evaluating the longitudinal risk of social vigilance on atherosclerosis: study protocol for the north texas heart study

by:CTECHi     2020-01-05
Psychosocial factors are increasingly recognized as important determinants of cardiovascular risk.
The North Texas heart study aims to understand the mechanism of this association, with a focus on social vigilance (
That is, scanning social threats in the environment).
People are also increasingly interested in supplementing traditional methods (
For example, the evaluation of the psychological and social risk survey paired with cross
Segmented and longitudinal health outcomes)
Daily or repeated short-term assessment of psychosocial factors.
However, there are relatively few longitudinal studies that directly compare these methods with hard endpoints.
Methods and analysis the North Texas heart study proposed a longitudinal measurement burst design to examine the psychosocial determinants of the sub-clinical.
A sample of 300 health community participants, stratified by age and gender, will complete the survey measures and at baseline and 2-year follow-up.
A range of psychosocial and behavioral factors, objective biomarkers, and the endometrium of the artery-
Medium thickness (cIMT)
The assessment will be conducted at two time points.
Models that have not been adjusted and adjusted will be evaluated cross
Segmentation associations and determinants of Cmt changes.
Institutional Review Committee of the Institute for coordination of research on ethics and communication (
University of North Texas)
The study has been approved.
Major and auxiliary findings of positive, negative or uncertain will be disseminated in scientific journals and conferences.
Psychosocial factors are increasingly recognized as important determinants of cardiovascular risk.
The North Texas heart study aims to understand the mechanism of this association, with a focus on social vigilance (
That is, scanning social threats in the environment).
People are also increasingly interested in supplementing traditional methods (
For example, the evaluation of the psychological and social risk survey paired with cross
Segmented and longitudinal health outcomes)
Daily or repeated short-term assessment of psychosocial factors.
However, there are relatively few longitudinal studies that directly compare these methods with hard endpoints.
Methods and analysis the North Texas heart study proposed a longitudinal measurement burst design to examine the psychosocial determinants of the sub-clinical.
A sample of 300 health community participants, stratified by age and gender, will complete the survey measures and at baseline and 2-year follow-up.
A range of psychosocial and behavioral factors, objective biomarkers, and the endometrium of the artery-
Medium thickness (cIMT)
The assessment will be conducted at two time points.
Models that have not been adjusted and adjusted will be evaluated cross
Segmentation associations and determinants of Cmt changes.
Institutional Review Committee of the Institute for coordination of research on ethics and communication (
University of North Texas)
The study has been approved.
Major and auxiliary findings of positive, negative or uncertain will be disseminated in scientific journals and conferences.
A large amount of evidence supports psychosocial stress as an important risk factor for the development of cardiovascular diseases (CVD)
Incidence and mortality, and allDeath.
1-7 for example, more frequent exposure to social stress, including interpersonal conflicts, discrimination, harsh working environments and vulnerable communities, increases the risk of coronary heart disease (CHD)
Incidence and Mortality
8-14 individual differences in the trend of perception or experience with more severe social stress are also positively correlated with accelerated development of artheras, adverse heart events and mortality.
15-19 vigilance reflects a sensory intake process in which the environment or potential threats are constantly monitored and re-evaluated in order to detect any changes in state.
Social vigilance is an act that may relate stress and a wide range of individuals, social and background presenters to cardiovascular disease (see figure 1).
Social vigilance refers to the behavior of monitoring the social environment against potential interpersonal challenges or threats, as well as monitoring changes in perceived threat states.
21 22 this behavior may be automatic, as is the case with general surveillance, or can be laborious in monitoring a particular target or environment.
It is worth noting that some factors may cause long-term vigilance against the social environment, which may include personal differences (
Hostile and negative feelings)
A more challenging social environment (
Unsafe community and bad working environment)
Social roles that need to be vigilant (
Safety work and care).
Although social vigilance may be adaptive in some cases (
(Dangerous situation)
Being vigilant or highly vigilant can have an important impact on health.
Download figureOpen in the new tabDownload powerpoint figure 1 conceptual model to illustrate the role of social vigilance.
Pathway A shows A wide range of relationships between psychological and social stress and artherosis.
Path B and path C represent the hypothetical intermediary role of social vigilance.
Path D represents the acute physiological accompaniment of socially vigilant behavior.
Path E represents the direct physiological pathway of the disease, which is a chronic function.
Blood pressure, blood pressure;
1) endometrium-cMedium thickness.
Previous evidence suggests that vigilant behavior causes a pattern of vascular resistance characterized by elevated blood pressure (BP)
Total peripheral resistance (TPR)
Usually, the heart rate does not change much (HR).
23 24 this pattern may be an important risk factor for cardiovascular disease.
1925 this finding is supported by a number of traditional tasks designed to evoke vigilant behavior, including mirror tracking, 26-28 Stroop color-
Word Interference Task 26 29 and computerized signal detection task.
Another 30 pieces of evidence from our lab extend these findings to vigilance against social stimuli.
For example, 24, male, potential competitors watching the video greatly increased blood pressure and TPR than those monitoring non-
The goal of social competition.
In conclusion, this study supports an intermediary pathway that links psychological stress to increased risk of physical illness by increasing vascular resistance.
Experience sampling or ecological instantaneous assessment (EMA)
, Is a research method used to evaluate psychosocial factors in time to approach their experience, inferring that this method improves the ecological effectiveness of experience compared to more traditional survey recall work.
It is superior to the traditional self
The report assesses measures for the frequency, nature and content of the acute experience as it is sampled in real-time and natural environments.
31-33 this approach, combined with real-time assessments of emotional, psychological and biological processes, may provide important information about the context of increased risk and may reveal mechanisms that may lead to physical change.
For example, a series of studies by Kamarck and colleagues have shown that daily task requirements are cross-cutting
Part related to the endometrium of the artery
Medium thickness (IMT)
34 and longitudinal projections of disease progression, there is more evidence that there is a possibility of mediation of baseline dynamic blood pressure.
35 The application of this constantly developing reality
Time micro-Process assessment methods should help to improve our understanding of how concepts such as vigilance in daily life affect disease risk and progress.
Objective the North Texas heart study is a longitudinal survey that will examine the effects of social vigilance and daily experience on the development of sub-clinical artheras.
The first objective of this study was to examine social vigilance as a predictor of progression in the middle thickness of the arteries in an initially healthy community sample.
