The NOURISH randomised control trial : positive feeding practices and food preferences in early childhood - a primary prevention program for childhood obesity

Background Primary prevention of childhood overweight is an international priority. In Australia 20-25% of 2-8 year olds are already overweight. These children are at substantially increased the risk of becoming overweight adults, with attendant increased risk of morbidity and mortality. Early feeding practices determine infant exposure to food (type, amount, frequency) and include responses (eg coercion) to infant feeding behaviour (eg. food refusal). There is correlational evidence linking parenting style and early feeding practices to child eating behaviour and weight status. A focus on early feeding is consistent with the national focus on early childhood as the foundation for life-long health and well being. The NOURISH trial aims to implement and evaluate a community-based intervention to promote early feeding practices that will foster healthy food preferences and intake and preserve the innate capacity to self-regulate food intake in young children. Methods/Design This randomised controlled trial (RCT) aims to recruit 820 first-time mothers and their healthy term infants. A consecutive sample of eligible mothers will be approached postnatally at major maternity hospitals in Brisbane and Adelaide. Initial consent will be for re-contact for full enrolment when the infants are 4-7 months old. Individual mother- infant dyads will be randomised to usual care or the intervention. The intervention will provide anticipatory guidance via two modules of six fortnightly parent education and peer support group sessions, each followed by six months of regular maintenance contact. The modules will commence when the infants are aged 4-7 and 13-16 months to coincide with establishment of solid feeding, and autonomy and independence, respectively. Outcome measures will be assessed at baseline, with follow up at nine and 18 months. These will include infant intake (type and amount of foods), food preferences, feeding behaviour and growth and self-reported maternal feeding practices and parenting practices and efficacy. Covariates will include sociodemographics, infant feeding mode and temperament, maternal weight status and weight concern and child care exposure. Discussion Despite the strong rationale to focus on parents’ early feeding practices as a key determinant of child food preferences, intake and self-regulatory capacity, prospective longitudinal and intervention studies are rare. This trial will be amongst to provide Level II evidence regarding the impact of an intervention (commencing prior to age 12 months) on children’s eating patterns and behaviours. Trial Registration: ACTRN12608000056392

Eco-cosmpolitanism

Two new landscape projects for Victoria's City of Moreland explore an intriguing fusion of indigenous and multicultural community qualities imbued with the romantic sensibilities of the collaborative design team.

Eco-retrofitting with building integrated living systems

Building integrated living systems (BILS), such as green roofs and living walls, could mitigate many of the challenges presented by climate change and biodiversity protection. However, few if any such systems have been constructed, and current tools for evaluating them are limited, especially under Australian subtropical conditions. BILS are difficult to assess, because living systems interact with complex, changing and site-specific social and environmental conditions. Our past research in design for eco-services has confirmed the need for better means of assessing the ecological values of BILS - let alone better models for assessing their thermal and hydrological performance. To address this problem, a research project is being developed jointly by researchers at the Central Queensland University (CQ University) and the Queensland University of Technology (QUT), along with industry collaborators. A mathematical model under development at CQ University will be applied and tested to determine its potential for predicting their complex, dynamic behaviour in different contexts. However, the paper focuses on the work at QUT. The QUT school of design is generating designs for living walls and roofs that provide a range of ecosystem goods and services, or ‘eco-services’, for a variety of micro-climates and functional contexts. The research at QUT aims to develop appropriate designs, virtual prototypes and quantitative methods for assessing the potential multiple benefits of BILS in subtropical climates. It is anticipated that the CQ University model for predicting thermal behaviour of living systems will provide a platform for the integration of ecological criteria and indicators. QUT will also explore means to predict and measure the value of eco-services provided by the systems, which is still largely uncharted territory. This research is ultimately intended to facilitate the eco-retrofitting of cities to increase natural capital and urban resource security - an essential component of sustainability. The talk will present the latest range of multifunctional, eco-productive living walls, roofs and urban space frames and their eco-services.

