Society for Ambulatory Assessment

First quarter 2012 (January to March)

Attu, S. D., Rhebergen, D., Comijs, H. C., Parker, G., & Stek, M. L. (2012). Psychomotor symptoms in depressed elderly patients: assessment of the construct validity of the Dutch CORE by accelerometry. J.Affect.Disord., 137, 146-150.

BACKGROUND: Psychomotor symptoms are putative distinguishing features of melancholia that may guide treatment decisions. Hence, there is a need for valid instruments to assess psychomotor symptoms. The objective of this study is to examine the construct validity of the CORE, an observational instrument designed to quantify psychomotor symptoms in depression. METHODS: Associations between CORE scores and levels of motor activity measured by accelerometry were examined in a sample of 25 elderly depressed in-patients, for various time intervals, during 24h of follow-up. RESULTS: Total CORE scores (as well as CORE retardation and agitation sub-scale scores) were negatively correlated with activity scores, with depression severity increasing the correlational strength substantively. For total CORE scores and retardation sub-scale scores, the highest associations were quantified across morning intervals. LIMITATIONS: Given the nature of the study mild levels of depression were overrepresented, monitoring of motor activity lasted only 24h and non-motor activity items in the CORE were not measured. CONCLUSION: Associations between CORE total scores and retardation sub-scale scores support the validity of the CORE as well as quantifying associations between severity of psychomotor disturbance and clinical depression severity. Study results also support the application of accelerometry tools in quantifying components of clinical depression

Beets, M. W., Beighle, A., Bottai, M., Rooney, L., & Tilley, F. (2012). Pedometer-determined step-count guidelines for afterschool programs. Journal of Physical Activity & Health, 9, 71-77.

Background: Policies to require afterschool programs (ASPs, 3 PM to 6 PM) to provide children a minimum of 30 minutes of moderate-to-vigorous physical activity (MVPA) exist. With few low-cost, easy-to-use measures of MVPA available to the general public, ASP providers are limited in their ability to track progress toward achieving this policy-goal. Pedometers may fill this gap, yet there are no step-count guidelines for ASPs linked to 30 minutes of MVPA. Methods: Steps and accelerometer estimates of MVPA were collected concurrently over multiple days on 245 children (8.2 years, 48% boys, BMI-percentile 68.2) attending 3 community-based ASPs. Random intercept logit models and receiver operating characteristic (ROC) analyses were used to identify a threshold of steps that corresponded with attaining 30 minutes of MVPA. Results: Children accumulated an average of 2876 steps (standard error [SE] 79) and 16.1 minutes (SE0.5) of MVPA over 111 minutes (SE1.3) during the ASP. A threshold of 4600 steps provided high specificity (0.967) and adequate sensitivity (0.646) for discriminating children who achieved the 30 minutes of MVPA; 93% of the children were correctly classified. The total area under the curve was 0.919. Children accumulating 4600 steps were 25 times more likely to accumulate 30 minutes of MVPA. Conclusions: This step threshold will provide ASP leaders with an objective, low-cost, easy-to-use tool to monitor progress toward policy-related goals.

Ben-Zeev, D., Young, M. A., & Depp, C. A. (2012). Real-time predictors of suicidal ideation: Mobile assessment of hospitalized depressed patients. Psychiatry Res..

Suicidal ideation is a risk factor for suicide attempt and completion. Cross-sectional or retrospective studies cannot capture the dynamic course and possible predictors of suicidal ideation as it occurs in daily life. This study utilizes an experience sampling paradigm to identify real-time predictors of suicidal ideation in inpatients with major depressive disorder. Thirty-one depressed patients admitted to a psychiatric unit were signaled by a mobile device to record suicidal ideation, affect, and other symptoms, multiple times a day over 1-week. Participants completed a total of 1350 questionnaires. Seventy-four percent of the sample reported suicidal ideation during the week. Time-lagged analyses revealed that momentary ratings of Sadness, Tension, and Boredom (as well as suicidal ideation itself) predicted subsequent suicidal thoughts in the following hours. Baseline severity of depression and past suicide attempts were both correlated with mean ideation severity during the week. A number of predictors identified in prior research (e.g. hopelessness) were unrelated to subsequent suicidal ideation in the current study. Momentary interventions that guide individuals through activities designed to reduce levels of Sadness, Tension, and Boredom in real-time (e.g., thought challenging, relaxation, behavioral activation) may be especially warranted

Bento, T., Cortinhas, A., Leitao, J. C., & Mota, M. P. (2012). Use of accelerometry to measure physical activity in adults and the elderly. Rev.Saude Publica.

OBJECTIVE: To review the use of accelerometry as an objective measure of physical activity in adults and elderly people. METHODS: A systematic review of studies on the use of accelerometty as an objective measure to assess physical activity in adults were examined in PubMed Central, Web of Knowledge, EBSCO and Medline databases from March 29 to April 15, 2010. The following keywords were used: “accelerometry,” “accelerometer,” “physical activity,” “PA,” “patterns,” “levels,” “adults,” “older adults,” and “elderly,” either alone or in combination using “AND” or “OR.” The reference lists of the articles retrieved were examined to capture any other potentially relevant article. Of 899 studies initially identified, only 18 were fully reviewed, and their outcome measures abstracted and analyzed. RESULTS: Eleven studies were conducted in North America (United States), five in Europe, one in Africa (Cameroon) and one in Australia. Very few enrolled older people, and only one study reported the season or time of year when data was collected. The articles selected had different methods, analyses, and results, which prevented comparison between studies. CONCLUSIONS: There is a need to standardize study methods for data reporting to allow comparisons of results across studies and monitor changes in populations. These data can help design more adequate strategies for monitoring and promotion of physical activity

Bergmann, J. H., Smith, I. C., & Mayagoitia, R. E. (2012). Using a body sensor network to measure the effect of fatigue on stair climbing performance. Physiol Meas., 33, 287-296.

In terms of self-rated health, the most important activities of daily living are those involving mobility. Of these activities stair climbing is regarded as the most strenuous. A loss of stair climbing ability with age is normally associated with a loss of muscle strength and power, while other factors that influence muscle function, such as fatigue, are often not taken into account. So far no research has been published on how long-lasting fatigue affects activities of daily living, despite the fact that it has been repeatedly proven, in laboratory settings, to influence muscle force production over long periods of time. Technological advances in body sensor networks (BSNs) now provide a method to measure performance during complex real-life situations. In this study the use of a BSN was explored to investigate the effects of long-lasting fatigue on stair climbing performance in 20 healthy adults. Stair climbing performance was measured before and after a fatiguing protocol using a BSN. Performance was defined by temporal and spatial parameters. Long-lasting fatigue was successfully induced in all participants using an exercise protocol. The BSN showed that post-exercise fatigue did not influence stair climbing times (p > 0.2) and no meaningful changes in joint angles were found. No effect on overall stair climbing performance was found, despite a clear presence of long-lasting fatigue. This study shows that physiological paradigms can be further explored using BSNs. Ecological validity of lab-based measurements can be increased by combining them with BSNs

Bracht, T., Heidemeyer, K., Koschorke, P., Horn, H., Razavi, N., Wopfner, A. et al. (2012). Comparison of objectively measured motor behavior with ratings of the motor behavior domain of the Bern Psychopathology Scale (BPS) in schizophrenia. Psychiatry Res..

Motor symptoms in schizophrenia are frequent and relevant to diagnosis and antipsychotic therapy. To date motor symptoms are difficult to assess and their pathobiology is a widely unresolved issue. The Bern Psychopathology Scale for the assessment of system-specific psychotic symptoms (BPS) was designed to identify homogenous patient groups by focusing on three domains: language, affectivity and motor behavior. The present study aimed to validate the motor behavior domain of the BPS using wrist actigraphy. In total, 106 patients were rated with the BPS and underwent 24h continuous actigraphy recording. The ratings of the global severity of the motor behavior domain (GSM) as well as the quantitative and the subjective items of the motor behavior domain of the BPS were significantly associated with actigraphic variables. In contrast, the qualitative items of the motor domain failed to show an association with actigraphy. Likewise, scores of the language and the affectivity domains were not related to actigraphic measures. In conclusion, we provided substantial external validity for global, quantitative and subjective ratings of the BPS motor behavior domain. Thus, the BPS is suitable to assess the dimension of quantitative motor behavior in the schizophrenia spectrum

Buckner, J. D., Crosby, R. D., Wonderlich, S. A., & Schmidt, N. B. (2012). Social anxiety and cannabis use: an analysis from ecological momentary assessment. J.Anxiety Disord., 26, 297-304.

Individuals with elevated social anxiety appear especially vulnerable to cannabis-related problems, yet little is known about the antecedents of cannabis-related behaviors among this high-risk population. The present study used ecological momentary assessment (EMA) to examine the relations among social anxiety, cannabis craving, state anxiety, situational variables, and cannabis use in the natural environment during ad-lib cannabis use episodes. Participants were 49 current cannabis users. During the two-week EMA period, social anxiety significantly interacted with cannabis craving to predict cannabis use both cross-sectionally and prospectively. Specifically, individuals with higher social anxiety and craving were most likely to use cannabis. There was a significant social anxiety x state anxiety x others’ use interaction such that when others were using cannabis, those with elevations in both trait social anxiety and state anxiety were the most likely to use cannabis

Carpenter, J. S., Newton, K. M., Sternfeld, B., Joffe, H., Reed, S. D., Ensrud, K. E. et al. (2012). Laboratory and ambulatory evaluation of vasomotor symptom monitors from the Menopause Strategies Finding Lasting Answers for Symptoms and Health network. Menopause..

OBJECTIVE: The aim of this study was to evaluate monitors for assessing vasomotor symptoms (VMS) in laboratory and ambulatory settings before use in the Menopause Strategies Finding Lasting Answers for Symptoms and Health network clinical trials testing VMS therapies. METHODS: This was a three-phase study. Phase 1 included laboratory testing of the Freedman and prototype Bahr Monitor, phase 2 included laboratory testing of the commercial Bahr Monitor and Biolog, and phase 3 included ambulatory testing of the commercial Bahr Monitor and Biolog. All phases enrolled midlife women with VMS, midlife women without VMS, and young women without VMS. The participants self-reported VMS by pressing event marker buttons. Questionnaires assessed demographics (all phases) and monitor acceptability (phases 2 and 3). RESULTS: Phase I testing was stopped because of sensitivity of the Freedman device to ambient humidity changes and lack of analytic software for the prototype Bahr Monitor. In phases 2 and 3, agreement between event-marked and commercial Bahr Monitor or Biolog-recorded VMS was higher in the laboratory than in the ambulatory setting; however, agreement between monitors was poor in two of three laboratory groups (midlife no VMS and young no VMS) and in all ambulatory groups. During ambulatory monitoring, the mean number of Bahr Monitor VMS was 16.33 in midlife women with VMS, 9.61 in midlife women without VMS, and 14.63 in young women without VMS (software version, March 2011). The Bahr Monitor was more acceptable than the larger Biolog, but feedback reflected annoyance at having to wear a device that itched and was visible under clothing. CONCLUSIONS: The Bahr Monitor and Biolog seem suitable for use in controlled laboratory conditions during short periods of time. However, the current versions of these monitors may not be suitable for ambulatory clinical trials at this time

Cohen, M. D., Cutaia, M., Brehm, R., Brutus, V., Courtney, P., V, & Lewendowski, D. (2012). Detecting motor vehicle travel in accelerometer data. COPD., 9, 102-110.

Abstract Chronic Obstructive Pulmonary Disease (COPD) frequently has a significant impact on patients’ everyday activity. Because of this, accurate measurement of daily activity is of particular interest. Although accelerometers are an objective means of measuring daily activity, these devices sense vibrations and erroneously score motor vehicle travel (MVT) as moderate physical activity. It is the objective of this study to develop a new method to analyze accelerometry data that would accurately classify MVT as non-acceleration, or sitting/standing. As sitting/standing has a different pattern of count-to-count variability than walking, we hypothesized that a rolling standard deviation (RSD), which is a measurement of volatility in the data, would more accurately classify periods of MVT than analysis based on activity counts alone. Twenty-two subjects with COPD were studied. A training set of 15% of the dataset was used to establish an RSD-threshold during MVT based on the upper 95%-confidence interval. The accuracy of the RSD thresholds were tested and presented as sensitivity, specificity and receiver operating curves. Results demonstrated high sensitivity and specificity suggesting that the RSD not only accurately classified MVT, but had a low rate of misclassification. The RSD analysis scored more MVT as sitting/standing than assessment by VMU alone. The accuracy of accelerometers to define the profile of daily activity in sedentary populations, such as those with COPD, is greatly improved

Conley, K. M. & Lehman, B. J. (2012). Test anxiety and cardiovascular responses to daily academic stressors. Stress Health, 28, 41-50.

