Process evaluation design and tools used in a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study

Process evaluation (PE) is used for the in-depth evaluation of the implementation process of health promotion programmes. The aim of the current paper was to present the PE design and tools used in the ToyBox-intervention. The PE design was based on a three-step approach, including the identification of ToyBox-specific PE elements (step 1), the development of PE tools and harmonization of procedures (step 2), and the implementation of PE using standardized protocol and tools across the intervention countries (step 3). Specifically, to evaluate the implementation of the intervention, teachers' monthly logbooks were recorded (dose delivered, fidelity, dose received); post-intervention questionnaires were completed by parents/caregivers and teachers (dose received); participation and attrition rates were recorded (recruitment, reach); and audit questionnaires and retrospective information on weather conditions were collected (physical and social environment within which the intervention was implemented). Regarding the teachers' training sessions, the researchers who performed the trainings completed evaluation forms and documented teachers' attendance after each training (dose delivered, fidelity, dose received) and teachers completed evaluation forms after each training (dose received). The PE performed in the ToyBox-intervention may contribute in the evaluation of its effectiveness, guide the revision of the intervention material and provide insights for future health promotion programmes and public health policy.

Cost effectiveness of surveillance for isocyanate asthma : finding an occupational health policy framework

Wild et al present an original cost effectiveness analysis for medical surveillance for isocyanate asthma in this issue of OEM.1 The general case for surveillance for isocyanate asthma is a compelling one. Most occupational physicians, practitioners, and researchers might rightly expect that if a cost effectiveness (CE) case cannot be made for this agent, it would be hard to make a case for most others. The causal link between isocyanate exposure and asthma is well established, and more is known about the pathophysiology, natural history, long term consequences, and benefits of medical surveillance in this instance than for most other occupational exposures.A mathematical simulation model was developed based on a carefully specified set of clinical parameters, drawing from empirical studies where possible (for example, in estimating sensitisation rates ranging from 0.7% to 5.3% per year), and well qualified expert opinion otherwise (for example, in estimating the chance of removal from exposure if a patient is diagnosed versus undiagnosed). Their “state transition” model compared passive case finding to surveillance (the heart of the CE analysis question as proposed) for a theoretical population of 100 000 otherwise healthy and exposed workers, predicting their progression over 10 years across three mutually exclusive “states”: healthy and exposed; symptomatic; and disabled. This alone is an impressive and valuable piece of research, integrating a substantial body of empirical research to show that surveillance is estimated to result in 700 fewer cases of disability over 10 years compared to passive case finding. While such a modelling exercise necessarily requires numerous assumptions and simplifications, each was well articulated and defensible.

Securely outsourcing attribute-based encryption with checkability

Attribute-Based Encryption (ABE) is a promising cryptographic primitive which significantly enhances the versatility of access control mechanisms. Due to the high expressiveness of ABE policies, the computational complexities of ABE key-issuing and decryption are getting prohibitively high. Despite that the existing Outsourced ABE solutions are able to offload some intensive computing tasks to a third party, the verifiability of results returned from the third party has yet to be addressed. Aiming at tackling the challenge above, we propose a new Secure Outsourced ABE system, which supports both secure outsourced key-issuing and decryption. Our new method offloads all access policy and attribute related operations in the key-issuing process or decryption to a Key Generation Service Provider (KGSP) and a Decryption Service Provider (DSP), respectively, leaving only a constant number of simple operations for the attribute authority and eligible users to perform locally. In addition, for the first time, we propose an outsourced ABE construction which provides checkability of the outsourced computation results in an efficient way. Extensive security and performance analysis show that the proposed schemes are proven secure and practical. © 2013 IEEE.

Can primary care team-based transition to insulin improve outcomes in adults with type 2 diabetes: the stepping up to insulin cluster randomized controlled trial protocol

Type 2 diabetes (T2D) brings significant human and healthcare costs. Its progressive nature means achieving normoglycaemia is increasingly difficult, yet critical to avoiding long term vascular complications. Nearly one-half of people with T2D have glycaemic levels out of target. Insulin is effective in achieving glycaemic targets, yet initiation of insulin is often delayed, particularly in primary care. Given limited access to specialist resources and the size of the diabetes epidemic, primary care is where insulin initiation must become part of routine practice. This would also support integrated holistic care for people with diabetes. Our Stepping Up Program is based on a general practitioner (GP) and practice nurse (PN) model of care supported appropriately by endocrinologists and credentialed diabetes educator-registered nurses. Pilot work suggests the model facilitates integration of the technical work of insulin initiation within ongoing generalist care.

