A Markov Approach for Increasing Precision in the Assessment of Data-Intensive Behavioral Interventions

Health interventions using real-time sensing technology are characterized by intensive longitudinal data, which has the potential to enable nuanced evaluations of individuals’ responses to treatment. Existing analytic tools were not developed to capitalize on this opportunity as they typically focus on first-order findings such as changes in the level and/or slope of outcome variables over different intervention phases. This paper introduces an exploratory, Markov-based empirical transition method that offers a more comprehensive assessment of behavioral responses when intensive longitudinal data are available. The procedure projects a univariate time-series into discrete states and empirically determines the probability of transitioning from one state to another. State transition probabilities are summarized separately in phase-specific transition matrices. Comparing transition matrices illuminates intricate, quantifiable differences in behavior between intervention phases. Statistical significance is estimated via bootstrapping techniques. This paper introduces the methodology via three case studies from a secondhand smoke reduction trial utilizing real-time air particle sensors. Analysis enabled the identification of complex phenomena such as avoidance and escape behavior in response to punitive contingencies for tobacco use. Additionally, the largest changes in behavior dynamics were associated with the introduction of behavioral feedback. The Markov approach‘s ability to elucidate subtle behavioral details has not typically been feasible with standard methodologies, mainly due to historical limitations associated with infrequent repeated measures. These results suggest that the evaluation of intervention effects in data-intensive single-case designs can be enhanced, providing rich information that can ultimately be used to develop interventions uniquely tailored to specific individuals

ALMA Resolves 30 Doradus: Sub-parsec Molecular Cloud Structure Near the Closest Super-Star Cluster

We present ALMA observations of 30 Doradus -- the highest resolution view of molecular gas in an extragalactic star formation region to date (~0.4pc x 0.6pc). The 30Dor-10 cloud north of R136 was mapped in 12CO 2-1, 13CO 2-1, C18O 2-1, 1.3mm continuum, the H30alpha recombination line, and two H2CO 3-2 transitions. Most 12CO emission is associated with small filaments and clumps (<1pc, ~1000 Msun at the current resolution). Some clumps are associated with protostars, including "pillars of creation" photoablated by intense radiation from R136. Emission from molecular clouds is often analyzed by decomposition into approximately beam-sized clumps. Such clumps in 30 Doradus follow similar trends in size, linewidth, and surface density to Milky Way clumps. The 30 Doradus clumps have somewhat larger linewidths for a given size than predicted by Larson's scaling relation, consistent with pressure confinement. They extend to higher surface density at a given size and linewidth compared to clouds studied at 10pc resolution. These trends are also true of clumps in Galactic infrared-dark clouds; higher resolution observations of both environments are required. Consistency of clump masses calculated from dust continuum, CO, and the virial theorem reveals that the CO abundance in 30 Doradus clumps is not significantly different from the LMC mean, but the dust abundance may be reduced by ~2. There are no strong trends in clump properties with distance from R136; dense clumps are not strongly affected by the external radiation field, but there is a modest trend towards lower dense clump filling fraction deeper in the cloud.Comment: accepted to Ap

The Relationship Between Molecular Gas, HI, and Star Formation in the Low-Mass, Low-Metallicity Magellanic Clouds

The Magellanic Clouds provide the only laboratory to study the effect of metallicity and galaxy mass on molecular gas and star formation at high (~20 pc) resolution. We use the dust emission from HERITAGE Herschel data to map the molecular gas in the Magellanic Clouds, avoiding the known biases of CO emission as a tracer of H$_{2}$. Using our dust-based molecular gas estimates, we find molecular gas depletion times of ~0.4 Gyr in the LMC and ~0.6 SMC at 1 kpc scales. These depletion times fall within the range found for normal disk galaxies, but are shorter than the average value, which could be due to recent bursts in star formation. We find no evidence for a strong intrinsic dependence of the molecular gas depletion time on metallicity. We study the relationship between gas and star formation rate across a range in size scales from 20 pc to ~1 kpc, including how the scatter in molecular gas depletion time changes with size scale, and discuss the physical mechanisms driving the relationships. We compare the metallicity-dependent star formation models of Ostriker, McKee, and Leroy (2010) and Krumholz (2013) to our observations and find that they both predict the trend in the data, suggesting that the inclusion of a diffuse neutral medium is important at lower metallicity.Comment: 24 pages, 14 figures, accepted for publication in ApJ. FITS files of the dust-based estimates of the H2 column densities for the LMC and SMC (shown in Figures 2 and 3) will be available online through Ap