Routine academic events may cause stress and produce temporary elevations in blood pressure. Students who experience test anxiety may be especially prone to cardiovascular activation in response to academic stress. This study drew on self-reported stress and ambulatory blood pressure measurements provided by 99 undergraduate participants (30% men, mean age=21 years) who participated over 4 days. Posture, activity level, recent consumption and the previous same-day reading were considered as covariates in a series of hierarchical linear models. Results indicate elevations in systolic blood pressure at times of acute academic stressors; neither diastolic blood pressure nor heart rate was linked with academic stress. In addition, those participants higher in test anxiety exhibited especially pronounced elevations in systolic blood pressure during times of acute academic stress. This research suggests that everyday academic stressors are linked with temporary increases in blood pressure and that test anxiety may contribute to these elevations. Test anxiety has implications for future academic and job success, and cardiovascular responses to everyday stress may contribute to health problems later in life

Cook, I., Alberts, M., & Lambert, E. V. (2012). Influence of cut-points on patterns of accelerometry-measured free-living physical activity in rural and urban black South african women. J.Phys.Act.Health, 9, 300-310.

BACKGROUND: We describe the effect of 2 different accelerometer cut-points on physical activity (PA) patterns in rural and urban black South African women. METHODS: Hip-mounted uni-axial accelerometers were worn for 6 to 7 days by rural (n = 272) and urban (n = 16) participants. Twenty-hour (4 AM to 12 AM) PA counts (cts) and volumes ( were extracted: sedentary (SED, <100 cts.min-1), light (100-759 cts.min-1), moderate-1 (MOD1, 760-1951 cts.min-1), moderate-2 to vigorous (MOD2VG, >/=1952 cts.min-1), and bouts >/=10 min for >/=760 cts.min-1 (MOD1VGbt) and >/=1952 cts.min-1 (MOD2VGbt). RESULTS: Valid data were obtained from 263 rural women and 16 urban women. Total counts and average counts were higher (+80,399, +98 (P < .01), SED lower (-61, P = .0042), MOD1 higher (+65, P < .0001), and MOD1VGbt higher (+19, P = .0179) in rural women compared with urban women. Estimated adherence (>/=30 for 5 days.wk-1) was 1.4-fold higher in rural women than urban women for MOD-1VGbt, but 3.3-fold higher in urban women than rural women for MOD2VGbt. CONCLUSIONS: Rural women accumulate greater amounts of PA than urban women within a particular count band. Depending on which moderate PA cut-point was used to estimate PA public health adherence, rural women could be classified as less physically active than urban women

Courvoisier, D. S., Eid, M., & Lischetzke, T. (2012). Compliance to a cell phone-based ecological momentary assessment study: The effect of time and personality characteristics. Psychol.Assess..

Ecological momentary assessment (EMA) is a method that is now widely used to study behavior and mood in the settings in which they naturally occur. It maximizes ecological validity and avoids the limitations of retrospective self-reports. Compliance patterns across time have not been studied. Consistent compliance patterns could lead to data not missing at random and bias the results of subsequent analyses. In order to use modern statistical approaches for handling missing data, it is important to include variables predicting missing values into the statistical analysis. Therefore, these predictors have to be known and measured. The authors collected data on 3 four-item mood scales measuring well-being, wakefulness, and nervousness on 6 occasions per day for 7 days (N = 305) and examined compliance rate across time, within day, and within week. Results show good global compliance (mean compliance: 74.9% of calls answered). Compliance varied more within day than within week. Within day, it was lower for the first call of the day between 9 p.m. and 11 p.m. and higher for the call between 5 p.m. and 7 p.m. Within week, calls were equally answered across days of the week, but, as the study progressed, there was a slight drop in compliance with a progressive decrease that was stronger for the first 2 calls. Compliance on the person level did not depend on personality or on satisfaction with life. Practical consequences of the results for conducting ambulatory assessment studies are discussed, and some recommendations are given.

Crespo, C., Aboy, M., Fernandez, J. R., & Mojon, A. (2012). Automatic identification of activity-rest periods based on actigraphy. Med.Biol.Eng Comput., 50, 329-340.

We describe a novel algorithm for identification of activity/rest periods based on actigraphy signals designed to be used for a proper estimation of ambulatory blood pressure monitoring parameters. Automatic and accurate determination of activity/rest periods is critical in cardiovascular risk assessment applications including the evaluation of dipper versus non-dipper status. The algorithm is based on adaptive rank-order filters, rank-order decision logic, and morphological processing. The algorithm was validated on a database of 104 subjects including actigraphy signals for both the dominant and non-dominant hands (i.e., 208 actigraphy recordings). The algorithm achieved a mean performance above 94.0%, with an average number of 0.02 invalid transitions per 48 h

Derogatis, L. R., Komer, L., Katz, M., Moreau, M., Kimura, T., Garcia, J. M. et al. (2012). Treatment of Hypoactive Sexual Desire Disorder in Premenopausal Women: Efficacy of Flibanserin in the VIOLET Study. J.Sex Med., 9, 1074-1085.

Introduction. Hypoactive Sexual Desire Disorder (HSDD) is the most common form of Female Sexual Dysfunction and is characterized by low sexual desire that causes distress. Aim. The aim of this study was to assess the efficacy and safety of flibanserin, a postsynaptic 5-HT(1A) agonist/5-HT(2A) antagonist, in premenopausal women with HSDD. Methods. North American premenopausal women with HSDD were randomized to 24 weeks’ treatment with placebo (N = 295), flibanserin 50 mg (N = 295), or flibanserin 100 mg (N = 290), once daily at bedtime. Main Outcome Measures. Coprimary endpoints were change from baseline to study end in number of satisfying sexual events (SSE) and sexual desire score measured daily using an electronic diary (eDiary). Secondary endpoints included change from baseline to study end in Female Sexual Function Index (FSFI) desire domain and total scores, Female Sexual Distress Scale-Revised (FSDS-R) Item 13 and total scores, and Patient’s Global Impression of Improvement. Results. Flibanserin 50 mg and 100 mg led to increases in SSE (P < 0.05 and P < 0.01 vs. placebo, respectively). There was a numerical trend toward improvement in eDiary desire score on flibanserin 100 mg, but statistical significance was not reached (P = 0.07 vs. placebo). FSFI desire domain and total scores increased with both flibanserin regimens (P < 0.05). FSDS-R total and Item 13 scores decreased with flibanserin 100 mg (P < 0.001), indicating reduced sexual distress. More women receiving flibanserin 50 mg and 100 mg considered their HSDD to have improved than women receiving placebo (39.6% and 50.0% vs. 30.3%, respectively) (P < 0.05). Conclusion. In premenopausal women with HSDD, flibanserin 50 mg and 100 mg once daily at bedtime were well tolerated and associated with statistically significant improvements in SSE, sexual desire (FSFI desire domain score but not eDiary desire score) and overall sexual function, and reduction of sexual distress, vs. placebo. DeRogatis LR, Komer L, Katz M, Moreau M, Kimura T, Garcia Jr. M, Wunderlich G, and Pyke R on behalf of the VIOLET trial investigators. Treatment of Hypoactive Sexual Desire Disorder in premenopausal women: Efficacy of flibanserin in the VIOLET study. J Sex Med 12;9:1074-1085

Dunton, G. F., Kawabata, K., Intille, S., Wolch, J., & Pentz, M. A. (2012). Assessing the social and physical contexts of children’s leisure-time physical activity: an ecological momentary assessment study. Am.J.Health Promot., 26, 135-142.

PURPOSE: To use Ecological Momentary Assessment with mobile phones to describe where and with whom children’s leisure-time physical activity occurs. DESIGN: Repeated assessments across 4 days (Friday-Monday) during nonschool time (20 total). SETTING: Chino, California, and surrounding communities. SUBJECTS: Primarily low to middle income children (N =121; aged 9-13 years; x =11.0 years, SD =1.2 years; 52% male, 38% Hispanic/Latino). MEASURES: Electronic surveys measured current activity (e.g., active play/sports/exercise, watching TV/movies), social company (e.g., family, friends, alone), physical location (e.g., home, outdoors, school), and other perceived contextual features (e.g., safety, traffic, vegetation, distance from home). Analysis . Multilevel linear and multinomial logistic regression. RESULTS: Most of children’s physical activity occurred outdoors (away from home) (42%), followed by at home (indoors) (30%), front/backyard (at home) (8%), someone else’s house (8%), at a gym/recreation center (3%), and other locations (9%). Children’s physical activity took place most often with multiple categories of people together (e.g., friends and family) (39%), followed by family members only (32%), alone (15%), and with friends only (13%). Age, weight status, income, and racial/ethnic differences in physical activity contexts were observed. CONCLUSIONS: The most frequently reported contexts for children’s leisure time physical activity were outdoors and with family members and friends together

Dunton, G. F., Intille, S. S., Wolch, J., & Pentz, M. A. (2012). Investigating the impact of a smart growth community on the contexts of children’s physical activity using Ecological Momentary Assessment. Health Place., 18, 76-84.

This quasi-experimental research used Ecological Momentary Assessment with electronic surveys delivered through mobile phones to determine whether children change the type of contexts (i.e., settings) where they engage in physical activity after a recent move to a smart growth (SG) community in the U.S. as compared to children living in conventional low-to-medium density U.S. suburban communities (controls). SG vs. control children engaged in a greater proportion of physical activity bouts with friends, a few blocks from home, and at locations to which they walked. Over six months, the proportion of physical activity bouts reported at home (indoors) and in high traffic locations decreased among SG but not control children. Six-month increases in daily moderate-to-vigorous physical activity did not significantly differ by group. Children might have altered the type of contexts where they engage in physical activity after moving to SG communities, yet more time may be necessary for these changes to impact overall physical activity

Edgar, C., McRorie, M., & Sneddon, I. (2012). Emotional intelligence, personality and the decoding of non-verbal expressions of emotion. Personality and Individual Differences, 52, 295-300.

Previous research has highlighted theoretical and empirical links between measures of both personality and trait emotional intelligence (EI), and the ability to decode facial expressions of emotion. Research has also found that the posed, static characteristics of the photographic stimuli used to explore these links affects the decoding process and differentiates them from the natural expressions they represent. This undermines the ecological validity of established trait-emotion decoding relationships. This study addresses these methodological shortcomings by testing relationships between the reliability of participant ratings of dynamic, spontaneously elicited expressions of emotion with personality and trait EI. Fifty participants completed personality and self-report EI questionnaires, and used a computer-logging program to continuously rate change in emotional intensity expressed in video clips. Each clip was rated twice to obtain an intra-rater reliability score. The results provide limited support for links between both trait EI and personality variables and how reliably we decode natural expressions of emotion. Limitations and future directions are discussed.

Ekelund, U., Luan, J., Sherar, L. B., Esliger, D. W., Griew, P., & Cooper, A. (2012). Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA, 307, 704-712.

