Cost-effectiveness of a telephone-delivered intervention for physical activity and diet

Background: Given escalating rates of chronic disease, broad-reach and cost-effective interventions to increase physical activity and improve dietary intake are needed. The cost-effectiveness of a Telephone Counselling intervention to improve physical activity and diet, targeting adults with established chronic diseases in a low socio-economic area of a major Australian city was examined. Methodology/Principal Findings: A cost-effectiveness modelling study using data collected between February 2005 and November 2007 from a cluster-randomised trial that compared Telephone Counselling with a “Usual Care” (brief intervention) alternative. Economic outcomes were assessed using a state-transition Markov model, which predicted the progress of participants through five health states relating to physical activity and dietary improvement, for ten years after recruitment. The costs and health benefits of Telephone Counselling, Usual Care and an existing practice (Real Control) group were compared. Telephone Counselling compared to Usual Care was not cost-effective ($78,489 per quality adjusted life year gained). However, the Usual Care group did not represent existing practice and is not a useful comparator for decision making. Comparing Telephone Counselling outcomes to existing practice (Real Control), the intervention was found to be cost-effective ($29,375 per quality adjusted life year gained). Usual Care (brief intervention) compared to existing practice (Real Control) was also cost-effective ($12,153 per quality adjusted life year gained). Conclusions/Significance: This modelling study shows that a decision to adopt a Telephone Counselling program over existing practice (Real Control) is likely to be cost-effective. Choosing the ‘Usual Care’ brief intervention over existing practice (Real Control) shows a lower cost per quality adjusted life year, but the lack of supporting evidence for efficacy or sustainability is an important consideration for decision makers. The economics of behavioural approaches to improving health must be made explicit if decision makers are to be convinced that allocating resources toward such programs is worthwhile.

A pilot randomised control trial of general practitioner and exercise physiologist interventions to reduce primary cardiovascular risk in overweight patients [Abstract]

Aims & Rationale/Objectives: With the knowledge that overweight is a major public health concern in Australia, that a multidisciplinary team approach to the management of lifestyle-related conditions is supported, and that the Australian Government recently recognised the role of the exercise physiologist (EP) in reducing the health burden of disease by their inclusion for reimbursement under the Medicare Plus scheme, this study sought to undertake a pilot RCT to compare GP and EP interventions to reduce primary cardiovascular risk in the overweight general practice population. Methods and Measures: Overweight patients recruited by a convenience sample of GPs were randomised into one of three arms: the control group, or the GP or EP intervention group (in which patients received either five GP or five EP consultations over 24 weeks). Patients had baseline, 12- and 24-week measures of body composition and cardio-respiratory fitness, and completed baseline and end-of-study surveys, fasting lipids and glucose. GPs and EPs completed an end-of-study survey. Results:Sixty-seven patients attended the baseline assessment. Overall retention rate was 67%. Patients were generally satisfied with the effectiveness of the interventions and their weight reduction. Favourable trends in BMI, weight, glucose and exercise levels for GP and EP intervention groups and in physical activity levels for all groups Conclusions: This study supports the feasibility of a RCT of GP and EP interventions for decreasing primary cardiovascular risk in the overweight general practice population.

What works elsewhere? A review of physical activity intervention studies

Obesity and type 2 diabetes mellitus (T2D) have reached epidemic proportions in many parts of the world with numbers projected to rise dramatically in coming decades (Wang and Lobstein, 2006; Zaninotto et al., 2006). In Australia, and consistent with much of the developed world, the problem has been described as a ‘juggernaut’ that is out of control (Zimmet and James, 2007). Unfortunately the burgeoning problem of non-communicable diseases, including obesity and T2D, is also impacting developing nations as populations are undergoing a nutrition transition (Caballero, 2005). The increased prevalence of overweight and obesity in children, adolescents and adults in both the developed and developing world is consistent with reductions in all forms of physical activity (Brownson et al., 2005). This brief paper provides an overview of the importance of physical activity and an outline of physical activity intervention studies with particular reference to the growing years. As many interventions studies involving physical activity have been undertaken in the context of childhood obesity prevention (Lobstein et al., 2004), and an increasing proportion of the childhood population is overweight or obese, this is a major focus of discussion.

