The infant feeding activity and nutrition trial (INFANT) an early intervention to prevent childhood obesity : cluster-randomised controlled trial

Background : Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.

Methods/Design : This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group.

Discussion : The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating, physical activity and reduced sedentary behaviours. If proven to be effective, INFANT may protect children from the development of obesity and its associated social and economic costs.

Load balancing based concurrent execution of NAS parallel benchmarks with BYTE sequential benchmarks on a non-dedicated cluster

Dedicated clusters are becoming commonly used for high performance parallel processing. Computers of a non-dedicated cluster are often idle or lightly loaded. These under utilised computers can be employed to execute parallel applications. Thus, they have to be shared by parallel and sequential applications, which could lead to the improvement of their execution performance. There is a lack of experimental study showing the behaviour and performance of executing parallel and sequential applications concurrently on a non-dedicated cluster. We present the result of an experimental study into load balancing of a mixture of parallel and sequential applications on a non-dedicated cluster.

A study of the concurrent execution of parallel and sequential applications on a non-dedicated cluster

Computers of a non-dedicated cluster are often idle (users attend meetings, have lunch or coffee breaks) or lightly loaded (users carry out simple computations to support problem solving activities). These underutilised computers can be employed to execute parallel applications. Thus, these computers can be shared by parallel and sequential applications, which could lead to the improvement of their execution performance. However, there is a lack of experimental study showing the applications’ performance and the system utilization of executing parallel and sequential applications concurrently and concurrent execution of multiple parallel applications on a non-dedicated cluster. Here we present the result of an experimental study into load balancing based scheduling of mixtures of NAS Parallel Benchmarks and BYTE sequential applications on a very low cost non-dedicated cluster. This study showed that the proposed sharing provided performance boost as compared to the execution of the parallel load in isolation on a reduced number of computers and better cluster utilization. The results of this research were used not only to validate other researchers’ result generated by simulation but also to support our research mission of widening the use of non-dedicated clusters. Our promising results obtained could promote further research studies to convince universities, business and industry, which require a large amount of computing resources, to run parallel applications on their already owned non-dedicated clusters.

Transparent and autonomic rollback-recovery in cluster systems

Cluster systems provide an excellent environment to run computation hungry applications. However, due to being created using commodity components they are prone to failures. To overcome these failures we propose to use rollback-recovery, which consists of the checkpointing and recovery facilities. Checkpointing facilities have been the focus of many previous studies; however, the recovery facilities have been overlooked. This paper focuses on the requirements, concept and architecture of recovery facilities. The synthesized fault tolerant system was implemented in the GENESIS system and evaluated. The results show that the synthesized system is efficient and scalable.

Adolescents' use of purpose built shade in secondary schools : cluster randomised controlled trial

Objective To examine whether students use or avoid newly shaded areas created by shade sails installed at schools.

Design Cluster randomised controlled trial with secondary schools as the unit of randomisation.

Setting 51 secondary schools with limited available shade, in Australia, assessed over two spring and summer terms.

Participants Students outside at lunch times.

Intervention Purpose built shade sails were installed in winter 2005 at full sun study sites to increase available shade for students in the school grounds.

Main outcome measure Mean number of students using the primary study sites during weekly observations at lunch time.

Results Over the study period the mean change in students using the primary study site from pre-test to post-test was 2.63 (95% confidence interval 0.87 to 4.39) students in intervention schools and –0.03 (–1.16 to 1.09) students in control schools. The difference in mean change between groups was 2.67 (0.65 to 4.68) students (P=0.011).

Conclusions Students used rather than avoided newly shaded areas provided by purpose built shade sails at secondary schools in this trial, suggesting a practical means of reducing adolescents’ exposure to ultraviolet radiation.

Trial registration Exempt.

