Decision trees for detection of activity intensity in youth with cerebral palsy

PURPOSE To develop and test decision tree (DT) models to classify physical activity (PA) intensity from accelerometer output and Gross Motor Function Classification System (GMFCS) classification level in ambulatory youth with cerebral palsy (CP); and 2) compare the classification accuracy of the new DT models to that achieved by previously published cut-points for youth with CP. METHODS Youth with CP (GMFCS Levels I - III) (N=51) completed seven activity trials with increasing PA intensity while wearing a portable metabolic system and ActiGraph GT3X accelerometers. DT models were used to identify vertical axis (VA) and vector magnitude (VM) count thresholds corresponding to sedentary (SED) (<1.5 METs), light PA (LPA) (>/=1.5 and <3 METs) and moderate-to-vigorous PA (MVPA) (>/=3 METs). Models were trained and cross-validated using the 'rpart' and 'caret' packages within R. RESULTS For the VA (VA_DT) and VM decision trees (VM_DT), a single threshold differentiated LPA from SED, while the threshold for differentiating MVPA from LPA decreased as the level of impairment increased. The average cross-validation accuracy for the VC_DT was 81.1%, 76.7%, and 82.9% for GMFCS levels I, II, and III, respectively. The corresponding cross-validation accuracy for the VM_DT was 80.5%, 75.6%, and 84.2%, respectively. Within each GMFCS level, the decision tree models achieved better PA intensity recognition than previously published cut-points. The accuracy differential was greatest among GMFCS level III participants, in whom the previously published cut-points misclassified 40% of the MVPA activity trials. CONCLUSION GMFCS-specific cut-points provide more accurate assessments of MVPA levels in youth with CP across the full spectrum of ambulatory ability.

Reliability and validity of objective measures of physical activity in youth with cerebral palsy who are ambulatory

BACKGROUND Physical therapy for youth with cerebral palsy (CP) who are ambulatory includes interventions to increase functional mobility and participation in physical activity (PA). Thus, reliable and valid measures are needed to document PA in youth with CP. OBJECTIVE The purpose of this study was to evaluate the inter-instrument reliability and concurrent validity of 3 accelerometer-based motion sensors with indirect calorimetry as the criterion for measuring PA intensity in youth with CP. METHODS Fifty-seven youth with CP (mean age=12.5 years, SD=3.3; 51% female; 49.1% with spastic hemiplegia) participated. Inclusion criteria were: aged 6 to 20 years, ambulatory, Gross Motor Function Classification System (GMFCS) levels I through III, able to follow directions, and able to complete the full PA protocol. Protocol activities included standardized activity trials with increasing PA intensity (resting, writing, household chores, active video games, and walking at 3 self-selected speeds), as measured by weight-relative oxygen uptake (in mL/kg/min). During each trial, participants wore bilateral accelerometers on the upper arms, waist/hip, and ankle and a portable indirect calorimeter. Intraclass coefficient correlations (ICCs) were calculated to evaluate inter-instrument reliability (left-to-right accelerometer placement). Spearman correlations were used to examine concurrent validity between accelerometer output (activity and step counts) and indirect calorimetry. Friedman analyses of variance with post hoc pair-wise analyses were conducted to examine the validity of accelerometers to discriminate PA intensity across activity trials. RESULTS All accelerometers exhibited excellent inter-instrument reliability (ICC=.94-.99) and good concurrent validity (rho=.70-.85). All accelerometers discriminated PA intensity across most activity trials. LIMITATIONS This PA protocol consisted of controlled activity trials. CONCLUSIONS Accelerometers provide valid and reliable measures of PA intensity among youth with CP.

Considering gambling involvement in the understanding of problem gambling: A large cross-sectional study of an Australian population

Instead of regarding a particular type of gambling activity (for example, electronic gambling machines, table games) as an isolated factor for problem gambling, recent research suggests that gambling involvement (for example, as measured by the number of different types of gambling activities played) should also be considered. Using a large sample of the Victorian adult population, this study found that the strength of association between problem gambling and the type of gambling reduced after adjusting for gambling involvement. This finding supports recent research that gambling involvement is an important factor in assessing the risk of problem gambling. The study also provides insights into the measurements of gambling involvement and provides alternative statistical modelling to analyse problem gambling.

