Within-person Variability Research Articles

The electronic nicotine delivery system (ENDS) purchase task: Are results sensitive to price framing?

Extension of the cigarette purchase task (CPT) to electronic nicotine delivery systems (ENDS) is complicated by the heterogeneous nature of this product class, as ambiguity exists regarding the appropriate price-frame (i.e., unit of the product being purchased). We explored correlations between ENDS purchase task (E-CPTs) outcomes featuring two common price-frames: 10 puffs and 1 mL of liquid. Adult exclusive ENDS users (N = 19) and dual users of ENDS and cigarettes (N = 16) completed two own-brand E-CPTs. One E-CPT used "10 puffs" as its price-frame; the other used "1 mL of liquid." Five outcomes were generated for each E-CPT: breakpoint, intensity, Omax, Pmax, and α. Exploratory Factor Analyses (EFA) considered how these outcomes captured latent structures of demand for ENDS. Spearman correlations in E-CPT outcomes assessed within-person variation between price-frames. Analyses also considered whether correlations differed by user group. E-CPT outcomes were highly correlated across price-frames (ρs > 0.57, ps < .001), and EFA revealed little difference in how outcomes from the tasks loaded onto two latent structures of demand ("Persistence" and "Amplitude") reported in the previous literature. The magnitude of correlations for E-CPT outcomes tended to be higher for exclusive ENDS users than for dual users. Participant responses to purchase task outcomes were similar across two E-CPT price-frames. Using "10 puffs" as a price-frame may be a generalizable approach among heterogenous groups of ENDS users, but researchers should consider their target population and structure the E-CPT to reflect participants' knowledge and purchasing behaviors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Personalized laboratory medicine in the digital health era: recent developments and future challenges.

Interpretation of laboratory data is a comparative procedure and requires reliable reference data, which are mostly derived from population data but used for individuals in conventional laboratory medicine. Using population data as a "reference" for individuals has generated several problems related to diagnosing, monitoring, and treating single individuals. This issue can be resolved by using data from individuals' repeated samples, as their personal reference, thus needing that laboratory data be personalized. The modern laboratory information system (LIS) can store the results of repeated measurements from millions of individuals. These data can then be analyzed to generate a variety of personalized reference data sets for numerous comparisons. In this manuscript, we redefine the term "personalized laboratory medicine" as the practices based on individual-specific samples and data. These reflect their unique biological characteristics, encompassing omics data, clinical chemistry, endocrinology, hematology, coagulation, and within-person biological variation of all laboratory data. It also includes information about individuals' health behavior, chronotypes, and all statistical algorithms used to make precise decisions. This approach facilitates more accurate diagnosis, monitoring, and treatment of diseases for each individual. Furthermore, we explore recent advancements and future challenges of personalized laboratory medicine in the context of the digital health era.

Urbanization gradient, diet, and gut microbiota in Sub-Saharan Africa: a systematic review

IntroductionAs Sub-Saharan Africa (SSA) undergoes rapid urbanization changes in diet and lifestyle have contributed to a rise in non-communicable diseases (NCDs) across the region. Changes in gut microbiota which play an important role in human health may be an underlying driving factor. While evidence suggests that the gut microbiota differs between the extreme levels of economic development (least vs highly developed), it is not well-established which factors along the urbanization gradient are most influential, especially for SSA. This systematic review analyzed published articles from SSA countries that examined the differences in the composition and diversity of gut microbiota along the urbanization gradient. The findings of this review have important implications for understanding the impact of urbanization on human health in the SSA.MethodsPeer-reviewed articles that examined the link between the urbanization gradient, dietary patterns, and gut microbiota using culture-independent techniques were included in the review.ResultsA total of 3,265 studies were identified and screened. Eighty-nine (89) studies underwent full-text review, and 23 studies were extracted and included for final analysis. Among these studies, it was observed that hunter-gatherers had high alpha diversity (within-person variation) and beta diversity (between-person variation) in their gut microbiota compared to rural and urban residents in SSA. However, there were inconsistent differences between rural and urban at the individual taxa levels, potentially due to limited statistical power and large variability in the study techniques and designs. Similarly, there were no clear differences in the relative abundance of genera across the urbanization gradient. Additionally, both diet and intestinal parasites were associated with the composition and diversity of the gut microbiota.ConclusionThe review revealed there are variations in both alpha and beta diversity of the gut microbiota across the urbanization gradient with a higher diversity observed in rural areas. However, we did not observe significant differences in the relative abundance at phyla or genus levels consistently across the urbanization gradient. Moreover, our findings suggest that the mode of subsistence, diet, and intestinal parasites play a role in shaping the composition and diversity of the gut microbiota in SSA.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021251006, identifier CRD42021251006.

