Baldwin Wallace University

The increased use of consumer off-the-shelf wearables (COTSW) for exercise training and self-monitoring has resulted in some COTSW offering individual 'recovery' or 'readiness' scores. These scores are derived using heart rate variability (HRV) and are designed to be easily interpreted (percent score; color codes) to assist users in optimizing their training. Limited research exists on the perceived informational utility associated with HRV-derived scores, which can impact user adoption and fidelity. The purpose of this study was to understand individuals' experiences using and interacting with their COTSW and readiness/recovery scores. Seventeen regular exercisers who owned and used a Whoop™ band or Oura™ ring for at least 3 months participated in a one-on-one virtual semi-structured interview. Interviews were analyzed using reflexive thematic analysis, with themes supported by 'in-vivo' quotes. This paper focuses on three key themes for a comprehensive demonstration. Theme 1, ‘It’s kinda validating, right?’ (Detroit) highlights how users found validation and reinforcement in their lifestyle choices and feelings about their well-being. Theme 2, ‘It’s really putting the power in my hands,’ (Misty) indicates users’ curiosity and experimentation with their devices, leading to behavioral adjustments aimed at improving their readiness/recovery scores. Theme 3, potential for ‘more of an emotional response rather than a rational one,’ (Brian) demonstrates the complex reactive responses users may have towards these scores and each wearable’s interface. These findings contribute to the understanding of how COTSW estimates of readiness or recovery impact users’ behavior and self-perception, while highlighting the potential need for user education and design considerations to promote positive interactions with such data.

Purpose Several decades of research on wellbeing has resulted in a variety of conceptual models used to measure wellbeing. The historical motivations behind these conceptual models have emphasized their differences to the point of clouding the wellbeing measurement landscape. A synthesis of the wellbeing literature is needed to move the field forward and guide future research. Methods In this review, we synthesize literature on the measurement of wellbeing from the past 50 years and present The Hierarchical Framework of Wellbeing (HiFWB) that organizes multiple prior models. Results We propose a general factor of wellbeing (i.e., “h” factor) at the top level of the hierarchy analogous to “g” in the intelligence literature and “p” in the psychopathology literature. Building off prior conceptualizations, we define general well-being as “the experience of personally valued fulfillment within one's life.” We detail the theoretical rationale and empirical evidence behind four hierarchical levels: general (i.e., “h” factor), lenses (e.g., subjective wellbeing), contents (e.g., affects), and characteristics (e.g., positive affect). Example wellbeing constructs are proposed for each level of HiFWB while emphasizing the hierarchical structure is prioritized above any (arbitrary) list of constructs. We discuss various approaches to distinguishing predictors of wellbeing from wellbeing itself (i.e., preventing tautologies) and how they fit into our framework. Considering the bulk of the empirical evidence comes from Western, Educated, Industrialized, Rich, Democratic (WEIRD) cultures, constraints on generalizability are important. Throughout, we compare and contrast HiFWB to other hierarchical structures in psychological science (e.g., five factor model of personality). Conclusion The HiFWB is a flexible, encompassing, evidence-based framework for wellbeing conceptualization and measurement in WEIRD populations.

Habitual consumption of low-calorie sweeteners (LCS) during juvenile-adolescence can lead to greater sugar intake later in life. Here, we investigated if exposure to the LCS Acesulfame Potassium (Ace-K) during this critical period of development reprograms the taste system in a way that would alter hedonic responding for common dietary compounds. Results revealed that early-life LCS intake not only enhanced the avidity for a caloric sugar (fructose) when rats were in a state of caloric need, it increased acceptance of a bitterant (quinine) in Ace-K-exposed rats tested when middle-aged. These behavior shifts, which endured months after the end of Ace-K exposure, were accompanied by widespread changes in the peripheral taste system. The anterior tongue had fewer fungiform taste papillae, and the circumvallate papillae had a reduced anterior to posterior span and diminished expression of genes involved in sweet reception, sweet and bitter intracellular signaling, fructose transport, and cellular progeneration in the Ace-K-exposed rats. Ace-K exposure also led to a significant reduction in dopamine-producing cells of the ventral tegmental area. The collective findings reveal that LCS intake early in life alters the taste-brain axis and the behavioral responsiveness to both positive and negative tastants that are important determinants of dietary preferences.

