Recruiting and engaging new mothers in nutrition research studies : lessons from the Australian NOURISH randomised controlled trial

Background: Despite important implications for the budgets, statistical power and generalisability of research findings, detailed reports of recruitment and retention in randomised controlled trials (RCTs) are rare. The NOURISH RCT evaluated a community-based intervention for first-time mothers that promoted protective infant feeding practices as a primary prevention strategy for childhood obesity. The aim of this paper is to provide a detailed description and evaluation of the recruitment and retention strategies used. Methods: A two stage recruitment process designed to provide a consecutive sampling framework was used. First time mothers delivering healthy term infants were initially approached in postnatal wards of the major maternity services in two Australian cities for consent to later contact (Stage 1). When infants were about four months old mothers were re-contacted by mail for enrolment (Stage 2), baseline measurements (Time 1) and subsequent random allocation to the intervention or control condition. Outcomes were assessed at infant ages 14 months (Time 2) and 24 months (Time 3). Results: At Stage 1, 86% of eligible mothers were approached and of these women, 76% consented to later contact. At Stage 2, 3% had become ineligible and 76% could be recontacted. Of the latter, 44% consented to full enrolment and were allocated. This represented 21% of mothers screened as eligible at Stage 1. Retention at Time 3 was 78%. Mothers who did not consent or discontinued the study were younger and less likely to have a university education. Conclusions: The consent and retention rates of our sample of first time mothers are comparable with or better than other similar studies. The recruitment strategy used allowed for detailed information from non-consenters to be collected; thus selection bias could be estimated. Recommendations for future studies include being able to contact participants via mobile phone (particular text messaging), offering home visits to reduce participant burden and considering the use of financial incentives to support participant retention.

Early evidence for direct and indirect effects of the infant rotavirus vaccine program in Queensland

Objective: To assess the impact of introducing a publicly funded infant rotavirus vaccination program on disease notifications and on laboratory testing and results. Design and setting: Retrospective analysis of routinely collected data (rotavirus notifications [2006–2008] and laboratory rotavirus testing data from Queensland Health laboratories [2000–2008]) to monitor rotavirus trends before and after the introduction of a publicly funded infant rotavirus vaccination program in Queensland in July 2007. Main outcome measures: Age group-specific rotavirus notification trends; number of rotavirus tests performed and the proportion positive. Results: In the less than 2 years age group, rotavirus notifications declined by 53% (2007) and 65% (2008); the number of laboratory tests performed declined by 3% (2007) and 15% (2008); and the proportion of tests positive declined by 45% (2007) and 43% (2008) compared with data collected before introduction of the vaccination program. An indirect effect of infant vaccination was seen: notifications and the proportion of tests positive for rotavirus declined in older age groups as well. Conclusions: The publicly funded rotavirus vaccination program in Queensland is having an early impact, direct and indirect, on rotavirus disease as assessed using routinely collected data. Further observational studies are required to assess vaccine effectiveness. Parents and immunisation providers should ensure that all Australian children receive the recommended rotavirus vaccine doses in the required timeframe.

Thinking Critically in the Land of Princesses and Giants : The Affordances and Challenges of Critical Approaches in the Early Years

During the last four decades, educators have created a range of critical literacy approaches for different contexts, including compulsory schooling (Luke & Woods, 2009) and second language education (Luke & Dooley, 2011). Despite inspirational examples of critical work with young students (e.g., O’Brien, 1994; Vasquez, 1994), Comber (2012) laments the persistent myth that critical literacy is not viable in the early years. Assumptions about childhood innocence and the priorities of the back-to-basics movement seem to limit the possibilities for early years literacy teaching and learning. Yet, teachers of young students need not face an either/or choice between the basic and critical dimensions of literacy. Systematic ways of treating literacy in all its complexity exist. We argue that the integrative imperative is especially important in schools that are under pressure to improve technical literacy outcomes. In this chapter, we document how critical literacy was addressed in a fairytales unit taught to 4.5 - 5.5 year olds in a high diversity, high poverty Australian school. We analyze the affordances and challenges of different approaches to critical literacy, concluding they are complementary rather than competing sources of possibility. Furthermore, we make the case for turning familiar classroom activities to critical ends.

Nutrition care practices in hospital wards : results from the Nutrition Care Day Survey 2010.

Background & aim: This paper describes nutrition care practices in acute care hospitals across Australia and New Zealand. Methods: A survey on nutrition care practices in Australian and New Zealand hospitals was completed by Directors of dietetics departments of 56 hospitals that participated in the Australasian Nutrition Care Day Survey 2010. Results: Overall 370 wards representing various specialities participated in the study. Nutrition risk screening was conducted in 64% (n=234) of the wards. Seventy nine percent(n=185) of these wards reported using the Malnutrition Screening Tool, 16% using the Malnutrition Universal Screening Tool (n=37), and 5% using local tools (n=12). Nutrition risk rescreening was conducted in 14% (n=53) of the wards. More than half the wards referred patients at nutrition risk to dietitians and commenced a nutrition intervention protocol. Feeding assistance was provided in 89% of the wards. “Protected” meal times were implemented in 5% of the wards. Conclusion: A large number of acute care hospital wards in Australia and New Zealand do not comply with evidence-based practice guidelines for nutritional management of malnourished patients. This study also provides recommendations for practice.

