Feasibility of Passive ECG Bio-sensing and EMA Emotion Reporting Technologies and Acceptability of Just-in-Time Content in a Well-being Intervention, Considerations for Scalability and Improved Uptake

Researchers increasingly use passive sensing data and frequent self-report to implement personalized mobile health (mHealth) interventions. Yet, we know that certain populations may find these technical protocols burdensome and intervention uptake as well as treatment efficacy may be affected as a result. In the present study, we predicted feasibility (participant adherence to protocol) and acceptability (participant engagement with intervention content) as a function of baseline sociodemographic, mental health, and well-being characteristics of 99 women randomized in the personalized preventive intervention Wellness-for-Two (W-4-2), a randomized trial evaluating stress-related alterations during pregnancy and their effect on infant neurodevelopmental trajectories. The W-4-2 study used ecological momentary assessment (EMA) and wearable electrocardiograph (ECG) sensors to detect physiological stress and personalize the intervention. Participant adherence to protocols was 67% for EMAs and 52% for ECG bio-sensors. Higher baseline negative affect significantly predicted lower adherence to both protocols. Women assigned to the intervention group engaged on average with 42% of content they received. Women with higher annual household income were more likely to engage with more of the intervention content. Researchers should carefully consider tailoring of the intensity of technical intervention protocols to reduce fatigue, especially among participants with higher baseline negative affect, which may improve intervention uptake and efficacy findings at scale.

How do academic health centers value and encourage clinical research?

To investigate whether there is a misalignment of the perceived values of and incentives for clinical research within U.S. academic health centers (AHCs), in 1999 the authors surveyed medical school deans, academic administrators, department chairs, and faculty members at 80 AHCs that are the members of the University HealthSystem Consortium, a not-for-profit consortium of AHCs. A total of 358 faculty from 58% of the institutions surveyed responded, with a mean of 3.76 responses/institution. There was general agreement that clinical research offers AHCs a considerable spectrum of benefits, including prestige, recruitment and retention of faculty, criteria for promotion of faculty, and financial support. Investigator-initiated research and government-funded research ranked highest in terms of their desirability compared with industry-sponsored and contract research. This preference was agreed upon across all categories of respondents and types of research (translational, clinical tests, and outcomes). Significant differences existed between the perceptions of deans/AHC administrators, who stated that they were increasing their emphasis on clinical investigation in the areas of research space (56% of responders), administrative support (81%), and patient recruitment (61%) and the perceptions of their departmental chairs/faculties in the same areas (34%, 52%, and 40%, respectively; p <.05). Faculty opinions documented few new investments in the actual infrastructure dedicated to clinical research. The authors conclude that their findings, which they consider reasonably representative, strongly suggest that the value of clinical research to AHCs is well understood. Their findings also identify important opportunities for AHCs to provide a wider range of incentives for the conduct of clinical research.

Enhancing the clinical research pipeline: training approaches for a new century

There is growing concern that the numbers of physician-scientists being trained in U.S. academic health centers will not be sufficient to continue the rate of current progress in biomedical research. The authors believe that the needs of current trainees and junior faculty must be addressed immediately, and that programs to train the next generation of patient-oriented researchers must be established without delay. The authors describe a two-pronged approach to this looming crisis. First is a description of innovative educational programs implemented at one academic health center from the K-12 level through the medical-school curriculum. Second, programs are discussed that have been developed to facilitate the recruitment, training, and retention of physician-scientists in the early parts of their professional careers. Four models of training "translational" investigators are presented, along with case studies of how these models have been implemented in real-life productive and professionally satisfying collaborations within one academic health center. The authors conclude by stating that to be prepared for the effects of future knowledge on human disease and preventive health, academic health centers must enhance training opportunities for physician-scientists.

Biomedical research leaders: report on needs, opportunities, difficulties, education and training, and evaluation

The National Association of Physicians for the Environment (NAPE) has assumed a leadership role in protecting environmental health in recent years. The Committee of Biomedical Research Leaders was convened at the recent NAPE Leadership Conference: Biomedical Research and the Environment held on 1--2 November 1999, at the National Institutes of Health, Bethesda, Maryland. This report summarizes the discussion of the committee and its recommendations. The charge to the committee was to raise and address issues that will promote and sustain environmental health, safety, and energy efficiency within the biomedical community. Leaders from every important research sector (industry laboratories, academic health centers and institutes, hospitals and care facilities, Federal laboratories, and community-based research facilities) were gathered in this committee to discuss issues relevant to promoting environmental health. The conference and this report focus on the themes of environmental stewardship, sustainable development and "best greening practices." Environmental stewardship, an emerging theme within and outside the biomedical community, symbolizes the effort to provide an integrated, synthesized, and concerted effort to protect the health of the environment in both the present and the future. The primary goal established by the committee is to promote environmentally responsible leadership in the biomedical research community. Key outcomes of the committee's discussion and deliberation were a) the need for a central organization to evaluate, promote, and oversee efforts in environmental stewardship; and b) immediate need to facilitate efficient information transfer relevant to protecting the global environment through a database/clearinghouse. Means to fulfill these needs are discussed in this report.

