An explanation for the accuracy of sensor-based measures of energy intake: Amount of food consumed matters more than dietary composition.

Understanding and intervening on eating behavior often necessitates measurement of energy intake (EI); however, commonly utilized and widely accepted methods vary in accuracy and place significant burden on users (e.g., food diaries), or are costly to implement (e.g., doubly labeled water). Thus, researchers have sought to leverage inexpensive and low-burden technologies such as wearable sensors for EI estimation. Paradoxically, one such methodology that estimates EI via smartwatch-based bite counting has demonstrated high accuracy in laboratory and free-living studies, despite only measuring the amount, not the composition, of food consumed. This secondary analysis sought to further explore this phenomenon by evaluating the degree to which EI can be explained by a sensor-based estimate of the amount consumed versus the energy density (ED) of the food consumed. Data were collected from 82 adults in free-living conditions (51.2% female, 31.7% racial and/or ethnic minority; Mage = 33.5, SD = 14.7) who wore a bite counter device on their wrist and used smartphone app to implement the Remote Food Photography Method (RFPM) to assess EI and ED for two weeks. Bite-based estimates of EI were generated via a previously validated algorithm. At a per-meal level, linear mixed effect models indicated that bite-based EI estimates accounted for 23.4% of the variance in RFPM-measured EI, while ED and presence of a beverage accounted for only 0.2% and 0.1% of the variance, respectively. For full days of intake, bite-based EI estimates and ED accounted for 41.5% and 0.2% of the variance, respectively. These results help to explain the viability of sensor-based EI estimation even in the absence of information about dietary composition.

Does maladaptive cardiovagal modulation extend to gastric modulation in women with chronic pelvic pain?

BACKGROUND: Women with chronic pelvic pain (CPP) have poor cardiovagal modulation. It is unclear whether this finding reflects a broader abnormality across many systems such as gastro-vagal modulation. AIM: To determine if maladaptive cardiovagal activity in females with CPP is accompanied by maladaptive gastric myoelectric activity. METHODS: A total of 36 health controls (HC) and 75 CPP underwent supine (10 min), then upright (tilted 70° head up; 30 min), and back to supine (10 min) positions. High-frequency heart rate variability (HF-HRV; 0.15-0.4 Hz) was measured as an index of cardiovagal activity. Cutaneous electrogastrography (EGG) assessed gastric myoelectric activity pre- and during-upright tilt. EGG measures from 16 HC and 31 CPP patients were available for analysis and included relative percentage of gastric activity within the normal (2-4 cpm) and tachygastria (4-10 cpm) ranges, plus ratio of normal/tachygastria. RESULTS: HF-HRV was lower in CPP individuals at all time points (each p < .05). CPP individuals showed lesser decrease in HF-HRV from supine to upright, and poorer HF-HRV recovery from upright back to supine (F[1, 106] = 4.62, p = .034). HC showed increase in tachygastria activity (t[15] = -2.09, p = .054) while the CPP group showed no change in tachygastria activity from pre-upright to upright (t[30] = -0.62, p = .537). CONCLUSIONS: Individuals with CPP going from supine to upright demonstrate an impairment in both tachygastria and the parallel decrement in HRV. These results support the hypothesis of a generalized blunting in the physiological modulation in CPP individuals affecting both cardiovascular and gastric systems.

A virtual experimenter to increase standardization for the investigation of placebo effects.