Randomized Trial to Reduce Air Particle Levels in Homes of Smokers and Children

Introduction Exposure to fine particulate matter in the home from sources such as smoking, cooking, and cleaning may put residents, especially children, at risk for detrimental health effects. A randomized clinical trial was conducted from 2011 to 2016 to determine whether real-time feedback in the home plus brief coaching of parents or guardians could reduce fine particle levels in homes with smokers and children. Design A randomized trial with two groups—intervention and control. Setting/participants A total of 298 participants from predominantly low-income households with an adult smoker and a child aged \u3c14 years. Participants were recruited during 2012–2015 from multiple sources in San Diego, mainly Women, Infants and Children Program sites. Intervention The multicomponent intervention consisted of continuous lights and brief sound alerts based on fine particle levels in real time and four brief coaching sessions using particle level graphs and motivational interviewing techniques. Motivational interviewing coaching focused on particle reduction to protect children and other occupants from elevated particle levels, especially from tobacco-related sources. Main outcome measures In-home air particle levels were measured by laser particle counters continuously in both study groups. The two outcomes were daily mean particle counts and percentage time with high particle concentrations (\u3e15,000 particles/0.01 ft3). Linear mixed models were used to analyze the differential change in the outcomes over time by group, during 2016–2017. Results Intervention homes had significantly larger reductions than controls in daily geometric mean particle concentrations (18.8% reduction vs 6.5% reduction, p\u3c0.001). Intervention homes’ average percentage time with high particle concentrations decreased 45.1% compared with a 4.2% increase among controls (difference between groups p\u3c0.001). Conclusions Real-time feedback for air particle levels and brief coaching can reduce fine particle levels in homes with smokers and young children. Results set the stage for refining feedback and possible reinforcing consequences for not generating smoke-related particles. Trial registration This study is registered at www.clinicaltrials.gov NCT01634334

Developing and Selecting Auditory Warnings for a Real-Time Behavioral Intervention

Real-time sensing and computing technologies are increasingly used in the delivery of real-time health behavior interventions. Auditory signals play a critical role in many of these interventions, impacting not only behavioral response but also treatment adherence and participant retention. Yet, few behavioral interventions that employ auditory feedback report the characteristics of sounds used and even fewer design signals specifically for their intervention. This paper describes a four-step process used in developing and selecting auditory warnings for a behavioral trial designed to reduce indoor secondhand smoke exposure. In step one, relevant information was gathered from ergonomic and behavioral science literature to assist a panel of research assistants in developing criteria for intervention-specific auditory feedback. In step two, multiple sounds were identified through internet searches and modified in accordance with the developed criteria, and two sounds were selected that best met those criteria. In step three, a survey was conducted among 64 persons from the primary sampling frame of the larger behavioral trial to compare the relative aversiveness of sounds, determine respondents\u27 reported behavioral reactions to those signals, and assess participant’s preference between sounds. In the final step, survey results were used to select the appropriate sound for auditory warnings. Ultimately, a single-tone pulse, 500 milliseconds (ms) in length that repeats every 270 ms for three cycles was chosen for the behavioral trial. The methods described herein represent one example of steps that can be followed to develop and select auditory feedback tailored for a given behavioral intervention

THE RELATIONSHIP BETWEEN MOLECULAR GAS, H I, AND STAR FORMATION IN THE LOW-MASS, LOW-METALLICITY MAGELLANIC CLOUDS

The Magellanic Clouds provide the only laboratory to study the effects of metallicity and galaxy mass on molecular gas and star formation at high (∼20 pc) resolution. We use the dust emission from HERITAGE Herschel data to map the molecular gas in the Magellanic Clouds, avoiding the known biases of CO emission as a tracer of . Using our dust-based molecular gas estimates, we find molecular gas depletion times () of ∼0.4 Gyr in the Large Magellanic Cloud and ∼0.6 in the Small Magellanic Cloud at 1 kpc scales. These depletion times fall within the range found for normal disk galaxies, but are shorter than the average value, which could be due to recent bursts in star formation. We find no evidence for a strong intrinsic dependence of the molecular gas depletion time on metallicity. We study the relationship between the gas and the star formation rate across a range of size scales from 20 pc to ≥1 kpc, including how the scatter in changes with the size scale, and discuss the physical mechanisms driving the relationships. We compare the metallicity-dependent star formation models of Ostriker et al. and Krumholz to our observations and find that they both predict the trend in the data, suggesting that the inclusion of a diffuse neutral medium is important at lower metallicit