Daylighting design in the architectural design studio

This paper discusses two different approaches to teaching design and their modes of delivery and reflects upon their successes and failures. Two small groups of third year design students have been given projects focussing on incorporation of daylighting to architectural design in studios having different design themes. In association with the curriculum, the themes were Digital Tools and Sustainability. Although both studios had the topic of daylighting, the aim and methodology used were different. Digital Tool studio’s aim was to teach how to design daylighting by using a digital tool, where as, Sustainability studio aimed at using scale modelling as a tool to learn about daylighting and integrating it into design. Positive results for providing student learning success within the University context were the students’ chance to learn and practice some new skills –using a new tool for designing; integration of the tutors’ extensive research expertise to their teaching practice; and the students’ construction of their own understanding of knowledge in a student-centred educational environment. This environment created a very positive attitude in the form of exchanging ideas and collaboration among the students of Digital Tools students at the discussion forum. Sustainability group students were enthusiastic about designing and testing various proposals. Problems that both studios experienced were mainly related to timing. Synchronizing with other groups of their studios and learning of a new skill on top of an already complicated process of design learning were the setbacks.

Intentional first year curriculum design as a means of facilitating student engagement: some exemplars

The importance of student engagement to higher education quality, making deep learning outcomes possible for students, and achieving student retention, is increasingly being understood. The issue of student engagement in the first year of tertiary study is of particular significance. This paper takes the position that the first year curriculum, and the pedagogical principles that inform its design, are critical influencers of student engagement in the first year learning environment. We use an analysis of case studies prepared for Kift’s ALTC Senior Fellowship to demonstrate ways in which student engagement in the first year of tertiary study can be successfully supported through intentional curriculum design that motivates students to learn, provides a positive learning climate, and encourages students to be active in their learning.

The social role of design on collaborative destination branding : creating a new journey, a new story for the Waterfall Way, New South Wales, Australia.

This paper suggests that collaborative design can be an effective tool to promote social change. A co-design methodology and the results of its application in branding the Waterfall Way (New South Wales, Australia) as an eco- and nature-based tourism destination are presented as an example. The co-design exercise actively involved stakeholders in all stages of the design process, harnessing local tacit knowledge in relation to communication design, stimulating reflection upon what is special about the places, and consequently reinforcing a sense of belonging and the environmental and cultural conservation of place. The achieved results reflect the involvement and ownership of the community towards the design process. However, the application of a collaborative brand design methodology produced more than just a destination brand that is attractive to visitors, in line with local values, ways of living and the environment. It helped to catalyse a social network around tourism, triggering self-organising activity amongst stakeholders, who started to liaise with each other around the emergent regional identity - represented by the new brand they created together. The Waterfall Way branding process is a good example of social construction of shared understanding in and through design, showing that design exercises can have a significant social impact not only on the final product, but also on the realities of people involved in the process.

Sustainable futures : the new design landscape

Design talks LOUDLY!!! Is a series of interactive presentations exploring issues and opportunities involving professional design. These seminars are organised by the Industrial Design Network Queensland (IDnetQLD) in coordination with the Design Institute of Australia (DIA). This event was held at the State Library of Queensland (SLQ) with invited public presentations by a panel of industry experts from Brisbane City Council, Sims Recycling Solutions and BEST Futures. The second seminar "Sustainable Futures: The New Design Landscape" highlighted to design professionals the positive effect the design industry can achieve in moving towards a sustainable future. A series of presentations from specialist speakers outlined the new generation of design and how design can surf the sustainable shift. A product’s journey from concept to creation and a life beyond was presented and discussed as a basis of designing for sustainability. The intent of the seminar was to inject a brand new sense of purpose into the design world through inspiring designers to find solutions which move forward into this new sustainable landscape.

Participatory design for technological disruption within the agricultural sector

Agricultural adoption of innovation has traditionally been described as slow to diffuse. This paper therefore describes a case study grounded in PD to address a disruptive technology/system within the livestock industry. Results of the process were positive, as active engagement of stakeholders returned rich data. The contribution of the work is also presented as grounds for further design research in the livestock industry.