Men's intimate partner abuse and control : reconciling paradoxical masculinities and social contradictions

Intimate partner abuse and control is one of the most common forms of violence against women, and is considered an international problem of social, political, legal and human rights significance. Yet few studies have attempted to understand this problem from the perspective of male perpetrators. This gap is addressed by conducting in-depth interviews with 16 able-bodied men of white European ancestry born and educated in New Zealand or Australia, who have been physically violent and/or emotionally, intellectually, sexually or financially controlling of a live-in female partner. This thesis extends and deepens the dominant ways of thinking about men’s intimate partner abuse by utilising a new theoretical framework compatible with contemporary feminist scholarship. A synthesis of Connell’s theory of masculinities and Bourdieu’s field theory is utilised for the purpose of exploring more nuanced, complex understandings of manliness and men’s relationships with men, women and social structures. Through such an analysis, this thesis finds that men’s perpetration of power and control over women is driven by a need to avoid the stigma of appearing weak. As a consequence, their desire and ability to show love, care and empathy is suppressed in favour of a presumed honourable manliness, and their female partners are used as weapons in the pursuit of symbolic capital in the form of recognition, prestige and acceptance from real and/or imagined men. This research also uncovers the complex interplay between masculine practices and particular social contexts. For example, the norms of practice encountered from those in authority, such as teachers, sports coaches, police, court judges and workplace management, influences the decision making of the men in this study, to use, or not to use, physical violence, psychological abuse and structural control. The principal conclusion is that there is a repertoire of paradoxical masculinities and contradictory social messages available to the men in this study. But gender policing by other men, complicit women and those in authority provides little room for legitimate complexity in masculine practices. Perpetrators in this study reconcile these conflicts of interest by generally avoiding subordinated masculinity and possible ostracism, and instead practicing more heroic hegemonic masculinities by abusing and controlling women and particular other men. This thesis concludes that for intimate partner abuse and control to cease, changes in power structures have to occur at all levels of society.

Control issues for velocity sourced Series Elastic Actuators

The Series Elasic Actuator has been proposed as a method for providing safe force or torque based acutation for robots that interact with humans. In this paper we look at some outstanding issues in the implementation and control of Series Elastic Actuators. The study addresses issues in making the Series Elastic Actuator respond effectively in the presence of physical difficulties such as restriction, using a computation efficient controller. The improvement over previous implementations is achieved by treating the motor as a velocity source to the elastic element, rather than as a torque source.

Physical and environmental determinants

This chapter describes physical and environmental determinants of the health of Australians, providing a background to the development of successful public health activity. Health determinants are the biomedical, genetic, behavioural, socio-economic and environmental factors that impact on health and wellbeing. These determinants can be influenced by interventions and by resources and systems (AIHW 2006). Many factors combine to affect the health of individuals and communities. People’s circumstances and the environment determine whether the population is healthy or not. Factors such as where people live, the state of their environment, genetics, their education level and income, and their relationships with friends and family, all are likely to impact on their health. The determinants of population health reflect the context of people’s lives; however, people are very unlikely to be able to control many of these determinants (WHO 2007). This chapter and Chapter 6 illustrate how various determinants can relate to, and influence other determinants, as well as health and wellbeing. We believe it is particularly important to provide an understanding of determinants and their relationship to health and illness in order to provide a structure in which a broader conceptualisation of health can be placed. Determinants of health do not exist in isolation from one another. More frequently they work together in a complex system. What is clear to anyone who works in public health is that many factors impact on the health and wellbeing of people. For example, in the next chapter we discuss factors such as living and working conditions, social support, ethnicity and class, income, housing, work stress and the impact of education on the length and quality of people’s lives. In 1974, the influential ‘Lalonde Report’ (Lalonde 1974) described key factors that impact on health status. These factors included lifestyle, environment, human biology and health services. Taking a population health approach builds on the Lalonde Report, and recognises that a range of factors, such as living and working conditions and the distribution of wealth in society, interact to determine the health status of a population. Tackling health determinants has great potential to reduce the burden of disease and promote the health of the general population. In summary, we understand very clearly now that health is determined by the complex interactions between individual characteristics, social and economic factors and physical environments; the entire range of factors that impact on health must be addressed if we are to make significant gains in population health, and focussing interventions on the health of the population or significant sub-populations can achieve important health gains. In 2007, the Australian Government included in the list of National Health Priority Areas the following health issues: cancer control, injury prevention and control, cardiovascular health, diabetes mellitus, mental health, asthma, and arthritis and musculoskeletal conditions. The National Health Priority Areas set the agenda for the Commonwealth, States and Territories, Local Governments and not-for-profit organisations to place attention on those areas considered to be the major foci for action. Many of these health issues are discussed in this chapter and the following chapter.

