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According to the COM-B model of behaviour, three factors are essential for behaviour to occur: capability, opportunity, and motivation. Some evidence suggests that obese children tend to feel less capable of exercising. An instrument aiming to measure perceived exercise capability, opportunity, and motivation was created and subsequently used to investigate the association between perceived exercise capability and childhood obesity, and how perceived exercise capability could be improved through intervention. A 19 item questionnaire about exercise capability, opportunity, and motivation was created systematically with the COM-B model. On arrival at a 6 week weight-management camp in northern England, children completed the questionnaire; Spanish schoolchildren attending after-school exercise sessions in Spain also completed the questionnaire to test generalisability of findings. Motion-sensor computer games were implemented at weekly sessions at the English weight-management camp to encourage exercise and improve attendees’ perceived exercise capability. No participants withdrew from the study. Linear regression was used to investigate associations between body-mass index SD scores (BMI SDS) and perceived exercise capability, opportunity, and motivation; confirmatory factor analysis was conducted to investigate scale construct validity; Cronbach's α tests were conducted to measure internal consistency. Informed consent was obtained from all children, and from their parents or guardians. Ethics approval was granted by the Imperial College Research Ethics Committee and the Ethics Committee for Clinical Research, University of La Rioja. On arrival at the camp, questionnaires were completed by 71 English children (34 girls, 48%) aged 9–17 years (mean 12·2, SD 2·0) with BMI SDS 2·80 (SD 0·66) and by 45 Spanish schoolchildren (22 girls, 49%) aged 9–13 years (mean 10·5, SD 1·2) with mean BMI SDS 0·80 (SD 0·99). 22 attendees of the English camp (12 girls, 55%) aged 9–16 years (mean 12·1, SD 2·2) reported how much they enjoyed the games; and they completed the COM-B questionnaire on both arrival at, and departure from, the camp. Questionnaire composite capability, opportunity, and motivation scores tested adequately for internal consistency (Cronbach's α=0·712–0·796) and construct validity (χ2/df=1·55, root mean square error of approximation 0·072, comparative fit index 0·92). Linear regression revealed an inverse association between perceived exercise capability and BMI SDS for both English (β=–0·289, p=0·010) and Spanish (β=–0·446, p=0·047) children; no association between BMI SDS and perceived exercise opportunity or motivation was found. A positive correlation was found between extent of motion-sensor game enjoyment and improvement in perceived exercise capability (r(22)=0·538, p=0·010), but not opportunity or motivation improvement, during stays at the camp. Perceived exercise capability can be measured with the instrument described here. This small-sample study provides preliminary evidence for an association between low perceived exercise capability and childhood obesity and for the possibility that perceived exercise capability can be improved through intervention. This research was supported by the Engineering and Physical Sciences Research Council (grant EP/K012673/1).

Weight-management camp interventions for obese children are effective for short-term weight loss. However, there is little evidence indicating how gains made with such interventions can be maintained in the longer term. The present prospective cohort study investigated effectiveness of an intervention consisting of a weight-management camp followed by weekly lifestyle education sessions. Obese children from eight Qatari schools participated in the intervention from Jan 27 to May 20, 2015. It started with a 2 week weight-management camp involving physical and social activities, lifestyle learning, and dietary control. Participants then attended school as usual for 3 weeks. Ten, weekly after-school club sessions were then held, each lasting 2 h, involving further lifestyle education and engagement of participants’ parents, with the aim of encouraging consolidation of learning that had taken place at the camp, and continuation of healthy behaviours. A control group of obese children from the same Qatari schools received no intervention. The primary outcome variable was body-mass index SD scores (BMI SDS). Wilcoxon signed rank tests were used to assess changes in BMI SDS. Informed consent was obtained from participants and their parents. Ethics approval was granted by the Qatar University Institutional Review Board. 56 children (42 girls) aged 9–13 years (mean 10·9, SD 1·1) took part in the intervention. BMI SDS ranged from 1·17 to 4·00 (mean 2·51, SD 0·62). The control group consisted of 37 children (27 girls) aged 8–12 years (mean 10·3, SD 1·1) with BMI SDS 1·40–3·98 (2·78, 0·43). Between the start of camp and the end of the clubs, there was no significant change in control group BMI SDS (mean −0·004, SD 0·29; p=0·784), but significant reduction in the intervention group BMI SDS (−0·10, 0·20; p=0·0003). Significant BMI SDS reduction occurred for the intervention group during weight-management camp (−0·13, 0·12; p<0·0001) and after-school club (−0·12, 0·19; p<0·0001) stages; significant BMI SDS increase occurred between these stages (0·15, 0·16; p<0·0001). This small-sample study suggests that weekly lifestyle education sessions can be effective in helping to sustain weight-loss achievements from more intensive childhood obesity interventions. Half of the intervention group achieved an overall BMI SDS reduction of at least 0·10, which has been shown to be associated with important reductions in insulin and total cholesterol. This research was supported by the National Priorities Research Program Qatar Foundation (grant X-036-3–01).

