Use Of Objective Measures Research Articles

Development and Validation of a Driving Simulator for Comfort Assessment

The passenger’s comfort is of vital importance in today’s car, even more so in the future autonomous car. Its thorough analysis requires the use of objective measures, but the subjectivity of the passenger must also be considered. The relationship between both aspects is an uncommon research avenue, and could greatly benefit from the use of a vehicle simulator. This study use a simulator to replicate a journey with diverse characteristics that numerous passengers may experience (including engaging in different activities). The appropriate variables for a proper comfort analysis are determined in this study, resulting in a comprehensive database for the same purpose. Additionally, a passenger comfort based questionnaire is developed and applied to obtain the subjective assessment of different passengers. The results of these questionnaires help not only in the identification and study of the self perception of comfort by the passengers but also in the use of the simulator for comfort experiments. The detailed comparison between both the objective approach of signal analysis and the subjective approach of questionnaires that is performed thanks to the simulator creates a foundation for future research and narrows the existing research gap.

Digital video analysis reveals gait parameters that predict performance in the jumping test phase of three-day eventing

In international equestrian sport, visual inspections assess gait and lameness to protect the welfare of performance horses during competition. Horses competing internationally in three-day eventing must pass two mandatory inspections (pre-competition and post-cross country) before attempting the final phase: the jumping test (JT). We hypothesized that digitally quantifying objective gait parameters captured during the two mandatory inspections will identify locomotor characteristics that predict success during the jumping test. Utilizing the DeepLabCut (DLC) software package for labeling of anatomical landmarks and a custom analysis pipeline we calculated gait parameters for 194 competition horses at the trot. During the pre-competition inspection, relative trot speed was significantly associated (P = 0.0060, GLMM), and the forelimb travel trended towards significance (P =0.0800, GLMM), with achieving a clear round in the later jumping test. Post-cross country, the forelimb travel significantly predicted JT results (P = 0.0188, GLMM). As our parameters are scaled for body size, these parameters may indicate conformational characteristics for superior jumping ability and overall athletic fitness. Within each competitive effort, comparisons of the post-cross country and pre-competition observations revealed that the change in speed and duty factor were significantly different in the group that accrued jumping faults (P = 0.00376 and P = 0.02430, GLMM), perhaps capturing locomotor signs of exercise fatigue. Further work employing these approaches to better understand competition performance will encourage the use of objective measures to protect sport horse welfare, as well as provide an advantageous tool for gait evaluation in the horse.

Physical Activity, Sedentary Behaviors, and Venous Thromboembolism: A Narrative Review of the Current Evidence

Abstract This narrative review aims to synthesize existing research on the impact of physical activity and sedentary behaviors on the risk of venous thromboembolism (VTE). It also delves into the biological mechanisms through which these lifestyle factors might influence VTE risk, assesses the clinical and public health implications of these findings, and highlights gaps in the current research landscape. Furthermore, it evaluates the causal relevance of physical activity and sedentary behaviors to VTE using Mendelian randomization studies. We conducted a literature search for interventional, observational cohort and genetic studies from MEDLINE and Embase up to April 2024. High physical activity levels are associated with a reduced risk of first-time VTE, independent of factors such as body mass index, age, sex, or geographical location. Nonetheless, the exact nature of the dose–response relationship between physical activity levels and VTE risk remains unclear, particularly regarding the optimal intensity, frequency, and duration needed for VTE prevention. Unlike its effects on initial VTE risk, physical activity does not appear to influence the risk of recurrent VTE. Conversely, sedentary behaviors such as prolonged television viewing and long-distance travel (e.g., long-haul flights) are linked to an increased risk of VTE, a risk that persists despite adherence to physical activity guidelines. The causality of these associations is supported by evidence suggesting biological pathways such as alterations in blood flow and coagulation, inflammation, endothelial and platelet function, and the modulation of cardiometabolic risk factors. Future research should aim to delineate the dose–response curves for the relationships, explore the use of objective measures to more accurately assess both physical activity and sedentary behaviors, and clarify their causal roles in VTE risk, potentially guiding targeted prevention strategies.

