Discordance of international adiposity classifications in Australian boys and girls - The LOOK study

Background: Various charts based on body mass index (BMI) and per cent body fat (%BF) are used to classify childhood body composition but outcomes may vary.

Aim: The study investigated variation in incidences of childhood obesity as depicted by four classification charts.

Subjects and methods: BMI and DXA-derived %BF were assessed in 741 children. Incidences of overweight and obesity were compared between two BMI charts and two bioelectrical impedance (BIA)-based %BF charts.

Results: The International Obesity Task Force (IOTF)-adopted BMI chart designated 21%, 6% (boys), and 26%, 9% (girls) as overweight and obese, respectively. Corresponding figures using the USA CDC BMI chart were 27%, 11% (boys) and 27%, 12% (girls). Using a USA-derived %BF chart incidences were 17%, 2% (boys) and 21%, 8% (girls) and using a UK-derived %BF chart 51%, 24% (boys) and 53%, 36% (girls). Sensitivity of BMI varied according to the %BF reference chart.

Conclusions: In contrast to the BMI-based charts, there were considerable variations in depicted incidences of obesity between the %BF-based charts. These discordances were considered to result from previously reported variation within and between BIA and DXA %BF assessments underlying the charts. The present study highlights the need for valid, reliable, unchanging BIA and DXA procedures.

Implementation of a medication guideline to improve medication safety for patients

Although the incidence of medication error remains unknown, in Australian hospitals, they are thought to occur in 5-20 % of drug administrations 1. Not surprisingly, international debate has focused on the mechanisms to improve the safety of patients. Thus a new National Inpatient Medication Chart (NIMC) was endorsed to improve communication and reduce medication errors 2. This study aimed to investigate the documentation practices of clinicians following the implementation of a medication guideline and NIMC.
A pre and post-test design was used to evaluate the adoption of and adherence to the medication guideline at Western Health, an 850 bed healthcare network in Australia. Audits of inpatient medication charts (N=265) were conducted at 3 months prior to and repeated 4 months (N=290) after implementation. The pre-test data was used to formulate an interdisciplinary organizational strategy that included mandatory education for all clinical staff, practice reminders, decision prompts, a telephone hotline for support, an intranet information website and electronically distributed Frequently Asked Questions.
Pre and post implementation audits highlighted areas of potential medication error. The post-test showed an overall trend towards improvement in documentation. There were significant improvements in 4 critical practices: Drug name clear (p=0.0003); Drug dose clear (p=0.0002); Prescribed frequency equals documented frequency (p=0) and; No signature by administrator (p=0).
The majority of documentation errors showed poor attention to detail and would be considered a slip or lapse in skill based judgment 3. Although this study was designed to evaluate documentation practices, future research should include observation methods to increase our understanding of the context behind the judgments such as work place interruptions, skill mix and knowledge levels. While evidence based guidelines enable work, they are not the actual work or substance of patient care. Organisational systems can assist in preventing unconscious aberrations that lead to error.

A hitchhiker's guide to assessing young people's physical activity : deciding what method to use

Researchers and practitioners interested in assessing physical activity in  children are often faced with the dilemma of what instrument to use. While there is a plethora of physical activity instruments to choose from, there is currently no guide regarding the suitability of common assessment instruments. The purpose of this paper is to provide a user’s guide for selecting physical activity assessment instruments appropriate for use with children and adolescents. While recommendations regarding specific instruments are not provided, the guide offers information about key attributes and considerations for the use of eight physical activity assessment approaches: heart rate monitoring; accelerometry; pedometry; direct observation; self-report; parent report; teacher report; and diaries/logs. Attributes of instruments and other factors to be considered in the selection of assessment instruments include: population (age); sample size; respondent burden; method/delivery mode; assessment time frame; physical activity information required (data output); data management; measurement error; cost (instrument and administration) and other limitations. A decision flow chart has been developed to assist researchers and practitioners to select an appropriate method of assessing physical activity. Five real-life scenarios are presented to illustrate this process in light of key instrument attributes. It is important that researchers, practitioners and policy makers understand the strengths and limitations of different methods of assessing physical activity, and are guided on selection of the most appropriate instrument/s to suit their needs.