Eye movement impairment and schizotypal psychopathology

OBJECTIVE

Eye movement dysfunction in relation to a smooth pursuit task has been documented in schizophrenic patients and in patients with the related personality disorder, schizotypal personality disorder. To investigate which quantitative measures are associated with the eye movement dysfunction and whether the dysfunction is more related to the psychotic-like or the deficit-like symptoms of schizotypal personality disorder, ratings of eye movements in several groups of subjects were compared.

METHOD

The study groups consisted of 26 patients with schizotypal personality disorder, 42 patients with other personality disorders (22 who also had two or more schizotypal personality traits and 20 who had fewer than two), and 37 normal comparison subjects. Smooth pursuit eye tracking of sinusoidal and constant velocity targets was recorded by an infrared eye tracking system. Two raters evaluated pursuit gain and large and small saccades in the direction of the target and in the direction opposite to that of the target (quantitative ratings) and constant velocity (qualitative rating).

RESULTS

Patients with schizotypal personality disorder and patients with other personality disorders and two or more schizotypal traits, but not those with fewer than two schizotypal traits, had significantly poorer qualitative ratings of tracking than the normal comparison subjects. Neither gain nor any of the saccadic measures significantly differed between groups. The number of large saccades in the direction of the target was the only quantitative variable that predicted low qualitative ratings. Qualitatively poor tracking was associated with the deficit-like, but not the psychotic-like, symptoms of schizotypal personality disorder.

CONCLUSIONS

Patients with schizotypal personality disorder demonstrate qualitatively poorer tracking than comparison groups, and the impaired tracking is associated with deficit-like symptoms.

Conformation of amine-modified DNA: 2-aminofluorene- and 2-(acetylamino)fluorene-modified deoxydinucleoside monophosphates with all possible nearest neighbors. A comparison of search and optimization methods

Although a significant part of the replication fork exists as single-stranded DNA, little is known about the effect of carcinogens and mutagens on single-strand conformation. Large-scale conformational searches with potential energy minimization, using the torsion angle space molecular mechanics program DUPLEX, were employed to explore the conformation of all 16 deoxydinucleoside monophosphates bearing 2-aminofluorene (AF) or 2-(acetylamino)fluorene (AAF) modification on guanine. We have thus examined the effect of 3' versus 5' modification, the presence or absence of the acetyl group, and the effect of four different neighbors in each case. The principal effect of the acetyl group appeared to be the destabilization of anti (and, to a lesser degree, borderline anti) conformations for modified guanine. This mattered little in the 5'-substituted dimers, where one conformational type predominated in the low-energy structures for the adducts of both AAF and AF: It was right-handed, with syn-guanine, imperfect base-base stacking, and fluorene to 3'-sugar contacts. Greater divergence was seen in the 3'-substituted series. The AAF-substituted 3'-adducts primarily displayed good base-fluorene stacking, with syn-guanine in contact with the 5'-sugar. The AF-substituted 3'-adducts displayed a variety of structures which included base-base and carcinogen-base stacked forms. Two novel forms were encountered [global minima for d(ApG-AF) and d(GpG-AF)], whose unusual structures suggest mutagenic capability. In order to address the multiple minimum problem, we conducted our searches of conformation space using two alternative optimization methods that also employ differing search strategies. We used the Powell algorithm, BOTM, with starting conformations that are selected combinations of rotamers, and the method of simulated annealing (SA), with random or arbitrary starting conformations. While both approaches were effective in defining the most important structures, SA was more successful than BOTM in locating the structures of lowest energy.

Effect of concurrent distraction on communication failures in schizophrenic patients. II. Medication status correlations

In order to examine the effects of irrelevant distracting information on speech disorder, medicated (n = 13) and unmedicated (n = 18) schizophrenics were compared to a mixed affective sample (n = 15) on the frequencies of linguistic measures of verbal communication disorder. Patients conversed with an interviewer during the presence and absence of irrelevant information inserted into their conversation. Affective patients manifested no distraction-related increase in communication disorder. Schizophrenics on medication manifested a small, but nonsignificant, increase in communication disorders during the concurrent distraction condition. Unmedicated schizophrenics manifested a substantial increase in their communication disorders during distraction. These data suggest that medication reduces the extent to which speech processes in schizophrenia are vulnerable to overload-related deterioration and provide confirmation of the hypothesis that some component of positive thought disorder in schizophrenia is due to medication-responsive attention deficits.

Biofeedback for disorders of initiating and maintaining sleep

Sleep disturbances are a frequent reason for pediatric consultation. When the disturbance persists in the form of delays in entering or maintaining sleep (DIMS), a vicious cycle develops. As part of the cycle, vigilance or arousal occurs, further inhibiting sleep occurrence. Persistent DIMS requires treatment to interrupt this self-perpetuating sequence. Interruption requires reduction in psychophysiological arousal and deconditioning of the events surrounding sleep. Electromyographic (EMG) and thermal biofeedback in conjunction with relaxation training were used with three children who maintained high levels of arousal resulting from stresses common to their developmental stages. Within seven sessions, all three patients showed attenuation of arousal and symptom abatement marked by uninterrupted sleep.

