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Background Adherence to weight loss interventions is crucial to successful outcomes, yet little is known about how best to improve it. This suggests a need for developing and improving adherence strategies, such as formal commitments. This review aims to identify the effect of including a commitment device alongside lifestyle interventions on weight loss, and identify the most appropriate delivery mechanisms and target behaviours. Methods We searched five databases and hand-searched reference lists for trials of behavioural interventions to achieve weight loss among adults with excess weight or obesity. Interventions incorporating commitment devices were included in a narrative review and meta-analysis where appropriate. Commitment devices with financial incentives were excluded. Results Of 2675 unique studies, ten met the inclusion criteria. Data from three randomised trials including 409 participants suggests that commitment interventions increases short-term weight loss by a mean of 1.5 kg (95% CI: 0.7, 2.4). Data from two randomised trials including 302 patients suggests that benefits were sustained at 12 months (mean difference 1.7 kg; 95% CI: 0.0, 3.4). Commitment devices appeared most successful when made publicly, and targeting diet rather than physical activity. Conclusions Using commitment devices, such as behavioural contracts, as part of a weight loss intervention may be useful in improving weight loss outcomes and dietary changes, at least in the short-term. However, evidence is limited and of variable quality so results must be interpreted with caution. Poor reporting of intervention details may have limited the number of identified studies. More rigorous methodology and longer term follow-ups are required to determine the effectiveness of behavioural contracts given their potential for use in public health interventions.

ObjectiveThe aim of this review was to investigate whether e-cigarette use compared with non-use in young non-smokers is associated with subsequent cigarette smoking.Data sourcesPubMed, Embase, Web of Science, Wiley Cochrane Library databases, and the 2018 Society for Research on Nicotine and Tobacco and Society for Behavioural Medicine conference abstracts.Study selectionAll studies of young people (up to age 30 years) with a measure of e-cigarette use prior to smoking and an outcome measure of smoking where an OR could be calculated were included (excluding reviews and animal studies).Data extractionIndependent extraction was completed by multiple authors using a preprepared extraction form.Data synthesisOf 9199 results, 17 studies were included in the meta-analysis. There was strong evidence for an association between e-cigarette use among non-smokers and later smoking (OR: 4.59, 95% CI: 3.60 to 5.85) when the results were meta-analysed in a random-effects model. However, there was high heterogeneity (I2 =88%).ConclusionsAlthough the association between e-cigarette use among non-smokers and subsequent smoking appears strong, the available evidence is limited by the reliance on self-report measures of smoking history without biochemical verification. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Much of the evidence also failed to consider the nicotine content of e-liquids used by non-smokers meaning it is difficult to make conclusions about whether nicotine is the mechanism driving this association.

Background Obesity rates are higher among people of lower socioeconomic status. While numerous health behaviour interventions targeting obesity exist, they are more successful at engaging higher socioeconomic status populations, leaving those in less affluent circumstances with poorer outcomes. This highlights a need for more tailored interventions. The aim of this study was to enhance an existing weight loss course for adults living in low socioeconomic communities. Methods The Behaviour Change Wheel approach was followed to design an add‐on intervention to an existing local authority‐run weight loss group, informed by mixed‐methods research and stakeholder engagement. Results The COM‐B analysis of qualitative data revealed that changes were required to psychological capability, physical and social opportunity and reflective motivation to enable dietary goal‐setting behaviours. The resulting SMART‐C booklet included 6 weeks of dietary goal setting, with weekly behavioural contract and review. Conclusion This paper details the development of the theory‐ and evidence‐informed SMART‐C intervention. This is the first report of the Behaviour Change Wheel being used to design an add‐on tool to enhance existing weight loss services. The process benefitted from a further checking stage with stakeholders.

Background Suicidal ideation is a key precursor for suicide attempts and suicide deaths. Performing routine screening of suicide precursors can help identify people who are at high risk of death by suicide. This is, arguably, an important suicide prevention effort. The aim of this study was to assess the validity, reliability, and factor structure of the Suicidal Ideation Attributes Scale (SIDAS) in a three-month longitudinal study with people with a diagnosis of schizophrenia or non-affective psychosis and experiences of suicidal ideation and/or behaviours. It was predicted that the SIDAS would have high internal consistency, test-retest reliability, convergent, discriminant and construct validity. Methods Ninety-nine participants experiencing psychosis completed the SIDAS at baseline and 89 participants completed it 3 months later. Additionally, participants completed a demographic questionnaire, the Beck Scale for Suicide Ideation, the Beck Hopelessness Scale, and the Defeat and Entrapment Scales. The internal consistency, test-retest reliability, convergent validity, and discriminant validity of the SIDAS were investigated in comparison to other constructs. Factor analysis was performed to examine the factor structure of the scale. Results Principal component analysis yielded a theoretically coherent one-dimensional factor structure of SIDAS, suggesting good construct validity (PCA = .71). The SIDAS had high internal consistency ( α  = .89) and good test-retest reliability ( α  = .73). It was highly correlated with other self-report measures, including the Beck Scale for Suicide Ideation, Beck Hopelessness Scale, Defeat and Entrapment scales, indicating excellent construct validity. Conclusion The SIDAS is a valid and reliable self-report instrument for assessing the severity of suicidal ideation in a population of people with a diagnosis of schizophrenia or non-affective psychosis. Further research should test the psychometric properties of the scale in individuals experiencing different mental health problems in cross-cultural settings, in order to establish its broader validity, reliability, and clinical utility.