Retina image assessment for microstructural difference detection

The dissimilarities in appearance of the iris texture patters can improve the individual’s recognition and can strength the capabilities of multibiometrics systems. There is an important within-person variation or intraclass variation that produces different patters such as the geometry or iris pigmentation details that change over time or could be different when the right iris and left iris are analyzed. Moreover, the sensing environment such as ambient lighting variations, eye rotation due to the head tilt or inconsistent iris size due to the distance from the camera can also introduce within-person variation. In this paper, we apply the fuzzy edges detection, in a comparative fashion between right iris and left iris, to find the interoperability capability of a particular biometric trait determined primarily by genotype. In other words, we investigated the degree of variation of the irises of the same person. The structural similarity index measure (SSIM) is implemented to investigate the structural similarity between two iris codes. Prior to the similarity analysis, the segmented iris (i.e., annular area between pupil and sclera) is the edges detection based on the fuzzy edge is performed. This operation allows comparisons between the right iris and left iris without any influence of the stretch or dilation of the pupil induced by different illumination conditions. Also, we can estimate if the left and right irises belong to the same or to different individuals. The proposed approach is tested on the MMU1 Iris Database (with 225 images of the left eye and 225 images of the right eye). An average SSIM value of 0.9216, indicates that proposed iris biometrics model effectively differentiates between left and right eyes of the same person. Also, this result indicates that there is recognizable similarity between left and right irises. These results could be useful for certain applications devoted to detect anomalies in the human irises that could be associated to various diseases.

Impact of age on measurement variability for axial length in myopic children

ABSTRACT Clinical relevance Axial length is a primary outcome in the management of progressive myopia. However, young children may have difficulty fixating during these measurements compared to older children, which can result in higher measurement variability. This may affect perceived axial length progression, leading to inappropriate management. Background This study assessed the impact of patient age on measurement variability for axial length measurements taken with the IOLMaster 700 and IOLMaster 500 in myopic children. Methods A retrospective review of records was undertaken at a university optometry clinic. Five axial length measurements captured at the same visit were collected with the IOLMaster 700 and IOLMaster 500 for myopic patients ≤16 years. The within-subject standard deviation and R2 were calculated for each instrument to examine the effects of age on instrument variability. Results Data was collected for 51 patients (30 female and 21 male), and the mean age was 10.98 ± 2.77 years. Mean axial length measured with the IOLMaster 700 was longer compared to the IOLMaster 500 (difference −0.02 ± 0.02 mm; p < 0.001). There was no effect of age on within-person variability for the measurement of axial lengths with either instrument, with R2 values of 0.021 (p = 0.305) and 0.13 (p = 0.420) for the IOLMaster 700 and IOLMaster 500, respectively. The within-subject variability of axial measurements with the IOLMaster 700 was significantly lower than that with the IOLMaster 500 (p < 0.001). Conclusion Measurement variability of axial length measurements with the IOLMaster 700 and IOLMaster 500 was not dependent on age. However, axial length measurements captured with the IOLMaster 700 were significantly longer and less variable than those with the IOLMaster 500. Eye health care practitioners should be aware of the differences between the two instruments and refrain from using them interchangeably, especially for myopia control where small changes in axial length can affect patient management.

