The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

Background
Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.

Methods
Searches of major electronic databases identified articles published from 1993–2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.

Results
Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m2 to -0.54 kg/m2 for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3–5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.

Conclusion
There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.

The influence of time since fire and distance from fire boundary on the distribution and abundance of arboreal marsupials in Eucalyptus regnans-dominated forest in the Central Highlands of Victoria

The impact of time since fire after two consecutive wildfires 44 years apart (1939 and 1983) within the same area, and the distance from the fire boundary «100 m or 500-2000 m), were investigated in relation to the distribution and abundance of arboreal marsupials in 1994. Arboreal marsupials were censused by stagwatching and spotlighting in two relatively young age classes of mountain ash (Eucalyptus regnans) dominated forest in the Central Highlands of Victoria. Five species of arboreal marsupial were detected, but only three were detected in sufficient numbers to determine habitat preferences. Petauroides volans (greater glider) was statistically more abundant in 1939 regrowth forests, while Trichosurus caninus (mountain brushtail possum) showed no significant preference for either age class of forest. All but one record of Gymnobelideus leadbeateri (Leadbeater's possum) came from young forest, though the effect of age-class was not statistically significant. Distance from fire boundary explained little or no variation in mammal distribution or abundance. While the actual number of hollow-bearing trees was similar in both age classes of forest, the long-term lifespan of hollow-bearing trees in more recently burnt forest is predicted to be lower than in unburnt or not recently burnt forest. Post-fire salvage logging following the 1983 wildfires appears to have reduced the number of hollow-bearing trees at sites burnt in 1983.

Foot-targeting in reaching and grasping

Foot positioning was investigated when right-handed (Experiment One) and left handed adults (Experiment Two) stopped walking to grasp a stationary 70 mm ball at shoulder height. In both experiments centroid location formed by the toe and heel coordinates relative to the object was highly consistent within a target-location condition, demonstrating a foot-targeting phenomenon. Centroid location in the anterior-posterior direction was uninfluenced by grasping hand but the centroid shifted right for left hand grasps and left for right hand grasps. With the target either centrally located or on the same side as the dominant hand, foot positioning brought the grasping hand closer to the target in the medial-lateral direction. When the target object was aligned with the shoulder opposite the dominant hand both groups adopted foot positions to the left of the target. Thus, neither group adopted optimal foot position when the target was located opposite their dominant hand. Foot orientation angle relative to the target was also influenced by choice of grasping hand. Collectively, the findings demonstrate a close association between grasping hand and foot position when approaching to reach and grasp an object but also suggest that foot-dominance may influence medial-lateral centroid location.

Home range of the squirrel glider (Petaurus norfolcensis) in a network of remnant linear habitats

Linear strips of natural or semi-natural vegetation are a characteristic feature of rural landscapes throughout the world. Their value for the conservation of fauna in heavily modified landscapes depends on the response of species to the linear shape of the habitat, and the pressures this imposes on population processes and spatial organization. In south-eastern Australia, woodland habitats occupied by the squirrel glider Petaurus norfolcensis, a threatened species of arboreal marsupial, have been preferentially cleared for agriculture leaving only remnants within cleared farmland. In this study, the home range of P. norfolcensis was investigated by radio-tracking 40 gliders within a highly modified landscape where the majority (83%) of remaining wooded habitat occurs as a network of linear strips along roadsides and streams. Individuals were tracked for one to four seasons, resulting in the collection of 4213 independent locational 'fixes'. All fixes of animals were from remnant woodland. Home ranges were elongated and linear, primarily determined by the shape and arrangement of woodland habitat. Seasonal home ranges were small (mean of 1.4–2.8 ha) and ranged between 320 and 840 m long. Small patches of trees in farmland adjacent to the linear habitats were also extensively used. Despite the highly modified landscape structure, home ranges of P. norfolcensis in the linear network were smaller than those estimated from other studies of this species in continuous habitat. The apparent high quality of the linear habitats is attributed to the density of large old trees, which provide foraging and breeding resources, and the productivity of the environment. Linear landscape elements may have a valuable conservation function where they provide resident habitat or enhance landscape connectivity, but their long-term viability is vulnerable to disturbance.