Attentional markers of vulnerability to schizophrenia: performance of medicated and unmedicated patients and normals

Medicated and unmedicated schizophrenic patients (both n's = 14) were compared to a normal control sample (n = 15) on two attentional tasks hypothesized to be markers of vulnerability to schizophrenia. These tasks, the continuous performance test and the visual backward masking task, were found to be more deviant in schizophrenic patients than in normals. In addition, the group mean levels of performance did not differ consistently across medication status within the medicated patients. It was found, however, that the association between these tasks varied as a function of medication status, with unmedicated patients more similar to normals than to medicated patients. The implications of these results for the two tasks as markers are discussed, with special focus on those earlier studies that did not evaluate unmedicated patients.

Recombinant DNA research; proposed actions under guidelines. National Institutes of Health, PHS, DHHS

This notice sets forth proposed actions to be taken under the National Institutes of Health (NIH) Guidelines for Research Involving Recombinant DNA Molecules. Interested parties are invited to submit comments concerning these proposals. These proposals will be considered by the Recombinant DNA Advisory Committee (RAC) at its meeting on October 6, 1989. After consideration of these proposals and comments by the RAC, the Acting Director of the National Institutes of Health will issue decisions in accordance with the NIH Guidelines.

Thermal biofeedback in the treatment of symptoms associated with reflex sympathetic dystrophy

A 12-year-old male, unresponsive to therapy for symptoms associated with reflex sympathetic dystrophy, was treated by thermal biofeedback techniques. Within the first four treatment sessions, transfer of training from digital warming to warming the affected knee area produced skin temperature elevation around the gastrocnemius and patellar areas. Attenuation of localized vasospasm and cold intolerance resulted, followed by total abolition within ten sessions. After symptom alleviation, a return to premorbid activity levels was reported. Implications for use of thermal biofeedback as a primary noninvasive technique for treatment of symptoms associated with reflex sympathetic dystrophy are discussed.

Nutrition education at the point of purchase: the foods for health project evaluated

Foods for Health, a nutrition education and research program sponsored by the National Heart, Lung, and Blood Institute and Giant Food, Inc., was designed to demonstrate the feasibility of cardiovascular nutrition education at the point of purchase, specifically, in the supermarket. To evaluate the program's effectiveness, measures of consumer awareness, knowledge, and food purchases were determined before, during, and after the campaign. The program was conducted in the Washington, D.C., area, with Baltimore, Maryland, area stores serving as controls. At the conclusion of the campaign, Washington shoppers showed a significant increase in knowledge scores, while these scores decreased in the Baltimore area. The gain in correct knowledge scores for Washington shoppers compared with Baltimore shoppers was 9% for food fat and cholesterol content and 11% for the relationship between dietary fat and blood cholesterols levels. The food sales data indicate no apparent differences attributable to the intervention. Issues that might account for the lack of a significant change in food purchases, such as cost and the markets' individual sales promotion campaigns, are discussed, and recommendations for the design of future projects are made.

Cardiovascular research: decades of progress, a decade of promise

Mortality due to cardiovascular diseases has decreased more than 30 percent in the last 30 years, and this decline has accelerated so much that over 60 percent of it has occurred between 1970 and 1980. The past and present contributions of advances in cardiovascular research to this decline are reviewed. Although three have been significant research accomplishments, too many people still die of heart and blood vessel diseases. Continued emphasis must be placed on research in the areas of etiology and pathogenesis, on validating potentially beneficial research hypotheses, and on the translation and dissemination of research results to the health care practitioner and the public. Only then can our long-term goal, the prevention of cardiovascular disease, be fully realized.

Iatrogenic endometriosis: substantiation of the Sampson hypothesis

A 31-year-old woman developed unilateral endometriosis at the site of ovarian implantation to a uterine window. This complication of the Estes procedure resembles the experimental endometriosis induced in rhesus monkeys by causing intraabdominal menstruation. This adds support to the Sampson hypothesis of endometriosis development.

Hormonal regulation of lipolysis and phosphorylase activity in human fat cells

Prostaglandin E(1) (PGE(1)) at a concentration of 1 ng/ml antagonized theophylline, and norepinephrine induced release of glycerol and free fatty acids (FFA) in human fat cell preparations. Insulin at higher doses also inhibited theophylline-stimulated lipolysis. The N(6)-2-0'dibutyryl derivative of cyclic adenosine monophosphate (DCAMP) stimulated lipolysis. Prostaglandin E(1) did not significantly inhibit the lipid mobilizing effects of DCAMP. Changes in glycogen phosphorylase activity after treatment with theophylline, norepinephrine, DCAMP, and PGE(1) paralleled those of lipolysis. These results suggest that in man as in experimental animals lipolysis and phosphorylase activity are regulated through processes involving cyclic AMP and that PGE(1) appears to exert its antilipolytic effect in human fat cells, as in rat fat cells, by interfering at the level of adenyl cyclase with the accumulation of cyclic AMP.