Dust and Gas in the Magellanic Clouds from the HERITAGE Herschel Key Project. II. Gas-to-Dust Ratio Variations across ISM Phases

The spatial variations of the gas-to-dust ratio (GDR) provide constraints on the chemical evolution and lifecycle of dust in galaxies. We examine the relation between dust and gas at 10-50 pc resolution in the Large and Small Magellanic Clouds (LMC and SMC) based on Herschel far-infrared (FIR), H I 21 cm, CO, and Halpha observations. In the diffuse atomic ISM, we derive the gas-to-dust ratio as the slope of the dust-gas relation and find gas-to-dust ratios of 380+250-130 in the LMC, and 1200+1600-420 in the SMC, not including helium. The atomic-to-molecular transition is located at dust surface densities of 0.05 Mo pc-2 in the LMC and 0.03 Mo pc-2 in the SMC, corresponding to AV ~ 0.4 and 0.2, respectively. We investigate the range of CO-to-H2 conversion factor to best account for all the molecular gas in the beam of the observations, and find upper limits on XCO to be 6x1020 cm-2 K-1 km-1 s in the LMC (Z=0.5Zo) at 15 pc resolution, and 4x 1021 cm-2 K-1 km-1 s in the SMC (Z=0.2Zo) at 45 pc resolution. In the LMC, the slope of the dust-gas relation in the dense ISM is lower than in the diffuse ISM by a factor ~2, even after accounting for the effects of CO-dark H2 in the translucent envelopes of molecular clouds. Coagulation of dust grains and the subsequent dust emissivity increase in molecular clouds, and/or accretion of gas-phase metals onto dust grains, and the subsequent dust abundance (dust-to-gas ratio) increase in molecular clouds could explain the observations. In the SMC, variations in the dust-gas slope caused by coagulation or accretion are degenerate with the effects of CO-dark H2. Within the expected 5--20 times Galactic XCO range, the dust-gas slope can be either constant or decrease by a factor of several across ISM phases. Further modeling and observations are required to break the degeneracy between dust grain coagulation, accretion, and CO-dark H2

Travel-Related Venous Thrombosis: Results from a Large Population-Based Case Control Study (MEGA Study)

BACKGROUND: Recent studies have indicated an increased risk of venous thrombosis after air travel. Nevertheless, questions on the magnitude of risk, the underlying mechanism, and modifying factors remain unanswered. METHODS AND FINDINGS: We studied the effect of various modes and duration of travel on the risk of venous thrombosis in a large ongoing case-control study on risk factors for venous thrombosis in an unselected population (MEGA study). We also assessed the combined effect of travel and prothrombotic mutations, body mass index, height, and oral contraceptive use. Since March 1999, consecutive patients younger than 70 y with a first venous thrombosis have been invited to participate in the study, with their partners serving as matched control individuals. Information has been collected on acquired and genetic risk factors for venous thrombosis. Of 1,906 patients, 233 had traveled for more than 4 h in the 8 wk preceding the event. Traveling in general was found to increase the risk of venous thrombosis 2-fold (odds ratio [OR] 2.1; 95% confidence interval [CI] 1.5–3.0). The risk of flying was similar to the risks of traveling by car, bus, or train. The risk was highest in the first week after traveling. Travel by car, bus, or train led to a high relative risk of thrombosis in individuals with factor V Leiden (OR 8.1; 95% CI 2.7–24.7), in those who had a body mass index of more than 30 kg/m(2) (OR 9.9; 95% CI 3.6–27.6), in those who were more than 1.90 m tall (OR 4.7; 95% CI 1.4–15.4), and in those who used oral contraceptives (estimated OR > 20). For air travel these synergistic findings were more apparent, while people shorter than 1.60 m had an increased risk of thrombosis after air travel (OR 4.9; 95% CI 0.9–25.6) as well. CONCLUSIONS: The risk of venous thrombosis after travel is moderately increased for all modes of travel. Subgroups exist in which the risk is highly increased

The Absolute Risk of Venous Thrombosis after Air Travel: A Cohort Study of 8,755 Employees of International Organisations

In a cohort study of 8,755 employees of large international organizations followed for 38,910 person-years, Suzanne Cannegieter and colleagues find a risk of one thrombosis per 4,656 long-haul flights

Communication style and exercise compliance in physiotherapy (CONNECT). A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods

Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations. \ud \ud This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded. \ud \ud We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects. \ud \ud This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients’ adherence to rehabilitation recommendations. Current Controlled Trials ISRCTN63723433\u