The development and evaluation of a web-based well-being intervention, for inclusion within an existing health promotion programme, to support and encourage health related lifestyle behaviour change

Unhealthy lifestyle behaviours constitute a significant burden of disease, globally. Web-based interventions offer a means to support individuals in adopting and maintaining positive healthy lifestyle behaviours to address and reduce this issue. The health behaviour change literature offers several useful theoretical models which aim to explain or predict the likelihood of successful, individual level, lifestyle behaviour change. Indeed, research findings have shown that digital health interventions informed by these models are more likely to be effective. However, in practice adherence and engagement to web-delivered interventions is often critically low and is associated with reduced effectiveness and cost effectiveness. This thesis developed an emotional well-being intervention (ACTivate your Well-being), for inclusion within an existing lifestyle behaviour change programme ‘Champions for Health’. Thirty-eight anticipated end-users and six stakeholders contributed to a three-staged Participatory Design project which led to the development of a twelve-week intervention, based on Acceptance and Commitment Therapy, and a new study website. Development was informed by two systematic literature reviews. Feasibility and acceptability were proven in a cluster randomised control trial (ISRCTN50074817) which recruited 142 participants. The majority (74%) enrolled on at least one lifestyle behaviour change module and health improvements were observed. Almost half (43%) of those randomised to the intervention arm enrolled onto the well-being intervention. Adherence was low (7%), no one completed the full 12-week programme. A randomised control trial (ISRCTN18190978) then evaluated impact on health behaviour change, adherence and engagement, and well-being. 182 participants were recruited. Adherence remained poor (4%) however some completed the full 12-week programme. Almost half (49%) enrolled on a lifestyle behaviour change module and health improvements were observed in three modules. COVID-19 limited evaluation. The ongoing relevance of the intervention and website is evidenced through its inclusion within the Well-being In work – In work support service, Swansea Bay University Health Board

A mixed methods evaluation of a peer mentoring programme (PASS) for international postgraduate students; Mentee and Mentor perspectives

Peer mentoring provides academic, social, and pastoral support to students. This enhances their educational experience and supports learning. However less is known about the value for international master’s students studying in the UK. To address this gap, this study introduced and evaluated a peer assisted study session (PASS) model of peer mentoring. Mentee expectations were explored at baseline: these were high and varied considerably. The post intervention survey showed students were (78-82%) highly satisfied with the quality, range of topics, usefulness, and opportunities for peer interaction provided by the ten-week, in-person programme. Equally mentors valued the experience; they developed leadership and communication skills, deepened their subject knowledge, and gained transferable skills. Despite this, mentees and mentors alike called for additional, longer sessions, and smaller mentor to mentee ratios to meet the demands and challenges faced by international students. Recommendations and practical implications for programme teams are identified

Divergence of NHS choice policy in the UK: what difference has patient choice policy in England made?

OBJECTIVES: To examine the types of choices available to patients in the English NHS when being referred for acute hospital care in the light of the divergence of patient choice policy in the four countries of the UK. METHODS: Case studies of eight local health economies in England, Scotland, Northern Ireland and Wales (two in each country); 125 semi-structured interviews with staff in acute services providers, purchasers and general practitioners (GPs). RESULTS: GPs and providers in England both had a clear understanding of the choice of provider policy and the right of patients to choose a provider. Other referral choices potentially available to patients in all four countries were date and time of appointment, site and specialist. In practice, the availability of these choices differed between and within countries and was shaped by factors beyond choice policy, such as the number of providers in an area. There were similarities between the four countries in the way choices were offered to patients, namely lack of clarity about the options available, limited discussion of choices between referrers and patients, and tension between offering choice and managing waiting lists. CONCLUSIONS: There are challenges in implementing pro-choice policy in health care systems where it has not traditionally existed. Differences between England and the other countries of the UK were limited in the way choice was offered to patients. A cultural shift is needed to ensure that patients are fully informed by GPs of the choices available to them

Development of a Web-Based Acceptance and Commitment Therapy Intervention to Support Lifestyle Behavior Change and Well-Being in Health Care Staff: Participatory Design Study

Background: Positive emotional well-being is associated with healthier lifestyle choices and overall health function, whereas poor mental health is associated with significant economic and psychological costs. Thus, the development of effective interventions that improve emotional well-being is crucial to address the worldwide burden of disease. Objective: This study aims to develop a web-based emotional well-being intervention for use by health care staff using participatory design to consider adherence and engagement from a user perspective. Methods: A 3-staged iterative participatory design process was followed, including multiple stakeholders: researchers, computer scientists, mental health experts, and health care staff. Stage 1 used document analyses, direct observation, and welcome interviews; stage 2 used focus group discussions, rapid prototyping, and usability tasks; and stage 3 evaluated a high-fidelity prototype. Results: Different health care staff (N=38) participated during a sustained period. A structured, sequential, automated, 12-week, web-based emotional well-being intervention based on acceptance and commitment therapy was developed. Freely navigated psychoeducational resources were also included. Conclusions: The iterative and collaborative participatory design process successfully met its objectives. It generated an in-depth understanding of well-being within the workplace and identified barriers to access. The 3-staged process ensured that participants had the opportunity to explore and articulate criteria relevant to their roles over time and reflect on decisions made at each stage

