cigarette smoking is a prototypical example of a recurrent event. The pattern of recurrent smoking events may depend on time-varying covariates including mood and environmental variables. Fixed effects and frailty models for recurrent events data assume that smokers have a common association with time-varying covariates. We develop a mixed effects version of a recurrent events model that may be used to describe variation among smokers in how they respond to those covariates, potentially leading to the development of individual-based smoking cessation therapies. Our method extends the modified EM algorithm of Steele (1996) for generalized mixed models to recurrent events data with partially observed time-varying covariates. It is offered as an alternative to the method of Rizopoulos, Verbeke, and Lesaffre (2009) who extended Steele’s (1996) algorithm to a joint-model for the recurrent events data and time-varying covariates. Our approach does not require a model for the time-varying covariates, but instead assumes that the time-varying covariates are sampled according to a Poisson point process with known intensity. Our methods are well suited to data collected using Ecological Momentary Assessment (EMA), a method of data collection widely used in the behavioral sciences to collect data on emotional state and recurrent events in the every-day environments of study subjects using electronic devices such as Personal Digital Assistants (PDA) or smart phones.

Roane, Brandy M.; van Reen, Eliza; Hart, Chantelle N.; Wing, Rena; Carskadon, Mary A. (2015): Estimating sleep from multisensory armband measurements: Validity and reliability in teens. In: Journal of Sleep Research. DOI: 10.1111/jsr.12317.

Summary Given the recognition that sleep may influence obesity risk, there is increasing interest in measuring sleep parameters within obesity studies. The goal of the current analyses was to determine whether the SenseWear® Pro3 Armband (armband), typically used to assess physical activity, is reliable at assessing sleep parameters. The armband was compared with the AMI Motionlogger® (actigraph), a validated activity monitor for sleep assessment, and with polysomnography, the gold standard for assessing sleep. Participants were 20 adolescents (mean age = 15.5 years) with a mean body mass index percentile of 63.7. All participants wore the armband and actigraph on their non‐dominant arm while in‐lab during a nocturnal polysomnographic recording (600 min). Epoch‐by‐epoch sleep/wake data and concordance of sleep parameters were examined. No significant sleep parameter differences were found between the armband and polysomnography; the actigraph tended to overestimate sleep and underestimate wake compared with polysomnography. Both devices showed high sleep sensitivity, but lower wake detection rates. Bland–Altman plots showed large individual differences in armband sleep parameter concordance rates. The armband did well estimating sleep overall, with group results more similar to polysomnography than the actigraph; however, the armband was less accurate at an individual level than the actigraph.

Roepke, Ann Marie; Jaffee, Sara R.; Riffle, Olivia M.; McGonigal, Jane; Broome, Rose; Maxwell, Bez (2015): Randomized Controlled Trial of SuperBetter, a Smartphone-Based/Internet-Based Self-Help Tool to Reduce Depressive Symptoms. In: Games for health journal 4 (3), S. 235–246. DOI: 10.1089/g4h.2014.0046.

OBJECTIVE: Technological advances have sparked the development of computer- and smartphone-based self-help programs for depressed people, but these programs’ efficacy is uncertain. This randomized controlled trial evaluated an intervention called SuperBetter (SB), which is accessed via smartphone and/or the SB Web site. MATERIALS AND METHODS: Online, we recruited 283 adult iPhone((R)) (Apple, Cupertino, CA) users with significant depression symptoms according to the Center for Epidemiological Studies Depression questionnaire (CES-D). They were randomly assigned to one of three conditions: (a) a version of SB using cognitive-behavioral therapy and positive psychotherapy strategies to target depression (CBT-PPT SB); (b) a general SB version focused on self-esteem and acceptance (General SB); or (c) a waiting list control group (WL). The two SB groups were instructed to use SB for 10 minutes daily for 1 month. All participants completed psychological distress and well-being measures online every 2 weeks through follow-up. An intent-to-treat analysis was conducted using hierarchical linear modeling. RESULTS: As hypothesized, SB participants achieved greater reductions in CES-D scores than WL participants by posttest (Cohen’s d=0.67) and by follow-up (d=1.05). Contrary to prediction, CBT-PPT SB did not perform better than General SB; both versions of SB were more effective than the WL control. Differences between SB versions favored General SB but were not statistically significant. CONCLUSIONS: These large effect sizes should be interpreted cautiously in light of high attrition rates and the motivated, self-selected sample. Nonetheless, smartphone-based/Internet-based self-help may play an important role in treating depression.

Salaffi, Fausto; Sarzi-Puttini, Piercarlo; Atzeni, Fabiola (2015): How to measure chronic pain: New concepts. In: Best practice & research. Clinical rheumatology 29 (1), S. 164–186. DOI: 10.1016/j.berh.2015.04.023.

The assessment of chronic pain and its impact on physical, emotional and social functions requires the use of multidimensional qualitative and health-related quality of life instruments, but there is still little agreement concerning what these may be or which approach to adopt. Increasing focus on patient-reported outcomes in medicine has had the positive effect of giving prominence to the views and experiences of patients with chronic pain, and the ecological momentary assessment (EMA) approach allows patients’ symptoms to be assessed in their natural environment in real time without the need for recall. Computerised EMA symptom diaries are now generally regarded as the ‘gold standard’ in the field of pain medicine, and they have recently attracted increasing attention as an essential component of health-care monitoring systems based on the information and communication technology. A web/Internet-based diary and patient terminal seem to provide a ubiquitous, easy-to-use and cost-efficient solution for patient-centred data acquisition. In addition, telemonitoring is increasingly seen as an effective means of supporting shared decision-making as it can inform patients about typical symptoms, treatment options and prognosis, and it is widely accepted as an additional source of information. This article reviews some of the instruments used to assess chronic pain, including newly developed and well-established validated multidimensional instruments and health-care monitoring systems based on information and communication technology, and it discusses their advantages and limitations.

Sanchez-Rodriguez, Elisabet; de la Vega, Rocio; Castarlenas, Elena; Roset, Roman; Miro, Jordi (2015): AN APP for the Assessment of Pain Intensity: Validity Properties and Agreement of Pain Reports When Used with Young People. In: Pain medicine (Malden, Mass.). DOI: 10.1111/pme.12859.

OBJECTIVE: Painometer is a mobile application that includes four pain intensity scales: the Numerical Rating Scale, the Faces Pain Scale-Revised, the mechanical visual analogue scale and the Colored Analogue Scale. The aim of this study was to analyze the validity and agreement of the intensity reports provided by these scales and their traditional counterparts. METHODS: Participants were 180 young people (mean age = 14.88; SD= 1.64; age range: 12-19). They were asked to report the maximum intensity of their most frequent pain in the previous three months using traditional and electronic versions of the scales. They also reported their level of fatigue and pain catastrophizing. Construct validity was evaluated by confirmatory factor analysis (CFA) and by convergent and discriminant validity. Criterion validity was assessed as concurrent validity. Agreement was calculated using the Bland and Altman method. Analyses were conducted for two confidence intervals (CI): 95% and 80%. RESULTS: CFA demonstrated that the four electronic versions of the scales measure a single factor. All the scales showed a) moderate to high convergent validity, b) adequate discriminant validity with fatigue ratings, and c) adequate concurrent validity with pain catastrophizing ratings. Results also show that traditional and electronic versions of the four scales are in agreement, at least at the 80% CI. CONCLUSIONS: Our results demonstrate that pain intensity scores reported with the scales in Painometer are valid, and concordant with their traditional counterparts.

Sawada, Natsumi; Gagné, Faby M.; Séguin, Louise; Kramer, Michael S.; McNamara, Helen; Platt, Robert W. et al. (2015): Maternal prenatal felt security and infant health at birth interact to predict infant fussing and crying at 12 months postpartum. In: Health Psychology 34 (8), S. 811–819. DOI: 10.1037/hea0000152.

Infants born with medical problems are at risk for less optimal developmental outcomes. This may be, in part, because neonatal medical problems are associated with maternal distress, which may adversely impact infants. However, the reserve capacity model suggests that an individual’s bank of psychosocial resources buffers the adverse effects of later-encountered stressors. This prospective longitudinal study examined whether preexisting maternal psychosocial resources, conceptualized as felt security in close relationships, moderate the association between neonatal medical problems and infant fussing and crying 12 months postpartum. Maternal felt security was measured by assessing its indicators in 5,092 pregnant women. At birth, infants were classified as healthy or having a medical problem. At 12 months, experience sampling was used to assess daily maternal reports of fussing and crying in 135 mothers of infants who were healthy or had medical problems at birth. Confirmatory factor analyses revealed that attachment, relationship quality, self-esteem, and social support can be conceptualized as indicators of a single felt security factor. Multiple regression analyses revealed that prenatal maternal felt security interacts with infant health at birth to predict fussing and crying at 12 months. Among infants born with medical problems, higher felt security predicted decreased fussing and crying. Maternal felt security assessed before birth dampens the association between neonatal medical problems and subsequent infant behavior. This supports the hypothesis that psychosocial resources in reserve can be called upon in the face of a stressor to reduce its adverse effects on the self or others.