A Comparison of Affective-Cognitive States in Daily Life Between Emerging Adults With and Without Past-Year Nonsuicidal Self-Injury

Although the literature suggests trait-like differences in affective and cognitive vulnerabilities between individuals with and without a history of nonsuicidal self-injury (NSSI), little is known about how these dispositional differences are experienced in the natural environment. The present study compares the intensity, inertia, interaction, and variability of affective (negative and positive affect) and cognitive states (rumination, self-criticism) in the everyday lives of individuals who do and do not engage in NSSI. Using experience sampling methodology (ESM), 60 emerging adults (ages = 18–22 years) with and without past-year NSSI (equally distributed) completed eight questionnaires per day for 12 days (in total, 96 questionnaires per participant), resulting in 4,587 assessments (median compliance = 83.3%; IQR = 71.9–91.7). In a dynamic structural equation modeling framework, dynamic parameters (i.e., mean intensity, carryover effects, spillover effects, and within-person variability) were evaluated using multilevel vector autoregressive models. Emerging adults who engage in NSSI experience higher intensity and greater variability of negative affect, rumination, and self-criticism, whereas those who do not engage in NSSI experience higher intensity and lower variability of positive affect. In addition, past-year NSSI predicted stronger affective-cognitive interactions over time, with stronger spillover effects of negative and positive affect on subsequent rumination and self-criticism in individuals who engage in NSSI. Depressive symptoms and trait levels of emotion dysregulation and self-criticism partially negated these differences. Our findings provide evidence that emerging adults who self-injure experience more negative affective-cognitive states in daily life and point to the potential relevance of boosting positive emotions to buffer negative cognitions.

Couples' communication quality differs by topic.

Extensive research has demonstrated that couples' communication quality is related to many aspects of couples' lives, including relationship satisfaction. However, the possibility that the quality of couples' communication might vary as a function of the topic of communication and the implications of this variability have received relatively little attention. Accordingly, this study sought to examine (a) within-person variability in communication quality between topics, (b) associations with relationship satisfaction, and (c) associations with stressors focal to specific topics. Black coparenting couples (N = 344) reported on their communication quality around four topics: finances, children, racial discrimination, and kinfolk. Results indicated that communication quality significantly differed across topics. Communication quality was lowest for finances and kinfolk, significantly higher when discussing problems with children, and highest when discussing racial discrimination. Moreover, communication quality when discussing finances, kinfolk, and racial discrimination each uniquely predicted relationship satisfaction, even after controlling for each other and for general communication skills. Experiencing more stress around finances and children was associated with poorer communication quality in the focal area (and for financial stress, in some other communication topics as well), whereas the extent of racial discrimination was not significantly associated with communication quality for any topic. These findings reveal significant variability in couples' communication across topics and demonstrate that considering communication for different topics can offer unique information about couples' relationship satisfaction beyond general communication skills. Further research examining topic-specific communication quality may enhance understanding of and interventions for couples' communication. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Neural representations of naturalistic person identities while watching a feature film

Abstract Recognising other people in naturalistic settings relies on differentiating between individuals (“telling apart”), as well as generalising across within-person variability (“telling together”; Burton, 2013; Lavan, Burston, &amp; Garrido, 2019; Lavan, Burton, et al., 2019). However, previous neuroscientific investigations of face and voice recognition have tended to measure identity-related responses and representations using tightly controlled stimuli, thus under sampling the naturalistic variability encountered in everyday life. In this study, we tested whether cortical regions previously implicated in processing faces and voices represent identities during naturalistic and task-free stimulation. Representational similarity analyses were conducted on functional MRI datasets collected while human participants watched feature-length movies. Identity representations—defined as similar response patterns to variable instances of the same person (“telling together”), and dissimilar patterns in response to different people (“telling apart”)—were observed in established face and voice processing areas, across two independent participant groups viewing different sets of identities. We also explored contributions of face versus voice information to identity representations, finding more widespread preferential sensitivity to faces. We thus characterise how the brain represents identities in the real world, for the first-time accounting for both “telling people together” and “telling people apart.” Despite substantial differences to previous experimental research, our findings align with previous work, showing that similar brain areas are engaged in the representation of identities under experimental and naturalistic exposure.

Influence of Recent Standing, Moving, or Sitting on Daytime Ambulatory Blood Pressure.