‘He just looked like he couldn’t learn, whereas he just couldn’t see’: exploring clinician experiences working with people who have co-occurring communication and visual impairment

ABSTRACT Individuals with concurrent visual and communication impairments necessitate specialized, multidisciplinary care, yet the adequacy of orthoptists' and speech pathologists' skills and resources remains underexplored. This research aims to examine these professionals' perspectives and test the acceptability of qualitative methods before a broader study. Qualitative focus group study with thematic analysis. Three, 1.5-hour semi-structured focus groups were conducted with a total of seven clinicians on videoconferencing platform, Zoom. Four orthoptists and three speech pathologists with at least 12 months of relevant clinical experience took part in focus groups. Focus groups were transcribed and analysed using thematic analysis. Four main themes with 12 subthemes were identified. Theme 1, positive impacts of interprofessional care, reflected the value of collaboration, dual knowledge and addressing both disabilities in improving client outcomes. Theme 2 highlighted barriers to effective clinical management, including limited communication between professions, lack of interprofessional knowledge, poor role awareness, orthoptists use of objective measures, and resource barriers. Theme 3 related to participants’ lack of formal and informal training experiences, and theme 4 included enablers to improving clinical competency. All participants agreed with the allocated time for each focus group and believed the questions were appropriate and relevant to the aim of the study. A number of suggestions were made to enable a more successful focus group discussion in the future. This study revealed perceived gaps in interdisciplinary collaboration, skills, and knowledge, including a lack of role awareness and effective management practices for clinicians. Further training, resource development and research is warranted.

Heart Rate Variability Measurement Can Be a Point-of-Care Sensing Tool for Screening Postpartum Depression: Differentiation from Adjustment Disorder.

Postpartum depression (PPD) is a serious mental health issue among women after childbirth, and screening systems that incorporate questionnaires have been utilized to screen for PPD. These questionnaires are sensitive but less specific, and the additional use of objective measures could be helpful. The present study aimed to verify the usefulness of a measure of autonomic function, heart rate variability (HRV), which has been reported to be dysregulated in people with depression. Among 935 women who had experienced childbirth and completed the Edinburgh Postnatal Depression Scale (EPDS), HRV was measured in EPDS-positive women (n = 45) 1 to 4 weeks after childbirth using a wearable device. The measurement was based on a three-behavioral-state paradigm with a 5 min duration, consisting of rest (Rest), task load (Task), and rest-after-task (After) states, and the low-frequency power (LF), the high-frequency power (HF), and their ratio (LF/HF) were calculated. Among the women included in this study, 12 were diagnosed with PPD and 33 were diagnosed with adjustment disorder (AJD). Women with PPD showed a lack of adequate HRV regulation in response to the task load, accompanying a high LF/HF score in the Rest state. On the other hand, women with AJD exhibited high HF and reduced LF/HF during the After state. A linear discriminant analysis using HRV indices and heart rate (HR) revealed that both the differentiation of PPD and AJD patients from the controls and that of PPD patients from AJD patients were possible. The sensitivity and specificity for PPD vs. AJD were 75.0% and 90.9%, respectively. Using this paradigm, an HRV measurement revealed the characteristic autonomic profiles of PPD and AJD, suggesting that it may serve as a point-of-care sensing tool in PPD screening systems.

Nurses' and Physicians' Experiences After Implementation of a Quality Improvement Project to Improve Sepsis Awareness in Hospitals.

