Identification and Validity of Accelerometer Cut-Points for Toddlers

The purpose of this study was to derive ActiGraph cut-points for sedentary (SED), light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) in toddlers and evaluate their validity in an independent sample. The predictive validity of established preschool cut-points were also evaluated and compared. Twenty-two toddlers (mean age = 2.1 years ± 0.4 years) wore an ActiGraph accelerometer during a videotaped 20-min play period. Videos were subsequently coded for physical activity (PA) intensity using the modified Children's Activity Rating Scale (CARS). Receiver operating characteristic (ROC) curve analyses were conducted to determine cut-points. Predictive validity was assessed in an independent sample of 18 toddlers (mean age = 2.3 ± 0.4 years). From the ROC curve analyses, the 15-s count ranges corresponding to SED, LPA, and MVPA were 0–48, 49–418, and >418 counts/15 s, respectively. Classification accuracy was fair for the SED threshold (ROC-AUC = 0.74, 95% confidence interval = 0.71–0.76) and excellent for MVPA threshold (ROC-AUC = 0.90, 95% confidence interval = 0.88–0.92). In the cross-validation sample, the toddler cut-point and established preschool cut-points significantly overestimated time spent in SED and underestimated time in spent in LPA. For MVPA, mean differences between observed and predicted values for the toddler and Pate cut-points were not significantly different from zero. In summary, the ActiGraph accelerometer can provide useful group-level estimates of MVPA in toddlers. The results support the use of the Pate cut-point of 420 counts/15 s for MVPA.

Calibration and comparison of accelerometer cut points in preschool children

Objective The present study aimed to develop accelerometer cut points to classify physical activities (PA) by intensity in preschoolers and to investigate discrepancies in PA levels when applying various accelerometer cut points. Methods To calibrate the accelerometer, 18 preschoolers (5.8 +/- 0.4 years) performed eleven structured activities and one free play session while wearing a GT1M ActiGraph accelerometer using 15 s epochs. The structured activities were chosen based on the direct observation system Children's Activity Rating Scale (CARS) while the criterion measure of PA intensity during free play was provided using a second-by-second observation protocol (modified CARS). Receiver Operating Characteristic (ROC) curve analyses were used to determine the accelerometer cut points. To examine the classification differences, accelerometer data of four consecutive days from 114 preschoolers (5.5 +/- 0.3 years) were classified by intensity according to previously published and the newly developed accelerometer cut points. Differences in predicted PA levels were evaluated using repeated measures ANOVA and Chi Square test. Results Cut points were identified at 373 counts/15 s for light (sensitivity: 86%; specificity: 91%; Area under ROC curve: 0.95), 585 counts/15 s for moderate (87%; 82%; 0.91) and 881 counts/15 s for vigorous PA (88%; 91%; 0.94). Further, applying various accelerometer cut points to the same data resulted in statistically and biologically significant differences in PA. Conclusions Accelerometer cut points were developed with good discriminatory power for differentiating between PA levels in preschoolers and the choice of accelerometer cut points can result in large discrepancies.

Influences of preschool policies and practices on children's physical activity

The objective of this study was to determine if moderate to vigorous physical activity (MVPA) of 3-5 year old preschool children varied with differences in policies/practices, and overall quality of preschools. A total of 266 children (47% males, 60% African American) from 9 preschools were observed for 1 hour on 3 different days. PA of children was observed twice per minute and scored as 1-5, with 1 for stationary/motionless and 5 for fast movement. Summary MVPA was calculated over the 3 days as percent of times observed at levels of 4 or 5, and percent of time at levels I or 2 as sedentary activity. A structured interview about PA policies was conducted with an administrator at each preschool and overall quality of the preschool was assessed using Early Childhood Environment Rating Scale-Revised Edition (ECERS-R). Preschools were divided into groups according to whether a specific policy/practice that would be logically hypothesized to promote PA was in place at the school. MVPA differences between groups of children was assessed using mixed ANOVA controlling for preschool. When preschools offered more field trips, and more college educated teachers, the children participated in more MVPA. Children who attended preschools with lower quality spent more time in sedentary activity. In conclusion, children in preschools which may have more resources and better quality appear to show both more sedentary behavior and more MVPA.

