Process and impact evaluation of the romp & chomp obesity prevention intervention in early childhood settings : lessons learned from implementation in preschools and long day care settings

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.
Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.
Results: The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.
Conclusions: These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

Children and university architecture students working together : a pedagogical model of children’s participation in architectural design

Increasing efforts have been made to engage children in the design of the built environment, and several participatory models have been developed. The aim of this paper is to propose a pedagogical model for children's genuine participation in architectural design, developed in an architectural education context. According to this pedagogical model, children (primary school students) and youth (university architecture students) work in teams to develop the architectural design proposals. This model was developed through a joint educational project between Deakin University and Wales Street Primary School (both institutions are based in Victoria, Australia). In the four-week duration of the project, first year architecture students worked with Grade 3 and 4 primary school children to design a school playground. The final product of the project was a 1:20 scale model of a playground, which was installed and presented at the end of the fourth week. The project received positive feedback from all the participants, including children, architecture students, university lecturers, primary school teachers and architects. In addition, it achieved a high level of children's genuine participation. This model can be refined and applied in new situations, and potentially with other primary schools working with Deakin University.

Comparison of Technology Enabled Learning Practices (TELP) in engineering : a student's perspective

BACKGROUND : Recent years have seen a steady growth in the use of technology in learning and teaching. Deakin’s School of Engineering uses its own set of Technology Enabled Learning Practices (TELP). Student surveys are taken after the completion of every unit, but although valuable, they give only a generic student view. What is required is a holistic approach from the student’s perspective.

PURPOSE : What type of TELP best helps the student to learn engineering?

DESIGN/METHOD : A survey dedicated to TELPs from the students’ point of view has been designed and will be given to students at various year levels in engineering at Deakin. The survey is designed to obtain quantitative as well as qualitative results. An analysis of this survey will give a view of the students’ perspective of TELPs as they progress through their engineering degree.

RESULTS : The survey indicated that the students find that the full professional recording and screen capture TELPs as the most helpful as an aid to learning. It is also indicates that of all the TELPs the screen capture is greatly sought after by the students.

CONCLUSIONS : These results give the School of Engineering the information needed to tailor the TELPs used in unit delivery to further enrich the learning experience.

Illegal immigration, technology adoption and welfare

A debate in the illegal immigration and technology adoption literature suggests that hiring illegal immigrants may be hindering the adoption of new technology, which in turn harms a country’s productivity growth. This paper analyses an individual firm’s behaviour regarding new technology adoption in the presence of illegal immigrants. We assume a Ricardian economy and analyse immigration of illegal unskilled workers in a model of Cournot duopoly where firms are producing homogenous and non-traded goods, and hiring illegal immigrants. A two-stage simultaneous move game is set up: in Stage 1, given the opportunity of hiring illegal immigrants, an individual firm decides whether to adopt the new technology or not, where technology adoption is costly. In Stage 2, each firm will choose the Cournot output level. Solving this two-stage game, we conclude that (i) given the opportunity of hiring illegal immigrants, an individual firm may adopt the new technology and (ii) in the case of zero tolerance of illegal immigration, technology adoption may increase but such technology adoption is immiserizing as it reduces the total surplus.

On the acoustic performance of a precast panel system made from environmentally sustainable concrete : application in sports hall buildings

The use of green building materials and products promotes conservation of non-renewable resources and help reduce associated environmental impacts. This article reports the acoustical performance of a precast panel system made largely from concrete waste material. Two major applications for such panels that are being investigated currently include walls and claddings to industrial and commercial buildings and sound barriers for urban freeways. In this study, the application of the concrete panels for optimizing reverberation time (RT) in sports halls is tested using numerical simulations. As an innovative approach, additional layers are added to the precast panels to improve their appearance. The absorption coefficients of the concrete panel improved significantly with the architectural finish. The material can be tuned according to the required peak frequency. The architectural finish helped reduce the RT for frequencies above 500 Hz. Its application to different types of ceilings revealed that the RT of curved ceiling reduced up to 40% compared to flat and hybrid ceiling. A comparison of wall and ceiling modifications in small, medium and large sports halls showed that medium-sized halls have better acoustical performance compared with small and large halls with ceiling as well as wall treatment.

