8 Few interventions to promote physical activity (PA) adapt dynamically to changes in 9 individuals' behavior. Interventions targeting determinants of behavior are linked with 10 increased effectiveness and should reflect changes in behavior over time. This paper 11 describes the application of two frameworks to assist the development of an adaptive 12 evidence-based smartphone-delivered intervention aimed at influencing PA and sedentary 13 behaviors (SB). Intervention Mapping was used to identify the determinants influencing 14 uptake of PA and optimal behavior change techniques (BCTs). Behavioral Intervention 15 Technology was used to translate and operationalise the BCTs and its modes of delivery. The 16 intervention was based on the Integrated Behavior Change Model, focussed on nine 17 determinants, consisted of 33 BCTs, and included three main components: 1) automated 18 capture of daily PA and SB via an existing smartphone application, 2) classification of the 19 individual into an activity profile according to their PA and SB, 3) behavior change content 20 delivery in a dynamic fashion via a proof-of concept application. This paper illustrates how 21 two complementary frameworks can be used to guide the development of a mobile health 22 behavior change program. This approach can guide the development of future mHealth 23 programs. 24 Keywords: Intervention design; Intervention mapping; Behavioral intervention 25 technology; Physical activity; Sedentary behavior; Integrated behavior change model 26 27 USING INTERVENTION MAPPING AND BIT
A method has been developed for simultaneously comparing the usefulness of many treatments of established value for symptomatic medical conditions. Medical assessment of outcome is not employed. Instead patients are required to assess treatments prescribed during the course of ordinary general practice rather than under the strictly controlled settings of most clinical trials. Outcome incorporates patient compliance and treatment acceptability and is based on patients' subjective judgments of the usefulness of randomly allocated treatments as recorded in self-completed diaries, which are mailed directly to a trial centre. Thus large and more representative samples are achieved through minimizing the efforts required, both of participating doctors and of patients. Although the approach was originally developed and tested for the comparison of hay fever treatment regimens, we believe that it can be adapted to compare many other treatments where patient-reported symptoms validly describe the outcome of interest. The feasibility of the approach was tested in two pilot studies, and it has been employed successfully in a two-year trial comparing seven hay fever treatments. Aspects of analysing such trials are discussed.
Many infusions are given by gravity assisted, drip sets that give a flowrate dependent on the height of the reservoir above the patient, the length of the tubing, the bore of the IV cannula, the density and viscosity of the fluid being delivered, and the patient’s venous pressure. However there is an increasing tendency to use programmable volumetric intravenous pumps and syringe drivers to deliver intravenous anaesthesia, fluids, patient controlled analgesia, epidural infusions and other drugs. Not only are they programmable, but they can also be adjusted to give desired flowrates or volumes. Some infusion devices are powered only by gravity, but the flowrate is controlled by a photoelectric drip rate detector in conjunction with a microprocessor controlled drip occlusion device. Other infusion devices use a stepper motor to control the rate of infusion. A stepper motor is designed so that the rotation is by a fixed amount per supplied electrical pulse, independent of the mechanical load it is carrying. The pulses are controlled by a microprocessor in the pump and the rate of infusion is dependent on the stepper motor’s output. Syringe drivers are designed to use a range of syringe sizes and some require special delivery tubing. The flow is a continuous, pulsatile flow and accuracy is 2–5%. Some syringe drivers are driven by clockwork motors, others by a battery powered motor that is intermittently on and off, depending on required flowrate. The driving mechanism is usually by a screw threaded rod connected to the syringe plunger. Other syringe drivers use a stepper motor connected to the screw threaded rod. Care should be taken not to position the syringe driver above the patient’s venous cannula or the syringe may siphon a drug additional to that programmed on the driver, by virtue of the weight of the column of fluid in the tubing above the patient. Care should also be taken to avoid any bubbles in the syringe reaching the patient. Modern syringe drivers are usually sufficiently accurate over the desired range of infusion [Stokes et al. 1990]. However, there may be a delay before the drug is delivered to the patient as the parts attached to the syringe take up slack [O’Kelly et al. 1992].
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