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ObjectiveIn March 2020, several countries banned unnecessary outdoor activities during COVID-19, commonly called ‘lockdowns. These lockdowns have the potential to impact associated levels of physical activity and sedentary behaviour. Given the numerous health outcomes associated with physical activity and sedentary behaviour, the aim of this review was to summarise literature that investigated differences in physical activity and sedentary behaviour before vs during the COVID-19 lockdown.Design, data sources and eligibility criteriaElectronic databases were searched from November 2019 to October 2020 using terms and synonyms relating to physical activity, sedentary behaviour and COVID-19. The coprimary outcomes were changes in physical activity and/or sedentary behaviour captured via device-based measures or self-report tools. Risk of bias was measured using the Newcastle-Ottawa Scale.ResultsSixty six articles met the inclusion criteria and were included in the review (total n=86 981). Changes in physical activity were reported in 64 studies, with the majority of studies reporting decreases in physical activity and increases in sedentary behaviours during their respective lockdowns across several populations, including children and patients with a variety of medical conditions.ConclusionGiven the numerous physical and mental benefits of increased physical activity and decreased sedentary behaviour, public health strategies should include the creation and implementation of interventions that promote safe physical activity and reduce sedentary behaviour should other lockdowns occur.

Biotechnology is a fascinating interdisciplinary field uniquely poised to take on some of the world's most complex problems. This takes a refreshing problems-based approach to exploring the field. Novice readers will come away with a broad appreciation for the significance of current and emerging biotechnologies--from regenerative medicine, to genetically enhanced crops, to biofuels. Experts will benefit from the concise review of timely game-changing technologies such as DNA sequence-by-synthesis and genome editing. Despite being set within a conceptual framework of \"wicked\" problems (i.e., disease, food production, environmental degradation), insights into the current state and future potential of biotechnologies make this book both optimistic and forward thinking. This is not just an informative text--it's an entry point into a discipline with the potential to change the world.

Objective The increase in reliance on online services for general practice has the potential to increase inequalities within some populations. Patients with a mental health condition are one such group. Digital facilitation is defined as a range of processes, procedures, and people, which seek to support NHS patients in using online services. This study aimed to examine the views and experiences of digital facilitation in primary care amongst patients living with a mental health condition. Methods Semi-structured interviews were conducted with patients living with a mental health condition, recruited from general practices across England participating in the Di-Facto study. Thematic analysis was conducted on interview transcripts. Results Interviews were conducted with ten participants with a mental health condition, recruited from five general practices. Three themes were identified: (1) familiarity with online services; (2) experiences of those using online services; (3) the need for digital facilitation. The need for digital facilitation was identified in the registration for online services, and in trusting online services. Conclusions Online services offer convenience for patients, but registration for the use of such services remains a potential area of difficulty. Participants had difficulties with registering for online services and had concerns about trust in using them. Support offered by general practices in using online services needs to be varied and adaptable to meet the needs of individual patients.

Arriving at a infection (CDI) diagnosis, treating patients and dealing with recurrences is not straightforward, but a comprehensive and well-rounded understanding of what is needed to improve patient care is lacking. This manuscript addresses the paucity of multidisciplinary perspectives that consider clinical practice related and healthcare system-related challenges to optimizing care delivery. We draw on narrative review, consultations with clinical experts and patient representatives, and a survey of 95 clinical and microbiology experts from the UK, France, Italy, Australia and Canada, adding novel multi-method evidence to the knowledge base. We examine the patient pathway and variations in clinical practice and identify, synthesize insights on and discuss associated challenges. Examples of key challenges include the need to conduct multiple tests for a conclusive diagnosis, treatment side-effects, the cost of some antibiotics and barriers to access of fecal microbiota transplantation, difficulties in distinguishing recurrence from new infection, workforce capacity constraints to effective monitoring of patients on treatment and of recurrence, and ascertaining whether a patient has been cured. We also identify key opportunities and priorities for improving patient care that target both clinical practice and the wider healthcare system. While there is some variety across surveyed countries' healthcare systems, there is also strong agreement on some priorities. Key improvement actions seen as priorities by at least half of survey respondents in at least three of the five surveyed countries include: developing innovative products for both preventing (Canada, Australia, UK, Italy, and France) and treating (Canada, Australia, and Italy) recurrences; facilitating more multidisciplinary patient care (UK, Australia, and France); updating diagnosis and treatment guidelines (Australia, Canada, and UK); and educating and supporting professionals in primary care (Italy, UK, Canada, and Australia) and those in secondary care who are not CDI experts (Italy, Australia, and France) on identifying symptoms and managing patients. Finally, we discuss key evidence gaps for a future research agenda.