Effect of vascular endothelial growth factor upregulation on retinal gene expression in the Kimba mouse

Background:  The Kimba mouse carries a human vascular endothelial growth factor transgene causing retinal neovascularisation similar to that seen in diabetic retinopathy. Here, we examine the relationship between differential gene expression induced by vascular endothelial growth factor overexpression and the architectural changes that occur in the retinae of these mice.

Methods:  Retinal gene expression changes in juvenile and adult Kimba mice were assayed by microarray and compared with age-matched wild-type littermates. Transcription of selected genes was validated by quantitative real-time polymerase chain reaction. Protein translation was determined using immunohistochemistry and enzyme-linked immunosorbent assay.

Results:  Semaphorin 3C was upregulated, and nuclear receptor subfamily 2, group 3, member 3 (Nr2e3) was downregulated in juvenile Kimba mice. Betacellulin and endothelin 2 were upregulated in adults. Semaphorin 3C colocalized with glial fibrillary acidic protein in Müller cells of Kimba retinae at greater signal intensities than in wild type. Endothelin 2 colocalised to Müller cell end feet and extended into the outer limiting membrane. Endothelin receptor type B staining was most pronounced in the inner nuclear layer, the region containing Müller cell somata.

Conclusions:  An early spike in vascular endothelial growth factor induced significant long-term retinal neovascularisation associated with changes to the retinal ganglion, photoreceptor and Müller cells. Overexpression of vascular endothelial growth factor led to dysregulation of photoreceptor metabolism through differential expression of Nr2e3, endothelin 2, betacellulin and semaphorin 3C. Alterations in the expression of these genes may therefore play key roles in the pathological mechanisms that result from retinal neovascularisation.

Factories of the future : a system of systems engineering perspective

Factories of the Future will be distinguished by intelligent machines, automation, human factors integration and knowledge management. Modelling and simulation is recognised as a key enabling technology essential to economic, social and environmental sustainability of future manufacturing systems. This talk will explore the history, recent achievements and directions in modelling and simulation for 21st century factories and supply chains. A systems science approach is employed, from stakeholder engagement through participative modelling to self-tuning and self-assembling simulations. Our contributions lower the cost of the application of modelling and simulation to manufacturing processes, enabling real time planning, dynamic risk analysis, dashboards and 3D visualisation. This realisation of the virtual factory integrates human factors and decisions into the core technology platform. The implications to future manufacturing enterprises are explored through a series of case studies from aerospace, mining and small and medium manufacturing enterprises.

The `knowledge-intensive development' agenda and equitable access to knowledge: higher education in Ethiopia

In light of the normative assumption of the role of knowledge in economic productivity and in response to strong exogenous policy orientations (mainly from the World Bank), the government of Ethiopia has restructured and expanded the higher education (HE) subsystem since the late 1990s. In critically analysing selected policy documents, this article seeks to understand the seemingly unlinked agendas of strengthening the role of HE in supporting the knowledge-intensive development agenda and the representation of the problem of inequality in access to and success in HE. It has been shown that the economic value of knowledge has been echoed in the reforms of Ethiopia, and that the problem of inequality has been superficially represented just as inequality of access while serious challenges that hinder participation and success of women, non-traditional students and ethnically and regionally disadvantaged groups remain unchallenged. Hence, the analysis indicates that under a situation of unequal opportunity to knowledge, the knowledge-intensive development agenda appears to be empty policy rhetoric.