Questions European colonization radically transformed the landscapes of eastern North America. Understanding this legacy is vital to managing current ecological communities. To do so requires spatially explicit information about presettlement vegetation. Here we test the ability of species distribution models, which have rarely been used with historical data like land survey records, to generate useful predictions of presettlement tree distributions. These models also allow us to assess pre‐disturbance vegetation‐environment relationships. Location Cuyahoga County, Ohio, USA. Methods Generalized linear models, generalized boosting models, random forests, and maximum entropy models related the distributions of 17 tree taxa to elevation, slope, aspect, and soil type, based on 4234 tree observations from circa‐1800 surveys. Cluster analysis defined forest types and created a prediction map of forest types using random forests. Results This study generated high‐resolution predictions of presettlement tree distributions. Fagus grandifolia and Carya spp. were predicted to have found suitable habitat in over half the area. Elevation was by far the most important predictor, followed by slope. Many taxa were more likely to occur at higher elevations, corresponding to the Allegheny Plateau, while others followed river valleys. Broadly, 51% of the county was predicted to support forest types with Fagus grandifolia and/or Acer spp., and 48% of the county was predicted to support forest types with Quercus spp., Carya spp., and/or Castanea dentata . Conclusions This study demonstrates that species distribution modeling with historical data provides insights into presettlement vegetation and vegetation‐environment relationships. Our results reveal striking ecological patterns not apparent in today's landscape, such as the sharp difference in vegetation between the Central Lowland and Allegheny Plateau. The maps created here offer a historical perspective that can inform conservation, education, and further research.

Background The objective of this study is to evaluate the risk of being diagnosed with an eating disorder among transgender and gender-diverse (TGD) individuals, specifically examining how this risk differs following gender-affirming medical therapy (GAMT). Methods The study utilizes electronic medical record (EMR) data from the TriNetX database. A total of 90,955 TGD individuals were identified in the TriNetX database. TGD individuals were divided into cohorts according to gender-affirming interventions they received. To assess the risk of eating disorder diagnoses across groups, we applied a Cox proportional hazards model with gender-affirming care as a time-varying covariate. Results Here we show that transfeminine individuals receiving hormone therapy (HT) have a significantly higher likelihood of being diagnosed with an eating disorder compared to those without intervention (HR:1.67, 95% CI:1.41, 1.98). Conversely, transmasculine individuals on HT exhibit a reduced risk of being diagnosed with an eating disorder relative to those without intervention (HR: 0.83, 95% CI: 0.76, 0.90). Conclusions After undergoing gender-affirming medical therapy, the risk of eating disorder diagnosis increases for transfeminine individuals and decreases for transmasculine individuals. The observed differences in risk between transfeminine and transmasculine individuals on GAMT may be attributed to factors such as gendered societal norms, variations in screening practices, and the physiological effects of hormone therapy on eating disorder symptomatology. Further research is needed to clarify these influences and support tailored interventions.

Associations were examined between sociodemographic characteristics of a US online survey sample of caregiver/adolescent dyads (n = 533) and food intake during independent eating occasions. Caregivers reported sociodemographic characteristics for dyads. Adolescents reported daily intake frequency of sugar-sweetened beverages, junk foods, sugary foods, fast food, and fruits and vegetables during independent eating occasions. Logistic regression analysis showed increased odds of sugar-sweetened beverage intake by White vs. Asian counterparts, decreased odds of sugary food intake by age (12 vs. 11-year-olds) and increased odds of sugary food intake by weight status (overweight/obesity vs. normal weight). Understanding these relationships may inform future intervention development.

