Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: the electronic games to aid motivation to exercise (eGAME) study

BACKGROUND: Childhood obesity has reached epidemic proportions in developed countries. Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity. Active video games, where players physically interact with images onscreen, may have utility as a novel intervention to increase physical activity and improve body composition in children. The aim of the Electronic Games to Aid Motivation to Exercise (eGAME) study is to determine the effects of an active video game intervention over 6 months on: body mass index (BMI), percent body fat, waist circumference, cardio-respiratory fitness, and physical activity levels in overweight children.

METHODS/DESIGN: Three hundred and thirty participants aged 10-14 years will be randomized to receive either an active video game upgrade package or to a control group (no intervention).

DISCUSSION: An overview of the eGAME study is presented, providing an example of a large, pragmatic randomized controlled trial in a community setting. Reflection is offered on key issues encountered during the course of the study. In particular, investigation into the feasibility of the proposed intervention, as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial.

Comparison of two modes of delivery of an exercise prescription scheme

SummaryGreen Prescription (GRx) is a referral from a health professional for a patient to become more physically active. In Auckland, GRx is delivered either on the telephone or face-to-face. A comparison of the two modes of delivery (telephone vs. face-to-face) was conducted. This evaluation involved staff interviews, patient interviews and analysis of GRx records for the 2007 calendar year. Results indicated that the modes of delivery were similar in terms of costs as well as outcomes. However, the face-to-face mode of delivery was more popular with Maori and Pacific peoples. Providing a choice of GRx mode of delivery allows participants to choose based on their personal and cultural needs.AbstractAimGreen Prescription (GRx) referrals from health professionals have been shown to be effective for increasing the physical activity levels of patients. Little is known about which methods of delivering the programme represents the best value for money. The purpose of this paper was to compare the cost and outcomes of two modes of delivery of a GRx programme. One mode offered phone support involving monthly telephone calls over a 3-4 month period to encourage physical activity participation. A second mode offered community support via weekly face-to-face support group meetings in which physical activities were offered.MethodThe evaluation involved staff interviews, patient interviews and analysis of GRx records for the 2007 calendar year.ResultsThere was a large rate of drop-out (68%) from GRx referral to registration. For those who registered, there was a clear preference for community support, and engagement of Māori and Pacific peoples was higher in this mode of delivery. The proportion (but not absolute number) of people who successfully completed their mode of delivery was higher with phone support. However, participants in community support self-reported a significantly greater number of days of exercise per week than those in phone support. The total expected cost per person for phone support was $102.07 and $108.15 for community support. A greater proportion of participants in community support were very satisfied overall with their mode of delivery.ConclusionThe two modes were comparable in cost and outcomes, though there was greater penetration of target ethnic populations in community support. Providing a choice of GRx mode of delivery allows participants to choose based on their personal and cultural needs.

Predicting physical activity intention and behavior in school-age children

Two studies were conducted to predict physical activity in school-aged children. Study 1 tested the utility of an integrated model in predicting physical activity (PA) intention and behavior-the theory of planned behavior (TPB) and self-efficacy theory. Six hundred and forty-five New Zealand children (aged 11-13 years) completed measures corresponding to the integrated model and a self-reported measure of PA one week later. Perceived behavioral control (PBC) and subjective norm were the two strongest predictors of intentions. Task efficacy and barrier efficacy were the two strongest predictors of PA. A second study (Study 2) was conducted to determine whether the self-efficacy measures could discriminate objectively measured PA levels. Sixty-seven Canadian children (aged 11-13 years) completed task and barrier self-efficacy measures. The following week, children classified as 'high' (n = 11) and 'lower' (n = 7) for both task and barrier efficacy wore an Actical® monitor for seven consecutive days to provide activity-related energy expenditure (AEE) data. Results showed that children with high efficacy expended significantly greater AEE than their lower efficacious counterparts. Findings from these two studies provide support for the use of self-efficacy interventions as a potentially useful means of increasing PA levels among school-aged children.

