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Translating dialectic dialogues into persuasive coaching strategies for personalized virtual coach

Obesity has become a major societal problem worldwide [1][2]. The main reason for severe overweight is excessive intake of energy, in relation to the individual needs of a human body. Obesity is associated with poor eating habits and/or a sedentary lifestyle. A significant part of the obese population (40%) belongs to a vulnerable target group of emotional eaters, who overeat due to negative emotions [3]. There is a need for self-management support and personalized coaching to enhance emotional eaters in recognising and self-regulating their emotions.Over the last years, coaching systems have been developed for behavior change support, healthy lifestyle, and physical activity support [4]-[9]. Existing virtual coach applications lack systematic evaluation of coaching strategies and usually function as (tele-)monitoring systems. They are limited to giving general feedback to the user on achieved goals and/or accomplished (online) assignments.Dialectical Behavior Therapy (DBT) focuses on getting more control over one’s ownemotions by reinforcing skills in mindfulness, emotion regulation, and stress tolerance [10]. Emotion regulation is about recognizing and acknowledging emotions and accepting the fact that they come and go. The behavior change strategies within DBT are based on validation and dialectics [11]. Dialectics changes the users’ attitude and behavior by creating incongruence between an attitude and behavior since stimuli or the given information contradict with each other.The ultimate goal of the virtual coach is to raise awareness of emotional eaters on their own emotions, and to enhance a positive change of attitude towards accepting the negative emotions they experience. This should result in a decrease of overeating and giving in to binges. We believe that the integration of the dialectical behavior change strategies and persuasive features from the Persuasive System Design Model by Kukkonen and Harjumaa [12] will enhance the personalization of the virtual coach for this vulnerable group. We aim at developing a personalized virtual coach ‘Denk je zèlf!’ (Dutch for ‘Develop a wise mind and counsel yourself’) providing support for self-regulation of emotions for young obese emotional eaters. This poster presents an eCoaching model and a research study protocol aiming at the validation of persuasive coaching strategies based on behavior change techniques using dialectical strategies. Based on the context (e.g., location), emotional state of the user, and natural language processing, the virtual coach application enables tailoring of the real-time feedback to the individual user. Virtual coach application communicates with the user over a chat timeline and provides personal feedback.The research protocol decribes the two weeks field study on validating persuasive coaching strategies for emotional eaters. Participants (N=30), recruited via a Dutch franchise organization of dietitian nutritionists, specialized in treating emotional eating behaviors, will voluntarily participate in this research study. Participants will be presented with short dialogues (existing questions and answers) and will be asked to select the preferred coaching strategy (validating or a dialectical), according to their (current) emotions. To trigger a certain emotion (e.g., the affect that fits best with the chosen coaching strategy), a set of pictures will be shown to the user that evoke respectively sadness, anger, fear, and disgust [13].Participants will be asked to fill out the demographics data ((nick) name, age, gender, weight, length, place of residence) and three questionnaires: • Dutch Eating Behavior Questionnaire (DEBQ) [14],• Five Factor Personality Inventory (FFPI) [15], • Quality of Life Index Questionnaire [16].This research study aims at answering the following research questions: “Which coaching strategies do users with a specific type of emotional eating behavior benefit most from while consulting their personalized virtual coach?; “Which coaching strategies are optimal for which emotions?” and “Which coaching approach do users prefer in which context, e.g. time of the day, before/after a craving?”

Wearables at work

This exploratory study aims to obtain a first impression of the wishes and needs of employees on the use of wearables at work for health promotion. 76 employ-ees with a mean age of 40 years old (SD ±11.7) filled in a survey after trying out a wearable. Most employees see the potential of using wearable devices for workplace health promotion. However, according to employees, some negative aspects should be overcome before wearables can effectively contribute to health promotion. The most mentioned negative aspects were poor visualization and un-pleasantness of wearing. Specifically for the workplace, employees were con-cerned about the privacy of data collection.

The intensive care medicine research agenda in nutrition and metabolism

PURPOSE: The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years.METHODS: Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0-4). Potential studies were ranked on the basis of average score.RESULTS: Recent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies.CONCLUSIONS: Priorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.

Early high protein intake and mortality in critically ill ICU patients with low skeletal muscle area and -density

Background & aims: Optimal nutritional support during the acute phase of critical illness remains controversial. We hypothesized that patients with low skeletal muscle area and -density may specifically benefit from early high protein intake. Aim of the present study was to determine the association between early protein intake (day 2–4) and mortality in critically ill intensive care unit (ICU) patients with normal skeletal muscle area, low skeletal muscle area, or combined low skeletal muscle area and -density. Methods: Retrospective database study in mechanically ventilated, adult critically ill patients with an abdominal CT-scan suitable for skeletal muscle assessment around ICU admission, admitted from January 2004 to January 2016 (n = 739). Patients received protocolized nutrition with protein target 1.2–1.5 g/kg/day. Skeletal muscle area and -density were assessed on abdominal CT-scans at the 3rd lumbar vertebra level using previously defined cut-offs. Results: Of 739 included patients (mean age 58 years, 483 male (65%), APACHE II score 23), 294 (40%) were admitted with normal skeletal muscle area and 445 (60%) with low skeletal muscle area. Two hundred (45% of the low skeletal muscle area group) had combined low skeletal muscle area and -density. In the normal skeletal muscle area group, no significant associations were found. In the low skeletal muscle area group, higher early protein intake was associated with lower 60-day mortality (adjusted hazard ratio (HR) per 0.1 g/kg/day 0.82, 95%CI 0.73–0.94) and lower 6-month mortality (HR 0.88, 95%CI 0.79–0.98). Similar associations were found in the combined low skeletal muscle area and -density subgroup (HR 0.76, 95%CI 0.64–0.90 for 60-day mortality and HR 0.80, 95%CI 0.68–0.93 for 6-month mortality). Conclusions: Early high protein intake is associated with lower mortality in critically ill patients with low skeletal muscle area and -density, but not in patients with normal skeletal muscle area on admission. These findings may be a further step to personalized nutrition, although randomized studies are needed to assess causality.

Airway care interventions and prone positioning in critically ill patients

Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients

Abstract: INTRODUCTION: Early protein and energy feeding in critically ill patients is heavily debated and early protein feeding hardly studied.