Delirium in advanced cancer : screening for the incidence on admission to an inpatient hospice unit

Background Delirium is a common underdiagnosed condition in advanced cancer leading to increased distress, morbidity, and mortality. Screening improves detection but there is no consensus as to the best screening tool to use with patients with advanced cancer. Objective To determine the incidence of delirium in patients with advanced cancer within 72 hours of admission to an acute inpatient hospice using clinical judgement and validated screening tools. Method One hundred consecutive patients with advanced cancer were invited to be screened for delirium within 72 hours of admission to an acute inpatient hospice unit. Two validated tools were used, the Delirium Rating Scale-Revised 98 (DRS-R-98) and the Confusion Assessment Method (CAM) shortened diagnostic algorithm. These results were compared with clinical assessment by review of medical charts. Results Of 100 consecutive admissions 51 participated and of these 22 (43.1%) screened positive for delirium with CAM and/or DRS-R-98 compared to 15 (29.4%) by clinical assessment. Eleven (21.6%) were identified as hypoactive delirium and 5 (9.8%) as subsyndromal delirium. Conclusion This study confirms that delirium is a common condition in patients with advanced cancer.While there remains a lack of consensus regarding the choice of delirium screening tool this study supports theCAMas being appropriate. Further research may determine the optimal screening tool for delirium enabling the development of best practice clinical guidelines for routinemedical practice.

Reawakening reflective capacity in the psychotherapy of schizophrenia : a case study

Disturbed sense of self has long been identified as a common experience among people suffering with schizophrenia. More recently, metacognitive deficits have been found to be a stable and independent feature of schizophrenia that contributes to disturbed self-experience and impedes recovery. Individual psychotherapy designed to target poor metacognition has been shown to promote a more coherent sense of self and enhanced recovery in people with schizophrenia. We provide a report of a 2-year individual psychotherapy with a patient suffering with chronic schizophrenia. Progress was assessed over the course of treatment using the Metacognition Assessment Scale and the Brief Psychiatric Rating Scale. The patient experienced improved metacognitive capacity and reduced symptom severity over the course of therapy. Implications for clinical practice are discussed.

Pituitary volume and early treatment response in drug-naïve first-episode psychosis patients

BACKGROUND: An early response to antipsychotic treatment in patients with psychosis has been associated with a better course and outcome. However, factors that predict treatment response are not well understood. The onset of schizophrenia and related disorders has been associated with increased levels of stress and hyper-activation of the hypothalamic-pituitary-adrenal (HPA) axis. This study examined whether pituitary volume at the onset of psychosis may be a potential predictor of early treatment response in first-episode psychosis (FEP) patients. METHODS: We investigated the relationship between baseline pituitary volume and symptomatic treatment response over 12 weeks using mixed model analysis in a sample of 42 drug-naïve or early treated FEP patients who participated in a controlled dose-finding study of quetiapine fumarate. Logistic regression was used to examine predictors of treatment response. Pituitary volume was measured from magnetic resonance imaging scans that were obtained upon entry into the trial. RESULTS: Larger pituitary volume was associated with less improvement in overall psychotic symptoms (Brief Psychiatric Rating Scale (BPRS) P=0.031) and positive symptoms (BPRS positive symptom subscale P=0.010). Regardless of gender, patients with a pituitary volume at the 25th percentile (413 mm(3)) were approximately three times more likely to respond to treatment by week 12 than those at the 75th percentile (635 mm(3)) (odds ratio=3.07, CI: 0.90-10.48). CONCLUSION: The association of baseline pituitary volumes with early treatment response highlights the importance of the HPA axis in emerging psychosis. Potential implications for treatment strategies in early psychosis are discussed.

