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BackgroundMedication management in residential aged care facilities is an ongoing concern. Numerous studies have reported high rates of inappropriate prescribing and medication use in aged care facilities, which contribute to residents’ adverse health outcomes. There is a need for new models of care that enhance inter-disciplinary collaboration between residential aged care facility staff and healthcare professionals, to improve medication management. Pilot research has demonstrated the feasibility and benefits of integrating a pharmacist into the aged care facility team to improve the quality use of medicines. This protocol describes the design and methods for a cluster randomised controlled trial to evaluate the outcomes and conduct economic evaluation of a service model where on-site pharmacists are integrated into residential aged care facility healthcare teams to improve medication management.MethodsIntervention aged care facilities will employ on-site pharmacists to work as part of their healthcare teams. Pharmacists will assume responsibility for medication management, and collaborate with facility nurses, prescribers, community pharmacists, residents and families to improve the quality use of medicines. The intervention will last for 12 months. Aged care facilities in the control group will continue usual care. The target sample size is 1,188 residents from a minimum of 13 aged care facilities. The primary outcome is the appropriateness of prescribing, measured by the proportion of residents who are prescribed at least one potentially inappropriate medicine according to the 2019 Beers Criteria. Secondary outcomes include hospital and Emergency Department presentations, fall rates, prevalence and dose of antipsychotics and benzodiazepines, Anticholinergic Cognitive Burden Score, staff influenza vaccination rate, time spent on medication rounds, appropriateness of dose form modification and completeness of resident’s allergy and adverse drug reaction documentation. A cost-consequence and cost-effectiveness analysis will be embedded in the trial.DiscussionThe results of this study will provide information on clinical and economic outcomes of a model that integrates on-site pharmacists into Australian residential aged care facilities. The results will provide policymakers with recommendations relevant to further implementation of this model.Trial registrationACTRN: ACTRN12620000430932, retrospectively registered with ANZCTR on 1 April 2020. Available from https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR&recruitmentRegion=&ethicsReview=&countryOfRecruitment=&registry=&searchTxt=ACTRN12620000430932&studyType=&allocationToIntervention=&dateOfRegistrationTo=&recruitmentStatus=&interventionCode=&healthCondition=&healthyVolunteers=&page=1&conditionCategory=&fundingSource=&trialStartDateTo=&trialStartDateFrom=&phase=

A growing literature is pointing towards the prevalence of healthy lifestyles, such as adequate walking, in the Central Business District (CBD) of many cities. However, only one study has investigated the presence of walking hotpsots. Using coarsely geocoded, routinely collected survey data from the Australian Capital Territory (ACT), and a unique ‘overlap of spatial clusters’ approach, we investigated if a) There were patterns of clustering in walking behaviours, b) If these clusters were co-located and therefore associated with various built environment characteristics and c) What the demographic and active transport use profiles of the residents of these clusters were. A hotspot of walking was found in the CBD of the ACT, co-located with hotspots or spatial clusters of dwelling density, public transport frequency and destination accessibility. Residents of the hotspot walked approximately an hour more than the average ACT resident and had significantly higher odds of using active transport to workplaces relative to driving. Odds ratios of walking relative to driving to work were 9.20 (5.97, 14.18) and bicycling were 3.54 (1.87, 6.69) in the walking hotspot compared to non-hotspots. Policies directed towards creating a ‘CBD like’ built environment in various locations of cities or refurbishing and redesigning existing CBDs to make them more liveable helps encourage walking behaviors. In addition coarsely geocoded, freely available routinely collected survey data can be used to investigate relationships that may help drive policy.

Background There is some evidence that simply measuring physical activity alone can increase self-reported physical activity behaviour. Objective measures of physical activity in intervention studies have increased substantially over the last decade. Yet, there is no synthesised evidence of observed changes in the control group physical activity in trials that have used objective physical activity measurement approaches. Understanding factors associated with control group increases (or decreases) in physical activity may have implications for planning physical activity research and in clinical settings where objective measures of physical activity may be used. The aim of this systematic review is to describe changes in objectively measured physical activity that have occurred within control groups in primary care physical activity intervention studies and, if possible, identify factors that are potentially associated with these changes. Methods The PRISMA-P reporting guidelines for systematic review protocols will be followed. Five electronic databases (PubMed, MEDLINE, SPORTDiscuss, PsychINFO, CINAHL) will be searched to identify physical activity controlled (randomised, cluster, quasi-experimental) studies conducted with adults in primary care. Search terms will be based on previous systematic reviews, and only peer-reviewed articles published in English will be considered. The main outcome measure is the change in objectively measured physical activity within the control group. Risk of bias will be assessed using the Cochrane Collaboration tool and the Risk Of Bias in Non-randomised Studies—of Interventions tool. Meta-analyses will be conducted where possible among studies with sufficient homogeneity. Discussion This systematic review and meta-analysis will determine the extent to which physical activity measurement alone is associated with changes in objectively measured physical activity levels in control groups in primary care. Findings from this study will inform future physical activity intervention research and practice. If measuring physical activity alone is associated with increases in physical activity levels that may be considered beneficial for health, this could indicate that measurement alone may be a low cost, efficient and effective method to increase a proprotion of the population’s physical activity levels. Systematic review registration PROSPERO CRD42018104896

Ovulation and fertility can be improved by weight loss in obese women with Polycystic Ovarian Syndrome (PCOS). The aim of this study was to investigate the effectiveness of a twelve-week supervised exercise program in combination with dietary restrictions for obese women with PCOS. The study is a quasi-experimental research and used an experimental pre- and post-test design. Fifteen women recruited from Fertility Clinic, Jessops Hospital for Women, Sheffield took part in this study. Respiratory exchange ratio (RER), heart rate, perceived exertion (RPE), and Houston non-exercise activity code were recorded. Height, weight, and body girth measurements were taken to calculate body mass index, fat percentage, and lean body weight. The intervention group lost an average of 3.1 kg and gained 3.45 kg of lean body weight. Loss of fat percentage was 12.1%. No significant difference was found in the control group. The RER and heart rate value decreased for the same workload in the intervention group, indicating higher tolerance towards exercise intensity. However, the changes for both groups were not significant. The average group compliance rate was 53% (at least two sessions per week). Bearing in mind the small sample size (n=4) for control, the improvement in fitness, significant weight loss, and body composition change (increase in fat-free mass) was achieved in this study. Twelve weeks of exercise, combined with dietary advice, were sufficient to benefit PCOS obese women. The research has achieved a commendable weight-loss objective and has demonstrated increases in standards of fitness among obese women.