Nest-tree selection by the threatened brush-tailed phascogale (phascogale tapoatafa) (marsupialia: dasyuridae) in a highly fragmented agricultural landscape

The conservation of roosting and nesting resources is of critical concern for many hollow-dependent species around the world. We investigated the nest-tree requirements of the threatened brush-tailed phascogale (Phascogale tapoatafa) in a highly cleared agricultural landscape in south-eastern Australia. We documented the physical characteristics of selected nest trees and describe the spatial and temporal patterns of nest-tree use as revealed by radio-tracking. Nine phascogales (seven females, two males) were radio-tracked between March and July 1999 in an area where most woodland habitat is confined to linear strips along roads and streams or small patches and scattered trees in cleared farmland. Female phascogales were monitored for 13–35 days over periods of 5–15 weeks and two males were monitored for 2 and 9 days respectively. A total of 185 nest-tree fixes was collected and all nests occupied by phascogales were in standing trees. Eighty-three nest trees were identified, ranging in diameter at breast height (dbh) from 25 to 171 cm, with a mean dbh for the trees used by each individual phascogale of >80 cm. Phascogales did not discriminate between canopy tree species in selecting nest trees, but showed highly significant selection for trees in the largest size class. All individuals used multiple nest trees, with the seven females occupying an average of 11.4 nest trees from a mean of 25 diurnal locations. The number of nest trees continued to increase throughout the study, suggesting that more would be identified during a longer or more intensive study. Occupied nest trees were located throughout each individual’s home range, highlighting the importance of a continuous spatial distribution of suitable nest trees across the landscape. Nest trees were also located in adjacent farmland up to 225 m from roadside vegetation, demonstrating the value that scattered clumps and even single trees in farmland can have for wildlife conservation.

Automated attention flags in chronic disease care planning

Objectives: To assess the value of computerised decision support in the management of chronic respiratory disease by comparing agreement between three respiratory specialists, general practitioners (care coordinators), and decision support software.
Methods: Care guidelines for two chronic obstructive pulmonary disease projects of the SA HealthPlus Coordinated Care Trial were formulated. Decision support software, Care Plan On-Line (CPOL), was created to represent the intent of these guidelines via automated attention flags to appear in patients' electronic medical records. For a random sample of 20 patients with care plans, decisions about the use of nine additional services (eg,.smoking cessation, pneumococcal vaccination) were compared between the respiratory specialists, the patients' GPs and the CPOL attention flags.
Results: Agreement among the specialists was at the lower end of moderate (intraclass correlation coefficient [ICC], 0.48; 95% CI, 0.39-0.56), with a 20% rate of contradictory decisions. Agreement with recommendations of specialists was moderate to poor for GPs (le, 0.49; 95% CI, 0.33-0.66) and moderate to good for CPOL (K, 0.72; 95% CI, 0.55-0.90). CPOL agreement with GPs was moderate to poor (le, 0.41; 95% CI, 0.24-0.58). GPs were less likely than specialists or CPOL to decide in favour of an additional service (P< 0.001). CPOL was 87% accurate as an indicator of specialist decisions. It gave a 16% false-positive rate according to specialist decisions, and flagged 61% of decisions where GPs said No and specialists said Yes.
Conclusions: Automated decision support may provide GPs with improved access to the intent of guidelines; however, further investigation is required.

Cross-national agreement on disability weights:the Eurpoean disability weights project

Background: Disability weights represent the relative severity of disease stages to be incorporated in summary measures of population health. The level of agreement on disability weights in Western European countries was investigated with different valuation methods.

Methods: Disability weights for fifteen disease stages were elicited empirically in panels of health care professionals or non-health care professionals with an academic background following a strictly standardised procedure. Three valuation methods were used: a visual analogue scale (VAS); the time trade-off technique (TTO); and the person trade-off technique (PTO). Agreement among England, France, the Netherlands, Spain, and Sweden on the three disability weight sets was analysed by means of an intraclass correlation coefficient (ICC) in the framework of generalisability theory. Agreement among the two types of panels was similarly assessed.