Second, the aim of this study was to investigate whether dynamic blood pressure mediated the relationship between social vigilance and middle thickness of the common cervical artery.
In order to help clarify the mechanisms that promote the progression of arterial disease, an exploratory purpose of this study is to capture measures for mental and social health
Presence, healthy behavior, emotional response, number and quality of subjective and objective sleep, and inflammatory biomarkers when studying intakeyear follow-up.
It was assumed that at each point in time, higher social vigilance would be associated with a higher value of etitidimt and would predict progress in the middle thickness of the common cervical arteries over time.
We also expect that the daily BP response to short-lived social vigilance will be 2-year follow-up.
The findings of this study will help to clarify cardiovascular disease risk factors for behavioral performance, which can then be used as an intervention target to reduce the risk of cardiovascular disease.
Methods and analysis project outlines this longitudinal survey, designed to assess social vigilance as a cognitive, behavioral and emotional risk factor, in a sample of racial and economic diversity recruited in Denton County, Texas, america.
This study will collect data using a variety of methods, including
Report survey, daily experience assessment, dynamic monitoring, medical examination, imaging and analysis of biomarkers.
Data collection will be carried out at the Learning Portal and at 2-year follow-up.
This multi-method approach will provide a wealth of data to provide an opportunity to study the contribution of psychosocial to objective disease progression and to compare the predictive values of sampling changes from surveys to short-lived experiences.
Baseline community sample of participants and recruitment of 300 adults (
150 men and 150 women)
Those aged 21-70 will be recruited from Denton County, Texas.
The sample will be layered by age (by decades)
To check age, within the range of gender and race/ethnicityRelated effects.
Participants will be recruited through various sources, including but not limited to advertisements in local newspapers, leaflets, community and university websites, hospital posts, and community organization posts.
Denton County, about 30 miles north of Dallas, is an economically and racially diverse community.
In 2009, the population of Denton County was estimated to be 65.
Up is described as 83. 3% white, 8. 3% black and 5. 7% Asian.
In addition, 17.
9% of the population in the community is Hispanic/Latino, including a considerable immigrant population.
The current study will aim at over-sampling Hispanic/Latino and African descent
Achieve at least 25% Hispanic/Latino and 15% non-Hispanic blacks
About 54-year-old Hispanic Black/African-American. 5% non-
Hispanic whites and 5. 5% non-Hispanic Asian.
In order to achieve our goal of racial/minority representation, we will work with community/community leaders to promote research objectives and benefits to participants.
In accordance with this effort, we will also use salutores de salud (
Hispanic/Latino community health worker, patient navigator, or health care advocate)
Promote the recruitment of Hispanic/Latino participants.
Given that promoters come from communities they wish to serve, they represent a unique cultural and linguistic approach and may also help to recruit researchers.
Participants must meet the following conditions :(1)
Over the age of 21 ,(2)
Living in Denton County and (3)
Fluent in written and oral English.
The exclusion criteria are :(1)
Cognitive Impairment (ie, dementia), (2)
Previous history of myocardial infarction or tertiary heart intervention (
Coronary artery bypass surgery and heart defibrillator implantation, (3)
Pregnant during the last year or during the study4)
Occupation requiring shift work.
Screening will be carried out to verify that there is no evidence of an apparent heart attack.
Anti-use
Drugs for inflammation and lipid management will be evaluated as covariates but will not be excluded.
The study plan is outlined in figure 2.
The study will be coordinated by a research team at the University of North Texas.
All laboratory visits will take place at a vascular medical clinic located in the community.
Download the figure open in the new tabDownload powerpoint figure 2 North Texas heart research protocol.
Blood pressure, blood pressure;
Ecological moment assessment EMA.
The research coordinator will screen and confirm the qualifications of potential participants by telephone.
A target matrix of gender, age and race/ethnicity by ten years will be used to ensure the sampling target: within 21 to 70 years of entry, gender and ethnic/ethnic representation are equal every decade.
Participants who meet the recruitment objectives and inclusion/exclusion criteria will be scheduled for a meeting.
All meetings will be held between 08: 00 and 10: 00 on Thursday morning.
Participants will be instructed to fast overnight (8u2009hours).
This appointment is limited (
All participants are in the same 2-to 3-
One hour in the morning)
It is important to ensure the fidelity of inflammatory biomarkers.
36 participants will meet with the research coordinator at the clinic at the scheduled appointment time to provide written, informed consent and start the agreement.
After laboratory access consent is provided, participants will receive a brief medical examination including a systematic review (ROS)
, Personal and family history, current medication and health status, healthy behavior, and a detailed history of heart disease.
Fasting blood tests will be performed to evaluate lipid and inflammatory markers.
Vascular technical experts will then conduct a complete bilateral ultrasound imaging study of the extra-cranial artery and related vessels.
Finally, participants will complete a questionnaire that includes metrics for vigilance, social experience, personality, and healthy behavior.
All participants will be equipped with wrists before leaving the lab
Wearing Actiwatch spectrum (Phillips-Respironics)
Sleep/wake-up activity monitor (ABPM; Oscar II; Suntech)
And will be subject to pre-set phone devices for a month-day/2-
Outpatient/emergency check-up at night.
Dynamic/EMA evaluation abpm measurements will be programmed to evaluate BP at random time within 45 minutes of the day.
This random sampling procedure prevents participants from predicting the results of the measurements, thus changing their activity.
Participants will be instructed to complete the EMA protocol using the provided mobile device in response to each BP measurement of waking time.
Participants will be further instructed to complete two additional EMA-Basic survey :(1)an End-of-Day (EOD)
The survey completed before going to bed and (2)
Morning survey on Awakening (Wake up investigation).
Actiwatch Spectrum will be programmed to evaluate activities in the 30 s era and participants will be instructed throughout 2-day/2-
Night monitoring period.
Participants will be instructed to turn off ABPM and remove it while sleeping the first night, and to connect and activate it when they wake up the next morning.
In order to collect night BP data the following night, participants will wear ABPM (
To estimate the decline at night).
On the third day, participants will meet with the research coordinator at the clinic to return mobile/EMA equipment.
Participants will also be asked about the development of symptoms of acute illness since the last appointment as a means to explain the pre-disease status of a potential disease (
That is, the asymptomatic infection state)
Inflammatory Markers
Longitudinal Assessment of all measures longitudinal changes will be passed at 2-year follow-
Access using the same program as outlined above.
