Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial

Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children.

Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment.

Setting 45 family practices (66 general practitioners) in Melbourne, Australia.

Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score 3.0) were excluded.

Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials.

Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI.

Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention – control) at 6 and 12 months were, for BMI, –0.12 (95% CI –0.40 to 0.15, P=0.4) and –0.11 (–0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (–4 to 52, P=0.09) and 11 (–26 to 49, P=0.6); and, for nutrition score, 0.2 (–0.03 to 0.4, P=0.1) and 0.1 (–0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm.

Conclusions Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia.

Vision-based target tracking and surveillance with robust set-valued state estimation

Tracking a target from a video stream (or a sequence of image frames) involves nonlinear measurements in Cartesian coordinates. However, the target dynamics, modeled in Cartesian coordinates, result in a linear system. We present a robust linear filter based on an analytical nonlinear to linear measurement conversion algorithm. Using ideas from robust control theory, a rigorous theoretical analysis is given which guarantees that the state estimation error for the filter is bounded, i.e., a measure against filter divergence is obtained. In fact, an ellipsoidal set-valued estimate is obtained which is guaranteed to contain the true target location with an arbitrarily high probability. The algorithm is particularly suited to visual surveillance and tracking applications involving targets moving on a plane.

Ozbot and haptics : remote surveillance to physical presence

This paper reports on robotic and haptic technologies and capabilities developed for the law enforcement and defence community within Australia by the Centre for Intelligent Systems Research (CISR). The OzBot series of small and medium surveillance robots have been designed in Australia and evaluated by law enforcement and defence personnel to determine suitability and ruggedness in a variety of environments. Using custom developed digital electronics and featuring expandable data busses including RS485, I2C, RS232, video and Ethernet, the robots can be directly connected to many off the shelf payloads such as gas sensors, x-ray sources and camera systems including thermal and night vision. Differentiating the OzBot platform from its peers is its ability to be integrated directly with haptic technology or the 'haptic bubble' developed by CISR. Haptic interfaces allow an operator to physically 'feel' remote environments through position-force control and experience realistic force feedback. By adding the capability to remotely grasp an object, feel its weight, texture and other physical properties in real-time from the remote ground control unit, an operator's situational awareness is greatly improved through Haptic augmentation in an environment where remote-system feedback is often limited.

A social ecological model of ICT cooption : surveillance creep in the information age

A model for ICT cooption is introduced using the example of ’surveillance creep’ which is the phenomenon of increasing dataveillance as the result of the introduction of seemingly benign, useful and convenient technological artefacts. The model identifies and discusses five main components of ICT artefact development and deployment: design, properties, affordances, appropriation and agent interests and locates them in a complex interrelated social ecology. The model provides a way to empirically examine how and why technology favours particular social or organisational outcomes.

Surveillance of wild birds for avian influenza virus

Recent demand for increased understanding of avian influenza virus in its natural hosts, together with the development of high-throughput diagnostics, has heralded a new era in wildlife disease surveillance. However, survey design, sampling, and interpretation in the context of host populations still present major challenges. We critically reviewed current surveillance to distill a series of considerations pertinent to avian influenza virus surveillance in wild birds, including consideration of what, when, where, and how many to sample in the context of survey objectives. Recognizing that wildlife disease surveillance is logistically and financially constrained, we discuss pragmatic alternatives for achieving probability-based sampling schemes that capture this host-pathogen system. We recommend hypothesis-driven surveillance through standardized, local surveys that are, in turn, strategically compiled over broad geographic areas. Rethinking the use of existing surveillance infrastructure can thereby greatly enhance our global understanding of avian influenza and other zoonotic diseases.

Disease surveillance and epidemiological investigations in Australian fur seals

This study is the first systematic investigation into the disease status of Australian fur seals and one of very few conducted on Southern Hemisphere pinnipeds. It contributes to the understanding of Australian fur seal disease ecology and so informs the conservation management of this species

Mutual obligation? Regulating by supervision and surveillance in Australian income support policy

Through an analysis of speeches by government ministers, documents and regulations, this article examines the Australian national government’s surveillance of unemployed people through what is known as Activity Testing, and more specifically as Mutual Obligation. It seeks to merge the social policy analysis of Mutual Obligation with a surveillance perspective in order to delve deeper into the underlying nature of the policy and its implications for people who are unemployed. It does this by 1. Outlining the neo-liberal political theory underlying these policies; 2. Illustrating the nature and extent of surveillance of people in receipt of income support, and 3. Employing Foucault’s concepts of the technologies of domination and the self to highlight the controlling and coercive aspects of Mutual Obligation in achieving certain of the Government’s political and policy objectives. In doing so, the analysis will make visible something of the power exerted over the disadvantaged while subject to such surveillance.