Stores healthy options project in remote indigenous communities (SHOP@RIC): a protocol of a randomised trial promoting healthy food and beverage purchases through price discounts and in-store nutrition education

Background
Indigenous Australians suffer a disproportionate burden of preventable chronic disease compared to their non-Indigenous counterparts – much of it diet-related. Increasing fruit and vegetable intakes and reducing sugar-sweetened soft-drink consumption can reduce the risk of preventable chronic disease. There is evidence from some general population studies that subsidising healthier foods can modify dietary behaviour. There is little such evidence relating specifically to socio-economically disadvantaged populations, even though dietary behaviour in such populations is arguably more likely to be susceptible to such interventions.

This study aims to assess the impact and cost-effectiveness of a price discount intervention with or without an in-store nutrition education intervention on purchases of fruit, vegetables, water and diet soft-drinks among remote Indigenous communities.

Methods/Design
We will utilise a randomised multiple baseline (stepped wedge) design involving 20 communities in remote Indigenous Australia. The study will be conducted in partnership with two store associations and twenty Indigenous store boards. Communities will be randomised to either i) a 20% price discount on fruit, vegetables, water and diet soft-drinks; or ii) a combined price discount and in-store nutrition education strategy. These interventions will be initiated, at one of five possible time-points, spaced two-months apart. Weekly point-of-sale data will be collected from each community store before, during, and for six months after the six-month intervention period to measure impact on purchasing of discounted food and drinks. Data on physical, social and economic factors influencing weekly store sales will be collected in order to identify important covariates. Intervention fidelity and mediators of behaviour change will also be assessed.

Discussion
This study will provide original evidence on the effectiveness and cost-effectiveness of price discounts with or without an in-store nutrition education intervention on food and drink purchasing among a socio-economically disadvantaged population in a real-life setting.

Physical Education can improve insulin resistance: The LOOK randomized cluster trial

Purpose
As impaired glucose metabolism may arise progressively during childhood, we sought to determine whether the introduction of specialist-taught school physical education (PE) based on sound educational principles could improve insulin resistance (IR) in elementary school children.

Methods
In this 4-yr cluster-randomized intervention study, participants were 367 boys and 341 girls (mean age = 8.1 yr, SD = 0.35) initially in grade 2 in 29 elementary schools situated in suburbs of similar socioeconomic status. In 13 schools, 100 min·wk−1 of PE, usually conducted by general classroom teachers, was replaced with two classes per week taught by visiting specialist PE teachers; the remaining schools formed the control group. Teacher and pupil behavior were recorded, and measurements in grades 2, 4, and 6 included fasting blood glucose and insulin to calculate the homeostatic model of IR, percent body fat, physical activity, fitness, and pubertal development.

Results
On average, the intervention PE classes included more fitness work than the control PE classes (7 vs 1 min, P < 0.001) and more moderate physical activity (17 vs 10 min, P < 0.001). With no differences at baseline, by grade 6, the intervention had lowered IR by 14% (95% confidence interval = 1%–31%) in the boys and by 9% (95% confidence interval = 5%–26%) in the girls, and the percentage of children with IR greater than 3, a cutoff point for metabolic risk, was lower in the intervention than the control group (combined, 22% vs 31%, P = 0.03; boys, 12% vs 21%, P = 0.06; girls, 32% vs 40%, P = 0.05).

Conclusions
Specialist-taught primary school PE improved IR in community-based children, thereby offering a primordial preventative strategy that could be coordinated widely although a school-based approach.

Constructivist learning: understanding and experience in IT tertiary education

This paper firstly introduces the concept of constructivist learning which advocates that students actively construct knowledge themselves with teachers’ assistance. Based on the six important elements of constructivist learning and teaching planning approach, detailed examples of designing the six constructivist elements of situation, groupings, bridge, questions, exhibit, and reflections for two units offered at school of Information Technology, Deakin University are provided. A conclusion emphasizing the learners' difference to be paid attention to while educators designing curriculum on CloudDeakin platform is made at the end of this paper.

The monsoon wedding phenomenon: understanding Indian students studying in Australian universities

How does the University sector identify and support the diverse needs of Indian students? This paper reports on a research project carried out on undergraduate students from India enrolled at a Melbourne‐based University. The focus is the need to understand why Indian students choose an overseas destination for tertiary study. The intent is to explore how the curriculum that they have experienced in their country prepares them for study in another. We examine the expectations of students in relation to studying overseas. The suggestion underlying this paper is that if academic and support staff in tertiary education understand international students in cultural cohorts, then it is more likely that their transition to tertiary education will be easier. We envisage that this may also lead to a greater retention rate for universities.