Specifically, participants will repeat the physical examination, questionnaire package, fasting blood draw, ultrasound scan and 2-day/2-
Outpatient/EMA protocol at night. A follow-
Considered appropriate follow-up for 2 years
Based on previous studies, the study demonstrated the effect of psychosocial risk factors on changes in the middle thickness of the common cervical artery during this period.
Three types of measures will be collected :(1)
Social psychological survey data (table 1), (2)
Ecological sampling data including EMA and daily diary (table 2)and (3)
Data on dynamic physiology and clinical outcomes (table 3).
The specific areas and structures are described in detail below.
View this table: View the inline View pop-up table 1 domain, structure, and measurement in the psychosocial survey View this table: use EMA CuffSurvey survey, End-of-
Daily survey and wake-up survey View this table: View inline View pop-up table 3 includes age, race, ethnicity, family income, education level, marital status, family size, professional status (
Hollingshead classification)
41 42 typical working hours and military experience will be assessed by self-assessmentreport.
These variables will be used as covariates in the model where the first target is tested, and may also be used later for auxiliary purposes.
Mental health
Self-existence and healthy behavior
The report questionnaire package will be used to collect four areas of conceptual-related psychosocial risk presenters (
See Table 1 for additional details).
Domain names include :(1)individual-
Level factors including healthy behavior, mood/influence, and personality traits ,(2)
Social factors ,(3)
Social roles and (4)
Context factor.
Select measures according to the following four criteria :(1)
The correlation with the alert structure ,(2)
Correlation with disease risk ,(3)
Attributes of psychological measurement and (4)length.
Social security alert will be evaluated through a new tool
Questionnaire on social vigilance (SVQ).
SVQ is a newly developed 10-item, three-factor self-
Report measurement to assess the extent to which a person is under pressure
Relevant vigilance or monitoring of the social environment.
Participants will get stem, \"on social occasions . . . . . . \", Then use 4-
Likert point scale from 0 \"almost no\" to 4 \"almost always.
We propose to evaluate the frequency of socially vigilant behavior using SVQ using two conceptual-related but different methods.
First, SVQ will be included in
The questionnaire package completed by all participants at baseline was reported.
The second method is to use EMA sampling to evaluate the frequency of vigilant behavior in daily life. The full 10-
The project SVQ will adapt to the EMA format by changing stem to sample alert behavior and will evaluate whether social interaction has occurred in each BP measurement.
This method will allow dynamic measurement of vigilant behavior every about 45 minutes during the day.
Medical history and laboratory tests, registered nurses will meet with participants to record the health status at the beginning of the study and describe their personal and family health history.
Physical examination includes the assessment of standard measures (
Such as height, weight, waist circumference, etc)
Health behavior information (
Smoking, drinking, physical activity, diet and sleep, for example)and an ROS (
For example, the function and symptoms of all major regulatory systems, including but not limited to cardiovascular, respiratory, ear, nose, mouth, throat, intestines and stomach, etc).
Measurements of the three resting BP will be collected and summarized as baseline measurements of the clinic BP.
An fasting blood draw will be performed by the blood draw to assess the baseline lipid profile (
Total cholesterol, high-
High density, low
Density lipoproteinand TG)
Fasting blood glucose and serum collection to evaluate inflammatory markers.
Use B-to imaging the extra-cranial arteryMode ultrasound
There are two kinds of methods. dimensional(2D)
Images of the artery vessels capable of measuring wall thickness.
The progress of using Doppler ultrasound imaging allows the measurement and visualization of blood flow velocity.
In the current study, all participants will receive a double scan of the artery.
The term \"repetition\" means B-
Create 2D images with blood flow in Doppler mode.
This method allows traditional measurement of the middle thickness of the endometrium of the arteries, as well as information about the direction of blood flow, flow rate, occlusion, significant plaque, and other abnormalities.
43 44 all scans will be performed by experienced ultrasound technicians.
In short, will be ordinary (CCA), bifurcation (BIF)
And internal jugular artery (ICA)
From four standard angles (
90 °, 150 °, 10 ° and 270 °).
Consistent with the recommendation, the arterial arc of Meijer (45-47)
Medical ultrasound;
Voorschoten, Netherlands)
Will be used to improve the accuracy of the measurement point and improve the reliability of the Interior
Participants measured over time.
Using Vascular Research Tools5. 0 (
Medical imaging application, collaville, Iowa, USA)
, Two readers who turned a blind eye to the features of the participants will be offline to score the middle thickness of the common cervical artery.
The software uses a semi-automatic edge detection algorithm to determine the thickness of the endometrium
Media Complex in designated areas (ROI)
For each frame in the clip series.
Consistent with the literature, the thickness of the middle of the endometrium of the artery is defined as the endometrium-
Tube cavity and inside
The external interface of the arterial segment within ROI.
It will also be analyzed whether there are patches in each segment.
The quality score of the plaque will be performed using the following criteria :(1)size (
That is, small, medium and large), (2)
Heterogeneity/homogeneity and (3)
Of fiber, fat, and calcium.
The software generates an average, minimum and maximum endometrial middle thickness score for each segment at each angle.
Based on the previous recommendation 48 and the team\'s past work, the maximum IMT value will be used as a focus marker.
Average of 49 maximum values (
The average of the highest score for each of the four Angels given the clip)
Will be exported for CCA, BIF, and ICA.
We will evaluate high-sensitivity c-inflammatory biomarkers to examine inflammation as it is related to the potential impact of social vigilance on
Active protein (CRP)
Tumor necrosis factor-alpha (TNF-α)
And il 6 (IL-6).
These markers are assumed to represent differences in the inflammatory process from stress to arterial congee hardening, and their addition not only enables us to address the presence of inflammation, it can also address how active inflammatory processes affect all stages of the process of atheroma.
51-53 CRP has received the greatest attention as a marker of inflammatory processes and is a reliable predictor of future cardiovascular risk in some prospective studies.
However, 54-58 CRP is a relatively late step in the course of inflammation, understanding early cytokines patterns and initiating inflammatory cascade prior to this is important for theoretical models linking psychosocial factors relationships with health outcomes
So far, tumor necrosis factor
Alpha is generally conceptualized as an acute phase cytokines and IL-
6 is conceptualized as Central early inflammatory cytokines that can directly initiate and regulate the inflammatory cascade.
ABPM will be provided to 59 60 outpatient BPParticipants (Oscar 2;
Raleigh SunTech Medical Devices, North Carolina)
Wear during the day and at night to capture measurements of systolic blood pressure, systolic blood pressure, and heart rate.