The aim of this study was to explore associations between internet/email use in a large sample of older English adults with their social isolation and loneliness. Data from the English Longitudinal Study of Ageing Wave 8 were used, with complete data available for 4,492 men and women aged ⩾ 50 years (mean age = 64.3, standard deviation = 13.3; 51.7% males). Binomial logistic regression was used to analyse cross-sectional associations between internet/email use and social isolation and loneliness. The majority of older adults reported using the internet/email every day (69.3%), fewer participants reported once a week (8.5%), once a month (2.6%), once every three months (0.7%), less than every three months (1.5%) and never (17.4%). No significant associations were found between internet/email use and loneliness, however, non-linear associations were found for social isolation. Older adults using the internet/email either once a week (odds ratio (OR) = 0.60, 95% confidence interval (CI) = 0.49–0.72) or once a month (OR = 0.60, 95% CI = 0.45–0.80) were significantly less likely to be socially isolated than every day users; those using internet/email less than once every three months were significantly more likely to be socially isolated than every day users (OR = 2.87, 95% CI = 1.28–6.40). Once every three months and never users showed no difference in social isolation compared with every day users. Weak associations were found between different online activities and loneliness, and strong associations were found with social isolation. The study updated knowledge of older adults’ internet/email habits, devices used and activities engaged in online. Findings may be important for the design of digital behaviour change interventions in older adults, particularly in groups at risk of or interventions targeting loneliness and/or social isolation.

Many older adults, especially those who are socially isolated, are insufficiently physically active and spend prolonged periods of time engaging in sedentary behaviours. Social isolation, insufficient physical activity (PA) and increased sedentary behaviour (SB) are independently associated with negative health outcomes. Traditional PA/SB interventions have achieved limited success, particularly in the long term, therefore novel interventions are required. This thesis followed the Medical Research Council (MRC) guidance on complex intervention development and used the Behaviour Change Wheel (BCW) to make recommendations for a digital behaviour change intervention (DBCI) for PA/SB in socially isolated older adults. This included undertaking four studies that addressed the three stages of the development phase of the MRC guidance. First, a systematic review and meta-analysis (n = 22 studies) found DBCI were effective in increasing total PA and moderate-to-vigorous PA by 52min/week, and reduced SB by 58min/day in older adults (≥ 50 years). A minimum of three behaviour change technique (BCT) clusters were found to increase efficacy of the DBCI, including social support, goal setting, feedback on behaviour and self-monitoring. Second, an analysis of data from the English Longitudinal Study of Ageing, found over two thirds of socially isolated older adults used the internet/email at least once a week and were more likely to access it via a laptop than any other device. Non-linear relationships were found between frequency of use and social isolation. Third, semi-structured interviews highlighted that socially isolated older adults preferred individual/small-group PA that they could undertake either at home or from their home, and their physical capabilities prevented them from engaging in certain types of PA. Fourth, socially isolated older adults' experiences of using two commercially available DBCI for PA/SB, and their ideas for future DBCI for PA/SB, were explored via semi-structured interviews. Generally, participants enjoyed using the DBCI and found it useful for increasing their PA, but they require a DBCI that is better tailored to their needs. The aim of this thesis was to use the MRC guidance on developing and evaluating complex interventions, in combination with the BCW, to make recommendations for the design of a DBCI for PA and/or SB in socially isolated older adults.