Feeding a baby (FAB) study. Reducing childhood obesity : influencing parental infant feeding practices

Background National and international rates of obesity are escalating, and programs to modify established eating habits are having limited success. Almost one in four 2-4 year old Australian children are overweight or obese. Interventions to prevent obesity in early childhood are on the rise. However, recruitment and retention issues and outcomes to date suggests a gap in meeting participant needs. Parents need both the knowledge and skills to establish behaviours that enable children to develop healthy food preferences and eating habits early. AIM To develop intervention recommendations to reduce childhood obesity by improving the infant feeding practices of parents, focusing on the transition from a milk diet to family foods.

Destination Brand Performance Measurement Over Time

With increasing investments being made in brand development by destination marketing organisations (DMO) since the 1990s, including rebranding and repositioning, more research is necessary to enhance understanding of how to effectively monitor destination brand performance over time. This chapter summarises key findings from a study of brand performance of a competitive set of destinations, in their most important market, between 2003 and 2012. Brand performance was measured from the perspective of consumer perceptions, based on the concept of consumer-based brand equity (CBBE). The results indicated almost no change in perceptions of the five destinations over the 10-year period. Due to the commonality of challenges faced by DMOs worldwide, it is suggested the CBBE hierarchy provides destination marketers with a practical tool for evaluating brand performance over time; in terms of measures of effectiveness of past marketing communications, as well as indicators of future performance.

Clinical trials in pediatrics

“Children are not little adults.” Almost all aspects of children's health including clinical trials and drug development are poor cousins of adult health. Over the years, pediatricians worldwide caution against blind extrapolation of adult data to children as it may result in considerable harm [1,2]. Also, it is increasingly recognized that the roots of many chronic diseases in adulthood stem from childhood and tackling health issues in children lead to improved health in adults [3,4]. Furthermore, investment in early childhood has long-term benefits in adults not only in health but also in other aspects of life such as education and crime reduction [4,5]. Arguably, health at birth is the single most important predictor of health in adulthood as the inequality of an infant at birth has intergenerational effects [5]. The Carolina Abecedarian Project showed that early childhood programs that are of high quality result in substantial societal benefits (e.g., reduction of crime, increased earnings, better education) [4,5]. A recent publication from this project found that this benefit also translated into improved adult health outcomes [4]. In a randomized trial, Campbell and colleagues described that disadvantaged children who were randomized to the intervention group (early education, health screenings and nutrition program) had significantly lower rates of metabolic syndrome, obesity and hypertension, when aged in their mid-30s, compared with the control group [4]...

'Bacon - hold the eggs' for uncontrollable nose bleeds

Almost everyone experiences a nosebleed at some time during their lives. In many cases, these nosebleeds are self-limiting, resolve without medical attention, and tend to be nothing more than a minor nuisance. However, in some instances they can be life threatening and urgent medical attention is required. One of these instances is when people who have Glanzmann's thrombasthenia (GT) experience a nosebleed...

Defining a ‘democratic elite’ : key media in the battle for social responsibility

This paper offers a definition of elite media arguing their content focus will sufficiently meet social responsibility needs of democracy. Its assumptions come from the Finkelstein and Leveson Inquiries and regulatory British Royal Charter (2013). These provide guidelines on how media outlets meet ‘social responsibility’ standards, e.g. press has a ‘responsibility to be fair and accurate’ (Finkelstein); ethical press will feel a responsibility to ‘hold power to account’ (Leveson); news media ‘will be held strictly accountable’ (RC). The paper invokes the British principle of media opting-in to observe standards, and so serve the democracy. It will give examples from existing media, and consider social responsibility of media more generally. Obvious cases of ‘quality’ media: public broadcasters, e.g. BBC, Al-Jazeera, and ‘quality’ press, e.g. NYT, Süddeutscher Zeitung, but also community broadcasters, specialised magazines, news agencies, distinctive web logs, and others. Where providing commentary, these abjure gratuitous opinion -- meeting a standard of reasoned, informational and fair. Funding is almost a definer, many such services supported by the state, private trusts, public institutions or volunteering by staff. Literature supporting discussion on elite media will include their identity as primarily committed to a public good, e.g. the ‘Public Value Test’, Moe and Donders (2011); with reference also to recent literature on developing public service media. Within its limits the paper will treat social media as participants among all media, including elite, and as a parallel dimension of mass communication founded on inter-activity. Elite media will fulfil the need for social responsibility, firstly by providing one space, a ‘plenary’ for debate. Second is the notion of building public recognition of elite media as trustworthy. Third is the fact that elite media together are a large sector with resources to sustain social cohesion and debate; notwithstanding pressure on funds, and impacts of digital transformation undermining employment in media more than in most industries.