Designed for dynamic evaluation, Oscar 2 is the only ABPM clinically validated to meet all three international standards.
61 62 the sensor and cuffs are unobtrusively worn under the clothes of the participants, with only one small control unit (About 4. 7×2. 8×1. 2 inches; 284 g)
Partially exposed to the participant\'s belt.
ABPM will be programmed to randomly evaluate BP every 45 minutes on first and second study days and second study nights (2 days 1 night).
Data will be cleaned up using established standards.
63 participants will be trained on how to remove and return to the unit after bathing or strenuous exercise, otherwise they will be required to keep the monitor on as instructed.
Eco-instant assessment participants will receive pre-programmed mobile devices as EMA delivery platforms.
Three surveys will be used to assess daily experience :(1)
The EMA/Cuff survey is the main short-lived sample survey for the entire study day ,(2)
EOD survey assessing participants\' impression of their day\'s summary and (3)
The wake-up survey will take the form of a sleep diary by assessing all aspects of the amount and quality of sleep (table 2).
Programming includes drop-down menus and slides for Likert scale.
The EMA/Cuff survey will be used as the primary daily sampling survey and paired with ABPM where the BP sampling will be used as a trigger event for participants to complete the survey.
The EMA/Cuff survey is divided into six measurement parts: body parameters, effects, stress, social exposure, interpersonal interaction, and perceived prospects (
See Table 2 for additional details).
It is important that the survey is balanced and that the number of questions received by the participants is relatively equal (
Range 38-40 questions)
No matter how the reaction
This reduces the possibility of inadvertently introducing certain answers related to shorter survey requirements.
EOD survey participants will be instructed to complete the EOD survey before going to bed on the first and second days.
The purpose is to evaluate a summary rating of mood, stress and vigilance for the day.
Wake-up survey participants will be instructed to complete the wake-up survey when they wake up on the second and third study days.
The Wake survey is a retrospective sleep diary that assesses all aspects of sleep the night before.
It consists of projects that will provide the following measures: sleep initiation latency, bed time, number of awakenings, awakening after the start of sleep, terminal awakening, total sleep time, sleep efficiency, sleep quality and use of sleep drugs.
Sleep Assessment subjective sleep quantity and quality participants sleep quantity and quality will use three self-assessments during each laboratory visit
Reporting Measures (table 1).
In general, these measures are designed to measure :(1)self-
Reported sleep time and quality ,(2)
The severity of subjective insomnia symptoms and (3)self-
Sleep without risk.
Objective sleep quantity and quality of Actiwatch spectrum Actiwatch (Philips-
Breathing in Bend, Oregon)
Small, wrist-worn, battery-
Operating Activity Monitor with physical features similar to the small watch.
The monitor uses a motion sensor called an accelerometer to monitor the occurrence and extent of movement.
This type of sensor integrates the degree and speed of motion and produces a small signal whose size and duration depend on the amount of motion.
Activity data will be collected in 30 years.
Also, Actiwatch Spectrum has an on-
The board event marker button pressed by the patient to determine the time to sleep and the time to get up.
Analyze this information with Actiware (Philips-Respironics)
The software detects wake-up using a medium activity threshold and a 10-minute immobility setting.
The derived variables include: sleep time, wake-up time, sleep time, sleep start latency, number of waking times at night, wake-up time after the start of sleep, total sleep time, and sleep efficiency, use proprietary scoring algorithms in software.
The evaluation of sleep parameters will be optimized in combination with tactile and sleep diary/EMA data.
Sample size and power analysis sample size and power were estimated based on the concept-related individual difference measurements and the thickness of the middle of the endometrium of the arteries in the previous study.
These data suggest that in a range of Trait negative effects, including hostility, anger, and anxiety, the effect is comparable in size.
38. 40. 65. 66 it is assumed that the correlation between the change in the social vigilance score and the change in the middle thickness of the common cervical artery is at least 0.
20, a total of 210 subjects who completed baseline and follow-up
Up will generate 83% of the power to detect the correlation of 20% instead of using two-
Edge test with significance level 0. 05.
Stewart and colleagues learn from the 38 power increase to 90% if we think there is an upward trend in the month within SD tertile of the hypothesis that the IMT of the arteries passes the four-digit social order. 10.
Finally, in the Stewart and colleagues study, 360 of the 464 registered subjects completed baseline and follow-up
Evaluation of the thickness of the middle membrane of the artery.
Assuming similar completion rates (ie, 78%)
We need to recruit a total of 270 subjects to explain dropping out of school.
Therefore, our target sample for 300 participants should be sufficient to detect the hypothetical relationships that account for the rate of progress, the intensity of association, and attrition.
Project Overview This longitudinal survey proposes to assess social vigilance as a cognitive, behavioral and emotional risk factor in response to higher levels of as in the sample of racial and economic diversity recruited in Denton County, Texas, USA.
This study will collect data using a variety of methods, including
Report survey, daily experience assessment, dynamic monitoring, medical examination, imaging and analysis of biomarkers.
Data collection will be carried out at the Learning Portal and at 2-year follow-up.
This multi-method approach will provide a wealth of data to provide an opportunity to study the contribution of psychosocial to objective disease progression and to compare the predictive values of sampling changes from surveys to short-lived experiences.
Baseline community sample of participants and recruitment of 300 adults (
150 men and 150 women)
Those aged 21-70 will be recruited from Denton County, Texas.
The sample will be layered by age (by decades)
To check age, within the range of gender and race/ethnicityRelated effects.
Participants will be recruited through various sources, including but not limited to advertisements in local newspapers, leaflets, community and university websites, hospital posts, and community organization posts.
Denton County, about 30 miles north of Dallas, is an economically and racially diverse community.
In 2009, the population of Denton County was estimated to be 65.
Up is described as 83. 3% white, 8. 3% black and 5. 7% Asian.
In addition, 17.
9% of the population in the community is Hispanic/Latino, including a considerable immigrant population.
The current study will aim at over-sampling Hispanic/Latino and African descent
Achieve at least 25% Hispanic/Latino and 15% non-Hispanic blacks
About 54-year-old Hispanic Black/African-American. 5% non-
Hispanic whites and 5. 5% non-Hispanic Asian.
In order to achieve our goal of racial/minority representation, we will work with community/community leaders to promote research objectives and benefits to participants.