BackgroundUnintentional injuries are a common cause of morbidity and mortality in the under-5s, but undertaking home safety practices can reduce injury risk. Stay One Step Ahead (SOSA) is an evidence-based standardised home safety programme. This study evaluates the cost-effectiveness of SOSA versus usual care in Nottingham, UK.MethodsCost-effectiveness analysis from a National Health Service and personal social services perspective. SOSA activity data, injury occurrence and associated short-term healthcare costs were collected within a controlled before-and-after study from 2017 to 2020. The primary outcome was the incremental cost-effectiveness ratio (ICER) per additional home adopting three key safety practices (working smoke alarm, safe poisons storage and fitted stair gate). Secondary outcomes were ICERs per injury avoided and quality-adjusted life-years (QALYs) gained.ResultsSOSA costs £30 per child but reduces short-term healthcare expenditure by £42. SOSA increased the number of homes with three key safety practices by 0.02 per child, reduced injuries per child by 0.15 and gained 0.0036 QALYs per child. SOSA was dominant as it was cheaper and more effective than current practice. ICERs were −£590 per additional home deemed safe, −£77 per injury avoided and −£3225 per QALY gained. Focusing on healthcare expenditure alone, SOSA saved £1.39 for every pound spent.ConclusionsSOSA is a cost-saving intervention. Commissioners should consider implementing SOSA.

ObjectiveEvaluate the effectiveness of systematically delivered evidence-based home safety promotion for improving child home safety practices.DesignControlled before-and-after study.SettingNine electoral wards in Nottingham, UK.Participants361 families with children aged 2–7 months at recruitment living in four intervention wards with high health, education and social need; and 401 in five matched control wards.InterventionEvidence-based home safety promotion delivered by health visiting teams, family mentors and children’s centres including 24 monthly safety messages; home safety activity sessions; quarterly ‘safety weeks’; home safety checklists.OutcomesPrimary: composite measure comprising having a working smoke alarm, storing poisons out of reach and having a stairgate. Secondary: other home safety practices; medically attended injuries. Parents completed questionnaires at 12 and 24 months after recruitment plus optional three monthly injury questionnaires.ResultsAt 24 months there was no significant difference between groups in the primary outcome (55.8% vs 48.8%; OR 1.58, 95% CI 0.98 to 2.55) or medically attended injury rates (incidence rate ratio 0.89, 95% CI 0.51 to 1.56), but intervention families were more likely to store poisons safely (OR 1.81, 95% CI 1.06 to 3.07), have a fire escape plan (OR 1.81, 95% CI 1.06 to 3.08), use a fireguard or have no fire (OR 3.17, 95% CI 1.63 to 6.16) and perform more safety practices (β 0.46, 95% CI 0.13 to 0.79).ConclusionsSystematic evidence-based home safety promotion in areas with substantial need increases adoption of some safety practices. Funders should consider commissioning evidence-based multicomponent child home safety interventions.Trial registration number ISRCTN31210493.

We describe the management of two linked severe acute respiratory coronavirus 2 (SARS-CoV-2) outbreaks, predominantly amongst 18–35-year-olds, in a UK county in July-to-September 2021, following the lifting of national coronavirus disease 2019 (COVID-19)-associated social restrictions. One was associated with a nightclub and one with five air force bases. On week beginning 2nd August 2021, air force contact tracing teams detected 68 cases across five bases within one county; 21 (30.9%) were associated with a night-time economy venue, 13 (19.1%) with night-time economy venues in the county's main town and at least one case per base (n = 6, 8.8%) with a particular nightclub in this town, which itself had been associated with 302 cases in the previous week (coinciding with its reopening following a national lockdown). In response, Public Health England/United Kingdom Health Security Agency, air force and local authority teams collaboratively implemented communication strategies and enhanced access to SARS-CoV-2 testing and vaccination. Key challenges included attempting to encourage behaviours that reduce likelihood of transmission to a population who may have considered themselves at low risk from severe COVID-19. This report may inform future preparation for, and management of, easing of potential future pandemic-related social restrictions, and how an outbreak in this context may be addressed.

