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

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

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

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

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

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

StearoylCoA Desaturase-5: A Novel Regulator of Neuronal Cell Proliferation and Differentiation

Recent studies have demonstrated that human stearoylCoA desaturase-1 (SCD1), a Δ9-desaturase that converts saturated fatty acids (SFA) into monounsaturated fatty acids, controls the rate of lipogenesis, cell proliferation and tumorigenic capacity in cancer cells. However, the biological function of stearoylCoA desaturase-5 (SCD5), a second isoform of human SCD that is highly expressed in brain, as well as its potential role in human disease, remains unknown. In this study we report that the constitutive overexpression of human SCD5 in mouse Neuro2a cells, a widely used cell model of neuronal growth and differentiation, displayed a greater n-7 MUFA-to-SFA ratio in cell lipids compared to empty-vector transfected cells (controls). De novo synthesis of phosphatidylcholine and cholesterolesters was increased whereas phosphatidylethanolamine and triacylglycerol formation was reduced in SCD5-expressing cells with respect to their controls, suggesting a differential use of SCD5 products for lipogenic reactions. We also observed that SCD5 expression markedly accelerated the rate of cell proliferation and suppressed the induction of neurite outgrowth, a typical marker of neuronal differentiation, by retinoic acid indicating that the desaturase plays a key role in the mechanisms of cell division and differentiation. Critical signal transduction pathways that are known to modulate these processes, such epidermal growth factor receptor (EGFR)Akt/ERK and Wnt, were affected by SCD5 expression. Epidermal growth factor-induced phosphorylation of EGFR, Akt and ERK was markedly blunted in SCD5-expressing cells. Furthermore, the activity of canonical Wnt was reduced whereas the non-canonical Wnt was increased by the presence of SCD5 activity. Finally, SCD5 expression increased the secretion of recombinant Wnt5a, a non-canonical Wnt, whereas it reduced the cellular and secreted levels of canonical Wnt7b. Our data suggest that, by a coordinated modulation of key lipogenic pathways and transduction signaling cascades, SCD5 participates in the regulation of neuronal cell growth and differentiation

Species Accumulation Curves and Incidence-Based Species Richness Estimators to Appraise the Diversity of Cultivable Yeasts from Beech Forest Soils

Background: Yeast-like fungi inhabit soils throughout all climatic zones in a great abundance. While recent estimations predicted a plethora of prokaryotic taxa in one gram of soil, similar data are lacking for fungi, especially yeasts. Methodology/Principal Findings: We assessed the diversity of soil yeasts in different forests of central Germany using cultivation-based techniques with subsequent identification based on rDNA sequence data. Based on experiments using various pre-cultivation sample treatment and different cultivation media we obtained the highest number of yeasts by analysing mixed soil samples with a single nutrient-rich medium. Additionally, several species richness estimators were applied to incidence-based data of 165 samples. All of them predicted a similar range of yeast diversity, namely 14 to 16 species. Randomized species richness curves reached saturation in all applied estimators, thus indicating that the majority of species is detected after approximately 30 to 50 samples analysed. Conclusions/Significance: In this study we demonstrate that robust species identification as well as mathematical approaches are essential to reliably estimate the sampling effort needed to describe soil yeast communities. This approach has great potential for optimisation of cultivation techniques and allows high throughput analysis in the future