In accordance with this effort, we will also use salutores de salud (
Hispanic/Latino community health worker, patient navigator, or health care advocate)
Promote the recruitment of Hispanic/Latino participants.
Given that promoters come from communities they wish to serve, they represent a unique cultural and linguistic approach and may also help to recruit researchers.
Participants must meet the following conditions :(1)
Over the age of 21 ,(2)
Living in Denton County and (3)
Fluent in written and oral English.
The exclusion criteria are :(1)
Cognitive Impairment (ie, dementia), (2)
Previous history of myocardial infarction or tertiary heart intervention (
Coronary artery bypass surgery and heart defibrillator implantation, (3)
Pregnant during the last year or during the study4)
Occupation requiring shift work.
Screening will be carried out to verify that there is no evidence of an apparent heart attack.
Anti-use
Drugs for inflammation and lipid management will be evaluated as covariates but will not be excluded.
The study plan is outlined in figure 2.
The study will be coordinated by a research team at the University of North Texas.
All laboratory visits will take place at a vascular medical clinic located in the community.
Download the figure open in the new tabDownload powerpoint figure 2 North Texas heart research protocol.
Blood pressure, blood pressure;
Ecological moment assessment EMA.
The research coordinator will screen and confirm the qualifications of potential participants by telephone.
A target matrix of gender, age and race/ethnicity by ten years will be used to ensure the sampling target: within 21 to 70 years of entry, gender and ethnic/ethnic representation are equal every decade.
Participants who meet the recruitment objectives and inclusion/exclusion criteria will be scheduled for a meeting.
All meetings will be held between 08: 00 and 10: 00 on Thursday morning.
Participants will be instructed to fast overnight (8u2009hours).
This appointment is limited (
All participants are in the same 2-to 3-
One hour in the morning)
It is important to ensure the fidelity of inflammatory biomarkers.
36 participants will meet with the research coordinator at the clinic at the scheduled appointment time to provide written, informed consent and start the agreement.
After laboratory access consent is provided, participants will receive a brief medical examination including a systematic review (ROS)
, Personal and family history, current medication and health status, healthy behavior, and a detailed history of heart disease.
Fasting blood tests will be performed to evaluate lipid and inflammatory markers.
Vascular technical experts will then conduct a complete bilateral ultrasound imaging study of the extra-cranial artery and related vessels.
Finally, participants will complete a questionnaire that includes metrics for vigilance, social experience, personality, and healthy behavior.
All participants will be equipped with wrists before leaving the lab
Wearing Actiwatch spectrum (Phillips-Respironics)
Sleep/wake-up activity monitor (ABPM; Oscar II; Suntech)
And will be subject to pre-set phone devices for a month-day/2-
Outpatient/emergency check-up at night.
Dynamic/EMA evaluation abpm measurements will be programmed to evaluate BP at random time within 45 minutes of the day.
This random sampling procedure prevents participants from predicting the results of the measurements, thus changing their activity.
Participants will be instructed to complete the EMA protocol using the provided mobile device in response to each BP measurement of waking time.
Participants will be further instructed to complete two additional EMA-Basic survey :(1)an End-of-Day (EOD)
The survey completed before going to bed and (2)
Morning survey on Awakening (Wake up investigation).
Actiwatch Spectrum will be programmed to evaluate activities in the 30 s era and participants will be instructed throughout 2-day/2-
Night monitoring period.
Participants will be instructed to turn off ABPM and remove it while sleeping the first night, and to connect and activate it when they wake up the next morning.
In order to collect night BP data the following night, participants will wear ABPM (
To estimate the decline at night).
On the third day, participants will meet with the research coordinator at the clinic to return mobile/EMA equipment.
Participants will also be asked about the development of symptoms of acute illness since the last appointment as a means to explain the pre-disease status of a potential disease (
That is, the asymptomatic infection state)
Inflammatory Markers
Longitudinal Assessment of all measures longitudinal changes will be passed at 2-year follow-
Access using the same program as outlined above.
Specifically, participants will repeat the physical examination, questionnaire package, fasting blood draw, ultrasound scan and 2-day/2-
Outpatient/EMA protocol at night. A follow-
Considered appropriate follow-up for 2 years
Based on previous studies, the study demonstrated the effect of psychosocial risk factors on changes in the middle thickness of the common cervical artery during this period.
The research coordinator will screen 37-40 potential participants for screening and confirmation by phone.
A target matrix of gender, age and race/ethnicity by ten years will be used to ensure the sampling target: within 21 to 70 years of entry, gender and ethnic/ethnic representation are equal every decade.
Participants who meet the recruitment objectives and inclusion/exclusion criteria will be scheduled for a meeting.
All meetings will be held between 08: 00 and 10: 00 on Thursday morning.
Participants will be instructed to fast overnight (8u2009hours).
This appointment is limited (
All participants are in the same 2-to 3-
One hour in the morning)
It is important to ensure the fidelity of inflammatory biomarkers.
36 participants will meet with the research coordinator at the clinic at the scheduled appointment time to provide written, informed consent and start the agreement.
After laboratory access consent is provided, participants will receive a brief medical examination including a systematic review (ROS)
, Personal and family history, current medication and health status, healthy behavior, and a detailed history of heart disease.
Fasting blood tests will be performed to evaluate lipid and inflammatory markers.
Vascular technical experts will then conduct a complete bilateral ultrasound imaging study of the extra-cranial artery and related vessels.
Finally, participants will complete a questionnaire that includes metrics for vigilance, social experience, personality, and healthy behavior.
All participants will be equipped with wrists before leaving the lab
Wearing Actiwatch spectrum (Phillips-Respironics)
Sleep/wake-up activity monitor (ABPM; Oscar II; Suntech)
And will be subject to pre-set phone devices for a month-day/2-
Outpatient/emergency check-up at night.
Dynamic/EMA evaluation abpm measurements will be programmed to evaluate BP at random time within 45 minutes of the day.
This random sampling procedure prevents participants from predicting the results of the measurements, thus changing their activity.
Participants will be instructed to complete the EMA protocol using the provided mobile device in response to each BP measurement of waking time.
Participants will be further instructed to complete two additional EMA-Basic survey :(1)an End-of-Day (EOD)
The survey completed before going to bed and (2)
Morning survey on Awakening (Wake up investigation).
Actiwatch Spectrum will be programmed to evaluate activities in the 30 s era and participants will be instructed throughout 2-day/2-
Night monitoring period.
Participants will be instructed to turn off ABPM and remove it while sleeping the first night, and to connect and activate it when they wake up the next morning.