Predictors of body mass index change in Australian primary school children

Objective. To assess associations between multiple potential predictors and change in child body mass index (BMI). Methods.In the 1997 Health of Young Victorians Study, children in Grades preparatory to three (aged 510 years) had their height and weight measured. Parents provided information on potential predictors of childhood overweight across six domains (children’s diet, children’s activity level, family composition, sociodemographic factors, prenatal factors and parental adiposity). Measures were repeated three years later in 2000/1. BMI was transformed to standardised (z) scores using the US 2000 Growth Chart data and children were classified as non-overweight or overweight according to international cutpoints.Regression analyses, including baseline BMI z-score as a covariate, assessed the contribution of each potential predictor to change in BMI z-score, development of overweight and spontaneous resolution of overweight in 1 373 children.Results. BMI z-score change was positively associated with frequency of take-away food, food quantity, total weekly screen time, non-Australian paternal country of birth, maternal smoking during pregnancy, and maternal and paternal BMI.Inverse associations were noted for the presence of siblings and rural residence (all pB0.05). Predictors of categorical change (development and resolution of overweight) were less clearly identified, apart from an association between maternal BMI and overweight development (p0.02). Multivariable models suggested individual determinants have a cumulative effect on BMI change. Conclusions. Strong short-term tracking of BMI makes it difficult to identify predictors of change. Nonetheless, putative determinants across all domains assessed were independently associated with adiposity change. Multi-faceted solutions are likely to be required to successfully deal with the complexities of childhood overweight.

Laboratory and non-laboratory-based risk prevention models for secondary prevention of cardiovascular disease : the LIPID study

Aims : The aims of this study were to examine whether risk prediction models for recurrent cardiovascular disease (CVD) events have prognostic value, and to particularly examine the performance of those models based on non-laboratory data. We also aimed to construct a risk chart based on the risk factors that showed the strongest relationship with CVD.

Methods and results : Cox proportional hazards models were used to calculate a risk score for each recurrent event in a CVD patient who was enrolled in a very large randomized controlled clinical trial. Patients were then classified into groups according to quintiles of their risk score. These risk models were validated by calibration and discrimination analyses based on data from patients recruited in New Zealand for the same study. Non-laboratory-based risk factors, such as age, sex, body mass index, smoking status, angina grade, history of myocardial infarction, revascularization, stroke, diabetes or hypertension and treatment with pravastatin, were found to be significantly associated with the risk of developing a recurrent CVD event. Patients who were classified into the medium and high-risk groups had two-fold and four-fold the risk of developing a CVD event compared with those in the low-risk group, respectively. The risk prediction models also fitted New Zealand data well after recalibration.

Conclusion : A simpler non-laboratory-based risk prediction model performed equally as well as the more comprehensive laboratory-based risk prediction models. The risk chart based on the further simplified Score Model may provide a useful tool for clinical cardiologists to assess an individual patient's risk for recurrent CVD events.

Solar energy use for energy savings in dairy processing plants

New Zealand is one of the world’s largest producers of dairy products and has a climate with high levels of solar radiation; however, the use of solar energy in the dairy processing industry has received limited attention. An examination of historical records found that the annual peak in New Zealand milk production and processing occurs at a time when solar radiation levels are increasing markedly. An F-Chart analysis was used to simulate the performance of large-area arrays of solar collectors and to determine their suitability for heating and cooling in a dairy processing environment. For the study four types of solar collectors were analysed: glazed flat plates, evacuated tubes, evacuated tubes with CPC reflectors and a building-integrated solar collector under development at the University of Waikato (UoW). It was found that of these echnologies, both flat plate and evacuated tubes with CPC reflectors could make useful heating and cooling contributions. Furthermore, the solar fraction was determined mainly by the collector area to storage volume ratio. Finally, it was found that the UoW building-integrated solar collector could make a significant contribution to energy use in dairies and may be an attractive future technology for the industry.

Designing a low cost solar collector system for process industry applications

New Zealand is a large producer and processor of primary products and has a climate with high levels of solar radiation. However, the use of solar energy for heating and cooling in the processing industries has received limited attention.
For this study, the design of a low cost solar collector is analysed and discussed. Furthermore, the methods for integrating the collector into water heating and cooling systems in a hypothetical processing environment are examined. An F-Chart analysis is used to simulate the performance of large-area arrays of the solar collector and to determine its potential contribution to heating and cooling loads.
The study shows that for a storage-based system, the contribution of solar energy is determined mainly by the collector area to storage volume ratio. It is suggested that this low cost collector could make a significant contribution to energy use in processing plants and may be an attractive future technology.

