Action, actor, context, target, time (AACTT): a framework for specifying behaviour

BACKGROUND: Designing implementation interventions to change the behaviour of healthcare providers and other professionals in the health system requires detailed specification of the behaviour(s) targeted for change to ensure alignment between intervention components and measured outcomes. Detailed behaviour specification can help to clarify evidence-practice gaps, clarify who needs to do what differently, identify modifiable barriers and enablers, design interventions to address these and ultimately provides an indicator of what to measure to evaluate an intervention's effect on behaviour change. An existing behaviour specification framework proposes four domains (Target, Action, Context, Time; TACT), but insufficiently clarifies who is performing the behaviour (i.e. the Actor). Specifying the Actor is especially important in healthcare settings characterised by multiple behaviours performed by multiple different people. We propose and describe an extension and re-ordering of TACT to enhance its utility to implementation intervention designers, practitioners and trialists: the Action, Actor, Context, Target, Time (AACTT) framework. We aim to demonstrate its application across key steps of implementation research and to provide tools for its use in practice to clarify the behaviours of stakeholders across multiple levels of the healthcare system. METHODS AND RESULTS: We used French et al.'s four-step implementation process model to describe the potential applications of the AACTT framework for (a) clarifying who needs to do what differently, (b) identifying barriers and enablers, (c) selecting fit-for-purpose intervention strategies and components and (d) evaluating implementation interventions. CONCLUSIONS: Describing and detailing behaviour using the AACTT framework may help to enhance measurement of theoretical constructs, inform development of topic guides and questionnaires, enhance the design of implementation interventions and clarify outcome measurement for evaluating implementation interventions

Introduction to the computational structural mechanics testbed

The Computational Structural Mechanics (CSM) testbed software system based on the SPAR finite element code and the NICE system is described. This software is denoted NICE/SPAR. NICE was developed at Lockheed Palo Alto Research Laboratory and contains data management utilities, a command language interpreter, and a command language definition for integrating engineering computational modules. SPAR is a system of programs used for finite element structural analysis developed for NASA by Lockheed and Engineering Information Systems, Inc. It includes many complementary structural analysis, thermal analysis, utility functions which communicate through a common database. The work on NICE/SPAR was motivated by requirements for a highly modular and flexible structural analysis system to use as a tool in carrying out research in computational methods and exploring computer hardware. Analysis examples are presented which demonstrate the benefits gained from a combination of the NICE command language with a SPAR computational modules

Syk tyrosine kinase is critical for B cell antibody responses and memory B cell survival

Signals from the BCR are required for Ag-specific B cell recruitment into the immune response. Binding of Ag to the BCR induces phosphorylation of immune receptor tyrosine-based activation motifs in the cytoplasmic domains of the CD79a and CD79b signaling subunits, which subsequently bind and activate the Syk protein tyrosine kinase. Earlier work with the DT40 chicken B cell leukemia cell line showed that Syk was required to transduce BCR signals to proximal activation events, suggesting that Syk also plays an important role in the activation and differentiation of primary B cells during an immune response. In this study, we show that Syk-deficient primary mouse B cells have a severe defect in BCR-induced activation, proliferation, and survival. Furthermore, we demonstrate that Syk is required for both T-dependent and T-independent Ab responses, and that this requirement is B cell intrinsic. In the absence of Syk, Ag fails to induce differentiation of naive B cells into germinal center B cells and plasma cells. Finally, we show that the survival of existing memory B cells is dependent on Syk. These experiments demonstrate that Syk plays a critical role in multiple aspects of B cell Ab responses

'Better' clinical decisions do not necessarily require more time to make

The Web-based intervention modeling experiment (IME; randomized study in a simulated setting) reported by Treweek et al. [1] provided support for using IME methodology in the evaluation of interventions to improve quality of care. As well as the management decision made, Treweek et al.'s data on general practitioners' (GPs) responses to scenarios describing uncomplicated upper respiratory tract infection (URTI) included a measure of perceived decision difficulty for each decision and the time taken to make each decision

Educating professionals to support self-management in people with asthma or diabetes: protocol for a systematic review and scoping exercise

This report is independent research funded by the National Institute for Health Research (Programme Development Grants, Implementing supported asthma self-management in routine clinical care: designing, refining, piloting and evaluating a whole systems implementation within an MRC Phase IV programme of research, RP-DG-1213-10008). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. This work is sponsored by the University of Edinburgh. The funder and sponsor have not had any role in developing the protocol

Na,K-ATPase alpha isoforms at the blood-cerebrospinal fluid-trigeminal nerve and blood-retina interfaces in the rat

