Garmin Fénix 7® Underestimates Performance at the Lactate Threshold in Comparison to Standardized Blood Lactate Field Test

Purpose

Lactate threshold (LT) is a critical performance measure traditionally obtained using costly laboratory-based tests. Wearables offer a practical and noninvasive alternative for LT assessment in recreational and professional athletes. However, the comparability of these estimates with the regular field tests requires further evaluation.

Patients and Methods

In our sample of 26 participants (nf=7 and nm=19), we compared the estimated running pace and heart rate (HR) at LT with two subsequent tests. First, participants performed the Fenix 7® threshold running test after a calibration phase. Subsequently, they were tested in a standardized, graded blood lactate field test. Age was 25.97 (± 6.26) years, and body mass index (BMI) was 24.58 (± 2.8) kg/m2.

Results

Pace at LT calculated by Fenix 7® (M=11.87 km/h ± 1.26 km/h) was 11.96% lower compared to the field test (M=13.28 km/h ± 1.72 km/h), which was significant (p <0.001, d=-1.19). HR estimated by the Fenix 7® at LT was 1.71% lower (p >0.05). LT data obtained in the field test showed greater overall variance.

Conclusion

Our results suggest sufficient accuracy of Fenix 7® LT estimates for recreational athletes. It can be assumed that for professional athletes, it would fail to provide the nuanced data needed for high-quality training management.

Comparing Self-Reported Running Distance and Pace With a Commercial Fitness Watch Data: Reliability Study

BACKGROUND

There is substantial evidence exploring the reliability of running distance self-reporting and GPS wearable technology, but there are currently no studies investigating the reliability of participant self-reporting in comparison to GPS wearable technology. There is also a critical sports science and medical research gap due to a paucity of reliability studies assessing self-reported running pace.

OBJECTIVE

The purpose of this study was to assess the reliability of weekly self-reported running distance and pace compared to a commercial GPS fitness watch, stratified by sex and age. These data will give clinicians and sports researchers insights into the reliability of runners' self-reported pace, which may improve training designs and rehabilitation prescriptions.

METHODS

A prospective study of recreational runners was performed. Weekly running distance and average running pace were captured through self-report and a fitness watch. Baseline characteristics collected included age and sex. Intraclass correlational coefficients were calculated for weekly running distance and running pace for self-report and watch data. Bland-Altman plots assessed any systemic measurement error. Analyses were then stratified by sex and age.

RESULTS

Younger runners reported improved weekly distance reliability (median 0.93, IQR 0.92-0.94). All ages demonstrated similar running pace reliability. Results exhibited no discernable systematic bias.

CONCLUSIONS

Weekly self-report demonstrated good reliability for running distance and moderate reliability for running pace in comparison to the watch data. Similar reliability was observed for male and female participants. Younger runners demonstrated improved running distance reliability, but all age groups exhibited similar pace reliability. Running pace potentially should be monitored through technological means to increase precision.

Investigation of the Dynamics of Salmonellosis in the Republic of North Macedonia

The main goals of this research are to determine the developmental tendency of salmonellosis in the Republic of North Macedonia and to determine the index of dynamics and the rate of decline/increase of salmonellosis in the Republic of North Macedonia. The research covers the period from 01.01.2012 until 31.12.2022. The data used to implement this study were obtained from the Institute of Public Health of the Republic of North Macedonia. The research included 2711 subjects who were sick with salmonellosis from 2012 to 2022. The following statistical methods of work are used: linear trend, dynamic index with a constant base, dynamic index with a variable base (chain index), rate of decline, and rate of increase. The results of the study suggest that in the period 2012-2022, the highest number of patients (n=373) and the highest incidence (18/100000) of salmonellosis were registered in 2018, and the lowest in 2020 (n=119, I=5.8/100000). From the linear trend values, it can be concluded that salmonellosis in the Republic of North Macedonia shows a decreasing tendency. The biggest increase in salmonellosis in the Republic of North Macedonia was in 2015 by 71% compared to 2014. The biggest decrease in salmonellosis in the Republic of North Macedonia was in 2020 by 48% compared to 2019. From the study, it can be concluded that food operators and manufacturers are observing the procedures of the HACCP control system for food safety, leading to a possible decrease in salmonellosis.

