User:Jenniferputri/sandbox

History
Ambulatory assessment is utilized in Germany since the 1980s for research, using computers as the main alternative instrument instead of manual method of booklet and pencil. The manual method of booklet and pencil questionnaires gives researchers less adaptability and does not give real-time data. Researchers in Germany uses computers to allow them observe patients' behavioral changes in naturalistic settings. A few years later, United States picked up the assessment using the manual method to monitor behavioral changes on the brain in patients.

Origins
Ambulatory assessment stemmed from 5 different observation methods each with independent purpose:


 * 1) Clinical (bedside) monitoring
 * 2) Biotelemetry
 * 3) Ambulatory monitoring
 * 4) Field research
 * 5) Behavioral assessment

Clinical (bedside) monitoring
Clinical (bedside) monitoring is used by hospitals to observe patients’ vital functions during hospitalization. Such vital functions include pulse rate, respiratory rate, blood pressure, and body temperature. In intensive care, this is a signal instrument that signals when a critical change in patient's physiology has occured and an alarm will go off to indicate the changes.

Biotelemetry
Biotelemetry is the use of telemetry methods that allows researchers to measure and observe certain psychological and physical function of living beings outside laboratory. Telemetry methods uses transmitter-receiver system to conduct the observation. The system is equipped with a radio that allows "input, telestimulation and telecommand" possible. Such examples include measuring the vital function of a patient after doing a performance test. Biotelemetry has also been used to observe animals migration activity.

Ambulatory monitoring
Ambulatory monitoring is an observation method for patients outside medical institution. Patients does not have to be physically attached to a clinical (bedside) monitoring while conducting the observation. Biotelemetry is used for conducting ambulatory monitoring. This observation method is for patients with pathological symptoms to allow researchers to detect the patterns when patients are carrying out their day to day normal activities. According to Fahrenberg,  "'Such cases include ventricular arrhythmia, ischaemic episodes, sleep apnea, epileptic seizures. Here, ambulatory monitoring, furthers valid diagnoses and, as well, the stabilization of medication'."

Field research
Field research is an observation method that takes part in natural settings. This observation is a fundemental methodology for different branches of social sciences such as, cultural anthropology, ethology, developmental psychology, social psychilogy, and clinical pscyhology. For clinical purposes, this method is for monitoring psychological and psychophysiological symtomps of participants.

Behavioral assessment
Behavioral assessment is an observation methodology in pscyhology that focuses on human behaviors. This type of observation is aimed at character developments. Such observation is commonly employed in applied and clinical pscyhology and, consequently, the ecological validity of such observation is important.

According to Fahrenberg, Ambulatory assessment combines these 5 different observation methods into one assessment method that analyze a specific issue using a combination of data with theory and a practical standard whilst attempting to attain ecological validity.

Advantages of Ambulatory assessment
According to Ebner-Priemer and Trull, there are several advantages of ambulatory assessment: "'(a) real-time assessment to circumvent biased recollection and cognitive reconstruction of the past; (b) assessment in real-life situations to enhance generalizability; (c) repeated assessment of individuals resulting in a series of assessment data points that can be used to inves- tigate the variability of experience and within-person processes; (d) multimodal assessment, including psychological, physiological and behavioral data; (e) the possibility of assessing the context of the report, allowing one to in- vestigate setting- or context-specific relationships; and (f) the possibility of giving feedback in real time'" With that, Ambulatory assessment allows researchers to collect data repeatedly and examine the patterns of physiological activity on a daily basis for clinical disorders with irregular psychological activities. For example, mental disorders, such as bipolar disorder, that comes with an unpredictable behavioral patterns are assessed using Ambulatory assessment.

Big data, technology and Ambulatory assessment
Big data allows a researcher to extract data for research and clinical purposes via technological applications and online platforms, such as social media. An example of technological application used for Ambulatory assessment is called electronically activated recorder (EAR) that records audio on a daily basis. A study by Robbins, Lopez, Weihs, and Mehl uses EAR to observe interpersonal language used in a romantic relationship when sickness occured. Blood pressure or cortisol are some of the main physiological feature being monitored when doing the assessment. Another technological advancement is "wearable biosensors" that detects physiological patterns. According to Hugdhal, "wearable biosensors" is used to detectelectrodermal activity (EDA) and electrocardiogram (ECG) together with parasympathethic and sympathethic responses.

EDA and ECG allows real-time feedback on behavioral or emotional changes as it occurs. Using technological advancement and big data for Ambulatory assessment allows researchers to interlink behavior, emotion and physiology in human relationships through their on-the-spot reactions in any situation. Timmons, Margolin & Saxbe suggests that physiological patterns is controlled by social interpersonal relationships and interlinks with various elements of relationships, such as satisfaction. Such physiological patterns aids in the characterization of peoples' reaction in interpersonal relationships. Timmons et al. suggests that,  "'By capturing spontaneously occurring interactions, such as displays of affection or conflict episodes, ambulatory assessment provides information on what precipitates these events and how they progress over time, move across locations, and whether they naturally diminish, maintain, or escalate'"Technological advancement has made Ambulatory assessment more practical and easier for researchers to collect real-time data with the use of tracking features, such as GPS, online surveys, and personal devices. Another advantage of using technological advancement is that it is cost-efficient and researchers can record accurate actual time data of human interaction and behavioral changes from one moment to the next.

Ethical and Legal Implications
There are ethical and legal implications that comes with using big data. Researchers must obtain consent from patients' for data privacy and data protection. Ambulatory assessment can't be conducted if participant's device is missing or data on participant's device is unavailable prior to assessment. Participants can protect their data from other patients by setting a password on their phone. Consent and protocol over the collection of audio data that is recorded in public or private setting is based on state law of privacy. Procedures conducted in different state must abide to the state law and overseen by Institutional Review Board (IRB). Participants is recommended to also check the state law before making a response in case such events occur.