Bringing up Children Gran’s Way: Insights from a research project on Indigenous child and youth mental health

Background In 2000, the Mater Child and Youth Mental Health Service Indigenous consultant saw that Indigenous families were isolated from kinship networks following the assimilation policy and clinicians were largely unaware of these socio-cultural histories. Experiences of marginalisation by mainstream society and services were exacerbated by assumptions clinicians made about this population. To enhance Mater’s care the consultant undertook research with Indigenous Elders. The project, “Bringing up Children Gran’s Way”, on which the presenter is the research advisor, was funded by AIATSIS. Aims Increase service quality Improve staff confidence, skills and satisfaction working with this population Promote the wellbeing of Indigenous families Acknowledge the significance of Elders and extended family networks. Methods Over 2006/07 the team used narrative and Indigenous methodologies, (e.g. yarning circles and the use of Indigenous research staff) to arrange and audio-record structured interviews with 19 Aboriginal Elders, on growing up and parenting. The participants were recruited by the Indigenous consultant and gave written consent, following ethical approval and information giving. The team immersed themselves in the material by repeated reading of the transcripts to note recurring themes in Elders’ narratives. Findings The recurring themes included the importance of cultural protocols and extended family; impacts of being ‘under the Act and stories of surviving change; culture, spiritualty and religion; trans-generational impacts; childrearing and the need to reconcile with Elders. Discussion The narratives show Elders resilience in the face of enduring impact of policies of genocide and assimilation. Clinicians need to approach their work with a deeper understanding of the diversity of clients’ social experience and cultural identity. Clinicians need to examine their own cultural assumptions about this population. Conclusion The dissemination of the knowledge and experience of Elders is a matter of social justice and crucial for the well-being of future generations and for improved service access.

Youth master plans as potential roadmaps to creating child- and youth-friendly cities

Communities across the globe are focusing on the needs of young people and their families in an effort to create child- and youth-friendly cities. In an attempt to become more child and youth friendly, over 40 communities in the United States have developed youth master plans (YMPs), as of 2009; however, our understanding of these plans is limited. To broaden this understanding, this research employed a multiple-methods approach, including an online questionnaire, plan analysis and semi-structured interviews with key community informants. Findings show that YMPs often focus on collaboration among community entities and youth participation, yet include only general normative statements regarding the physical environment. Furthermore, urban planners do not typically take the lead in development of YMPs, and, in some cases, are not involved at all. To inform and improve future YMPs, this paper recommends greater focus on the physical environment, particularly in relation to safety, access to nature and sustainable transportation.

Unbounding the interaction design problem: The contribution of HCI in three interventions for well-being

In this paper we consider HCI's role in technology interventions for health and well-being. Three projects carried out by the authors are analysed by appropriating the idea of a value chain to chart a causal history from proximal effects generated in early episodes of design through to distal health and well-being outcomes. Responding to recent arguments that favour bounding HCI's contribution to local patterns of use, we propose an unbounded view of HCI that addresses an extended value chain of influence. We discuss a view of HCI methods as mobilising this value chain perspective in multi-disciplinary collaborations through its emphasis on early prototyping and naturalistic studies of use.