A sweet promise among Malaysians [Letter to the Editor]

The prevalence of diabetes in Malaysia has increased by almost twofold indicating that for every six Malaysians older than 30, one is diabetic.1 In Malaysia, diabetes is reportedly most common among persons of Indian descent followed by the Malays and Chinese...

Solar Assisted Fast Pyrolysis: A Novel Approach of Renewable Energy Production

Biofuel produced by fast pyrolysis from biomass is a promising candidate. The heart of the system is a reactor which is directly or indirectly heated to approximately 500°C by exhaust gases from a combustor that burns pyrolysis gas and some of the by-product char. In most of the cases, external biomass heater is used as heating source of the system while internal electrical heating is recently implemented as source of reactor heating. However, this heating system causes biomass or other conventional forms of fuel consumption to produce renewable energy and contributes to environmental pollution. In order to overcome these, the feasibility of incorporating solar energy with fast pyrolysis has been investigated. The main advantages of solar reactor heating include renewable source of energy, comparatively simpler devices, and no environmental pollution. A lab scale pyrolysis setup has been examined along with 1.2 m diameter parabolic reflector concentrator that provides hot exhaust gas up to 162°C. The study shows that about 32.4% carbon dioxide (CO2) emissions and almost one-third portion of fuel cost are reduced by incorporating solar heating system. Successful implementation of this proposed solar assisted pyrolysis would open a prospective window of renewable energy.

Anatomical specializations for enhanced olfactory sensitivity in kiwi, Apteryx mantelli

The ability to function in a nocturnal and ground-dwelling niche requires a unique set of sensory specializations. The New Zealand kiwi has shifted away from vision, instead relying on auditory and tactile stimuli to function in its environment and locate prey. Behavioral evidence suggests that kiwi also rely on their sense of smell, using olfactory cues in foraging and possibly also in communication and social interactions. Anatomical studies appear to support these observations: the olfactory bulbs and tubercles have been suggested to be large in the kiwi relative to other birds, although the extent of this enlargement is poorly understood. In this study, we examine the size of the olfactory bulbs in kiwi and compare them with 55 other bird species, including emus, ostriches, rheas, tinamous, and 2 extinct species of moa (Dinornithiformes). We also examine the cytoarchitecture of the olfactory bulbs and olfactory epithelium to determine if any neural specializations beyond size are present that would increase olfactory acuity. Kiwi were a clear outlier in our analysis, with olfactory bulbs that are proportionately larger than those of any other bird in this study. Emus, close relatives of the kiwi, also had a relative enlargement of the olfactory bulbs, possibly supporting a phylogenetic link to well-developed olfaction. The olfactory bulbs in kiwi are almost in direct contact with the olfactory epithelium, which is indeed well developed and complex, with olfactory receptor cells occupying a large percentage of the epithelium. The anatomy of the kiwi olfactory system supports an enhancement for olfactory sensitivities, which is undoubtedly associated with their unique nocturnal niche.

Echolocation call intensity in the aerial hawking bat Eptesicus bottae (Vespertilionidae) studied using stereo videogrammetry

Aerial hawking bats use intense echolocation calls to search for insect prey. Their calls have evolved into the most intense airborne animal vocalisations. Yet our knowledge about call intensities in the field is restricted to a small number of species. We describe a novel stereo videogrammetry method used to study flight and echolocation behaviour, and to measure call source levels of the aerial hawking bat Eptesicus bottae (Vespertilionidae). Bats flew close to their predicted minimum power speed. Source level increased with call duration; the loudest call of E. bottae was at 133 dB peSPL. The calculated maximum detection distance for large flying objects (e.g. large prey, conspecifics) was up to 21 m. The corresponding maximum echo delay is almost exactly the duration of one wing beat in E. bottae and this also is its preferred pulse interval. These results, obtained by using videogrammetry to track bats in the field, corroborate earlier findings from other species from acoustic tracking methods.