Background Cardiac rehabilitation participants are encouraged to meet physical activity guidelines to reduce the risk of repeat cardiac events. However, previous studies have found that physical activity levels are low and sedentary behavior is high, both during and after cardiac rehabilitation. There is potential for smartphone apps to be effective in reducing sedentary behavior, although among the few studies that have investigated smartphone apps in cardiac rehabilitation, none targeted sedentary behavior. Objective This study aims to evaluate the feasibility of a behavioral smartphone app (Vire) and a web-based behavior change program (ToDo-CR) to decrease sedentary behavior in cardiac rehabilitation participants. Methods Using a single-center, pre-post design, participants were recruited by nursing staff on admission to cardiac rehabilitation. All eligible participants installed the Vire app, were given a Fitbit Flex, and received the 6-week ToDo-CR program while attending cardiac rehabilitation. The ToDo-CR program uses personalized analytics to interpret important behavioral aspects (physical activity, variety, and social opportunity) and real-time information for generating and suggesting context-specific actionable microbehavioral alternatives (Do’s). Do’s were delivered via the app, with participants receiving 14 to 19 Do’s during the 6-week intervention period. Outcome measures were collected at 0, 6, and 16 weeks. The assessors were not blinded. Feasibility outcomes included recruitment and follow-up rates, resource requirements, app usability (Unified Theory of Acceptance and Use of Technology 2 [UTAUT2] questionnaire), and objectively measured daily minutes of sedentary behavior (ActiGraph) for sample size estimation. Secondary outcomes included functional aerobic capacity (6-min walk test), quality of life (MacNew Heart Disease Health-Related Quality of Life Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), BMI, waist circumference, waist-to-hip ratio, and blood pressure. Results Between January and May 2019, 20 participants were recruited consecutively. One-third of people who commenced cardiac rehabilitation were eligible to participate. Other than declining to take part in the study (15/40, 38%), not having a smartphone was a major reason for exclusion (11/40, 28%). Those excluded without a smartphone were significantly older than participants with a smartphone (mean difference 20 [SD 5] years; P Conclusions The use of a behavioral smartphone app to decrease sitting time appears to be feasible in cardiac rehabilitation. A larger randomized controlled trial is warranted to determine the effectiveness of the app.

Highlights • Some evidence of control group increases in self-reported PA in primary care. • Meta-analyses found no significant improvement in control group objectively-measured PA. • 17% of studies reported increased (≥10%) objectively-measured PA in control groups. • Healthy younger adults may increase objectively-measured PA with measurement alone. • PA measurement using pedometers alone may be particularly useful to increase PA., There is evidence that simply measuring physical activity alone can increase self-reported physical activity behaviour. The aim of this review was to describe changes in objectively-measured physical activity within control groups in primary care physical activity intervention studies. Five electronic databases (PubMed, MEDLINE, SPORTDiscus, PsychINFO and CINAHL) were searched from inception to February 2019. Physical activity controlled intervention studies objectively measuring physical activity in primary care with adults were included and meta-analyses were completed. Thirty studies were eligible and 22 studies were included in the meta-analysis. No statistically significant change in steps.day−1, counts.day−1 and counts.minute-1 were found in the meta-analyses within control groups. Moderate-to-vigorous physical activity minutes.day−1 significantly decreased (-3.97; 95% CI −6.31 to −1.64; P

Background There is limited evidence of Aboriginal and Torres Strait Islander people attending cardiac rehabilitation (CR) programs despite high levels of heart disease. One key enabler for CR attendance is a culturally safe program. This study evaluates improving access for Aboriginal and Torres Strait Islander women to attend a CR program in a non-Indigenous health service, alongside improving health workforce cultural safety. Methods An 18-week mixed-methods feasibility study was conducted, with weekly flexible CR sessions delivered by a multidisciplinary team and an Aboriginal and/or Torres Strait Islander Health Worker (AHW) at a university health centre. Aboriginal and Torres Strait Islander women who were at risk of, or had experienced, a cardiac event were recruited. Data was collected from participants at baseline, and at every sixth-session attended, including measures of disease risk, quality-of-life, exercise capacity and anxiety and depression. Cultural awareness training was provided for health professionals before the program commenced. Assessment of health professionals’ cultural awareness pre- and post-program was evaluated using a questionnaire (n = 18). Qualitative data from participants (n = 3), the AHW, health professionals (n = 4) and referrers (n = 4) was collected at the end of the program using yarning methodology and analysed thematically using Charmaz’s constant comparative approach. Results Eight referrals were received for the CR program and four Aboriginal women attended the program, aged from 24 to 68 years. Adherence to the weekly sessions ranged from 65 to 100%. At the program’s conclusion, there was a significant change in health professionals’ perception of social policies implemented to ‘improve’ Aboriginal people, and self-reported changes in health professionals’ behaviours and skills. Themes were identified for recruitment, participants, health professionals and program delivery, with cultural safety enveloping all areas. Trust was a major theme for recruitment and adherence of participants. The AHW was a key enabler of cultural authenticity, and the flexibility of the program contributed greatly to participant perceptions of cultural safety. Barriers for attendance were not unique to this population. Conclusion The flexible CR program in a non-Indigenous service provided a culturally safe environment for Aboriginal women but referrals were low. Importantly, the combination of cultural awareness training and participation in the program delivery improved health professionals’ confidence in working with Aboriginal people. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) 12618000581268, http://www.ANZCTR.org.au/ACTRN12618000581268.aspx, registered 16 April 2018.

IntroductionSharing findings with research participants is gaining attention as an ethical imperative for the research community. However, current discussions on this topic typically take a paternalistic approach to the issue, with the research team having the power to decide whether or not the sharing of results should be carried out and how this is done. In this paper we propose an alternative approach to engaging participants with the findings from the research to which they have contributed.MethodsThe ethnographic fieldwork for our study was carried out in multiple phases from August 2018 to January 2019 and again from August 2019 to December 2019 among two vulnerable communities in the south Indian state of Kerala. Engagement of research participants with findings was integrated into the research protocol and various strategies including forming partnerships with participants and identifying appropriate forms of dissemination among the different categories of participants were carried out during fieldwork. The format and mode of dissemination varied depending on the participant category and was tailored to ensure that each participant was able to engage actively with the findings as opposed to merely passively receiving the results from our study,ResultsPrevious research studies that had been undertaken among our participants had not shared research results with them and were interpreted by the communities that researchers were not interested in making any difference to their situation. Building reciprocal relationships in a way that minimised power disparities and tailoring outputs to forms that promoted active engagement were key factors that helped participants to engage with our results. Such engagement added value to our research by enabling us to jointly evolve the recommendations from our study.Conclusion Participants contribute to the success of research by providing information that is sought by researchers. Compared to the dominant bio-medical research ethics framework, a rights informed approach to sharing research results with participants acknowledges this and recognises their agency to engage with research findings. Such an approach is not only socially responsible and ethical, but also improves the impact and legitimacy of research among the participants and the larger population that they represent.