In order to collect night BP data the following night, participants will wear ABPM (
To estimate the decline at night).
On the third day, participants will meet with the research coordinator at the clinic to return mobile/EMA equipment.
Participants will also be asked about the development of symptoms of acute illness since the last appointment as a means to explain the pre-disease status of a potential disease (
That is, the asymptomatic infection state)
Inflammatory Markers
Longitudinal Assessment of all measures longitudinal changes will be passed at 2-year follow-
Access using the same program as outlined above.
Specifically, participants will repeat the physical examination, questionnaire package, fasting blood draw, ultrasound scan and 2-day/2-
Outpatient/EMA protocol at night. A follow-
Considered appropriate follow-up for 2 years
Based on previous studies, the study demonstrated the effect of psychosocial risk factors on changes in the middle thickness of the common cervical artery during this period.
Three types of measures will be collected :(1)
Social psychological survey data (table 1), (2)
Ecological sampling data including EMA and daily diary (table 2)and (3)
Data on dynamic physiology and clinical outcomes (table 3).
The specific areas and structures are described in detail below.
View this table: View the inline View pop-up table 1 domain, structure, and measurement in the psychosocial survey View this table: use EMA CuffSurvey survey, End-of-
Daily survey and wake-up survey View this table: View inline View pop-up table 3 includes age, race, ethnicity, family income, education level, marital status, family size, professional status (
Hollingshead classification)
41 42 typical working hours and military experience will be assessed by self-assessmentreport.
These variables will be used as covariates in the model where the first target is tested, and may also be used later for auxiliary purposes.
Mental health
Self-existence and healthy behavior
The report questionnaire package will be used to collect four areas of conceptual-related psychosocial risk presenters (
See Table 1 for additional details).
Domain names include :(1)individual-
Level factors including healthy behavior, mood/influence, and personality traits ,(2)
Social factors ,(3)
Social roles and (4)
Context factor.
Select measures according to the following four criteria :(1)
The correlation with the alert structure ,(2)
Correlation with disease risk ,(3)
Attributes of psychological measurement and (4)length.
Social security alert will be evaluated through a new tool
Questionnaire on social vigilance (SVQ).
SVQ is a newly developed 10-item, three-factor self-
Report measurement to assess the extent to which a person is under pressure
Relevant vigilance or monitoring of the social environment.
Participants will get stem, \"on social occasions . . . . . . \", Then use 4-
Likert point scale from 0 \"almost no\" to 4 \"almost always.
We propose to evaluate the frequency of socially vigilant behavior using SVQ using two conceptual-related but different methods.
First, SVQ will be included in
The questionnaire package completed by all participants at baseline was reported.
The second method is to use EMA sampling to evaluate the frequency of vigilant behavior in daily life. The full 10-
The project SVQ will adapt to the EMA format by changing stem to sample alert behavior and will evaluate whether social interaction has occurred in each BP measurement.
This method will allow dynamic measurement of vigilant behavior every about 45 minutes during the day.
Medical history and laboratory tests, registered nurses will meet with participants to record the health status at the beginning of the study and describe their personal and family health history.
Physical examination includes the assessment of standard measures (
Such as height, weight, waist circumference, etc)
Health behavior information (
Smoking, drinking, physical activity, diet and sleep, for example)and an ROS (
For example, the function and symptoms of all major regulatory systems, including but not limited to cardiovascular, respiratory, ear, nose, mouth, throat, intestines and stomach, etc).
Measurements of the three resting BP will be collected and summarized as baseline measurements of the clinic BP.
An fasting blood draw will be performed by the blood draw to assess the baseline lipid profile (
Total cholesterol, high-
High density, low
Density lipoproteinand TG)
Fasting blood glucose and serum collection to evaluate inflammatory markers.
Use B-to imaging the extra-cranial arteryMode ultrasound
There are two kinds of methods. dimensional(2D)
Images of the artery vessels capable of measuring wall thickness.
The progress of using Doppler ultrasound imaging allows the measurement and visualization of blood flow velocity.
In the current study, all participants will receive a double scan of the artery.
The term \"repetition\" means B-
Create 2D images with blood flow in Doppler mode.
This method allows traditional measurement of the middle thickness of the endometrium of the arteries, as well as information about the direction of blood flow, flow rate, occlusion, significant plaque, and other abnormalities.
43 44 all scans will be performed by experienced ultrasound technicians.
In short, will be ordinary (CCA), bifurcation (BIF)
And internal jugular artery (ICA)
From four standard angles (
90 °, 150 °, 10 ° and 270 °).
Consistent with the recommendation, the arterial arc of Meijer (45-47)
Medical ultrasound;
Voorschoten, Netherlands)
Will be used to improve the accuracy of the measurement point and improve the reliability of the Interior
Participants measured over time.
Using Vascular Research Tools5. 0 (
Medical imaging application, collaville, Iowa, USA)
, Two readers who turned a blind eye to the features of the participants will be offline to score the middle thickness of the common cervical artery.
The software uses a semi-automatic edge detection algorithm to determine the thickness of the endometrium
Media Complex in designated areas (ROI)
For each frame in the clip series.
Consistent with the literature, the thickness of the middle of the endometrium of the artery is defined as the endometrium-
Tube cavity and inside
The external interface of the arterial segment within ROI.
It will also be analyzed whether there are patches in each segment.
The quality score of the plaque will be performed using the following criteria :(1)size (
That is, small, medium and large), (2)
Heterogeneity/homogeneity and (3)
Of fiber, fat, and calcium.
The software generates an average, minimum and maximum endometrial middle thickness score for each segment at each angle.
Based on the previous recommendation 48 and the team\'s past work, the maximum IMT value will be used as a focus marker.
Average of 49 maximum values (
The average of the highest score for each of the four Angels given the clip)
Will be exported for CCA, BIF, and ICA.
We will evaluate high-sensitivity c-inflammatory biomarkers to examine inflammation as it is related to the potential impact of social vigilance on
Active protein (CRP)
Tumor necrosis factor-alpha (TNF-α)
And il 6 (IL-6).
These markers are assumed to represent differences in the inflammatory process from stress to arterial congee hardening, and their addition not only enables us to address the presence of inflammation, it can also address how active inflammatory processes affect all stages of the process of atheroma.
51-53 CRP has received the greatest attention as a marker of inflammatory processes and is a reliable predictor of future cardiovascular risk in some prospective studies.