Schüz, Natalie; Ferguson, Stuart G. (2015): Australian smokers’ and nonsmokers’ exposure to antismoking warnings in day-to-day life: A pilot study. In: Nicotine & Tobacco Research 17 (7), S. 876–881. DOI: 10.1093/ntr/ntu253.

Introduction: Smokers and nonsmokers can encounter a variety of antismoking messages in their everyday life. Antismoking warnings often involve fear appeals to which particularly smokers may react in a defensive manner by avoiding or derogating the messages, or downplaying their personal risk. However, previous studies testing the effects of antismoking warnings have either been retrospective or lab-based, thus introducing potential recall biases and yielding limited ecological validity. We used ecological momentary assessment (EMA) to give an overview on the number, type, and locations where individuals encounter such messages and to examine their immediate reactions. Methods: In an EMA study, 33 smokers and 37 never-smokers logged every encounter with antismoking warnings during 2.5 weeks (1,237 participant days of monitoring). After randomly selected encounters, several markers of defensiveness were assessed. Results: On average, nonsmokers reported noticing significantly fewer warnings than smokers (M = 0.49/day vs. M = 2.14/day). Both groups saw the majority of warnings on cigarette packages. Smokers reported a significantly higher level of message derogation and a significantly lower level of message acceptance than nonsmokers. There were no differences in feelings of vulnerability between smokers and nonsmokers upon encountering the warnings. Conclusions: The overall number of encounters with antismoking warnings in people’s everyday life is relatively low, particularly among smokers. Smokers are likely to avoid messages and respond defensively, thus limiting their potential effectiveness.

Scott, Stacey B.; Graham-Engeland, Jennifer E.; Engeland, Christopher G.; Smyth, Joshua M.; Almeida, David M.; Katz, Mindy J. et al. (2015): The Effects of Stress on Cognitive Aging, Physiology and Emotion (ESCAPE) Project. In: BMC Psychiatry 15.

Background: Despite evidence that psychological stress is an important risk factor for age-related cognitive loss, little research has directly evaluated psychological and physiological mediators of the relationship between stressful experiences and cognitive function. A key objective of the ESCAPE (Effects of Stress on Cognitive Aging, Physiology, and Emotion) project is to evaluate whether engaging in stress-related unconstructive repetitive thought (URT) is a pathway through which stressful experiences negatively affect cognitive health over the short- and long-term. Over the short-term, we hypothesize that engaging in URT will deplete attentional resources and result in worse cognitive performance in daily life. Over the long-term, we expect that the effects of chronic stress, from repeated exposure to stressors and regular engagement in URT, will be apparent in dysregulated hypothalamic-pituitary-adrenal (HPA) axis function and inflammation. Over time, stress-related physiological dysregulation will result in accelerated cognitive decline. Methods/Design: This study utilizes a prospective longitudinal measurement-burst design. A systematic probability sample of participants aged 25 to 65 is recruited from residents of the Bronx, NY. Consenting participants complete a baseline assessment and follow-up waves at 9, 18, and 27 months post-baseline. At each wave, participants complete a 14 day measurement burst of brief surveys and cognitive assessments delivered via study smartphones during daily life. Participants provide saliva samples four times each day for five days during the measurement burst and fasting blood samples at the end of each burst from which cortisol and dehydroepiandrosterone sulfate (DHEAS), circulating inflammatory markers, and stimulated inflammatory responses to lipopolysaccharide in whole blood are determined. Discussion: This study takes a multi-pronged approach to assessing stress (i.e., early adversity, chronic strains, major events, daily hassles), psychological mediators (e.g., URT), biological mechanisms (i.e., HPA function, inflammation) and outcomes across different time-scales (i.e., momentary cognitive performance, cognitive decline across years). The systematic probability sample is locally representative and can be compared with national norms on key markers of health and well-being. The findings will improve our understanding of how environmental, psychological, and physiological stress-related influences accumulate to affect cognitive health and identify potential targets (e.g., URT, inflammation) for prevention and intervention promoting cognitive health.

Selby, Edward A.; Cornelius, Talea; Fehling, Kara B.; Kranzler, Amy; Panza, Emily A.; Lavender, Jason M. et al. (2015): A perfect storm: examining the synergistic effects of negative and positive emotional instability on promoting weight loss activities in anorexia nervosa. In: Frontiers in psychology 6, S. 1260. DOI: 10.3389/fpsyg.2015.01260.

Growing evidence indicates that both positive and negative emotion potentially influence the development and maintenance of anorexia nervosa, through both positive and negative reinforcement of weight loss activities. Such reactive emotional experience may be characterized by frequent and intense fluctuations in emotion, a construct known as “emotional instability.” The purpose of this study was to investigate the association between positive emotional instability and weight loss activities in anorexia nervosa, and to investigate the synergistic effects of positive and negative emotional instability on promoting weight loss activities. Using ecological momentary assessment methods, 118 participants with anorexia nervosa reported their emotional experiences and behaviors at least six times daily over 2 weeks using a portable digital device. Using generalized linear modeling, results indicated that high levels of both positive and negative emotional instability, and the interaction between the two, were associated with more frequent weight-loss activities, beyond anorexia subtype and mean levels of emotional intensity. These findings indicate that when women with anorexia exhibit both high levels of both positive and negative emotional instability they are more prone to a variety of weight loss activities. The importance of addressing the role of both positive and negative emotion in anorexia treatment is discussed.

Sheets, Erin S.; Bujarski, Spencer; Leventhal, Adam M.; Ray, Lara A. (2015): Emotion differentiation and intensity during acute tobacco abstinence: A comparison of heavy and light smokers. In: Addictive Behaviors 47, S. 70–73. DOI: 10.1016/j.addbeh.2015.03.024.

The ability to recognize and label discrete emotions, termed emotion differentiation, is particularly pertinent to overall emotion regulation abilities. Patterns of deficient emotion differentiation have been associated with mood and anxiety disorders but have yet to be examined in relation to nicotine dependence. This study employed ecological momentary assessment to examine smokers’ subjective experience of discrete emotions during 24-h of forced tobacco abstinence. Thirty daily smokers rated their emotions up to 23 times over the 24-hour period, and smoking abstinence was biologically verified. From these data, we computed individual difference measures of emotion differentiation, overall emotion intensity, and emotional variability. As hypothesized, heavy smokers reported poorer negative emotion differentiation than light smokers (d = 0.55), along with more intense negative emotion (d = 0.97) and greater negative emotion variability (d = 0.97). No differences were observed in positive emotion differentiation. Across the sample, poorer negative emotion differentiation was associated with greater endorsement of psychological motives to smoke, including negative and positive reinforcement motives, while positive emotion differentiation was not.

Shiffman, Saul; Dunbar, Michael S.; Tindle, Hilary A.; Ferguson, Stuart G. (2015): Nondaily smokers’ experience of craving on days they do not smoke. In: Journal of Abnormal Psychology 124 (3), S. 648–659. DOI: 10.1037/abn0000063.

Nondaily, or intermittent smokers (ITS), represent a growing pattern in adult smoking that needs to be explained by models of drug dependence. ITS regularly and voluntarily abstain from smoking, yet have difficulty quitting. We examine potential accounts of ITS’ smoking by exploring their experience of craving and withdrawal on the days they abstain. For 3 weeks, 146 ITS and 194 daily smokers used the Ecological Momentary Assessment (EMA) to monitor craving, withdrawal, and smoking in real-time. ITS’ craving (p < .001) and arousal (p < .001) were significantly lower on the 34.4% of days when they abstained (compared with days they smoked), and they experienced no increases in withdrawal symptoms. ITS who abstained for longer experienced lower craving, even on their first day of abstinence (p < .001). Within strata defined by longest duration of abstinence (1, 2–3, 4–6, ≥7 days), craving did not change over time, demonstrating no increase as resumption of smoking approached. Craving increased only at the moment smoking resumed. Furthermore, duration of abstinence runs varied more within persons than across persons. These findings contradict the predictions of a model positing that craving recurs at fixed intervals. Findings are consistent with the hypothesis that ITS’ smoking is cued or primed by particular stimuli rather than by temporal cycles. These analyses demonstrate that ITS do not experience increased craving or withdrawal on days they do not smoke, and show neither signs of classical dependence nor regular cycles of craving and smoking.

Shiffman, Saul; Li, Xiaoxue; Dunbar, Michael S.; Ferguson, Stuart G.; Tindle, Hilary A.; Scholl, Sarah M. (2015): Social smoking among intermittent smokers. In: Drug and Alcohol Dependence 154, S. 184–191. DOI: 10.1016/j.drugalcdep.2015.06.027.