Mood enhancement using smartphone apps

The significant physical, emotional, educational and social developmental challenges faced by adolescents and young adults are associated with high levels of emotional vulnerability. Thus, the development and use of effective emotion-regulation strategies during this period is critical. Music listening is commonly used by young people to identify, express, enhance and regulate their emotions. Modern mobile technology provides an engaging, easily accessible means of assisting young people with identifying and managing emotions through music. A systematic contextual review of iPhone applications addressing emotions through music was conducted. Their quality was evaluated by two independent raters using the Mobile App Rating Scale (MARS). Three participatory design workshops (PDW; N=13, 6 males, 7 females; age 15-25) were conducted, exploring young people’s use of music to enhance wellbeing. Young people were also asked to trial existing mood and music apps and to conceptualise their ultimate mood-targeting music application. Of the identified 117 music apps, 20 met inclusion criteria (to play songs, not sounds; priced below $5.00). Characteristics and overall quality of the music apps are described and key features of the five highest- rating apps are presented. Thematic analysis of the PDW content identified the following music affect- regulation strategies: relationship building, modifying cognitions, modifying emotions, and immersing in emotions (i.e. habituation or mood enhancement). The application of key learnings from the mobile app review and PDW to the design and development of the new music eScape app will be presented. Implications for future research and for applying the new app in clinical practice are discussed.

Association of IL23R and ERAP1 genes with ankylosing spondylitis in a Portuguese population

Objective: Association between ankylosing spondylitis (AS) and two genes, ERAP1 and IL23R, has recently been reported in North American and British populations. The population attributable risk fraction for ERAP1 in this study was 25%, and for IL23R, 9%. Confirmation of these findings to ERAP1 in other ethnic groups has not yet been demonstrated. We sought to test the association between single nucleotide polymorphisms (SNPs) in these genes and susceptibility to AS among a Portuguese population. We also investigated the role of these genes in clinical manifestations of AS, including age of symptom onset, the Bath Ankylosing Spondylitis Disease Activity, Metrology and Functional Indices, and the modified Stoke Ankylosing Spondylitis Spinal Score. Methods: The study was conducted on 358 AS cases and 285 ethnically matched Portuguese healthy controls. AS was defined according to the modified New York Criteria. Genotyping of IL23R and ERAP1 allelic variants was carried out with TaqMan allelic discrimination assays. Association analysis was performed using the Cochrane-Armitage and linear regression tests of genotypes as implemented in PLINK for dichotomous and quantitative variables respectively. A meta-analysis for Portuguese and previously published Spanish IL23R data was performed using the StatsDirect® Statistical tools, by fixed and random effects models. Results: A total of 14 nsSNPs markers (8 for IL23R, 5 for ERAPl, 1 for LN-PEP) were analysed. Three markers (2 for IL23R and 1 for ERAP1) showed significant single-locus disease associations, confirming that the association of these genes with AS in the Portuguese population. The strongest associated SNP in IL23R was rs1004819 (OR=1.4, p=0.0049), and in ERAP1 was rs30187 (OR=1.26, p=0.035). The population attributable risk fractions in the Portuguese population for these SNPs are 11% and 9.7% respectively. No association was seen with any SNP in LN-PEP, which flanks ERAP1 and was associated with AS in the British population. No association was seen with clinical manifestations of AS. Conclusions: These results show that IL23R and ERAP1 genes are also associated with susceptibility to AS in the Portuguese population, and that they contribute a significant proportion of the population risk for this disease.