Results: A total of 232 participants were included. Similar rankings of disease stages across countries were found with all valuation methods. The ICC of country agreement on disability weights ranged from 0.56 [95% CI, 0.52–0.62] with PTO to 0.72 [0.70–0.74] with VAS and 0.72 [0.69–0.75] with TTO. The ICC of agreement between health care professionals and non-health care professionals ranged from 0.64 [0.58–0.68] with PTO to 0.73 [0.71–0.75] with VAS and 0.74 [0.72–0.77] with TTO.

Conclusions: Overall, the study supports a reasonably high level of agreement on disability weights in Western European countries with VAS and TTO methods, which focus on individual preferences, but a lower level of agreement with the PTO method, which focuses more on societal values in resource allocation.

Fuzzy logic in clinical practice decision support systems

Computerized clinical guidelines can provide significant benefits to health outcomes and costs, however, their effective implementation presents significant problems. Vagueness and ambiguity inherent in natural (textual) clinical guidelines is not readily amenable to formulating automated alerts or advice. Fuzzy logic allows us to formalize the treatment of vagueness in a decision support architecture. This paper discusses sources of fuzziness in clinical practice guidelines. We consider how fuzzy logic can be applied and give a set of heuristics for the clinical guideline knowledge engineer for addressing uncertainty in practice guidelines. We describe the specific applicability of fuzzy logic to the decision support behavior of Care Plan On-Line, an intranet-based chronic care planning system for General Practitioners.

The fine line between harm reduction and harm production - development of a clinical policy on femoral (groin) injecting

The femoral region ('groin') appears to be increasingly commonly used by injecting drug users in the UK. With the advent of Britain's first supervised prescribed injectable opioid treatment clinic, unprecedented decisions and judgements were required about the safe supervision of this practice, or whether to permit this behaviour on site at all. This paper reports the reasons for, and outcome of, development of a clinical policy on injecting into the deep femoral vein (groin injecting)

Categorisation of knowledge management processes in the development of sustainable enterprises

Sustainable development is a growing area of interest in organisations. Particularly those that have large energy demands for processing, use dwindling raw materials or produce a great deal of waste through production. Knowing those processes that can contribute to making an organisation more sustainable provides a great advantage both in terms of project implementation success and in measurable Triple Bottom Line returns.

In previous research we identified that many of the Information Technology processes used to assist organisations in developing sustainable practices were more clearly suited as Knowledge Management processes (Van Der Meer and Sinnappan, 2008), however less empirical study has been done to categorise them meaningfully.

In this study we have taken these Knowledge Management processes and categorised them according to the sustainable development practice where we identify they can be of service based on Waage et al (2003). Through this we are hoping to develop a framework for organisations to determine what Knowledge Management processes are needed to achieve the particular sustainable development. We may also be able to judge what steps an organisation needs to take to develop further sustainable practices in other areas.

Development of a framework for knowledge management tools in sustainable development would assist industries in determining the best processes for these sustainable projects. This framework also contributes to the body of knowledge on sustainable development and Information Technology.

Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005

OBJECTIVE—Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for the development of type 2 diabetes in the mother and is  responsible for morbidity in the child. To better identify women at risk of developing GDM we examined sociodemographic correlates and changes in the prevalence of GDM among all births between 1995 and 2005 in Australia's largest state.
RESEARCH DESIGN AND METHODS—A computerized database of all births (n = 956,738) between 1995 and 2005 in New South Wales, Australia, was used in a multivariate logistic regression that examined the association between sociodemographic characteristics and the occurrence of GDM.
RESULTS—Between 1995 and 2005, the prevalence of GDM increased by 45%, from 3.0 to 4.4%. Women born in South Asia had the highest adjusted odds ratio (OR) of any region (4.33 [95% CI 4.12–4.55]) relative to women born in Australia. Women living in the three lowest socioeconomic quartiles had higher adjusted ORs for GDM relative to women in the highest quartile (1.54 [1.50–1.59], 1.74 [1.69–1.8], and 1.65 [1.60–1.70] for decreasing socioeconomic status quartiles). Increasing age was strongly associated with GDM, with women aged >40 years having an adjusted OR of 6.13 (95% CI 5.79–6.49) relative to women in their early 20s. Parity was associated with a small reduced risk. There was no association between smoking and GDM.
CONCLUSIONS—Maternal age, socioeconomic position, and ethnicity are important correlates of GDM. Future culturally specific interventions should target prevention of GDM in these high-risk groups.