BACKGROUND: “Social smoking” - smoking mostly or even only with others - may be an important pattern that implies smoking motivated extrinsically by social influences. Non-daily smokers (intermittent smokers; ITS) are often assumed to be social smokers, with some authors even assuming that all ITS are social smokers (SS+). We sought to identify and characterize social smokers in a sample of ITS. METHODS: 204 adult ITS (smoking 4-27 days/month) recorded the circumstances of smoking in their natural settings using Ecological Momentary Assessment, while also recording their circumstances in nonsmoking moments. SS+ were defined as ITS who were with others when they smoked most of their cigarettes, and who were >/=50% more likely to be with others when smoking than when not. RESULTS: Only 13% of ITS were SS+. Although defined solely on the basis of presence of others, SS+ showed a distinct pattern of smoking across multiple dimensions: compared to other ITS (who were significantly less likely to smoke when with others), SS+ smoking was more associated with socializing, being with friends and acquaintances, drinking alcohol, weekends, evening or nighttime, being in other people’s homes, but not their own home. SS+ smoking was low in the morning and increased in the evening. SS+ smoked fewer days/week and were less dependent, but did not differ demographically. CONCLUSIONS: Social smoking does constitute a highly distinct smoking pattern, but is not common among adult ITS.

Simons, Jeffrey S.; Wills, Thomas A.; Emery, Noah N.; Spelman, Philip J. (2015): Keep calm and carry on: Maintaining self-control when intoxicated, upset, or depleted. In: Cognition & emotion, S. 1–15. DOI: 10.1080/02699931.2015.1069733.

This study tested within-person associations between intoxication, negative affect, and self-control demands and two forms of self-control failure, interpersonal conflict, and neglecting responsibilities. Effortful control was hypothesised to act as a buffer, reducing individual susceptibility to these within-person effects. In contrast, reactivity was hypothesised to potentiate the within-person associations. 274 young adults aged 18-27 (56% women, 93% white) completed experience sampling assessments for up to 49 days over the course of 1.3 years. Results indicated independent within-person effects of intoxication, negative affect, and self-control demands on the outcomes. Hypothesised moderating effects of reactivity were not supported. Effortful control did not moderate the effects of self-control demands as expected. However, effortful control exhibited a protective effect when individuals were intoxicated or upset to reduce the likelihood of maladaptive behavioural outcomes.

Simons, Jeffrey S.; Wills, Thomas A.; Emery, Noah N.; Marks, Russell M. (2015): Quantifying alcohol consumption: Self-report, transdermal assessment, and prediction of dependence symptoms. In: Addictive Behaviors 50, S. 205–212. DOI: 10.1016/j.addbeh.2015.06.042.

Research on alcohol use depends heavily on the validity of self-reported drinking. The present paper presents data from 647 days of self-monitoring with a transdermal alcohol sensor by 60 young adults. We utilized a biochemical measure, transdermal alcohol assessment with the WrisTAS, to examine the convergent validity of three approaches to collecting daily self-report drinking data: experience sampling, daily morning reports of the previous night, and 1-week timeline follow-back (TLFB) assessments. We tested associations between three pharmacokinetic indices (peak concentration, area under the curve (AUC), and time to reach peak concentration) derived from the transdermal alcohol signal and within- and between- person variation in alcohol dependence symptoms. The WrisTAS data corroborated 85.74% of self-reported drinking days based on the experience sampling data. The TLFB assessment and combined experience sampling and morning reports agreed on 87.27% of drinking days. Drinks per drinking day did not vary as a function of wearing or not wearing the sensor; this indicates that participants provided consistent reports of their drinking regardless of biochemical verification. In respect to self-reported alcohol dependence symptoms, the AUC of the WrisTAS alcohol signal was associated with dependence symptoms at both the within- and between- person level. Furthermore, alcohol dependence symptoms at baseline predicted drinking episodes characterized in biochemical data by both higher peak alcohol concentration and faster time to reach peak concentration. The results support the validity of self-report alcohol data, provide empirical data useful for optimal design of daily process sampling, and provide an initial demonstration of the use of transdermal alcohol assessment to characterize drinking dynamics associated with risk for alcohol dependence.

Sims, Tamara; Tsai, Jeanne L.; Jiang, Da; Wang, Yaheng; Fung, Helene H.; Zhang, Xiulan (2015): Wanting to maximize the positive and minimize the negative: Implications for mixed affective experience in American and Chinese contexts. In: Journal of Personality and Social Psychology 109 (2), S. 292–315. DOI: 10.1037/a0039276.

Previous studies have demonstrated that European Americans have fewer mixed affective experiences (i.e., are less likely to experience the bad with the good) compared with Chinese. In this article, we argue that these cultural differences are due to “ideal affect,” or how people ideally want to feel. Specifically, we predict that people from individualistic cultures want to maximize positive and minimize negative affect more than people from collectivistic cultures, and as a result, they are less likely to actually experience mixed emotions (reflected by a more negative within-person correlation between actual positive and negative affect). We find support for this prediction in 2 experience sampling studies conducted in the United States and China (Studies 1 and 2). In addition, we demonstrate that ideal affect is a distinct construct from dialectical view of the self, which has also been related to mixed affective experience (Study 3). Finally, in Study 4, we demonstrate that experimentally manipulating the desire to maximize the positive and minimize the negative alters participants’ actual experience of mixed emotions during a pleasant (but not unpleasant or combined pleasant and unpleasant) TV clip in the United States and Hong Kong. Together, these findings suggest that across cultures, how people want to feel shapes how they actually feel, particularly people’s experiences of mixed affect.

Skorka-Brown, Jessica; Andrade, Jackie; Whalley, Ben; May, Jon (2015): Playing Tetris decreases drug and other cravings in real world settings. In: Addictive Behaviors 51, S. 165–170. DOI: 10.1016/j.addbeh.2015.07.020.

Most research on cognitive processes in craving has been carried out in the laboratory and focuses on food craving. This study extends laboratory findings to real world settings and cravings for drugs or activities as well as food. Previous laboratory research has found that playing Tetris reduces craving strength. The present study used an ecological momentary assessment protocol in which 31 undergraduate participants carried iPods for a week and were prompted 7 times each day, by SMS message, to use their iPod to report craving. Participants reported craving target and strength (0-100), whether they indulged their previous craving (yes/no), and whether they were under the influence of alcohol (yes/no). Those randomly assigned to the intervention condition (n=15) then played Tetris for 3min and reported their craving again. Those in the monitoring-only control condition (n=16) provided baseline craving data to test if Tetris reduced the incidence and strength of spontaneous cravings across the week. Playing Tetris decreased craving strength for drugs (alcohol, nicotine, caffeine), food and drink, and activities (sex, exercise, gaming), with a mean reduction of 13.9 percentage points, effect size f(2)=0.11. This effect was consistent across the week. This is the first demonstration that visual cognitive interference can be used in the field to reduce cravings for substances and activities other than eating.

Smith, Dylan M.; Parmelee, Patricia A. (2015): Within-Day Variability of Fatigue and Pain among African Americans and Non-Hispanic Whites with Osteoarthritis of the Knee. In: Arthritis care & research. DOI: 10.1002/acr.22690.

OBJECTIVE: Fatigue is common among person with osteoarthritis (OA), but little is known about racial/ethnic differences in prevalence, correlates or dynamics of fatigue in OA. This research therefore used experience sampling methodology (ESM) to examine fatigue and pain at global and momentary levels among African Americans (AAs) and non-Hispanic Whites (NHWs) with OA. METHODS: Thirty-nine AAs and 81 NHWs with physician-diagnosed knee OA completed a baseline interview and an ESM protocol assessing fatigue, pain and mood 4 times daily for 7 days. In addition to analysis of basic group differences, multilevel modeling examined within- versus between-subjects patterns and correlates of variability in momentary fatigue, controlling demographics and other potential confounders. RESULTS: Both racial groups experienced moderate levels of fatigue; however, there were clear individual differences in both mean level and variability across momentary assessments. Mean fatigue levels were associated with global pain and depression. Increase in fatigue over the course of the day was much stronger among NHWs than AAs. Momentary fatigue and pain were closely correlated. Mean fatigue predicted variability in mood; at the momentary level, both fatigue and pain were independently associated with mood. CONCLUSIONS: Fatigue is a significant factor for both AAs and NHWs with OA, and is negatively related to quality of life. Pain symptoms, at both the momentary level and across individuals were robust predictors of fatigue. Although overall levels of reported symptoms was similar across these two groups, the pattern of fatigue symptoms across the day differed. This article is protected by copyright. All rights reserved.

Snelleman, Michelle; Schoenmakers, Tim Michael; van de Mheen, Dike (2015): Attentional Bias and Approach/Avoidance Tendencies Do Not Predict Relapse or Time to Relapse in Alcohol Dependency. In: Alcoholism, clinical and experimental research 39 (9), S. 1734–1739. DOI: 10.1111/acer.12817.