Review and evaluation of mindfulness-based iPhone apps

Background There is growing evidence for the positive impact of mindfulness on wellbeing. Mindfulness-based mobile apps may have potential as an alternative delivery medium for training. While there are hundreds of such apps, there is little information on their quality. Objective This study aimed to conduct a systematic review of mindfulness-based iPhone mobile apps and to evaluate their quality using a recently-developed expert rating scale, the Mobile Application Rating Scale (MARS). It also aimed to describe features of selected high-quality mindfulness apps. Methods A search for “mindfulness” was conducted in iTunes and Google Apps Marketplace. Apps that provided mindfulness training and education were included. Those containing only reminders, timers or guided meditation tracks were excluded. An expert rater reviewed and rated app quality using the MARS engagement, functionality, visual aesthetics, information quality and subjective quality subscales. A second rater provided MARS ratings on 30% of the apps for inter-rater reliability purposes. Results The “mindfulness” search identified 700 apps. However, 94 were duplicates, 6 were not accessible and 40 were not in English. Of the remaining 560, 23 apps met inclusion criteria and were reviewed. The median MARS score was 3.2 (out of 5.0), which exceeded the minimum acceptable score (3.0). The Headspace app had the highest average score (4.0), followed by Smiling Mind (3.7), iMindfulness (3.5) and Mindfulness Daily (3.5). There was a high level of inter-rater reliability between the two MARS raters. Conclusions Though many apps claim to be mindfulness-related, most were guided meditation apps, timers, or reminders. Very few had high ratings on the MARS subscales of visual aesthetics, engagement, functionality or information quality. Little evidence is available on the efficacy of the apps in developing mindfulness.

Interleukin 10 polymorphisms in ankylosing spondylitis

Genetic polymorphisms of the IL10 promoter region have been implicated in many autoimmune diseases, including seronegative spondyloarthropathies. We studied three SNPs (IL10-1087,-824, and -597) and two microsafellites(IL10R and IL10G) lying within the promoter region of IL10 for association with susceptibility to and clinical manifestations of ankylosing spondylitis (AS), a common form of spondyloarthritis. Four hundred and sixty-eight individuals from 182 Finnish families affected with AS were studied. No association between individual IL10 promoter region polymorphisms or marker haplotype was observed with susceptibility to AS, but weak association was noted between the IL10-597 and -824 SNPs and age of disease onset (P= 0.01 for each SNP). The IL10.G4 allele was associated with BASFI (corrected for disease duration) (P= 0.03). We conclude that IL10 promoter polymorphisms have no significant effect on susceptibility to AS, but may play a minor role in determining age of disease onset and disease severity. © 2003 Nature Publishing Group All rights reserved.

Creating a standardised teaching and learning framework for social work field placements

Mapping and evaluating a student's progress on placement is a core element of social work education but there has been scant attention to indicate how to effectively create and assess student learning and performance. This paper outlines a project undertaken by the Combined Schools of Social Work to develop a common learning and assessment tool that is being used by all social work schools in Victoria. The paper describes how the Common Assessment Tool (CAT) was developed, drawing on the Australian Association of Social Work Practice Standards, leading to seven key learning areas that form the basis of the assessment of a student's readiness for practice. An evaluation of the usefulness of the CAT was completed by field educators, liaison staff, and students, which confirmed that the CAT was a useful framework for evaluating students' learning goals. The feedback also identified a number of problematic features that were addressed in a revised CAT and rating scale.

Patient preferences for receiving remote communication support for lifestyle physical activity behaviour change: The perspective of patients with musculoskeletal disorders from three hospital services

This study examined patients’ preference ratings for receiving support via remote communication to increase their lifestyle physical activity. Methods People with musculoskeletal disorders ( n=221 of 296 eligible) accessing one of three clinics provided preference ratings for “how much” they wanted to receive physical activity support via five potential communication modalities. The five ratings were generated on a horizontal analogue rating scale (0 represented “not at all”; 10 represented “very much”). Results Most (n=155, 70%) desired referral to a physical activity promoting intervention. “Print and post” communications had the highest median preference rating (7/10), followed by email and telephone (both 5/10), text messaging (1/10), and private Internet-based social network messages (0/10). Desire to be referred was associated with higher preference for printed materials (coefficient = 2.739, p<0.001), telephone calls (coefficient = 3.000, p<0.001), and email (coefficient = 2.059, p=0.02). Older age was associated with lower preference for email (coefficient = −0.100, p<0.001), texting (coefficient = −0.096, p<0.001), and social network messages (coefficient = −0.065, p<0.001). Conclusion Patients desiring support to be physically active indicated preferences for interventions with communication via print, email, or telephone calls.

