Digital Intervention With Lifestyle Coach Support to Target Dietary and Physical Activity Behaviors of Adults With Nonalcoholic Fatty Liver Disease: Systematic Development Process of VITALISE Using Intervention Mapping

Background: Non-alcoholic fatty liver disease (NAFLD) is linked to excess calorie consumption, physical inactivity and being overweight. Patients with NAFLD can halt or decelerate progression, and potentially reverse their condition by changing their lifestyle behaviour. National and international guidelines recommend the use of lifestyle interventions, however there remains a discordance between published guidelines and clinical practice. This is primarily due to a lack of NAFLD-specific lifestyle interventions to support weight loss and improve liver function. Objective: To use Intervention Mapping to systematically develop a digital intervention to support patients with NAFLD to initiate and maintain changes to their dietary and physical activity behaviour to promote weight loss. Methods: Intervention Mapping consisted of 6 steps. A needs assessment with primary and secondary healthcare professionals and patients with NAFLD (step 1). Identification of the social cognitive determinants of change and behavioural outcomes of the intervention (step 2). Linking social cognitive determinants of behavioural outcomes with behaviour change techniques to effectively target dietary and physical activity behaviour (step 3). Step 4 involved the development of a prototype digital intervention that integrated the strategies from step 3, and the information content identified as important for improving knowledge and skills from steps 1 and 2. Step 5 involved development of an implementation plan with a digital provider of lifestyle behaviour change programmes to NHS patients using their delivery platform and lifestyle coaches. Finally, step 6 involved piloting the digital intervention with patients to obtain data on access, usability and content. Results: A digital intervention was developed consisting of eight modules, self-regulatory tools and provision of telephone support by trained lifestyle coaches to help facilitate behavioural intention, enactment and maintenance. A commercial provider of digital lifestyle behaviour change programmes enrolled 16 patients with NAFLD to the prototype intervention for 12 consecutive weeks. Eleven of the 16 participants successfully accessed the intervention and continued to engage with the content following initial log-in (on average four times over the piloting period). Most frequently accessed modules were “welcome to the programme”, “understanding NAFLD”, and “food and NAFLD”. Goal setting and self-monitoring tools were accessed on 22 occasions (four times per tool on average). Three out of eleven participants requested access to a lifestyle coach. Conclusions: Intervention Mapping provided a systematic methodological framework to guide a theory- and evidence-informed co-design intervention development process with patients and HCPs. The digital intervention with remote support by a lifestyle coach was acceptable to patients with NAFLD and feasible to deliver. Issues with initial access, optimisation of information content and promoting the value of remote lifestyle coach support require further development ahead of future research to establish intervention effectiveness

Country Characteristics, Internet Connectivity and Combating Misinformation: A Network Analysis of Global North-South

Analyzing data on 152 countries using network and regression analyses, this study examined how countries’ positions in the global Internet network are associated with their political, economic, and technological characteristics, and how those characteristics are related to media, information, and digital (MID) education programs in the countries. This research shows countries with higher levels of international Internet bandwidth capacity, Internet use, and press freedom status are more likely to have MID programs that are comprehensive. Differences between Global North and Global South countries were significant both in terms of Internet capacity and use and in terms of MID complexity and dimensions. MID literacy education is an important long-term solution to misinformation, as such education informs people’s epistemological beliefs which in turn have direct effects on their comprehension of various issues and topics. This study offers important scholarly and policy implications in the areas of digital connectivity, MID literacies, misinformation, and international communication. In particular, it offers guidance for comparative studies in this area

Lifestyle Behavior Change in Patients With Nonalcoholic Fatty Liver Disease:A Qualitative Study of Clinical Practice

Nonalcoholic fatty liver disease (NAFLD) is the most common liver condition worldwide and is linked largely to obesity and inactivity. Lifestyle modification is the primary treatment for NAFLD targeting dietary change, physical activity, and exercise to facilitate weight loss and weight loss maintenance. This has been shown to reduce steatosis and ameliorate steatohepatitis. European Clinical Practice Guidelines for the management of NAFLD highlight the importance of targeting lifestyle behavior change in all patients with NAFLD regardless of disease severity. These guidelines recommend combining dietary restriction and a progressive increase in aerobic exercise and resistance training with a focus on tailoring interventions to the individual patient. Practice guidelines published by the American Association for the Study of Liver Diseases recommend weight loss of at least 3% to 5% of body weight via hypocaloric diet or diet combined with increased physical activity but state that these lifestyle interventions should target patients with nonalcoholic steatohepatitis. Given the benefits of lifestyle behavior change, this study explored the perceptions surrounding clinical care as currently offered to patients with NAFLD. The aim of this study was to establish whether current provision of lifestyle behavior change support is sufficient, whether health care professionals believe they have the tools to target lifestyle behavior changes effectively, and how targeting diet and physical activity/exercise to facilitate weight loss and weight loss maintenance in practice can be improved from the perspective of health care professionals and patients