Background: Cerebrospinal fluid (CSF) sodium concentration increases during migraine attacks, and both CSF and vitreous humor sodium increase in the rat migraine model. The Na,K-ATPase is a probable source of these sodium fluxes. Since Na,K-ATPase isoforms have different locations and physiological roles, our objective was to establish which alpha isoforms are present at sites where sodium homeostasis is disrupted. Methods: Specific Na,K-ATPase alpha isoforms were identified in rat tissues by immunohistochemistry at the blood-CSF barrier at the choroid plexus, at the blood-CSF-trigeminal barrier at the meninges, at the blood-retina barrier, and at the blood-aqueous barrier at the ciliary body. Calcitonin gene-related peptide (CGRP), occludin, or von Willibrand factor (vWF) were co-localized with Na,K-ATPase to identify trigeminal nociceptor fibers, tight junctions, and capillary endothelial cells respectively. Results: The Na,K-ATPase alpha-2 isoform is located on capillaries and intensely at nociceptive trigeminal nerve fibers at the meningeal blood-CSF-trigeminal barrier. Alpha-1 and −3 are lightly expressed on the trigeminal nerve fibers but not at capillaries. Alpha-2 is expressed at the blood-retina barriers and, with alpha-1, at the ciliary body blood aqueous barrier. Intense apical membrane alpha-1 was associated with moderate cytoplasmic alpha-2 expression at the choroid plexus blood-CSF barrier. Conclusion: Na,K-ATPase alpha isoforms are present at the meningeal, choroid plexus, and retinal barriers. Alpha-2 predominates at the capillary endothelial cells in the meninges and retinal ganglion cell layer

The chameleon groups of Richard J. Thompson: automorphisms and dynamics

The automorphism groups of several of Thompson's countable groups of piecewise linear homeomorphisms of the line and circle are computed and it is shown that the outer automorphism groups of these groups are relatively small. These results can be interpreted as stability results for certain structures of PL functions on the circle. Machinery is developed to relate the structures on the circle to corresponding structures on the line

Knaster's problem for (Z2)k(Z_2)^k-symmetric subsets of the sphere S2k−1S^{2^k-1}

We prove a Knaster-type result for orbits of the group $(Z_2)^k$ in $S^{2^k-1}$, calculating the Euler class obstruction. Among the consequences are: a result about inscribing skew crosspolytopes in hypersurfaces in $\mathbb R^{2^k}$, and a result about equipartition of a measures in $\mathbb R^{2^k}$ by $(Z_2)^{k+1}$-symmetric convex fans

Maximum Oxygen Uptake During Long-Duration Space Flight: Preliminary Results

INTRODUCTION: Maximum oxygen uptake (VO2max) is maintained during space flight lasting <15 d, but has not been measured during long-duration missions. This abstract describes pre-flight and in-flight preliminary findings from the International Space Station (ISS) VO2max experiment. METHODS: Seven astronauts (4 M, 3 F: 47 +/- 5 yr, 174 +/- 7 cm, 74.1 +/- 14.7 kg [mean +/- SD]) performed cycle exercise tests to volitional maximum approx.45 d before flight and tests were scheduled every 30 d during flight beginning on flight day (FD) 14. Tests consisted of three 5-min stages designed to elicit 25%, 50%, and 75% of preflight VO2max, followed by 25 W/min increases. VO2 and heart rate (HR) were measured using the ISS Portable Pulmonary Function System (PPFS) (Damec, Odense, DK). Unfortunately the PPFS did not arrive at the ISS in time to support early test sessions for 3 crewmembers. Descriptive statistics are presented for pre-flight vs. late-flight (FD 147 +/- 33 d) comparisons for all subjects (n=7); and pre-flight, early (FD 18 +/- 3) and late-flight (FD 156 +/- 5) data are presented for subjects (n=4) who completed all of these test sessions. RESULTS: When all subjects are considered, average VO2max decreased from pre- to late in-flight (2.98 +/- 0.85 vs. 2.57 +/- 0.50 L/min) while maximum HR late-flight seemed unchanged (178 +/- 9 vs. 175 +/- 8 beats/min). Similarly, for subjects who completed pre-, early, and late flight measurements (n=4), mean VO2max declined from 3.19 +/- 0.75 L/min preflight to 2.43 +/- 0.43 and 2.62 +/- 0.38 L/min early and late-flight, respectively. Maximum HR was 183 +/- 8, 174 +/- 8, and 179 +/- 6 beats/min pre-, early- and late-flight. DISCUSSION: Average VO2max declined during flight and did not appreciably recover as flight duration increased; however much inter-subject variation occurred in these changes

Oxygen Uptake Responses to Submaximal Exercise Loads Do Not Change During Long-Duration Space Flight

In previous publications we have reported that the heart rate (HR) responses to graded submaximal exercise tests are elevated during long-duration International Space Station (ISS) flights. Furthermore, the elevation in HR appears greater earlier, rather than later, during the missions. A potential confounder in the interpretation of HR results from graded exercise tests on ISS is that the cycle ergometer used (CEVIS) is vibration-isolated from the station structure. This feature causes the CEVIS assembly to sway slightly during its use and debriefing comments by some crewmembers indicate that there is a "learning curve" associated with CEVIS use. Therefore, one could not exclude the possibility that the elevated HRs experienced in the early stages of ISS missions were related to a lowered metabolic efficiency of CEVIS exercise that would raise the submaximal oxygen uptake (VO2) associated with graded exercise testing work rates