BACKGROUND: Placebo effects are mediated by expectancy, which is highly influenced by psychosocial factors of a treatment context. These factors are difficult to standardize. Furthermore, dedicated placebo research often necessitates single-blind deceptive designs where biases are easily introduced. We propose a study protocol employing a virtual experimenter - a computer program designed to deliver treatment and instructions - for the purpose of standardization and reduction of biases when investigating placebo effects. METHODS: To evaluate the virtual experimenter's efficacy in inducing placebo effects via expectancy manipulation, we suggest a partially blinded, deceptive design with a baseline/retest pain protocol (hand immersions in hot water bath). Between immersions, participants will receive an (actually inert) medication. Instructions pertaining to the medication will be delivered by one of three metaphors: The virtual experimenter, a human experimenter, and an audio/text presentation (predictor "Metaphor"). The second predictor includes falsely informing participants that the medication is an effective pain killer, or correctly informing them that it is, in fact, inert (predictor "Instruction"). Analysis will be performed with hierarchical linear modelling, with a sample size of N = 50. Results from two pilot studies are presented that indicate the viability of the pain protocol (N = 33), and of the virtual experimenter software and placebo manipulation (N = 48). DISCUSSION: It will be challenging to establish full comparability between all metaphors used for instruction delivery, and to account for participant differences in acceptance of their virtual interaction partner. Once established, the presence of placebo effects would suggest that the virtual experimenter exhibits sufficient cues to be perceived as a social agent. He could consequently provide a convenient platform to investigate effects of experimenter behavior, or other experimenter characteristics, e.g., sex, age, race/ethnicity or professional status. More general applications are possible, for example in psychological research such as bias research, or virtual reality research. Potential applications also exist for standardizing clinical research by documenting and communicating instructions used in clinical trials.

Prediction of Symptom Change in Placebo Versus No-Treatment Group in Experimentally Induced Motion Sickness.

The long-standing question of who responds to placebo and who does not is of great theoretical and clinical relevance and has received increasing attention in recent years. We therefore performed a post hoc analysis of one of our previously published studies on placebo responses (PRs). In the analysis, fourteen potential predictors for the PR on experimentally induced motion sickness in 32 healthy volunteers were explored using moderated multiple regression. Generalized self-efficacy, generalized self, internal locus of control and cognitive flexibility were significantly associated with symptom improvement in the placebo group, as compared to the untreated control group. Notably, the directions of the associations were such that the "unfavorable" side of the constructs (e.g. low self-efficacy) predicted a higher PR. Instead, the "favorable" side predicted symptom improvement in the control group. Results fit well with prior research into psychological influences on motion sickness. Although PRs in motion sickness are not well established, it is suggested to include the identified constructs in future research involving motion sickness-related symptoms such as nausea and vertigo. Concerning PRs in general, the results may have implications for clinical as well as experimental research on other symptoms and disorders, such as pain or depression.

Reduction of motion sickness with an enhanced placebo instruction: an experimental study with healthy participants.

OBJECTIVE: Expectancy and conditioning are underlying mechanisms of placebo and nocebo responses. In previous studies with motion sickness, we could induce nocebo responses by both methods, but no placebo responses. METHODS: In Experiment 1, 64 volunteers (50% women, mean age = 23.5 years) were evaluated to determine the degree they realized speed changes in nauseogenic rotation. For Experiment 2, 32 volunteers (50% women, mean age = 26.0 years) were exposed to fast rotation (15 rounds per minute, or rpm) on Day 1. On Day 2, they either received a drink with a presumed effective antiemetic (actually placebo) or were told they belonged to the control group. Rotation was surreptitiously reduced (to 10 rpm). On Day 3, they were tested with the initial rotation speed. Outcome variables in both experiments were symptom ratings; additionally in Experiment 2, the number of nauseogenic head movements, tolerated rotation time, and electrogastrogram were analyzed for changes between Days 1 and 2 (expectancy plus speed reduction) and Days 1 and 3 (expectancy plus conditioning). RESULTS: In Experiment 1, a dose-response function was established for different rotation speeds, with the smallest perceived difference between 10 and 15 rpm. In Experiment 2, placebo application induced better maximal symptom rating, head movement, and rotation time at Day 2 (F = 3.097, p = .043) and Day 3 (F = 3.401, p = .031). Electrogastrogram was unaffected. CONCLUSIONS: Verbal suggestions combined with a conditioning procedure are effective in reducing symptoms of motion sickness.