Beyond reaction: the responsibility to protect and the United Nations

This thesis examines how the principle of The Responsibility to Protect (R2P) has influenced international responses to large scale human suffering. Examining atrocities in Darfur and Libya, this examination finds that rather than occupy ends of a spectrum of choice between prevention and reaction, responses elicited by R2P were fluid.

Preparing health professionals to work in diabetes education and care: a situation analysis

Worldwide, the increasing prevalence of chronic diseases places enormous expectations of and responsibility on health systems. Preparing the health workforce to adequately respond to these increasing demands is a challenge of critical importance. The aim of this study was to provide an overview of how health professionals (HPs) are prepared to work in diabetes care and education. A one shot cross-sectional study was undertaken to collect the data using self-completed anonymous on-line questionnaires. The invitation to complete the questionnaire was sent to more than 3745 HPs. One thousand one hundred and sixteen responses were collected, 68% were from highincome countries and 32% from middle- and low-income countries (LMIC). Most HPs developed their knowledge and skills through work experience and self-study: very few attended a formal education program as part of their training. Thirty-six percent of LMIC respondents did not have a credential/certification in diabetes and 72% reported their organizations support them to learn about diabetes education/care. Moreover, 80% referred to the International Diabetes Federation publications when making clinical decisions or planning diabetes care. Results provide insight into how HPs are educationally prepared to work in diabetes education and care and could serve as a foundation for future research. These findings emphasize the emerging necessity to develop certified/credentialing programs for HPs, especially in LMIC.

Building Nature’s Safety Net 2014 : A decade of protected area achievements in Australia