Ustekinumab for the treatment of moderate to severe psoriasis

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of ustekinumab for the treatment of moderate to severe psoriasis based upon a review of the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submission's main evidence came from three randomised controlled trials (RCTs), of reasonable methodological quality and measuring a range of clinically relevant outcomes. Higher proportions of participants treated with ustekinumab (45 mg and 90 mg) than with placebo or etanercept achieved an improvement on the Psoriasis Area and Severity Index (PASI) of at least 75% (PASI 75) after 12 weeks. There were also statistically significant differences in favour of ustekinumab over placebo for PASI 50 and PASI 90 results, and for ustekinumab over etanercept for PASI 90 results. A weight-based subgroup dosing analysis for each trial was presented, but the methodology was poorly described and no statistical analysis to support the chosen weight threshold was presented. The manufacturer carried out a mixed treatment comparison (MTC); however, the appropriateness of some of the methodological aspects of the MTC is uncertain. The incidence of adverse events was similar between groups at 12 weeks and withdrawals due to adverse events were low and less frequent in the ustekinumab than in the placebo or etanercept groups; however, statistical comparisons were not reported. The manufacturer's economic model of treatments for psoriasis compared ustekinumab with other biological therapies. The model used a reasonable approach; however, it is not clear whether the clinical effectiveness estimates from the subgroup analysis, used in the base-case analysis, were methodologically appropriate. The base-case incremental cost-effectiveness ratio for ustekinumab versus supportive care was 29,587 pounds per quality-adjusted life-year (QALY). In one-way sensitivity analysis the model was most sensitive to the number of hospital days associated with supportive care, the cost estimate for intermittent etanercept 25 mg and the utility scores used. In the ERG's scenario analysis the model was most sensitive to the price of ustekinumab 90 mg, the proportion of patients with baseline weight > 100 kg and the relative risk of intermittent versus continuous etanercept 25 mg. In the ERG's probabilistic sensitivity analysis ustekinumab had the highest probability of being cost-effective at conventional NICE thresholds, assuming the same price for the 45-mg and 90-mg doses; however, doubling the price of ustekinumab 90 mg resulted in ustekinumab no longer dominating the comparators. In conclusion, the clinical effectiveness and cost-effectiveness of ustekinumab in relation to other drugs in this class is uncertain. Provisional NICE guidance issued as a result of the STA states that ustekinumab is recommended as a treatment option for adults with plaque psoriasis when a number of criteria are met. Final guidance is anticipated in September 2009.

Entecavir for the treatment of chronic hepatitis B infection

This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of entecavir for the treatment of chronic hepatitis B (CHB) in adults based upon a review of the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submission's evidence came from five randomised controlled trials (RCTs), of good methodological quality and measuring a range of clinically relevant outcomes, comparing entecavir with lamivudine. After 1 year of treatment entecavir was statistically superior to lamivudine in terms of the proportion of patients achieving hepatitis B virus (HBV) DNA suppression, alanine aminotransferase (ALT) normalisation and histological improvement, but not in terms of the proportion of patients achieving hepatitis B e antigen (HBeAg) seroconversion. The incidence of adverse or serious adverse events was similar for both treatments. The results of the manufacturer's mixed treatment comparison (MTC) model to compare entecavir with the comparator drugs in nucleoside-naive patients were considered to be uncertain because of concerns over its conduct and reporting. For the economic evaluation the manufacturer constructed two Markov state transition models, one in HBeAg-positive and one in HBeAg-negative patients. The modelling approach was considered reasonable subject to some uncertainties and concerns over some of the structural assumptions. In HBeAg-positive patients the base-case incremental cost-effectiveness ratios (ICER) for entecavir compared with lamivudine and pegylated interferon alpha-2a were 14,329 pounds and 8403 pounds per quality-adjusted life-year (QALY) respectively. Entecavir was dominated by telbivudine. In HBeAg-negative patients the base-case ICERs for entecavir compared with lamivudine, pegylated interferon alpha-2a and telbivudine were 13,208 pounds, 7511 pounds and 6907 pounds per QALY respectively. In HBeAg-positive lamivudine-refractory patients entecavir dominated adefovir added to lamivudine. In one-way deterministic sensitivity analysis on all key input parameters for entecavir compared with lamivudine in nucleoside-naive patients, ICERs generally remained under 30,000 pounds per QALY. In probabilistic sensitivity analysis in nucleoside-naive HBeAg-positive patients the probability of the ICER for entecavir being below 20,000 pounds per QALY was 57%, 82% and 45% compared with lamivudine, pegylated interferon alpha-2a and telbivudine respectively. In nucleoside-naive HBeAg-negative patients the probabilities were 90%, 100% and 96% respectively. The manufacturer's lifetime treatment scenario for HBeAg-negative patients and the ERG's 20-year treatment scenario for HBeAg-positive patients increased the ICERs, particularly in the latter case. Amending the HBeAg-negative model so that patients with compensated cirrhosis would also receive lifetime treatment gave probabilities of entecavir being cost-effective at a willingness to pay of 20,000 pounds and 30,000 pounds of 4% and 40% respectively. The NICE guidance issued in August 2008 as a result of the STA states that entecavir is recommended as an option for the treatment of people with chronic HBeAg-positive or HBeAg-negative hepatitis B in whom antiviral treatment is indicated.