The contribution of major depression to the global burden of ischemic heart disease : a comparative risk assessment

Background Cardiovascular disease and mental health both hold enormous public health importance, both ranking highly in results of the recent Global Burden of Disease Study 2010 (GBD 2010). For the first time, the GBD 2010 has systematically and quantitatively assessed major depression as an independent risk factor for the development of ischemic heart disease (IHD) using comparative risk assessment methodology. Methods A pooled relative risk (RR) was calculated from studies identified through a systematic review with strict inclusion criteria designed to provide evidence of independent risk factor status. Accepted case definitions of depression include diagnosis by a clinician or by non-clinician raters adhering to Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) classifications. We therefore refer to the exposure in this paper as major depression as opposed to the DSM-IV category of major depressive disorder (MDD). The population attributable fraction (PAF) was calculated using the pooled RR estimate. Attributable burden was calculated by multiplying the PAF by the underlying burden of IHD estimated as part of GBD 2010. Results The pooled relative risk of developing IHD in those with major depression was 1.56 (95% CI 1.30 to 1.87). Globally there were almost 4 million estimated IHD disability-adjusted life years (DALYs), which can be attributed to major depression in 2010; 3.5 million years of life lost and 250,000 years of life lived with a disability. These findings highlight a previously underestimated mortality component of the burden of major depression. As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010. Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest. Conclusions The present work comprises the most robust systematic review of its kind to date. The key finding that major depression may be responsible for approximately 3% of global IHD DALYs warrants assessment for depression in patients at high risk of developing IHD or at risk of a repeat IHD event.

Burden of depressive disorders by country, sex, age, and year : findings from the Global Burden of Disease Study 2010

Background Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD) 1990 and 2000 studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions, burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease. Methods and Findings Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders.Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%-10.8%) of global YLDs and dysthymia for 1.4% (0.9%-2.0%). Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%-3.2%) of global DALYs and dysthymia for 0.5% (0.3%-0.6%). There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%-3.8%) to 3.8% (3.0%-4.7%) of global DALYs. Conclusions GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing cost-effective interventions to reduce its burden.Please see later in the article for the Editors' Summary.

Comparison of eight published lumbar spine finite element models

Due to its ability to represent intricate systems with material nonlinearities as well as irregular loading, boundary, geometrical and material domains, the finite element (FE) method has been recognized as an important computational tool in spinal biomechanics. Current FE models generally account for a single distinct spinal geometry with one set of material properties despite inherently large inter-subject variability. The uncertainty and high variability in tissue material properties, geometry, loading and boundary conditions has cast doubt on the reliability of their predictions and comparability with reported in vitro and in vivo values. A multicenter study was undertaken to compare the results of eight well-established models of the lumbar spine that have been developed, validated and applied for many years. Models were subjected to pure and combined loading modes and their predictions were compared to in vitro and in vivo measurements for intervertebral rotations, disc pressures and facet joint forces. Under pure moment loading, the predicted L1-5 rotations of almost all models fell within the reported in vitro ranges; their median values differed on average by only 2° for flexion-extension, 1° for lateral bending and 5° for axial rotation. Predicted median facet joint forces and disc pressures were also in good agreement with previously published median in vitro values. However, the ranges of predictions were larger and exceeded the in vitro ranges, especially for facet joint forces. For all combined loading modes, except for flexion, predicted median segmental intervertebral rotations and disc pressures were in good agreement with in vivo values. The simulations yielded median facet joint forces of 0 N in flexion, 38 N in extension, 14 N in lateral bending and 60 N in axial rotation that could not be validated due to the paucity of in vivo facet joint forces. In light of high inter-subject variability, one must be cautious when generalizing predictions obtained from one deterministic model. This study demonstrates however that the predictive power increases when FE models are combined together. The median of individual numerical results can hence be used as an improved tool in order to estimate the response of the lumbar spine.