Creating more physical activity–supportive built environments is recommended by the World Health Organization for controlling noncommunicable diseases. The IPEN (International Physical Activity and Environment Network) Adult Study was undertaken to provide international evidence on associations of built environments with physical activity and weight status in 12 countries on 5 continents ( n > 14,000). This article presents reanalyzed data from eight primary papers to identify patterns of findings across studies. Neighborhood environment attributes, whether measured objectively or by self-report, were strongly related to all physical activity outcomes (accelerometer-assessed total physical activity, reported walking for transport and leisure) and meaningfully related to overweight/obesity. Multivariable indexes of built environment variables were more strongly related to most outcomes than were single-environment variables. Designing activity-supportive built environments should be a higher international health priority. Results provide evidence in support of global initiatives to increase physical activity and control noncommunicable diseases while achieving sustainable development goals.

The study's main aim was to examine whether adults' accelerometer-based physical activity and sedentary time mediated the associations of neighbourhood physical environmental perceptions with body mass index (BMI) and weight status across 10 high- and middle-income countries. Data from the IPEN Adult study, an observational multi-country study (n=5712) were used. Results showed that sedentary time was a non-significant or inconsistent mediator in all models. MVPA mediated the associations of street connectivity, land use mix-diversity, infrastructure/safety for walking and aesthetics with BMI in single models. In the multiple model, MVPA only fully mediated the relation between land use mix-diversity and BMI. This finding was replicated in the models with weight status as outcome. MVPA partially mediated associations of composite environmental variables with weight status. So, although MVPA mediated some associations, future comprehensive studies are needed to determine other mechanisms that could explain the relation between the physical environment and weight outcomes. Food intake, food accessibility and the home environment may be important variables to consider. Based on the consistency of results across study sites, global advocacy for policies supporting more walkable neighbourhoods should seek to optimize land-use-mix when designing and re-designing cities or towns.

BACKGROUND AND OBJECTIVES : Non-dispensing pharmacists are being suggested as a useful addition to the workforce in general practice. The aim of this study was to describe the activities of three general practice pharmacists over six months in a pilot trial. METHOD : Three general practices integrated a part-time (15.2-16 hours per week) non-dispensing pharmacist to be employed according to their individual skillset and local workplace needs. Each general practice pharmacist maintained a daily activity diary, which was subsequently analysed. RESULTS : The general practice pharmacists' activities were categorised as quality of practice (37%), administration (34%), medication review (19%) and patient education (11%). Within the quality of practice category, most time was spent conducting clinical audits (47%). Over the course of the six months, time spent on administration decreased, while time communicating with general practitioners (GPs) on clinical issues increased. DISCUSSION : The general practice pharmacists conducted a range of predominantly clinically related activities involving their expertise in the quality use of medications. Involvement in clinical activities to support GPs increased with time working in the practice. Randomised controlled trials are required to collect clinical outcomes and determine which activities conducted by pharmacists are most beneficial to Australian patients and GPs.

Objectives: To determine the role of physical activity intensity and bout-duration in modulating associations between physical activity and cardiometabolic risk markers.Methods: A cross-sectional study using the International Children’s Accelerometry Database (ICAD) including 38,306 observations (in 29,734 individuals aged 4–18 years). Accelerometry data was summarized as time accumulated in 16 combinations of intensity thresholds (≥500 to ≥3000 counts/min) and bout-durations (≥1 to ≥10 min). Outcomes were body mass index (BMI, kg/m2), waist circumference, biochemical markers, blood pressure, and a composite score of these metabolic markers. A second composite score excluded the adiposity component. Linear mixed models were applied to elucidate the associations and expressed per 10 min difference in daily activity above the intensity/bout-duration combination. Estimates (and variance) from each of the 16 combinations of intensity and bout-duration examined in the linear mixed models were analyzed in meta-regression to investigate trends in the association.Results: Each 10 min positive difference in physical activity was significantly and inversely associated with the risk factors irrespective of the combination of intensity and bout-duration. In meta-regression, each 1000 counts/min increase in intensity threshold was associated with a −0.027 (95% CI: −0.039 to −0.014) standard deviations lower composite risk score, and a −0.064 (95% CI: −0.09 to −0.038) kg/m2 lower BMI. Conversely, meta-regression suggested bout-duration was not significantly associated with effect-sizes (per 1 min increase in bout-duration: −0.002 (95% CI: −0.005 to 0.0005) standard deviations for the composite risk score, and −0.005 (95% CI: −0.012 to 0.002) kg/m2 for BMI).Conclusions: Time spent at higher intensity physical activity was the main determinant of variation in cardiometabolic risk factors, not bout-duration. Greater magnitude of associations was consistently observed with higher intensities. These results suggest that, in children and adolescents, physical activity, preferably at higher intensities, of any bout-duration should be promoted.

Establishing and maintaining a healthy lifestyle is essential in assuring a child’s health and wellbeing over the life-course. Of national concern in Australia is the fact that nearly three in every 10 children and young people are overweight or obese. Childhood overweight/obesity is also a global concern. The energy deficit needed to reverse the trend in childhood obesity may be quite small for most children however that intervention should start early and be sustained. Children can be active participants in creating new social norms for society but this is not often recognized. Society tends to position children as passive spectators and/or gives them superficial roles in creating artifacts for use in schools and other institutions such as health care centers. In order to support healthy lifestyle change in primary school settings, a Physical Activity and Lifestyle Management (PALM) report card system for progression, monitoring and reporting of anthropometric achievement standards for children has been proposed. In order for this system to be an effective communication tool it needed to be designed in a way that would not only be visually appealing and easy to use but would also allow parents and children to take a sense of ownership of the design and enable it to be accepted by the wider community. This paper describes and discusses the co-design approach that enabled children and designers to develop the PALM card and to provide some understanding of children’s perceptions of healthy habits and behaviors.

Medication management in residential aged care facilities (RACFs) is complex and often sub-optimal. Pharmacist practice models and services have emerged internationally to address medication-related issues in RACFs. This narrative review aimed to explore pharmacist practice models in aged care in Australia, England and the USA, and identify key activities and characteristics within each model. A search strategy using key terms was performed in peer-reviewed databases, as well as the grey literature. Additionally, experts from the selected countries were consulted to obtain further information about the practice models in their respective countries. Thirty-six documents met the inclusion criteria and were included in the review. Four major pharmacist practice models were identified and formed the focus of the review: (1) the NHS’s Medicine Optimisation in Care Homes (MOCH) program from England; (2) the Australian model utilising visiting accredited pharmacists; (3) the Centers for Medicare and Medicaid (CMS) pharmacy services in long-term care from the USA; and (4) the Medication Therapy Management (MTM) program from the USA. Medication reviews were key activities in all models, but each had distinct characteristics in relation to the comprehensiveness, who is eligible, and how frequently residents receive medication review activity. There was heterogeneity in the types of facility-level activities offered by pharmacists, and further research is needed to determine the effectiveness of these activities in improving quality use of medicines in the aged care setting. This review found that in some models, pharmacists have a limited level of collaboration with other healthcare professionals, emphasising the need to trial innovative models with integrated services and increased collaboration to achieve a holistic patient-centred approach to medication management.