Prognostic Value of Pace Variability, a Novel 6MWT-Derived Feature, in Patients with Chronic Obstructive Pulmonary Disease

Purpose

The 6-minute walk test (6MWT) is often used to evaluate chronic obstructive pulmonary disease (COPD) patients' functional capacity, with 6-minute walk distance (6MWD) and related measures being linked to mortality and hospitalizations. This study investigates the prognostic value of pace variability, a significant indicator in sports medicine, during the 6MWT for COPD patients.

Patients and Methods

We retrospectively screened consecutive COPD patients who had been prospectively enrolled in a pay-for-performance program from January 2019 to May 2020 to determine their eligibility. Patient characteristics, including demographics, exacerbation history, and 6MWT data, were analyzed to investigate their potential associations with prognosis. The primary outcome was a composite of adverse events, including overall mortality or hospitalizations due to exacerbations during a 1-year follow-up period. To analyze the 6MWT data, we divided it into three 2-minute epochs and calculated the average walk speed for each epoch. We defined pace variability as the difference between the maximum and minimum average speed in a single 2-minute epoch, divided by the average speed for the entire 6-minute walk test.

Results

A total of 163 patients with COPD were included in the study, and 19 of them (12%) experienced the composite adverse outcome. Multivariable logistic regression analyses revealed that two predictors were independently associated with the composite outcome: % predicted 6MWD <72 (adjusted odds ratio [aOR] 7.080; 95% confidence interval [CI] 1.481-33.847) and pace variability ≥0.39 (aOR 9.444; 95% CI 2.689-33.170). Patients with either of these adverse prognostic features had significantly worse composite outcome-free survival, with both log-rank P values less than 0.005. Notably, COPD patients with both adverse features experienced an especially poor outcome after 1 year.

Conclusion

Patients with COPD who exhibited greater pace variability during the 6MWT had a significantly higher risk of overall mortality and COPD-related hospitalizations, indicating a worse prognosis.

Like clockwork? (Re)imagining rhythms and routines when living with irritable bowel syndrome (IBS)

Temporal trajectories of health, illness and disability-from biographical change to micro-embodied practices within social time-are important strands within medical sociology and disability studies. Drawing upon a UK-based qualitative study using diaries and follow-up interviews to explore everyday life with irritable bowel syndrome (IBS), this article explores routines when living with the condition. It focuses specifically on accounts of routines being anticipated, slowed down and stretched out to accommodate and/or care for bodies, with personal and social rhythms weaved in, out and with each other. Such reflections are told through participants' accounts of knowing routines and rhythms, stretching out and pacing morning routines to care for the body and how everyday practices are reimagined as the body and the social meet. Drawing upon the concept of 'Crip Time' where the social bends to meet with the body, this article seeks to illuminate important intersections between medical sociology and disability studies through accounts of living with IBS. This article demonstrates the entanglement of structural, disabling temporal rhythms and embodied temporalities, through an acknowledgement of routines reimagined. It offers a contribution to both medical sociology and disability studies in reimagining social lives with embodied temporalities in mind.

Osteoarthritis and Diabetes: Where Are We and Where Should We Go?

Diabetes mellitus (DM) and osteoarthritis (OA) are chronic noncommunicable diseases that affect millions of people worldwide. OA and DM are prevalent worldwide and associated with chronic pain and disability. Evidence suggests that DM and OA coexist within the same population. The coexistence of DM in patients with OA has been linked to the development and progression of the disease. Furthermore, DM is associated with a greater degree of osteoarthritic pain. Numerous risk factors are common to both DM and OA. Age, sex, race, and metabolic diseases (e.g., obesity, hypertension, and dyslipidemia) have been identified as risk factors. These risk factors (demographics and metabolic disorder) are associated with DM or OA. Other possible factors may include sleep disorders and depression. Medications for metabolic syndromes might be related to the incidence and progression of OA, with conflicting results. Given the growing body of evidence indicating a relationship between DM and OA, it is vital to analyze, interpret, and integrate these findings. Therefore, the purpose of this review was to evaluate the evidence on the prevalence, relationship, pain, and risk factors of both DM and OA. The research was limited to knee, hip, and hand OA.