A domain-specific approach for assessing physical activity efficacy in adolescents: from scale conception to predictive validity

Objective: To develop and test the utility of a domain-specific physical activity efficacy scale in adolescents for predicting physical activity behaviour. Design: Two independent studies were conducted. Study 1 examined the psychometric properties of a newly constructed Domain-Specific Physical Activity Efficacy Questionnaire (DSPAEQ) and study 2 tested the utility of the scale for predicting leisure- and school-time physical activity. Methods: In study 1, descriptive physical activity data were used to generate scale items. The scales factor structure and internal consistency were tested in a sample of 272 adolescents. A subsequent sample of Canadian (N = 104) and New Zealand (N = 29) adolescents, was recruited in study 2 to explore the scale's predictive validity using a subjective measure of leisure- and school-time physical activity. Results: A principle axis factor analysis in study 1 revealed a 26-item, five-factor coherent and interpretable solution; representative of leisure and recreation, household, ambulatory, transportation, and school physical activity efficacy constructs, respectively. The five-factor solution explained 81% of the response variance. In study 2 the domain-specific efficacy model explained 16% and 1% of leisure- and school-time physical activity response variance, respectively, with leisure time physical activity efficacy identified as a unique and significant contributor of leisure-time physical activity. Conclusion: Study 1 provides evidence for the tenability of a five factor DSPEAQ, while study 2 shows that the DSPEAQ has utility in predicting domain-specific physical activity. This latter finding underscores the importance of scale correspondence between the behavioural elements (leisure-time physical activity) and cognitive assessment of those elements (leisure-time physical activity efficacy).

Evaporation, seepage and water quality management in storage dams: a review of research methods

One of the most significant sources of water wastage in Australia is loss from small storage dams, either by seepage or evaporation. Over much of Australia, evaporative demand routinely exceeds precipitation. This paper outlines first, methodologies and measurement techniques to quantify the rate of evaporative loss from fresh water storages. These encompass high-accuracy water balance monitoring; determination of the validity of alternative estimation equations, in particular the FAO56 Penman- Monteith ETo methodology; and the commencement of CFD modeling to determine a 'dam factor' in relation to practical atmospheric measurement techniques. Second, because the application of chemical monolayers is the only feasible alternative to the high cost of physically covering the storages to retard evaporation, the use of cetyl alcohol-based monolayers is reviewed, and preliminary research on their degradation by photolytic action, by wind break-up and by microbial degradation reported. Similarly, preliminary research on monolayer visualisation techniques for field application is reported; and potential enhancement of monolayers by other chemicals and attendant water quality issues are considered.

EXPERIMENTAL INVESTIGATION INTO PARTICULATE MATTER DISTRIBUTION IN CATALYZED PARTICULATE FILTERS USING A 3D TERAHERTZ WAVE SCANNER

The particulate matter distribution (PM) trends that exist in catalyzed particulate filters (CPFs) after loading, passive oxidation, active regeneration, and post loading conditions are not clearly understood. These data are required to optimize the operation of CPFs, prevent damage to the CPFs caused by non-uniform distributions, and develop accurate CPF models. To develop an understanding of PM distribution trends, multiple tests were conducted and the PM distribution was measured in three dimensions using a terahertz wave scanner. The results of this work indicate that loading, passive oxidation, active regeneration, and post loading can all cause non-uniform PM distributions. The density of the PM in the substrate after loading and the amount of PM that is oxidized during passive oxidations and active regenerations affect the uniformity of the distribution. Post loading that occurs after active regenerations result in distributions that are less uniform than post loading that occurs after passive oxidations.

High bandwidth freestanding semipolar (11–22) InGaN/GaN light-emitting diodes

Freestanding semipolar (11–22) indium gallium nitride (InGaN) multiplequantum-well light-emitting diodes (LEDs) emitting at 445 nm have been realized by the use of laser lift-off (LLO) of the LEDs from a 50- m-thick GaN layer grown on a patterned (10–12) r -plane sapphire substrate (PSS). The GaN grooves originating from the growth on PSS were removed by chemical mechanical polishing. The 300 m × 300 m LEDs showed a turn-on voltage of 3.6 V and an output power through the smooth substrate of 0.87 mW at 20 mA. The electroluminescence spectrum of LEDs before and after LLO showed a stronger emission intensity along the [11–23]InGaN/GaN direction. The polarization anisotropy is independent of the GaN grooves, with a measured value of 0.14. The bandwidth of the LEDs is in excess of 150 MHz at 20 mA, and back-to-back transmission of 300 Mbps is demonstrated, making these devices suitable for visible light communication (VLC) applications.