The aim of this study was to identify determinants of walking and whether walking maintained mobility among women as they transition from their mid-70s to their late 80s. We used 12 years of follow-up data (baseline 1999) from the Australian Longitudinal Study on Women’s Health (n = 10,322). Fifteen determinants of walking were included in the analysis and three indicators of mobility. Longitudinal data analyses techniques were employed. Thirteen of the 15 determinants were significant predictors of walking. Women in their mid-70s who walked up to 1 hr per week were less likely to experience loss of mobility in very old age, including reduced likelihood of using a mobility aid. Hence, older women who do no walking should be encouraged to walk to maintain their mobility and their independence as they age, particularly women in their 70s and 80s who smoke, are overweight, have arthritis, or who have had a recent fall.

A growing literature has indicated a relationship between social capital and certain aspects of the built environment with contributions from various disciplines, including environmental psychology, urban design, and health geography. In this systematic review and research synthesis, we summarize the literature in this domain using existing sociological and design frameworks to ascertain the effect of specific built environment domains on social capital. Our review shows that there is a significant relationship between social capital and the built environment, specifically between social cohesion and access to destinations/walkability. Positive relationships exist between social capital, design, and diversity, whereas the effect of population density on social capital is negative and unclear. We find significant methodological limitations and gaps in the published literature, including the absence of longitudinal studies and the use of a plethora of social capital and built environment measures.

An automatic identification of the heart disease status can give timely support to medical decision-making process. The identified key factors can expedite the prevention actions in right direction. Existing solutions to identify disease factor or current disease status is based on hybrid approach which requires significant amount of human efforts. In addition to that an information extraction and de-identification on clinical dataset performed manually is error prone, expensive, prohibitively and time consuming [1]. These drawbacks can be overcome by using deep learning approach, in this paper we have used LSTM, BiLSTM and Google's Sentence encoder for automatic disease status identification. We have used i2b2 dataset with the proposed deep learning models that have led to promising results.

In the original article, four authors (Dr AJ Atkin, Dr DW Eslinger, Dr BH Hansen and Dr LB Sherar) were not included in the affiliations. This has been corrected in the XML, PDF and HTML versions of this article.

Physical activity (PA) patterns track from childhood through to adulthood. The study aimed to determine the levels and correlates of sedentary time (ST), total PA (TPA), and moderate-to-vigorous PA (MVPA) in preschool-aged children. We conducted cross-sectional analyses of 1052 children aged three-to-four-years-old from six studies included in the International Children&rsquo, s Accelerometry Database. Multilevel linear regression models adjusting for age, gender, season, minutes of wear time, and study clustering effects were used to estimate associations between age, gender, country, season, ethnicity, parental education, day of the week, time of sunrise, time of sunset, and hours of daylight and the daily minutes spent in ST, TPA, and MVPA. Across the UK, Switzerland, Belgium, and the USA, children in our analysis sample spent 490 min in ST per day and 30.0% and 21.2% of children did not engage in recommended daily TPA (&ge, 180 min) and MVPA (&ge, 60 min) guidelines. There was evidence for an association between all 10 potential correlates analyzed and at least one of the outcome variables, average daily minutes spent in ST, TPA and/or MVPA. These correlates can inform the design of public health interventions internationally to decrease ST and increase PA in preschoolers.

Background There is evidence that brief physical activity interventions by health professionals can increase physical activity levels. In addition, there is some evidence that simply measuring physical activity alone can increase physical activity behaviour. However, preliminary work is required to determine the effects of potential measurement frequency. The aim of this pilot study was to examine whether frequency of physical activity measurement, with very brief advice from a physiotherapist, influenced objectively measured physical activity in insufficiently active adults. Methods Using concealed allocation and blinded assessments, eligible participants (n = 40) were randomised to a lower-measurement-frequency (baseline and 18-weeks) or higher-measurement-frequency group (baseline, 6, 12 and 18-weeks). The primary outcome was daily minutes of moderate-to-vigorous physical activity (accelerometry). Secondary outcomes included functional aerobic capacity (STEP tool), quality-of-life (AQoL-6D), body mass index, waist circumference, waist-to-hip ratio and blood pressure. Results Between-group comparisons were not significant in intention-to-treat analyses. However, there was a trend for the higher-measurement-frequency group to complete more daily minutes of moderate-to-vigorous physical activity at 18-weeks (mean difference 19.6 vs − 11.9 mins/week, p = 0.084), with a medium effect size (Cohen’s d = 0.58). This was significant in per-protocol analysis (p = 0.049, Cohen’s d = 0.77). Within-group comparisons indicated both groups increased their aerobic fitness (p ≤ 0.01), but only the higher-measurement-frequency group decreased their waist circumference (mean decrease 2.3 cm, 95%CI 0.3–4.3, p = 0.024), diastolic blood pressure (mean decrease 3.4 mmHg, 95%CI 0.03–6.8, p = 0.048) and improved their quality-of-life for independent living (mean increase 3.3, 95%CI 0.2–6.4, p = 0.031). Conclusion Very brief physical activity interventions by physiotherapists may be an efficient approach to increase physical activity in community-dwelling adults. A larger trial is warranted. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616000566437, http://www.ANZCTR.org.au/ACTRN12616000566437.aspx, registered 2 May 2016.

Within the growing body of research linking neighbourhood environmental attributes with physical activity, associations between recreational destinations and non-walking leisure-time physical activity (LTPA) are rarely studied, and to date, not across multiple cities. We examined six potential associations of objectively-measured access to private recreational facilities (e.g., fitness centres, swimming pools) and parks with adults’ non-walking LTPA (e.g., swimming, cycling, tennis), using data gathered with consistent methods from adults living in international cities with a range of environment attributes. The potential effects of socio-demographic moderators and between-city variations were also examined. Data from 6725 adults from 10 cities (6 countries) were gathered. Adults were more likely to engage in non-walking LTPA if they had a greater number of private recreational facilities within 0.5 or 1 km of the home, particularly in women, and if they lived closer to a park. The amount of non-zero LTPA was only associated (positively) with the number of recreational facilities within 1 km. Relationships between amount of LTPA and park proximity appear complex, with likely contextual and cultural differences. Improving access to private recreational facilities could promote non-walking LTPA, especially in women.