Minority Older Adults' Access to and Use of Programs of All-Inclusive Care for the Elderly

Programs of All-Inclusive Care for the Elderly (PACE) are an effective approach to improve care quality and delay institutional admissions especially for Black and Hispanic older adults who have seen a disproportionate rise in nursing home use. Guided by Andersen's Behavioral Model of Health Services Use and employing focus groups and one-on-one interviews, we qualitatively examined factors influencing access to and use of PACE by Black and Hispanic older adults. The study sample consisted of thirty-two PACE enrollees, six marketing-team members, and four family-caregivers from three PACE sites in a northeast urban city. Informed knowledge, cultural beliefs, and attitudes toward PACE were found to affect access. Community resources, available services, and care quality facilitated enrollment/participation. Barriers identified included poor dissemination of information and inadequate emphasis on staff's sensitivity to enrollees' cultural and disability differences. Findings will help healthcare leaders capitalize on facilitators and address barriers to enhance access and use of PACE by racial and ethnic minority older adults.

Speed and Blood Parameters Differ between Arabian and Žemaitukai Horses during Endurance Racing

Fédération Equestre Internationale (FEI) has described equine endurance racing as the second largest discipline in the world, above which is only show jumping. The Žemaitukai is an ancient indigenous Lithuanian horse breed known since the 6th or 7th century. The Arabian horse breed is one of the oldest human-developed horse breeds in the world. Compared with other race horse breeds, the muscle tissue of Arabian horses is characterized by significant differences in structure-a predominance of oxidative fiber type I is observed in Arabians, making them the prevailing breed in endurance racing. The Arabian horses are recognized as the leading breed in endurance competitions. Speed, pace, and total time in the race strategy have been extensively studied in human sports, and in contrast, this strategy appears to have been virtually ignored in equestrian sport, despite the potential for contributing to performance optimization. In relation to speed and total time in the race, there are limited data on postrace physical, biochemical, and blood gas parameters of endurance horses. Thus, this study was carried out to investigate the effects of speed on the blood parameters of the Arabian and Žemaitukai horses during an endurance race. Blood samples were taken before and immediately after the exercise. Biochemical and blood gas indicators were analyzed. The study showed significant increases in mean blood gasometrical indicators, such as partial carbon dioxide pressure (8.09-15.18%, p < 0.001); base excess in the extracellular fluid (14.01%, p < 0.001 in the Arabian horses and 172.01% in the Žemaitukai breed, p = 0.006); decreases of the blood electrolyte ionized calcium (4.38-8.72%, p < 0.001) and the hematocrit and hemoglobin values (20.05-20.12%, p < 0.001 in the Arabian horses and 6.22-6.23% in the Žemaitukai breed, p = 0.003-0.004); and decreases in the base excess in the blood values (29.24-39.38%, p < 0.001) and lactate (13.45-31.97%, p < 0.001) in the blood of both breeds in the post-competition horses. Significant increases after competition were determined for the values of creatinine (21.34-30.82%, p = 0.001-0.004), total bilirubin (50.84-56.24%, PH < 0.001), and albumin (2.63-4.48%, p = 0.048-0.001) for both breeds. For the faster Arabian horse breed, recovering after racing took half the time that the local Žemaitukai breed did.

Evaluation of an interprofessional, evidence-based falls training

Fall-related injuries and mortality are increasing in older adults. Evidence suggests a need for a multifactorial, interprofessional approach to reducing falls. The Program for All-Inclusive Care for the Elderly (PACE) utilizes an interprofessional approach to care and serves a high-risk population. The purpose of this study was to investigate the effectiveness of an EBP falls prevention training program conducted at a PACE. The program was a revision of an established program and was led by an interprofessional team. The evaluation used a mixed-methods approach to assess program quality, learning and self-efficacy gains, and intended behavioral changes. Quantitative evaluation demonstrated program satisfaction and qualitative responses identified the depth and interprofessional delivery as favorable. Qualitative data identified opportunities to enhance content and learning design. Overall knowledge gains were statistically significant (mean difference 5%), with the greatest gains related to the evidence base (mean difference 2.67%). Self-efficacy ratings increased significantly after each session. Participants noted changes to team function and a willingness to consider practice changes as a result of the training. The findings support the effectiveness of this interprofessional, EBP training program on falls prevention practices in a PACE and highlight the value of a multifaceted assessment and iterative development.