Background There are no recommendations for being seated versus nonseated during ambulatory blood pressure (BP) monitoring (ABPM). The authors examined how recent standing or moving versus sitting affect average daytime BP on ABPM. Methods and Results This analysis used baseline assessments from a clinical trial in desk workers with office systolic BP (SBP) 120 to 159 mm Hg or diastolic BP (DBP) 80 to 99 mm Hg. ABPM was measured every 30 minutes with a SunTech Medical Oscar 2 monitor. Concurrent posture (standing or seated) and moving (steps) were measured via a thigh-worn accelerometer. Linear regression determined within-person BP variability explained (R2) by standing and steps before ABPM readings. Mean daytime BP and the prevalence of mean daytime BP >135/85 mm Hg from readings after sitting (seated) or after recent standing or moving (nonseated) were compared with all readings. Participants (n=266, 59% women; age, 45.2±11.6 years) provided 32.5±3.9 daytime BP readings. Time standing and steps before readings explained variability up to 17% for daytime SBP and 14% for daytime DBP. Using the 5-minute prior interval, seated SBP/DBP was lower (130.8/79.7 mm Hg, P<0.001) and nonseated SBP/DBP was higher (137.8/84.3 mm Hg, P<0.001) than mean daytime SBP/DBP from all readings (133.9/81.6 mm Hg).The prevalence of mean daytime SBP/DBP ≥135/85 mm Hg also differed: 38.7% from seated readings, 70.3% from nonseated readings, and 52.6% from all readings (P<0.05). Conclusions Daytime BP was systematically higher after standing and moving compared with being seated. Individual variation in activity patterns could influence the diagnosis of high BP using daytime BP readings on ABPM.

How's the boss? Integration of the health-oriented leadership concept into the job demands-resources theory

PurposeHealth-oriented leadership (HoL) encompasses leaders' health behaviors and attitudes toward their followers (StaffCare) and themselves (SelfCare), and there is ample evidence of its positive effects on employee well-being. However, research on the antecedents of StaffCare is still in its infancy and does not account for within-person variability. Therefore, the authors adopt a leader-centered perspective and propose a serial mediation model that links leaders' intrapersonal fluctuations in job resources and demands to StaffCare, mediated by leaders' SelfCare, work engagement and emotional exhaustion.Design/methodology/approachOver five working weeks, 234 school principals responded to a weekly questionnaire, resulting in a total of 956 responses. Multilevel structural equation models were used for analysis.FindingsThe data supported SelfCare as a mechanism in leaders' motivational and health-impairment processes. The proposed serial mediation of the relationship between job resources and StaffCare via leader SelfCare and work engagement was also supported.Practical implicationsThe study can guide job redesign for leaders by highlighting the role of job resources. Investing in interventions aimed at the SelfCare of leaders is likely to have a positive impact on their leadership.Originality/valueThese findings suggest that job characteristics and the leader's well-being shape leader cognitions and behaviors. Therefore, the authors suggest integrating the HoL model into the job demands–resources (JD-R) model for leaders.

Assessing Repeated Urinary Proline Betaine Measures as a Biomarker of Usual Citrus Intake during Pregnancy: Sources of Within-Person Variation and Correlation with Reported Intake.

Proline betaine (Pro-B) has been identified as a biomarker of dietary citrus intake, yet gaps remain in its validation as a quantitative predictor of intake during various physiological states. This study quantified sources of within-individual variation (WIV) in urinary Pro-B concentration during pregnancy and assessed its correlation with the reported usual intake of citrus fruit and juice. Pro-B concentrations were determined by 1H-NMR spectroscopy in spot and 24-h urine specimens (n = 255) collected throughout pregnancy from women participating in the MARBLES cohort study. Adjusted linear or log mixed effects models quantified WIV and tested potential temporal predictors of continuous or elevated Pro-B concentration. Pearson or Spearman correlations assessed the relationship between averaged repeated biomarker measures and usual citrus intake reported by food frequency questionnaires. The proportion of variance in urinary Pro-B attributable to WIV ranged from 0.69 to 0.74 in unadjusted and adjusted models. Citrus season was a significant predictor of Pro-B in most analyses (e.g., adjusted β [95% CI]: 0.52 [0.16, 0.88] for non-normalized Pro-B), while gestational age predicted only non-normalized Pro-B (adjusted β [95% CI]: -0.093 [-0.18, -0.0038]). Moderate correlations (rs of 0.40 to 0.42) were found between reported usual citrus intake and averaged repeated biomarker measurements, which were stronger compared to using a single measurement. Given the high degree of WIV observed in urinary Pro-B, multiple samples per participant are likely needed to assess associations between citrus consumption and health outcomes.

Cyclical exacerbation of suicidal ideation in female outpatients: Prospective evidence from daily ratings in a transdiagnostic sample.