A new method for measuring meal intake in humans via automated wrist motion tracking.

Measuring the energy intake (kcal) of a person in day-to-day life is difficult. The best laboratory tool achieves 95 % accuracy on average, while tools used in daily living typically achieve 60-80 % accuracy. This paper describes a new method for measuring intake via automated tracking of wrist motion. Our method uses a watch-like device with a micro-electro-mechanical gyroscope to detect and record when an individual has taken a bite of food. Two tests of the accuracy of our device in counting bites found that our method has 94 % sensitivity in a controlled meal setting and 86 % sensitivity in an uncontrolled meal setting, with one false positive per every 5 bites in both settings. Preliminary data from daily living indicates that bites measured by the device are positively related to caloric intake illustrating the potential of the device to monitor energy intake. Future research should seek to further explore the relationship between bites taken and kilocalories consumed to validate the device as an automated measure of energy intake.

Heart rate variability as a measure of cardiac autonomic function in anorexia nervosa: a review of the literature.

OBJECTIVE: Patients with anorexia nervosa (AN) exhibit a wide range of autonomic system disturbances; these patients have also high mortality risk due to cardio-vascular complications. Origin and pathogenesis of such changes are not absolutely clear. METHODS: Relevant publications were drawn from PUBMED using the keywords 'anorexia nervosa' AND 'autonomic'. Fifty two abstracts were identified and screened for papers that measured the state of autonomic regulation by means of analysis of heart rate variability either during 24-hour electrocardiography (ECG) monitoring or during a short-term laboratory test. Studies selected were analysed for the number of patients included, the presence and quality of control groups, gender, age and body mass index (BMI) of patients, type of AN as well as methods used to determine heart rate variability (HRV). RESULTS: Twenty papers on HRV in patients with anorexia were identified and analysed, revealing three distinct positions regarding changes of autonomic nervous system (ANS) functions in patients with AN. The majority of papers identified parasympathetic/sympathetic imbalance with parasympathetic dominance and decreased sympathetic modulation; others could not replicate these findings, but instead described sympathetic dominance; finally a group of papers could not identify any autonomic differences in comparison to control samples. We conclude that in its current state of analysis HRV may not be suitable for routine assessment of ANS function in AN patients but rather remains a research tool.

Head movements and simulator sickness generated by a virtual environment.

BACKGROUND: For virtual environments (VEs) to be useful in training it is important to understand the negative effects of VE exposure. The purpose of this study was to observe head movements in virtual and real environments and the relation between those movements and simulator sickness. METHOD: There were 48 men who were trained in 4-person teams in either a head-mounted display (HMD)-based VE or in a real world environment. Head position data were collected in both systems and simulator sickness scores were collected in the VE. The relationship of head movements and sickness scores in theVE was examined and the degree of head movements in the real world and VE compared. RESULTS: Differences were found in the length of time subjects spent moving their heads; subjects with the highest sickness scores moved their heads less often than other subjects in the VE. Also, subjects moved their heads significantly less and less often in the VE (means: 3 degrees x 50 ms(-1), 71% of trial time not moving head), compared to the real world (means: 10 degrees 50 ms(-1), 59% of trial time not moving head). CONCLUSIONS: This study observed that when head movements are quantified, past assumptions of the link between increased sickness scores and decreased head movements may not hold. Though not linked to simulator sickness, head movements were reduced in the VE compared to the real world. Though observational in nature, this study is one of the first to quantify head movements and how they may relate to simulator sickness.

A virtual experimenter does not increase placebo hypoalgesia when delivering an interactive expectancy manipulation.