Ongoing colonial legacy : contemporary education beliefs and practices in Papua New Guinea

In the late 1980ˇ¦s, a realisation that the western education system bequeathed to Papua New Guinea at the time of Independence had functioned to devalue and marginalise many of the traditional beliefs, knowledge and skills students brought with them to education, led to a period of significant education reform. The Reform was premised on the report of a Ministerial Review Committee called A Philosophy of Education. This report made recommendations about how education in Papua New Guinea could respond to the issues and challenges this nation faced as it sought to chart a course to serve the needs of its citizens on its own terms. The issues associated with managing and implementing institutionalised educational change premised on importing western values and practices are a central theme of this thesis. The impact of importing foreign curriculum and associated curriculum officers and consultants to assist with curriculum change and development in the former Language and Literacy unit of the Curriculum Development Division, is considered in three related sections of this report: „P a critical review of the imported educational system and related practices and related issues since Independence „P narrative report of the experience of two colleagues in western education „P evidential research based on curriculum Reform in the Language and Literacy Unit. How Papua New Guinea has sought to come to terms with the issues and challenges that arose in response to a practice of importing western curriculum both at the time of Independence and currently through the Reform, are explored throughout the thesis. The findings issues reveal much about the capacity of individuals and institutions to respond to a post-colonial world particularly associated with an ongoing colonial legacy in the principle researcherˇ¦s work context. The thesis argues that the challenges Papua New Guinea curriculum officers face today, as they manage and implement changes associated with another imported curriculum are caught up in existing power relations. These power relations function to stifle creative thinking at a time when it is most needed. Further, these power relations are not well understood by the curriculum officers and remained hidden and unquestioned throughout the research project. The thesis also argues that in the researcherˇ¦s work context, techniques of surveillance were brought to bear and functioned to curtail critical thinking about how the reformed curriculum could be sensitive and respectful of those beliefs and traditions that had sustained life in Papua New Guinea for thousands of years. Consequently, many outmoded beliefs and practices associated with an uncritical and ongoing acceptance of the superiority of western imports have been retained, thereby effectively denying the collective voices of Paua New Guineans in the current curriculum Reform.

Attachment as a predictor of leadership and follower outcomes

Research has suggested that effective leadership, specifically the utilisation of transformational leadership behaviours, is heavily entrenched in a leader’s interpersonal skills. However, few studies have investigated the interpersonal factors that drive appropriate use of transformational and transactional leadership in leader-follower settings. Attachment theory provides a robust framework in which to chart the developmental precursors of effective leadership that underpin positive leader-follower relationships and potential organisational outcomes. In this study, 46 manager-non manager dyads recruited from a Victorian education institution, a national telecommunications company and a Victorian real-estate business (managers – Mean age = 48.5 years, SD = 7.78, non-managers – Mean age 43.92 years, SD = 8.72) took part in an online questionnaire. Participants completed measures of attachment, leadership behaviour and organisational citizenship behaviour. Path analysis revealed that manager’s attachment style significantly predicted follower ratings of transformational and transactional leadership behaviours. Additionally, follower ratings of leadership were associated with organisational citizenship behaviour. Thus, it is concluded that attachment theory provides a valid framework in which to understand follower perceptions of leadership behaviour and subsequent organisational outcomes. These findings are discussed within the context of attachment theory and the leadership literature.

Skipping breakfast : longitudinal associations with cardiometabolic risk factors in the childhood determinants of adult health study

Background: The long-term effects of skipping breakfast on cardiometabolic health are not well understood.

Objective: The objective was to examine longitudinal associations of breakfast skipping in childhood and adulthood with cardiometabolic risk factors in adulthood.

Design: In 1985, a national sample of 9–15-y-old Australian children reported whether they usually ate breakfast before school. During follow-up in 2004–2006, 2184 participants (26–36 y of age) completed a meal-frequency chart for the previous day. Skipping breakfast was defined as not eating between 0600 and 0900. Participants were classified into 4 groups: skipped breakfast in neither childhood nor adulthood (n = 1359), skipped breakfast only in childhood (n = 224), skipped breakfast only in adulthood (n = 515), and skipped breakfast in both childhood and adulthood (n = 86). Diet quality was assessed, waist circumference was measured, and blood samples were taken after a 12-h fast (n = 1730). Differences in mean waist circumference and blood glucose, insulin, and lipid concentrations were calculated by linear regression.

Results: After adjustment for age, sex, and sociodemographic and lifestyle factors, participants who skipped breakfast in both childhood and adulthood had a larger waist circumference (mean difference: 4.63 cm; 95% CI: 1.72, 7.53 cm) and higher fasting insulin (mean difference: 2.02 mU/L; 95% CI: 0.75, 3.29 mU/L), total cholesterol (mean difference: 0.40 mmol/L; 95% CI: 0.13, 0.68 mmol/L), and LDL cholesterol (mean difference: 0.40 mmol/L; 95% CI: 0.16, 0.64 mmol/L) concentrations than did those who ate breakfast at both time points. Additional adjustments for diet quality and waist circumference attenuated the associations with cardiometabolic variables, but the differences remained significant.

Conclusions: Skipping breakfast over a long period may have detrimental effects on cardiometabolic health. Promoting the benefits of eating breakfast could be a simple and important public health message.

