Developing theory-informed interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework

Background: There is little systematic operational guidance about how best to develop complex interventions to reduce the gap between practice and evidence. This article is one in a series of articles documenting the development and use of the Theoretical Domains Framework (TDF) to advance the science of implementation research. Methods: The intervention was developed considering three main components: theory, evidence, and practical issues. We used a four-step approach, consisting of guiding questions, to direct the choice of the most appropriate components of an implementation intervention: Who needs to do what, differently? Using a theoretical framework, which barriers and enablers need to be addressed? Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? And how can behaviour change be measured and understood? Results: A complex implementation intervention was designed that aimed to improve acute low back pain management in primary care. We used the TDF to identify the barriers and enablers to the uptake of evidence into practice and to guide the choice of intervention components. These components were then combined into a cohesive intervention. The intervention was delivered via two facilitated interactive small group workshops. We also produced a DVD to distribute to all participants in the intervention group. We chose outcome measures in order to assess the mediating mechanisms of behaviour change. Conclusions: We have illustrated a four-step systematic method for developing an intervention designed to change clinical practice based on a theoretical framework. The method of development provides a systematic framework that could be used by others developing complex implementation interventions. While this framework should be iteratively adjusted and refined to suit other contexts and settings, we believe that the four-step process should be maintained as the primary framework to guide researchers through a comprehensive intervention development process

Are osseous artefacts a window to perishable material culture? Implications of an unusually complex bone tool from the Late Pleistocene of East Timor

We report the discovery of an unusually complex and regionally unique bone artefact in a Late Pleistocene archaeological assemblage (c. 35 ka [thousands of years ago]) from the site of Matja Kuru 2 on the island of Timor, in Wallacea. The artefact is interpreted as the broken butt of a formerly hafted projectile point, and it preserves evidence of a complex hafting mechanism including insertion into a shaped or split shaft, a complex pattern of binding including lateral stabilization of the cordage within a bilateral series of notches, and the application of mastic at several stages in the hafting process. The artefact provides the earliest direct evidence for the use of this combination of hafting technologies in the wider region of Southeast Asia, Wallacea, Melanesia and Australasia, and is morphologically unparallelled in deposits of any age. By contrast, it bears a close morphological resemblance to certain bone artefacts from the Middle Stone Age of Africa and South Asia. Examination of ethnographic projectile technology from the region of Melanesia and Australasia shows that all of the technological elements observed in the Matja Kuru 2 artefact were in use historically in the region, including the unusual feature of bilateral notching to stabilize a hafted point. This artefact challenges the notion that complex bone-working and hafting technologies were a relatively late innovation in this part of the world. Moreover, its regional uniqueness encourages us to abandon the perception of bone artefacts as a discrete class of material culture, and to adopt a new interpretative framework in which they are treated as manifestations of a more general class of artefacts that more typically were produced on perishable raw materials including wood

The chiral and flavour projection of Dirac-Kahler fermions in the geometric discretization

It is shown that an exact chiral symmetry can be described for Dirac-Kahler fermions using the two complexes of the geometric discretization. This principle is extended to describe exact flavour projection and it is shown that this necessitates the introduction of a new operator and two new structures of complex. To describe simultaneous chiral and flavour projection, eight complexes are needed in all and it is shown that projection leaves a single flavour of chiral field on each.Comment: v2: 17 pages, Latex. 5 images eps. Added references, reformatted and clarification of some point

The Specific Heat of a Ferromagnetic Film.

We analyze the specific heat for the $O(N)$ vector model on a $d$-dimensional film geometry of thickness $L$ using ``environmentally friendly'' renormalization. We consider periodic, Dirichlet and antiperiodic boundary conditions, deriving expressions for the specific heat and an effective specific heat exponent, \alpha\ef. In the case of $d=3$, for $N=1$, by matching to the exact exponent of the two dimensional Ising model we capture the crossover for \xi_L\ra\infty between power law behaviour in the limit {L\over\xi_L}\ra\infty and logarithmic behaviour in the limit {L\over\xi_L}\ra0 for fixed $L$, where $\xi_L$ is the correlation length in the transverse dimensions.Comment: 21 pages of Plain TeX. Postscript figures available upon request from [email protected]

Electrical characterization of the soft breakdown failure mode in MgO layers

The soft breakdown (SBD) failure mode in 20 nm thick MgO dielectric layers grown on Si substrates was investigated. We show that during a constant voltage stress, charge trapping and progressive breakdown coexist, and that the degradation dynamics is captured by a power-law time dependence. We also show that the SBD current-voltage (I-V) characteristics follow the power-law model I = aVb typical of this conduction mechanism but in a wider voltage window than the one reported in the past for SiO2. The relationship between the magnitude of the current and the normalized differential conductance was analyzed

Recommended Thermal Rate Coefficients for the C + H3+_3^+ Reaction and Some Astrochemical Implications

We have incorporated our experimentally derived thermal rate coefficients for C + H$_3^+$ forming CH$^+$ and CH$_2^+$ into a commonly used astrochemical model. We find that the Arrhenius-Kooij equation typically used in chemical models does not accurately fit our data and use instead a more versatile fitting formula. At a temperature of 10 K and a density of 10$^4$ cm$^{-3}$, we find no significant differences in the predicted chemical abundances, but at higher temperatures of 50, 100, and 300 K we find up to factor of 2 changes. Additionally, we find that the relatively small error on our thermal rate coefficients, $\sim15\%$, significantly reduces the uncertainties on the predicted abundances compared to those obtained using the currently implemented Langevin rate coefficient with its estimated factor of 2 uncertainty.Comment: 19 pages, 5 figures. Accepted for publication in Ap

Merged-beams Reaction Studies of O + H_3^+

We have measured the reaction of O + H3+ forming OH+ and H2O+. This is one of the key gas-phase astrochemical processes initiating the formation of water molecules in dense molecular clouds. For this work, we have used a novel merged fast-beams apparatus which overlaps a beam of H3+ onto a beam of ground-term neutral O. Here, we present cross section data for forming OH+ and H2O+ at relative energies from \approx 3.5 meV to \approx 15.5 and 0.13 eV, respectively. Measurements were performed for statistically populated O(3PJ) in the ground term reacting with hot H3+ (with an internal temperature of \approx 2500-3000 K). From these data, we have derived rate coefficients for translational temperatures from \approx 25 K to \approx 10^5 and 10^3 K, respectively. Using state-of-the-art theoretical methods as a guide, we have converted these results to a thermal rate coefficient for forming either OH+ or H2O+, thereby accounting for the temperature dependence of the O fine-structure levels. Our results are in good agreement with two independent flowing afterglow measurements at a temperature of \approx 300 K, and with a corresponding level of H3+ internal excitation. This good agreement strongly suggests that the internal excitation of the H3+ does not play a significant role in this reaction. The Langevin rate coefficient is in reasonable agreement with the experimental results at 10 K but a factor of \approx 2 larger at 300 K. The two published classical trajectory studies using quantum mechanical potential energy surfaces lie a factor of \approx 1.5 above our experimental results over this 10-300 K range.Comment: 43 pages, 11 figures. Submitted to the Astrophysical Journa