Lack of standardization and unblinding threaten the research of mechanisms involved in expectancy effects on pain. We evaluated a computer-controlled virtual experimenter (VEx) to avoid these issues. Fifty-four subjects underwent a baseline-retest heat pain protocol. Between sessions, they received an expectancy manipulation (placebo or no-treatment) delivered by VEx or text-only control condition. The VEx provided standardized "social" interaction with the subjects. Pain ratings and psychological state/trait measures were recorded. We found an interaction of expectancy and delivery on pain improvement following the intervention. In the text conditions, placebo was followed by lower pain, whereas in the VEx conditions, placebo and no-treatment were followed by a comparable pain decrease. Secondary analyses indicated that this interaction was mirrored by decreases of negative mood and anxiety. Furthermore, changes in continuous pain were moderated by expectation of pain relief. However, retrospective pain ratings show an effect of expectancy but not of delivery. We conclude that we successfully applied an automated protocol for inducing expectancy effects on pain. The effect of the VEx regardless of treatment may be due to interactions of attention allocation and locus of control. This points to the diversity of expectancy mechanisms, and has implications for research and computer-based treatment applications.

The role of self-efficacy and information processing in weight loss during an mHealth behavioral intervention.

Self-efficacy (SE) and information processing (IP) may be important constructs to target when designing mHealth interventions for weight loss. The goal of this study was to examine the relationship between SE and IP with weight loss at six-months as part of the Dietary Interventions Examining Tracking with mobile study, a six-month randomized trial with content delivered remotely via twice-weekly podcasts. Participants were randomized to self-monitor their diet with either a mobile app (n = 42) or wearable Bite Counter device (n = 39). SE was assessed using the Weight Efficacy Life-Style Questionnaire and the IP variables assessed included user control, cognitive load, novelty, elaboration. Regression analysis examined the relationship between weight loss, SE change & IP at six months. Results indicate that elaboration was the strongest predictor of weight loss (ß =-0.423, P = 0.011) among all SE & IP variables and that for every point increase in elaboration, participants lost 0.34 kg body weight.

Effects of medical training scenarios on heart rate variability and motivation in students and simulated patients.

CONTEXT: Research regarding the experience of stress during medical training scenarios using standardised patients (SPs) has been primarily qualitative and has focused on the SPs. The purpose of this study was to quantitatively evaluate stress and motivation in both students and SPs during these scenarios by measuring heart rate variability (HRV) and administering the German version of the Questionnaire on Current Motivation (QCM). METHODS: A total of 44 medical students (23 women, 21 men) participated in two medical history-taking training scenarios. In one scenario the SP role-played a patient with a somatic disease; in the other the SP played a patient with a psychosomatic disease, creating easy and difficult scenarios, respectively, for the student. Each student interviewed one of 11 SPs (five women, six men), using the same SP in both scenarios. Heart rate variability was measured during baseline periods and during the training scenarios in both students and SPs. Motivation was assessed before each training scenario. RESULTS: Heart rate variability was lower in both students and SPs during the scenarios compared with baseline values, but did not differ by scenario type. For students, motivation increased when the first scenario involved psychosomatic illness, but decreased when the first condition was somatic. For SPs motivation was consistent over time for scenarios involving psychosomatic disease, but decreased for somatic disease-related scenarios. CONCLUSIONS: The training scenarios induced stress in both students and SPs, as indicated by decreased HRV. Student motivation was high, indicating that SP scenarios represent a valid teaching method. Further studies in the natural setting of SP examinations are needed.

Between- and Within-Subjects Predictors of the Kilocalorie Content of Bites of Food.