However, 54-58 CRP is a relatively late step in the course of inflammation, understanding early cytokines patterns and initiating inflammatory cascade prior to this is important for theoretical models linking psychosocial factors relationships with health outcomes
So far, tumor necrosis factor
Alpha is generally conceptualized as an acute phase cytokines and IL-
6 is conceptualized as Central early inflammatory cytokines that can directly initiate and regulate the inflammatory cascade.
ABPM will be provided to 59 60 outpatient BPParticipants (Oscar 2;
Raleigh SunTech Medical Devices, North Carolina)
Wear during the day and at night to capture measurements of systolic blood pressure, systolic blood pressure, and heart rate.
Designed for dynamic evaluation, Oscar 2 is the only ABPM clinically validated to meet all three international standards.
61 62 the sensor and cuffs are unobtrusively worn under the clothes of the participants, with only one small control unit (About 4. 7×2. 8×1. 2 inches; 284 g)
Partially exposed to the participant\'s belt.
ABPM will be programmed to randomly evaluate BP every 45 minutes on first and second study days and second study nights (2 days 1 night).
Data will be cleaned up using established standards.
63 participants will be trained on how to remove and return to the unit after bathing or strenuous exercise, otherwise they will be required to keep the monitor on as instructed.
Eco-instant assessment participants will receive pre-programmed mobile devices as EMA delivery platforms.
Three surveys will be used to assess daily experience :(1)
The EMA/Cuff survey is the main short-lived sample survey for the entire study day ,(2)
EOD survey assessing participants\' impression of their day\'s summary and (3)
The wake-up survey will take the form of a sleep diary by assessing all aspects of the amount and quality of sleep (table 2).
Programming includes drop-down menus and slides for Likert scale.
The EMA/Cuff survey will be used as the primary daily sampling survey and paired with ABPM where the BP sampling will be used as a trigger event for participants to complete the survey.
The EMA/Cuff survey is divided into six measurement parts: body parameters, effects, stress, social exposure, interpersonal interaction, and perceived prospects (
See Table 2 for additional details).
It is important that the survey is balanced and that the number of questions received by the participants is relatively equal (
Range 38-40 questions)
No matter how the reaction
This reduces the possibility of inadvertently introducing certain answers related to shorter survey requirements.
EOD survey participants will be instructed to complete the EOD survey before going to bed on the first and second days.
The purpose is to evaluate a summary rating of mood, stress and vigilance for the day.
Wake-up survey participants will be instructed to complete the wake-up survey when they wake up on the second and third study days.
The Wake survey is a retrospective sleep diary that assesses all aspects of sleep the night before.
It consists of projects that will provide the following measures: sleep initiation latency, bed time, number of awakenings, awakening after the start of sleep, terminal awakening, total sleep time, sleep efficiency, sleep quality and use of sleep drugs.
Sleep Assessment subjective sleep quantity and quality participants sleep quantity and quality will use three self-assessments during each laboratory visit
Reporting Measures (table 1).
In general, these measures are designed to measure :(1)self-
Reported sleep time and quality ,(2)
The severity of subjective insomnia symptoms and (3)self-
Sleep without risk.
Objective sleep quantity and quality of Actiwatch spectrum Actiwatch (Philips-
Breathing in Bend, Oregon)
Small, wrist-worn, battery-
Operating Activity Monitor with physical features similar to the small watch.
The monitor uses a motion sensor called an accelerometer to monitor the occurrence and extent of movement.
This type of sensor integrates the degree and speed of motion and produces a small signal whose size and duration depend on the amount of motion.
Activity data will be collected in 30 years.
Also, Actiwatch Spectrum has an on-
The board event marker button pressed by the patient to determine the time to sleep and the time to get up.
Analyze this information with Actiware (Philips-Respironics)
The software detects wake-up using a medium activity threshold and a 10-minute immobility setting.
The derived variables include: sleep time, wake-up time, sleep time, sleep start latency, number of waking times at night, wake-up time after the start of sleep, total sleep time, and sleep efficiency, use proprietary scoring algorithms in software.
The evaluation of sleep parameters will be optimized in combination with tactile and sleep diary/EMA data.
Demographic data, including age, race, ethnicity, family income, education level, marital status, family size, occupational status (
Hollingshead classification)
41 42 typical working hours and military experience will be assessed by self-assessmentreport.
These variables will be used as covariates in the model where the first target is tested, and may also be used later for auxiliary purposes.
Mental health
Self-existence and healthy behavior
The report questionnaire package will be used to collect four areas of conceptual-related psychosocial risk presenters (
See Table 1 for additional details).
Domain names include :(1)individual-
Level factors including healthy behavior, mood/influence, and personality traits ,(2)
Social factors ,(3)
Social roles and (4)
Context factor.
Select measures according to the following four criteria :(1)
The correlation with the alert structure ,(2)
Correlation with disease risk ,(3)
Attributes of psychological measurement and (4)length.
Social security alert will be evaluated through a new tool
Questionnaire on social vigilance (SVQ).
SVQ is a newly developed 10-item, three-factor self-
Report measurement to assess the extent to which a person is under pressure
Relevant vigilance or monitoring of the social environment.
Participants will get stem, \"on social occasions . . . . . . \", Then use 4-
Likert point scale from 0 \"almost no\" to 4 \"almost always.
We propose to evaluate the frequency of socially vigilant behavior using SVQ using two conceptual-related but different methods.
First, SVQ will be included in
The questionnaire package completed by all participants at baseline was reported.
The second method is to use EMA sampling to evaluate the frequency of vigilant behavior in daily life. The full 10-
The project SVQ will adapt to the EMA format by changing stem to sample alert behavior and will evaluate whether social interaction has occurred in each BP measurement.
This method will allow dynamic measurement of vigilant behavior every about 45 minutes during the day.
Medical history and laboratory tests, registered nurses will meet with participants to record the health status at the beginning of the study and describe their personal and family health history.
Physical examination includes the assessment of standard measures (
Such as height, weight, waist circumference, etc)
Health behavior information (
Smoking, drinking, physical activity, diet and sleep, for example)and an ROS (
For example, the function and symptoms of all major regulatory systems, including but not limited to cardiovascular, respiratory, ear, nose, mouth, throat, intestines and stomach, etc).
Measurements of the three resting BP will be collected and summarized as baseline measurements of the clinic BP.