Previous research has explored nurses´ experience with the implementation of early detection alert systems, and nurses and physicians' perceptions of sepsis management and use of sepsis triage. As one of the first, this study aims to investigate the perceived usefulness of an interdisciplinary quality improvement project including standardized sepsis patient pathway to improve the early identification and treatment of sepsis patients. This study was a qualitative study that employed semi-structured interviews with thirteen ward nurses and five ward physicians recruited by convenience and respondent-driven sampling, respectively. The interviews explored the perceived usefulness of mutual training in sepsis care in medical hospital wards. We applied Systematic Text Condensation to analyze the experiences and knowledge of professional identification and cooperation in early identification of sepsis patients. The results revealed three main themes: Awareness of sepsis, collaboration between nurses and physicians, and clinical assessment and judgement. The findings highlighted the positive impact of the project in terms of raising awareness, improving communication, and enhancing the ability to detect and treat sepsis. The study also identified the importance of repetition and reminders to maintain awareness, the need for ongoing training for new healthcare professionals, and the challenges of collaboration and decision-making processes. The sepsis intervention seemed successful in improving awareness of sepsis and enhancing interprofessional collaboration between nurses and physicians. Health professionals continued to rely on their clinical judgment but increased the use of objective measurements and communication of vital signs. Continuous repetition and education for new colleagues were identified as important factors for the sustainability of the intervention. Overall, the study highlights the importance of standardized protocols and training for early detection and management of sepsis in healthcare settings.

Daytime sleepiness in Parkinson's disease: a multifaceted symptom

Excessive daytime sleepiness is a symptom experienced by more than one-third of patients with Parkinson's disease and is associated with disease duration and severity, dopaminergic therapy, and several non-motor symptoms. In recent years, growing evidence has been suggesting “primary” sleepiness as a symptom in Parkinson's disease due to common pathophysiological features: for this reason, it is crucial to recognize sleepiness in these patients and to investigate and exclude other conditions possibly leading to sleepiness (e.g., heavy dopaminergic therapy or breathing disorders during sleep). For both inpatients and outpatients, the key to a correct diagnosis is a structured clinical interview, together with questionnaires, for a better characterization of symptoms and the use of objective measures as the most precise method to assess excessive daytime sleepiness. Finally, there are some therapeutical approaches that may be attempted for these patients, and although there is still no consensus on a standardized therapy, clinical trials with new drugs are currently persevered on.

Diode laser targeting red-complex bacteria in periodontitis: a systematic review.

This systematic review examines the effectiveness of diode laser irradiation in reducing the levels of red complex bacteria as well as periodontal parameters of pocket depth and clinical attachment level. We conducted electronic searches across databases such as Scopus, Embase, Medline, and Web of Science databases in July 2022. Randomized controlled trials that evaluated the reduction of red-complex bacteria in patients with periodontitis using diode lasers were included. The primary focus was the reduction in the microbial count of red complex bacteria, whereas probing depth and attachment level were considered secondary outcomes. Articles in languages other than English were excluded. Study quality was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and the ROB2 tool. After searching the databases, eight independent studies were included, with a sample size of 210 subjects. The average age group of the study population was 30-60 years, and there was a lack of consensus on the antimicrobial effect of diode lasers. Out of the eight studies, four studies reported no significant difference in the levels of red complex bacteria before and after laser application. Three studies reported significantly lower levels of red complex bacteria in the intergroup comparison. One study reported that laser had no significant effect on intergroup bacterial levels. The combination of diode laser irradiation with scaling reduced the count of red complex bacteria and improved the clinical parameters, although not significantly. Based on the limited evidence available, the adjunctive use of diode laser for scaling and root planning may provide some additional benefit in terms of reduction of red complex bacterial count and clinical parameters. Further well-designed trials and the use of objective measures are necessary before outlining universal guidelines for best practice. The adjunctive use of diode laser in non-surgical periodontal therapy may provide a reduction in the red complex microbial count and improvement in clinical parameters, decreasing the need for periodontal surgery.