BACKGROUND: Implicit processes such as attentional bias (AB) and automatic approach/avoidance tendencies (AA) play a role in substance use disorders. Whether these processes can predict a relapse in alcohol-dependent patients is still unclear and must be examined in more detail than has been done previously. We aimed to establish whether AB and AA measured during treatment would predict relapse in alcohol-dependent patients. We also investigated whether these implicit processes predicted time to relapse better than a more common binary relapse variable. METHODS: A total of 50 alcohol-dependent outpatients undergoing treatment completed the study. Patients completed the Addiction Stroop Task, which assesses AB, and the relevant Stimulus-Response Compatibility Task, which measures AA. Time to relapse was assessed 1, 2, and 3 months after the bias assessment. RESULTS: Twenty patients (40%) relapsed during the follow-up period. The average time to relapse was 40 days after the first session. Overall, participants had an AB for alcohol-related stimuli and a tendency to avoid these stimuli. Neither relapse nor time to relapse was predicted by either bias type. CONCLUSIONS: Although both AB and avoidance tendencies were present in our sample, these measures did not predict relapse or time to relapse in an outpatient alcohol-dependent sample in the following 3 months. Future research should focus on studying the predictive value of these biases in the short term, for example, using ecological momentary assessment techniques to assess implicit processes shortly before a relapse.

Snir, Avigal; Rafaeli, Eshkol; Gadassi, Reuma; Berenson, Kathy; Downey, Geraldine (2015): Explicit and inferred motives for nonsuicidal self-injurious acts and urges in borderline and avoidant personality disorders. In: Personality Disorders: Theory, Research, and Treatment 6 (3), S. 267–277. DOI: 10.1037/per0000104.

Nonsuicidal self-injury (NSSI) is a perplexing phenomenon that may have differing motives. The present study used experience sampling methods (ESM) which inquired explicitly about the motives for NSSI, but also enabled a temporal examination of the antecedents/consequences of NSSI; these allow us to infer other motives which were not explicitly endorsed. Adults (n = 152, aged 18–65) with borderline personality disorder (BPD), avoidant personality disorder (APD), or no psychopathology participated in a 3-week computerized diary study. We examined 5 classes of explicit motives for engaging in NSSI, finding support primarily for internally directed rather than interpersonally directed ones. We then used multilevel regression to examine changes in affect, cognition, and behavior surrounding moments of NSSI acts/urges compared with control moments (i.e., without NSSI). We examined changes in 5 scales of inferred motives, designed to correspond to the 5 classes of explicit motives. The results highlight differing motives for NSSI among individuals with BPD and APD, with some similarities (mostly in the explicit motives) and some differences (mostly in the inferred motives) between the disorders. Despite their infrequent explicit endorsement, fluctuations in interpersonally oriented scales were found surrounding NSSI acts/urges. This highlights the need to continue attending to interpersonal aspects of NSSI in research and in clinical practice. Additionally, NSSI urges, like acts, were followed by decline in affective/interpersonal distress (although in a delayed manner). Thus, interventions that build distress tolerance and enhance awareness for affective changes, and for antecedent/consequence patterns in NSSI, could help individuals resist the urge to self-injure.

Solymosi, Reka; Bowers, Kate; Fujiyama, Taku (2015): Mapping fear of crime as a context‐dependent everyday experience that varies in space and time. In: Legal and Criminological Psychology 20 (2), S. 193–211. DOI: 10.1111/lcrp.12076.

Purpose: There is a current need for innovation in research on the fear of crime to move on from general and static representations and instead approach it as a dynamic phenomenon experienced in everyday life, to inform or evaluate situational interventions. Methods: This study presents a novel approach to fear of crime research using the framework of routine activities theory and environmental criminology to present it as a specific event characterized by spatial, temporal, and personal variables. We suggest and illustrate a new experience sampling approach to data collection, captured via a mobile phone application. Results: By studying the fear of crime in the environment where it occurs, and focusing on a microscale geography with the additional dimension of time, new insight into fear of crime can be attained. Results from a data collection pilot demonstrate significant spatiotemporal variation in individuals’ fear of crime levels and hence illustrate the viability of such approaches. Conclusions: We argue that this new insight can lead to the development of situational interventions which target fear of crime hot spots as they move about in place and time, allowing limited resources to be allocated more efficiently to enhance perceptions of safety.

Spindler, Gabriela; Stopsack, Malte; Aldinger, Maren; Grabe, Hans Jörgen; Barnow, Sven (2015): What about the ‘ups and downs’ in our daily life? The influence of affective instability on mental health. In: Motivation and Emotion. DOI: 10.1007/s11031-015-9509-7.

Although affective instability is considered to be a crucial factor for mental disorders, research on affective instability and mental health is still rare. The aim of the present study was to investigate affective instability and mental health operationalized by the degree of psychological distress and life satisfaction. Using ecological momentary assessment, we investigated affective intensity and instability in a general population sample (n = 218). Psychological distress and life satisfaction were examined cross-sectionally and longitudinally. In general, we found that positive affect was more variable than negative affect. When we accounted for the overlap between variables, our findings demonstrated that besides the effects of intensity in negative affect and positive affect, higher positive affective instability was related to better concurrent mental health. Longitudinally, negative affective intensity was a decisive factor in the development of mental health. In sum, our findings revealed that affective instability was not dysfunctional per se. In fact, instability in positive affect seems to be important to achieve mental health.

Thielsch, Carolin; Andor, Tanja; Ehring, Thomas (2015): Do metacognitions and intolerance of uncertainty predict worry in everyday life? An ecological momentary assessment study. In: Behavior Therapy 46 (4), S. 532–543. DOI: 10.1016/j.beth.2015.05.001.

Cognitive models of generalized anxiety disorder (GAD) suggest that excessive worry is due to positive and negative metacognitive beliefs and/or intolerance of uncertainty. Empirical support mainly derives from cross-sectional studies with limited conclusiveness, using self-report measures and thereby possibly causing recall biases. The aim of the present study therefore was to examine the power of these cognitive variables to predict levels of worry in everyday life using Ecological Momentary Assessment (EMA). Metacognitions and intolerance of uncertainty were assessed using well-established self-report questionnaires in 41 nonclinical participants who subsequently completed ratings on worry intensity and burden on a portable device for 1 week at seven times a day once every 2 hours. Results showed significant associations of negative metacognitive beliefs and intolerance of uncertainty, but not positive metacognitive beliefs, with worry in everyday life. In multilevel regression analyses, a substantial proportion of variance of everyday worry could be accounted for by negative metacognitions over and above trait worry and daily hassles. Intolerance of uncertainty likewise emerged as a valid predictor when tested in isolation, but did not explain additional variance once negative metacognitions were controlled. The findings support current cognitive models of excessive worry and highlight the role of negative metacognitions. By using EMA to assess levels of worry in everyday life, they extend earlier findings focusing exclusively on retrospective questionnaire measures.

Tomko, Rachel L.; Lane, Sean P.; Pronove, Lisa M.; Treloar, Hayley R.; Brown, Whitney C.; Solhan, Marika B. et al. (2015): Undifferentiated negative affect and impulsivity in borderline personality and depressive disorders: A momentary perspective. In: Journal of Abnormal Psychology 124 (3), S. 740–753. DOI: 10.1037/abn0000064.

Individuals with borderline personality disorder (BPD) often report experiencing several negative emotions simultaneously, an indicator of “undifferentiated” negative affect. The current study examined the relationship between undifferentiated negative affect and impulsivity. Participants with a current BPD (n = 67) or depressive disorder (DD; n = 38) diagnosis carried an electronic diary for 28 days, reporting on emotions and impulsivity when randomly prompted (up to 6 times per day). Undifferentiated negative affect was quantified using momentary intraclass correlation coefficients, which indicated how consistently negative emotion items were rated across fear, hostility, and sadness subscales. Undifferentiated negative affect at the occasion-level, day-level, and across 28 days was used to predict occasion-level impulsivity. Multilevel modeling was used to test the hypothesis that undifferentiated negative emotion would be a significant predictor of momentary impulsivity above and beyond levels of overall negative affect. Undifferentiated negative affect at the occasion and day levels were significant predictors of occasion-level impulsivity, but undifferentiated negative affect across the 28-day study period was only marginally significant. Results did not differ depending on BPD or DD status, though individuals with BPD did report significantly greater momentary impulsivity and undifferentiated negative affect. Undifferentiated negative affect may increase risk for impulsivity among individuals with BPD and depressive disorders, and the current data suggest that this process can be relatively immediate as well as cumulative over the course of a day. This research supports the consideration of undifferentiated negative affect as a transdiagnostic construct, but one that may be particularly relevant for those with BPD.

Tregarthen, Jenna P.; Lock, James; Darcy, Alison M. (2015): Development of a smartphone application for eating disorder self-monitoring. In: The International journal of eating disorders. DOI: 10.1002/eat.22386.