Sleep problems are a modifiable risk factor for suicidal thoughts and behaviors. Yet, sparse research has examined temporal relationships between sleep disturbance, suicidal ideation, and psychological factors implicated in suicide, such as entrapment. This is the first in-the-moment investigation of relationships between suicidal ideation, objective and subjective sleep parameters, and perceptions of entrapment. Fifty-one participants with current suicidal ideation completed week-long ecological momentary assessments. An actigraph watch was worn for the duration of the study, which monitored total sleep time, sleep efficiency, and sleep latency. Daily sleep diaries captured subjective ratings of the same sleep parameters, with the addition of sleep quality. Suicidal ideation and entrapment were measured at six quasi-random time points each day. Multi-level random intercept models and moderation analyses were conducted to examine the links between sleep, entrapment, and suicidal ideation, adjusting for anxiety and depression severity. Analyses revealed a unidirectional relationship whereby short sleep duration (both objective and subjective measures), and poor sleep quality, predicted the higher severity of next-day suicidal ideation. However, there was no significant association between daytime suicidal ideation and sleep the following night. Sleep quality moderated the relationship between pre-sleep entrapment and awakening levels of suicidal ideation. This is the first study to report night-to-day relationships between sleep disturbance, suicidal ideation, and entrapment. Findings suggest that sleep quality may alter the strength of the relationship between pre-sleep entrapment and awakening suicidal ideation. Clinically, results underscore the importance of assessing and treating sleep disturbance when working with those experiencing suicidal ideation.

Enteral feeding tube (EFT) use is common to deliver much-needed enteral nutrition (EN), fluids, and medications to the neonate and pediatric population, whose growth and development depend on receiving adequate nutrition. Typically, a short-term feeding tube, such as a nasogastric (NG), orogastric (OG), or postpyloric (PP) tube, is used until a longer-term surgical tube is required. Since this population is diverse in terms of age (preterm to 18 years old) and size (less than 1 Kg to morbidly obese), most institutions stock tubes from 4 to 10 French (Fr) for feeding purposes. The smaller the child, the less likely it is that assistive technology is used during insertion to prevent misplacement due to the required 6 Fr or smaller bore tube. In pediatrics, flexibility in methods is used to verify placement of blindly placed tubes because radiation exposure is typically avoided. Although placement techniques vary, best practices regarding EFT placement and verification have been determined for nasogastric tube use in pediatrics, and blind placement remains the primary technique. Since delivering adequate nutrition to this population is so important, ensuring the safe use of EFT is imperative.

Background Suicidal experiences are highly prevalent in people with non-affective psychosis, as are anxiety problems. Understanding the interplay between suicidal and anxiety-related experiences in people with psychosis has been somewhat neglected. The over-arching aim of the current study was to redress this gap using a qualitative approach. Methods A secondary Framework Analysis was applied to qualitative interviews with 18 people with recent suicidal and psychotic experiences. Results Qualitative analyses evidenced a complex dynamic between psychotic, anxiety-related, and suicidal experiences. An emotional and cognitive-emotional dynamic was central which reflected: (a) the prominence of fear; (b) the perceived relentlessness of mental health problems; (c) feeling overpowered, overwhelmed, thwarted, and defeated; (d) perceptions of no hope and no future; and (e) wanting an unlikely end to the trap of ‘mental illness’. Within the emotional and cognitive-emotional dynamic, two pathways were clearly discernible: i.a. direct influence of anxiety on suicidal experiences with psychosis exacerbating anxiety-related experiences; and ii. an explicit pathway between psychotic and suicidal experiences with anxiety worsening psychotic experiences. A third pathway captured a non-discernible ‘mixture’ of anxiety-related, psychotic, and suicidal experiences. A fourth pathway illustrated how depressed and low mood states could interact with psychosis and anxiety to trigger and/or worsen suicidal states of mind. Implications It is vital to better understand the interplay between psychosis, anxiety-related, and suicidal experiences whilst conjointly developing suicide-focused psychological therapies so that they directly address ways in which different manifestations of anxiety interact with psychosis to lead to, and worsen, suicidal experiences. Trial registration ClinicalTrials.gov (NCT03114917), first submitted 29th March 2017 (29/03/2017), first submitted that met QC Criteria 10th April 2017, first posted 14th April 2017 (14/04/2017). ISRCTN (reference ISRCTN17776666 https://doi.org/10.1186/ISRCTN17776666 ); 5th June 2017, (05/06/2017). Registration was recorded prior to participant recruitment commencing.

