Reliability assessment of pedometer activity measurements

Pedometers (step counters) are inexpensive devices for obtaining naturalistic activity measurements. The existing reliability literature on pedometers is inconsistent. This article presents reasons for the disparity including (a) distinguishing between instrument reliability (Experiment 1) and clinical repeatability (Experiments 2–4) and (b) discussing methods of evaluating the reliability of activity measuring instruments. Experiment 1 shows that pedometer measurements have an uncertainty of approximately 5% (the test-retest correlational equivalent of .97) under laboratory conditions. Experiment 2 shows that pedometer measurements in college students walking a measured half-mile have approximately the same uncertainty. Experiment 3 shows that pedometer measurements from normal children walking a measured half-mile have an uncertainty of approximately 18% (the correlational equivalent of .91), while measurements from mildly hyperactive children have an uncertainty of approximately 29% (the correlational equivalent of .84). Experiment 4 shows that electronic step counters have an uncertainty of approximately 9% in normal and mildly hyperactive children and about 12% in clinically hyperactive children.     

Fully proportional actigraphy: A new instrument

The relevance of activity measurement is reviewed. Technical information regarding a new, small, lightweight, fully proportional accelerometer-based activity monitor suited for a wide range of wrist, waist, and ankle activity measurements over extended time periods in free-ranging persons is presented. Calibration data demonstrating within- and between-device reliability and validity are presented. Field trial data are presented showing that wrist and waist actigraphs can predict kilocalories of energy expended. The issue of how activity monitors should be validated is discussed. Instrument reliability is distinguished from clinical repeatability. Recommendations are provided to assist investigators with instrument selection.     

A therapist's use of verbal response categories in engagement and nonengagement interviews

Client return for post-intake therapy is one indication of client engagement in the therapy process. A therapist's verbal responses from seven engagement and four nonengagement interviews were classified using the 12-category Hill Therapist Verbal Response Category System (Hill, 1993). In engagement interviews, the therapist provided the client with more information than in nonengagement interviews. Therapist information utterances increased and therapist use of questions decreased throughout engagement sessions. In nonengagement interviews, therapist information declined and therapist questions increased during the sessions. Results suggest that clients returned for further therapy after intake when their problems had been clarified through the use of questions and work on the problems had begun with the therapist providing information.     

No ownership of common factors

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler's informative article raised several issues worthy of comment. His choice of the word distinctive (p. 98) in describing aspects of psychodynamic technique is open to at least two interpretations. On the one hand, distinctive can have a qualitative meaning and indicate the presence of a characteristic that is not shared. For example, a sign in the Bronx Zoo distinguishes birds from all other creatures as follows: "If it has feathers it's a bird, if it doesn't, it isn't." On the other hand, distinctive can have a quantitative meaning and indicate that one practice has more of a common element than another practice. Careful reading of Shedler's article and the article by Blagys and Hilsenroth (2000) that forms the basis of the "seven features [that] reliably distinguished psychodynamic therapies from other therapies" (Shedler, 2010, p. 98) shows that Shedler subscribes to the latter, quantitative, definition of distinctive. In other words, the seven features he presented are present in both psychodynamic therapies and the cognitive-behavioral therapies to which he compares them. For example, although Shedler did not mention it, dialectical behavior therapy explicitly focuses on six of the seven features, namely, "focus on affect and expression of emotion," "exploration of attempts to avoid distressing thoughts and feelings," "identification of recurring themes and patterns," "discussion of past experience," "focus on interpersonal relations," and "focus on the therapy relationship" (Shedler, 2010, p. 99). However, in the articles that Blagys and Hilsenroth reviewed, psychodyamic therapists engaged in more of these behaviors than did cognitive-behavioral therapists.     

Genetic Counselors’ Experiences Regarding Communication of Reproductive Risks with Autosomal Recessive Conditions found on Cancer Panels

The development of hereditary cancer genetic testing panels has altered genetic counseling practice. Mutations within certain genes on cancer panels pose not only a cancer risk, but also a reproductive risk for autosomal recessive conditions such as Fanconi anemia, constitutional mismatch repair deficiency syndrome, and ataxia telangiectasia. This study aimed to determine if genetic counselors discuss reproductive risks for autosomal recessive conditions associated with genes included on cancer panels, and if so, under what circumstances these risks are discussed. An on-line survey was emailed through the NSGC list-serv. The survey assessed 189 cancer genetic counselors' experiences discussing reproductive risks with patients at risk to carry a mutation or variant of uncertain significance (VUS) in a gene associated with both an autosomal dominant cancer risk and an autosomal recessive syndrome. Over half (n = 82, 55 %) reported having discussed reproductive risks; the remainder (n = 66, 45 %) had not. Genetic counselors who reported discussing reproductive risks primarily did so when patients had a positive result and were of reproductive age. Reasons for not discussing these risks included when a patient had completed childbearing or when a VUS was identified. Most counselors discussed reproductive risk after obtaining results and not during the informed consent process. There is inconsistency as to if and when the discussion of reproductive risks is taking place. The wide variation in responses suggests a need to develop professional guidelines for when and how discussions of reproductive risk for autosomal recessive conditions identified through cancer panels should occur with patients.