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.

Symptoms of depression and difficulty initiating sleep from early adolescence to early adulthood: a longitudinal study

STUDY OBJECTIVES: To assess the direction of the relationship and degree of shared associations between symptoms of depression and difficulty initiating sleep (DIS) from early adolescence to early adulthood. DESIGN: Cross-sectional and longitudinal assessment of the symptoms of depression-DIS association from early adolescence (age 13 y) to early adulthood (age 23 y). SETTING: Hordaland, Norway. PARTICIPANTS: There were 1,105 individuals (55% male) who took part in the Norwegian Longitudinal Health Behaviour Study (NLHB) and participated at least once across seven data collection waves during the years 1990-2000. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Characteristic data were obtained during the first assessment. Symptoms of depression and instances of DIS were assessed during each data collection wave. Symptoms of depression and DIS were associated in all data waves, and one-step cross-lagged bivariate correlations were significant and comparatively high for both factors. Structural equation modelling indicated that DIS and symptoms of depression at wave 1 remain relatively stable across waves (all P < 0.001), and a significant and consistent unidirectional cross-lagged effect was noted running from symptoms of depression to DIS from early adolescence to early adulthood. DIS is only marginally and inconsistently associated with the lagged symptoms of depression score across waves. CONCLUSIONS: These results suggest that symptoms of depression established in early adolescence are a moderate predictor of difficulty initiating sleep (DIS) in early adulthood, whereas the reverse association of DIS predicting depression was not convincingly supported. These findings are in contrast to previous findings that suggest sleep problems as a risk factor for the later development of depression.

The extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) Program : a cluster-randomized controlled trial of an early intervention to prevent childhood obesity

BACKGROUND: Understanding how we can prevent childhood obesity in scalable and sustainable ways is imperative. Early RCT interventions focused on the first two years of life have shown promise however, differences in Body Mass Index between intervention and control groups diminish once the interventions cease. Innovative and cost-effective strategies seeking to continue to support parents to engender appropriate energy balance behaviours in young children need to be explored. METHODS/DESIGN: The Infant Feeding Activity and Nutrition Trial (InFANT) Extend Program builds on the early outcomes of the Melbourne InFANT Program. This cluster randomized controlled trial will test the efficacy of an extended (33 versus 15 month) and enhanced (use of web-based materials, and Facebook® engagement), version of the original Melbourne InFANT Program intervention in a new cohort. Outcomes at 36 months of age will be compared against the control group. DISCUSSION: This trial will provide important information regarding capacity and opportunities to maximize early childhood intervention effectiveness over the first three years of life. This study continues to build the evidence base regarding the design of cost-effective, scalable interventions to promote protective energy balance behaviors in early childhood, and in turn, promote improved child weight and health across the life course. TRIAL REGISTRATION: ACTRN12611000386932 . Registered 13 April 2011.

Cross-fostering reduces obesity induced by early exposure to monosodium glutamate in male rats

Maternal obesity programmes a range of metabolic disturbances for the offspring later in life. Moreover, environmental changes during the suckling period can influence offspring development. Because both periods significantly affect long-term metabolism, we aimed to study whether cross-fostering during the lactation period was sufficient to rescue a programmed obese phenotype in offspring induced by maternal obesity following monosodium L-glutamate (MSG) treatment. Obesity was induced in female Wistar rats by administering subcutaneous MSG (4 mg/g body weight) for the first 5 days of postnatal life. Control and obese female rats were mated in adulthood. The resultant pups were divided into control second generation (F2) (CTLF2), MSG-treated second generation (F2) (MSGF2), which suckled from their CTL and MSG biological dams, respectively, or CTLF2-CR, control offspring suckled by MSG dams and MSGF2-CR, MSG offspring suckled by CTL dams. At 120 days of age, fat tissue accumulation, lipid profile, hypothalamic leptin signalling, glucose tolerance, glucose-induced, and adrenergic inhibition of insulin secretion in isolated pancreatic islets were analysed. Maternal MSG-induced obesity led to an obese phenotype in male offspring, characterized by hyperinsulinaemia, hyperglycaemia, hyperleptinaemia, dyslipidaemia, and impaired leptin signalling, suggesting central leptin resistance, glucose intolerance, impaired glucose-stimulated, and adrenergic inhibition of insulin secretion. Cross-fostering normalized body weight, food intake, leptin signalling, lipid profiles, and insulinaemia, but not glucose homeostasis or insulin secretion from isolated pancreatic islets. Our findings suggest that alterations during the lactation period can mitigate the development of obesity and prevent the programming of adult diseases.

Location, perception and dissolution of form 1991-1993

The thesis covers a series of two and three-dimensional installations created in the investigation of both metaphorical and literal perceptions of form. The journey leads from the idea of painted-related dissolution of form in the early works, to the translation from three-dimensional to two-dimensional installations, and lastly, to experimentation with sound works where non-physical form is explored.