Ecology of arboreal marsupials in a network of remnant linear habitats

Linear strips of vegetation set within a less-hospitable matrix are common features of landscapes throughout the world. Depending on location, form and function, these linear landscape elements include hedgerows, fencerows, shelterbelts, roadside or streamside strips and wildlife corridors. In many anthropogenically-modified landscapes, linear strips are important components for conservation because they provide a large proportion of the remaining wooded or shrubby habitat for fauna. They may also function to provide connectivity across the landscape. In some districts, the linear strips form an interconnected network of habitat. The spatial configuration of remnant habitat (size, shape and arrangement) may influence habitat suitability, and hence survival, of many species of plant and animal in modified landscapes. Near Euroa in south-eastern Australia, the clearing and fragmentation of temperate woodlands for agriculture has been extensive and, at present, less than 5% tree cover remains, most of which (83%) occurs as linear strips along roads and streams. The remainder of the woodland occurs as relatively small patches and single isolated trees scattered across the landscape. As an assemblage, arboreal marsupials are woodland dependent and vary in their sensitivity to habitat loss and fragmentation. This thesis focusses on determining the conservation status of arboreal marsupials in the linear network and understanding how they utilise the landscape mosaic. Specifically, the topics examined in this thesis are: (1) the composition of the arboreal marsupial assemblage in linear and non-linear woodland remnants; (2) the status and habitat preferences of species of arboreal marsupial within linear remnants; and (3) the ecology of a population of the Squirrel Glider Petaurus norfolcensis in the linear network, focusing on population dynamics, spatial organisation, and use of den trees. The arboreal marsupial fauna in the linear network was diverse, and comprised seven out of eight species known to occur in the district. The species detected within the strips were P. norfolcensis, the Sugar Glider Petaurus breviceps, Common Brushtail Possum Trichosums vulpecula, Common Ringtail Possum Pseudocheirus peregrinus, Brush-tailed Phascogale Phascogale tapoatafa, Koala Phascolarctos cinereus and Yellow-footed Antechinus Antechinus flavipes. The species not detected was the Feathertail Glider Acrabates pygmaeus. Survey sites in linear remnants (strips of woodland along roads and streams) supported a similar richness and density of arboreal mammals to sites in non-linear remnants (large patches or continuous tracts of woodland nearby). Furthermore, the combined abundance of all species of arboreal marsupials was significantly greater in sites in the linear remnants than in the non-linear remnants. This initial phase of the study provided no evidence that linear woodland remnants support a degraded or impoverished arboreal marsupial fauna in comparison with the nonlinear remnants surveyed. Intensive trapping of arboreal marsupials within a 15 km linear network between February 1997 and June 1998 showed that all species of arboreal marsupial (except A. pygmaeus) were present within the linear strips. Further analyses related trap-based abundance estimates to measures of habitat quality and landscape structure. Width of the linear habitat was significantly positively correlated with the combined abundance of all arboreal marsupials, as well as with the abundance of P. norfolcensis and T. vulpecula. The abundance of T. vulpecula was also significantly positively correlated with variation in overstorey species composition, Acacia density and the number of hollow-bearing trees. The abundance of P. norfolcensis was positively correlated with Acacia density and canopy width, and negatively correlated with distance to the nearest intersection with another linear remnant. No significant variables were identified to explain the abundance of P. tapoatafa, and there were insufficient captures of the remaining species to investigate habitat preferences. Petaurus norfolcensis were resident within the linear network and their density (0.95 -1.54 ha-1) was equal to the maximum densities recorded for this species in continuous forest elsewhere in south-eastern Australia. Rates of reproduction were also similar to those in continuous forest, with births occurring between May and December, a mean natality rate of 1.9, and a mean litter size of 1.7. Sex ratios never differed significantly from parity. Overall, the population dynamics of P. norfolcensis were comparable with published results for the species in contiguous forest, clearly suggesting that the linear remnants currently support a self-sustaining, viable population. Fifty-one P. norfolcensis were fitted with radio transmitters and tracked intermittently between December 1997 and November 1998. Home ranges were small (1.3 - 2.8 ha), narrow (20 - 40 m) and elongated (322 - 839 m). Home ranges were mostly confined to the linear remnants, although 80% of gliders also utilised small clumps of adjacent woodland within farm paddocks for foraging or denning. Home range size was significantly larger at intersections between two or more linear remnants than within straight sections of linear remnants. Intersections appeared to be important sites for social interaction because the overlap of home ranges of members of adjacent social groups was significantly greater at intersections than straight sections. Intersections provided the only opportunity for members of three or more social groups to interact, while still maintaining their territories. The 51 gliders were radiotracked to 143 different hollow-bearing trees on 2081 occasions. On average, gliders used 5.3 den trees during the study (range 1-15), and changed den trees every 4.9 days. The number of den trees used by each glider is likely to be conservative because the cumulative number of den trees continued to increase over the full duration of the study. When gliders shifted between den trees, the mean distance between consecutive den sites was 247 m. Den trees were located throughout a glider's home range, thereby reducing the need to return to a central den site and potentially minimising energy expenditure. Dens were usually located in large trees (mean diameter 88.5 cm) and were selected significantly more often than expected based on their occurrence within the landscape. The overall conclusion of this thesis is that the linear network I studied provides high quality habitat for resident populations of arboreal marsupials. Important factors influencing the suitability of the linear remnants appear to be the high level of network connectivity, the location on soils of high nutrient status, the high density of large trees and an acacia understorey. In highly fragmented landscapes, linear habitats as part of the remaining woodland mosaic have the potential to be an integral component in the conservation of woodland-dependent fauna. The habitat value of linear strips of vegetation should not be underestimated.