Inadequate sleep associated with increased odds of subjective cognitive decline among transgender and gender nonbinary adults in the U.S., 2016‐2018

AbstractBackgroundInadequate sleep (<7 hours/night) and subjective cognitive decline (SCD), a self‐reported experience of worsening memory or thinking, are independently associated with an increased risk for Alzheimer’s disease and related dementias (ADRD) and cognitive impairment. Transgender and nonbinary (TNB) adults report significantly poorer sleep quality and are more likely to report SCD compared to cisgender adults. However, little is known about ADRD risk or how inadequate sleep is associated with SCD among TNB adults.Method2016‐2018 Behavioral Risk Factor Surveillance System data, representing 14 U.S. states that assessed sleep duration, SCD, and TNB status from adults ages 45+, were analyzed to examine differences in inadequate sleep prevalence and SCD among TNB adults (n = 394) and cisgender adults (n = 120,688). Odds ratios (OR) along with 95% confidence intervals (CI) were calculated to investigate group differences in inadequate sleep prevalence. A separate analysis compared the prevalence of SCD among TNB and cisgender adults with inadequate sleep.ResultInadequate sleep was highest among TNB adults (37.9%) compared to cisgender adults (31.34%). TNB adults were 34% more likely to report inadequate sleep compared to cisgender adults (95% CI: 1.1‐1.7, p = 0.0180). Inadequate sleep significantly increases the likelihood of SCD by 1.3 times (95% CL: 1.2, 1.3) compared to sleeping ≥7 hours/night. Among those with inadequate sleep, TNB adults were 2.3 times more likely to report SCD compared to cisgender adults (95% CI: 1.2‐3.6, p = <0.0001).ConclusionInadequate sleep and its relationship with SCD is not uniformly experienced among TNB and cisgender adults. It is important to explore and address modifiable risk factors affecting sleep duration among TNB adults. Given the literature linking sleep duration, SCD, and ADRD risk, these data highlight the need for additional research focused on better understanding TNB cognitive health. The use of objective measures to assess sleep and cognition will provide more precision, which is needed to develop tailored interventions for TNB adults.

Exploring objective measures for assessing team performance in healthcare: an interview study

IntroductionEffective teamwork plays a critical role in achieving high-performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach.MethodsA total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question.ResultsThe findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures.DiscussionThe study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research.

Cyclical underreporting of seizures in patient-based seizure documentation.

Circadian and multidien cycles of seizure occurrence are increasingly discussed as to their biological underpinnings and in the context of seizure forecasting. This study analyzes if patient reported seizures provide valid data on such cyclical occurrence. We retrospectively studied if circadian cycles derived from patient-based reporting reflect the objective seizure documentation in 2003 patients undergoing in-patient video-EEG monitoring. Only 24.1% of more than 29000 seizures documented were accompanied by patient notifications. There was cyclical underreporting of seizures with a maximum during nighttime, leading to significant deviations in the circadian distribution of seizures. Significant cyclical deviations were found for focal epilepsies originating from both, frontal and temporal lobes, and for different seizure types (in particular, focal unaware and focal to bilateral tonic-clonic seizures). Patient seizure diaries may reflect a cyclical reporting bias rather than the true circadian seizure distributions. Cyclical underreporting of seizures derived from patient-based reports alone may lead to suboptimal treatment schemes, to an underestimation of seizure-associated risks, and may pose problems for valid seizure forecasting. This finding strongly supports the use of objective measures to monitor cyclical distributions of seizures and for studies and treatment decisions based thereon.

Evaluating the Effectiveness of Mobile Health in Breast Cancer Care: A Systematic Review.