Purpose: To examine how post-concussion changes to the N200 and P300 event-related potentials (ERPs) are associated with cognitive symptoms and neurocognitive performance. Methods: High-density electroencephalography (EEG) was recorded during a Go/No-Go task from 16 young adults within one month after their concussion and 16 matched controls. Participants were also administered the Cognitive-Linguistic Quick Test (CLQT) and self-reported concussion-like symptoms. Mixed analysis of variance models compared the N200/P300 ERPs between concussion and control groups. Nested linear regressions examined associations between the N200/P300 ERPs and CLQT cognitive domains, cognitive symptom clusters, and total concussion symptoms, with particular interest in within-task changes in the N200/P300 ERPs (e.g. habituation). Results: N200 and P300 ERP amplitudes were associated with individual differences in cognitive outcomes after concussion. For concussion participants only, smaller P300 amplitudes were significantly associated with greater cognitive symptoms. When considering within-task changes in ERPs over repeated trial presentations, reduced habituation of N200 amplitudes was significantly associated with poorer attention and memory CLQT domain scores. Reduced habituation of P300 amplitudes was also associated with greater cognitive symptoms and total symptoms for concussion participants. Conclusion: Within-task changes in ERP dynamics supporting attention and executive control are associated with individual differences in cognitive outcomes after concussion.

A frequent debate and misconception about Restorative justice (RJ) is whether it inherently requires harmed parties to exert emotional labor for the primary benefit of those who initiated harm. To explore this question, this chapter first defines and differentiates emotional labor—including extra pressure on members of historically resilient communities to educate or accommodate the feelings and needs of people who have caused harm—from emotional work, which involves shared investment for shared benefit. The chapter further explores types of harm and examines the role of harmed parties and those who initiated harm in healing one another through RJ. Finally, the chapter outlines the importance of facilitators and identifying suitability, pre-work, prompts, and resolution agreements to appropriately attend to healing labor.

Fashion is a means of communicating who we are. Dress codes, both formal and informal, are a means of controlling that communication and are used to convey norms, structure hierarchies, and determine power. In this chapter, we explore the politics of dress codes for members of state legislatures in the United States. How do state legislatures regulate their members’ attire? What does this tell us about power and place? First, we investigate the dress codes for 89 of the 99 state legislative chambers across the United States that were in place during the summer of 2022. Our analysis shows that over half of the state legislative chambers in our study had dress codes and most were formal (written down) and public. These dress codes varied widely in their content and specificity, but two-thirds contained phrases like “business attire.” Most dress codes were gendered. We then provide a qualitative analysis of the meaning of “business attire,” the gendered terms for specific items of clothing, and allowances for “cultural attire” in some states.

Gender-affirming surgery (GAS) is a highly personalized decision for transgender and gender diverse (TGD) individuals. However, the proportion of TGD individuals who desire GAS is unknown. A questionnaire was created after identifying themes surrounding experiences with gender-affirming medical care by community focus groups. Respondents who reported medically transitioning and who had undergone GAS were compared to those without prior GAS. From 88 completed surveys, 18 (20.5%) individuals did not wish to undergo GAS. Of those medically transitioning and desiring GAS, 15.2% (9/59) desired GAS but had not received it yet, with 6.7% (6/9) identifying as non-binary. Individuals who had not had GAS were more likely to earn under $15,000 annually, compared to$25,000–49,000 in the GAS group (p = 0.01). There was no significant difference in educational level (p = 0.32) or insurance status (p = 0.33). Of TGD individuals who desire GAS, out-of-pocket expenses such as hair removal, opaque insurance policies, lack of social support, and access to gender-affirming providers can hinder the transition process. Understanding barriers and rationales for pursuing GAS can provide targets for improving healthcare delivery to this diverse population.

There is growing consensus that wellness strategies should be incorporated into health professions education; however, there is more to be learned about developing targeted, effective curricular interventions. Study objectives were to identify aspects of mindfulness most prominent in physician assistant (PA) students and determine which aspects of mindfulness most strongly predict well-being. The study examined cognitive patterns, protective (self-compassion) and harmful (maladaptive perfectionism), that underlie impostor phenomenon which may impact professional identity development and risk for burnout. Newly matriculated students (n = 351) at six PA programs nationally were invited to participate. Validated survey instruments assessed mindfulness, self-compassion, maladaptive perfectionism, impostor phenomenon, and well-being. Data were assessed using descriptive statistics and linear regressions. The survey response rate was 94.8% (351/370). At the onset of training, PA students were highest in Non-judgement, followed by Observation and Description. Their relatively lowest levels were Non-reactivity and Acting with Awareness. Of the five aspects of mindfulness, Non-judgement was the strongest predictor of well-being, followed by Description and Non-reactivity. Collectively, these three abilities explained 24.62% of variance in well-being. Higher levels of maladaptive perfectionism and lower levels of self-compassion accounted for 53% of the reported level of impostor phenomenon in PA students. Study results provide direction for educators when developing wellness curricula. Three of the five aspects of mindfulness examined were significant predictors of well-being. Higher levels of maladaptive perfectionism and lower levels of self-compassion accounted for experiences of impostor phenomenon in PA students. Findings suggest potential benefit from a targeted approach to implementing mindfulness curricula.