Suicide is a leading cause of death among females of reproductive age. The menstrual cycle is a plausible yet understudied trigger for acute suicide risk. Cross-sectional studies have demonstrated a greater frequency of suicide attempts and deaths in the weeks before and after the onset of menses compared to other cycle phases. Here, using prospective daily ratings, we examine the relationship between the cycle and suicidal ideation (SI) and related symptoms known to show a cyclical change in some patients (depression, hopelessness, guilt, rejection sensitivity, interpersonal conflict, anxiety, mood swings, and anger/irritability). Thirty-eight naturally cycling outpatients recruited for past-month SI reported SI severity and other symptoms across an average of 40 days. Participants were excluded for hormone use, pregnancy, irregular cycles, serious medical illness, and body mass index > 29.9 or < 18. Intraclass correlations ranged from .29 to .46, highlighting that most symptom variance lies within-person. Cyclical worsening of symptoms was evaluated using phase contrasts in multilevel models. Most symptoms, including SI, were significantly worse in the perimenstrual phase than in all other phases. Additionally, anger/irritability was higher in the midluteal than in the midfollicular phase, and several symptoms of depression were higher in the midfollicular than in the periovulatory phase. Otherwise, symptoms did not significantly differ between the midluteal, midfollicular, and periovulatory phases. Cycle phase predictors accounted for 25% of the within-person variance in SI. Females with SI may be at risk for perimenstrual worsening of SI and related symptoms. These findings highlight the importance of assessing the cycle phase for improved prediction of suicide risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Who will like me? Individual differences in the sources of meta-liking judgments at zero-acquaintance

People have general working models of how likeable they are from past experiences, but do some people apply these models more flexibly than others? In two studies, we used the extended Social Relations Model to index how much within-person variability in people’s meta-liking judgments at zero-acquaintance was the result of tracking a shared reality of target differences (sensitivity) versus distinguishing between targets in unique ways (differentiation). We found that the main source of variability was making unique distinctions across targets (differentiation). Importantly, there were individual differences in both sensitivity and differentiation, and the latter was related to narcissism, social anxiety, and neuroticism. This work demonstrates the flexibility of some people’s working models of themselves in relation to others.

Developmental Trajectories of Irritability across the Transition to Toddlerhood: Associations with Effortful Control and Psychopathology.

Preschool-age irritability is a transdiagnostic marker of internalizing and externalizing problems. However, researchers have generally been reluctant to examine irritability within a clinically salient framework at younger ages due to some instability during the "terrible twos" period. Developmentally sensitive and dense measurements to capture intra- and inter-individual variability, as well as exploration of developmental processes that predict change, are needed. This study aimed to examine (1) the trajectories of irritability at the transition to toddlerhood (12-24months of age) using repeated measures, (2) whether effortful control was associated with individual differences in level and growth rate of irritability, and (3) whether individual differences in the irritability trajectories were associated with later psychopathology. Families were recruited when the child was 12-18months old (N = 333, 45.65% female). Mothers reported on their toddler's irritability at baseline and every two months until a follow-up laboratory assessment approximately one year later. Effortful control was measured at baseline. Clinical internalizing/externalizing symptoms were measured at the follow-up assessment. Hierarchical linear models revealed an increase in irritability over time, yet there was relatively little within-person variability. Effortful control was only associated with the level of irritability and not growth rate. Level of irritability was associated with internalizing, externalizing, and combined symptoms, but growth rate was not. Findings suggest intraindividual stability in irritability at the transition to toddlerhood and the possibility that screening for elevated irritability at toddler age is meaningful.

Reciprocal Effects of Sickness Presence, Job Satisfaction, and Health: A Six-Wave Longitudinal Study

Numerous cross-sectional studies have examined associations of employees’ sickness presence (i.e., working while being ill) with job satisfaction and health. However, these studies conflate between- and within-person variance and do not allow disentangling the direction of effects among these constructs. Sickness presence may have positive or negative within-person effects on job satisfaction and health, and vice versa. Based on conservation of resources theory, the effort-recovery model, and the job demands-resources model, we test a set of competing hypotheses using a six-wave longitudinal study over 15 months with N = 363 employees. Results of random-intercept cross-lagged panel modeling showed that both sickness presence spells and frequency had negative within-person effects on job satisfaction, but did not predict health. In addition, job satisfaction had a negative within-person effect on sickness presence spells, and health had a negative within-person effect on sickness presence frequency. Overall, these findings contribute to the organizational literature by providing evidence for reciprocal and negative effects among sickness presence and job satisfaction, as well as a negative effect of health on sickness presence at the within-person level. Based on the findings, organizational practitioners could implement programs to enhance job satisfaction and health and to raise awareness about the potential negative consequences of sickness presence.