Breast cancer is affecting millions of people worldwide. If not appropriately handled, the side effects of different modalities of cancer treatment can negatively impact patients' quality of life and cause treatment interruptions. In recent years, mobile health (mHealth) interventions have shown promising opportunities to support breast cancer care. Numerous studies implemented mobile health interventions aiming to support patients with breast cancer, for example, through physical activity promotion or educational content. Nonetheless, current literature reveals that real-world evidence for the actual benefits remains unclear. In this systematic review, we focus on analyzing the methodology used in recent studies to determine the effects of mHealth applications and wearable devices on the outcome of patients with breast cancer. We followed the PRISMA guideline for the selection, analysis, and reporting of relevant studies found in the databases of Medline, Scopus, Web of Science, and Cochrane Library. A total of 276 unique records were identified, and 20 studies met the inclusion criteria. Study quality was assessed with the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. While many of the studies used standardized questionnaires as patient-reported outcome measures, there was minimal use of objective measurements, such as activity sensors. Adoption, drop-out rates, and usage behavior of users of the mobile health intervention were often not reported. Future work should clearly define the focus and desired outcome of mHealth interventions and select outcome measures accordingly. Greater transparency facilitates the interpretation of results and conclusions about the real-world evidence of mobile health in breast cancer care.

Motor and cognitive skills implicated in the Motor Observation Questionnaire for Teachers (MOQ-T): A multidisciplinary approach

This study was designed to determine the relationship between an observational measure of motor skills for teachers (i.e., MOQ-T), age, and some objectively assessed cognitive and motor indices. Two further goals were to examine which motor and cognitive factors predicted MOQ-T scores and to explore whether pupils with very low motor skills identified through MOQ-T also exhibited lower scores on objectively assessed motor and visuo-spatial tasks. A sample of 156 pupils aged 8.4 years–11.3 years and attending Italian primary school completed a battery of tests assessing writing speed, visuo-spatial abstract reasoning, fluency, and static balance abilities objectively assessed by measuring postural sway. Small to medium associations were found between MOQ-T scores and age, motor, and cognitive parameters, respectively. Moreover, approximately 26% of the variance in MOQ-T was predicted by sway area in the eyes-open condition, visuo-spatial fluency, and writing speed. Finally, pupils at risk of developmental coordination disorder exhibited poorer writing speed, and motor and higher-order visuo-spatial deficits. In conclusion, the synergistic use of objective measures of motor and cognitive functioning and observational screening questionnaires such as MOQ-T should be encouraged at school to identify pupils at risk of developmental coordination disorder.

33 Assessing the effect of fatigue on stadium jumping penalty scores in elite three-day event horses utilizing artificial intelligence

Mandatory veterinary inspections assess lameness and fatigue to help predict the success of performance horses during competition. Horses competing at the international level in 3-d eventing must pass both mandatory inspections (pre-competition and post-cross country) to attempt the final phase: stadium jumping. With this in mind we hypothesize that quantifying the gait quality of horses for fatigue during the inspections will help predict if they will have faults in stadium jumping. However, these pass/fail exams are based on subjective and non-repeatable guidelines referencing the locomotor function of the horse, and do not have the ability to detect small gait changes over time. The development of artificial intelligence-based video analysis approaches allows for the objective production of quantitative scores which can be used to accurately assess the physical capability of the equine athlete. We quantified our custom gait parameter pipeline using the software package DeepLabCut (DLC) of horses at the trot during the veterinary inspections and analyzed 197 horses across 3 levels (CCI-2*, CCI-3*, and CCI-4*) and 5 venues. We used a Quadratic Discriminant Analysis to assign a standardized coefficient score, which we noted as a fatigue score, to all horses. Utilizing 3 common fatigueparameters in a multivariate model using the row-wise method we found stride length (P < 0.001) and speed (P < 0.001) had significant negative correlation probabilities, and stance time (P < 0.001) had a significant positive correlation probability with the fatigue scores. The significance supports the idea that a higher fatigue score is indicative of greater fatigue in the horse. We then applied a qualitative label to each horse, faults or no faults, where a horse with no faults had zero time and zero jump faults, and a horse with faults had any combination of the 2. Then we compared the horse's fatigue score to the qualitative label and found that horses with faults had a significantly higher (P = 0.0149, standard t-test) fatigue score suggesting that fatigue may impact stadium jumping performance more than previously appreciated. Further work investigating the impact of locomotor phenotypes and fatigue on competition performance will encourage the use of objective measures to protect sport horse welfare and improve training strategies, as well as providing the opportunity to add an objective tool to the procedures for mandatory veterinary inspections.