Nutritional status and dietary intake of acute care patients : results from the Nutrition Care Day Survey 2010

Background & aims: One aim of the Australasian Nutrition Care Day Survey was to determine the nutritional status and dietary intake of acute care hospital patients. Methods: Dietitians from 56 hospitals in Australia and New Zealand completed a 24-h survey of nutritional status and dietary intake of adult hospitalised patients. Nutritional risk was evaluated using the Malnutrition Screening Tool. Participants ‘at risk’ underwent nutritional assessment using Subjective Global Assessment. Based on the International Classification of Diseases (Australian modification), participants were also deemed malnourished if their body mass index was <18.5 kg/m2. Dietitians recorded participants’ dietary intake at each main meal and snacks as 0%, 25%, 50%, 75%, or 100% of that offered. Results: 3122 patients (mean age: 64.6 ± 18 years) participated in the study. Forty-one percent of the participants were “at risk” of malnutrition. Overall malnutrition prevalence was 32%. Fifty-five percent of malnourished participants and 35% of well-nourished participants consumed ≤50% of the food during the 24-h audit. “Not hungry” was the most common reason for not consuming everything offered during the audit. Conclusion: Malnutrition and sub-optimal food intake is prevalent in acute care patients across hospitals in Australia and New Zealand and warrants appropriate interventions.

Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010

Background & aims The Australasian Nutrition Care Day Survey (ANCDS) ascertained if malnutrition and poor food intake are independent risk factors for health-related outcomes in Australian and New Zealand hospital patients. Methods Phase 1 recorded nutritional status (Subjective Global Assessment) and 24-h food intake (0, 25, 50, 75, 100% intake). Outcomes data (Phase 2) were collected 90-days post-Phase 1 and included length of hospital stay (LOS), readmissions and in-hospital mortality. Results Of 3122 participants (47% females, 65 ± 18 years) from 56 hospitals, 32% were malnourished and 23% consumed ≤ 25% of the offered food. Malnourished patients had greater median LOS (15 days vs. 10 days, p < 0.0001) and readmissions rates (36% vs. 30%, p = 0.001). Median LOS for patients consuming ≤ 25% of the food was higher than those consuming ≤ 50% (13 vs. 11 days, p < 0.0001). The odds of 90-day in-hospital mortality were twice greater for malnourished patients (CI: 1.09–3.34, p = 0.023) and those consuming ≤ 25% of the offered food (CI: 1.13–3.51, p = 0.017), respectively. Conclusion The ANCDS establishes that malnutrition and poor food intake are independently associated with in-hospital mortality in the Australian and New Zealand acute care setting.

Embedding information and communication technologies in the early childhood classroom

New technologies and the pace of change in modern society mean changes for classroom teaching and learning. Information and communication technologies (ICTs) feature in everyday life and provide ample opportunities for enhancing classroom programs. This article outlines how ICTs complement curriculum implementation in one year two classroom. It suggests practical strategies demonstrating how teachers can make ICTs work for them and progressively teach children how to make ICTs work for them.

Democratic participation in a globalised World : immigrants in Australia in the early 21st century

This study considers patterns of political participation in Australia in the early 21st Century, using recent data from the Australian Election Study. The paper reassesses how Australia fits within broader patterns of political participation and investigates major predictors of participation in Australia to see how these have or have not changed in a globalised era that has brought new challenges. Factors considered include socio-demographic variables, such as education, age, gender, birthplace and place of residence and also attitudinal orientations towards politics, such as political interest, efficacy and trust. The paper pays particular attention to those who have moved to Australia from other countries. One of the most important findings is that immigrants show little or no sign of any participatory disadvantage and indeed tend to participate more than the Australian-born in some modes of participation, such as campaign activities. The analysis also identifies a clear participatory divide within a number of socio-demographic groups in use of the internet for gaining election information.

A qualitative think aloud study of the early Neo-Piagetian stages of reasoning in novice programmers

Recent research indicates that some of the difficulties faced by novice programmers are manifested very early in their learning. In this paper, we present data from think aloud studies that demonstrate the nature of those difficulties. In the think alouds, novices were required to complete short programming tasks which involved either hand executing ("tracing") a short piece of code, or writing a single sentence describing the purpose of the code. We interpret our think aloud data within a neo-Piagetian framework, demonstrating that some novices reason at the sensorimotor and preoperational stages, not at the higher concrete operational stage at which most instruction is implicitly targeted.