Significance Common features have been observed in the genome sequences of bacterial pathogens that infect few hosts. These “host adaptations” include the acquisition of pathogenicity islands of multiple genes involved in disease, losses of whole genes, and even single mutations that affect gene function. Within Salmonella enterica is a natural model system of four pathogens that are each other’s closest relatives, including a host-generalist, two host-specialists, and one with strong host associations. With whole-genome sequences, we aimed to improve our understanding of the number, nature, and order of these host adaptation events, shedding light on how human and animal pathogens arose in the past, and potentially allowing us to predict how emerging pathogens will evolve in the future. Many bacterial pathogens are specialized, infecting one or few hosts, and this is often associated with more acute disease presentation. Specific genomes show markers of this specialization, which often reflect a balance between gene acquisition and functional gene loss. Within Salmonella enterica subspecies enterica , a single lineage exists that includes human and animal pathogens adapted to cause infection in different hosts, including S. enterica serovar Enteritidis (multiple hosts), S. Gallinarum (birds), and S. Dublin (cattle). This provides an excellent evolutionary context in which differences between these pathogen genomes can be related to host range. Genome sequences were obtained from ∼60 isolates selected to represent the known diversity of this lineage. Examination and comparison of the clades within the phylogeny of this lineage revealed signs of host restriction as well as evolutionary events that mark a path to host generalism. We have identified the nature and order of events for both evolutionary trajectories. The impact of functional gene loss was predicted based upon position within metabolic pathways and confirmed with phenotyping assays. The structure of S. Enteritidis is more complex than previously known, as a second clade of S. Enteritidis was revealed that is distinct from those commonly seen to cause disease in humans or animals, and that is more closely related to S. Gallinarum. Isolates from this second clade were tested in a chick model of infection and exhibited a reduced colonization phenotype, which we postulate represents an intermediate stage in pathogen–host adaptation.

Background Communication between patients and staff is a crucial component of safe and effective healthcare. As people age, they have more consultations and these become more complex. As such, older people may be more likely to experience gaps and breakdowns in communication. Objective To develop a better understanding of older people's communication in interactions with primary care staff and the barriers to and enablers of this. Search Strategy Four databases were searched. Search terms covered the sample (older people), domain (verbal communication in healthcare interactions), context (primary care) and research type (qualitative research). Data Extraction and Synthesis A meta‐ethnographic approach was followed by one researcher, with input from the wider team. Twelve studies were included. Details of the designs, participants, methods and results were extracted. Data were synthesised through reciprocal translation, and a line of argument was developed. Main Results Barriers to communication were found in relation to raising and addressing concerns. Barriers arose from patient perceptions of their role, the nature of their relationship with staff, patient and staff perceptions of responsibility and reluctance to broach a topic, individual factors such as memory, how staff respond when concerns are raised and the degree of patient involvement in consultations. Potential enablers of communication were preparation and support from family or peers. Conclusions Synthesising the existing qualitative literature on older people's communication in healthcare interactions enabled the identification of barriers and enablers that can be used to inform the development of an intervention to improve communication with primary care staff. Patient or Public Contribution By identifying healthcare communication as the most important topic for the patient safety of older people with multiple long‐term conditions in primary care and setting the scope of the review, patients and the public were involved in the design of the study. Four public contributors (older people with multiple long‐term conditions and carers of older people with multiple long‐term conditions) attended regular meetings, provided their reflections on the study findings and supported the interpretation of the data.

Chickens, pigs, and cattle are key reservoirs of Salmonella enterica, a foodborne pathogen of worldwide importance. Though a decade has elapsed since publication of the first Salmonella genome, thousands of genes remain of hypothetical or unknown function, and the basis of colonization of reservoir hosts is ill-defined. Moreover, previous surveys of the role of Salmonella genes in vivo have focused on systemic virulence in murine typhoid models, and the genetic basis of intestinal persistence and thus zoonotic transmission have received little study. We therefore screened pools of random insertion mutants of S. enterica serovar Typhimurium in chickens, pigs, and cattle by transposon-directed insertion-site sequencing (TraDIS). The identity and relative fitness in each host of 7,702 mutants was simultaneously assigned by massively parallel sequencing of transposon-flanking regions. Phenotypes were assigned to 2,715 different genes, providing a phenotype-genotype map of unprecedented resolution. The data are self-consistent in that multiple independent mutations in a given gene or pathway were observed to exert a similar fitness cost. Phenotypes were further validated by screening defined null mutants in chickens. Our data indicate that a core set of genes is required for infection of all three host species, and smaller sets of genes may mediate persistence in specific hosts. By assigning roles to thousands of Salmonella genes in key reservoir hosts, our data facilitate systems approaches to understand pathogenesis and the rational design of novel cross-protective vaccines and inhibitors. Moreover, by simultaneously assigning the genotype and phenotype of over 90% of mutants screened in complex pools, our data establish TraDIS as a powerful tool to apply rich functional annotation to microbial genomes with minimal animal use.