Strategy and continuous improvement in small-to-medium Australian manufacturers

While Australian firms have generally recognised the value of continuous improvement (CI) in improving performance, many have yet to develop systems to ensure that the efforts of the CI program are focussed on issues of strategic importance to the company. In fact, as recognised in operations management generally, CI activities can have a significant impact on the development of strategy as well as its implementation. The research reported here uses a CI mapping methodology to chart the relationship between CI and strategy in small- to medium-sized manufacturers. Analysis of the link between the firms’ strategies and CI programs indicates that most firms involved in the study made little attempt to link the two and some appear to be unaware of any need to do so. However, such findings seem to be dependent on company size, the maturity of the CI program and the competitive position of the firm. The paper also includes an examination of the role of operations and shopfloor CI in company strategy, particularly as related to SMEs.

Explanations for variation in cognitive ability : behavioural ecology meets comparative cognition

Sara Shettleworth has played a defining role in the development of animal cognition and its integration into other parts of biology, especially behavioural ecology. Here we chart some of that progress in understanding the causes and importance of variation in cognitive ability and highlight how Tinbergen's levels of explanation provide a useful framework for this field. We also review how experimental design is crucial in investigating cognition and stress the need for naturalistic experiments and field studies. We focus particularly on the example of the relationship among food hoarding, spatial cognition and hippocampal structure, and review the conflicting evidence for sex differences in spatial cognition. We finish with speculation that a combination of Tinbergen and Shettleworth-style approaches would be the way to grapple with the as-yet unanswered questions of why birds mimic heterospecifics.

Three dimensional stability charts for slopes based on limit analysis methods

This paper uses finite element upper and lower bound limit analysis to produce chart solutions for three-dimensional (3D) natural slopes for both short- and long-term stability. The presented chart solutions are convenient tools that can be used for preliminary design purposes. The rigorous limit analysis results in this paper were found to bracket the true factor of safety within ±10% or better, which can be used as a benchmark for the solutions from other methods. The depth of the slip surfaces is observed to be generally shallow for most analyzed cases, particularly for the long-term slope stability problem. In addition, it was found that using a two-dimensional (2D) analysis may lead to significant differences in estimating safety factors, which can differ by 2%–60% depending on the slope geometry and soil properties. Therefore, great care and judgement are required when applying 2D analyses to 3D slope problems.

Charting changes in the discipline : a tri-continental analysis

The purpose of this paper is to describe and chart three key and underpinning dimensions of Information Systems (IS) research in three ‘flagship’ journals of three continents, over a period of nine years. The dimensions are: research domain, research paradigm, and research setting and they comprise respectively, ‘the what’, ‘the how’, and ‘the where’ of research. The paper contributes to the debate on research diversity in Information Systems in three ways. Firstly, it provides a view of ‘research domain’ that is at a semantically higher level than previous schemas examining the ‘what’ of research. This view reveals deep structural trends within the IS literature. Secondly, it details the results of a content analysis which examined research domain, research paradigm, and research setting within the journals MIS Quarterly (MISQ), European Journal of Information Systems (EJIS) and the Australasian Journal of Information Systems (AJIS) during the years 2001-2009. Lastly, the study compares the publication trends across the three continents and identifies an emerging, if tentative convergence across the Atlantic and to some extent in Australia. The paper suggests some reasons for this convergence and some avenues to explore it.

Mixed methods evaluation research for a mental health screening and referral clinical pathway

Rationale: This study is an exemplar of mixed method evaluation research for development of a clinical pathway.

Aim: To develop and evaluate an evidence-based, feasible mental health screening and referral clinical pathway for Department of Veterans’ Affairs-funded community nursing care of war veterans and war widows in the Australian context.

Methods: Mixed methods were applied to formulate and clinically evaluate an appropriate pathway. The pathway was applied at urban and rural sites for the nursing care of 97 war veteran and war widow clients. Evaluative data were collected from clients, their informal carers, community nurses, and general practitioners. Chart auditing and pre-post measures were undertaken. Collaboration occurred with an interdisciplinary design team.

Results: The final modified six-page pathway includes use of validated screening tools (Kessler Psychological Distress Scale [K10]) and Alcohol Use Disorder Identification Test, appropriate referral information, directions for support and health-promoting education, and evidence-based guidelines. Implications for Practice: The clinical pathway is a useful, tested, evidence-based guide for generalist community nurses to identify and suitably respond to common mental healthcare needs of war veterans and war widows. The pathway provides outcomes acceptable to clients and their carers, nurses and doctors.

Conclusions: This study provides an evaluated clinical pathway for generalist community nurses to screen for mental health difficulties, make appropriate referrals as required and to support war veteran and war widow clients. However, the study also shows how research can be used to develop and evaluate
practical, evidence-based clinical pathways.