BACKGROUND: This study builds on previous research that seeks to estimate kilocalorie intake through microstructural analysis of eating behaviors. As opposed to previous methods, which used a static, individual-based measure of kilocalories per bite, the new method incorporates time- and food-varying predictors. A measure of kilocalories per bite (KPB) was estimated using between- and within-subjects variables. OBJECTIVE: The purpose of this study was to examine the relationship between within-subjects and between-subjects predictors and KPB, and to develop a model of KPB that improves over previous models of KPB. Within-subjects predictors included time since last bite, food item enjoyment, premeal satiety, and time in meal. Between-subjects predictors included body mass index, mouth volume, and sex. PARTICIPANTS/SETTING: Seventy-two participants (39 female) consumed two random meals out of five possible meal options with known weights and energy densities. There were 4,051 usable bites measured. MAIN OUTCOME MEASURES: The outcome measure of the first analysis was KPB. The outcome measure of the second analysis was meal-level kilocalorie intake, with true intake compared to three estimation methods. STATISTICAL ANALYSES PERFORMED: Multilevel modeling was used to analyze the influence of the seven predictors of KPB. The accuracy of the model was compared to previous methods of estimating KPB using a repeated-measured analysis of variance. RESULTS: All hypothesized relationships were significant, with slopes in the expected direction, except for body mass index and time in meal. In addition, the new model (with nonsignificant predictors removed) improved over earlier models of KPB. CONCLUSIONS: This model offers a new direction for methods of inexpensive, accurate, and objective estimates of kilocalorie intake from bite-based measures.

Defining Adherence to Mobile Dietary Self-Monitoring and Assessing Tracking Over Time: Tracking at Least Two Eating Occasions per Day Is Best Marker of Adherence within Two Different Mobile Health Randomized Weight Loss Interventions.

BACKGROUND: Mobile dietary self-monitoring methods allow for objective assessment of adherence to self-monitoring; however, the best way to define self-monitoring adherence is not known. OBJECTIVE: The objective was to identify the best criteria for defining adherence to dietary self-monitoring with mobile devices when predicting weight loss. DESIGN: This was a secondary data analysis from two 6-month randomized trials: Dietary Intervention to Enhance Tracking with Mobile Devices (n=42 calorie tracking app or n=39 wearable Bite Counter device) and Self-Monitoring Assessment in Real Time (n=20 kcal tracking app or n=23 photo meal app). PARTICIPANTS/SETTING: Adults (n=124; mean body mass index=34.7±5.6) participated in one of two remotely delivered weight-loss interventions at a southeastern university between 2015 and 2017. INTERVENTION: All participants received the same behavioral weight loss information via twice-weekly podcasts. Participants were randomly assigned to a specific diet tracking method. MAIN OUTCOME MEASURES: Seven methods of tracking adherence to self-monitoring (eg, number of days tracked, and number of eating occasions tracked) were examined, as was weight loss at 6 months. STATISTICAL ANALYSES PERFORMED: Linear regression models estimated the strength of association (R2) between each method of tracking adherence and weight loss, adjusting for age and sex. RESULTS: Among all study completers combined (N=91), adherence defined as the overall number of days participants tracked at least two eating occasions explained the most variance in weight loss at 6 months (R2=0.27; P<0.001). Self-monitoring declined over time; all examined adherence methods had fewer than half the sample still tracking after Week 10. CONCLUSIONS: Using the total number of days at least two eating occasions are tracked using a mobile self-monitoring method may be the best way to assess self-monitoring adherence during weight loss interventions. This study shows that self-monitoring rates decline quickly and elucidates potential times for early interventions to stop the reductions in self-monitoring.

Internet-based assessment of bowel symptoms and quality of life.

(Table is included in full-text article). Internet-based questionnaires will, no doubt, continue to gain popularity. Internet presents an attractive medium for the researcher to collect large amounts of data with relatively little effort. The questionnaires can be available to respondents all over the world, 24 h a day, with very little labor involved. The questionnaires can be electronically scored immediately upon completion. Results can then be stored in an analyzable form or be used instantly to redirect the respondent to follow-up questionnaires. Nonetheless, good questionnaire design and psychometric principles still apply. This is true even when porting a valid paper and pencil test to the Internet. In addition, technical and logistical issues in web-based testing can affect the reliability and validity of the questionnaires. Researchers are cautioned to follow good questionnaire development practices and consider the unique problems of Internet-based instruments.