Community wide interventions for increasing physical activity

Background Multi-strategic community wide interventions for physical activity are increasingly popular but their ability to achieve population level improvements is unknown. Objectives To evaluate the effects of community wide, multi-strategic interventions upon population levels of physical activity. Search methods We searched the Cochrane Public Health Group Segment of the Cochrane Register of Studies,The Cochrane Library, MEDLINE, MEDLINE in Process, EMBASE, CINAHL, LILACS, PsycINFO, ASSIA, the British Nursing Index, Chinese CNKI databases, EPPI Centre (DoPHER, TRoPHI), ERIC, HMIC, Sociological Abstracts, SPORTDiscus, Transport Database and Web of Science (Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index). We also scanned websites of the EU Platform on Diet, Physical Activity and Health; Health-Evidence.org; the International Union for Health Promotion and Education; the NIHR Coordinating Centre for Health Technology (NCCHTA); the US Centre for Disease Control and Prevention (CDC) and NICE and SIGN guidelines. Reference lists of all relevant systematic reviews, guidelines and primary studies were searched and we contacted experts in the field. The searches were updated to 16 January 2014, unrestricted by language or publication status. Selection criteria Cluster randomised controlled trials, randomised controlled trials, quasi-experimental designs which used a control population for comparison, interrupted time-series studies, and prospective controlled cohort studies were included. Only studies with a minimum six-month follow up from the start of the intervention to measurement of outcomes were included. Community wide interventions had to comprise at least two broad strategies aimed at physical activity for the whole population. Studies which randomised individuals from the same community were excluded. Data collection and analysis At least two review authors independently extracted the data and assessed the risk of bias. Each study was assessed for the setting, the number of included components and their intensity. The primary outcome measures were grouped according to whether they were dichotomous (per cent physically active, per cent physically active during leisure time, and per cent physically inactive) or continuous (leisure time physical activity time (time spent)), walking (time spent), energy expenditure (as metabolic equivalents or METS)). For dichotomous measures we calculated the unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. For continuous measures we calculated percentage change from baseline, unadjusted and adjusted. Main results After the selection process had been completed, 33 studies were included. A total of 267 communities were included in the review (populations between 500 and 1.9 million). Of the included studies, 25 were set in high income countries and eight were in low income countries. The interventions varied by the number of strategies included and their intensity. Almost all of the interventions included a component of building partnerships with local governments or non-governmental organisations (NGOs) (29 studies). None of the studies provided results by socio-economic disadvantage or other markers of equity. However, of those included studies undertaken in high income countries, 14 studies were described as being provided to deprived, disadvantaged or low socio-economic communities. Nineteen studies were identified as having a high risk of bias, 10 studies were unclear, and four studies had a low risk of bias. Selection bias was a major concern with these studies, with only five studies using randomisation to allocate communities. Four studies were judged as being at low risk of selection bias although 19 studies were considered to have an unclear risk of bias. Twelve studies had a high risk of detection bias, 13 an unclear risk and four a low risk of bias. Generally, the better designed studies showed no improvement in the primary outcome measure of physical activity at a population level. All four of the newly included, and judged to be at low risk of bias, studies (conducted in Japan, United Kingdom and USA) used randomisation to allocate the intervention to the communities. Three studies used a cluster randomised design and one study used a stepped wedge design. The approach to measuring the primary outcome of physical activity was better in these four studies than in many of the earlier studies. One study obtained objective population representative measurements of physical activity by accelerometers, while the remaining three low-risk studies used validated self-reported measures. The study using accelerometry, conducted in low income, high crime communities of USA, emphasised social marketing, partnership with police and environmental improvements. No change in the seven-day average daily minutes of moderate to vigorous physical activity was observed during the two years of operation. Some program level effect was observed with more people walking in the intervention community, however this result was not evident in the whole community. Similarly, the two studies conducted in the United Kingdom (one in rural villages and the other in urban London; both using communication, partnership and environmental strategies) found no improvement in the mean levels of energy expenditure per person per week, measured from one to four years from baseline. None of the three low risk studies reporting a dichotomous outcome of physical activity found improvements associated with the intervention. Overall, there was a noticeable absence of reporting of benefit in physical activity for community wide interventions in the included studies. However, as a group, the interventions undertaken in China appeared to have the greatest possibility of success with high participation rates reported. Reporting bias was evident with two studies failing to report physical activity measured at follow up. No adverse events were reported.The data pertaining to cost and sustainability of the interventions were limited and varied. Authors' conclusions Although numerous studies have been undertaken, there is a noticeable inconsistency of the findings in the available studies and this is confounded by serious methodological issues within the included studies. The body of evidence in this review does not support the hypothesis that the multi-component community wide interventions studied effectively increased physical activity for the population, although some studies with environmental components observed more people walking. Plain language summary Community wide interventions for increasing physical activity Not having enough physical activity leads to poorer health. Regular physical activity can reduce the risk of chronic disease and improve one's health and wellbeing. The lack of physical activity is a common and in some cases a growing health problem. To address this, 33 studies have used improvement activities directed at communities, using more than one approach in a single program. When we first looked at the available research in 2011 we observed that there was a lack of good studies which could show whether this approach was beneficial or not. Some studies claimed that community wide programs improved physical activities and other studies did not. In this update we found four new studies that were of good quality; however none of these four studies increased physical activity levels for the population. Some studies reported program level effects such as observing more people walking, however the population level of physical activity had not increased. This review found that community wide interventions are very difficult to undertake, and it appears that they usually fail to provide a measurable benefit in physical activity for a population. It is apparent that many of the interventions failed to reach a substantial portion of the community, and we speculate that some single strategies included in the combination may lack individual effectiveness. Laički sažetak Intervencije u zajednici za povećanje tjelesne aktivnosti Nedostatna tjelesna aktivnost povezana je s lošijim zdravljem.Redovita tjelesna aktivnost može umanjiti rizik od kroničnih bolesti te poboljšati zdravlje i kvalitetu života pojedinca.Manjak tjelesne aktivnosti čest je problem, a učestalost tog problema se povećava.Cochrane sustavni pregled je analizirao 33 studije koje su istražile programe za povećanje tjelesne aktivnosti u zajednici, u kojima se koristilo više od jednog pristupa.Kad su prvi put pregledani dokazi iz istraživanja koja su bila dostupna 2011. godine, utvrđeno je da nema dovoljno dobrih studija koje bi mogle pokazati je li takav pristup koristan ili ne.Primjerice, neke studije tvrde da programi za povećanje tjelesne aktivnosti u zajednici poboljšavaju tjelesnu aktivnost pojedinaca u zajednici, a druge studije tvrde suprotno.U ovom obnovljenom sustavnom pregledu pronađene su 4 nove studije koje su bile visoke kvalitete, ail nijedna od tih studija nije pokazala da je istraživana intervencija dovela do povećanja tjelesne aktivnosti u zajednici.Neke su studije opisale učinak na način da je opisano da je uočeno da više ljudi u zajednici hoda, međutim, ukupna razina tjelesne aktivnosti u promatranoj populaciji nije se povećala.Ovaj sustavni pregled je utvrdio da je intervencije za povećanje tjelesne aktivnosti u zajednici teško provesti i čini se da one obično ne uspijevaju u svojoj namjeri da na mjerljiv način povećaju tjelesnu aktivnost u populaciji.Čini se da mnoge intervencije nisu uspjele doseći veći broj stanovnika u zajednici pa se može smatrati da neke od strategija uključene u analizirane kombinacije nisu zasebno učinkovite.