Xiamen Hai Cang tourism project : landscape planning and design of five islands

International practice-led design research in landscape architecture has identified the need for addressing the loss of biodiversity in urban environments. China has lost much of its biodiversity in rural and urban environments over thousands of years. However some Chinese cities have attempted to conserve what remains and enhance existing vegetation communities in isolated pockets. Island biogeography has been used as the basis for planning and designing landscapes in Australia and North America but not as yet in China, as far as we know. A gap in landscape design knowledge exists regarding how to apply landscape ecology concepts to urban islands of remaining biodiversity being developed for heavy Chinese domestic tourism impacts in the future. This project responded to the demands for harbour-side tourism opportunities in Xiamen City, Fujian Province, by proposing a range of eco-design innovations using concepts of patch, edge and interior to interconnect people and nature in a Chinese setting.

A generative nervous system for the planet

Generative systems are now being proposed for addressing major ecological problems. The Complex Urban Systems Project (CUSP) founded in 2008 at the Queensland University of Technology, emphasises the ecological significance of the generative global networking of urban environments. It argues that the natural planetary systems for balancing global ecology are no longer able to respond sufficiently rapidly to the ecological damage caused by humankind and by dense urban conurbations in particular as evidenced by impacts such as climate change. The proposal of this research project is to provide a high speed generative nervous system for the planet by connecting major cities globally to interact directly with natural ecosystems to engender rapid ecological response. This would be achieved by active interactions of the global urban network with the natural ecosystem in the ecological principle of entropy. The key goal is to achieve ecologically positive cities by activating self-organising cities capable of full integration into natural eco-systems and to netowork the cities globally to provide the planet with a nervous system.

House as home : emotions centred design for disability

In this paper we highlight how current approaches to design for disability have failed to consider the emotional needs not only of those with disabilities but their families and other carers as well. In conjunction with this, we demonstrate through a review of literature the significance of the house, the home and home in the support and growth of the person as a whole in association with their loved ones, and the potential inequity that arises when the emotional and holistic dimensions of 'being' are neglected. With a growing trend nationally and internationally away from group and shared housing, a greater focus on the family and their home is required. However, as research has shown, home for families where a family member has a disability is not necessarily a positive experience; it can be a source of stress, work, conflict and burden, arousing emotions ranging from loss of control through guilt. As proposed in the paper, consideration of the negative as well as positive emotions demands exploration of the 'middle ground' between institutions and home-based care models. This paper outlines the beginning of one such exploration.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

Visceral hedonic rhetoric : exploring the design of interactive products

Blurb: This empirical study analysed consumer emotional responses towards interactive products, specifically looking at properties that persuasively induce the pursuit of pleasure at an instinctual level of cognition, now known as ‘visceral hedonic rhetoric'. By analysing three different types of interactive products results found hierarchical and inter-relatable attributes with the potential to provide a positive consumer-product relationship that is more meaningful, less disposable and more sustainable in the future.

The subtropical residential tower: An investigation by Design Charrette

QUT's Centre for Subtropical Design (CSD) partnered with a major developer to bring together some of Brisbane’s most experienced and creative architects and designers in a two-day intensive design charrette to propose innovative design strategies for naturally-ventilated high rise residential buildings. An inner-urban renewal site in Queensland’s capital city Brisbane gave four multi-disciplinary teams the opportunity to address a raft of issues that developers and consultants will confront more and more in the future in warm humid climates. The quest to release apartment dwellers from dependence on energy-hungry air-conditioning and artificial lighting was central to the design brief for the towers. Mentored by Richard Hassell of WOHA, the creative teams focussed on climate-responsive design principles for passive climate control including orientation, cross-ventilation and outdoor living in order to reduce greenhouse gas emissions and offset occupants’ rising energy costs. This article discusses how outcomes of the charrette take their cue from the city’s subtropical climate and demonstrate how high-density high-rise living can be attractive, affordable and sustainable through positive engagement with the subtropical climate’s natural attributes.

QUT Design Lecture Series

The QUT Design Lecture Series 2010 was a partnered event between QUT School of Design and the State Library of Queensland. The series, spanning from July to September 2010, involved 10 lectures delivered by international, national and local academics, researchers and practitioners. The QUT Design Lecture series 2010 was a public event which examined the cross over between design, digital technologies and artistic practices focusing upon research themes of intangible media, experimental eco-technologies and artistic-design production. Gold Medal Australian Institute of Architects, Clare Design opened the series, whilst internationally awarded and recognised Spanish design group Cloud 9 concluded the series, both focusing on new eco-technologies in the development of contemporary architecture.