CONTEXT: Sparse data exist on the combined associations between physical activity and sedentary time with cardiometabolic risk factors in healthy children. OBJECTIVE: To examine the independent and combined associations between objectively measured time in moderate- to vigorous-intensity physical activity (MVPA) and sedentary time with cardiometabolic risk factors. DESIGN, SETTING, AND PARTICIPANTS: Pooled data from 14 studies between 1998 and 2009 comprising 20 871 children (aged 4-18 years) from the International Children’s Accelerometry Database. Time spent in MVPA and sedentary time were measured using accelerometry after reanalyzing raw data. The independent associations between time in MVPA and sedentary time, with outcomes, were examined using meta-analysis. Participants were stratified by tertiles of MVPA and sedentary time. MAIN OUTCOME MEASURES: Waist circumference, systolic blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and insulin. RESULTS: Times (mean [SD] min/d) accumulated by children in MVPA and being sedentary were 30 (21) and 354 (96), respectively. Time in MVPA was significantly associated with all cardiometabolic outcomes independent of sex, age, monitor wear time, time spent sedentary, and waist circumference (when not the outcome). Sedentary time was not associated with any outcome independent of time in MVPA. In the combined analyses, higher levels of MVPA were associated with better cardiometabolic risk factors across tertiles of sedentary time. The differences in outcomes between higher and lower MVPA were greater with lower sedentary time. Mean differences in waist circumference between the bottom and top tertiles of MVPA were 5.6 cm (95% CI, 4.8-6.4 cm) for high sedentary time and 3.6 cm (95% CI, 2.8-4.3 cm) for low sedentary time. Mean differences in systolic blood pressure for high and low sedentary time were 0.7 mm Hg (95% CI, -0.07 to 1.6) and 2.5 mm Hg (95% CI, 1.7-3.3), and for high-density lipoprotein cholesterol, differences were -2.6 mg/dL (95% CI, -1.4 to -3.9) and -4.5 mg/dL (95% CI, -3.3 to -5.6), respectively. Geometric mean differences for insulin and triglycerides showed similar variation. Those in the top tertile of MVPA accumulated more than 35 minutes per day in this intensity level compared with fewer than 18 minutes per day for those in the bottom tertile. In prospective analyses (N = 6413 at 2.1 years’ follow-up), MVPA and sedentary time were not associated with waist circumference at follow-up, but a higher waist circumference at baseline was associated with higher amounts of sedentary time at follow-up. CONCLUSION: Higher MVPA time by children and adolescents was associated with better cardiometabolic risk factors regardless of the amount of sedentary time

Elavsky, S., Molenaar, P. C., Gold, C. H., Williams, N. I., & Aronson, K. R. (2012). Daily physical activity and menopausal hot flashes: applying a novel within-person approach to demonstrate individual differences. Maturitas, 71, 287-293.

BACKGROUND: Physical activity (PA) may be a useful tool in the management of menopausal hot flashes (HFs) but findings are generally inconsistent. There are few well-designed and sufficiently powered RCTs. Applying a longitudinal within-person approach offers an alternative way to examine the PA-HFs relationship which enables complete accommodation of inter-individual differences. OBJECTIVES: Aprospective daily diary study which applied experience sampling methods and time series modeling techniques investigated, at the within-person level, the relationship between objectively measured daily PA of varying intensities and self-reported menopausal HFs. METHODS: Twenty-four symptomatic middle-aged women (M age=50.4; SD=4.9) completed fitness, body composition and hormonal status screening, and reported on daily HFs using an electronic PDA device across one menstrual cycle or for 30 days (if postmenopausal). Daily PA and PA intensity was measured using accelerometry and subjects completed a battery of psychological measures. RESULTS: Within person analysis identified significant relations between PA and HFs in 50% of subjects, although the specific PA indicators that predicted HFs varied, both in terms of direction and magnitude. Perceived control over HFs was the variable that most consistently differentiated between women for whom more PA was associated with fewer HFs as compared to those for whom more PA was associated with more HFs, but other individual difference characteristics such as affect, depressive symptoms, and anxiety were identified. CONCLUSIONS: There is great individual variation in the way daily PA impacts self-reported HFs. Affective outcomes and perceived control may help potentially explain this variability

Fan, L., Blumenthal, J. A., Hinderliter, A. L., & Sherwood, A. (2012). The effect of job strain on nighttime blood pressure dipping among men and women with high blood pressure. Scand.J.Work Environ.Health.

OBJECTIVES: Blunted nighttime blood pressure dipping is an established cardiovascular risk factor. This study examined the effect of job strain on nighttime blood pressure dipping among men and women with high blood pressure. METHODS: The sample consisted of 122 blue- and white collar workers (men=72, women=50). The Job Content Questionnaire was used to measure job psychological demands, job control, and social support. The ratio of job demands to job control was used to assess job strain. Nighttime blood pressure dipping was evaluated from 24-hour ambulatory blood pressure monitoring performed on three workdays. RESULTS: Men with high job strain had a 5.4 mm Hg higher sleep systolic blood pressure (P=0.03) and 3.5 mm Hg higher sleep pulse pressure (P=0.02) compared to men with low job strain. Men with high job strain had a smaller fall in systolic blood pressure and pulse pressure from awake to sleep state than those with low job strain (P<0.05). Hierarchical analyses showed that job strain was an independent determinant of systolic blood pressure dipping (P=0.03) among men after adjusting for ethnicity, body mass index, anxiety and depression symptoms, current smoking status, and alcohol consumption. Further exploratory analyses indicated that job control was the salient component of job strain associated with blood pressure dipping (P=0.03). CONCLUSIONS: High job strain is associated with a blunting of the normal diurnal variation in blood pressure and pulse pressure, which may contribute to the relationship between job strain and cardiovascular disease

Fay, D. & Sonnentag, S. (2012). Within-person fluctuations of proactive behavior: How affect and experienced competence regulate work behavior. Human Performance, 25, 72-93.

This article studies proactive work behavior from a within-person perspective. Building on the broaden-and-build model and the mood-as-information approach, we hypothesized that negative trait affect and positive state affect predict the relative time spent on proactive behavior. Furthermore, based on self-determination theory we argued that persons want to feel competent and that proactive behavior is one way to experience competence. In an experience-sampling study, 52 employees responded to surveys 3 times a day for 5 days. Hierarchical linear modeling confirmed the hypotheses on trait and state affect. Analyses furthermore showed that although a higher level of experienced competence at core task activities was associated with a subsequent increase in time spent on these activities, low experienced competence predicted an increase in time spent on proactive behavior.

Fitzgerald-DeJean, D. M., Rubin, S. S., & Carson, R. L. (2012). An application of the experience sampling method to the study of aphasia: A case report. Aphasiology, 26, 234-251.

Background: Researchers stress that functional health and psychological well-being are important aspects of quality of life in the investigation of individuals with aphasia. Employed in the social sciences, the experience sampling method (ESM) has begun to shed light on deviations in participants’ momentary responses to behavioural contingencies in naturalistic environments. Applications of ESM have demonstrated value in monitoring within-participant variations in mood, psychopathology, and treatment outcomes while minimising the effect of memory bias. Additionally, the application of ESM in psychological cognitive-behavioural therapy and occupational therapy (OT) research reportedly appeared to contribute to treatment success. A time-based, fixed-schedule sampling application of ESM was used in this study to attain self-reports throughout an aphasia treatment programme. Aims: The current investigation introduced the ESM paradigm to the study of aphasia and piloted its use in measuring psychoemotional variables in an individual with chronic aphasia participating in an intensive treatment regime. Methods & Procedures: Repeated ESM probes were administered during a university-based treatment programme to measure the daily responses of a 75-year-old participant with a moderate-to-severe communicative impairment secondary to a cerebral vascular accident (CVA). A total of 20 brief ESM probes were cued by clinicians at four fixed times per day, 5 days a week during a 35-hour a week, 6-week programme. Probes conducted throughout each day used a 5-point Likert scale to query participant response to psychoemotional variables perceived happiness, perceived tiredness, perceived stress, and perceived communication satisfaction. Outcomes & Results: Findings revealed that the participant with aphasia was able to respond to a 5-point Likert scale administered with a personal data assistant (PDA) with 100% compliance when cued by clinicians that it was time to complete the ESM probe (464 responses across 29 days). The internal validity of internal states used in this study is supported by the strong negative correlation found with perceived happiness between both perceived tiredness (p < .01) and perceived stress (p < .01), as well as the positive correlation found between the negative states of perceived tiredness and perceived stress (p < .01). Conclusions: This initial success of ESM implementation in this case study of aphasia treatment suggests that further explorations are needed in the application of ESM in aphasia research.

Fonareva, I., Amen, A. M., Ellingson, R. M., & Oken, B. S. (2012). Differences in stress-related ratings between research center and home environments in dementia caregivers using ecological momentary assessment. International Psychogeriatrics, 24, 90-98.

Background: Clinicians and researchers working with dementia caregivers typically assess caregiver stress in a clinic or research center, but caregivers’ stress is rooted at home where they provide care. This study aimed to compare ratings of stress-related measures obtained in research settings and in the home using ecological momentary assessment (EMA). Methods: EMA of 18 caregivers (mean age 66.4 years ±7.8; 89% females) and 23 non-caregivers (mean age 66.4 years ±7.9; 87% females) was implemented using a personal digital assistant. Subjects rated their perceived stress, fatigue, coping with current situation, mindfulness, and situational demand once in the research center and again at 3-4 semi-random points during a day at home. The data from several assessments conducted at home were averaged for statistical analyses and compared with the data collected in the research center. Results: The testing environment had a differential effect on caregivers and non-caregivers for the ratings of perceived stress (p < 0.01) and situational demand (p = 0.01). When tested in the research center, ratings for all measures were similar between groups, but when tested at home, caregivers rated their perceived stress as higher than non-caregivers (p = 0.02). Overall, caregivers reported higher perceived stress at home than in the research center (p = 0.02), and non-caregivers reported greater situational demand in the research center than at home (p < 0.01). Conclusions: The assessment method and environment affect stress-related outcomes. Evaluating participants in their natural environment provides a more sensitive measure of stress-related outcomes. EMA provides a convenient way to gather data when evaluating dementia caregivers.

Forbes, E. E., Stepp, S. D., Dahl, R. E., Ryan, N. D., Whalen, D., Axelson, D. A. et al. (2012). Real-world affect and social context as predictors of treatment response in child and adolescent depression and anxiety: an ecological momentary assessment study. J.Child Adolesc.Psychopharmacol., 22, 37-47.

OBJECTIVE: Response to treatment in child and adolescent affective disorders is variable, with limited ability of any one treatment to improve outcome across patients. Unfortunately, we know little about the factors that explain this variability in treatment response. Individual differences in the social and affective dynamics of daily life could help to elucidate the characteristics of youth who respond to treatment. METHODS: We used ecological momentary assessment of negative affect, positive affect, and companions in natural settings over 4 days in a sample of young people with depressive and anxiety disorders who participated in an 8-week open trial of cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), or a combination of the two. Clinicians rated participants’ clinical severity at five time points, and participants reported their symptoms before and after treatment. Latent growth curve models were used to predict rate of change in clinical severity from pretreatment affect in natural settings. RESULTS: Participants with high positive affect (PA), low negative affect (NA), and a high PA:NA ratio at baseline had lower severity, depressive symptoms, and anxiety symptoms at the end of treatment. Lower posttreatment symptoms were associated with spending more time with fathers and less time with peers before treatment. Although baseline affect was not associated with initial symptom severity, high NA and low PA:NA at baseline were related to slower rate of decline of severity during treatment. When baseline symptoms were included in models, NA and PA: NA predicted rate of decline in severity during treatment, whereas self-reported depressive and anxiety symptoms at baseline did not. CONCLUSION: A more typical profile of baseline affective functioning in natural settings-that is, lower NA and higher PA-and time with fathers, could provide a foundation for treatment response in children and adolescents. Affective and social dynamics in natural settings could ultimately help investigate which young people might benefit from current treatments

Franklin, S. S., Thijs, L., Hansen, T. W., Li, Y., Boggia, J., Kikuya, M. et al. (2012). Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population. Hypertension, 59, 564-571.

The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (>/=90 mm Hg) or by daytime ABP (>/=85 mm Hg), a history of cardiovascular disease, and persons <18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP >/=140/<90 mm Hg and ABP <135/<85 mm Hg) and subjects with normal BP (CBP <140/<90 mm Hg and ABP <135/<85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95% CI: 0.87-1.57]; P=0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79-1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43-2.79]; P<0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95% CI: 1.49-2.62]; P<0.0001) were at higher risk as compared with untreated normotensive subjects. In conclusion, subjects with sustained hypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, “treated normalized hypertension.” Therefore, one should be cautious in applying the term “white-coat hypertension” to persons receiving antihypertensive treatment

Franks, A. M., Schmidt, J. M., McCain, K. R., & Fraer, M. (2012). Comparison of the effects of energy drink versus caffeine supplementation on indices of 24-hour ambulatory blood pressure. Ann.Pharmacother., 46, 192-199.