OBJECTIVE: This case report aims to (1) describe the development and refinement of a smartphone application for eating disorder self-monitoring; (2) characterize its users in terms of demographic and clinical characteristics; and (3) explore its feasibility and utilization as a self-monitoring tool. METHOD: We developed a mobile phone application through which people with eating disorders can self-monitor meals, emotions, behaviors, and thoughts. The application also included positive reinforcement, coping skill suggestions, social support, and feedback components. The app was made available on two Internet app stores. Data include number of downloads and subsequent usage statistics, consumer ratings on app-stores are used as indicators of satisfaction, anonymous aggregate demographic data and Eating Disorder Examination Questionnaire scores from 57,940 individuals collected over a two-year period. RESULTS: The app demonstrated population-level utilization with over 100,000 users over a two-year period. Almost 50% percent of users stated that they are not currently receiving clinical treatment and 33% reported they had not told anyone about their eating disorder. A surprising number of people with severe problems are using the app. DISCUSSION: Smartphone apps have the capacity to reach and engage traditionally underserved individuals with eating disorders at a large scale. Additional work is indicated for the evaluation of the clinical effectiveness of applications for specific user groups and in clinical treatment contexts. (c) 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015).

Treloar, Hayley; Piasecki, Thomas M.; McCarthy, Denis M.; Sher, Kenneth J.; Heath, Andrew C. (2015): Ecological evidence that affect and perceptions of drink effects depend on alcohol expectancies. In: Addiction. DOI: 10.1111/add.12982.

Abstract Aims (1) To compare affective changes over drinking and non‐drinking days among frequent drinkers and (2) to evaluate whether drinkers’ expectations influence affective changes and perceived pleasure and relief from drinking. Design Observational study involving ecological momentary assessments collected via electronic diaries during the course of 3 weeks. Setting Drinkers’ usual settings in Columbia, MO, USA. Participants A total of 400 adult, frequent drinkers, aged 18–70 years. Measurements Ecological assessments included morning reports, pre‐drinking random prompts, user‐initiated first‐drink reports and device‐prompted follow‐ups over drinking episodes. Participants rated positive (enthusiastic, excited, happy) and negative (distressed, sad) affect and perceived pleasure and relief from drinking in real time. A self‐report questionnaire completed at baseline evaluated expectancies for enhanced sociability and tension reduction from drinking. Findings Relative to affective changes over non‐drinking days, positive affect increased prior to drinking [95% confidence interval (CI) = 0.004, 0.023], and at first drink (95% CI = 0.238, 0.317), whereas negative affect decreased prior to drinking (95% CI = − 0.007, 0.000) and at first drink (95% CI = − 0.154, − 0.098). Sociability expectancies augmented increases in positive affect prior to drinking (95% CI = 0.009, 0.027) and at first drink (95% CI = 0.017, 0.169). Sociability expectancies also enhanced perceived pleasure from first drinks (95% CI = 0.046, 0.318). Tension‐reduction expectancies attenuated decreases in negative affect at first drink (95% CI = − 0.133, − 0.029), but augmented perceived relief from first drinks (95% CI = 0.001, 0.304). Conclusions Although theoretical models tend to focus on negative affective outcomes of drinking, changes in positive affect prior to drinking and early in drinking episodes are important for maintaining drinking behavior. Frequent drinkers’ expectations for enhanced sociability or tension reduction from drinking influence their affective experiences over drinking days and perceptions of pleasure and relief from drinking.

Tung, James Y.; Chee, Justin N.; Zabjek, Karl F.; McIlroy, William E. (2015): Combining ambulatory and laboratory assessment of rollator use for balance and mobility in neurologic rehabilitation in-patients. In: Disability and Rehabilitation: Assistive Technology 10 (5), S. 407–414. DOI: 10.1037/t28729-000.

Purpose: Despite the common use of rollators (four-wheeled walkers), understanding their effects on gait and balance is limited to laboratory testing rather than everyday use. This study evaluated the utility of an ambulatory assessment approach to examine balance and mobility in everyday conditions compared to a laboratory assessment. Methods: Standing and walking with a rollator was assessed in three neurological rehabilitation in-patients under two conditions: (1) in laboratory (i.e. forceplate, GaitRite), and (2) while performing a natural walking course within and outside of the institution. An instrumented rollator (iWalker) was used to measure variables related to the balance control (e.g. upper limb kinetics), destabilizing events (e.g. stumbling), and environmental context. Results: Two of three patients demonstrated greater reliance on the rollator for standing balance (2.3–5.9 times higher vertical loading, 72–206% increase in COP excursion) and 29–42% faster gait during the walking course compared to the laboratory. Importantly, destabilizing events (collisions, stumbling) were recorded during the walking course. Such events were not observed in the laboratory. Conclusion: This study illustrated a greater reliance on the rollator during challenges in everyday use compared to laboratory assessment and provided evidence of specific circumstances associated with destabilizing events that may precipitate falls in non-laboratory settings.

Uhr, Marcel B F; Redel, Bianca; Biallas, Martin; Andrushevich, Aliaksei; Morandell, Martin; Dittenberger, Sandra; Koscher, Andrea (2015): RelaxedCare - Connecting people in care situations: User involvement to collect informal caregivers needs. In: Studies in health technology and informatics 217, S. 865–872.

“How is my mom doing right now?” Answering this question in a quick, clear way without the need of calling or stopping by could take away a lot of stress from informal caregivers. The RelaxedCare system aims to develop a solution built upon an existing AAL platform, using a multi-level pattern recognition approach to detect the current state of an assisted person, and then to communicate the state in a pervasive and unobtrusive way (i.e. lava lamp, smartphone widget, picture frame) to the caregiver. For the development of the RelaxedCare system a user centred design approach has been chosen applying especially the ISO 9241-210 [3] and the user-inspired innovation process [2]. A first technical prototype was evaluated with representative end users in lab trials via usability testing to find out, how the generated ideas match with the end user needs. The results show that the project is on the correct path. The majority of participants approved, that the RelaxedCare system supports the informal caregiver in a worry-free way to care for the assisted person (thus allowing the older generation to live longer in their own homes). 19 of 25 participants felt an advantage by using the system in their care situation in general. Overall 18 of them rate the advantage of the usage at home positively and 20 of them rate the usage positively, if they use it on the way. Also interesting is that in total 19 participants could imagine, that there would be an improvement of the care situation for their own family through the RelaxedCare system.

van der Krieke, Lian; Emerencia, Ando C.; Bos, Elisabeth H.; Rosmalen, Judith Gm; Riese, Harriette; Aiello, Marco et al. (2015): Ecological Momentary Assessments and Automated Time Series Analysis to Promote Tailored Health Care: A Proof-of-Principle Study. In: JMIR research protocols 4 (3), S. e100. DOI: 10.2196/resprot.4000.

BACKGROUND: Health promotion can be tailored by combining ecological momentary assessments (EMA) with time series analysis. This combined method allows for studying the temporal order of dynamic relationships among variables, which may provide concrete indications for intervention. However, application of this method in health care practice is hampered because analyses are conducted manually and advanced statistical expertise is required. OBJECTIVE: This study aims to show how this limitation can be overcome by introducing automated vector autoregressive modeling (VAR) of EMA data and to evaluate its feasibility through comparisons with results of previously published manual analyses. METHODS: We developed a Web-based open source application, called AutoVAR, which automates time series analyses of EMA data and provides output that is intended to be interpretable by nonexperts. The statistical technique we used was VAR. AutoVAR tests and evaluates all possible VAR models within a given combinatorial search space and summarizes their results, thereby replacing the researcher’s tasks of conducting the analysis, making an informed selection of models, and choosing the best model. We compared the output of AutoVAR to the output of a previously published manual analysis (n=4). RESULTS: An illustrative example consisting of 4 analyses was provided. Compared to the manual output, the AutoVAR output presents similar model characteristics and statistical results in terms of the Akaike information criterion, the Bayesian information criterion, and the test statistic of the Granger causality test. CONCLUSIONS: Results suggest that automated analysis and interpretation of times series is feasible. Compared to a manual procedure, the automated procedure is more robust and can save days of time. These findings may pave the way for using time series analysis for health promotion on a larger scale. AutoVAR was evaluated using the results of a previously conducted manual analysis. Analysis of additional datasets is needed in order to validate and refine the application for general use.

van Ockenburg, Sonja L; Booij, Sanne H.; Riese, Harriette; Rosmalen, Judith G M; Janssens, Karin A M (2015): How to assess stress biomarkers for idiographic research? In: Psychoneuroendocrinology 62, S. 189–199. DOI: 10.1016/j.psyneuen.2015.08.002.