Nausea induced by vection drum: contributions of body position, visual pattern, and gender.

INTRODUCTION: The purpose of this work was to investigate intrinsic (gender) and extrinsic factors (body position, visual pattern) and their relative contribution to the development of motion sickness during pseudo-rotation. METHODS: A series of 3 experiments with 24, 12, and 48 subjects respectively, balanced for gender, was completed: Experiment 1 investigated the effect of body position (upright, supine) and gender; Experiment 2 investigated the additional influence of the visual pattern (dots, stripes), but only for the supine position; and Experiment 3 investigated the complex interaction of gender, body position, and visual pattern on symptom rating (SR), rotation tolerance (RT), and time to first perception of vection (VT). A novel vection drum that allowed varied body positions and visual patterns was used to create pseudo-rotation. RESULTS: Experiment 1: there was a significant effect of rotation on SR, and a significant rotation x position interaction such that the rotation-induced symptom increase was significantly higher in the supine compared to the upright position. In addition, there was a significant effect of gender, with women showing lower SR in both positions. RT was lower while supine compared to upright; this effect was significantly more pronounced in male subjects. Experiment 2: a significant effect of rotation on SR was found, but no effect of the visual stimulus pattern or gender on SR, RT, or VT. Women exhibited significantly lower VT than men. Experiment 3: rotation induced a significant increase in SR independent of gender, body position, and visual pattern. Supine position induced significantly higher SR and RT than upright, and a significant interaction between gender, body position, and visual pattern. CONCLUSION: The complex interaction of intrinsic and extrinsic factors may partially explain the mixed findings in the literature regarding the relationship of gender to motion sickness.

Bite count rates in free-living individuals: new insights from a portable sensor.

BACKGROUND: Conclusions regarding bite count rates and body mass index (BMI) in free-living populations have primarily relied on self-report. The objective of this exploratory study was to compare the relationship between BMI and bite counts measured by a portable sensor called the Bite Counter in free-living populations and participants eating in residence. METHODS: Two previously conducted studies were analyzed for relationships between BMI and sensor evaluated bite count/min, and meal duration. Participants from the first study (N = 77) wore the bite counter in a free-living environment for a continuous period of 14 days. The second study (N = 214) collected bite count/min, meal duration, and total energy intake in participants who consumed one meal in a cafeteria. Linear regression was applied to examine relationships between BMI and bite count/min. RESULTS: There was no significant correlation in the free-living participants average bite counts per second and BMI (R2 = 0.03, p = 0.14) and a significant negative correlation in the cafeteria participants (R 2 = 0.04, p = 0.03) with higher bite count rates observed in lean versus obese participants. There was a significant correlation between average meal duration and BMI in the free-living participants (R 2 = 0.08, p = 0.01). Total energy intake in the cafeteria participants was also significantly correlated to meal duration (R 2 = 0.31, p < 0.001). CONCLUSIONS: With additional novel applications of the Bite Counter, insights into free-living eating behavior may provide avenues for future interventions that are sustainable for long term application.

Real-time correction of heart interbeat intervals.

Heart rate variability (HRV) is traditionally analyzed while a subject is in a controlled environment, such as at rest in a clinic, where it can be used as a medical indicator. This paper concerns analyzing HRV outside of controlled environments, such as on an actively moving person. We describe automated methods for inter-heartbeat interval (IBI) error detection and correction. We collected 124,998 IBIs from 18 subjects, undergoing a variety of active motions, for use in evaluating our methods. Two human graders manually labeled each IBI, evaluating 10% of the IBIs as having an error, which is a far greater error percentage than has been examined in any previous study. Our automated method had a 96% agreement rate with the two human graders when they themselves agreed, with a 49% rate of matching specific error corrections and a 0.01% false alarm rate.

High dose ondansetron for reducing motion sickness in highly susceptible subjects.