BACKGROUND: Cardiovascular events associated with energy drink consumption have been reported, but few data exist to delineate the hemodynamic effects of energy drinks. OBJECTIVE: To compare the effects of an energy drink versus caffeine supplementation on blood pressure (BP) indices as measured by 24-hour ambulatory BP monitoring (ABPM). METHODS: Healthy, nonsmoking, normotensive volunteers (aged 18-45 years) taking no medications were enrolled in a single-center, open-label, 2-period crossover pilot study. During each study period, subjects received either an energy drink (Red Bull Energy Drink, each dose containing 80 mg of caffeine and 1000 mg of taurine in an 8.3-oz serving) or a control (compounded caffeine solution, each dose containing 80 mg of caffeine solution in 8 oz of bottled water) at 0800, 1100, 1500, and 1900 hours and underwent 24-hour ABPM. The study periods were separated by a washout period (4-30 days). Mean 24-hour, daytime, and nighttime systolic (SBP), diastolic (DBP), and mean arterial (MAP) BP; BP load; and percent nocturnal dipping were compared between study periods. RESULTS: Nine subjects (5 females, mean [SD] age 27.7 [5.0] years) completed the study. Mean 24-hour SBP (123.2 vs 117.4 mm Hg, p = 0.04), DBP (73.6 vs 68.2 mm Hg, p = 0.02), and MAP (90.1 vs 84.8 mm Hg, p = 0.03) were significantly higher during energy drink supplementation versus caffeine supplementation. Daytime DBP (77.0 vs 72.0 mm Hg, p = 0.04) also was significantly higher with the energy drink versus caffeine supplementation. Trends in higher daytime SBP (127.0 vs 121.9 mm Hg, p = 0.05) and MAP (93.6 vs 88.6 mm Hg, p = 0.05) were recorded with energy drink supplementation versus caffeine supplementation. Nighttime SBP and DBP loads were significantly higher with the energy drink, but nocturnal dipping did not differ significantly between study periods. CONCLUSIONS: Single-day energy drink supplementation increased mean 24-hour and daytime BP compared to caffeine control in this pilot study. Additional research is warranted to better understand the hemodynamic effects of energy drink consumption

Giesbrecht, G. F., Granger, D. A., Campbell, T., & Kaplan, B. (2012). Salivary alpha-amylase during pregnancy: Diurnal course and associations with obstetric history, maternal demographics, and mood. Dev.Psychobiol..

Diurnal patterns of salivary alpha amylase (sAA) in pregnant women have not previously been described. The current study employed ecological momentary assessment to examine the association between the diurnal sAA, obstetric history, maternal demographics, and mood during pregnancy. Saliva was self-collected by 83 pregnant women (89% White, age 25.3-43.0 years; mean gestational age 21.9 weeks, range 6-37 weeks; gravida 1-6) at home over three days. Results indicated that current pregnancy (gestational age and fetal sex) and maternal demographics were not related to diurnal sAA. In contrast, a history of previous miscarriage (Parameter = -.17; SE = .05; p < .05) was associated with an atypical diurnal pattern. Even after accounting for obstetric history, trait anxiety (Parameter = .16; SE = .04; p < .001) was associated with increased sAA over the day while chronic levels of fatigue (Parameter = -.06; SE = .03; p < .05) were associated with decreased sAA. In a separate model, we also tested the time varying covariation of sAA and mood. The effects of momentary mood were in contrast to those for trait mood. Both momentary depression (Parameter = .22; SE = .09; p < .01) and vigour/positive mood (Parameter = .12; SE = .04; p < .001) were associated with momentary increases in sAA while momentary anxiety and fatigue were not related to sAA. The findings suggest that basal sAA during pregnancy is sensitive to emotional arousal. Evaluating diurnal patterns of sAA holds promise for advancing understanding of how emotional arousal during pregnancy may affect fetal development. (c) 2012 Wiley Periodicals, Inc. Dev Psychobiol

Giesbrecht, G. F., Campbell, T., Letourneau, N., Kooistra, L., & Kaplan, B. (2012). Psychological distress and salivary cortisol covary within persons during pregnancy. Psychoneuroendocrinology, 37, 270-279.

The mechanisms whereby maternal stress during pregnancy exerts organizational effects on fetal development require elaboration. The aim of this study was to assess the plausibility of cortisol as a biological link between maternal psychological distress during pregnancy and fetal development. Previous research has resulted in equivocal findings for between-persons differences in stress and cortisol. Ecological momentary assessment was used to simultaneously assess mood and cortisol 5 times daily for 3 days in 83 women (gestational ages 6-37 weeks). Results from multilevel analysis indicated a robust within-person association between negative mood and cortisol. For each 1.0% increase in negative mood there was a corresponding 1.9% increase in cortisol. This association was unaffected by advancing gestational age. The results suggest that cortisol is a plausible biological mechanism for transducing the effects of maternal psychological distress during pregnancy to fetal development.

Hedeker, D., Mermelstein, R. J., & Demirtas, H. (2012). Modeling between-subject and within-subject variances in ecological momentary assessment data using mixed-effects location scale models. Stat.Med..

Ecological momentary assessment and/or experience sampling methods are increasingly used in health studies to study subjective experiences within changing environmental contexts. In these studies, up to 30 or 40 observations are often obtained for each subject. Because there are so many measurements per subject, one can characterize a subject’s mean and variance and can specify models for both. In this article, we focus on an adolescent smoking study using ecological momentary assessment where interest is on characterizing changes in mood variation. We describe how covariates can influence the mood variances and also extend the statistical model by adding a subject-level random effect to the within-subject variance specification. This permits subjects to have influence on the mean, or location, and variability, or (square of the) scale, of their mood responses. These mixed-effects location scale models have useful applications in many research areas where interest centers on the joint modeling of the mean and variance structure. Copyright (c) 2012 John Wiley & Sons, Ltd

Helbig-Lang, S., Lang, T., Petermann, F., & Hoyer, J. (2012). Anticipatory Anxiety as a Function of Panic Attacks and Panic-Related Self-Efficacy: An Ambulatory Assessment Study in Panic Disorder. Behav.Cogn Psychother., 1-15.

Background: Panic attacks and anticipatory anxiety are considered to be inter-correlated, yet distinctive, features of panic disorder, both contributing to its onset and maintenance as well as to the associated impairment. Given the difficulty to yield ecologically valid data on these fluctuating symptoms the natural course of anticipatory anxiety and its correlates have seldom been addressed with adequate methods. Aims: The current study aimed at further exploring the natural variance of anticipatory anxiety and its interdependence with panic-related variables. In addition, impact of anxiety sensitivity, and perceived ability to cope with panic on the relation between panic attacks and subsequent anxiety was inspected. Method: Based on an Ecological Momentary Assessment approach, 21 patients with panic disorder rated study variables continuously over one week; 549 question sets were completed. Results: Anticipatory anxiety followed a diurnal pattern and was associated with situational and internal variables typically linked to panic experiences. Preceding panic attacks intensified anticipatory anxiety and associated negative emotional states; however, perceived ability to cope attenuated these effects. Conclusion: Based on natural observation data, results largely support the importance of cognitive appraisals for anticipatory anxiety, and its interplay with panic attacks as it has been suggested by cognitive theory and recent findings in extinction learning research

Hunter, E. J. (2012). Teacher response to ambulatory monitoring of voice. Logoped.Phoniatr.Vocol..

Voice accumulation and dosimetry devices are used for unobtrusive monitoring of voice use. While numerous studies have used these devices to examine how individuals use their voices, little attention has been paid to how subjects respond to them. Therefore, the purpose of this short communication is to begin to explore two questions: 1) How do voice monitoring devices affect daily communication? and 2) How do participants feel about the physical design and function of these types of voice monitoring devices? One key finding is that most of the subjects remain aware of the dosimeter while wearing it, which may impact the data collected. Further, most subjects have difficulty with the accelerometer and/or the data storage device

Iida, M., Shrout, P. E., Laurenceau, J. P., & Bolger, N. (2012). Using diary methods in psychological research. In H.Cooper, P. M. Camic, D. L. Long, A. T. Panter, D. Rindskopf, K. J. Sher, H. Cooper, P. M. Camic, D. L. Long, A. T. Panter, D. Rindskopf, & K. J. Sher (Eds.), APA handbook of research methods in psychology, Vol 1: Foundations, planning, measures, and psychometrics (pp. 277-305). Washington, DC US: American Psychological Association.

(from the chapter) This chapter examines diary methods in psychological research. Diary methods in psychological research build on the tradition of daily written accounts and the willingness of some persons to provide exquisite detail about their experiences on a daily basis for a specified period of time. The earliest diary study in psychological research that we know of is by Csikszentmihalyi, Larson, and Prescott (1977), who examined interpersonal contacts and interaction quality among adolescents. They structured reporting forms and response intervals to make the information more systematic than free-form diaries of the literary tradition. Larson and Csikszentimihalyi (1983) called this methodology experience sampling methods (also called ecological momentary assessment [EMA]), and their method revolutionized modern psychological research by allowing investigators to capture daily experiences in participants’ own, natural environment.

Kelly, J., Gooding, P., Pratt, D., Ainsworth, J., Welford, M., & Tarrier, N. (2012). Intelligent real-time therapy: Harnessing the power of machine learning to optimise the delivery of momentary cognitive-behavioural interventions. J.Ment.Health.

Background Experience sampling methodology (ESM) [Csikszentmihalyi, M. & Larson, R. (1987). Validity and reliability of the experience-sampling method. Journal of Nervous and Mental Disease, 175(9), 526-536] has been used to elucidate the cognitive-behavioural mechanisms underlying the development and maintenance of complex mental disorders as well as mechanisms involved in resilience from such states. We present an argument for the development of intelligent real-time therapy (iRTT). Machine learning and reinforcement learning specifically may be used to optimise the delivery of interventions by observing and altering the timing of real-time therapies based on ongoing ESM measures. Aims The aims of the present article are to outline the principles of iRTT and to consider how it would be applied to complex problems such as suicide prevention. Methods Relevant literature was identified through use of PychInfo. Results iRTT may provide an important and ecologically valid adjunct to traditional CBT, providing a means of balancing population-based data with individual data, thus addressing the “knowledge-practice gap” [Tarrier, N. (2010b). The cognitive and behavioral treatment of PTSD, what is known and what is known to be unknown: How not to fall into the practice gap. Clinical Psychology: Science and Practice, 17(2), 134-143] and facilitating the delivery of interventions in situ, thereby addressing the “therapy-real-world gap”. Conclusions iRTT may provide a platform for the development of individualised and multifaceted momentary intervention strategies that are ecologically valid and aimed at attenuating pathological pathways to complex mental health problems and amplifying pathways associated with resilience

Kööts, L., Realo, A., & Allik, J. (2012). Relationship between linguistic antonyms in momentary and retrospective ratings of happiness and sadness. Journal of Individual Differences, 33, 43-53.

Momentary ratings of affective states with a pair of strict antonyms (“happy” vs. “sad”) were studied with an experience-sampling method in a group of 110 participants during 14 consecutive days at 7 randomly determined occasions per day. Before and after the experimental session participants also retrospectively rated how happy or sad they had been during the previous 2 weeks. Multilevel analysis showed that, at the level of single measurement trials, the momentary ratings of happiness and sadness were moderately negatively correlated (r =-.32, p < .001). A between-subject correlation of the two antonyms, however, was in a positive direction (r = .13, p = .123). Participants experienced mixed feelings during a considerable number of measurement trials, whereas the tendency to feel mixed emotions was predicted by all Big Five personality traits except Agreeableness. A configural frequency analysis (CFA) demonstrated that, although there was no strict bipolarity between momentary ratings of happiness and sadness, they were nevertheless used in an exclusive manner in many occasions.

Kwon, S., Burns, T. L., Levy, S. M., & Janz, K. F. (2011). Breaks in Sedentary Time during Childhood and Adolescence: Iowa Bone Development Study. Med.Sci.Sports Exerc..

PURPOSE: The frequency of interruptions in sedentary time (sedentary breaks) is an aspect of sedentary behaviors which may be associated with metabolic health outcomes. The aim of this study was to describe the change in the frequency of sedentary breaks over a 10-year period from ages 5 to 15. METHODS: The longitudinal Iowa Bone Development Study has collected accelerometry data at approximately 5, 8, 11, 13, and 15 years of age. Data from participants who wore an accelerometer at least 10 hours per day and three days per data collection episode were used (423 children at age 5, 550 at age 8, 520 at age 11, 454 at age 13, and 344 at age 15). The frequency of sedentary breaks was determined based on accelerometry data and compared by weekday/weekend, time period during the day, gender, and data collection episode. RESULTS: The frequency of sedentary breaks decreased by > 200 times/day over a 10-year period from ages 5 to 15. Linear regression models estimated a 1.84 times/hour decrease per year for boys and a 2.04 times/hour decrease per year for girls (Ps < 0.0001). Both boys and girls showed significantly fewer breaks on weekdays from morning to 3:00 PM than on weekends from morning to 3:00 PM (Ps < 0.0001). The frequency of sedentary breaks was slightly higher among boys than girls (gender difference </= 2 times/hour; Ps < 0.01 at ages 11, 13, and 15). CONCLUSION: Breaks in sedentary time notably decrease during childhood and adolescence. During school hours, boys and girls have fewer breaks in sedentary time than during any other time period of weekday or weekend day

Larsen, H., Overbeek, G., Granic, I., & Engels, R. C. (2012). The strong effect of other people’s drinking: two experimental observational studies in a real bar. Am.J.Addict., 21, 168-175.