All Anglos are alike? A study of whinging Poms and bloody-minded Aussies

Cross-cultural service research is an important topic with a rich array of empirical evidence for differences in customer perceptions, attitudes and behaviours. However, the extant literature is almost exclusively focused on differences between cultures at each end of the diversity spectrum (most commonly East vs. West). Contemporary researchers have observed that existing studies fail to acknowledge the substantially greater levels of intra-cluster variation that exist. A cultural cluster is a group of countries that reflect values, attitudes and beliefs stemming from a common cultural ancestry. This seems surprising given the anecdotal evidence and stereotypes that are portrayed in popular culture, media and art. One area where intra-cluster variation may be evident is consumer complaint behaviour and in particular within the Anglo-cultural cluster in countries. A cultural cluster is a group of countries that reflect values, attitudes and beliefs stemming from a common cultural ancestry. The aim of this study is therefore to explore and elucidate the nature of differences in consumer complaint behaviour between cultures traditionally conceived and operationalised as identical. This study presents a qualitative study of 60 in-depth interviews with consumers in the United Kingdom and Australia and identifies differences in complaining styles, parental influence and the conceptualisation of complaining.

Natural free convection in porous media: First field documentation in groundwater

Natural free convection is a process of great importance in disciplines from hydrology to meteorology, oceanography, planetary sciences, and economic geology, and for applications in carbon sequestration and nuclear waste disposal. It has been studied for over a century - but almost exclusively in theoretical and laboratory settings, Despite its importance, conclusive primary evidence of free convection in porous media does not currently exist in a natural field setting. Here, we present recent electrical resistivity measurements from a sabkha aquifer near Abu Dhabi, United Arab Emirates, where large density inversions exist. The geophysical images from this site provide, for the first time, compelling field evidence of fingering associated with natural free convection in groundwater.