Dating App Use and Wellbeing: An Application-Based Pilot Study Employing Ecological Momentary Assessment and Objective Measures of Use.

Smartphones are part of individuals' daily lifestyles, as are smartphone applications such as dating apps. Previous evidence suggests that high engagement in dating applications can be detrimental to some users' wellbeing. However, much of the published research has relied on cross-sectional studies and self-report measures. Therefore, the present study aims to overcome the limitations of subjective measures in cross-sectional designs by investigating for the first time the relationship between dating app users' wellbeing (self-esteem, craving and mood) and objective measures of their use during a one-week period. To do this, the present study employed a newly developed application, DiaryMood and utilized ecological momentary assessment (EMA), as it measured subjects' mood, self-esteem and craving three times per day and the time spent using the dating apps per day during one week. A convenience sample of 22 online dating app users participated in the present study. Findings from a three-level multilevel analysis indicated that increased time spent on dating apps predicted craving among dating app users and that notifications led to an improved mood and higher self-esteem. The results are discussed in relation to previous online dating studies. In sum, the present study sets a precedent for the use of EMA within the scope of online dating research, which may promote further studies adopting this methodology.

The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators.

The United States Medical Licensing Examination (USMLE) Step 1, arguably the most significant assessment in the USMLE examination series, changed from a 3-digit score to a pass/fail outcome in January 2022. Given the rapidly evolving body of literature on this subject, this paper aims to provide a comprehensive review of the historical context and impact of this change on various stakeholders involved in residency selection. For this, relevant keyword-based searches were performed in PubMed, Google Scholar, and Scopus to identify relevant literature. Given the unique history of USMLE Step 1 in the US residency selection process and the score's correlation with future performance in board-certifying examinations in different specialties, this scoring change is predicted to significantly impact US Doctor of Medicine students, US Doctor of Osteopathic Medicine students, international medical graduates, and residency program directors, among others. The significance and the rationale of the pass/fail change along with the implications for both residency applicants and educators are also summarized in this paper. Although medical programs, academic institutions, and residency organizing bodies across the United States have swiftly stepped up to ensure a seamless transition and have attempted to ensure equity for all, the conversion process carries considerable uncertainty for residency applicants. For educators, the increasing number of applications conflicts with holistic application screening, leading to the expected greater use of objective measures, with USMLE Step 2 Clinical Knowledge likely becoming the preferred screening tool in lieu of Step 1.

An objective comparison of speech intelligibility and quality of hearing aid of different companies

Abstract Purpose: This study aimed to verify the intelligibility and quality of hearing aid-processed speech across companies through objective measures. The output of hearing aids programmed to different prescriptive formulae (Company fit, NAL NL 1, NAL NL 2, and DSLv5) across companies (Company I, Company II, Company III, Company IV, and Company V) were recorded and stored in the sound level meter connected to the manikin. Materials and Methods: Offline analysis of speech quality of the recorded speech was done using the Hearing Aid Speech Quality Index (HASQI), the intelligibilty was measured using the Hearing Aid Speech Perception Index (HASPI) and Speech Intelligibility Index (SII), and Long-Term Average Speech Spectrum (LTASS) was used to measure the spectral composition of speech. Results: When the companies are compared, the hearing aid of Company V showed significantly higher SII values for all prescriptive formulae indicative of better speech intelligibility provided by Company V hearing aids. In terms of speech quality, all the hearing aids showed similar HASQI values. Conclusions: The reasons for each of these findings are highlighted and recommendations for best practices on the use of objective measures for verifying the hearing aid output in clinical setups are suggested.