Part 1. Chemical and Physical Restraints in the Management of Mechanically Ventilated Patients in the ICU: Contributing Factors

Chemical and physical restraints are frequently used in the intensive care unit (ICU) to control agitated patients and to prevent self-harm and unplanned extubations. Published work relating to the numerous issues of the care and treatment strategies for these patients remains conflicting and unclear. Literature regarding sedation and chemical restraint reveals a trend towards management with lighter sedation, use of sedation assessment tools and sedation protocols. It remains unclear which treatment is best for agitated and delirious patients, and the evidence on the effect of sedation is conflicting. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. The purpose of this paper is to provide a summary of the existing literature on the use of physical and chemical restraints in the ICU setting. In Part 1 of this two-part paper, the evidence on chemical and physical restraints is explored with specific focus on definition of terms, unplanned

Nonlinear control of the Reaction Wheel Pendulum

In this paper we introduce the Reaction Wheel Pendulum, a novel mechanical system consisting of a physical pendulum with a rotating bob. This system has several attractive features both from a pedagogical standpoint and from a research standpoint. From a pedagogical standpoint, the dynamics are the simplest among the various pendulum experiments available so that the system can be introduced to students earlier in their education. At the same time, the system is nonlinear and underactuated so that it can be used as a benchmark experiment to study recent advanced methodologies in nonlinear control, such as feedback linearization, passivity methods, backstepping and hybrid control. In this paper we discuss two control approaches for the problems of swingup and balance, namely, feedback linearization and passivity based control. We first show that the system is locally feedback linearizable by a local diffeomorphism in state space and nonlinear feedback. We compare the feedback linearization control with a linear pole-placement control for the problem of balancing the pendulum about the inverted position. For the swingup problem we discuss an energy approach based on collocated partial feedback linearization, and passivity of the resulting zero dynamics. A hybrid/switching control strategy is used to switch between the swingup and the balance control. Experimental results are presented.

Ghrelin and obestatin concentrations during puberty: Relationships with adiposity, nutrition and physical activity

Ghrelin and obestatin are two peptides associated with appetite control and the regulation of energy balance in adults. It is intuitive that they have an important role in growth and development during puberty. Therefore, it is acknowledged that these peptides, in addition to others, form part of the substrate underlying energy homeostasis which in turn will contribute to body weight regulation and could explain changes in energy balance during puberty. Both peptides originate from the stomach; hence, it is intuitive that they are involved in generating signals from tissue stores which influence food intake. This could be manifested via alterations in the drive to eat (i.e. hunger), eating behaviors and appetite regulation. Furthermore, there is some evidence that these peptides might also be associated with physical activity behaviors and metabolism. Anecdotally, children and adolescents experience behavioral and metabolic changes during growth and development which will be associated with physiological changes.

Physical activity and regulation of food intake: current evidence

Objective: The evidence was reviewed on how physical activity could influence the regulation of food intake by either adjusting the sensitivity of appetite control mechanisms or by generating an energy deficit that could adjust the drive to eat. Design: Interventionist and correlational studies that had a significant influence on the relationship between physical activity and food intake were reviewed. Interventionist studies involve a deliberate imposition of physical activity with subsequent monitoring of the eating response. Correlational studies make use of naturally occurring differences in the levels of physical activity (between and within subjects) with simultaneous assessment of energy expenditure and intake. Subjects: Studies using lean, overweight, and obese men and women were included. Results: Only 19% of interventionist studies report an increase in energy intake after exercise; 65% show no change and 16% show a decrease in appetite. Of the correlational studies, approximately half show no relationship between energy expenditure and intake. These data indicate a rather loose coupling between energy expenditure and intake. A common sense view is that exercise is futile as a form of weight control because the energy deficit drives a compensatory increase in food intake. However, evidence shows that this is not generally true. One positive aspect of this is that raising energy expenditure through physical activity (or maintaining an active life style) can cause weight loss or prevent weight gain. A negative feature is that when people become sedentary after a period of high activity, food intake is not “down-regulated” to balance a reduced energy expenditure. Conclusion: Evidence suggests that a high level of physical activity can aid weight control either by improving the matching of food intake to energy expenditure (regulation) or by raising expenditure so that it is difficult for people to eat themselves into a positive energy balance.