There is a growing interest in developing exercise programs that are adaptive to individuals’ changing contexts and situations. Some consumer wearables aim to guide exercise decisions through ‘recovery’ or 'readiness’ scores, primarily derived from heart rate variability. To date, however, there is limited research on how users interact, interpret, and use these scores. PURPOSE: Understand individuals' experiences using readiness or recovery scores provided by their wearable device. METHODS: Seventeen regular exercisers self-reported owning and using a Whoop™ band or Oura™ ring for at least 3 months, underwent a one-on-one virtual semi-structured interview. Interviews were recorded, transcribed, and analyzed using reflexive thematic analysis. The emerging themes were supported with ‘in-vivo’ quotes from our sample. RESULTS: Our analysis identified six themes, but we focus on three, providing each a thorough exploration and demonstration. Theme 1, 'It's more about how I can make adjustments to optimize my programming,' (MPR) highlights using their wearables as intended, for guiding training purposes (e.g., reducing intensity when recovery scores are low). Theme 2, 'So many things outside of training modifications have changed,' (Misty) indicates users concurrently modify non-exercise behaviors (e.g., sleep, nutrition) to manage and optimize recovery/readiness scores. Within theme 3, ‘You can’t really capture the complexities of a human on a device,’ (Letty) users acknowledge the limitations and errors associated with these devices (e.g., provided scores sometimes incongruent with subjective perceptions) in capturing the complexities of human experiences, necessitating self-reliance to further direct behavioral adjustments. CONCLUSION: These wearable devices offer a simplified numeric-based approach to passively gauge readiness/recovery status. Users emphasized the importance of self-awareness, flexibility, and personal judgment in their exercise decisions. They viewed their wearables as valuable tools but not infallible authorities. Understanding these experiences and the psycho-behavioral aspects of user interactions can help create and refine person-adaptive approaches for exercise behavior.

Background Chronic pain, affecting approximately 20% of the global population, is the leading cause of disability worldwide. Transgender individuals are disproportionately exposed to chronic pain risk factors compared with the cisgender population. This study compares the incidence of chronic pain between transgender and cisgender individuals and examines the impact of gender affirming hormone therapy, anxiety, and depression on chronic pain. Methods The study analysed medical records data of 56,470 transgender men and 41,882 transgender women in the TrinetX database. Six cohorts were created: transgender women either receiving oestrogen or no intervention, transgender men receiving testosterone or no intervention and cohorts of cisgender males and females. Unmatched age‐adjusted incidence rates were calculated. Then cohorts were matched on 22 chronic pain‐associated covariates and the rate of new chronic pain diagnoses was compared between those receiving hormone therapy and those without. Results We observed significantly higher rates of chronic pain among transgender individuals compared with cisgender counterparts. Transgender men on testosterone therapy and transgender women on oestrogen therapy exhibited an increased likelihood of chronic pain diagnoses compared with those not receiving hormone therapy. Individuals with anxiety and depression were more likely to be diagnosed with chronic pain. Conclusion This study demonstrates a significant burden of chronic pain in transgender individuals, with an increased risk among those receiving hormone therapy. Our study, the first to assess chronic pain in a large cohort of transgender patients, provides support for a potential association between hormone therapy and risk of chronic pain diagnosis. Further research is required to understand causal mechanisms and to develop improved screening and management of chronic pain in transgender populations. Significance Statement Our study, featuring the largest cohort of Transgender and Gender Diverse (TGD) individuals assembled to date, reveals critical disparities in chronic pain among TGD populations, notably those on hormone therapy, compared with the cisgender population. It highlights the urgent need for specialized screening and treatment for this vulnerable population, and research into hormone therapy's impact on pain. These insights aim to foster more effective, personalized healthcare, enhancing the well‐being and quality of life for the TGD community.