Background Accelerometers are widely used to assess child physical activity (PA) levels. Using the accelerometer data, several PA metrics can be estimated. Knowledge about the relationships between these different metrics can improve our understanding of children’s PA behavioral patterns. It also has significant implications for comparing PA metrics across studies and fitting a statistical model to examine their health effects. The aim of this study was to examine the relationships among the metrics derived from accelerometers in children. Methods Accelerometer data from 24,316 children aged 5 to 18 years were extracted from the International Children’s Accelerometer Database (ICAD) 2.0. Correlation coefficients between wear time, sedentary behavior (SB), light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), moderate- and vigorous-intensity PA (MVPA), and total activity counts (TAC) were calculated. Results TAC was approximately 22X103 counts higher (p

Increasing evidence suggests that attributes of neighbourhood environments may play an important role in physical activity.1 2 However, nearly all studies in the field are cross-sectional and are subject to substantial bias.3 Residential relocation provides an opportunity for natural experiments where relocating to a new neighbourhood may ‘interrupt’ habitual behaviours and help establish new behavioural patterns.4 We conducted a systematic review on the effects of residential relocation on physical activity, walking and travel behaviour (PROSPERO registration number CRD42017077681, available at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=77681).5 We found 23 …

Background: Leisure-time and transport activity domains are studied most often because they are considered more amenable to intervention, but to date evidence on these domains is limited. The aim of the present study was to examine patterns of socio-demographic correlates of adults' leisure-time and transport physical activity and how these associations varied across 17 cities in 12 countries. Methods: Participants (N = 13,745) aged 18-66 years in the IPEN Adult study and with complete data on socio-demographic and self-reported physical activity characteristics were included. Participants reported frequency and duration of leisure-time and transport activities in the last 7 days using the self-administered International Physical Activity Questionnaire-Long Form. Six physical activity outcomes were examined in relation with age, education, and sex, and analyses explored variations by city and curvilinear associations. Results: Sex had the most consistent results, with five of six physical activity outcomes showing females were less active than males. Age had the most complex associations with self-report transport and leisure-time physical activity. Compared to older people, younger adults were less likely to engage in transport physical activity, but among those who did, younger people were likely to engage in more active minutes. Curvilinear associations were found between age and all three leisure-time physical activity outcomes, with the youngest and the oldest being more active. Positive associations with education were found for leisure-time physical activity only. There were significant interactions of city with sex and education for multiple physical activity outcomes. Conclusions: Although socio-demographic correlates of physical activity are widely studied, the present results provide new information. City-specific findings suggest there will be value in conducting more detailed case studies. The curvilinear associations of age with leisure-time physical activity as well as significant interactions of leisure-time activity with sex and education should be further investigated. The findings of lower leisure-time physical activity among females as well as people with low education suggest that greater and continued efforts in physical activity policies and programs tailored to these high-risk groups are needed internationally. Data collection in Hong Kong was supported by the grants (#HKU740907H and #747807H) and the HKU URC Strategic Research Theme (Public Health). US data collection and Coordinating Center processing was supported by the following NIH grant: R01 CA127296 (NCI). The study conducted in Bogota was funded by Colciencias grant 519 2010, Fogarty and CeiBA (Center in Complex-Systems, Basic and Applied Research at the Universidad de los Andes). Ester Cerin is supported by an Australian Research Council Future Fellowship (FT3 #140100085). The contributions of Neville Owen were supported by a NHMRC Program Grant (#569940), a NHMRC Senior Principal Research Fellowship (#1003960), and by the Victorian Government’s Operational Infrastructure Support Program. The Danish study was partly funded by the Municipality of Aarhus. Data collection in the Czech Republic was supported by the grant of Ministry of Education, Youths and Sports (# MSM 6198959221). Data collection in New Zealand was supported by the Health Research Council of New Zealand grant # 07/356. Data collection in Mexico was supported by the CDC Foundation which received an unrestricted training grant from The Coca-Cola Company.

The study aimed to examine associations of neighborhood built environments and proximity of food outlets (BE measures) with body weight status using pooled data from an international study (IPEN Adult). Objective BE measures were calculated using geographic information systems for 10,008 participants (4463 male, 45%) aged 16-66 years in 14 cities. Participants self-reported proximity to three types of food outlets. Outcomes were body mass index (BMI) and overweight/obesity status. Male and female weight status associations with BE measures were estimated by generalized additive mixed models. Proportion (95% CI) of overweight (BMI 25 to

This current research presents an inventive multilevel named entity recognition scheme for explaining the confrontation with biomedical entity recognition which based on divergent algorithms. The presented scheme contains multilevels, which enables Biomedical entity recognition tasks to extract and identify important biomedical concept: DNA, RNA, CELL-LINE, CELL-TYPE, PROTEIN, and O classes with ease. The BioNLP/NLPBPA 2004 challenge datasets have been used and evaluated, resulted in promising outcomes in terms of biomedical recognition model performance.

Detection of early signs of the diseases at geospatial level can help in promoting evidence-based health policies and proper disease management strategies to be formulated beforehand. In this paper, we report the performance of XGboosting algorithm as a part of a novel unified predictive modelling framework. The proposed scalable end to end tree boosting system called XGBoost, results in significantly improved performance. The experimental validation of the proposed algorithm, when compared with traditional shallow machine learning techniques, for two publicly available cardiovascular disease datasets (the NHANES dataset, and the Framingham Heart Study CHS dataset), resulted in promising outcomes, in terms of performance of different performance metrics including prediction accuracy and model building time.

An early detection of the disease status can play a vital role, as timely action can save patient's life. A disease status of the patient is a type of PHI (Protected Health Infonnation).In general the process ofidentifying the PHI is done manually on the structured dataset, this activity is prohibitively expensive, time consuming and error prone.In order to overcome the known drawback of the manual identification system an implementation of automated personal health information identification like disease status is required. In our work an effort has been done to build a model with a novel approach based on deep neural models for automatic identification of disease status (one of the PHIs) from free text clinical records. The experimental evaluation of the proposed models on two different datasets from i2b2 Challenge tasks, show the merit ofthe proposed scheme.

Discovering the initial signs of the illness with geospatial information will facilitate and encourage the fact-based policies from health prospective and appropriate management approaches to be developed for diseases. During the paper, we tend to propose a machine learning primarily based prognostic modelling framework, which may run in static/low speed, massive information from electronic health records, furthermore as extreme velocity, streaming massive information settings captured from wearables, like fitness bands and biosensor watches. During our paper, we describe a scalable algorithm called Neuron network, which is used to achieve highly accurate results in fuzzy data. We have presented the outcomes of the proposed framework implementation for static and low-velocity/volume settings from the EHR & clinical DBs, with the experimental authentication of the planned framework, for 2 openly accessible CVD data sets which are “NHANES” dataset, and the “Framingham Heart Study” dataset), shown promising outcomes, in terms of performance of different modelling algorithms for the disease status prediction.