Research has demonstrated that when people are with heavy-drinking peers, they consume more alcohol than when they are in the company of light-drinking peers. This social influence process has usually been investigated in clinical laboratories or seminaturalistic drinking settings such as laboratory bars. The question remains whether these robust effects can be replicated in real-life drinking settings. The aim of these experimental studies was to examine social influence processes in real bars. In Study 1 a two (confederate drank alcoholic vs. nonalcoholic drinks) by two (male vs. female participant) between-participant design was used to test imitation in same-sex dyads (N = 79). Study 2 tested differences in imitation between same- and other-sex dyads with a two (confederate drank alcoholic vs. nonalcoholic drinks) by two (male vs. female confederate) between-participant design (N = 60). Both studies showed that participants consumed more alcohol in the alcohol condition than the nonalcohol condition. No sex differences emerged in the extent to which participants imitated their drinking partners. Study 2 demonstrated no difference in imitation between same-sex and other-sex dyads. Results support the ecological validity of research on imitation of alcohol consumption conducted in laboratory bars

Lassalle-Lagadec, S., Allard, M., Dilharreguy, B., Schweitzer, P., Swendsen, J., & Sibon, I. (2012). Linking MRI to daily life experience: the example of poststroke depression. Neurology, 78, 322-325.

OBJECTIVE: The state-of-the-art tools of neurology, in particular modern neuroimaging techniques, have yet to benefit from the revolution in mobile technologies that provide new insights into the mechanisms underlying clinical syndromes. This study demonstrates the manner in which mobile technologies may provide information that is complementary to MRI data, using the illustration of poststroke depression. METHODS: MRI examinations were provided to 15 stroke patients, followed by computerized ambulatory monitoring of daily life experiences over 1 week. RESULTS: The occurrence of daily life events was significantly associated with the intensity of positive affect during the ambulatory monitoring period. This emotional reactivity was also significantly associated with functional connectivity in brain regions linked with the risk of depression 3 months following stroke. CONCLUSIONS: Novel mobile technologies provide information that is inaccessible to hospital-based tests, and allow for more complete investigations of disorder expression and etiology

Loprinzi, P. D., Cardinal, B., Crespo, C. J., Brodowicz, G. R., Andersen, R. E., & Smit, E. (2012). Differences in Demographic, Behavioral, and Biological Variables Between those with Valid and Invalid Accelerometry Data: Implications for Generalizability. J.Phys.Act.Health.

BACKGROUND: The exclusion of participants with invalid accelerometry data (IAD) may lead to biased results and/or lack of generalizability in large population studies. The purpose of this study was to investigate whether demographic, behavioral, and biological differences occur between those with IAD and valid accelerometry data (VAD) among adults using a representative sample of the civilian non-institutionalized U.S. population. METHODS: Ambulatory participants from NHANES (2003-2004) who were 20-85 years of age were included in the present study and wore an ActiGraph 7164 accelerometer for 7 days. A “valid person” was defined as those with 4 or more days of at least 10+ hrs of monitoring per day. Among adults (20-85 yrs), 3,088 participants provided VAD, and 987 providing IAD. Demographic, behavioral, and biological information was obtained from the household interview or from data obtained in a mobile examination center. RESULTS: Differences were observed in age, BMI, ethnicity, education, smoking status, marital status, use of street drugs, current health status, HDL-cholesterol, C-reactive protein, self-reported vigorous physical activity, and plasma glucose levels between those with VAD and IAD. CONCLUSIONS: Investigators should take into consideration the potential cut-off bias in interpreting results based on data that excludes IAD participants

López, V., Ahumada, L., Galdames, S., & Madrid, R. (2012). School principals at their lonely work: Recording workday practices through ESM logs. Computers & Education, 58, 413-422.

This study used portable technology based on Experience Sampling Methodology (ESM log) to register workday practices of school principals and heads from Chilean schools who were implementing school improvement plans aimed at developing a culture of organizational learning. For a week, Smartphone devices which beeped seven times a day were given to School Principals and Heads of Technical-Pedagogical Units, who then answered closed questions about their current agenda. Six municipal schools in a district of the V Region of Chile participated in the study. The main results support the notion that, at the time of data collection, most school Principals and Heads of Technical-Pedagogical Units were working alone, and if they were interacting with other people, they were always in command. Following underlying assumed roles, most school principals reported performing administrative tasks, while Heads of Technical-Pedagogical Units mainly addressed instructional issues, fostering a rigid framework for the assignment of tasks. Follow-up semi-structured interviews confirmed that participants were not working as a team but rather alone on important issues and urgent matters. Participants regarded the use of the device as a very practical and useful tool to analyze their daily practices. Results are discussed focusing on the use of portable technology to address methodological issues faced when approaching research on educational leadership from a distributed leadership perspective.

40. Mackinnon, S. P., Sherry, S. B., Antony, M. M., Stewart, S. H., Sherry, D. L., & Hartling, N. (2012). Caught in a Bad Romance: Perfectionism, Conflict, and Depression in Romantic Relationships. J.Fam.Psychol..

According to the social disconnection model, perfectionistic concerns (i.e., harsh self-scrutiny, extreme concern over mistakes and others’ evaluations, and excessive reactions to perceived failures) confer vulnerability to depressive symptoms indirectly through interpersonal problems. This study tested the social disconnection model in 226 heterosexual romantic dyads using a mixed longitudinal and experience sampling design. Perfectionistic concerns were measured using three partner-specific self-report questionnaires. Conflict was measured as a dyadic variable, incorporating reports from both partners. Depressive symptoms were measured using a self-report questionnaire. Perfectionistic concerns and depressive symptoms were measured at Day 1 and Day 28. Aggregated dyadic conflict was measured with daily online questionnaires from Days 2 to 15. Data were analyzed using structural equation modeling. There were four primary findings: (a) Dyadic conflict mediated the link between perfectionistic concerns and depressive symptoms, even when controlling for baseline depressive symptoms; (b) depressive symptoms were both an antecedent and a consequence of dyadic conflict; (c) perfectionistic concerns incrementally predicted dyadic conflict and depressive symptoms beyond neuroticism (i.e., a tendency to experience negative emotions) and other-oriented perfectionism (i.e., rigidly demanding perfection from one’s partner); and (d) the relationships among variables did not differ based on gender. As the most rigorous test of the social disconnection model to date, this study provides strong support for this emerging model. Results also clarify the characterological and the interpersonal context within which depressive symptoms are likely to occur.

Martin-Martinez, D., Casaseca-de-la-Higuera, P., Alberola-Lopez, S., Andres-de-Llano, J., Lopez-Villalobos, J. A., Ardura-Fernandez, J. et al. (2012). Nonlinear analysis of actigraphic signals for the assessment of the attention-deficit/hyperactivity disorder (ADHD). Med.Eng Phys..

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children and adolescents; however, its etiology is still unknown, which hinders the existence of reliable, fast and inexpensive standard diagnostic methods. In this paper, we propose a novel methodology for automatic diagnosis of the combined type of ADHD based on nonlinear signal processing of 24h-long actigraphic registries. Since it relies on actigraphy measurements, it constitutes an inexpensive and non-invasive objective diagnostic method. Our results on real data reach 96.77% sensitivity and 84.38% specificity by means of multidimensional classifiers driven by combined features from different time intervals. Our analysis also reveals that, if features from a single time interval are used, the whole 24-h interval is the only one that yields classification figures with practical diagnostic capabilities. Overall, our figures overcome those obtained by actigraphy-based methods reported and are comparable with others based on more expensive (and not so convenient) adquisition methods

McCance, A. S. (2012). Emotional labor in intercultural service encounters: An experience sampling study. ProQuest Information & Learning, US.

The body of literature surrounding emotional labor, defined as service employees’ effort to manage their emotions to meet organizational goals (Hochschild, 1983; Morris & Feldman, 1996), exhibits a severe lack of studies examining intercultural service encounters (i.e., service episodes in which a provider from culture A delivers a service to a customer from culture B; Stauss & Mang, 1999). This dissertation posits an intrapersonal model of emotional labor in intercultural service encounters. Central to this model is the construct of cultural competence (Earley & Ang, 2003), which is defined as the ability to adapt effectively and flexibly in culturally diverse settings. Using experience sampling methodology with a hospitality industry sample, I found that cultural competence was associated with deep acting and performance. Openness to experience predicted cultural competence through active seeking of multicultural experience (i.e., multicultural personality). Implications for the selection (based on openness) and training (for deep acting and cultural competence) of service providers in an increasingly globalized service industry are discussed.

McMurdo, M. E., Argo, I., Crombie, I. K., Feng, Z., Sniehotta, F. F., Vadiveloo, T. et al. (2012). Social, environmental and psychological factors associated with objective physical activity levels in the over 65s. PLoS One, 7, e31878.

OBJECTIVE: To assess physical activity levels objectively using accelerometers in community dwelling over 65 s and to examine associations with health, social, environmental and psychological factors. DESIGN: Cross sectional survey. SETTING: 17 general practices in Scotland, United Kingdom. PARTICIPANTS: Random sampling of over 65 s registered with the practices in four strata young-old (65-80 years), old-old (over 80 years), more affluent and less affluent groups. MAIN OUTCOME MEASURES: Accelerometry counts of activity per day. Associations between activity and Theory of Planned Behaviour variables, the physical environment, health, wellbeing and demographic variables were examined with multiple regression analysis and multilevel modelling. RESULTS: 547 older people (mean (SD) age 79(8) years, 54% female) were analysed representing 94% of those surveyed. Accelerometry counts were highest in the affluent younger group, followed by the deprived younger group, with lowest levels in the deprived over 80 s group. Multiple regression analysis showed that lower age, higher perceived behavioural control, the physical function subscale of SF-36, and having someone nearby to turn to were all independently associated with higher physical activity levels (R(2) = 0.32). In addition, hours of sunshine were independently significantly associated with greater physical activity in a multilevel model. CONCLUSIONS: Other than age and hours of sunlight, the variables identified are modifiable, and provide a strong basis for the future development of novel multidimensional interventions aimed at increasing activity participation in later life

Meltzer, L. J., Walsh, C. M., Traylor, J., & Westin, A. M. (2012). Direct comparison of two new actigraphs and polysomnography in children and adolescents. Sleep, 35, 159-166.

STUDY OBJECTIVES: To evaluate the validity and reliability of 2 new models of commercially available actigraphs compared to polysomnography for children and adolescents. DESIGN AND SETTING: Subjects concurrently wore the Ambulatory Monitoring Inc. Motionlogger Sleep Watch (AMI) and the Phillips Respironics Mini-Mitter Actiwatch-2 (PRMM) while undergoing overnight polysomnography (PSG) in a pediatric sleep laboratory housed in a tertiary care children’s hospital. PARTICIPANTS: 115 youth (59 girls, 56 boys), ages 3-18 years (mean 8.8 years, SD 4.4 years). MEASUREMENTS: Outcome variables were total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). Epoch-by-epoch comparisons were made between the 2 devices and PSG to determine sensitivity, specificity, and accuracy. Agreement between the 2 devices was determined with t-tests and the Bland-Altman concordance technique. Different algorithms/sensitivities, developmental age groups, and sleep disordered breathing (SDB) status were also examined. RESULTS: For both device brands, sensitivity (0.89-0.97), specificity (0.54-0.77), and accuracy (0.87-0.90) were similar to previous reports. Notably, compared to PSG, both device brands significantly overestimated WASO, while the AMI device also significantly underestimated TST. Inter-device comparison of the 2 brands found poor agreement for TST, WASO, and SE. Agreement with PSG differed depending on the scoring algorithm (AMI) or sensitivity setting (PRMM), as well as across developmental age group and sleep disordered breathing (SDB) status. CONCLUSIONS: Similar to previous reports, both new actigraph brands were found to have good sensitivity (to detect sleep), but poorer specificity (to detect wake). Study results also suggest that researchers should adjust the scoring algorithm/sensitivity depending on a study’s design (e.g., young children vs. adolescents, healthy children vs. youth with SDB). Further, inter-device reliability was poor, suggesting the need for caution when comparing results across studies that use different brands of actigraphic devices

Mogle, J. (2012). Development of a daily diary method for the assessment of everyday cognitive failures. ProQuest Information & Learning, US.