Associations between stress-related biomarkers, like cortisol or catecholamines, and somatic or psychological symptoms have often been examined at the group level. Studies using this nomothetic approach reported equivocal findings, which may be due to high levels of intra-individual variance of stress biomarkers. More importantly, analyses at the group level provide information about the average patient, but do not necessarily have meaning for individual patients. An alternative approach is to examine data at the level of individual patients in so-called idiographic research. This method allows identifying individuals in whom symptoms are explained by preceding alterations in specific stress biomarkers, based on time series of symptoms and stress biomarkers. To create time series of sufficient length for statistical analysis, many subsequent stress biomarker measurements are needed for each participant. In the current paper, different matrices (i.e. saliva, urine, nail and hair) are discussed in light of their applicability for idiographic research. This innovative approach might lead to promising new insights in the association between stress biomarkers and psychological or somatic symptoms. New collection tools for stress biomarkers, like the use of sweat pads, automated microdialysis systems, dried blood spots, or smartphone applications, might contribute to the feasibility and implementation of idiographic research in the future.

Verkuil, Bart; Brosschot, Jos F.; Marques, Andrea H.; Kampschroer, Kevin; Sternberg, Esther M.; Thayer, Julian F. (2015): Gender differences in the impact of daily sadness on 24-h heart rate variability. In: Psychophysiology. DOI: 10.1111/psyp.12541.

Reduced heart rate variability (HRV) is proposed to mediate the relation between depressive symptoms and cardiovascular health problems. Yet, several studies have found that in women depression is associated with higher HRV levels, whereas in men depression is associated with lower HRV levels. So far, these studies have only examined gender differences in HRV levels using a single assessment. This study aimed to test the interactive effects of gender and sadness on ambulatory-assessed HRV levels. A sample of 60 (41 women) employees participated in an ambulatory study. HRV levels (mean of successive differences; MSD) were continuously measured for 24 h. During the daytime, hourly assessments of sadness and other mood states were taken, while depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale (CES-D). Gender differences were observed when examining the impact of average daily sadness on MSD. In women, but not in men, the total amount of sadness experienced during the day was associated with higher circadian MSD levels. These findings suggest that researchers need to take gender differences into account when examining the relation between sadness, HRV, and cardiovascular problems.

Walsh, Kate; Basu, Archana; Monk, Catherine (2015): The Role of Sexual Abuse and Dysfunctional Attitudes in Perceived Stress and Negative Mood in Pregnant Adolescents: An Ecological Momentary Assessment Study. In: Journal of pediatric and adolescent gynecology 28 (5), S. 327–332. DOI: 10.1016/j.jpag.2014.09.012.

STUDY OBJECTIVE: Latinas have the highest rates of adolescent pregnancy in the United States. Identifying means to improve the well-being of these young women is critical. The current study examined whether a history of child sexual abuse-itself a risk factor for adolescent pregnancy-was associated with more perceived stress and negative mood over the course of pregnancy and whether dysfunctional attitudes explained these associations. DESIGN AND SETTING: This mixed methods study involved laboratory-based assessments of perceived stress, sexual abuse history, and dysfunctional attitudes, as well as Ecological Momentary Assessments (EMA) of mood states every 30 minutes during a 24-hour period once during each trimester of pregnancy. PARTICIPANTS: Pregnant adolescents (N = 204, 85% Latina). MAIN OUTCOME MEASURES: EMA mood states and laboratory-based retrospective self-reports of perceived stress. RESULTS: One in 4 pregnant adolescents had a history of sexual abuse. Sexually abused adolescents reported greater perceived stress during the first trimester relative to those without, though the groups did not differ on EMA negative mood ratings. Dysfunctional attitudes explained associations between sexual abuse and perceived stress. Sexual abuse was indirectly associated with the intercept and slope of negative mood through dysfunctional attitudes. Findings were circumscribed to sexual abuse and not other types of child abuse. CONCLUSIONS: Identifying sexually abused pregnant adolescents and providing support and cognitive therapy to target dysfunctional beliefs may decrease stress during the first trimester as well as negative affect throughout pregnancy.

Wang, Fu-Tai; Chan, Hsiao-Lung; Wang, Chun-Li; Jian, Hung-Ming; Lin, Sheng-Hsiung (2015): Instantaneous Respiratory Estimation from Thoracic Impedance by Empirical Mode Decomposition. In: Sensors (Basel, Switzerland) 15 (7), S. 16372–16387. DOI: 10.3390/s150716372.

Impedance plethysmography provides a way to measure respiratory activity by sensing the change of thoracic impedance caused by inspiration and expiration. This measurement imposes little pressure on the body and uses the human body as the sensor, thereby reducing the need for adjustments as body position changes and making it suitable for long-term or ambulatory monitoring. The empirical mode decomposition (EMD) can decompose a signal into several intrinsic mode functions (IMFs) that disclose nonstationary components as well as stationary components and, similarly, capture respiratory episodes from thoracic impedance. However, upper-body movements usually produce motion artifacts that are not easily removed by digital filtering. Moreover, large motion artifacts disable the EMD to decompose respiratory components. In this paper, motion artifacts are detected and replaced by the data mirrored from the prior and the posterior before EMD processing. A novel intrinsic respiratory reconstruction index that considers both global and local properties of IMFs is proposed to define respiration-related IMFs for respiration reconstruction and instantaneous respiratory estimation. Based on the experiments performing a series of static and dynamic physical activates, our results showed the proposed method had higher cross correlations between respiratory frequencies estimated from thoracic impedance and those from oronasal airflow based on small window size compared to the Fourier transform-based method.

Wasan, Ajay D.; Michna, Edward; Edwards, Robert R.; Katz, Jeffrey N.; Nedeljkovic, Srdjan S.; Dolman, Andrew J. et al. (2015): Psychiatric Comorbidity Is Associated Prospectively with Diminished Opioid Analgesia and Increased Opioid Misuse in Patients with Chronic Low Back Pain. In: Anesthesiology 123 (4), S. 861–872. DOI: 10.1097/ALN.0000000000000768.

BACKGROUND: Opioids are frequently prescribed for chronic low back pain (CLBP), but there are little prospective data on which patient subgroups may benefit. Psychiatric comorbidity, such as high levels of depression and anxiety symptoms (termed comorbid negative affect [NA]), is a common presentation and may predict diminished opioid analgesia and/or increased opioid misuse. METHODS: The authors conducted a 6(1/2)-month prospective cohort study of oral opioid therapy, with an active drug/placebo run-in period, in 81 CLBP patients with low, moderate, and high levels of NA. Treatment included an opioid titration phase with a prescribing physician blinded to NA group assignment and a 4-month continuation phase, during which subjects recorded daily pain levels using an electronic diary. The primary outcome was the percent improvement in average daily pain, summarized weekly. RESULTS: There was an overall 25% dropout rate. Despite the high NA group being prescribed a higher average daily dose of morphine equivalents, linear mixed model analysis revealed that the 24 study completers in each of the high NA and low NA groups had an average 21 versus 39% improvement in pain, respectively (P < 0.01). The high NA group also had a significantly greater rate of opioid misuse (39 vs. 8%, P < 0.05) and significantly more and intense opioid side effects (P < 0.01). CONCLUSIONS: These results indicate that the benefit and risk considerations in CLBP patients with high NA versus low NA are distinctly different. Thus, NA is an important phenotypic variable to characterize at baseline, before deciding whether to prescribe opioids for CLBP.

Watanabe, Norio; Horikoshi, Masaru; Yamada, Mitsuhiko; Shimodera, Shinji; Akechi, Tatsuo; Miki, Kazuhira et al. (2015): Adding smartphone-based cognitive-behavior therapy to pharmacotherapy for major depression (FLATT project): study protocol for a randomized controlled trial. In: Trials 16, S. 293. DOI: 10.1186/s13063-015-0805-z.

BACKGROUND: Major depression is one of the most debilitating diseases in terms of quality of life. Less than half of patients suffering from depression can achieve remission after adequate antidepressant treatment. Another promising treatment option is cognitive-behavior therapy (CBT). However, the need for experienced therapists and substantive dedicated time prevent CBT from being widely disseminated. In the present study, we aim to examine the effectiveness of switching antidepressants and starting a smartphone-based CBT program at the same time, in comparison to switching antidepressants only, among patients still suffering from depression after adequate antidepressant treatment. METHODS/DESIGN: A multi-center randomized trial is currently being conducted since September 2014. The smartphone-based CBT program, named the “Kokoro-App,” for major depression has been developed and its feasibility has been confirmed in a previous open study. The program consists of an introduction, 6 sessions and an epilogue, and is expected to be completed within 9 weeks by patients. In the present trial, 164 patients with DSM-5 major depressive disorder and still suffering from depressive symptoms after adequate antidepressant treatment for more than 4 weeks will be allocated to the Kokoro-App plus switching antidepressant group or the switching antidepressant alone group. The participants allocated to the latter group will receive full components of the Kokoro-App after 9 weeks. The primary outcome is the change in the total score on the Patient Health Questionnaire through the 9 weeks of the program, as assessed at week 0, 1, 5 and 9 via telephone by blinded raters. The secondary outcomes include the change in the total score of the Beck Depression Inventory-II, change in side effects as assessed by the Frequency, Intensity and Burden of Side Effects Rating, and treatment satisfaction. DISCUSSION: An effective and reachable intervention may not only lead to healthier mental status among depressed patients, but also to reduced social burden from this illness. This paper outlines the background and methods of a trial that evaluates the possible additive value of a smartphone-based CBT program for treatment-resistant depression. TRIAL REGISTRATION: UMIN-CTR: UMIN000013693 (registered on 1 June 2014).