MOSAIC (MOthers' Advocates In the Community): protocol and sample description of a cluster randomised trial of mentor mother support to reduce intimate partner violence among pregnant or recent mothers

Background : Intimate partner violence (IPV) is prevalent globally, experienced by a significant minority of women in the early childbearing years and is harmful to the mental and physical health of women and children. There are very few studies with rigorous designs which have tested the effectiveness of IPV interventions to improve the health and wellbeing of abused women. Evidence for the separate benefit to victims of social support, advocacy and non-professional mentoring suggested that a combined model may reduce the levels of violence, the associated mental health damage and may increase a woman's health, safety and connection with her children. This paper describes the development, design and implementation of a trial of mentor mother support set in primary care, including baseline characteristics of participating women.

Methods/Design : MOSAIC (MOtherS' Advocates In the Community) was a cluster randomised trial embedded in general practice and maternal and child health (MCH) nursing services in disadvantaged suburbs of Melbourne, Australia. Women who were pregnant or with infants, identified as abused or symptomatic of abuse, were referred by IPV-trained GPs and MCH nurses from 24 general practices and eight nurse teams from January 2006 to December 2007. Women in the intervention arm received up to 12 months support from trained and supported non-professional mentor mothers. Vietnamese health professionals also referred Vietnamese women to bilingual mentors in a sub-study. Baseline and follow-up surveys at 12 months measured IPV (CAS), depression (EPDS), general health (SF-36), social support (MOS-SF) and attachment to children (PSI-SF). Significant development and piloting occurred prior to trial commencement. Implementation interviews with MCH nurses, GPs and mentors assisted further refinement of the intervention. In-depth interviews with participants and mentors, and follow-up surveys of MCH nurses and GPs at trial conclusion will shed further light on MOSAIC's impact.

Discussion : Despite significant challenges, MOSAIC will make an important contribution to the need for evidence of effective partner violence interventions, the role of non-professional mentors in partner violence support services and the need for more evaluation of effective health professional training and support in caring for abused women and children among their populations.

Weight, physical activity and dietary behavior change in young mothers : short term results of the HeLP-her cluster randomized controlled trial

Background
Preventing weight gain rather than treating established obesity is an important economic and public health response to the rapidly increasing rates of obesity worldwide. Treatment of established obesity is complex and costly requiring multiple resources. Preventing weight gain potentially requires fewer resources to reach broad population groups, yet there is little evidence for successful interventions to prevent weight gain in the community. Women with children are an important target group because of high rates of weight gain and the potential to influence the health behaviors in family members.

Methods
The aim of this cluster randomized controlled trial was to evaluate the short term effect of a community-based self-management intervention to prevent weight gain. Two hundred and fifty mothers of young children (mean age 40 years ± 4.5, BMI 27.9 kg/m2 ± 5.6) were recruited from the community in Melbourne, Australia. The intervention group (n = 127) attended four interactive group sessions over 4 months, held in 12 local primary schools in 2006, and was compared to a group (n = 123) receiving a single, non-interactive, health education session. Data collection included self-reported weight (both groups), measured weight (intervention only), self-efficacy, dietary intake and physical activity.

Results
Mean measured weight decreased significantly in the intervention group (-0.78 kg 95% CI; -1.22 to -0.34, p < 0.001). Comparing groups using self-reported weight, both the intervention and comparison groups decreased weight, -0.75 kg (95% CI; -1.57 to 0.07, p = 0.07) and -0.72 kg (95% CI; -1.59 to 0.14 p = 0.10) respectively with no significant difference between groups (-0.03 kg, 95% CI; -1.32 to 1.26, p = 0.95). More women lost or maintained weight in the intervention group. The intervention group tended to have the greatest effect in those who were overweight at baseline and in those who weighed themselves regularly. Intervention women who rarely self-weighed gained weight (+0.07 kg) and regular self-weighers lost weight (-1.66 kg) a difference of -1.73 kg (95% CI; -3.35 to -0.11 p = 0.04). The intervention reported increased physical activity although the difference between groups did not reach significance. Both groups reported replacing high fat foods with low fat alternatives and self-efficacy deteriorated in the comparison group only.