Assessing affect in adolescents with e-diaries: multilevel confirmatory factor analyses of different factor models.

In the last two decades, e-diary studies have gained increasing interest, with a dominant focus on mood and affect. Although requested in current guidelines, psychometric properties are rarely reported, and methodological investigations of factor structure, model fit, and the reliability of mood and affect assessment are limited. We used a seven-day e-diary dataset of 189 adolescent participants (12-17 years). The e-diary affect assessments revealed a considerable portion of within-person variance. The six-factor model showed the best model fit compared to the less complex models. Factor loadings also improved with the complexity of the models. Accordingly, we recommend that future e-diary studies of adolescents use the six-factor model of affect as well as reporting psychometric properties and model fit. For future e-diary scale development, we recommend using a minimum of three items per scale to enable the use of confirmatory multilevel factor analyses.

Leave the screen: The influence of everyday behaviors on self-reported interoception

The influence of physical activity on interoception is apparent, however little is known about within-person variability following physical activity and sedentary behavior in daily life. To test this, 70 healthy adults (Mage 21.67 ± 2.50) wore thigh-mounted accelerometers for 7-days, with self-reported interoception recorded on movement-triggered smartphones. Participants additionally reported the predominant activity type performed across the last 15 min. Investigating this timeframe, multi-level analyses revealed that each one-unit increase in physical activity was associated with an increase in self-reported interoception (B = 0.0025, p = .013), whereas contrastingly, each one-minute increase in sedentary behavior was associated with a decrease (B = −0.06. p = .009). Investigating the influence of different activity types in comparison to screen time behavior, both partaking in exercise (B = 4.48, p < .001) and daily-life physical activity (B = 1.21, p < .001) were associated with an increase in self-reported interoception. Regarding other behavior categories, non-screen time behavior both with (B = 1.13, p < .001) and without (B = 0.67, p = .004) social interaction were also associated with an increase in self-reported interoception compared to screen-time behavior. Extending from previous laboratory-based studies, these findings indicate that physical activity influences interoceptive processes in real-life, further supplemented by the novel and contrasting findings regarding sedentary behavior. Furthermore, associations with activity type reveal important mechanistic information, highlighting the importance of reducing screen-time behavior to preserve and support interoceptive perceptions. Findings can be used to inform health recommendations for reducing screen-time behavior and guiding evidence-based physical activity interventions to promote interoceptive processes.

Between-Person and Daily Within-Person Variation Patterns in Measures of Views of Aging.

Recent work suggests that views of aging (VOA; a meta-construct reflective of individuals' aging-related thoughts, beliefs, feelings, and experiences) fluctuate within persons in day-to-day life. This study characterized the extent of daily variability in VOA and explored differences in variability patterns based on measure to enhance understanding of the dynamic nature of VOA. An online sample of 122 adults aged 26-78 years completed multiple measures of VOA (subjective age, age group identity, aging attitudes, implicit theories of aging, awareness of age-related losses or gains) on each of 7 consecutive days. We partitioned variance in responses to each measure at the person level and day level to assess between-person and within-person variability, respectively. Between-person variability accounted for most of the total observed variation in VOA, whereas within-person variability accounted for a smaller amount. Different measures exhibited different ratios of between-person to within-person variation, with the lowest ratios observed for subjective age. Exploration of potential differences between age groups also suggests lower ratios in younger compared to older adults. Analyses suggest relative stability in daily measures of VOA over a 1-week period. Further study of measures (and age groups) showing greater within-person variability (evidenced by lower ratios of between-person to within-person variation) can increase understanding about constructs with greater sensitivity to fluctuating contexts. It can also inform future work linking VOA to other phenomenon in daily life.

Real-World Effects of Second-Generation Versus Earlier Intermediate/Basal Insulin Analogues on Rates of Hypoglycemia in Adults with Type 1 and 2 Diabetes (iNPHORM, US).