Whelan, Pauline; Machin, Matthew; Lewis, Shon; Buchan, Iain; Sanders, Caroline; Applegate, Eve et al. (2015): Mobile early detection and connected intervention to coproduce better care in severe mental illness. In: Studies in health technology and informatics 216, S. 123–126.

Current approaches to the management of severe mental illness have four major limitations: 1) symptom reporting is intermittent and subject to problems with reliability; 2) service users report feelings of disengagement from their care planning; 3) late detection of symptoms delay interventions and increase the risk of relapse; and 4) care systems are held back by the costs of unscheduled hospital admissions that could have been avoided with earlier detection and intervention. The ClinTouch system was developed to close the loop between service users and health professionals. ClinTouch is an end-to-end secure platform, providing a validated mobile assessment technology, a web interface to view symptom data and a clinical algorithm to detect risk of relapse. ClinTouch integrates high-resolution, continuous longitudinal symptom data into mental health care services and presents it in a form that is easy to use for targeting care where it is needed. The architecture and methodology can be easily extended to other clinical domains, where the paradigm of targeted clinical interventions, triggered by the early detection of decline, can improve health outcomes.

Wigman, J. T. W.; van Os, J.; Borsboom, D.; Wardenaar, K. J.; Epskamp, S.; Klippel, A. et al. (2015): Exploring the underlying structure of mental disorders: Cross-diagnostic differences and similarities from a network perspective using both a top-down and a bottom-up approach. In: Psychological Medicine 45 (11), S. 2375–2387. DOI: 10.1017/S0033291715000331.

Background: It has been suggested that the structure of psychopathology is best described as a complex network of components that interact in dynamic ways. The goal of the present paper was to examine the concept of psychopathology from a network perspective, combining complementary top-down and bottom-up approaches using momentary assessment techniques. Method: A pooled Experience Sampling Method (ESM) dataset of three groups (individuals with a diagnosis of depression, psychotic disorder or no diagnosis) was used (pooled N = 599). The top-down approach explored the network structure of mental states across different diagnostic categories. For this purpose, networks of five momentary mental states (‘cheerful’, ‘content’, ‘down’, ‘insecure’ and ‘suspicious’) were compared between the three groups. The complementary bottom-up approach used principal component analysis to explore whether empirically derived network structures yield meaningful higher order clusters. Results: Individuals with a clinical diagnosis had more strongly connected moment-to-moment network structures, especially the depressed group. This group also showed more interconnections specifically between positive and negative mental states than the psychotic group. In the bottom-up approach, all possible connections between mental states were clustered into seven main components that together captured the main characteristics of the network dynamics. Conclusions: Our combination of (i) comparing network structure of mental states across three diagnostically different groups and (ii) searching for trans-diagnostic network components across all pooled individuals showed that these two approaches yield different, complementary perspectives in the field of psychopathology. The network paradigm therefore may be useful to map transdiagnostic processes.

Wray, Tyler B.; Merrill, Jennifer E.; Monti, Peter M. (2014): Using Ecological Momentary Assessment (EMA) to Assess Situation-Level Predictors of Alcohol Use and Alcohol-Related Consequences. In: Alcohol research : current reviews 36 (1), S. 19–27.

Ecological momentary assessment (EMA) has afforded several important advances in the field of alcohol research, including testing prominent models of alcohol abuse etiology in “high resolution.” Using high-tech methods for signaling and/or assessment, such as mobile electronic diaries, personal data assistants, and smartphones, EMA approaches potentially can improve understanding of precipitants of drinking, drinking patterns, and consequences. For example, EMA has been used to study complex drinking patterns and dynamic predictors of drinking in near-real time. Compared with other methods, EMA can better sample and capture changes in these phenomena that occur in relatively short time frames. EMA also has several potential applications in studying the consequences of alcohol use, including physical, interpersonal, behavioral, and legal problems. However, even with all these potential capabilities, EMA research in the alcohol field still is associated with some limitations, including the potential for measurement reactivity and problems with acceptability and compliance. Despite these limitations, electronically based EMA methods are versatile and are capable of capturing data relevant to a variety of momentary influences on both alcohol use and consequences. Therefore, it will be exciting to fully realize the potential of future applications of EMA technologies, particularly if the associated costs can be reduced.

Wrzus, Cornelia; Wagner, Gert G.; Riediger, Michaela (2015): Personality-Situation Transactions From Adolescence to Old Age. In: Journal of Personality and Social Psychology. DOI: 10.1037/pspp0000054.

People presumably choose and create their daily environments according to their personality. Prior research shows that, for example, more extraverted people engage more often in social situations, and more conscientious people engage more often in work-related activities compared with less extraverted or less conscientious people, respectively. The current study examined such personality-situation transactions in people’s daily life. Based on the assumption that older people know themselves and their personality better than younger people, we investigated whether momentary and proximate personality-situation associations (i.e., changing from 1 type of situation into another) increase with older age. Three-hundred and 78 people aged 14 to 82 years described their Big Five traits and took part in a 3-week experience-sampling phase. Using mobile-phone based assessments in daily life, participants reported on average 55 times on their momentary situation. Multilevel modeling results showed that personality-situation associations varied with the age of participants. Some of the “established” personality-situation associations, such as for extraversion and time spent with friends or conscientiousness and time spent with work activities, were only observed in adolescence and young adulthood. In contrast, other personality-situation associations appeared only in late adulthood, such as for openness and time spent with friends. Yet most personality-situation associations did not vary significantly with people’s age. In addition, personality traits predicted maintaining or entering personality-congruent situations. The latter results point to the active role of personality in shaping one’s environment. The findings imply that some personality-situation transactions may be largely similarly across the life span.

Xiao, Luo; He, Bing; Koster, Annemarie; Caserotti, Paolo; Lange-Maia, Brittney; Glynn, Nancy W. et al. (2015): Movement prediction using accelerometers in a human population. In: Biometrics. DOI: 10.1111/biom.12382.

We introduce statistical methods for predicting the types of human activity at sub-second resolution using triaxial accelerometry data. The major innovation is that we use labeled activity data from some subjects to predict the activity labels of other subjects. To achieve this, we normalize the data across subjects by matching the standing up and lying down portions of triaxial accelerometry data. This is necessary to account for differences between the variability in the position of the device relative to gravity, which are induced by body shape and size as well as by the ambiguous definition of device placement. We also normalize the data at the device level to ensure that the magnitude of the signal at rest is similar across devices. After normalization we use overlapping movelets (segments of triaxial accelerometry time series) extracted from some of the subjects to predict the movement type of the other subjects. The problem was motivated by and is applied to a laboratory study of 20 older participants who performed different activities while wearing accelerometers at the hip. Prediction results based on other people’s labeled dictionaries of activity performed almost as well as those obtained using their own labeled dictionaries. These findings indicate that prediction of activity types for data collected during natural activities of daily living may actually be possible.

Zawadzki, Matthew J.; Smyth, Joshua M.; Costigan, Heather J. (2015): Real-time associations between engaging in leisure and daily health and well-being. In: Annals of Behavioral Medicine 49 (4), S. 605–615. DOI: 10.1007/s12160-015-9694-3.

Background: Engagement in leisure has a wide range of beneficial health effects. Yet, this evidence is derived from between-person methods that do not examine the momentary within-person processes theorized to explain leisure’s benefits.Purpose: This study examined momentary relationships between leisure and health and well-being in daily life.Methods: A community sample (n = 115) completed ecological momentary assessments six times a day for three consecutive days. At each measurement, participants indicated if they were engaging in leisure and reported on their mood, interest/boredom, and stress levels. Next, participants collected a saliva sample for cortisol analyses. Heart rate was assessed throughout the study.Results: Multilevel models revealed that participants had more positive and less negative mood, more interest, less stress, and lower heart rate when engaging in leisure than when not.Conclusions: Results suggest multiple mechanisms explaining leisure’s effectiveness, which can inform leisure-based interventions to improve health and well-being.

Zhang, Melvyn W B; Ho, Roger C M; Sockalingam, Sanjeev (2015): Online and smartphone based cognitive behavioral therapy for bariatric surgery patients: Initial pilot study. In: Technology and health care : official journal of the European Society for Engineering and Medicine. DOI: 10.3233/THC-151026.