Bridging the gap: early warning, gender and the responsibility to protect

Women, Peace and Security (WPS) scholars and practitioners have expressed reservations about the Responsibility to Protect (R2P) principle because of its popular use as a synonym for armed humanitarian intervention. On the other hand, R2P’s early failure to engage with and advance WPS efforts such as United Nations Security Council (UNSC) resolution 1325 (2000) has seen the perpetuation of limited roles ascribed to women in implementing the R2P principle. As a result, there has been a knowledge and practice gap between the R2P and WPS agendas, despite the fact that their advocates share common goals in relation to the prevention of atrocities and protection of populations. In this article we propose to examine just one of the potential avenues for aligning the WPS agenda and R2P principle in a way that is beneficial to both and strengthens the pursuit of a shared goal – prevention. We argue that the development and inclusion of gender-specific indicators – particularly economic, social and political discriminatory practices against women – has the potential to improve the capacity of early warning frameworks to forecast future mass atrocities.

Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature

Preventing the development of obesity in children is an international health priority. To assess the effectiveness of interventions designed to prevent obesity, promote healthy eating and/or physical activity and/or to reduce sedentary behaviours in 0–5-year-old children, a systematic review of the literature was performed. Literature searches were limited to articles published between January 1995 and June 2006, printed in English and sampling children aged 0–5-years. Searches excluded literature concerned with breastfeeding, eating disorders, and interventions which were school-based or concerned with obesity treatment. Two reviewers independently extracted data and assessed study strengths and weaknesses. Nine included studies were grouped based on the settings in which they were delivered. Most studies involved multi-approach interventions, were conducted in the USA and varied in study designs and quality. All showed some level of effectiveness on at least one obesity-behaviour in young children. These studies support, at a range of levels, the premise that parents are receptive to and capable of some behavioural changes that may promote healthy weight in their young children. The small quantity of research heralds the need, particularly given the potential for early intervention to have long-lasting impacts on individual and population health, to build in a substantial way upon this evidence base.

Online interaction impacts on learning: teaching the teachers to teach online

This paper explores the importance of interaction in the online teaching environment and the important role of staff development in developing teacher presence online. Professionally developing staff to use information and communication technologies is viewed from the standpoint of diffusion of innovation, moving from early adopters to mainstream majority, and targeting staff development at this latter group. Approaches to staff development using information and communication technologies are described, and recommendations for staff development for online teaching are made.

Poetry as a starting point for drama: learning to tolerate ambiguity

This article explores the use of process drama in an English classroom to explore issues raised by 'A poem for the Rainforest' by Judith Nicholls. The drama is used to explore both the themes and forms of the poem, the episodic nature of the drama reflecting the episodic form of the poem. The work engages the students, and the process drama works to layer complexity onto the issues rather than simplifying them.

Top Taiwanese and Turkish companies and their engagement with corporate ethics

The objective of this paper is to describe and compare the current, emerging Taiwanese and Turkish interest in corporate ethical engagement. This paper is based upon a survey amongst the top companies operating in Taiwan and Turkey. There are major differences between the top Taiwanese and Turkish companies, where the Turkish companies appear to be more ethically engaged than the Taiwanese companies which came as a surprise to the researchers as Taiwan is a more substantially developed economy than Turkey and one may have assumed therefore more engaged with ethical practices.

Implementation of evidence into practice : Development of a tool to improve emergency nursing care of acute stroke

Background
Stroke is an increasing global health issue that places considerable burden on society and health care services. An important part of acute stroke management and decreasing stroke-related mortality is preventing complications within the first 24–48 hours. The current climate of prolonged time spent in the Emergency Department (ED) means that many aspects of stroke management are now the responsibility of emergency nurses.

Aims
The aims of this paper are to: i) examine the evidence related to nursing care of acute stroke, ii) identify evidence-based elements of stroke care with most applicability to emergency nursing and iii) use evidence-based stroke care recommendations to develop a guideline for the emergency nursing management of acute stroke.

Results
Emergency nursing care of acute stroke should focus on optimal triage decisions, physiological surveillance, fluid management, risk management, and early referral to specialists.

Conclusions
The role of emergency nurses in stroke care will increase and it is important that emergency nurses deliver evidence-based stroke care in order to optimise patient outcomes. Guidelines and decision support tools for use in emergency nursing must be practical and have high levels of clinical utility for maximum uptake in a busy clinical environment.

The impact of business outsourcing on corporate real estate in India

Driven by Western companies' requirements for efficiency and effectiveness, a trend towards outsourcing of business activities to India and other low-cost countries commenced in the early 1990s and has continued to grow at a surprisingly fast pace. In a relatively short timeframe India has become a global hub for back-office services, although the effect on the urban cities is yet to be fully comprehended. As American and European companies continue to relocate their information technology services and other back office works to the subcontinent, there has been a considerable flow-on effect on Indian corporate real estate. This paper addresses two key questions. Firstly, the factors important for Western companies' outsourcing of organisational activities to India, and secondly, the effect of business outsourcing on corporate real estate locational requirements in India. A survey of corporate real estate representatives in India and the UK was conducted with the results providing an insight into the present state and possible future direction of outsourcing for India. This research presents a unique insight into the impacts of Western business outsourcing on corporate real estate in India, and presents findings that are useful to both organisations seeking to relocate business activities to India and for property market analysts looking to understand drivers behind this sustained demand for Indian corporate real estate.