The X-ray spectrum of the newly discovered accreting millisecond pulsar IGR J17511-3057

We report on an XMM-Newton observation of the accreting millisecond pulsar, IGR J17511-3057. Pulsations at 244.8339512(1) Hz are observed with an RMS pulsed fraction of 14.4(3)%. A precise solution for the P_orb=12487.51(2)s binary system is derived. The measured mass function indicates a main sequence companion with a mass between 0.15 and 0.44 Msun. The XMM-Newton spectrum of the source can be modelled by at least three components, multicoloured disc emission, thermal emission from the NS surface and thermal Comptonization emission. Spectral fit of the XMM-Newton data and of the RXTE data, taken in a simultaneous temporal window, constrain the Comptonization parameters: the electron temperature, kT_e=51(+6,-4) keV, is rather high, while the optical depth (tau=1.34(+0.03,-0.06)) is moderate. The energy dependence of the pulsed fraction supports the interpretation of the cooler thermal component as coming from the accretion disc, and indicates that the Comptonizing plasma surrounds the hot spots on the NS surface, which provide the seed photons. Signatures of reflection, such as a broadened iron K-alpha emission line and a Compton hump at 30 keV ca., are also detected. We derive from the smearing of the reflection component an inner disc radius of ~> 40 km for a 1.4 Msun neutron star, and an inclination between 38{\deg} and 68{\deg}. XMM-Newton also observed two type-I X-ray bursts, probably ignited in a nearly pure helium environment. No photospheric radius expansion is observed, thus leading to an upper limit on the distance to the source of 10 kpc. A lower limit of 6.5 kpc can be also set if it is assumed that emission during the decaying part of the burst involves the whole neutron star surface. Pulsations observed during the burst decay are compatible with being phase locked, and have a similar amplitude, than pre-burst pulsations.Comment: 16 pages, 10 figures, 4 tables, accepted for publication in MNRA

A Content Analysis and Comparison of Two Peaks of Newspaper Reporting During a Suicide Cluster to Examine Implications for Imitation, Suggestion, and Prevention

Background: During 2007–2008, media attention focused on a cluster of youth suicides in the UK. There were two peaks (P1, P2) in the volume of newspaper reporting of the deaths. The number of possible suicides was greater than expected at the time of the first peak but not at the time of the second. Aims: To explore any differences in the content of the reporting peaks and to consider implications for imitation and prevention. Method: A content analysis of two peaks of newspaper reporting was conducted. Results: There were 204 articles in P1 (December 27, 2007 to February 19, 2008) and 157 in P2 (February 20, 2008 to March 15, 2008). Four main themes were identified: individual stories; possible causes; features of reporting of the cluster; and educating and informing the public. P1 articles more frequently contained: explicit details of method; photographs of the deceased, and contained more characterization of individuals. Limitations: The focus was on print media, future studies should incorporate online and social media content. Conclusion: The findings provide some support for the hypothesis of a process of suggestion initiated by sensationalist reporting in P1. This contributes to the evidence base of the role of the press in suicide imitation and prevention, highlighting the importance of care when reporting suicides

Effectiveness of Web-Delivered Acceptance and Commitment Therapy in Relation to Mental Health and Well-Being: A Systematic Review and Meta-Analysis

BACKGROUND: The need for effective interventions to improve mental health and emotional well-being at a population level are gaining prominence both in the United Kingdom and globally. Advances in technology and widespread adoption of Internet capable devices have facilitated rapid development of Web-delivered psychological therapies. Interventions designed to manage a range of affective disorders by applying diverse therapeutic approaches are widely available. OBJECTIVE: The main aim of this review was to evaluate the evidence base of acceptance and commitment therapy (ACT) in a Web-based delivery format. METHOD: A systematic review of the literature and meta-analysis was conducted. Two electronic databases were searched for Web-delivered interventions utilizing ACT for the management of affective disorders or well-being. Only Randomized Controlled Trials (RCTs) were included. RESULTS: The search strategy identified 59 articles. Of these, 10 articles met the inclusion criteria specified. The range of conditions and outcome measures that were identified limited the ability to draw firm conclusions about the efficacy of Web-delivered ACT-based intervention for anxiety or well-being. CONCLUSIONS: ACT in a Web-based delivery format was found to be effective in the management of depression. Rates of adherence to study protocols and completion were high overall suggesting that this therapeutic approach is highly acceptable for patients and the general public

Recycling of memory B cells between germinal center and lymph node subcapsular sinus supports affinity maturation to antigenic drift

Infection or vaccination leads to the development of germinal centers (GC) where B cells evolve high affinity antigen receptors, eventually producing antibody-forming plasma cells or memory B cells. Here we follow the migratory pathways of B cells emerging from germinal centers (BEM) and find that many BEM cells migrate into the lymph node subcapsular sinus (SCS) guided by sphingosine-1-phosphate (S1P). From the SCS, BEM cells may exit the lymph node to enter distant tissues, while some BEM cells interact with and take up antigen from SCS macrophages, followed by CCL21-guided return towards the GC. Disruption of local CCL21 gradients inhibits the recycling of BEM cells and results in less efficient adaption to antigenic variation. Our findings thus suggest that the recycling of antigen variant-specific BEM cells and transport of antigen back to GC may support affinity maturation to antigenic drift

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication