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Background: Physical activity (PA) can improve a range of outcomes following a cancer diagnosis. These include an improvement in experience of side effects of treatment (e.g. fatigue) and management of comorbid conditions. PA may also increase survival and reduce recurrence. Digital interventions have shown potential for PA promotion among cancer survivors, but most in a prior review were web-based and few studies used smartphone applications (apps). There are many PA apps available for general public use but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis. Objective: This study sought post-treatment, non-metastatic, breast, prostate and colorectal cancer survivors’ opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention. Methods: Each participant was randomly assigned to download two of four apps (Human, The Walk, The Johnson & Johnson Official 7 Minute Workout, and Gorilla Workout). Participants used each app for one week consecutively. In-depth semi-structured telephone interviews were then conducted to understand participants’ experiences of using the apps and how app-based PA interventions could be developed for cancer survivors. The interviews were analysed using thematic analysis. Results: 32 participants took part: 16 (50%) had prostate cancer, 8 (25%) had breast and 8 (25%) had colorectal cancer. Three core themes were identified. The first theme was that multiple factors affect engagement with PA apps and this is highly personalised. Factors affecting engagement included participants’ perceptions of i) the advantages and disadvantages of using apps to support PA; ii) the relevance of the app to the user (e.g. in terms of cancer-related factors, their PA goals, the difficulty level of the app, the way in which they interact with their smartphone and the extent to which the app fits with their self-identity), iii) the quality of the app (e.g. usability, accuracy, quality of production, scientific evidence-base), and of iv) the behaviour change techniques used to promote PA. In the second theme, participants recommended that apps that promote walking are most appealing, as walking removes many barriers to PA. Finally, the participants suggested that PA apps should be integrated into cancer care, as they valued guidance and recommendations from healthcare professionals. Conclusions: This sample of breast, prostate and colorectal cancer survivors were receptive to the use of apps to promote PA. Although no publicly available PA app was deemed wholly suitable, many suggestions for adaptation and intervention development were provided. The results can inform the development of an app-based PA intervention for cancer survivors. They also highlight the wide-ranging and dynamic influences on engagement with digital interventions, which can be applied to other evaluations of mHealth products in other health conditions and other health behaviours.

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Breakdown and streamer formation is simulated in atmospheric pressure nitrogen for a 2D planar electrode system. A PIC code with multigrid potential solver is used to simulate the evolution of the non-equilibrium ionization front on sub-nanosecond timescales. The ion and electron energy distributions are computed, accounting for the inclusion of inelastic scattering of electrons, and collisionally excited metastable production and ionization. Of particular interest is the increased production of metastable and low-energy ions and electrons when the applied field is reversed during the progress of the ionization front, giving insight into the improved species yields in nanosecond pulsed systems.

Background: The first lines of defence against the swine flu pandemic of 2009 were behavioural, for example improving public hand hygiene. Mass communication, through government advertising and via the media, offers the potential to promote recommended behaviours, but are these communications effective and are there dangers of scaremongering? Objectives: To assess whether reporting or advertising affected public perceptions of the swine flu outbreak. Methods: Thirty-six weekly telephone surveys were conducted in the UK during the outbreak (total n = 38,182), each using a new, randomly selected, sample of the population. Outcome measures included respondents’ ratings of their worry about the risk of catching swine flu, satisfaction with the amount of information available, perceived Government preparedness, perceiving that ‘too much fuss’ had been made about swine flu, and willingness to have a flu vaccine. Predictor variables included the total amount of media coverage relating to swine flu and the severity of the outbreak at the time of each survey. Additional questions in the first five surveys (early May) also covered other behavioural outcomes. Results: Worry fluctuated over the course of the pandemic, and was associated with the amount of media coverage (partial r = 0.52, p < 0.001). However, this effect did not persist beyond the first summer wave of cases. During the early stages of the outbreak, exposure to media coverage and adverts was associated with lower worry in path analyses, and with higher levels of recommended behaviours, in part through the perceived higher efficacy of these behaviours. Conclusions: Worrying about public health incidents has been shown to predict adaptive behavioural changes among the public. Finding ways to keep a pandemic in the news may help to maintain such changes. Perceived efficacy is another channel to promote such changes. Concerns about media scaremongering in the initial period were unproven.

CONTEXT: The extensive research literature on electronic patient records (EPRs) presents challenges to systematic reviewers because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. METHODS: Using the meta-narrative method and searching beyond the Medline-indexed literature, this review used "conflicting" findings to address higher-order questions about how researchers had differently conceptualized and studied the EPR and its implementation. FINDINGS: Twenty-four previous systematic reviews and ninety-four further primary studies were considered. Key tensions in the literature centered on (1) the EPR ("container" or "itinerary"); (2) the EPR user ("information-processer" or "member of socio-technical network"); (3) organizational context ("the setting within which the EPR is implemented" or "the EPR-in-use"); (4) clinical work ("decision making" or "situated practice"); (5) the process of change ("the logic of determinism" or "the logic of opposition"); (6) implementation success ("objectively defined" or "socially negotiated"); and (7) complexity and scale ("the bigger the better" or "small is beautiful"). CONCLUSIONS: The findings suggest that EPR use will always require human input to recontextualize knowledge; that even though secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper may offer a unique degree of ecological flexibility; and that smaller EPR systems may sometimes be more efficient and effective than larger ones. We suggest an agenda for further research.

Objective: Computerised CBT promises a way of bringing an effective intervention to a large population. However, there are challenges to achieving this within a viable business model. One approach may be through Occupational Health departments. Methodology: Case study of the introduction of the Xanthis system, a cCBT package, in three large, public sector organisations in the UK: Dyfed-Powys Police, Cardiff University and Oxford University. Xanthis was made confidentially available to all employees, accessible over the Internet. Its use was tied into Occupational Health/Human Resources policies. Different research methods were conducted to investigate use. User numbers were monitored; results now cover three years. Interviews were conducted with purchasers of the package. At Dyfed-Powys Police, a before/after questionnaire was conducted on users. Conclusions: User numbers peaked after launch in all organisations before settling at 5-10% staff. Users find the tool a useful support and like that it is confidential, accessible, increases knowledge and understanding about problems, and links to sources of help. The best testimonial was from a suicidal individual who used Xanthis to gain understanding of their situation and then seek help. The experience shows that technology has a role within organisations for the support of employees and in early intervention for mental health problems. There were many problems associated with the implementation and launch of the tool. Different organisations wanted to use Xanthis in different ways and in conjunction with other activity. How the tool was promoted internally was critical. Commercialisation was constrained by the resources devoted to Occupational Health.

Objective: Computerised CBT is an accepted treatment for anxiety and depression. There is now a public health focus on the prevention and early management of these conditions. Internet-delivered approaches appear promising as a cost-effective way of reaching a large population for what are sensitive and stigmatised conditions. Prevention of mental illness and use of cCBT are both fields new in development. We sought to systematically review the relevant literature. Methodology: A realist review method was used as it provides a more flexible and pluralistic approach to deconstructing complex interventions, allowing us to examine all relevant literature. A structured search methodology was developed and key medical databases searched. Results: We found very different papers invesitgating whether cCBT works in prevention and early treatment. Only five specifically considered cCBT in the prevention of depression and anxiety, providing mixed results. There were further papers on cCBT as a community-based, sub-clinical treatment rather than specifically for prevention. These vary hugely in terms of method, cCBT package, population and conditions treated. Outcomes are generally positive. Research was mostly on high risk groups rather than the general population. Terminology and definitions varied between and within papers. Conclusions: cCBT in prevention and early management of mental illness is a new but promising field. Technology offers a new delivery platform for reaching individuals at different illness stages, confidentially and accessibly. cCBT can reduce symptoms in sub-clinical populations, including spontaneous Internet users, but adherence and attrition rates are a challenge. More research is needed.

Introduction: Mental health issues such as anxiety and depression are a leading cause of morbidity and a huge public health cost. Prevention and early treatment are effective, but are difficult to deliver in traditional forms to large populations. Internet-delivered approaches, such as computerised CBT (cCBT), appear promising as a cost-effective way of reaching populations for what are sensitive and stigmatised conditions. However, there are challenges to achieving this within a viable financial model. Objective: Explore the use of cCBT in sub-clinical or preventative care, within a work-based delivery model. Method: A realist methodology was adopted for a programme of research as it provides a flexible and pluralistic approach to deconstructing complex interventions. This included: a systematic literature review on cCBT in a preventative context; and data collected around use of Xanthis, a commercial sub-clinical cCBT package. Xanthis was made available to all employees, accessible over the Internet, in three large, UK, public sector organisations: Dyfed-Powys Police, Cardiff University and Oxford University. Its use was tied into Occupational Health/Human Resources policies. User numbers were monitored. Interviews were conducted with purchasers of the package. At Dyfed-Powys Police, a before/after questionnaire was conducted on users. Results: The literature on cCBT in prevention and early treatment is heterogeneous. Five papers specifically considered cCBT in the prevention of depression and anxiety, showing mixed results. There were further papers on cCBT as a community-based, sub-clinical treatment rather than specifically as prevention. These vary in terms of method, cCBT package, population and conditions treated. Outcomes were generally positive. Research was mostly on high risk groups rather than the general population. Terminology and definitions varied between and within papers. Attrition rates remain high in internet-based spontaneous self help. Xanthis user numbers peaked after launch in all organisations before settling at 5-10% staff. Users find the tool a useful support and like that it is confidential, accessible, increases knowledge and understanding about problems, and links to sources of help. However, there were many problems associated with the implementation and launch of the tool. Different organisations sought to use Xanthis in different ways and in conjunction with other activity. How the tool was promoted internally was critical. Commercialisation was constrained by the resources typically devoted to Occupational Health. Conclusion: cCBT in prevention and early management of mental illness is a new but promising field. Technology offers a new delivery platform for reaching individuals at different illness stages, confidentially and accessibly. cCBT can reduce symptoms in sub-clinical populations, including spontaneous Internet users, but adherence and attrition rates are a challenge. The financing and implementation of sub-clinical cCBT packages must be researched, including determining which are suitable for use in different user populations and circumstances. Packages such as Xanthis have potential for use within sub-clinical care in a variety of contexts, but there are challenges in its commercialisation, delivery and use within a work-based delivery model which must be overcome.