Multilevel converter structure and control

In recent years, multilevel converters are becoming more popular and attractive than traditional converters in high voltage and high power applications. Multilevel converters are particularly suitable for harmonic reduction in high power applications where semiconductor devices are not able to operate at high switching frequencies or in high voltage applications where multilevel converters reduce the need to connect devices in series to achieve high switch voltage ratings. This thesis investigated two aspects of multilevel converters: structure and control. The first part of this thesis focuses on inductance between a DC supply and inverter components in order to minimise loop inductance, which causes overvoltages and stored energy losses during switching. Three dimensional finite element simulations and experimental tests have been carried out for all sections to verify theoretical developments. The major contributions of this section of the thesis are as follows: The use of a large area thin conductor sheet with a rectangular cross section separated by dielectric sheets (planar busbar) instead of circular cross section wires, contributes to a reduction of the stray inductance. A number of approximate equations exist for calculating the inductance of a rectangular conductor but an assumption was made that the current density was uniform throughout the conductors. This assumption is not valid for an inverter with a point injection of current. A mathematical analysis of a planar bus bar has been performed at low and high frequencies and the inductance and the resistance values between the two points of the planar busbar have been determined. A new physical structure for a voltage source inverter with symmetrical planar bus bar structure called Reduced Layer Planar Bus bar, is proposed in this thesis based on the current point injection theory. This new type of planar busbar minimises the variation in stray inductance for different switching states. The reduced layer planar busbar is a new innovation in planar busbars for high power inverters with minimum separation between busbars, optimum stray inductance and improved thermal performances. This type of the planar busbar is suitable for high power inverters, where the voltage source is supported by several capacitors in parallel in order to provide a low ripple DC voltage during operation. A two layer planar busbar with different materials has been analysed theoretically in order to determine the resistance of bus bars during switching. Increasing the resistance of the planar busbar can gain a damping ratio between stray inductance and capacitance and affects the performance of current loop during switching. The aim of this section is to increase the resistance of the planar bus bar at high frequencies (during switching) and without significantly increasing the planar busbar resistance at low frequency (50 Hz) using the skin effect. This contribution shows a novel structure of busbar suitable for high power applications where high resistance is required at switching times. In multilevel converters there are different loop inductances between busbars and power switches associated with different switching states. The aim of this research is to consider all combinations of the switching states for each multilevel converter topology and identify the loop inductance for each switching state. Results show that the physical layout of the busbars is very important for minimisation of the loop inductance at each switch state. Novel symmetrical busbar structures are proposed for multilevel converters with diode-clamp and flying-capacitor topologies which minimise the worst case in stray inductance for different switching states. Overshoot voltages and thermal problems are considered for each topology to optimise the planar busbar structure. In the second part of the thesis, closed loop current techniques have been investigated for single and three phase multilevel converters. The aims of this section are to investigate and propose suitable current controllers such as hysteresis and predictive techniques for multilevel converters with low harmonic distortion and switching losses. This section of the thesis can be classified into three parts as follows: An optimum space vector modulation technique for a three-phase voltage source inverter based on a minimum-loss strategy is proposed. One of the degrees of freedom for optimisation of the space vector modulation is the selection of the zero vectors in the switching sequence. This new method improves switching transitions per cycle for a given level of distortion as the zero vector does not alternate between each sector. The harmonic spectrum and weighted total harmonic distortion for these strategies are compared and results show up to 7% weighted total harmonic distortion improvement over the previous minimum-loss strategy. The concept of SVM technique is a very convenient representation of a set of three-phase voltages or currents used for current control techniques. A new hysteresis current control technique for a single-phase multilevel converter with flying-capacitor topology is developed. This technique is based on magnitude and time errors to optimise the level change of converter output voltage. This method also considers how to improve unbalanced voltages of capacitors using voltage vectors in order to minimise switching losses. Logic controls require handling a large number of switches and a Programmable Logic Device (PLD) is a natural implementation for state transition description. The simulation and experimental results describe and verify the current control technique for the converter. A novel predictive current control technique is proposed for a three-phase multilevel converter, which controls the capacitors' voltage and load current with minimum current ripple and switching losses. The advantage of this contribution is that the technique can be applied to more voltage levels without significantly changing the control circuit. The three-phase five-level inverter with a pure inductive load has been implemented to track three-phase reference currents using analogue circuits and a programmable logic device.

Fiji pre-service primary teachers' understanding of physical science : a cultural perspective