Phage-assisted continuous and non-continuous evolution

Directed evolution, which applies the principles of Darwinian evolution to a laboratory setting, is a powerful strategy for generating biomolecules with diverse and tailored properties. This technique can be implemented in a highly efficient manner using continuous evolution, which enables the steps of directed evolution to proceed seamlessly over many successive generations with minimal researcher intervention. Phage-assisted continuous evolution (PACE) enables continuous directed evolution in bacteria by mapping the steps of Darwinian evolution onto the bacteriophage life cycle and allows directed evolution to occur on much faster timescales compared to conventional methods. This protocol provides detailed instructions on evolving proteins using PACE and phage-assisted non-continuous evolution (PANCE) and includes information on the preparation of selection phage and host cells, the assembly of a continuous flow apparatus and the performance and analysis of evolution experiments. This protocol can be performed in as little as 2 weeks to complete more than 100 rounds of evolution (complete cycles of mutation, selection and replication) in a single PACE experiment.

Everyday Care and Precarity: Buddhaghosa and Thai Social Story-Making

In this article, Buddhaghosa's fifth century philosophy provides a productive framework for deciphering contemporary social caregiving in Thailand. In particular, his work and the tradition it inspired helps bring forth a local theory of mind and related narrative forms that, when utilized in examination of group patterns of interaction, illuminate the intertwining of care and precarity in everyday practices of providing for others. In turn, I call for experimentation in anthropological storytelling, including ensemble work, to ensure that habits of professional practice do justice to the care manifest in the precarious conditions in which anthropologists so often engage.

Relationship between foot strike pattern, running speed, and footwear condition in recreational distance runners

Compared to competitive runners, recreational runners appear to be more prone to injuries, which have been associated with foot strike patterns. Surprisingly, only few studies had examined the foot strike patterns outside laboratories. Therefore, this study compared the foot strike patterns in recreational runners at outdoor tracks with previously reported data. We also investigated the relationship between foot strike pattern, speed, and footwear in this cohort. Among 434 recreational runners analysed, 89.6% of them landed with rearfoot strike (RFS). Only 6.9 and 3.5% landed with midfoot and forefoot, respectively. A significant shift towards non-RFS was observed in our cohort, when compared with previously reported data. When speed increased by 1 m/s, the odds of having forefoot strike and midfoot strike relative to RFS increased by 2.3 times and 2.6 times, respectively. Runners were 9.2 times more likely to run with a forefoot strike in minimalists compared to regular running shoes, although 70% of runners in minimalists continued to use a RFS. These findings suggest that foot strike pattern may differ across running conditions and runners should consider these factors in order to mitigate potential injury.

The Effect of Diuresis on the Paced QRS Complexes in Pacing-Dependent Patients with Heart Failure

BACKGROUND

Augmentation of the amplitude of QRS complexes with diuretic therapy for patients with congestive heart failure has been well documented. However, the effect of diuresis on the paced QRS complexes in pacing-dependent patients with heart failure is scarce.

OBJECTIVE

To investigate the effect of diuresis on the paced QRS complexes in pacing-dependent patients with heart failure.

METHOD

Thrity-two consecutive pacing-dependent patients with heart failure were enrolled in this study. Before and after diuresis, the sums of paced QRS amplitude of leads I+II (ΣpQRSI+II ), six limb leads (ΣpQRS6L ), leads V1 -V3 (ΣpQRSV1-V3 ), leads V4 -V6 (ΣpQRSV4-V6 ), leads V1 -V6 (ΣpQRSV1-V6 ), and lead aVR (pQRSaVR ), paced QRS duration (pQRSd ), paced QT intervals (pQT) and the body weight of each patient were measured, then the % changes (Δ%) in paced electrocardiogram (ECG) variables and the Δ% in body weight were evaluated.

RESULTS

Compared with before diuresis, paced ECG variables significantly increased and body weight significantly decreased after diuresis, Δ% in paced QRS amplitude(s) in all ECG variables (ΣpQRSI+II, ΣpQRS6L, ΣpQRSV1-V3 , ΣpQRSV4-V6 , ΣpQRSV1-V6 , and pQRSaVR ) correlated well with Δ% in body weight (r = 0.416, r = 0.849, r = 0.901, r = 0.371, r = 0.837, r = 0.619, and P = 0.018, P < 0.001, P < 0.001, P = 0.037, P < 0.001, P < 0.001), while there was no correlation between Δ% in pQRSd and pQT and Δ% in body weight.

CONCLUSIONS

The changes in amplitude of paced QRS complexes may be useful for the monitoring of therapy of pacing-dependent patients with heart failure.