Assessing how well an individual can meet real world cognitive demands is an important clinical outcome, particularly for older adults. Research examining real world cognitive functioning has used both lab-based tasks as well as questionnaires. However, these assessments were limited for a number of reasons. Lab-based tasks lack personal relevance which may affect the strategies and amount of effort individuals apply, reducing their ecological validity. Questionnaires are considered more ecologically valid but require individuals to recall cognitive failures over weeks and months depending on an individual’s fallible cognitive ability to remember their mistakes over long periods of time. More recent research has attempted to develop methods for the daily reporting of cognitive failures but focus primarily on memory failures and ignore more general types of cognitive failures. These daily diary studies also failed to assess the impact of cognitive failures on daily functioning. The current study built on this previous research and introduced a set of assessment tools designed to capture missed activities, memory failures, and difficulties with attention and concentration that individuals experience on a daily basis as well as the impact of these events on daily functioning. One hundred thirty-one participants, 20 to 80 years old completed these assessments once each day for a period of seven days as well as a series of lab-based cognitive tasks. These data revealed that participants reported missing the most activities due to overload (e.g., running out of time) but found missing activities due to somatic complaints as the most bothersome. With regard to daily memory failures, participants reported equal numbers of retrospective and prospective memory failures but reported expecting more future consequences from prospective memory failures. Older participants reported experiencing more missed activities and memory failures but rated these events as less bothersome, less interfering, and as less likely to bring about future consequences compared with younger adults. Daily failures of attention and concentration were captured using a Likert-style scale that assesses cognitive interference. This questionnaire exhibited adequate reliability and factor structure both between- and within-persons and tapped a construct separable from negative affect. Finally, there was evidence of weak relationships among self-reported cognitive failures and objective cognitive performance. Findings are discussed relative to previous research on self-reported cognitive failures, the importance of assessing other daily processes and their effects on daily cognitive failures, and the continued lack of relationship between self-reported cognitive failures and objective cognitive performance.

Moreno, M. A., Jelenchick, L., Koff, R., Eikoff, J., Diermyer, C., & Christakis, D. A. (2012). Internet use and multitasking among older adolescents: An experience sampling approach. Computers in Human Behavior.

Internet use is challenging for individuals to quantify and describe. Previous internet use studies have relied on self-report measures, which may be subject to recall bias. This studied aimed to assess college student internet use using a real-time methodology, experience sampling method (ESM). Undergraduate students participated in a 7-day ESM campaign using text message surveys sent at 6 random times each day. Survey questions evaluated current internet use time and activities. Analyses included hierarchical clustering analysis, multilevel and probability modeling. Among the 189 participants, mean age was 18.9 (SD=0.9), 58.8% were female and most were Caucasian (90.5%). The modeled average total amount of daily internet time was 56min, 95% CI [51, 62]. The correlation between self-reported internet use time and ESM data was 0.31 (p<0.001). Over half of the time participants were on the internet they reported multitasking (56.5%, 95% CI [52.7%, 60.4%]). Study findings suggest that multitasking is frequent among college students, which may explain over-reported internet use.

Morris, T. R., Cho, C., Dilda, V., Shine, J. M., Naismith, S. L., Lewis, S. J. et al. (2012). A comparison of clinical and objective measures of freezing of gait in Parkinson’s disease. Parkinsonism Relat Disord..

Freezing of gait, a paroxysmal motor block, is common in the latter stages of Parkinson’s disease. The current ‘gold standard’ of assessing the severity of freezing is based on clinical identification (by up to 3 raters) of the number of episodes from video. The aims of this study were to systematically assess this ‘gold standard’ across multiple Parkinson’s disease centers, and to compare these clinical ratings with objective measures derived from lower limb acceleration data. Video recordings were acquired during a timed up-and-go task from 10 Parkinson’s disease patients (with a clinical history of freezing) in the ‘off’ state. Patients were instrumented with accelerometers on the lateral aspect of each shank. Ten experienced clinicians were recruited from four Parkinson’s disease centers to independently assess the videos for number and duration of freezing events. The reliability of clinical video assessment for number of freezing events was moderate (intraclass correlation coefficient 0.63). Percent time frozen (cumulative duration of freezing episodes/total duration of the walking task) demonstrated stronger agreement between raters (0.73). Agreement of accelerometry-derived measures of freezing severity with mean clinician ratings was strong for number of episodes (0.78) and very strong for percent time frozen (0.93). The results demonstrate the viability of objective measures of freezing, and that percent time frozen is a more reliable metric of severity than number of freezing events for both clinical and objective measures. The large variability between clinicians suggests that caution should be used when comparing subjective ratings across centers

Nielsen, G., Bugge, A., Hermansen, B., Svensson, J., & Andersen, L. B. (2012). School playground facilities as a determinant of children’s daily activity: A cross-sectional study of Danish primary school children. Journal of Physical Activity & Health, 9, 104-114.

Background: This study investigates the influence of school playground facilities on childrenGÇÖs daily physical activity. Methods: Participants were 594 school children measured at preschool (age 6 to 7 years) and 3 years later in third grade (518 children age 9 to 10 years) from 18 schools in 2 suburban municipalities in Denmark. Physical activity data were obtained using accelerometers. These were related to the number of permanent play facilities in school grounds and the school playground area (m-¦). Results: The number of play facilities in the school grounds was positively associated with all measures of children’s activity. In preschool every 10 additional play facilities the children had access to was associated with an increase in the average accelerometer counts of 14% (r = .273, P < .001) in school time and 6.9% (r = .195, P < .001) overall. For the children in third grade, access to 10 additional play facilities was associated with an increase in school time activity level of 26% (r = .364, P < .001) and an increase in overall activity level of 9.4% (r = .211, P < .001). School playground area did not affect activity levels independently of the number of permanent play facilities. Conclusion: Increasing the number of play facilities in primary school playgrounds may increase the level of children’s daily physical activity.

Palatini, P., Saladini, F., Mos, L., Benetti, E., Bortolazzi, A., Cozzio, S. et al. (2012). Obesity is a strong determinant of hypertensive target organ damage in young-to-middle-age patients. Int.J.Obes.(Lond).

OBJECTIVE: To examine the impact of overweight and obesity on development of target organ damage in the early stage of hypertension. SUBJECTS: Participants were 727 young-to-middle-age subjects screened for stage 1 hypertension and followed for 8 years. MEASUREMENTS: Ambulatory blood pressure (BP), albumin excretion rate and echocardiographic data were obtained at entry, every 5 years and/or before starting antihypertensive treatment. RESULTS: During the follow-up, hypertension needing treatment was developed by 54.7% of the subjects with normal weight, 66.6% of those with overweight and 73.0% of those with obesity (P<0.001). Kaplan-Meier curves showed that patients with obesity or overweight progressed to sustained hypertension earlier than those with normal weight (P<0.001). At study end, rate of organ damage was 10.7% in the normal weight, 16.4% in the overweight and 30.1% in the obese subjects (P<0.001). In a multivariable logistic regression analysis, overweight (P=0.008) and obesity (P<0.001) were significant predictors of final organ damage. Inclusion of changes in 24-h BP and body mass index, and of baseline organ damage did not virtually modify these associations (P=0.002 and <0.001, respectively). Obesity was a significant predictor of both left ventricular hypertrophy (P<0.001) and microalbuminuria (P=0.015) with an odds ratio (95% confidence interval) of 8.5 (2.7-26.8) and 3.5 (1.3-9.6), respectively. CONCLUSION: These data indicate that in hypertensive subjects obesity has deleterious effects on the cardiovascular system already at an early age. Preventive strategies addressed to achieve weight reduction should be implemented at a very early stage in young people with excess adiposity and high BP. International Journal of Obesity advance online publication, 6 March 2012; doi:10.1038/ijo.2012.32

Palmier-Claus, J. E., Taylor, P. J., Gooding, P., Dunn, G., & Lewis, S. W. (2012). Affective variability predicts suicidal ideation in individuals at ultra-high risk of developing psychosis: an experience sampling study. Br.J.Clin.Psychol., 51, 72-83.

OBJECTIVE: There is a suggestion in the literature that more variable affect increases suicidal ideation through the repeated re-activation of latent suicidal cognitions. The hypothesis that affective variability would be a better predictor of suicidal ideation and related behaviour than affect level was tested in individuals at ultra-high risk of developing psychosis. This study also examined the prediction that affective variability is a suicide-specific mechanism and would not predict levels of attenuated psychotic phenomena. METHOD: Twenty-seven ultra-high risk individuals were required to complete ambulant ratings of their affect when prompted by an electronic wristwatch for six days (the experience sampling method). In the debriefing session, participants were assessed with a semi-structured interview (the Comprehensive Assessment of At-Risk Mental State), which assessed the severity and frequency of suicidality and psychosis-related phenomena. RESULTS: The variability of negative and positive affect was predictive of the frequency of suicidal thoughts and behaviour. More variable negative, but not positive affect, was also associated with more severe suicidal ideation and related behaviour. Affect variability was not significantly related to the severity of attenuated psychotic phenomena. CONCLUSION: Affective variability appears to be a specific risk factor for suicidal ideation in individuals at ultra-high risk of developing psychosis. Early intervention should focus on providing individuals with skills for regulating their own affect

Poh, M. Z., Loddenkemper, T., Reinsberger, C., Swenson, N. C., Goyal, S., Sabtala, M. C. et al. (2012). Convulsive seizure detection using a wrist-worn electrodermal activity and accelerometry biosensor. Epilepsia.

The special requirements for a seizure detector suitable for everyday use in terms of cost, comfort, and social acceptance call for alternatives to electroencephalography (EEG)-based methods. Therefore, we developed an algorithm for automatic detection of generalized tonic-clonic (GTC) seizures based on sympathetically mediated electrodermal activity (EDA) and accelerometry measured using a novel wrist-worn biosensor. The problem of GTC seizure detection was posed as a supervised learning task in which the goal was to classify 10-s epochs as a seizure or nonseizure event based on 19 extracted features from EDA and accelerometry recordings using a Support Vector Machine. Performance was evaluated using a double cross-validation method. The new seizure detection algorithm was tested on >4,213 h of recordings from 80 patients and detected 15 (94%) of 16 of the GTC seizures from seven patients with 130 false alarms (0.74 per 24 h). This algorithm can potentially provide a convulsive seizure alarm system for caregivers and objective quantification of seizure frequency

Pryce, R., Johnson, M., Goytan, M., Passmore, S., Berrington, N., & Kriellaars, D. (2012). The Relationship Between Ambulatory Performance and Self-rated Disability in Patients with Lumbar Spinal Stenosis. Spine (Phila Pa 1976.).

Study Design. cross-sectionalObjective. To identify the relationship between performance measures derived from accelerometry and subjective reports of pain, disability and health in patients with lumbar spinal stenosis (LSS).Summary of Background Data. Accelerometers have emerged as a measure of performance, providing the ability to characterize the pattern and magnitude of real life activity, and sedentarism. Pain and loss of function, particularly ambulation, are common in LSS. The extent that pain, perceived disability and self-rated health relate to performance in patients with LSS is not well known.Methods. Self-reported pain, disability (Oswestry Disability Index, Roland-Morris Disability Questionnaire, Disabilities of Arm Shoulder and Hand) and health (Short Form-36) were collected from patients with LSS (n = 33). Physical activity, ambulation and inactivity performance measures were derived from 7-day accelerometer records. Correlation and step-wise regression were used.Results. The physical function subscale of the Short Form-36, a non-pathology specific outcome, had the best overall correlation to physical activity and ambulation (average r = 0.53) compared to pain (average r = 0.32) and disability (average r = -0.45) outcomes. Stepwise regression models for performance were predominantly single variable (4 of 8 models); pain was not selected as a predictor. A second non-pathology specific outcome, the Disabilities of Arm Shoulder and Hand, improved the prediction of performance in 5 of 8 models.Conclusions. Subjective measures of pain and disability had limited ability to account for real life performance in LSS patients. Future research is required to identify determinants of performance in LSS since barriers to activity may not be disease specific

Rey-Lopez, J. P., Ruiz, J. R., Vicente-Rodriguez, G., Gracia-Marco, L., Manios, Y., Sjostrom, M. et al. (2012). Physical activity does not attenuate the obesity risk of TV viewing in youth. Pediatr.Obes..