Second-generation basal insulin analogues have been shown to reduce hypoglycemia in several trials and observational studies of select populations; however, it remains unclear whether these results persist in real-world settings. Using self-reported hypoglycemia events, we assessed whether second-generation basal insulin analogues reduce rates of hypoglycemia events (non-severe/severe; overall/daytime/nocturnal) compared to earlier intermediate/basal insulin analogues among people with insulin-treated type 1 or 2 diabetes. We used prospectively collected data from the Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-World Models (iNPHORM) panel survey. This US-wide, 1-year internet-based survey assessed hypoglycemia experiences and related sociodemographic and clinical characteristics of people with diabetes (February 2020-March 2021). We estimated population-average rate ratios for hypoglycemia comparing second-generation to earlier intermediate/basal insulin analogues using negative binomial regression, adjusting for confounders. Within-person variability of repeated observations was addressed with generalized estimating equations. Among iNPHORM participants with complete data, N = 413 used an intermediate/basal insulin analogue for ≥ 1month during follow-up. After adjusting for baseline and time-updated confounders, average second-generation basal insulin analogue users experienced a 19% (95% CI 3-32%, p = 0.02) lower rate of overall non-severe hypoglycemia and 43% (95% CI 26-56%, p < 0.001) a lower rate of nocturnal non-severe hypoglycemia compared to earlier intermediate/basal insulin users. Overall severe hypoglycemia rates were similar among second-generation and earlier intermediate/basal insulin users (p = 0.35); however, the rate of severe nocturnal hypoglycemia was reduced by 44% (95% CI 10-65%, p = 0.02) among second-generation insulin users compared to earlier intermediate/basal insulin users. Our real-world results suggest second-generation basal insulin analogues reduce rates of hypoglycemia, especially nocturnal non-severe and severe events. Whenever possible and feasible, clinicians should prioritize prescribing these agents over first-generation basal or intermediate insulin in people with type 1 and 2 diabetes.

Ecological Momentary Assessment of Cognition in Clinical and Community Samples: Reliability and Validity Study.

The current methods of evaluating cognitive functioning typically rely on a single time point to assess and characterize an individual's performance. However, cognitive functioning fluctuates within individuals over time in relation to environmental, psychological, and physiological contexts. This limits the generalizability and diagnostic utility of single time point assessments, particularly among individuals who may exhibit large variations in cognition depending on physiological or psychological context (eg, those with type 1 diabetes [T1D], who may have fluctuating glucose concentrations throughout the day). We aimed to report the reliability and validity of cognitive ecological momentary assessment (EMA) as a method for understanding between-person differences and capturing within-person variation in cognition over time in a community sample and sample of adults with T1D. Cognitive performance was measured 3 times a day for 15 days in the sample of adults with T1D (n=198, recruited through endocrinology clinics) and for 10 days in the community sample (n=128, recruited from TestMyBrain, a web-based citizen science platform) using ultrabrief cognitive tests developed for cognitive EMA. Our cognitive EMA platform allowed for remote, automated assessment in participants' natural environments, enabling the measurement of within-person cognitive variation without the burden of repeated laboratory or clinic visits. This allowed us to evaluate reliability and validity in samples that differed in their expected degree of cognitive variability as well as the method of recruitment. The results demonstrate excellent between-person reliability (ranging from 0.95 to 0.99) and construct validity of cognitive EMA in both the sample of adults with T1D and community sample. Within-person reliability in both samples (ranging from 0.20 to 0.80) was comparable with that observed in previous studies in healthy older adults. As expected, the full-length baseline and EMA versions of TestMyBrain tests correlated highly with one another and loaded together on the expected cognitive domains when using exploratory factor analysis. Interruptions had higher negative impacts on accuracy-based outcomes (β=-.34 to -.26; all P values <.001) than on reaction time-based outcomes (β=-.07 to -.02; P<.001 to P=.40). We demonstrated that ultrabrief mobile assessments are both reliable and valid across 2 very different clinic versus community samples, despite the conditions in which cognitive EMAs are administered, which are often associated with more noise and variability. The psychometric characteristics described here should be leveraged appropriately depending on the goals of the cognitive assessment (eg, diagnostic vs everyday functioning) and the population being studied.