Learning style and digital activity: An ecological study

In order to understand student engagement in higher education through the use of digital technologies, it is necessary to appreciate the broader use of differing technologies. Forty-eight first-year university students completed an online survey that queried patterns of digital activity across home, school and community contexts and that included rating scale items that measured learning style (i.e., active-reflective, sensing-intuitive, visual-verbal, sequential-global). Results suggest that students vary widely in digital activities and that such variation is related to differences in learning style. For example, active learners were more likely than reflective learners to engage in digital activities in the community and users of some specific application, as opposed to non-users, were more likely to be verbal than visual learners. Implications for instructional applications of digital technology in higher education are presented.

The profile of psychiatric symptoms exacerbated by methamphetamine use

Background Methamphetamine use can produce symptoms almost indistinguishable from schizophrenia. Distinguishing between the two conditions has been hampered by the lack of a validated symptom profile for methamphetamine-induced psychiatric symptoms. We use data from a longitudinal cohort study to examine the profile of psychiatric symptoms that are acutely exacerbated by methamphetamine use. Methods 164 methamphetamine users, who did not meet DSM-IV criteria for a lifetime primary psychotic disorder, were followed monthly for one year to assess the relationship between days of methamphetamine use and symptom severity on the 24-item Brief Psychiatric Rating Scale. Exacerbation of psychiatric symptoms with methamphetamine use was quantified using random coefficient models. The dimensions of symptom exacerbation were examined using principal axis factoring and a latent profile analysis. Results Symptoms exacerbated by methamphetamine loaded on three factors: positive psychotic symptoms (suspiciousness, unusual thought content, hallucinations, bizarre behavior); affective symptoms (depression, suicidality, guilt, hostility, somatic concern, self-neglect); and psychomotor symptoms (tension, excitement, distractibility, motor hyperactivity). Methamphetamine use did not significantly increase negative symptoms. Vulnerability to positive psychotic and affective symptom exacerbation was shared by 28% of participants, and this vulnerability aligned with a past year DSM-IV diagnosis of substance-induced psychosis (38% vs. 22%, _2 (df1) = 3.66, p = 0.056). Conclusion Methamphetamine use produced a symptom profile comprised of positive psychotic and affective symptoms, which aligned with a diagnosis of substance-induced psychosis, with no evidence of a negative syndrome.

Investigating the effect of Eye Movement Desensitization and Reprocessing (EMDR) on postoperative pain intensity in adolescents undergoing surgery: A randomized controlled trial

Aim To investigate the efficacy of Eye Movement Desensitization and Reprocessing for postoperative pain management in adolescents. Background Eye Movement Desensitization and Reprocessing is an inexpensive, non-pharmacological intervention that has successfully been used to treat chronic pain. It holds promise in the treatment of acute, postsurgical pain based on its purported effects on the brain and nervous system. Design A randomized controlled trial was used. Methods Fifty-six adolescent surgical patients aged between 12-18 years were allocated to gender-balanced Eye Movement Desensitization and Reprocessing (treatment) or non-Eye Movement Desensitization and Reprocessing (control) groups. Pain was measured using the Wong-Baker FACES® Pain Rating Scale (WBFS) before and after the intervention (or non-intervention for the control group). Findings A Wilcoxon signed-rank test demonstrated that the Eye Movement Desensitization and Reprocessing group experienced a significant reduction in pain intensity after treatment intervention, whereas the control group did not. Additionally, a Mann–Whitney U-test showed that, while there was no significant difference between the two groups at time 1, there was a significant difference in pain intensity between the two groups at time 2, with the Eye Movement Desensitization and Reprocessing group experiencing lower levels of pain. Conclusion These results suggest that Eye Movement Desensitization and Reprocessing may be an effective treatment modality for postoperative pain.