Elevated Psychiatric Risk in Same-Sex Married Individuals: Large-scale Evidence is Consistent with a Substantial Role of Familial Common Causes

ABSTRACT Xu et al. present a study of practically the whole Swedish-born population over the age of 25, in which they report an elevated risk in same-sex (compared to opposite-sex) married individuals of depression, substance abuse, and attempted or completed suicide. This elevated psychiatric risk is substantially reduced when same-sex married individuals are compared with their opposite-sex married siblings, which is consistent with a substantial role of familial (e.g., genetic and shared environmental) common causes of both same-sex orientation and psychiatric risk. I discuss the study’s strengths, including its huge, comprehensive sample and its use of objective measures, which avoid some of the potential biases in other studies. I also discuss the study’s limitations and argue that the authors misinterpret the role of shared familial influences as accounting for a “small proportion (less than 20%)” of the elevated psychiatric risk in same-sex married individuals. The proportion shown by their results is much larger than the authors report, and even these larger values are best understood as lower bounds in terms of what could be accounted for by familial common causes. Lastly, I discuss future directions for research aiming to understand elevated psychiatric risk in lesbian, gay, and bisexual individuals.

Community-dwelling older adults' acceptance of smartwatches for health and location tracking.

Despite rapid growth in the popularity of smartwatches, evidence lacks regarding older adults' acceptance of smartwatches. Since most wearable sensors are not designed specifically for older adults, there is a need to examine wearability and usability challenges of wearable sensing devices faced by older adults to facilitate the use of objective measurements of health and mobility. We aimed to examine older adults' perceptions of GPS-enabled smartwatches and to identify potential barriers and facilitators of smartwatch and sensor data use. As part of a larger feasibility study, we conducted a mixed-methods study that included a descriptive content analysis of interviews and a brief usability survey with 30 participants aged 60 years and older after they had used a smartwatch for 3 days. Most participants perceived wearable activity trackers including smartwatches and sensor-based data as useful for tracking health, finding activity patterns and promoting healthy behaviours. Privacy was of little concern, leading to willingness to share activity and location data with others. Participants identified barriers to usability as clumsy design, lack of aesthetic appeal, and difficulty reading the display and using the GPS tracking function. In contrast, identified facilitators of adoption included a big display, high-tech look, self-awareness and possible behaviour change. Smartwatches have the potential of personalised detection of health deterioration and disability prevention, based on analysis of older adults' activities in free-living environments. The usefulness of this technology for older adults can be significantly increased by addressing usability issues and providing instructions on challenging features. To support sustained self-monitoring behaviours through wearable sensor devices in older adults, it is critical to examine how they perceive those devices and identify factors affecting technology acceptance that can maximise adoption.

Correlates of sedentary behavior in Asian preschool-aged children: A systematic review.

This systematic review aims to identify the multilevel correlates of sedentary behavior (SB) and its sub-domains among preschool-aged children aged 0-7years in Asia. We systematically searched for studies published from 2000 onwards using terms related to SB correlates and Asia in six databases. Eligible studies were observational and used quantitative methods to examine correlates of total, and domain-specific SB (screen viewing [SV] and non-screen-based SB) in Asian children living in Asia. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis to summarize the evidence on the intrapersonal, interpersonal, environmental correlates of total and domain-specific SB (PROSPERO: CRD42018095268). Twenty-two studies from 4 regions and 12 countries/territories were included. Out of the 94 correlates explored, the following associations were consistent: older age, being a boy, non-Chinese ethnicity (Southeast Asia), younger maternal age, higher maternal and paternal television-viewing time with higher SV; higher SV at earlier age with higher SV and total SB; and presence of TV/computer in the bedroom with higher leisure-time SB. We encourage more studies from low- and middle-income Asian countries with an increased focus on different SB domains, further exploration of environmental correlates, and the use of objective measurements to capture SB.