Child physical activity levels and associations with modifiable characteristics in centre-based childcare

Objective: To describe children's physical activity levels during childcare and associations with modifiable characteristics. Methods: A cross-sectional study of 328 preschool children (43% girls; age 3-5 years) and 145 staff from 20 long day care centres in the Hunter Region of NSW, Australia. Pedometers assessed child physical activity levels. Centre characteristics and staff attitudes and behaviours towards children's physical activity were assessed using surveys, interviews and observational audit. Results were analysed using descriptive statistics and linear regression. Results: Over the measurement period, average step count of children was 15.8 (SD=6.8) steps/minute. Four-year-olds had the highest step counts (16.4, SD=7.1, p=0.03) with no differences by sex. Step counts were significantly higher in centres that had a written physical activity policy (+3.8 steps/minute, p=0.03) and where staff led structured physical activity (+3.7 steps/minute, p<0.001) and joined in active play (+2.9 steps/minute, p=0.06). Conclusions: Written physical activity policy, structured staff-led physical activity and staff joining in active play were associated with higher levels of physical activity. Implications: Childcare physical activity interventions should consider including strategies to encourage written physical activity policies and support structured staff led physical activities.

Analysis of operating environments: A diagnostic model for linking science, society and policy for sustainability

Through analysis of the dynamics between science and decision-making, we argue that diagnosing fit-for purpose approaches to linking science and decision-making may be possible. Such diagnosis should enable identification of appropriate processes, institutions, objects (e.g. tools, information products) and relationships that can facilitate outcomes. We begin the paper by unsettling the traditional constructions that science must distance itself from debates about values and what is at stake, and so from policy making. Then, drawing from mixed methods case studies in coastal South-eastern Australia, we describe how scientific research has had a bearing on decisions affecting society and the environment. These analyses suggest that the willingness and capacity of research organisations, programmes or projects to actively reflect on and participate in the evolution of the 'operating environment' for their research is integral to their ability to inform outcomes through science. © 2014 Elsevier Ltd.

Towards a BIM-based energy rating system

Governments in Australia are faced with policy implementation that mandates higher energy efficient housing (Foran, Lenzen & Dey 2005). To this effect, the National Construction Code (NCC) 2013 stipulates the minimum energy performance for residential buildings as 114MJ/m2 per annum or 6 stars on an energy rating scale. Compliance with this minimum is mandatory but there are several methods through which residential buildings can be rated to comply with the deemed to satisfy provisions outlined in the NCC. FirstRate5 is by far the most commonly used simulation software used in Victoria, Australia. Meanwhile, Building Information Modelling (BIM), using software such as ArchiCAD has gained a foothold in the industry. The energy simulation software within ArchiCAD, EcoDesigner, enables the reporting on the energy performance based on BIM elements that contain thermal information. This research is founded on a comparative study between FirstRate5 and EcoDesigner. Three building types were analysed and compared. The comparison finds significant differences between simulations, being, measured areas, thermal loads and potentially serious shortcomings within FirstRate5, that are discussed along with the future potential of a fully BIM-integrated model for energy rating certification in Victoria. © 2014, The Association for Computer-Aided Architectural Design Research in Asia (CAADRIA), Hong Kong.

A map of community-based obesity prevention initiatives in Australia following obesity funding 2009-2013.

Obesity is the single biggest public health threat to developed and developing economies. In concert with healthy public policy, multi-strategy, multi-level community-based initiatives appear promising in preventing obesity, with several countries trialling this approach. In Australia, multiple levels of government have funded and facilitated a range of community-based obesity prevention initiatives (CBI), heterogeneous in their funding, timing, target audience and structure. This paper aims to present a central repository of CBI operating in Australia during 2013, to facilitate knowledge exchange and shared opportunities for learning, and to guide professional development towards best practice for CBI practitioners.

Small area-level socioeconomic status and all-cause mortality within 10 years in a population-based cohort of women: Data from the Geelong Osteoporosis Study

Background: The social gradient of health and mortality is well-documented. However, data are scarce regarding whether differences in mortality are observed across socio-economic status (SES) measured at the small area-level. We investigated associations between area-level SES and all-cause mortality in Australian women aged ≥. 20. years. Methods: We examined SES, obesity, hypertension, lifestyle behaviors and all-cause mortality within 10. years post-baseline (1994), for 1494 randomly-selected women. Participants' residential addresses were matched to Australian Bureau of Statistics Census data to identify area-level SES, and deaths were ascertained from the Australian National Deaths Index. Logistic regression models were adjusted for age, and subsequent adjustments made for measures of weight status and lifestyle behaviors. Results: We observed 243 (16.3%) deaths within 10. years post-baseline. Females in SES quintiles 2-4 (less disadvantaged) had lower odds of mortality (0.49-0.59) compared to SES quintile 1 (most disadvantaged) under the best model, after adjusting for age, smoking status and low mobility. Conclusions: Compared to the lowest SES quintile (most disadvantaged), females in quintiles 2 to 5 (less disadvantaged) had significantly lower odds ratio of all-cause mortality within 10. years. Associations between extreme social disadvantage and mortality warrant further attention from research, public health and policy arenas.

Cost effectiveness of an elementary school active physical education policy

INTRODUCTION: Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA, less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state "active PE" policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA. METHODS: A cohort model was used to simulate the impact of an active PE policy on physical activity, BMI, and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6-11 years. Data were analyzed in 2014. RESULTS: An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23, 2.51) and cost $70.7 million (95% UI=$51.1, $95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15, $2.15), and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148, $3,100). From 2015 to 2025, the policy would cost $235 million (95% UI=$170 million, $319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million, $153 million). CONCLUSIONS: Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.