Use of fluorescence lifetime imaging microscopy (FLIM) as a timer of cell cycle S phase

Incorporation of thymidine analogues in replicating DNA, coupled with antibody and fluorophore staining, allows analysis of cell proliferation, but is currently limited to monolayer cultures, fixed cells and end-point assays. We describe a simple microscopy imaging method for live real-time analysis of cell proliferation, S phase progression over several division cycles, effects of anti-proliferative drugs and other applications. It is based on the prominent (~ 1.7-fold) quenching of fluorescence lifetime of a common cell-permeable nuclear stain, Hoechst 33342 upon the incorporation of 5-bromo-2’-deoxyuridine (BrdU) in genomic DNA and detection by fluorescence lifetime imaging microscopy (FLIM). We show that quantitative and accurate FLIM technique allows high-content, multi-parametric dynamic analyses, far superior to the intensity-based imaging. We demonstrate its uses with monolayer cell cultures, complex 3D tissue models of tumor cell spheroids and intestinal organoids, and in physiological study with metformin treatment.

The Museum of Doubt

Is there a God? Does my bum look big in this? Why doesn’t my house cost only the materials used to build it? Is Video Art dead? When Peter Hill curated his first Museum of Doubt exhibition at Zeppelin Projects in Brunswick, these were some of the questions his artist friends wrote on one wall of the gallery. Those artists included Jon Cattapan, Phil Edwards, Julian Goddard, Ceri Hahn, and Peter Ellis. Others, who are also in this second outing of The Museum of Doubt, include Louise Weaver, Patrick Pound, Josh Foley and Michael Vale. How do we know what is true or false in any given visual statement? How willing are we to suspend our disbelief? And does that even matter if the artworks can be enjoyed for their own formal beauty, angst, or inquisitiveness?“I have a great sympathy with both doubt and faith as beacons for navigating this sublime universe,” says Peter Hill. “Remembering that the sublime in art, as in life and death, hovers between beauty and terror. Doubt and faith are both on the same side of the same coin – a coin that has “certainty” on the reverse. Most of the problems we face today are caused by individuals and nations being “certain” that they have the answer. Don’t listen to them. Be skeptical. The truth can be approached, as Karl Popper, the great philosopher of science tells us, but it can rarely be found. It can only be falsified.”So bring your doubt and your faith to this Wunderkammer of Super Fictions and enjoy the lightness, the darkness, and the strangeness in the works of: Glen Clarke, Josh Foley, Tony Garifalakis, Grant Hill, Peter Hill, Patrick Pound, Michael Vale, Louise Weaver and Robert Zhao.

Screen Time Weight-loss Intervention Targeting Children at Home (SWITCH): process evaluation of a randomised controlled trial intervention.

BACKGROUND: The Screen Time Weight-loss Intervention Targeting Children at Home (SWITCH) trial tested a family intervention to reduce screen-based sedentary behaviour in overweight children. The trial found no significant effect of the intervention on children's screen-based sedentary behaviour. To explore these null findings, we conducted a pre-planned process evaluation, focussing on intervention delivery and uptake. METHODS: SWITCH was a randomised controlled trial of a 6-month family intervention to reduce screen time in overweight children aged 9-12 years (n = 251). Community workers met with each child's primary caregiver to deliver the intervention content. Community workers underwent standard training and were monitored once by a member of the research team to assess intervention delivery. The primary caregiver implemented the intervention with their child, and self-reported intervention use at 3 and 6 months. An exploratory analysis determined whether child outcomes at 6 months varied by primary caregiver use of the intervention. RESULTS: Monitoring indicated that community workers delivered all core intervention components to primary caregivers. However, two thirds of primary caregivers reported using any intervention component "sometimes" or less frequently at both time points, suggesting that intervention uptake was poor. Additionally, analyses indicated no effect of primary caregiver intervention use on child outcomes at 6 months, suggesting the intervention itself lacked efficacy. CONCLUSIONS: Poor uptake, and the efficacy of the intervention itself, may have played a role in the null findings of the SWITCH trial on health behaviour and body composition. TRIAL REGISTRATION: The trial was registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12611000164998 ); registration date: 10/02/2011.

Randomised controlled trial of a digitally assisted low intensity intervention to promote personal recovery in persisting psychosis: SMART-Therapy study protocol

BACKGROUND: Psychosocial interventions have an important role in promoting recovery in people with persisting psychotic disorders such as schizophrenia. Readily available, digital technology provides a means of developing therapeutic resources for use together by practitioners and mental health service users. As part of the Self-Management and Recovery Technology (SMART) research program, we have developed an online resource providing materials on illness self-management and personal recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment (CHIME) framework. Content is communicated using videos featuring persons with lived experience of psychosis discussing how they have navigated issues in their own recovery. This was developed to be suitable for use on a tablet computer during sessions with a mental health worker to promote discussion about recovery.