Underwater and surface strategies of 200 m world level swimmers

Pacing strategies of elite swimmers have been consistently characterised from the average lap velocities. In the present study, we examined the racing strategies of 200 m world class-level swimmers with regard to their underwater and surface lap components. The finals and semi-finals of the 200 m races at the 2013 World Swimming Championships (Barcelona, Spain) were analysed by an innovative image-processing system (InThePool® 2.0). Free swimming velocities of elite swimmers typically decreased throughout the 200 m race laps (-0.12 m · s(-1), 95% CI -0.11 to -0.14 m · s(-1), P = 0.001, η(2) = 0.81), whereas underwater velocities, which were faster than free swimming, were not meaningfully affected by the race progress (0.02 m · s(-1), -0.01 to 0.04 m · s(-1), P = 0.01, η(2) = 0.04). When swimming underwater, elite swimmers typically travelled less distance (-0.66 m, -0.83 to -0.49 m, P = 0.001, η(2) = 0.34) from the first to the third turn of the race, although underwater distances were maintained on the backstroke and butterfly races. These strategies allowed swimmers to maintain their average velocity in the last lap despite a decrease in the free swimming velocity. Elite coaches and swimmers are advised to model their racing strategies by considering both underwater and surface race components.

Worldwide frequency distribution of the 'Gait keeper' mutation in the DMRT3 gene

For centuries, domestic horses have represented an important means of transport and served as working and companion animals. Although their role in transportation is less important today, many horse breeds are still subject to intense selection based on their pattern of locomotion. A striking example of such a selected trait is the ability of a horse to perform additional gaits other than the common walk, trot and gallop. Those could be four-beat ambling gaits, which are particularly smooth and comfortable for the rider, or pace, used mainly in racing. Gaited horse breeds occur around the globe, suggesting that gaitedness is an old trait, selected for in many breeds. A recent study discovered that a nonsense mutation in DMRT3 has a major impact on gaitedness in horses and is present at a high frequency in gaited breeds and in horses bred for harness racing. Here, we report a study of the worldwide distribution of this mutation. We genotyped 4396 horses representing 141 horse breeds for the DMRT3 stop mutation. More than half (2749) of these horses also were genotyped for a SNP situated 32 kb upstream of the DMRT3 nonsense mutation because these two SNPs are in very strong linkage disequilibrium. We show that the DMRT3 mutation is present in 68 of the 141 genotyped horse breeds at a frequency ranging from 1% to 100%. We also show that the mutation is not limited to a geographical area, but is found worldwide. The breeds with a high frequency of the stop mutation (>50%) are either classified as gaited or bred for harness racing.

Singapore Programme for Integrated Care for the Elderly (SPICE)—an integrated model of care to enable frail elderly to be cared for in the community

Purpose

Alternative models of care for the frail elderly are needed in Singapore in view of the rapidly ageing population, increased longevity and increase in the complexity of elderly care needs. The objective of the programme (SPICE) is to delay and avoid institutional care for the frail elderly by meeting their complex care needs in the community.

Theory

SPICE is modeled after the US-based Programme for All-Inclusive Care of the Elderly (PACE), which delivers comprehensive care for NH eligible individuals. Evidence has shown that the community-based, integrated and comprehensive programme decreases overall hospital re-admission, average length of stay in hospital and visits to the emergency department (ED), decreases caregiver stress and improves overall satisfaction with care arrangements [1, 2].

Method

In SPICE, an inter-disciplinary team (IDT) delivers an integrated suite of medical, nursing, rehabilitation, social and personal care services, both in the centre and at the participant’s home, dependent on the needs. A comprehensive assessment, regular re-evaluation and detailed individualised care plan (ICP) is tailored and implemented to enable these frail elderly to avoid institutional care.

Results

37 participants have been recruited for the programme since October 2010. Preliminary 6-month pre-post analysis showed that caregiver stress decreased by 42% and participants perception of their own health increased by 18%. The total number of hospital admissions also decreased by 66.6%, average length of stay in the hospital decreased by 47.8% and the number of visits to the ED decreased by 50% over the 6 months.

Conclusion

The results suggest that SPICE is effective in enabling the frail elderly to reduce and avoid institutional care and improving their overall satisfaction with care arrangements. Further investigations with matched controls are needed to study if the long-term results.

"Knowing is better": preferences of diverse older adults for discussing prognosis

BACKGROUND

Prognosis is critical in individualizing care for older adults with late life disability. Evidence suggests that preferences for prognostic information may be culturally determined. Yet little is known about the preferences of diverse elders for discussing prognosis.