Human trafficking heroes and villains: Representing the problem in anti-trafficking awareness campaigns

Since the declaration by the United Nations that awareness raising should be a key part of efforts to combat human trafficking, government and non-government organisations have produced numerous public awareness campaigns designed to capture the public’s attention and sympathy. These campaigns represent the ‘problem’ of trafficking in specific ways, creating heroes and villains by placing the blame for trafficking on some, while obscuring the responsibility of others. This paper adopts Carol Bacchi’s ‘What is the problem represented to be?’ framework for examining the politicisation of problem representation in 18 anti-trafficking awareness campaigns. It is argued that these campaigns construct a narrow understanding of the problem through the depiction of ‘ideal offenders’. In particular, a strong focus on the demand for commercial sex as causative of human trafficking serves to obscure the problematic role of consumerism in a wide range of industries, and perpetuates an understanding of trafficking that fails to draw a necessary distinction between the demand for labour, and the demand for ‘exploitable’ labour. This problem representation also obscures the role governments in destination countries may play in causing trafficking through imposing restrictive migration regimes that render migrants vulnerable to traffickers.

The problem of simplification: Think-tanks, recipes, equity and ‘Turning around low-performing schools’

Non-government actors such as think-tanks are playing an important role in Australian policy work. As governments increasingly outsource policy work previously done by education departments and academics to these new policy actors, more think-tanks have emerged that represent a wide range of political views and ideological positions. This paper looks at the emergence of the Grattan Institute as one significant player in Australian education policy with a particular emphasis on Grattan’s report ‘Turning around low-performing schools’. Grattan exemplifies many of the facets of Barber’s ‘deliverology’, as they produce reports designed to be easily digested, simply actioned and provide reassurance that there is an answer, often through focusing on ‘what works’ recipes. ‘Turning around low-performing schools’ is a perfect example of this deliverology. However, a close analysis of the Report suggests that it contains four major problems which seriously impact its usefulness for schools and policymakers: it ignores data that may be more important in explaining the turn-around of schools, the Report is overly reliant on NAPLAN data, there are reasons to be suspicious about the evidence assembled, and finally the Report falls into a classic trap of logic—the post hoc fallacy.

The present attitude of African youth towards entrepreneurship

It is widely known that entrepreneurship plays a crucial role within the economy. As the African economy needs rapid development and growth, this paper investigates the present attitude of African youth towards new business creation and entrepreneurship. Both quantitative and qualitative research methods were used, and 204 people participated in the study. The participants were accessed via social media such as Facebook (pages and groups), LinkedIn (groups), Twitter, and WhatsApp. The results reveal that African youth have positive attitudes and that they are entrepreneurially active and ready to take risks, provided that they can be self-dependent. Similarly, the results show that entrepreneurship education is much needed to improve innovative start-ups in Africa.

The problem with teamwork: A discursive investigation

- Background Teamwork sits comfortably within the vocabularies of most physical education teachers. It is used to both describe and prescribe student behaviour in a variety of physical and sport-related activities. Yet while supporters of sport and PE have readily employed the term, remarkably few pedagogues have taken the time to consider what teamwork refers to, let alone what it means to teach it. - Focus of study In this paper, we examine practitioners' constructions of teamwork. - Participants and setting Data were generated with seven physical education teachers (four male and three female) at a state-funded secondary school near Brisbane, Australia. The teachers ranged in experience from three months to more than 30 years. - Research design The investigation was a case study of one physical education department at a secondary school. - Data collection Three interviews were conducted with each of the teachers. The first was biographical in nature and covered themes such as education and sporting experiences. During the second interviews, teachers produced examples and statements on the topic of teamwork as it occurs within their lessons. The material from the second set of interviews was explored in the final set where the teachers were invited to elaborate on and explain comments from their previous interviews. - Analysis Data were considered from a discursive-constructionist perspective and attention was given to linguistic and grammatical features of the teachers' commentary as well as the cultural relevance of the utterances. The notion of ‘interpretive repertoires’ – essentially cultural explanations bounded by particular socio-linguistic features – provided the central unit of analysis. - Findings The teachers in the project made use of an array of discursive resources to make sense of teamwork. These constructions often bore little resemblance to one another or to existing theories of teamwork. In some cases, the teachers offered vague descriptions or drew on alternative concepts to make sense of teamwork. - Conclusions Without a certain level of agreement in their everyday usage, teachers' constructions of teamwork fail to be convincing or useful. We maintain that a more substantive conceptualisation of teamwork is needed in the field of sport pedagogy and offer suggestions on how this might be accomplished.