This dissertation is a comparative study of the great powers in the Mediterranean world during the third and second centuries BC: the imperial republics of Rome and Carthage in the West, and the great Hellenistic dynasties of Antigonid Macedonia, Ptolemaic Egypt, and the Seleucid Near East. These states fought a series of wars among one another; the end result was the establishment of Roman hegemony across the entire Mediterranean. Why Rome? This dissertation treats two metrics of state power, manpower mobilization and state revenues, and examines them in relationship to the known outcomes of interstate warfare. Part I of the dissertation reconstructs the manpower resources of each power. Each chapter in this section focuses on a particular power and explores three separate issues. I first determine the maximum mobilization each state could achieve. Next, I explore the strategies each state used to obtain recruits, in particular citizen soldiers, subject levies, and mercenary hires. Finally, each chapter concludes with a discussion of the military organization employed by each state in arranging coherent fighting units. Part II reconstructs the state revenues of each power, using a method of forensic accounting based on estimated expenditures (in particular the cost of armies) and critical examination of fragmentary source references to tax rates, mining revenues, and other sources of state income. The dissertation concludes that the Romans enjoyed a substantial comparative advantage over any of the Hellenistic powers in terms of the maximum mobilization rate, with a peak deployment of 175,000 soldiers in 190 BC. By comparison, the maximum Seleucid and Ptolemaic mobilizations both stood at around 80,000, while the Macedonian mobilization peaked at approximately 45,000. While this advantage has important explanatory power as to why Rome defeated the Seleucid and Macedonian kingdoms, is important to note that Rome deployed only a fraction of her manpower against these kingdoms, and frequently fought outnumbered in the decisive battles of the period. Moreover, Rome lacked significant manpower superiority over Carthage during much of the Second Punic War. On the side of state finance, the dissertation finds surprising disconnects between state revenues and military success. The wealthiest state, the Ptolemaic dynasty, extracted enormous revenues from the agricultural regions of Egypt (roughly 90 million drachmai), but after the middle of the third century the geopolitical fortunes of the dynasty declined markedly. Meanwhile, the Romans had perhaps the smallest revenues during the third century, and their lack of fiscal sophistication was represented by a clumsy system of caste bronze coinage. Roman revenues did rise over the course of the successful imperial activity in the second century, but remained comparatively modest even during the period of unquestioned military dominance. The organization of the Roman state accounts for its ability to mobilize more men for less money. The Roman habit of exploiting subject populations in Italy for unpaid military service dramatically lowered Roman military costs. Furthermore, citizen troops served for far lower pay than their counterparts in the Hellenistic East. Finally, the Republican nature of the Roman state (and Carthage as well) eliminated the substantial expense of maintaining a sumptuous royal court. The dissertation concludes by discussing the role of resources in the arc of Mediterranean history during the period. It argues that Macedonia was an under resourced state both in terms of manpower and revenues, but one that “punched above its weight” due to an effective, well-organized army based on a heavily militarized citizenry. It notes that the geographic position of both the Seleucids and the Ptolemies made it difficult for them to exert control over the entirety of the Mediterranean, although each had the resources to gain hegemony over the Eastern Mediterranean, in the manner of the Ottoman Turks in the early modern period. Yet dynastic difficulties in both states and a tripartite balance of power in the East prevented either power from gaining permanent control over the east. Ultimately, the dissertation concludes that, on the level of resources, Carthage was the only serious challenger to Rome. Like Rome, Carthage was centrally located, a geographic advantage that could have supported extending domination over the whole Mediterranean basin. During the Second Punic War, Carthage’s revenues and manpower mobilization equaled, and at times exceeded, that of Rome. It is not difficult to imagine an alternative history in which Carthage gained hegemony of the Mediterranean. Nonetheless, Rome’s republican system of government, its expansive system of citizenship, and its exploitation of Italian subjects for military service allowed it to raise unusually large, effective military forces despite a limited fiscal base. As a result, Rome was not only an effective conquest state, but the only state in history to unify the Mediterranean. (Abstract shortened by ProQuest.)

Computer-generated, web-based environments, known as 'virtual worlds', allow for novel and innovative methods of high-quality remote interaction. Virtual worlds have been used in various organisational contexts, including healthcare, though there remains potential for new ways that they may be used to facilitate non-clinical healthcare-related interacitons. This Thesis investigated use of virtual worlds to improve collaboration and engagement in healthcare. Results of research detailed here contribute to new understanding of how interpersonal interactions are altered in a virtual world context, and of drivers, barriers and implications of possible use of virtual worlds in a number of non-clinical healthcare-related contexts, which had not previously been empirically tested.