Conclusion
Both a single health education session and interactive behavioral intervention will result in a similar weight loss in the short term, although more participants in the interactive intervention lost or maintained weight. There were small non-significant changes to physical activity and changes to fat intake specifically replacing high fat foods with low fat alternatives such as fruit and vegetables. Self-monitoring appears to enhance weight loss when part of an intervention.

Improved 3D thinning algorithms for skeleton extraction

In this study, we focused on developing a novel 3D Thinning algorithm to extract one-voxel wide skeleton from various 3D objects aiming at preserving the topological information. The 3D Thinning algorithm was testified on computer-generated and real 3D reconstructed image sets acquired from TEMT and compared with other existing 3D Thinning algorithms. It is found that the algorithm has conserved medial axes and simultaneously topologies very well, demonstrating many advantages over the existing technologies. They are versatile, rigorous, efficient and rotation invariant.

Evaluation of a decision aid for prenatal testing of fetal abnormalities : a cluster randomised trial [ISRCTN22532458]

Background: By providing information on the relative merits and potential harms of the options available and a framework to clarify preferences, decision aids can improve knowledge and realistic expectations and decrease decisional conflict in individuals facing decisions between alternative forms of action. Decision-making about prenatal testing for fetal abnormalities is often confusing and difficult for women and the effectiveness of decision aids in this field has not been established. This study aims to test whether a decision aid for prenatal testing of fetal abnormalities, when compared to a pamphlet, improves women's informed decision-making and decreases decisional conflict.

Methods/design: A cluster designed randomised controlled trial is being conducted in Victoria, Australia. Fifty General Practitioners (GPs) have been randomised to one of two arms: providing women with either a decision aid or a pamphlet. The two primary outcomes will be measured by comparing the difference in percentages of women identified as making an informed choice and the difference in mean decisional conflict scores between the two groups. Data will be collected from women using questionnaires at 14 weeks and 24 weeks gestation.

The sample size of 159 women in both arms of the trial has been calculated to detect a difference of 18% (50 to 68%) in informed choice between the two groups. The required numbers have been adjusted to accommodate the cluster design, miscarriage and participant lost – to – follow up.

Baseline characteristics of women will be summarised for both arms of the trial. Similarly, characteristics of GPs will be compared between arms.

Differences in the primary outcomes will be analysed using 'intention-to-treat' principles. Appropriate regression techniques will adjust for the effects of clustering and include covariates to adjust for the stratifying variable and major potential confounding factors.

Discussion: The findings from this trial will make a significant contribution to improving women's experience of prenatal testing and will have application to a variety of maternity care settings. The evaluation of a tailored decision aid will also have implications for pregnancy care providers by identifying whether or not such a resource will support their role in providing prenatal testing information.

Performance execution of multiple NAS parallel programs on a cluster

Currently, coordinated scheduling of multiple parallel applications across computers has been considered as the critical factor to achieve high execution performance. We claim in this report that the performance and costs of the execution of parallel applications could be improved if not only dedicated clusters but also non-dedicated clusters were used and several parallel applications were executed concurreontly. To support this claim we carried out experimental study into the performance of multiple NAS parallel programs executing concurrently on a non-dedicated cluster.

Scheduling of a parallel computation-bound application and sequential applications executing concurrently on a cluster - a case study.

Studies have shown that most of the computers in a non-dedicated cluster are often idle or lightly loaded. The underutilized computers in a non-dedicated cluster can be employed to execute parallel applications. The aim of this study is to learn how concurrent execution of a computation-bound and sequential applications influence their execution performance and cluster utilization. The result of the study has demonstrated that a computation-bound parallel application benefits from load balancing, and at the same time sequential applications suffer only an insignificant slowdown of execution. Overall, the utilization of a non-dedicated cluster is improved.