METHODS/DESIGN: This is a rater-blinded randomised controlled trial comparing a low intensity recovery intervention of eight one-to-one face-to-face sessions with a mental health worker using the SMART website alongside routine care, versus an eight-session comparison condition, befriending. The recruitment target is 148 participants with a schizophrenia-related disorder or mood disorder with a history of psychosis, recruited from mental health services in Victoria, Australia. Following baseline assessment, participants are randomised to intervention, and complete follow up assessments at 3, 6 and 9 months post-baseline. The primary outcome is personal recovery measured using the Process of Recovery Questionnaire (QPR). Secondary outcomes include positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, subjective experiences of psychosis, emotional symptoms, quality of life and resource use. Mechanisms of change via effects on self-stigma and self-efficacy will be examined.

DISCUSSION: This protocol describes a novel intervention which tests new therapeutic methods including in-session tablet computer use and video-based peer modelling. It also informs a possible low intensity intervention model potentially viable for delivery across the mental health workforce.

Using an evidence-based online module to improve parents’ ability to manage their child with Developmental Coordination Disorder

Background : Developmental coordination disorder (DCD) is a prevalent neurodevelopmental disorder. Best practices include raising parents’ awareness and building capacity but few interventions incorporating these best practices are documented. Objective : To examine whether an evidence-based online module can increase the perceived knowledge and skills of parents of children with DCD, and lead to behavioural changes when managing their child’s health condition. Methods : A mixed-methods, before-after-follow-up design guided by the theory of planned behaviour was employed. Data about the knowledge, skills and behaviours of parents of children with DCD were collected using questionnaires prior to completing the module, immediately after, and three months later. One-way repeated measures ANOVAs and thematic analyses were performed on data as appropriate. Results : Fifty-eight participants completed all questionnaires. There was a significant effect of time on self-reported knowledge [F(2.00,114.00)=16.37, p=0.00] and skills [F(1.81,103.03)=51.37, p=0.00] with higher post- and follow-up scores than pre-intervention scores. Thirty-seven (65%) participants reported an intention to change behaviour postintervention; 29 (50%) participants had tried recommended strategies at follow-up. Three themes emerged to describe parents’ behavioural change: sharing information, trialing strategies and changing attitudes. Factors influencing parents’ ability to implement these behavioural changes included clear recommendations, time, and ‘right’ attitude. Perceived outcomes associated with the parental behavioural changes involved improvement in well-being for the children at school, at home, and for the family as a whole. Conclusions : The online module increased parents’ self-reported knowledge and skills in DCD management. Future research should explore its impacts on children’s outcomes long-term.

Using an evidence-based online module to improve parents’ ability to manage their child with Developmental Coordination Disorder

Background : Developmental coordination disorder (DCD) is a prevalent neurodevelopmental disorder. Best practices include raising parents’ awareness and building capacity but few interventions incorporating these best practices are documented. Objective : To examine whether an evidence-based online module can increase the perceived knowledge and skills of parents of children with DCD, and lead to behavioral changes when managing their child’s health condition. Methods : A mixed-methods, before-after design guided by the theory of planned behavior was employed. Data about the knowledge, skills and behaviors of parents of children with DCD were collected using questionnaires prior to completing the module, immediately after, and three months later. Paired T-tests, sensitivity analyses and thematic analyses were performed on data as appropriate. Results: One hundred-sixteen, 81 and 58 participants respectively completed the three questionnaires. For knowledge and skills, post- and follow-up scores were significantly higher than baseline scores (p<0.01). Fifty-two (64%) participants reported an intention to change behavior post-intervention and 29 (50%) participants had tried recommended strategies at follow-up. Three themes emerged to describe parents’ behavioral change: sharing information, trialing strategies and changing attitudes. Factors influencing parents’ ability to implement these behavioral changes included clear recommendations, time, and ‘right’ attitude. Perceived outcomes associated with the parental behavioral changes involved improvement in well-being for the children at school, at home, and for the family as a whole. Conclusions : The online module increased parents’ self-reported knowledge and skills in DCD management. Future research should explore its impacts on children’s long-term outcomes.

Supervivencia y mortalidad por tipo de terapia de reemplazo renal, en pacientes con enfermedad renal crónica terminal, en una cohorte de pacientes asegurados en Colombia

En Colombia se ha podido establecer que la incidencia y mortalidad de la Enfermedad Renal Crónica Terminal continúan en aumento en los últimos 6 años a pesar de las estrategias de intervención para prevención y control de la enfermedad implementadas nivel nacional. Este trabajo busca establecer la línea de base para la población asegurada en Colombia, frente a la supervivencia de pacientes en terapia de remplazo renal (TRR).