BACKGROUND: The respective rates of obesity in Canada and the United states are estimated to be 24.1% and 34.1%. Due to the increased incidence of obesity, Bariatric surgery has been recognized as one of the treatment options. Despite the success of Bariatric surgery, studies have proposed that it has neglected the contributions of other factors, such as psychological factors in the causation as well as the maintenance of obesity amongst individuals. Cognitive behavioral therapy (CBT) is largely a psychosocial intervention that has been shown to be efficacious, as studies have demonstrated that even brief CBT interventions could help in the reduction of binge eating and maintenance of weight loss. Previously identified problems with regards to the integration and the provision of such interventions include that of geographical barriers. In order to overcome the geographical barriers, telephone-based CBT has been conceptualized. Over the past decade, there has been massive advancement and development in Internet, Web-based and smartphone technologies, but there is still a paucity of applications in this area. OBJECTIVE: Our current research objective is to determine if bariatric surgery patients will be receptive towards an online and smartphone based CBT intervention. METHODOLOGY: The Bariatric Surgery Online CBT portal and Smartphone companion application was developed between July 2013 and December 2013. A low-cost methodology of developing the online portal was adopted. In terms of development, 4 core development phases were adopted. These included that of: a) Formulation of users’ requirements, b) System design and development, c) System evaluation and d) System deployment and pilot application. The bariatric surgery workgroup from the Toronto Western Hospital helped with the recruitment of the subjects from the outpatient specialist service. Links to the web-portal was provided to each of the participants recruited. RESULTS: Since the inception of the online portal to date, in terms of usage rates, there have been a total of 2408 visitors to the online portal. The majority of the visitors are from Canada (n= 1879). From the analytics, a total of 8 users have participated in the pre-assessment questionnaire and have attempted and tried to use the individual modules. Since the inception of the pilot study from January 2014 till October 2014, 4 individuals have completed at least 3 modules available on the online portal. CONCLUSIONS: This is one of the first few studies that have demonstrated the potential feasibility of having an online and smartphone cognitive behavioral portal to serve the psychological needs of bariatric surgery patients.

Zhang, Melvyn W B; Ho, Roger C M; Sockalingam, Sanjeev (2015): Pilot implementation and user preferences of a Bariatric After-care application. In: Technology and health care : official journal of the European Society for Engineering and Medicine. DOI: 10.3233/THC-151025.

BACKGROUND: The respective rates of obesity in Canada and the United states are estimated to be 24.1% and 34.1%. Due to the increased incidence of obesity, Bariatric surgery has been recognized as one of the treatment options. Patients who have undergone Bariatric surgery tend to need chronic long-term follow-up with a multi-disciplinary team. In the past decade, there has been massive advancemcent and development in Internet, Web-based and Smartphone technologies. However, there seemed to be a pacuity of applications in this area that enables post-bariatric patients to self-manage their own condition. In addition, past research have highlighted the limited evidence based with regards to currently available bariatric applications, mainly due to the lack of medical professionals involvement. OBJECTIVE: Our current research objective is to illustrate the development of a Bariatric After-care smartphone application and to highlight user preferences with regards to the features integrated within the application. METHODOLOGY: The Bariatric Aftercare application was developed between the months of March 2014 to April 2014. Making use of low-cost online web-based application developmental technologies, the authors embarked on the development of the web-based application. Patients who attended their routine follow-up appointments are given the links to the web-based application. They were also recruited to participate in an online user evaluation survey to identify their preferences with regards to the features integrated. RESULTS: Since the inception of the web-based application to date, there has been a cumulative total of 385 unique assess to the online web-based application. There is a slight change in the confidence levels of the participants with regards to using the application to help them self-manage their own condition. The majority of the users have indicated that they preferred the information pertaining to what happens during each consult with members of the multidisciplinary team and also greatly valued the feature with regards to the ability to re-schedule their appointments. The vast majority also found the additional resources to be helpful. CONCLUSIONS: This is one of the first studies to demonstrate the potential use of smartphone innovations in Bariatric After-care self-management. The current study has shown that users are generally receptive towards such an innovative implementation and has also highlighted some of their preferences with regards to such a self-management application for self-management of their health condition post bariatric surgery. In addition, the authors have also managed to demonstrate how clinicians could be involved in the formulation of a bariatric care application, which has an evidence base.

Zhang, Lin; Yang, Wentao; Yang, Yuankui; Liu, Hong; Gu, Zhongze (2015): Smartphone-based point-of-care testing of salivary alpha-amylase for personal psychological measurement. In: The Analyst. DOI: 10.1039/c5an01664a.

Here we report a smartphone-based potentiometric biosensor for point-of-care testing of salivary alpha-amylase (sAA), which is one of the most sensitive indices of autonomic nervous system activity, and therefore a promising non-invasive biomarker for mental health. The biosensing system includes a smartphone having a sAA-detection App, a potentiometric reader and a sensing chip with preloaded reagents. The saliva sample wicks into the reaction zone on the sensing chip so that the sAA reacts with the preloaded reagents, resulting in conversion of an electron mediator Fe(CN)63- to Fe(CN)64-. The sensing chip is then pressed by fingers to push the reaction mixture into the detection zone for the potentiometric measurement. The potential measured by the smartphone-powered potentiometric reader is sent to the smartphone App via the USB port, and converted into sAA concentration based on a calibration curve. Using our method, sAA in real human sample is quantitatively analyzed within 5 min. The results are in good agreement with that obtained using a reference method, and correlated to psychological states of the subjects.

Zhang, Peng; Zhao, Qile; Li, You; Niu, Xiaoji; Zhuang, Yuan; Liu, Jingnan (2015): Collaborative WiFi Fingerprinting Using Sensor-Based Navigation on Smartphones. In: Sensors (Basel, Switzerland) 15 (7), S. 17534–17557. DOI: 10.3390/s150717534.

This paper presents a method that trains the WiFi fingerprint database using sensor-based navigation solutions. Since micro-electromechanical systems (MEMS) sensors provide only a short-term accuracy but suffer from the accuracy degradation with time, we restrict the time length of available indoor navigation trajectories, and conduct post-processing to improve the sensor-based navigation solution. Different middle-term navigation trajectories that move in and out of an indoor area are combined to make up the database. Furthermore, we evaluate the effect of WiFi database shifts on WiFi fingerprinting using the database generated by the proposed method. Results show that the fingerprinting errors will not increase linearly according to database (DB) errors in smartphone-based WiFi fingerprinting applications.

Zia, Jasmine K.; Le, Thai; Munson, Sean; Heitkemper, Margaret M.; Demiris, George (2015): Download Alert: Understanding Gastroenterology Patients’ Perspectives on Health-Related Smartphone Apps. In: Clinical and translational gastroenterology 6, S. e96. DOI: 10.1038/ctg.2015.25.

OBJECTIVES: The aims of this study were to understand patients’ willingness to use different types of health-related smartphone apps and to explore their attitudes on the overall value, usability, feasibility, credibility, intrusiveness, and obtrusiveness of these apps. METHODS: Questionnaires were distributed to adult patients presenting to gastroenterology clinics at an academic medical center. The 25-question survey consisted of 5-point Likert-type scale statements, multiple-choice questions, and open-ended questions. RESULTS: Participants were mainly White (N=94, 78%) and smartphone owners (N=125, 93%). The mean age was 40.8 years (N=121, s.d.=13.2). Participants were willing to use most types of apps unless it monitored their location or social networking activity. Half were less willing to use an app if it required a visible accessory. Most participants were willing to use a health-related app up to 5 min a day indefinitely but unwilling to pay out-of-pocket for it. Participants generally disagreed that an app would be hard to learn how to use, interfere with their daily routine, or be embarrassing to use in public. Overall, participants felt that health-related apps could help them and their doctors better manage their medical problems, but were neutral in trusting their quality. Most worried that personal information used for an app would fall into the wrong hands. CONCLUSION: Gastroenterology patients were willing to use and valued most types of health-related apps. They perceived this technology as feasible, usable, and relatively unobtrusive unless a visible accessory was required. However, many were concerned about their privacy.

Zuzanek, Jiri; Zuzanek, Tamara (2015): Of happiness and of despair, is there a measure? Time use and subjective well-being. In: Journal of Happiness Studies 16 (4), S. 839–856. DOI: 10.1007/s10902-014-9536-1.

Data from the 1975 U.S. time use survey, Canadian time use surveys (GSS) conducted from 1986 to 2010, and experience sampling surveys (ESM) conducted in 1985 and 2003 at the University of Waterloo (Canada) are used to examine well-being effects of time use. Indicators of subjective well-being (SWB) under investigation include: (a) generalised enjoyment ratings of selected daily activities; (b) reporting of the single most enjoyed activity performed on the time diary day; (c) affect ratings of daily activities recorded in ESM surveys at the time of their occurrence; (d) correlations between time use and levels of respondents’ perceived happiness and life satisfaction, and (e) relationships between frequency of participation in different groups of daily activities and respondents’ cumulative affect ratings during a survey week (ESM 1985, 2003). An argument is made that attempts to delineate indices of SWB as multiples of activity enjoyment ratings and their duration encounter considerable measurement and conceptual difficulties. It is suggested that prolonged exposure to highly enjoyed daily activities does not always foretell higher levels of cumulative subjective well-being, which is associated with balanced use of time rather than increased participation in individual activities.


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