OBJECTIVE: This study aimed to examine the association of television (TV) time, the frequency of meals while watching TV and the presence of TV set in the bedroom with total and abdominal obesity and to assess whether physical activity (PA) attenuates the obesity risk of TV viewing. METHODS: Cross-sectional data were obtained from 2200 adolescents (46% boys) from 10 European cities, The Healthy Lifestyle in Europe by Nutrition in Adolescence study, between 2006 and 2007. TV viewing, PA (by accelerometry) and body composition were measured. Binary logistic regression analyses were performed. RESULTS: Even adjusting by vigorous PA, TV in the bedroom (odds ratio [OR]: 1.33, 95% confidence interval [CI], 1.01-1.74) and >4 h d(-1) TV during week days (OR: 1.30, 95% CI, 1.02-1.67) (in boys) and eating every day with TV (OR: 1.18, 95% CI, 1.07-1.30) and >2 h d(-1) TV during weekend days (OR: 1.68, 95% CI, 1.25-2.26) (in girls) were significantly associated with total obesity. Likewise, in both sexes, having a TV set at bedroom was significantly associated with abdominal obesity. CONCLUSIONS: Adolescents spending excessive TV time are prone to obesity independently of their PA levels. Families should put TV sets out of adolescents’ bedroom and keep TV sets off during meal times

Robertson, B. M., Piasecki, T. M., Slutske, W. S., Wood, P. K., Sher, K. J., Shiffman, S. et al. (2012). Validity of the Hangover Symptoms Scale: Evidence from an electronic diary study. Alcoholism: Clinical and Experimental Research, 36, 171-177.

Background: The Hangover Symptoms Scale (HSS) assesses the frequency of 13 symptoms experienced after drinking in the past year. Cross-sectional analyses in college drinkers showed preliminary evidence for the validity of the HSS (Slutske et al., 2003). The current investigation extended this work by examining the construct validity of the HSS in an ecological momentary assessment investigation. Methods: Frequent drinkers (N = 404) carried electronic diaries to track their daily experiences over 3 weeks. Each morning, the diary assessed prior-night drinking behaviors, the presence of current hangover, and intensity of current headache and nausea. Results: Adjusting for sex and body mass, the HSS significantly predicted diary endorsement of hangover (OR = 2.11, 95% CI = 1.78 to 2.49, p < 0.001). Participants who endorsed the HSS headache and nausea items were especially likely to report the elevations of corresponding symptoms in diary records made the morning after drinking. HSS scores incrementally predicted hangover when the number of drinks consumed in the episode was covaried but did not moderate the relationship between the number of drinks and diary hangover reports. Conclusions: The HSS appears to be a valid tool for hangover research. Higher HSS scores identify individuals who complain of “real world” hangovers and who may be especially likely to display particular symptoms after a night of drinking. Past hangovers predicted future hangovers, suggesting hangovers do not necessarily discourage or inhibit future drinking, at least across the several-week time interval studied here. There is a need to develop and evaluate complementary measures that can more directly index individual differences in hangover susceptibility in survey designs.

Roth, M. A. & Mindell, J. S. (2012). Who provides accelerometry data? Correlates of adherence to wearing an accelerometry motion sensor: the 2008 Health Survey for England. J.Phys.Act.Health.

BACKGROUND: Use of objective physical activity measures is rising. We investigated the representativeness of survey participants who wore an accelerometer. METHODS: 4,273 adults aged 16+ from a cross-sectional survey of a random, nationally-representative general population sample in England in 2008 were categorised as: provided sufficient accelerometry data (4-7 valid days (10+ hrs/d), n=1,724); less than that (n=237); or declined (n=302). Multinomial logistic regression identified demographic, socio-economic, health, lifestyle, and biological correlates of participants in these latter two groups, compared with those who provided sufficient accelerometry data (4+ valid days). RESULTS: Those in the random sub-sample offered the accelerometer were older and more likely to be retired and to report having a longstanding limiting illness than the rest of the adult HSE participants. Compared with those providing sufficient accelerometery data, those wearing the accelerometer less were younger, less likely to be in paid employment, and more likely to be a current smoker. Those who declined to wear an accelerometer did not differ significantly from those who wore it for sufficient time. CONCLUSIONS: We found response bias in wearing the accelerometers for sufficient time, but refusers did not differ from those providing sufficient data. Differences should be acknowledged by data users

Sakai, M., Okuyama, Y., & Wei, D. (2012). Separation of EEG and ECG components based on wavelet shrinkage and variable cosine window. J.Med.Eng Technol., 36, 135-143.

During ambulatory monitoring, it is sometimes required to record an electroencephalogram (EEG) and an electrocardiogram (ECG) simultaneously. It would be ideal if both EEG and ECG could be obtained with one measurement. Here, we introduce an algorithm that combines the wavelet shrinkage and variable cosine window operation to separate the EEG and ECG components from an EEG signal recorded with a noncephalic reference (NCR). Evaluation using simulated data and actual measured data showed that accurate frequency analysis of EEG and an R-R detection-based heart rate analysis were feasible with our proposed algorithm, which improved the signal-averaging based algorithm so that ECG components containing ectopic beats can be applied

Shadel, W. G., Martino, S. C., Setodji, C., & Scharf, D. (2012). Momentary Effects of Exposure to Prosmoking Media on College Students’ Future Smoking Risk. Health Psychol..

Objective: This study used ecological momentary assessment to examine acute changes in college students’ future smoking risk as a function of their exposure to prosmoking media (e.g., smoking in movies, paid advertising, point-of-sale displays). Method: A sample of 135 college students (“ever” and “never” smokers) carried handheld computers for 21 days, recording their exposures to all forms of prosmoking media during the assessment period. They also responded to three investigator-initiated control prompts during each day of the assessment period (i.e., programmed to occur randomly). After each prosmoking media exposure and after each random control prompt they answered questions that measured their risk of future smoking. Responses between prosmoking media encounters were compared (within subjects) to responses made during random control prompts. Results: Compliance with the study protocol was high, with participants responding to over 83% of all random prompts. Participants recorded nearly three encounters with prosmoking media each week. Results of linear mixed modeling indicated that all participants had higher future smoking risk following exposure to prosmoking media compared with control prompts (p < .05); this pattern of response did not differ between ever and never smokers (p = .769). Additional modeling of the variances around participants’ risk of future smoking revealed that the response of never smokers to prosmoking media was significantly more variable than the response of ever smokers. Conclusion: Exposure to prosmoking media is associated with acute changes in future smoking risk, and never smokers and ever smokers respond differently to these exposures.

Sibon, I., Lassalle-Lagadec, S., Renou, P., & Swendsen, J. (2012). Evolution of Depression Symptoms following Stroke: A Prospective Study Using Computerized Ambulatory Monitoring. Cerebrovasc.Dis., 33, 280-285.

Background: Despite the high prevalence and impact of post-stroke depression (PSD), questions persist concerning the nature and stability of PSD over time. The current study uses state-of-the-art computerized ambulatory monitoring techniques to assess daily life depression symptoms following stroke and examines the evolution of depression levels over a three-month period. Methods: 48 patients admitted to a university hospital neurology unit for ischemic or hemorrhagic stroke participated in ambulatory monitoring of DSM-IV depression symptoms for a one-week period after hospital discharge. Clinician-administered measures of depression were also obtained at discharge and again three months later. Results: The percentage of the sample with elevated depression scores was the same at discharge and three months later, but consistency in depression profiles was low. Ambulatory monitoring revealed that elevated depression levels at hospital discharge were most strongly associated with anhedonia (t ratio = 4.840, p < 0.001) and fatigue (t ratio = 4.00, p < 0.001), whereas individuals with elevated scores at three months were predicted by daily life negative thoughts (t ratio = 4.051, p < 0.001), anxious mood (t ratio = 3.489, p < 0.01), sad mood (t ratio = 2.621, p < 0.05) and emotional reactivity (t ratio = 2.466, p < 0.05). Conclusions: The prevalence of depression may appear stable during the immediate weeks and months following stroke, but it is likely to be composed of very different symptom profiles. The immediate physical and psychological impact of stroke may induce somatic symptoms that explain elevated depression levels and which may not indicate a risk factor for later depression

Silk, J. S., Stroud, L. R., Siegle, G. J., Dahl, R. E., Lee, K. H., & Nelson, E. E. (2012). Peer acceptance and rejection through the eyes of youth: Pupillary, eyetracking and ecological data from the Chatroom Interact Task. Social Cognitive and Affective Neuroscience, 7, 93-105.

We developed an ecologically valid virtual peer interaction paradigm — the Chatroom Interact Task in which 60 pre-adolescents and adolescents (ages 9-17 years) were led to believe that they were interacting with other youth in a simulated internet chatroom. Youth received rejection and acceptance feedback from virtual peers. Findings revealed increased pupil dilation, an index of increased activity in cognitive and affective processing regions of the brain, to rejection compared to acceptance trials, which was greater for older youth. Data from a cell-phone Ecological Momentary Assessment (EMA) protocol completed following the task indicated that increased pupillary reactivity to rejection trials was associated with lower feelings of social connectedness with peers in daily life. Eyetracking analyses revealed attentional biases toward acceptance feedback and away from rejection feedback. Biases toward acceptance feedback were stronger for older youth. Avoidance of rejection feedback was strongest among youth with increased pupillary reactivity to rejection, even in the seconds leading up to and following rejection feedback. These findings suggest that adolescents are sensitive to rejection feedback and seek to anticipate and avoid attending to rejection stimuli. Furthermore, the salience of social rejection and acceptance feedback appears to increase during adolescence.

Sisson, S. B., Camhi, S. M., Tudor-Locke, C., Johnson, W. D., & Katzmarzyk, P. T. (2012). Characteristics of step-defined physical activity categories in U.S. adults. American Journal of Health Promotion, 26, 152-159.

Purpose: Descriptive physical activity epidemiology of the U.S. population is critical for program development and resource allocation. The purpose of this project was to describe step-defined categories (as measured by accelerometer) of U.S. adults and to determine predictors of sedentary classification (<5000 steps/d). Design: The National Health and Nutrition Examination Survey (NHANES) is an annual, nationally representative survey used to determine the health status of the U.S. populace. Setting: In-home interviews and physical examination components of NHANES. Participants: Overall, 4372 eligible adults wore accelerometers in the 2005-2006 NHANES; 628 were excluded, which yielded 3744 adults (of which 46.8% were men). Measures: Steps per day; body mass index (BMI); demographic, household and behavioral variables. Analysis: Means and frequencies were calculated. Logistic regression was utilized to determine predictors of sedentary classification. Results: Overall, 36.1% were sedentary (i.e., <5000 steps/d); 47.6% were low to somewhat active (5000-9999 steps/d); 16.3% were active to highly active (<10,000 steps/d). Advancing age (odds ratio [OR], 1.95; confidence intervals [CIs], 1.78, 2.13), higher BMI (OR, 1.40; CIs, 1.23, 1.59), female sex (OR, 1.86; CIs, 1.46, 2.36), African-American versus European-American ethnicity (OR, 1.36; CIs, 1.13, 1.65), household income versus ≥$45,000 (<$25,000: OR, 1.94; CIs, 1.40, 2.69; $25,000-44,000: OR, 1.51; CIs, 1.23, 1.85), and current versus never smoker (OR, 1.53; CIs, 1.26, 1.86) variables had higher odds of sedentary classification. Usual daily occupational/domestic physical activity categories of standing/walking (OR, .51; CIs, .38, .69); lifting/climbing (OR, .26; CIs, .17, .38); and heavy loads/labor (OR, .16; CIs, .10, .26) had lower odds of sedentary classification than sitting. Conclusions: Over one-third of the U.S. population was classified as sedentary by accelerometer-determined steps per day, and several characteristics predicted sedentary classification.

Smith, T. W., Birmingham, W., & Uchino, B. N. (2012). Evaluative threat and ambulatory blood pressure: Cardiovascular effects of social stress in daily experience. Health Psychol..