Nowadays medical research plays an important role of community safeguard by finding the solutions to health related problems. An early detection or Co-morbidity Detection of a disease can help both patients and doctors to act and eradicate the root cause or work on preventing further deterioration of the detected disease symptoms. One of the methods to detect the disease is by going through patients’ medical history but this is time-consuming manual process which comes with an expense of error-prone analysis. Hence a need to detect the co-morbidity or the existing disease in an automated or semi-automated fashion is become a need of the hour. In this paper we have used machine learning and deep learning techniques on publically available i2b2 clinical datasets to detect the chronic disease status like obesity. Our experiments have shown promising results.

BACKGROUND: Physical inactivity is a global pandemic responsible for over 5 million deaths annually through its effects on multiple non-communicable diseases. We aimed to document how objectively measured attributes of the urban environment are related to objectively measured physical activity, in an international sample of adults.METHODS: We based our analyses on the International Physical activity and Environment Network (IPEN) adult study, which was a coordinated, international, cross-sectional study. Participants were sampled from neighbourhoods with varied levels of walkability and socioeconomic status. The present analyses of data from the IPEN adult study included 6822 adults aged 18-66 years from 14 cities in ten countries on five continents. Indicators of walkability, public transport access, and park access were assessed in 1·0 km and 0·5 km street network buffers around each participant's residential address with geographic information systems. Mean daily minutes of moderate-to-vigorous-intensity physical activity were measured with 4-7 days of accelerometer monitoring. Associations between environmental attributes and physical activity were estimated using generalised additive mixed models with gamma variance and logarithmic link functions.RESULTS: Four of six environmental attributes were significantly, positively, and linearly related to physical activity in the single variable models: net residential density (exp[b] 1·006 [95% CI 1·003-1·009]; p=0·001), intersection density (1·069 [1·011-1·130]; p=0·019), public transport density (1·037 [1·018-1·056]; p=0·0007), and number of parks (1·146 [1·033-1·272]; p=0·010). Mixed land use and distance to nearest public transport point were not related to physical activity. The difference in physical activity between participants living in the most and least activity-friendly neighbourhoods ranged from 68 min/week to 89 min/week, which represents 45-59% of the 150 min/week recommended by guidelines.INTERPRETATION: Design of urban environments has the potential to contribute substantially to physical activity. Similarity of findings across cities suggests the promise of engaging urban planning, transportation, and parks sectors in efforts to reduce the health burden of the global physical inactivity pandemic.FUNDING: Funding for coordination of the IPEN adult study, including the present analysis, was provided by the National Cancer Institute of National Institutes of Health (CA127296) with studies in each country funded by different sources.

To investigate the longitudinal effect of sport participation in physical activity, fitness and body fat changes during childhood and adolescence.Longitudinal study (134 boys, 155 girls) of Australian youth aged 8-16 years.Physical activity was assessed by pedometers and accelerometers, fitness by the 20m shuttle-run, body fat by DEXA and club sport participation by questionnaire. Linear mixed models were used to determine the effects of sport participation and gender differences.Sports club participants were more physically active at all age groups than non-participants; boys took an extra 1800 steps (p0.001) and girls 590 steps per day (p0.01) and boys engaged in an extra 9min and girls 6min more moderate to vigorous PA per day (both p0.05). Fitness was higher among sports participants (boys 27% and girls 20% higher, both p0.001) and sport participant girls had 2.9% less body fat (p0.05). Higher fitness scores were maintained over time by sports participants but their greater PA diminished during adolescence, this being more evident among girls. Only 20% of sports club participants met the recommended daily average of 60min MVPA.Sport participants were more active, fitter and had less body fat (girls only) than non-sports participants. However, the associated benefits of sport with PA diminished during adolescence and the majority of sports participants did not meet recommended levels of PA. Strategies aiming to maximise the benefits of sports participation may be enhanced by providing special attention to the early adolescent period particularly among girls.

Background The prevalence of overweight and obesity is increasing amongst women of child bearing age. Maternal obesity has implications for both mother and baby including increased health risks from gestational hypertensive disorders, caesarean section and stillbirth. Despite the increasing prevalence of maternal obesity little is known of the experiences of these women within the health care system. The aim of this research was to investigate the perspectives of pregnant women with a body mass index (BMI) of ≥30kg/m 2 receiving antenatal care. Methods A qualitative study using individual interviews was undertaken. Sixteen pregnant women with a BMI ≥30kg/m 2 participated. Interviews were audio recorded, transcribed, cross checked for consistency and then entered into a word processing document for analysis. Data was analysed using Interpretative Phenomenological Analysis. In any phenomenological study the researcher's objective is to elicit the participant's views on their lived experiences. Findings Four major themes emerged: (1) obese during pregnancy as part of a long history of obesity; (2) lack of knowledge of the key complications of obesity for both mother and child; (3) communication about weight and gestational weight gain can be conflicting, confusing and judgmental; (4) most women are motivated to eat well during pregnancy and want help to do so. Conclusion Specialist lifestyle interventions for obese women should be a priority in antenatal care. Extra support is required to assist obese women in pregnancy achieve recommended nutritional and weight goals. Health professionals should approach the issue of maternal obesity in an informative but non-judgmental way.

The study objectives were (1) to determine the variation in prevalence of overweight between school communities, (2) to evaluate the relationship between cardiorespiratory fitness and the probability of being overweight among different school communities, and (3) to test whether this relationship varies between school communities. Using a repeated cross-sectional design, data from 31,424 (15,298 girls, 16,126 boys) Australian school children who had objective assessments of body composition and physical performance were used. Ninety-one schools located across 5 states and territories were included. Independent samples were taken across 12 school years (2000–2011). Analysis used generalised linear mixed models in R with a two-level hierarchical structure—children, nested within school communities. Predictor variables considered were: level 1—gender, age, cardiorespiratory fitness and year of measurement; level 2—school community. A total of 24.6% of the children were overweight and 69% were of low fitness. Variation in the prevalence of overweight between school communities was significant, ranging from 19% to 34%. The probability of being overweight was negatively associated with increasing cardiorespiratory fitness. The relationship was steepest at low fitness and varied markedly between school communities. Children of low fitness had probabilities of being overweight ranging between 26% and 75% depending on school community, whereas those of high fitness had probabilities of

The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P

This paper describes a novel deep learning-based framework for biomedical name entity recognition. Bio-Entity name entity recognition task based on three different deep learning techniques: Feedforward Networks (FFNs), Recurrent Neural Networks (RNNs), and Hybrid Convolutional Neural Networks (CNNs), has allowed better latent feature learning and discovery for the complex NLP task. The performance evaluation of the proposed framework with the BioNLP dataset corresponding to biomedical entity recognition task, has led to promising performance, when assessed in terms of F-measure, Recall and Precision. The best performing deep learner based on Hybrid CNN approach has resulted in an F-score of 70.32%, and surpassed the performance reported by other participants in the Challenge task.