BACKGROUND: Ondansetron is currently being explored as a treatment for motion sickness due to its proven prophylactic effect on post-operative nausea, the nausea and vomiting associated with chemotherapy, and its lack of side effects. This study sought to compare the effectiveness of placebo, dimenhydrinate, and ondansetron for preventing motion sickness in highly susceptible subjects. METHODS: A total of 63 subjects with a history of frequent motion sickness and positive report of self-treatment of motion sickness with over-the-counter medications were divided into 3 groups of 20 (3 were disqualified). Depending on their group assignment, subjects were given placebo, dimenhydrinate, or ondansetron 1 h before being rotated at 20 rpm while making head movements. Symptoms of motion sickness and electrogastrogram (EGG) data were collected prior to and during rotation. RESULTS: There were no differences between the groups in number of head movements tolerated, time rotating, or symptom questionnaire scores. All groups showed a marginally significant decrease in normal 3 cycle per minute activity [F (1.45) = 3.04, p = 0.088] and a significant increase in gastric tachyarrhythmia [F (1,45) = 9.71, p = 0.003], a pattern typically associated with motion sickness development. CONCLUSION: Neither ondansetron or dimenhydrinate prevented motion sickness in groups of highly susceptible people. Continued development of new treatments is necessary.

Human performance under sustained operations and acute sleep deprivation conditions: toward a model of controlled attention.

INTRODUCTION: Although a number of studies have examined the effects of sleep deprivation on performance, the results are not easily explained. The purpose of the current study was to examine the effects of sustained operations and acute sleep deprivation on tasks that require a wide range of information processing. The current study also provided preliminary data on the use of the controlled attention model to better understand the effects of sleep deprivation. METHODS: There were 24 college students who were paid to remain awake for one night and complete a variety of cognitive and vigilance tasks. Each task was administered four times during the night, once in each testing session (17:30-21:30, 21:45-01:45, 02:30-06:30, and 06:45-10:45). All tasks were counterbalanced across the testing sessions. RESULTS: The data were converted to z-scores and repeated-measures ANOVAs were completed. Performance did not significantly decrease on the more complex cognitive tasks over the night of sleep deprivation. Performance on the vigilance tasks decreased significantly across the night. CONCLUSIONS: Examining the characteristics of the cognitive tasks indicated that although they required different types of processing, they encouraged the participants to remain attentive to and engaged in the task. In contrast, the vigilance tasks were less intrinsically interesting and engaging. Thus, it seems likely that the participants were less capable of maintaining attention on the vigilance tasks than the cognitive tasks. These results indicate that a controlled attention model may be useful in better understanding the effects of sustained operations and sleep deprivation on performance.

Assessing the Accuracy of a Wrist Motion Tracking Method for Counting Bites Across Demographic and Food Variables.

This paper describes a study to test the accuracy of a method that tracks wrist motion during eating to detect and count bites. The purpose was to assess its accuracy across demographic (age, gender, and ethnicity) and bite (utensil, container, hand used, and food type) variables. Data were collected in a cafeteria under normal eating conditions. A total of 271 participants ate a single meal while wearing a watch-like device to track their wrist motion. A video was simultaneously recorded of each participant and subsequently reviewed to determine the ground truth times of bites. Bite times were operationally defined as the moment when food or beverage was placed into the mouth. Food and beverage choices were not scripted or restricted. Participants were seated in groups of 2-4 and were encouraged to eat naturally. A total of 24 088 bites of 374 different food and beverage items were consumed. Overall the method for automatically detecting bites had a sensitivity of 75% with a positive predictive value of 89%. A range of 62-86% sensitivity was found across demographic variables with slower eating rates trending toward higher sensitivity. Variations in sensitivity due to food type showed a modest correlation with the total wrist motion during the bite, possibly due to an increase in head-toward-plate motion and decrease in hand-toward-mouth motion for some food types. Overall, the findings provide the largest evidence to date that the method produces a reliable automated measure of intake during unrestricted eating.