The single most important asset for the conservation of Australia’s unique and globally significant biodiversity is the National Reserve System, a mosaic of over 10,000 discrete protected areas on land on all tenures: government, Indigenous and private,including on-farm covenants, as well as state, territory and Commonwealth marine parks and reserves.THE NATIONAL RESERVE SYSTEMIn this report, we cover major National Reserve System initiatives that have occurred in the period 2002 to the present and highlight issues affecting progress toward agreed national objectives. We define a minimum standard for the National Reserve System to comprehensively, adequately and representatively protect Australia’s ecosystem and species diversity on sea and land. Using government protected area, species and other relevant spatial data, we quantify gaps: those areas needing to move from the current National Reserve System to one which meets this standard. We also provide new estimates of financial investments in protected areas and of the benefits that protected areas secure for society. Protected areas primarily serve to secure Australia’s native plants and animals against extinction, and to promote their recovery.BENEFITSProtected areas also secure ecosystem services that provide economic benefits forhuman communities including water, soil and beneficial species conservation, climatemoderation, social, cultural and health benefits. On land, we estimate these benefitsare worth over $38 billion a year, by applying data collated by the Ecosystem ServicesPartnership. A much larger figure is estimated to have been secured by marineprotected areas in the form of moderation of climate and impact of extreme eventsby reef and mangrove ecosystems. While these estimates have not been verified bystudies specific to Australia, they are indicative of a very large economic contributionof protected areas. Visitors to national parks and nature reserves spend over $23.6 billion a year in Australia, generating tax revenue for state and territory governments of $2.36 billion a year. All these economic benefits taken together greatly exceed the aggregate annual protected area expansion and management spending by all Australian governments, estimated to be ~$1.28 billion a year. It is clear that Australian society is benefiting far greater than its governments’ investment into strategic growth and maintenance of the National Reserve System.Government investment and policy settings play a leading role in strategic growth of the National Reserve System in Australia, and provide a critical stimulus fornon-government investment. Unprecedented expansion of the National Reserve System followed an historic boost in Australian Government funding under Caring for Our Country 2008–2013. This expansion was highly economical for the Australian Government, costing an average of only $44.40 per hectare to buy and protect land forever. State governments have contributed about six times this amount toward the expansion of the National Reserve System, after including in-perpetuity protected area management costs. The growth of Indigenous Protected Areas by the Australian Government has cost ~$26 per hectare on average, including management costs capitalised in-perpetuity, while also delivering Indigenous social and economic outcomes. The aggregate annual investment by all Australian governments has been ~$72.6 million per year on protected area growth and ~$1.21 billion per year on recurrent management costs. For the first time in almost two decades, however, the Australian Government’s National Reserve System Program, comprising a specialist administrative unit and funding allocation, was terminated in late 2012. This program was fundamental in driving significant strategic growth in Australia’s protected area estate. It is highly unlikely that Australia can achieve its long-standing commitments to an ecologically representative National Reserve System, and prevent major biodiversity loss, without this dedicated funding pool. The Australian Government has budgeted ~$400 million per year over the next five years (2013-2018) under the National Landcare and related programs. This funding program should give high priority to delivery of national protected area commitments by providing a distinct National Reserve System funding allocation. Under the Convention on Biological Diversity (CBD), Australia has committed to bringing at least 17 percent of terrestrial and at least 10 per cent of marine areas into ecologically representative, well-connected systems of protected areas by 2020 (Aichi Target 11).BIODIVERSITY CONSERVATIONAustralia also has an agreed intergovernmental Strategy for developing a comprehensive, adequate and representative National Reserve System on land andsea that, if implemented, would deliver on this CBD target. Due to dramatic recent growth, the National Reserve System covers 16.5 per cent of Australia’s land area, with highly protected areas, such as national parks, covering 8.3 per cent. The marine National Reserve System extends over one-third of Australian waters with highly protected areas such as marine national parks, no-take or green zones covering 13.5 per cent. Growth has been uneven however, and the National Reserve System is still far from meeting Aichi Target 11, which requires that it also be ecologically representative and well-connected. On land, 1,655 of 5,815 ecosystems and habitats for 138 of 1,613 threatened species remain unprotected. Nonetheless, 436 terrestrial ecosystems and 176 threatened terrestrial species attained minimum standards of protection due to growth of the National Reserve System on land between 2002 and 2012. The gap for ecosystem protection on land – the area needed to bring all ecosystems to the minimum standard of protection – closed by a very substantial 20 million hectares (from 77 down to 57 million hectares) between 2002 and 2012, not including threatened species protection gaps. Threatened species attaining a minimum standard for habitat protection increased from 27 per cent to 38 per cent over the decade 2002–2012. A low proportion of critically endangered species meeting the standard (29 per cent) and the high proportion with no protection at all (20 per cent) are cause for concern, but one which should be relatively easy to amend, as the distributions of these species tend to be small and localised. Protected area connectivity has increased modestly for terrestrial protected areas in terms of the median distance between neighbouring protected areas, but this progress has been undermined by increasing land use intensity in landscapes between protected areas.A comprehensive, adequate and representative marine reserve system, which meetsa standard of 15 per cent of each of 2,420 marine ecosystems and 30 per cent of thehabitats of each of 177 marine species of national environmental significance, wouldrequire expansion of marine national parks, no-take or green zones up to nearly 30per cent of state and Australian waters, not substantially different in overall extentfrom that of the current marine reserve system, but different in configuration.Protection of climate change refugia, connectivity and special places for biodiversityis still low and requires high priority attention. FINANCING TO FILL GAPS AND MEET COMMITMENTSIf the ‘comprehensiveness’ and ‘representativeness’ targets in the agreed terrestrial National Reserve System Strategy were met by 2020, Australia would be likely to have met the ‘ecologically representative’ requirement of Aichi Target 11. This would requireexpanding the terrestrial reserve system by at least 25 million hectares. Considering that the terrestrial ecosystem protection gap has closed by 20 million hectares over the past decade, this required expansion would be feasible with a major boost in investment and focus on long-standing priorities. A realistic mix of purchases, Indigenous Protected Areas and private land covenants would require an Australian Government National Reserve System investment of ~$170 million per year over the five years to 2020, representing ~42 per cent of the $400 million per year which the Australian Government has budgeted for landcare and conservation over the next five years. State, territory and local governments, private and Indigenous partners wouldlikewise need to boost financial commitments to both expand and maintain newprotected areas to meet the agreed National Reserve System strategic objectives.The total cost of Australia achieving a comprehensive, adequate and representativemarine reserve system that would satisfy Aichi Target 11 is an estimated $247 million.