Timely identification or prediction of a disease status can be a boon to patient's life. The elements that can detect the diseases status are mostly present in free text clinical records; these records contain private information about the patients. The time-consuming manual process to identify the disease status from these clinical records can be error-prone and comes with an expense. Hence the need to automate or semi automate this process is felt in the community. In this paper, we have used deep learning techniques on the publically available i2b2 clinical datasets to detect the chronic disease status, leading to promising results.

PURPOSE Physical inactivity and sedentary behavior (SB) are independent risk factors for cardiovascular disease and all-cause mortality. No studies appear to have investigated whether SB in cardiac rehabilitation (CR) participants changes over time. The aim of this study was to objectively assess physical activity (PA) and SB of CR participants over 6 wks. METHODS Using a prospective cohort study design, 72 CR participants, age = 64.2 ± 9.6 y (mean ± standard deviation [SD]) (79% male), wore an ActiGraph ActiSleep accelerometer for 7 consecutive days at the beginning and end of a 6-wk program to assess daily minutes of moderate-to-vigorous PA (MVPA) and SB (

BACKGROUND: Approximately 50% of women gain excessive weight in pregnancy. Optimizing gestational weight gain is important for the short- and long-term health of the childbearing woman and her baby. Despite this, there is no recommendation for routine weighing in pregnancy, and weight is a topic that many maternity care providers avoid. Resource-intensive interventions have mainly targeted overweight and obese women with variable results. Few studies have examined the way that socioeconomic status might influence the effectiveness or acceptability of an intervention to participants. Given the scale of the problem of maternal weight gain, maternity services will be unlikely to sustain resource intensive interventions; therefore, innovative strategies are required to assist women to manage weight gain in pregnancy.OBJECTIVE: The primary aim of the trial was to examine the effectiveness of the Eating4Two smartphone app in assisting women of all body mass index categories to optimize gestational weight gain. Secondary aims include comparing childbirth outcomes and satisfaction with antenatal care and examining the way that relative advantage and disadvantage might influence engagement with and acceptability of the intervention.METHODS: This randomized controlled trial will randomize 1330 women to control or intervention groups in 3 regions of different socioeconomic status. Women will be recruited from clinical and social media sites. The intervention group will be provided with access to the Eating4Two mobile phone app which provides nutrition and dietary information specifically tailored for pregnancy, advice on food serving sizes, and a graph that illustrates women's weight change in relation to the range recommended by the Institute of Medicine. Women will be encouraged to use the app to prompt conversations with their maternity care providers about weight gain in pregnancy. The control group will receive routine antenatal care.RESULTS: Recruitment has commenced though the recruitment rate is slower than expected. Additional funds are required to employ research assistants and promote the study in an advertising campaign.CONCLUSION: Feasibility testing highlighted the inadequacy of the original recruitment strategy and the need to provide the app in both major platforms (Android and iOS). Smartphone technologies may offer an effective alternative to resource intensive strategies for assisting women to optimize weight gain in pregnancy.TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000169347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371470 (Archived by WebCite at http://www.webcitation.org /6zDvgw5bo).REGISTERED REPORT IDENTIFIER: RR1-10.2196/9920.

Rationale Residents of neighbourhoods with high destination accessibility (higher population density, more-interconnected streets, and better access to services, public transport and parks) are more physically active. Evidence on the factors that underlie these associations is sparse and inconsistent. Objective We examined (1) five socio-demographic and four non-destination perceived neighbourhood attributes as moderators of the relationship between objectively-assessed destination accessibility and moderate-to-vigorous physical activity (MVPA); (2) perceived indicators of destination accessibility as mediators of those relationships; and, (3) the generalizability of findings across 14 cities. Methods Data were from the International Physical Activity and Environment Network (IPEN) Adult study (N = 6822), which provided comparable objective and perceived environmental variables and accelerometer-based MVPA from 14 cities across 10 countries. Mediation and mediation moderation analyses were performed. Results Objective net residential density, public transport density, and number of parks in the neighbourhood were consistently associated with MVPA across all examined socio-demographic groups and non-destination perceived neighbourhood characteristics. However, only the association between number of parks and MVPA was mediated by its conceptually-comparable perceived indicator. While the associations of objective intersection density and land use mix with MVPA were moderated by both gender and perceived pedestrian infrastructure/safety, only the latter moderating effects were mediated by the conceptually-comparable perceived indicators. Perceived neighbourhood safety and/or aesthetics moderated the associations of objective ratio of retail/civic land to total area and distance to nearest transport stop with MVPA. These associations were not mediated by the conceptually-comparable perceived indicators. Conclusion Densely populated neighbourhoods with access to public transport and parks have the potential to significantly and equitably contribute to adults' MVPA on a global scale. Perceived neighbourhood aesthetics, pedestrian-friendliness and safety can magnify the positive effects of mixed-use neighbourhoods on residents' MVPA by interacting with the perceived ease of access to a variety of destinations.

Background/Aim: Walking is a significant physical activity and is known to be driven by aspects of the built environment. While many studies investigate relationships between the built environment ...

BACKGROUND Approximately 50% of women gain excessive weight in pregnancy. Optimizing gestational weight gain is important for the short- and long-term health of the childbearing woman and her baby. Despite this, there is no recommendation for routine weighing in pregnancy, and weight is a topic that many maternity care providers avoid. Resource-intensive interventions have mainly targeted overweight and obese women with variable results. Few studies have examined the way that socioeconomic status might influence the effectiveness or acceptability of an intervention to participants. Given the scale of the problem of maternal weight gain, maternity services will be unlikely to sustain resource intensive interventions; therefore, innovative strategies are required to assist women to manage weight gain in pregnancy. OBJECTIVE The primary aim of the trial was to examine the effectiveness of the Eating4Two smartphone app in assisting women of all body mass index categories to optimize gestational weight gain. Secondary aims include comparing childbirth outcomes and satisfaction with antenatal care and examining the way that relative advantage and disadvantage might influence engagement with and acceptability of the intervention. METHODS This randomized controlled trial will randomize 1330 women to control or intervention groups in 3 regions of different socioeconomic status. Women will be recruited from clinical and social media sites. The intervention group will be provided with access to the Eating4Two mobile phone app which provides nutrition and dietary information specifically tailored for pregnancy, advice on food serving sizes, and a graph that illustrates women’s weight change in relation to the range recommended by the Institute of Medicine. Women will be encouraged to use the app to prompt conversations with their maternity care providers about weight gain in pregnancy. The control group will receive routine antenatal care. RESULTS Recruitment has commenced though the recruitment rate is slower than expected. Additional funds are required to employ research assistants and promote the study in an advertising campaign. CONCLUSION Feasibility testing highlighted the inadequacy of the original recruitment strategy and the need to provide the app in both major platforms (Android and iOS). Smartphone technologies may offer an effective alternative to resource intensive strategies for assisting women to optimize weight gain in pregnancy. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12617000169347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371470 (Archived by WebCite at http://www.webcitation.org /6zDvgw5bo) REGISTERED REPORT IDENTIFIER RR1-10.2196/9920