'Royal science' and civil war in Sri Lanka : a comment on S. Goonatilake

In highlighting the relationship between the production of knowledge, the administration of government and the formation of subject–citizens in colonial systems, post-colonialism has arguably found its most fertile field of inquiry and revision in South Asia. The reasons for this are complex and relate, in part, to the nature of both colonial administration and the colonised civilisations to be found in the region, as well as to the nature of the different independence movements—many of these persisting well beyond the formal grants of independence in the late 1940s. Also important is the emerging post-colonial middle class, its transnational interconnections comprising inter alia extensive participation in knowledge/information economies, and its ‘organic intellectuals’ (Gramsci 1971) whose work represents the interests of their class. In other words, the tremendous insights offered by post-colonial theory into the nature of latent or implicit power relations to be found in forms of knowledge reveal the ongoing complicity of scholarship in government. Post-colonialism, thus, raises the issue of how the nexus of knowledge and power translates into contemporary situations—the post-colonial predicament (Breckenridge and van der Veer 1993).

Groin injecting in injectable opioid treatment service users in South London

Femoral (or groin) injecting is an emerging public health challenge to all drug-related services within the UK. Recent work in the area has proposed that groin injecting in the UK has moved from being a ‘risk boundary’ to an ‘acceptable behaviour’. This article uses data from 10 in-depth qualitative interviews with service users from a supervised injectable opiate treatment service in South London to report on pathways to, and reasons for, groin injecting. Our findings indicate that even though groin injecting constitutes a risk boundary for some injectors, the practice is no longer heavily stigmatised and is perceived by some to be an acceptable risk. Narratives also pointed to the importance of peers in the initiation of groin injecting. Interviewees described the groin as a site of ‘last resort’ in contrast to ‘convenience’ groin injectors described in some previous research. We conclude that it might be helpful to distinguish between convenience and last resort groin injectors and support the call for innovative interventions which aim to reduce modelling of groin injection and which promote social norms supportive of using peripheral injecting sites.

Structural characterization of novel ionic materials incorporating the bis(trifluoromethanesulfonyl)amide anion

A range of low melting salts of the bis(trifluoromethanesulfonyl)amide (TFSA) anion with hindered organic cations (N-methyl-1-methylpyrrolinium, N,N-dimethylpyrrolidinium, N,N,N,-trimethylammonium, and N,N,N,N-tetrakis(n-propyl)ammonium) have been crystallized. Single-crystal X-ray diffraction data show these materials to consist of discrete ions with only weak C−H···O (or for Me₃NH N−H···O) contacts between the constituent atoms of the cations and anions close to the limits of van der Waals separations. Consequently, the observed physical properties of these materials presumably result from the diffuse negative charge on the TFSA anion and inefficient packing of these large and irregularly shaped ions.