Death or survival from invasive pneumococcal disease in Scotland: associations with serogroups and multilocus sequence types

We describe associations between death from invasive pneumococcal disease (IPD) and particular serogroups and sequence types (STs) determined by multilocus sequence typing (MLST) using data from Scotland. All IPD episodes where blood or cerebrospinal fluid (CSF) culture isolates were referred to the Scottish Haemophilus, Legionella, Meningococcal and Pneumococcal Reference Laboratory (SHLMPRL) from January 1992 to February 2007 were matched to death certification records by the General Register Office for Scotland. This represented 5959 patients. The median number of IPD cases in Scotland each year was 292. Deaths, from any cause, within 30 days of pneumococcal culture from blood or CSF were considered to have IPD as a contributing factor. Eight hundred and thirty-three patients died within 30 days of culture of Streptococcus pneumoniae from blood or CSF [13.95%; 95% confidence interval (13.10, 14.80)]. The highest death rates were in patients over the age of 75. Serotyping data exist for all years but MLST data were only available from 2001 onward. The risk ratio of dying from infection due to particular serogroups or STs compared to dying from IPD due to all other serogroups or STs was calculated. Fisher's exact test with Bonferroni adjustment for multiple testing was used. Age adjustment was accomplished using the Cochran-Mantel-Haenszel test and 95% confidence intervals were reported. Serogroups 3, 11 and 16 have increased probability of causing fatal IPD in Scotland while serogroup 1 IPD has a reduced probability of causing death. None of the 20 most common STs were significantly associated with death within 30 days of pneumococcal culture, after age adjustment. We conclude that there is a stronger association between a fatal outcome and pneumococcal capsular serogroup than there is between a fatal outcome and ST

The View from the Top: CALIOP Ice Water Content in the Uppermost Layer of Tropical Cyclones

NASA's CALIPSO satellite carries both the Cloud and Aerosol Lidar with Orthogonal Polarization (CALIOP) and the Imaging Infrared Radiometer (IIR). The lidar is ideally suited to viewing the very top of tropical cyclones, and the IIR provides critical optical and microphysical information. The lidar and the IIR data work together to understand storm clouds since they are perfectly co-located, and big tropical cyclones provide an excellent complex target for comparing the observations. There is a lot of information from these case studies for understanding both the observations and the tropical cyclones, and we are just beginning to scratch the surface of what can be learned. Many tropical cyclone cloud particle measurements are focused on the middle and lower regions of storms, but characterization of cyclone interaction with the lowermost stratosphere at the upper storm boundary may be important for determining the total momentum and moisture transport budget, and perhaps for predicting storm intensity as well. A surprising amount of cloud ice is to be found at the very top of these big storms

BAFF selectively enhances the survival of plasmablasts generated from human memory B cells

The generation of Ig-secreting cells (ISCs) from memory B cells requires interactions between antigen-specific (Ag-specific) B cells, T cells, and dendritic cells. This process must be strictly regulated to ensure sufficient humoral immunity while avoiding production of pathogenic autoantibodies. BAFF, a member of the TNF family, is a key regulator of B cell homeostasis. BAFF exerts its effect by binding to three receptors — transmembrane activator of and CAML interactor (TACI), B cell maturation antigen (BCMA), and BAFF receptor (BAFF-R). To elucidate the contribution of BAFF to the differentiation of B cells into ISCs, we tracked the fate of human memory B cells stimulated with BAFF or CD40L. BAFF and CD40L significantly increased the overall number of surviving B cells. This was achieved via distinct mechanisms. CD40L induced proliferation of nondifferentiated blasts, while BAFF prevented apoptosis of ISCs without enhancing proliferation. The altered responsiveness of activated memory B cells to CD40L and BAFF correlated with changes in surface phenotype such that expression of CD40 and BAFF-R were reduced on ISCs while BCMA was induced. These results suggest BAFF may enhance humoral immunity in vivo by promoting survival of ISCs via a BCMA-dependent mechanism. These findings have wide-ranging implications for the treatment of human immunodeficiencies as well as autoimmune diseases.This work was supported by the National Health and Medical Research Council of Australia. S.G. Tangye was supported by a U2000 Postdoctoral Fellowship awarded by the University of Sydney. P.D. Hodgkin is a Senior Research Fellow of the National Health and Medical Research Council of Australia. F. Mackay is a Wellcome Trust Senior Research Fellow