It's my time to shine : young Australians reflect on past, present and imagined future alcohol consumption

Drawing on interviews about the drinking trajectories of sixty young Victorian drinkers (aged 20-24), this paper outlines patterns of change over time and explores two drinking biographies in depth. For most research participants, drinking alcohol was an enjoyable and integral part of their social lives, but its role changed as they made other transitions in their lives. Most participants considered their early twenties to be a time for heavy alcohol consumption, and most imagined that they would drink less when they were middle-aged.

Beyond mimesis : place, interpretation and response

My study examines the subjective nature of artistic interpretation through the notion of mimesis as process or transformation of material. Influential factors that mediate in the artistic process, such as memory, reflection and an awareness of cultural analogy and metaphor, are examined and related to a specific project in the studio, where the mediation process is further influenced by the materials used to produce the images. My studies of the concept of mimesis have revealed an intermediary realm that exists in the space between empirical reality and its interpretation. Throughout history the process of mimesis has been integral to all forms of the arts. In Plato's time the production of an image that simulated things as they appeared to the eye was considered a desired ideal. Aristotle later introduced developments which extended this concept to include a refiguring or reforming of material derived from the original source, making new connections between existing factors and in this transformation bringing new meanings to a symbolically constituted world. This discussion of the representation of reality, the influence of a dialogue between notions of imitation and the recreation of material continues throughout the exegesis. My study emphasises the interpretive stage of the mimetic process where a consideration of these themes is most relevant and some of the factors that can influence its outcome. It is my opinion that the production of images in response to the particularities of place can be defined in three stages. Firstly, the experience of the place; secondly, the beginning and maturation of the idea or concept; where mimesis takes place, and thirdly, the production of the art work in response. This process is illustrated in Part 2 of the exegesis, where the development of the studio work is documented and linked with the themes discussed in Part 1. The geographic site or place I selected to study is adjacent to Mt. Noorat, a volcanic site in the Western district of Victoria; the surrounding plains are littered with scoria that has been thrown out of the volcano thousands of years ago. Early British, Scottish and Irish settlers to this region used the stone to construct fences reminiscent of their homeland, through this activity they cleared the land and confined and protected their stock. My interests are in factors that include - the material of the stone, notions of enclosure and safety, of boundaries and circumscribed space, and of the cultural reflection that has taken place in this reconstruction of Eurocentric vision. These walls also represent the means by which land was enclosed and property defined, moving from a situation of public access to notions of ownership and the annexation of land for individual gain. Around each point of eruption, the craggy volcanic scoria has been used to create a constructed landscape which both symbolises and mirrors the Anglo - Celtic origins of the people. I have used the legend of Narcissus to illustrate the self-reflective and introspective processes that the settlers invoked in their attempts to come to terms with a strange land. I consider that the story of Narcissus, who fell in love with his own reflection, finds a parellel in the creation of the walls. The re-creation of artifacts from their own cultural environment provided the settlers with a familiar 'face' in an alien world; a reassurance of the familiar in an unfamiliar terrain. Part of this study is an investigation of this notion of landscape as cultural reflection. Geographers have long known that landscape is a cultural construct, an historically evolving ideal manifested in painting, prints and drawings as well as poetry, gardens and parks. One can view these constructions as illustrations or images of meaning which constitute representations of cultural ideals. The neo-classical influence reflected in the paintings of artists who accompanied the early expeditions to Australia demonstrates these themes. The medium of the mirror provides the opportunity to suggest aspects of a cultural reflection and an awareness of identity that has relevance to contemporary Australian culture, therefore, I have allowed it to play a major role throughout this study. Its role in mimesis, firstly, as a reflection in an imitative sense is established, then in its refigurative role, in which the similarities between the original and the reformed rely more on correlative factors than representation. I have used examples from the history of art to illustrate this potential. The formation and development of a narrative involving reflection threads throughout the thesis, both in the visual presentation and in the exegesis. The production of a body of paintings, drawings and sculpture reflect my interpretation and response to the particular site. The correspondences between these works and my theoretical concerns is articulated in the exegesis. The metaphor implied by the use of the walls as agents of enclosure also refers to the capacity of the individual to be confined by notional boundaries and restrictive practices where totalising systems of thought dominate theoretical debate and restrict its freedom. I have used images where gaps in the walls represent the potential implicit to the concept of liminal space, where the spectator moves from one physical space to another and from one stage of development to another. The threshold of this opening in the walls becomes the site where transformation can take place, a metaphor for the mimetic process where the initial experience is translated and transformed into the final product. The paintings, drawings and other works in this series fulfil the role of marks on the surface of the mirror, separating the initial experience from the processes of memory, reflection and speculation. The works draw attention to the materiality that they represent and yet provide the opportunity for new insights and experiences, allowing the subjective nature of artistic activity to combine symbolic elements relating to the site, resulting in the production of meaning.