A framework for exploring the sense of community and social life in residential environments

Sense of community and social life are two key concepts related to social cohesion, which have been the subject of extensive studies in several disciplines including sociology, psychology and built environment. Social life studies have been mostly conducted in the built environment discipline focusing on city centres; while sense of community studies were mostly the target of sociologists and psychologists focusing on neighbourhoods. As a result, the role of the built environment on the sense of community and social life of neighbourhoods is considered as a missing gap in the literature. This paper, through defining the concepts of social life and sense of community, aims to develop a conceptual framework for further implementation in future research. Accurate implication and interpretation of the concepts show that neighbourhoods can include the sense of community in the residential environment and the social life in the commercial environment. This is because residential environments are where residents' requirements can be met through their commitment to the community and commercial environments are the fulcrum of interaction and communication.

The impact of IT intervention programs for girls

The goal of our study is to investigate the longitudinal effects of one intervention program for schoolgirls in the Information Technology (IT) field. This bi-annual event has been conducted regularly since 2006 with the aim of confronting a decline in the interest among girls to study IT and promoting study and work opportunities in the field. Each event has been evaluated with pre- and post-event surveys. Longitudinally, both students and teachers have also been surveyed three to four years after the event in which they participated. Results from the 2006 cohort surveyed in 2009-2010 are reported on in this paper. The main conclusion is that, unfortunately, any increase in the uptake of IT in schools that occurred as a result of attending the event was transitory. Therefore, it is crucial that inspiring, engaging, and empowering computing classes are being offered continuously at all secondary schools.

Safety applications using Kinect technology

 Microsoft Kinect sensor was introduced with the XBOX gaming console. It features a simple and portable motion capturing system. Kinect nowadays presents a point of interest in many fields of study and areas of research where its affordable price compared to its capabilities. The Kinect sensor has the capability to capture and track detected 3D objects with accuracy comparable to that captured by state of the art commercial systems. Human safety is considered one of the highest concerns, specially nowadays where the existence of machines and robots is widely used. In this paper we present using the Kinect technology for enhancing the safety of equipment and operations in seven different applications. These applications include 1) positioning of child’s car seat to optimise the child’s position in respected to front and side air-bags; 2) board positioning system to improve the teacher’s arm reach posture; 3) gas station safety to prevent children from accessing the gas pump; 4) indoor pool safety to avoid children access to deep pool area; 5) robot safety emergency stop; 6) Workplace safety; and 7) older adults fall prediction.

Exploring nurses' reactions to a novel technology to support acute health care delivery

AIMS AND OBJECTIVES: To explore nurses' reactions to new novel technology for acute health care. BACKGROUND: Past failures of technology developers to deliver products that meet nurses' needs have led to resistance and reluctance in the technology adoption process. Thus, involving nurses in a collaborative process from early conceptualisation serves to inform design reflective upon current clinical practice, facilitating the cementing of 'vision' and expectations of the technology. DESIGN: An exploratory descriptive design to capture nurses' immediate impressions. METHODS: Four focus groups (52 nurses from medical and surgical wards at two hospitals in Australia; one private and one public). RESULTS: Nursing reactions towards the new technology illustrated a variance in barrier and enabler comments across multiple domains of the Theoretical Domains Framework. Most challenging for nurses were the perceived threat to their clinical skill, and the potential capability of the novel technology to capture their clinical workflow. Enabling reactions included visions that this could help integrate care between departments; help management and support of nursing processes; and coordinating their patients care between clinicians. Nurses' reactions differed across hospital sites, influenced by their experiences of using technology. For example, Site 1 nurses reported wide variability in their distribution of barrier and enabling comments and nurses at Site 2, where technology was prevalent, reported mostly positive responses. CONCLUSION: This early involvement offered nursing input and facilitated understanding of the potential capabilities of novel technology to support nursing work, particularly the characteristics seen as potentially beneficial (enabling technology) and those conflicting (barrier technology) with the delivery of both safe and effective patient care. RELEVANCE TO CLINICAL PRACTICE: Collaborative involvement of nurses from the early conceptualisation of technology development brings benefits that increase the likelihood of successful use of a tool intended to support the delivery of safe and efficient patient care.