Neighborhood environmental attributes have been found to be associated with residents' time spent walking and in physical activity, in studies from single countries and in multiple-country investigations. There are, however, mixed findings on such environmental relationships with sedentary (sitting) time, which primarily have used evidence derived from single-country investigations with self-reported behavioral outcome measures. We examined potential relationships of neighborhood environmental attributes with objectively-assessed sedentary time using data from 5712 adults recruited from higher and lower socio-economic status neighborhoods in 12 sites in 10 countries, between 2002 and 2011. Ten perceived neighborhood attributes, derived from an internationally-validated scale, were assessed by questionnaire. Sedentary time was derived from hip-worn accelerometer data. Associations of individual environmental attributes and a composite environmental index with sedentary time were estimated using generalized additive mixed models. In fully adjusted models, higher street connectivity was significantly related to lower sedentary time. Residential density, pedestrian infrastructure and safety, and lack of barriers to walking were related to higher sedentary time. Aesthetics and safety from crime were related to less sedentary time in women only. The predicted difference in sedentary time between those with the minimum versus maximum composite environmental index values was 71 min/day. Overall, certain built environment attributes, including street connectivity, land use mix and aesthetics were found to be related to sedentary behavior in both expected and unexpected directions. Further research using context-specific measures of sedentary time is required to improve understanding of the potential role of built environment characteristics as influences on adults' sedentary behavior. All authors declare financial support for the submitted work from the National Cancer Institute of the United States National Institutes of Health. Data collection in Hong Kong was supported by the HK Research Grants Council GRF grants (#HKU740907H and #747807H) and HKU URC Strategic Research Theme (Public Health). US data collection and Coordinating Center processing was supported by the NIH grants R01 HL67350 (NHLBI) and R01 CA127296 (NCI). The study conducted in Bogota was funded by Colciencias grant 519_2010, Fogarty International Center (NIH) and CeiBA. The contributions of Neville Owen were supported by NHMRC Program Grant #569940, NHMRC Senior Principal Research Fellowship #1003960, and by the Victorian Government's Operational Infrastructure Support Program. The Danish study was partly funded by the Municipality of Aarhus. Data collection in the Czech Republic was supported by the grant MEYS (# MSM 6198959221). Data collection in New Zealand was supported by the Health Research Council of New Zealand grant # 07/356. Data collection in Mexico was supported by the CDC Foundation which received an unrestricted grant from The Coca-Cola Company. The UK study was funded by the Medical Research Council under the National Preventive Research Initiative. Deborah Salvo was supported by a training grant from the CDC Foundation. James F Sallis received grants and personal fees from the Robert Wood Johnson Foundation outside of submitted work, grants and non-financial support from Nike, Inc. outside of submitted work, and is a consultant and receiver of royalties from SPARK Programs of School Specialty, Inc.

Objectives: To estimate: 1) daily energy deficit required to reduce the weight of overweight children to within normal range; 2) time required to reach normal weight for a proposed achievable (small) target energy deficit of 0.42 MJ/day; 3) impact that such an effect may have on prevalence of childhood overweight. Methods: Body mass index and fitness were measured in 31,424 Australian school children aged between 4.5 and 15 years. The daily energy deficit required to reduce weight to within normal range for the 7,747 (24.7%) overweight children was estimated. Further, for a proposed achievable target energy deficit of 0.42 MJ/day, the time required to reach normal weight was estimated. Results: About 18% of children were overweight and 6.6% obese; 69% were either sedentary or light active. If an energy deficit of 0.42 MJ/day could be achieved, 60% of overweight children would reach normal weight and the current prevalence of overweight of 24.7% (24.2%–25.1%) would be reduced to 9.2% (8.9%–9.6%) within about 15 months. Conclusions: The prevalence of overweight in Australian school children could be reduced significantly within one year if even a small daily energy deficit could be achieved by children currently classified as overweight or obese.

Increasingly, public sector programmes respond to complex social problems that intersect specific fields and individual disciplines. Such responses result in multi-site initiatives that can span nations, jurisdictions, sectors and organisations. The rigorous evaluation of public sector programmes is now a baseline expectation. For evaluations of large and complex multi-site programme initiatives, the processes of ethics review can present a significant challenge. However in recent years, there have been new developments in centralised ethics review processes in many nations. This paper provides the case study of an evaluation of a national, inter-jurisdictional, cross-sector, aged care health initiative and its encounters with Australian centralised ethics review processes. Specifically, the paper considers progress against the key themes of a previous five-year, five nation study (Fitzgerald and Phillips, 2006), which found that centralised ethics review processes would save time, money and effort, as well as contribute to more equitable workloads for researchers and evaluators. The paper concludes with insights for those charged with refining centralised ethics review processes, as well as recommendations for future evaluators of complex multi-site programme initiatives.

In this paper, we propose a novel multilevel NER framework, for addressing the challenges of clinical name entity recognition, based on different machine learning and text mining algorithms. The proposed framework, with multiple levels, allows models for increasingly complex NER tasks to be built. The experimental evaluation on two different publicly available datasets, corresponding to different application contexts - the CLEF 2016 challenge shared task 1A for nursing handover context, and the BIONLP/NLPBPA 2004 challenge shared task on GENIA corpus for recognizing entities in microbiology, has validated the proposed framework.

Smart watches / Fitness bands aim to capture the different vital signs, such as heart rate, energy expenditure and sleep patterns of the users which can be immensely useful for monitoring and prediction of the overall wellbeing of the user. Further, detection of early signs of the diseases at geospatial level can help in promoting evidence based health policies and proper disease management strategies to be formulated beforehand. In this paper, a novel unified predictive modelling framework is proposed, which can perform in both static and low velocity, big data clinical settings from EHRs, as well as high velocity, dynamic, streaming big data settings captured from personal wearable devices, such as smart watches and fitness bands. In this paper, we report the results of the platform implementation of the framework for static/low velocity settings from the electronic health records and hospital databases, with the experimental validation of the proposed framework, for two publicly available cardiovascular disease datasets (the NHANES dataset, and the Framingham Heart Study CHS dataset), showing promising outcomes, in terms of performance of different predictive modelling algorithms for prediction of disease status.