An fasting blood draw will be performed by the blood draw to assess the baseline lipid profile (
Total cholesterol, high-
High density, low
Density lipoproteinand TG)
Fasting blood glucose and serum collection to evaluate inflammatory markers.
Use B-to imaging the extra-cranial arteryMode ultrasound
There are two kinds of methods. dimensional(2D)
Images of the artery vessels capable of measuring wall thickness.
The progress of using Doppler ultrasound imaging allows the measurement and visualization of blood flow velocity.
In the current study, all participants will receive a double scan of the artery.
The term \"repetition\" means B-
Create 2D images with blood flow in Doppler mode.
This method allows traditional measurement of the middle thickness of the endometrium of the arteries, as well as information about the direction of blood flow, flow rate, occlusion, significant plaque, and other abnormalities.
43 44 all scans will be performed by experienced ultrasound technicians.
In short, will be ordinary (CCA), bifurcation (BIF)
And internal jugular artery (ICA)
From four standard angles (
90 °, 150 °, 10 ° and 270 °).
Consistent with the recommendation, the arterial arc of Meijer (45-47)
Medical ultrasound;
Voorschoten, Netherlands)
Will be used to improve the accuracy of the measurement point and improve the reliability of the Interior
Participants measured over time.
Using Vascular Research Tools5. 0 (
Medical imaging application, collaville, Iowa, USA)
, Two readers who turned a blind eye to the features of the participants will be offline to score the middle thickness of the common cervical artery.
The software uses a semi-automatic edge detection algorithm to determine the thickness of the endometrium
Media Complex in designated areas (ROI)
For each frame in the clip series.
Consistent with the literature, the thickness of the middle of the endometrium of the artery is defined as the endometrium-
Tube cavity and inside
The external interface of the arterial segment within ROI.
It will also be analyzed whether there are patches in each segment.
The quality score of the plaque will be performed using the following criteria :(1)size (
That is, small, medium and large), (2)
Heterogeneity/homogeneity and (3)
Of fiber, fat, and calcium.
The software generates an average, minimum and maximum endometrial middle thickness score for each segment at each angle.
Based on the previous recommendation 48 and the team\'s past work, the maximum IMT value will be used as a focus marker.
Average of 49 maximum values (
The average of the highest score for each of the four Angels given the clip)
Will be exported for CCA, BIF, and ICA.
We will evaluate high-sensitivity c-inflammatory biomarkers to examine inflammation as it is related to the potential impact of social vigilance on
Active protein (CRP)
Tumor necrosis factor-alpha (TNF-α)
And il 6 (IL-6).
These markers are assumed to represent differences in the inflammatory process from stress to arterial congee hardening, and their addition not only enables us to address the presence of inflammation, it can also address how active inflammatory processes affect all stages of the process of atheroma.
51-53 CRP has received the greatest attention as a marker of inflammatory processes and is a reliable predictor of future cardiovascular risk in some prospective studies.
However, 54-58 CRP is a relatively late step in the course of inflammation, understanding early cytokines patterns and initiating inflammatory cascade prior to this is important for theoretical models linking psychosocial factors relationships with health outcomes
So far, tumor necrosis factor
Alpha is generally conceptualized as an acute phase cytokines and IL-
6 is conceptualized as Central early inflammatory cytokines that can directly initiate and regulate the inflammatory cascade.
ABPM will be provided to 59 60 outpatient BPParticipants (Oscar 2;
Raleigh SunTech Medical Devices, North Carolina)
Wear during the day and at night to capture measurements of systolic blood pressure, systolic blood pressure, and heart rate.
Designed for dynamic evaluation, Oscar 2 is the only ABPM clinically validated to meet all three international standards.
61 62 the sensor and cuffs are unobtrusively worn under the clothes of the participants, with only one small control unit (About 4. 7×2. 8×1. 2 inches; 284 g)
Partially exposed to the participant\'s belt.
ABPM will be programmed to randomly evaluate BP every 45 minutes on first and second study days and second study nights (2 days 1 night).
Data will be cleaned up using established standards.
63 participants will be trained on how to remove and return to the unit after bathing or strenuous exercise, otherwise they will be required to keep the monitor on as instructed.
Eco-instant assessment participants will receive pre-programmed mobile devices as EMA delivery platforms.
Three surveys will be used to assess daily experience :(1)
The EMA/Cuff survey is the main short-lived sample survey for the entire study day ,(2)
EOD survey assessing participants\' impression of their day\'s summary and (3)
The wake-up survey will take the form of a sleep diary by assessing all aspects of the amount and quality of sleep (table 2).
Programming includes drop-down menus and slides for Likert scale.
The EMA/Cuff survey will be used as the primary daily sampling survey and paired with ABPM where the BP sampling will be used as a trigger event for participants to complete the survey.
The EMA/Cuff survey is divided into six measurement parts: body parameters, effects, stress, social exposure, interpersonal interaction, and perceived prospects (
See Table 2 for additional details).
It is important that the survey is balanced and that the number of questions received by the participants is relatively equal (
Range 38-40 questions)
No matter how the reaction
This reduces the possibility of inadvertently introducing certain answers related to shorter survey requirements.
EOD survey participants will be instructed to complete the EOD survey before going to bed on the first and second days.
The purpose is to evaluate a summary rating of mood, stress and vigilance for the day.
Wake-up survey participants will be instructed to complete the wake-up survey when they wake up on the second and third study days.
The Wake survey is a retrospective sleep diary that assesses all aspects of sleep the night before.
It consists of projects that will provide the following measures: sleep initiation latency, bed time, number of awakenings, awakening after the start of sleep, terminal awakening, total sleep time, sleep efficiency, sleep quality and use of sleep drugs.
The EMA/Cuff survey will be used as the primary daily sampling survey and paired with ABPM where the BP sampling will be used as a trigger event for participants to complete the survey.
The EMA/Cuff survey is divided into six measurement parts: body parameters, effects, stress, social exposure, interpersonal interaction, and perceived prospects (
See Table 2 for additional details).
It is important that the survey is balanced and that the number of questions received by the participants is relatively equal (
Range 38-40 questions)
No matter how the reaction
This reduces the possibility of inadvertently introducing certain answers related to shorter survey requirements.
EOD survey participants will be instructed to complete the EOD survey before going to bed on the first and second days.
The purpose is to evaluate a summary rating of mood, stress and vigilance for the day.
Wake-up survey participants will be instructed to complete the wake-up survey when they wake up on the second and third study days.
The Wake survey is a ret
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