Free Trade Agreements and US Foreign Policy

The United States has completed numerous free trade agreements (FTAs), but the pattern of these agreements defies conventional explanations. Arguments that are based on domestic interests and economic gains cannot explain the comparative under-performance of US trade agreements. The pattern of US trade agreements is also inconsistent with explanations that focus on state power, which depict FTAs as a “reward” for loyal clients. This article finds a better explanation for the pattern of the United States’ FTAs by consideringthe systemic level of analysis, and in particular the dynamics of the international economic order. It illustrates that strong competition for bilateral trade agreements has resulted in patterns of agreements that the United States cannot easily dominate. This is not to say that the United States has no capacity to finalize trade agreements: the United States remains the world’s most influential nation-state, but the constraints of the international system necessarily limit the degree to which FTAs can serve the interests of US foreign economic policy. The recent evolution of international trade politics, however, indicates that smaller states are comparatively less vulnerable to pressure from great powers, such as the United States.

Heat affected zone microstructures and their influence on toughness in two microalloyed HSLA steels

Microstructures and Charpy impact properties have been examined in two microalloyed steels following heat treatments to simulate weld heat affected zone (HAZ) structures over a range of heat input conditions, characterised by the cooling time from 800 to 500°C (Δt8/5). The base materials were low carbon structural steel plates microalloyed with vanadium and nitrogen (V-N) and niobium (Nb), respectively. The toughnesses of the HAZs displayed remarkably different behaviours as shown by their impact transition temperatures. For the V-N steel, the toughness improved with increasingly rapid cooling (low heat input conditions) whereas the Nb steel showed an opposite trend. Some of this behaviour could be explained by the presence of coarse ferrite grains in the slowly cooled V-N steel. However, other conditions where all the structures were bainitic and rather similar in optical micrographs gave widely different toughness values. The recently developed method of five dimensional boundary analysis based on electron backscattering diffraction has been applied to these cases for the first time. This showed that the lath boundaries in the bainite were predominantly on {1 1 0} planes of the ferrite and that the average spacing of these boundaries varied depending on steel composition and cooling rate. Since {1 1 0} is also the slip plane in ferrite, it is considered that close spacing between the lath boundaries inhibits general plasticity at stress concentrations and favours initiation of fracture. The differences between the two steels are believed to be due to their transformation behaviours on cooling where precipitation of vanadium nitride in austenite accelerates ferrite formation and raises the temperature of the phase transformation in V-N steels.

Leaning too far? PISA, policy and Australia's ‘top five’ ambitions

 Australia has declared its ambition to be within the ‘top five’ in the Programme for International Student Assessment (PISA) by 2025. So serious is it about this ambition, that the Australian Government has incorporated it into the Australian Education Act, 2013. Given this focus on PISA results and rankings, we go beyond average scores to take a close look at Australia’s performance in PISA, examining rankings by different geographical units, by item content and by test completion. Based on this analysis and using data from interviews with measurement and policy experts, we show how uninformative and even misleading the ‘average performance scores’, on which the rankings are based, can be. We explore how a more nuanced understanding would point to quite different policy actions. After considering the PISA data and Australia’s ‘top five’ ambition closely, we argue that neither the rankings nor such ambitions should be given much credence.

The age of STEM : educational policy and practice across the world in science, technology, engineering and mathematics

 Across the world STEM (learning and work in Science, Technology, Engineering and Mathematics) has taken central importance in education and the economy in a way that few other disciplines have. STEM competence has become seen as key to higher productivity, technological adaptation and research-based innovation. No area of educational provision has a greater current importance than the STEM disciplines yet there is a surprising dearth of comprehensive and world-wide information about STEM policy, participation, programs and practice.

The geopolitical economy of social policy in the Philippines: securitisation, emerging powers and multilateral policies

Recent geopolitical and economic changes have altered global social policy formation. Bretton Woods multilateral development agencies (MDAs) have selectively incorporated ideas that have emerged from developing country states and decision makers. Recent years have witnessed an increased acceptance of social transfers as part of renewed efforts at poverty alleviation policies based on social risk management. There has been an instance in the use and promotion of conditional cash transfer (CCT) policies by MDAs. One case is the Philippines. CCTs were a product of the emergence of a neostructuralist welfare regime (understood as an ideal type) in Latin America. There was an attempt to reconcile neoliberal strategies of development with aspirations for guaranteed minimum incomes. The Bretton Woods and regional development bank MDAs have facilitated the adoption of CCTs in other developing country contexts. In the Philippines, a combination of actions by national political actors and MDAs resulted in the implementation of a securitised and compliance-focused version of CCTs derived from the Colombian security state. Although poor households welcome income assistance, CCTs have acted to enforce further state monitoring without altering the national-based political and economic processes that replicate poverty.