A comparison of mobile learning attitudes among university students in four nations

This paper contains findings based on administering a Likert-type mobile learning attitude survey to 261 university students from four nations, China, Lebanon, the UAE and the USA. Students were asked to provide attitudes and perceptions toward the use of mobile technologies in education. The results of the survey indicate that students in different regions of the world tend to agree that mobile learning could empower informal learning and could enhance teaching and learning. Lebanon students were most similar to those from the USA, while students from China were more similar to those from the UAE. Similarities and differences in results among nations and implications of these findings are discussed.

Evaluation of nurses' perceptions of the impact of targeted depression education and a screening and referral tool in an acute cardiac setting.

AIMS AND OBJECTIVES: The aim of this study was to evaluate nurses' perceptions of an education programme and screening and referral tool designed for cardiac nurses to facilitate depression screening and referral procedures for patients with coronary heart disease. BACKGROUND: There is a high prevalence of depression in patients with coronary heart disease that is often undetected. It is important therefore that nurses working with cardiac patients are equipped with the knowledge and skills to recognise the signs and symptoms of depression and refer appropriately. DESIGN: A qualitative approach with purposive sampling and semi-structural interviews was implemented within the Donabedian 'Structure-Process-Outcome' evaluation framework. METHODS: Semi-structured interviews were conducted with 14 cardiac nurses working in a major metropolitan hospital six weeks post-attending an education programme on depression and coronary heart disease. Thematic data analysis was implemented, specifically adhering to Halcomb and Davidson's (2006) pragmatic data analysis, to examine nurse knowledge and experience of depression assessment and referral in an acute cardiac ward. RESULTS: The key findings of this study were that the education programme: (1) increased the knowledge base of nurses working with cardiac patients on comorbid depression and coronary heart disease, and (2) assisted in the identification of depression and the referral of 'at risk' patients. CONCLUSIONS: Emphasis was placed on the translational significance of educating cardiac nurses about depression via the introduction of a depression screening and referral instrument designed specifically for use in the cardiac ward. As a result, participants found they were better equipped to identify depressive symptoms and, guided by the screening instrument, to confidently instigate referral procedures. RELEVANCE TO CLINICAL PRACTICE: Much complexity lies in caring for cardiac patients with depression, including issues such as misdiagnosis. Targeted education, including use of appropriate instruments, has the potential to facilitate early recognition of the signs and symptoms of depression in the acute cardiac setting.

To aspire: a systematic reflection on understanding aspirations in higher education

Aspirations for higher education by people from low socioeconomic status backgrounds are now a focus of government policy in many OECD nations. This is part of a global trend emphasizing the perceived benefits of ‘raising’ aspirations among under-represented groups as a social inclusion strategy to widen university participation, but also ultimately as a strategy to increase national competitiveness in the global knowledge economy. Yet despite its importance, aspiration tends to carry simplistic meanings in much higher education policy and practice. This paper attempts to craft a more nuanced account of the term, informed by four concept-clusters derived from sociological and philosophical literatures and research, and with a more mutual relation of public and private interests. It complements this ‘intellectual craftsmanship’ or ‘systematic reflection’ (Mills in The sociological imagination, 1959) with data drawn from a future-focused survey of secondary school students from low and low-mid socioeconomic status backgrounds in regional Australia. Results from the survey provide illustrations that help expand understandings of student aspirations for higher education, from a group presumed to be deficit in aspirations.

Reducing the risk of heart disease among Indian Australians: knowledge, attitudes, and beliefs regarding food practices - a focus group study

BACKGROUND: Australia has a growing number of Asian Indian immigrants. Unfortunately, this population has an increased risk for coronary heart disease (CHD). Dietary adherence is an important strategy in reducing risk for CHD. This study aimed to gain greater understanding of the knowledge, attitudes and beliefs relating to food practices in Asian Indian Australians. METHODS: Two focus groups with six participants in each were recruited using a convenience sampling technique. Verbatim transcriptions were made and thematic content analysis undertaken. RESULTS: Four main themes that emerged from the data included: migration as a pervasive factor for diet and health; importance of food in maintaining the social fabric; knowledge and understanding of health and diet; and elements of effective interventions. DISCUSSION: Diet is a complex constructed factor in how people express themselves individually, in families and communities. There are many interconnected factors influencing diet choice that goes beyond culture and religion to include migration and acculturation. CONCLUSIONS: Food and associated behaviors are an important aspect of the social fabric. Entrenched and inherent knowledge, attitudes, beliefs and traditions frame individuals' point of reference around food and recommendations for an optimal diet.