Science and technology are promoted as major contributors to national development. Consequently, improved science education has been placed high on the agenda of tasks to be tackled in many developing countries, although progress has often been limited. In fact there have been claims that the enormous investment in teaching science in developing countries has basically failed, with many reports of how efforts to teach science in developing countries often result in rote learning of strange concepts, mere copying of factual information, and a general lack of understanding on the part of local students. These generalisations can be applied to science education in Fiji. Muralidhar (1989) has described a situation in which upper primary and middle school students in Fiji were given little opportunity to engage in practical work; an extremely didactic form of teacher exposition was the predominant method of instruction during science lessons. He concluded that amongst other things, teachers' limited understanding, particularly of aspects of physical science, resulted in their rigid adherence to the text book or the omission of certain activities or topics. Although many of the problems associated with science education in developing countries have been documented, few attempts have been made to understand how non-Western students might better learn science. This study addresses the issue of Fiji pre-service primary teachers' understanding of a key aspect of physical science, namely, matter and how it changes, and their responses to learning experiences based on a constructivist epistemology. Initial interviews were used to probe pre-service primary teachers' understanding of this domain of science. The data were analysed to identify students' alternative and scientific conceptions. These conceptions were then used to construct Concept Profile Inventories (CPI) which allowed for qualitative comparison of the concepts of the two ethnic groups who took part in the study. This phase of the study also provided some insight into the interaction of scientific information and traditional beliefs in non-Western societies. A quantitative comparison of the groups' conceptions was conducted using a Science Concept Survey instrument developed from the CPis. These data provided considerable insight into the aspects of matter where the pre-service teachers' understanding was particularly weak. On the basis of these preliminary findings, a six-week teaching program aimed at improving the students' understanding of matter was implemented in an experimental design with a group of students. The intervention involved elements of pedagogy such as the use of analogies and concept maps which were novel to most of those who took part. At the conclusion of the teaching programme, the learning outcomes of the experimental group were compared with those of a control group taught in a more traditional manner. These outcomes were assessed quantitatively by means of pre- and post-tests and a delayed post-test, and qualitatively using an interview protocol. The students' views on the various teaching strategies used with the experimental group were also sought. The findings indicate that in the domain of matter little variation exists in the alternative conceptions held by Fijian and Indian students suggesting that cultural influences may be minimal in their construction. Furthermore, the teaching strategies implemented with the experimental group of students, although largely derived from Western research, showed considerable promise in the context of Fiji, where they appeared to be effective in improving the understanding of students from different cultural backgrounds. These outcomes may be of significance to those involved in teacher education and curriculum development in other developing countries.

Vector control of a high power induction machine

The design and implementation of a high-power (2 MW peak) vector control drive is described. The inverter switching frequency is low, resulting in high-harmonic-content current waveforms. A block diagram of the physical system is given, and each component is described in some detail. The problem of commanded slip noise sensitivity, inherent in high-power vector control drives, is discussed, and a solution is proposed. Results are given which demonstrate the successful functioning of the system

Identifying key belief-based targets for promoting regular physical activity among mothers and fathers with young children

We investigated the key beliefs to target in interventions aimed at increasing physical activity (PA) among mothers and fathers of young children. Parents (288 mothers and 292 fathers) completed a Theory of Planned Behaviour belief-based questionnaire and a 1-week follow-up of PA behaviour. We found that a range of behavioural, normative, and control beliefs were significantly correlated with parents’ PA intentions and behaviour, with only a few differences observed in correlations between PA beliefs and intention and behaviour by gender. A range of key beliefs was identified as making independent contributions to parents’ PA intentions; however, the behavioural beliefs about improving parenting practices (β = 0.13), interfering with other commitments (β = −0.29); normative beliefs about people I exercise with (β = 0.20); and control beliefs about lack of time (β = −0.24), inconvenience (β = −0.14), lack of motivation (β = −0.34), were revealed as significant independent predictors of actual PA behaviour. Furthermore, we found that a limited amount of parents already hold these beliefs, suggesting that these key beliefs warrant changing and, therefore, are appropriate targets for subsequent intervention. The current study fills an empirical gap in the PA literature by investigating an at-risk group and using a well established theoretical framework to identify key beliefs that guide parents’ PA decision-making. Overall, we found support for parents being a unique group who hold distinctive behavioural, normative, and control beliefs toward PA. Attention to these key underlying beliefs will assist intervention work aimed at combating inactivity among this at-risk population.

An overview of physical growth and maturation

An understanding of physical growth and maturation is relevant to many disciplines, including exercise and sport science, anthropology, human biology, medicine, psychology and education. Growth and maturation is governed by a complex interaction between genetic and environmental factors. There is increasing evidence that physical activity plays an important role in normal growth, development, health and well-being of children and youth, however, caution is required in the activity setting so that growth and maturation is not jeopardised. To appreciate the impact of physical activity and/or exercise on growth and maturation, a thorough understanding of the general principles of auxology is useful. Following an introduction to terminology, an overview of physical growth and development is provided in the context of morphological changes. Detailed information is provided regarding individual variability in growth and development along with sexual dimorphism. A small degree of sexual dimorphism exists at birth however striking differences develop during the pubertal years. Sexual dimorphism in body composition is largely regulated by endocrine factors with critical roles played by growth hormone and gonadal steroids.