Evaluation of the "reconceptualising early mathematics learning" project

The Pattern and Structure Mathematics Awareness Project (PASMAP) has investigated the development of patterning and early algebraic reasoning among 4 to 8 year olds over a series of related studies. We assert that an awareness of mathematical pattern and structure enables mathematical thinking and simple forms of generalisation from an early age. The project aims to promote a strong foundation for mathematical development by focusing on critical, underlying features of mathematics learning. This paper provides an overview of key aspects of the assessment and intervention, and analyses of the impact of PASMAP on students’ representation, abstraction and generalisation of mathematical ideas. A purposive sample of four large primary schools, two in Sydney and two in Brisbane, representing 316 students from diverse socio-economic and cultural contexts, participated in the evaluation throughout the 2009 school year and a follow-up assessment in 2010. Two different mathematics programs were implemented: in each school, two Kindergarten teachers implemented the PASMAP and another two implemented their regular program. The study shows that both groups of students made substantial gains on the ‘I Can Do Maths’ assessment and a Pattern and Structure Assessment (PASA) interview, but highly significant differences were found on the latter with PASMAP students outperforming the regular group on PASA scores. Qualitative analysis of students’ responses for structural development showed increased levels for the PASMAP students; those categorised as low ability developed improved structural responses over a relatively short period of time.

Blood cultures for evaluation of early postoperative fever after femoral neck fracture surgery

PURPOSE. To evaluate the utility of blood cultures in the assessment of early postoperative fever in hip fracture patients with no other indicators of sepsis. METHODS. 101 blood cultures were drawn on postoperative days 0 to 5 to investigate 84 febrile episodes in 31 women and 30 men (mean age, 80 years) whose body temperature measured via the tympanic route was ≥38ºC. Culture results of these 61 patients were divided into culture-positive and culture-negative groups for comparison. RESULTS. Of the 101 blood cultures, only 2 were positive: one was obtained 5 days after dynamic hip screw fixation, and the other 4 days after hemiarthroplasty. Both blood cultures grew coagulase-negative staphylococcal species, which were deemed to be skin contaminants not requiring change of patient management. 44 of these patients were treated with oral or intravenous antibiotics for a period of time. CONCLUSION. The risk of bacteraemia in patients with postoperative fever but no other symptoms of infection is low. Routine procurement of blood cultures in such patients is ineffective and of limited utility.

To separate or not to separate? Parental decision-making regarding the separation of twins in the early years of schooling

In recent times concerns about possible adverse effects of early separation and advocacy for individual rights have resulted in a movement away from organizational level policies about the separation of twin children as they enter school. Instead, individualized approaches that focus on the twin children’s characteristics and family perspectives have been proposed. This study, conducted in Australia where all but a few families had choice about the class placement of their twin children, questioned parents (N = 156) about their placement decisions. Results indicated that most parents opted for placement together in the early years of schooling. The choice to separate twins at school entry was associated with parent identification of risk in the twin relationship, while being kept together was associated with parent identification of absence of such risk. The findings are discussed in light of the current evidence against separation, and suggest that parent choices regarding the separation of twin children in the early years are informative to educational policy and practice.

Modeling as a means for making powerful ideas accessible to children at an early age

The SimCalc Vision and Contributions Advances in Mathematics Education 2013, pp 419-436 Modeling as a Means for Making Powerful Ideas Accessible to Children at an Early Age Richard Lesh, Lyn English, Serife Sevis, Chanda Riggs … show all 4 hide » Look Inside » Get Access Abstract In modern societies in the 21st century, significant changes have been occurring in the kinds of “mathematical thinking” that are needed outside of school. Even in the case of primary school children (grades K-2), children not only encounter situations where numbers refer to sets of discrete objects that can be counted. Numbers also are used to describe situations that involve continuous quantities (inches, feet, pounds, etc.), signed quantities, quantities that have both magnitude and direction, locations (coordinates, or ordinal quantities), transformations (actions), accumulating quantities, continually changing quantities, and other kinds of mathematical objects. Furthermore, if we ask, what kind of situations can children use numbers to describe? rather than restricting attention to situations where children should be able to calculate correctly, then this study shows that average ability children in grades K-2 are (and need to be) able to productively mathematize situations that involve far more than simple counts. Similarly, whereas nearly the entire K-16 mathematics curriculum is restricted to situations that can be mathematized using a single input-output rule going in one direction, even the lives of primary school children are filled with situations that involve several interacting actions—and which involve feedback loops, second-order effects, and issues such as maximization, minimization, or stabilizations (which, many years ago, needed to be postponed until students had been introduced to calculus). …This brief paper demonstrates that, if children’s stories are used to introduce simulations of “real life” problem solving situations, then average ability primary school children are quite capable of dealing productively with 60-minute problems that involve (a) many kinds of quantities in addition to “counts,” (b) integrated collections of concepts associated with a variety of textbook topic areas, (c) interactions among several different actors, and (d) issues such as maximization, minimization, and stabilization.