The transfer problem and the intertemporal terms of trade

In this paper the effects of a transfer on the intertemporal terms of trade are examined in the context of a simple two-country, two-period model. When intertemporal trade occurs because the two economies have different rates of time preference, a transfer improves the terms of trade of the paying country. Alternatively, when trade occurs owing to international differences in the endowments of goods over the two periods, the effect of a transfer depends on (a) the relationship between the interest rate and the rates of time preference of the two countries and (b) the relationship between their elasticities of intertemporal consumption substitution.

What the problem may be with family intervention . . . and with dissemination more generally: A commentary

While the two decades since the study by Kavanagh et al. (1993) has given additional insights into effective dissemination of family interventions, the accompanying papers show that progress remains limited. The effectiveness trial that triggered this series of papers offers a cautionary tale. Despite management support, 30–35 hr of workshop training and training of local supervisors who could act as champions, use of the full intervention was limited. In part, this seemed due to the demanding nature of the intervention and its incompatibility with practitioners’ roles, in part, to limitations in the training, among other factors. While the accompanying papers note these and other barriers to dissemination, they miss a more disturbing finding in the original paper: Practitioners said they were using several aspects in routine care, despite being unable to accurately describe what they were. This finding highlights the risks in taking practitioners’ reports of their practice in files or supervision sessions at face value and potentially has implications for reports of other clinical work. The fidelity of disseminated treatments can only be assured by audits of practice, accompanied by affirming but also corrective feedback.

Understanding who cares: Creating the evidence to address the long-standing policy problem of staff shortages in early childhood education and care

Evidence-based policy is a means of ensuring that policy is informed by more than ideology or expedience. However, what constitutes robust evidence is highly contested. In this paper, we argue policy must draw on quantitative and qualitative data. We do this in relation to a long entrenched problem in Australian early childhood education and care (ECEC) workforce policy. A critical shortage of qualified staff threatens the attainment of broader child and family policy objectives linked to the provision of ECEC and has not been successfully addressed by initiatives to date. We establish some of the limitations of existing quantitative data sets and consider the potential of qualitative studies to inform ECEC workforce policy. The adoption of both quantitative and qualitative methods is needed to illuminate the complex nature of the work undertaken by early childhood educators, as well as the environmental factors that sustain job satisfaction in a demanding and poorly understood working environment.

Problem-based learning in an e-learning environment: A case study at Griffith University School of Medicine

Increasing numbers of medical schools in Australia and overseas have moved away from didactic teaching methodologies and embraced problem-based learning (PBL) to improve clinical reasoning skills and communication skills as well as to encourage self-directed lifelong learning. In January 2005, the first cohort of students entered the new MBBS program at the Griffith University School of Medicine, Gold Coast, to embark upon an exciting, fully integrated curriculum using PBL, combining electronic delivery, communication and evaluation systems incorporating cognitive principles that underpin the PBL process. This chapter examines the educational philosophies and design of the e-learning environment underpinning the processes developed to deliver, monitor and evaluate the curriculum. Key initiatives taken to promote student engagement and innovative and distinctive approaches to student learning at Griffith promoted within the conceptual model for the curriculum are (a) Student engagement, (b) Pastoral care, (c) Staff engagement, (d) Monitoring and (e) Curriculum/Program Review. © 2007 Springer-Verlag Berlin Heidelberg.

12-weeks supervised exercise training is a feasible and efficacious treatment for reducing depression in youth with major depressive disorder

Introduction: Major Depressive Disorder (MDD) has high prevalence among adolescents and young adults. Evidence of any effective treatments is limited. Exercise as an effective treatment for adults has some support but studies in younger populations are lacking. Therefore the aim of this study was to investigate the feasibility and preliminary efficacy of brief motivational interviewing (MI) plus 12-weeks exercise training as a treatment for MDD in youth...