Objective: Physiological effects of social evaluation are central in models of psychosocial influences on physical health. Experimental manipulations of evaluative threat evoke substantial cardiovascular and neuroendocrine responses in laboratory studies, but only preliminary evidence is available regarding naturally occurring evaluative threats in daily life. In such nonexperimental ambulatory studies, it is essential to distinguish effects of evaluative threat from related constructs known to alter stress, such as ability perceptions and concerns about appearance. Methods: 94 married, working couples (mean age 29.2 years) completed a 1-day (8 a.m. to 10 p.m.) ambulatory blood pressure protocol with random interval-contingent measurements using a Suntech monitor and Palm Pilot-based measures of control variables and momentary experiences of social-evaluative threat, concerns about appearance, and perceived ability. Results: In hierarchical analyses for couples and multiple measurement occasions (Proc Mixed; SAS) and controlling individual differences (BMI, age, income) and potential confounds (e.g., posture, activity), higher reports of social-evaluative threat were associated with higher concurrent systolic (estimate = .87, SE = .34) and diastolic blood pressure (estimate = 1.06; SE = .26), both p < .02. Effects of social-evaluative threat remained significant when perceived ability and appearance concerns were controlled. Conclusions: Naturally occurring social-evaluative threat during daily activity is associated with increased systolic and diastolic blood pressure. Given associations between ambulatory blood pressure and risk of cardiovascular disease, the findings support conceptual models of threats to the social self as a potentially important influence on physical health.

Tan, P. Z., Forbes, E. E., Dahl, R. E., Ryan, N. D., Siegle, G. J., Ladouceur, C. D. et al. (2012). Emotional reactivity and regulation in anxious and nonanxious youth: A cell-phone ecological momentary assessment study. Journal of Child Psychology and Psychiatry, 53, 197-206.

Background: Reviews have highlighted anxious youths’ affective disturbances, specifically, elevated negative emotions and reliance on ineffective emotion regulation strategies. However, no study has examined anxious youth’s emotional reactivity and regulation in real-world contexts. Methods: This study utilized an ecological momentary assessment approach to compare real-world emotional experiences of 65 youth with generalized anxiety disorder, social anxiety disorder, or social phobia (ANX) and 65 age-matched healthy controls (CON), ages 9-13 years. Results: Hierarchical linear models revealed that ANX reported higher levels of average past-hour peak intensity of nervous, sad and upset emotions than CON youth but similar levels during momentary reports of current emotion. As expected, ANX youth reported more frequent physiological reactions in response to a negative event; however, there were no group differences in how frequently they used cognitive-behavioral strategies. Avoidance, distraction and problem solving were associated with the down-regulation of all negative emotions except nervousness for both ANX and CON youth; however, group differences emerged for acceptance, rumination and physiological responding. Conclusions: In real-world contexts, ANX youth do not report higher levels of momentary negative emotions but do report heightened negative emotions in response to challenging events. Moreover, ANX youth report no differences in how frequently they use adaptive regulatory strategies but are more likely to have physiological responses to challenging events. They are also less effective at using some strategies to down-regulate negative emotion than CON youth.

Vanhelst, J., Beghin, L., Duhamel, A., Bergman, P., Sjotrom, M., & Gottrand, F. (2012). Comparison of uniaxial and triaxial accelerometry in the assessment of physical activity among adolescents under free-living conditions: the HELENA study. BMC.Med.Res.Methodol., 12, 26.

BACKGROUND: Different types of devices are available and the choice about which to use depends on various factors: cost, physical characteristics, performance, and the validity and intra- and interinstrument reliability. Given the large number of studies that have used uniaxial or triaxial devices, it is of interest to know whether the different devices give similar information about PA levels and patterns. The aim of this study was to compare physical activity (PA) levels and patterns obtained simultaneously by triaxial accelerometry and uniaxial accelerometry in adolescents in free-living conditions. METHODS: Sixty-two participants, aged 13-16 years, were recruited in this ancillary study, which is a part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA). All participants wore a uniaxial accelerometer (ActiGraph GT1M(R), Pensacola, FL) and a triaxial accelerometer (RT3(R), Stayhealthy, Monrovia, CA) simultaneously for 7 days. The patterns were calculated by converting accelerometer data output as a percentage of time spent at sedentary, light, moderate, and vigorous PA per day. Analysis of output data from the two accelerometers were assessed by two different tests: Equivalence Test and Bland & Altman method. RESULTS: The concordance correlation coefficient between the data from the triaxial accelerometer and uniaxial accelerometer at each intensity level was superior to 0.95. The ANOVA test showed a significant difference for the first three lower intensities while no significant difference was found for vigorous intensity. The difference between data obtained with the triaxial accelerometer and the uniaxial monitor never exceeded 2.1% and decreased as PA level increased. The Bland & Altman method showed good agreement between data obtained between the both accelerometers (p < 0.05). CONCLUSIONS: Uniaxial and triaxial accelerometers do not differ in their measurement of PA in population studies, and either could be used in such studies

Walther, S., Hugli, S., Hofle, O., Federspiel, A., Horn, H., Bracht, T. et al. (2012). Frontal white matter integrity is related to psychomotor retardation in major depression. Neurobiol.Dis..

Altered frontal white matter integrity has been reported in major depression. Still, the behavioral correlates of these alterations are not established. In healthy subjects, motor activity correlated with white matter integrity in the motor system. To explore the relation of white matter integrity and motor activity in major depressive disorder, we investigated 21 medicated patients with major depressive disorder and 21 matched controls using diffusion tensor imaging and wrist actigraphy at the same day. Patients had lower activity levels (AL) compared with controls. Fractional anisotropy (FA) differed between groups in frontal white matter regions and the posterior cingulum. AL was linearly associated with white matter integrity in two clusters within the motor system. Controls had an exclusive positive association of FA and AL in white matter underneath the right dorsal premotor cortex. Only patients had a positive association within the posterior cingulum. Furthermore, patients had negative associations of FA and AL underneath the left primary motor cortex and within the left parahippocampal gyrus white matter. These differences in the associations between structure and behavior may contribute to well-known impaired motor planning or gait disturbances in major depressive disorder. Therefore, signs of psychomotor slowing in major depressive disorder may be linked to changes of the white matter integrity of the motor system

Waters, A. J., Marhe, R., & Franken, I. H. A. (2012). Attentional bias to drug cues is elevated before and during temptations to use heroin and cocaine. Psychopharmacology, 219, 909-921.

Rationale: Relapse is an important problem in substance dependence treatment. When drug users try to abstain from drug use, they often report strong temptations to use drugs. Temptation episodes have commonalities with relapse episodes, and assessment of temptation episodes may help to identify individuals at risk of relapse. Objectives: This study aims to examine affect and cognition prior to and during temptation episodes by administering self-report and implicit cognitive assessments on a handheld computer (PDA) using Ecological Momentary Assessment. Methods: Heroin-dependent patients (N = 68) attending a drug detoxification unit completed up to four random assessments (RAs) per day on a PDA for 1 week. They also completed an assessment when they experienced a temptation to use drugs (temptation assessment; TA). Results: Participants completed 1,482 assessments (353 TAs, 1,129 RAs). The rate of TAs was maximal during the first 2 days. Participants reported higher levels of negative affect, anxiety, and difficulty concentrating, and more positive explicit attitudes to drugs, at TAs compared to RAs. In addition, they exhibited elevated attentional bias to drug cues (assessed using the modified Stroop task) at TAs compared to RAs. Implicit affective associations with drug cues (assessed using the Implicit Association Test) were not different at TAs compared to RAs. Attentional bias was elevated in the 1 h prior to the entry of a temptation episode. Conclusions: Elevated attentional bias may be a harbinger of temptation episodes. Interventions that target cognitions prior to or during temptation episodes may reduce the probability or severity of a temptation episode.

Yalachkov, Y., Kaiser, J., & Naumer, M. J. (2012). Functional neuroimaging studies in addiction: Multisensory drug stimuli and neural cue reactivity. Neuroscience and Biobehavioral Reviews, 36, 825-835.

Neuroimaging studies on cue reactivity have substantially contributed to the understanding of addiction. In the majority of studies drug cues were presented in the visual modality. However, exposure to conditioned cues in real life occurs often simultaneously in more than one sensory modality. Therefore, multisensory cues should elicit cue reactivity more consistently than unisensory stimuli and increase the ecological validity and the reliability of brain activation measurements. This review includes the data from 44 whole-brain functional neuroimaging studies with a total of 1168 subjects (812 patients and 356 controls). Correlations between neural cue reactivity and clinical covariates such as craving have been reported significantly more often for multisensory than unisensory cues in the motor cortex, insula and posterior cingulate cortex. Thus, multisensory drug cues are particularly effective in revealing brainGÇôbehavior relationships in neurocircuits of addiction responsible for motivation, craving awareness and self-related processing.

Yano, Y. & Kario, K. (2012). Nocturnal blood pressure and cardiovascular disease: a review of recent advances. Hypertens.Res..

The accurate measurement, prediction and treatment of high blood pressure (BP) are essential issues in the management of hypertension. Ambulatory blood pressure monitoring (ABPM) has been shown to be superior to clinic BP measurements as ABPM can provide the following important information: (i) the mean BP levels, (ii) the diurnal variation in BP and (iii) the short-term BP variability. Among these parameters, there is increasing evidence that the mean nocturnal BP level is the most sensitive predictor of cardiovascular morbidity and mortality. Furthermore, several studies have shown that less nocturnal BP dipping, defined as less nocturnal BP decline relative to daytime BP, or a high night-day BP ratio was associated with poor prognosis irrespective of the 24-hour BP levels. These findings can be interpreted in at least two ways: namely, high nocturnal BP or less nocturnal BP dipping might be not only a potent risk factor for cardiovascular disease (CVD), but also a marker of pre-existing or concurrent diseases that can lead to nocturnal BP elevation. In this review, we consider the clinical utility of ABPM and in particular focus on the nocturnal BP levels or nocturnal BP dipping as a potent risk factor for CVD. In addition, the clinical management of high nocturnal BP and blunted nocturnal BP dipping with antihypertensive medications is discussed.Hypertension Research advance online publication, 1 March 2012; doi:10.1038/hr.2012.26

Yeung, D. Y. & Fung, H. H. (2012). Impacts of Suppression on Emotional Responses and Performance Outcomes: An Experience-Sampling Study in Younger and Older Workers. J.Gerontol.B Psychol.Sci.Soc.Sci..

Objectives.Past studies have demonstrated that older adults used less emotional suppression to regulate their emotions than did younger adults, but the effectiveness of using this emotion regulatory strategy on psychosocial well-being across age remains largely unexplored. The present study adopted an experience-sampling method to examine whether the impacts of momentary employment of emotional suppression on momentary positive and negative emotions and job performance would be different by age. Method. Eighty-seven Chinese insurance workers, aged between 18 and 61 years, participated in a 5-day sampling study. Their affective responses at work, momentary task performance, and sales productivity were recorded. RESULTS: Results showed that older workers’ greater use of suppression at work was associated with lower intensity of negative emotions, whereas such association was not found among younger workers. Moreover, greater use of suppression over the sampling period was significantly predictive of sales productivity of older workers, but such a positive association was not shown in younger workers.Discussion.These findings reveal that the use of suppression at work may be more effective for older workers than for younger workers

Zeitzer, J. M., David, R., Friedman, L., Mulin, E., Garcia, R., Wang, J. et al. (2012). Phenotyping Apathy in Individuals With Alzheimer Disease Using Functional Principal Component Analysis. Am.J.Geriatr.Psychiatry.

OBJECTIVES:: To determine if there is a specific pattern of gross motor activity associated with apathy in individuals with Alzheimer disease (AD). DESIGN: Examination of ad libitum 24-hour ambulatory gross motor activity patterns. SETTING: Community-dwelling, outpatient. PARTICIPANTS:: Ninety-two individuals with AD, 35 of whom had apathy. MEASUREMENTS:: Wrist actigraphy data were collected and examined using functional principal component analysis (fPCA). RESULTS: Individuals with apathy have a different pattern of gross motor activity than those without apathy (first fPCA component, p <0.0001, t = 5.73, df = 90, t test) such that there is a pronounced decline in early afternoon activity in those with apathy. This change in activity is independent of depression (p = 0.68, F[1, 89] = 0.05, analysis of variance). The decline in activity is consistent with an increase in napping. Those with apathy also have an early wake and bedtime (second fPCA component, t = 2.53, df = 90, p <0.05, t test). CONCLUSIONS: There is a signature activity pattern in individuals with apathy and AD that is distinct from those without apathy and those with depression. Actigraphy may be a useful adjunctive measurement in the clinical diagnosis of apathy in the context of AD

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