OBJECTIVE

To determine the preferences for discussing prognosis of a diverse sample of older adults with late-life disability.

DESIGN & PARTICIPANTS

We interviewed 60 older adults with mean age 78 and mean 2.5 Activities of Daily Living dependencies. Participants were recruited from San Francisco's On Lok program, the first Program of All-inclusive Care for the Elderly (PACE). Participants were interviewed in English, Spanish, and Cantonese, and responded to scenarios in which their doctors estimated they had 5 years and 1 year left to live. Open-ended questions explored the reasons for their responses. Results were analyzed qualitatively using grounded theory.

KEY RESULTS

Sixty-five percent of participants wanted to discuss the prognosis if their doctor estimated they had <5 years to live and 75% if the estimate was <1 year. Three themes were prominent among patients who wanted to discuss prognosis: to prepare, to make the most of the life they had left, and to make medical or health-related decisions. Those who preferred not to discuss prognosis described emotional difficulty, the uncertainty of prognosis, or that it would not be useful. Nearly all participants said that doctors should not make assumptions based on race or ethnicity, though differences between ethnic groups emerged.

CONCLUSIONS

Most patients in this diverse sample of disabled elders were interested in discussing prognosis, while a substantial minority was not. Among those participants who preferred to discuss prognosis, many said that prognostic information would be important as they made difficult medical and personal decisions in late-life. Clinicians should inquire about preferences for discussing prognosis before sharing prognostic estimates.

Real-time motion and B0 correction for localized adiabatic selective refocusing (LASER) MRSI using echo planar imaging volumetric navigators

A method is presented to correct the effects of motion and motion-related B(0) perturbations on spectroscopic imaging in real time through the use of a volumetric navigator. It is demonstrated that, for an axial slice, lifting the chin significantly disrupts the B(0) homogeneity in the zero-order (frequency), first-order Y (coronal) axis and second-order ZY term. This volumetric navigator is able to measure and correct in real time both head pose and zero- to first-order B(0) inhomogeneities. The volumetric navigator was validated in six volunteers who deliberately lifted and then dropped their chin during the scan. These scans show that motion correction alone is not sufficient to recover the spectral quality. By applying real-time shim adjustments, spectral quality was fully recovered to linewidths below 0.08 ppm and the signal-to-noise ratio to within acceptable limits in five of six subjects. In the sixth subject, 83% of the spectra within the volume of interest were recovered, compared with the worst case nonshim-corrected scan, where none of the voxels fell within these quality bounds. It is shown that the use of a volumetric navigator comes at no additional cost to the scan time or spectral signal-to-noise ratio.

Risk assessment for cancer surgery in elderly patients

Global growth of the elderly population is requiring healthcare providers to cater for an expanding elderly cancer subpopulation. The aggression with which cancer should be treated in this subpopulation is an ethical dilemma and is an ongoing debate, as surgeons have feared increases in postoperative morbidity and mortality. As a result elderly patients often receive suboptimal cancer treatment. The need for standardization of cancer surgery is well recognized despite the difficulties in view of heterogeneity of the group. In this article, epidemiological changes, tumor biology specific to elderly cancer are visited, operative risk assessment tools are discussed, and interim results of ongoing multinational investigation ie, PACE (Preoperative Assessment of Cancer Elderly) revealed.

Brief measure of expressed emotion: internal consistency and stability over time

The study examined three methodological aspects of expressed emotion (EE) as assessed in the course of PACE (Psychosocial Assessment of Childhood Experiences) interviews with a parent. In a sample of 87 children, aged 6 13 years, enrolled in a prospective study examining the role of stress on the course of asthma, EE was assessed at three time points, 9 months apart. A high degree of agreement was found among the three concurrent measures of negative and positive EE (kappas from 0.74 to 0.97, and from 0.45 to 0.88, respectively; p < or = 0.0001 in all instances). The temporal stability of all measures was lower, although statistically significant in all but 2 instances (kappas from 0.19 to 0.59, and from 0.11 to 0.39, respectively). The temporal stability across measures, as well as across interviewers and over time, was broadly similar (kappas from 0.21 to 0.56 for negative EE, and from 0.09 to 0.38 for positive EE, with all but three of the 36 statistically significant). The findings provide support for the underlying assumptions of the PACE-EE and show the utility of measures based on just very brief periods of non-directive interviewing, making them practical in a wide range of studies with EE just one of a larger set of measures.