7-point Subjective Global Assessment is more time sensitive than conventional Subjective Global Assessment in detecting nutrition changes

Background: It is important for nutrition intervention in malnourished patients to be guided by accurate evaluation and detection of small changes in the patient’s nutrition status over time. However, the current Subjective Global Assessment (SGA) is not able to detect changes in a short period of time. The aim of the study was to determine whether 7-point SGA is more time sensitive to nutrition changes than the conventional SGA. Methods: In this prospective study, 67 adult inpatients assessed as malnourished using both the 7-point SGA and conventional SGA were recruited. Each patient received nutrition intervention and was followed up post-discharge. Patients were reassessed using both tools at 1, 3 and 5 months from baseline assessment. Results: It took significantly shorter time to see a one-point change using 7-point SGA compared to conventional SGA (median: 1 month vs. 3 months, p = 0.002). The likelihood of at least a one-point change is 6.74 times greater in 7-point SGA compared to conventional SGA after controlling for age, gender and medical specialties (odds ratio = 6.74, 95% CI 2.88-15.80, p<0.001). Fifty-six percent of patients who had no change in SGA score had changes detected using 7-point SGA. The level of agreement was 100% (k = 1, p < 0.001) between 7-point SGA and 3-point SGA and 83% (k=0.726, p<0.001) between two blinded assessors for 7-point SGA. Conclusion: The 7-point SGA is more time sensitive in its response to nutrition changes than conventional SGA. It can be used to guide nutrition intervention for patients.

Trends in demographic, health behaviour factors, and self-perceived weight status : influences on obesity in Australia from 1995 to 2005

Overweight and obesity are two of the most important emerging public health issues in our time and regarded by the World Health Organisation [WHO] (1998) as a worldwide epidemic. The prevalence of obesity in the USA is the highest in the world, and Australian obesity rates fall into second place. Currently, about 60% of Australian adults are overweight (BMI „d 25kg/m2). The socio-demographic factors associated with overweight and/or obesity have been well demonstrated, but many of the existing studies only examined these relationships at one point of time, and did not examine whether significant relationships changed over time. Furthermore, only limited previous research has examined the issue of the relationship between perception of weight status and actual weight status, as well as factors that may impact on people¡¦s perception of their body weight status. Aims: The aims of the proposed research are to analyse the discrepancy between perceptions of weight status and actual weight status in Australian adults; to examine if there are trends in perceptions of weight status in adults between 1995 to 2004/5; and to propose a range of health promotion strategies and furth er research that may be useful in managing physical activity, healthy diet, and weight reduction. Hypotheses: Four alternate hypotheses are examined by the research: (1) there are associations between independent variables (e.g. socio -demographic factors, physical activity and dietary habits) and overweight and/or obesity; (2) there are associations between the same independent variables and the perception of overweight; (3) there are associations between the same independent variables and the discrepancy between weight status and perception of weight status; and (4) there are trends in overweight and/or obesity, perception of overweight, and the discrepancy in Australian adults from 1995 to 2004/5. Conceptual Framework and Methods: A conceptual framework is developed that shows the associations identified among socio -demographic factors, physical activity and dietary habits with actual weight status, as well as examining perception of weight status. The three latest National Health Survey data bases (1995 , 2001 and 2004/5) were used as the primary data sources. A total of 74,114 Australian adults aged 20 years and over were recruited from these databases. Descriptive statistics, bivariate analyses (One -Way ANOVA tests, unpaired t-tests and Pearson chi-square tests), and multinomial logistic regression modelling were used to analyse the data. Findings: This research reveals that gender, main language spoken at home, occupation status, household structure, private health insurance status, and exercise are related to the discrepancy between actual weight status and perception of weight status, but only gender and exercise are related to the discrepancy across the three time point s. The current research provides more knowledge about perception of weight status independently. Factors which affect perception of overweight are gender, age, language spoken at home, private health insurance status, and diet ary habits. The study also finds that many factors that impact overweight and/or obesity also have an effect on perception of overweight, such as age, language spoken at home, household structure, and exercise. However, some factors (i.e. private health insurance status and milk consumption) only impact on perception of overweight. Furthermore, factors that are rel ated to people’s overweight are not totally related to people’s underestimation of their body weight status in the study results. Thus, there are unknown factors which can affect people’s underestimation of their body weight status. Conclusions: Health promotion and education activities should provide education about population health education and promotion and education for particular at risk sub -groups. Further research should take the form of a longitudinal study design ed to examine the causal relationship between overweight and/or obesity and underestimation of body weight status, it should also place more attention on the relationships between overweight and/or obesity and dietary habits, with a more comprehensive representation of SES. Moreover, further research that deals with identification of characteristics about perception of weight status, in particular the underestimation of body weight status should be undertaken.

Application of operations research techniques to improve efficiency in the emergency department

The main aim of this thesis is to analyse and optimise a public hospital Emergency Department. The Emergency Department (ED) is a complex system with limited resources and a high demand for these resources. Adding to the complexity is the stochastic nature of almost every element and characteristic in the ED. The interaction with other functional areas also complicates the system as these areas have a huge impact on the ED and the ED is powerless to change them. Therefore it is imperative that OR be applied to the ED to improve the performance within the constraints of the system. The main characteristics of the system to optimise included tardiness, adherence to waiting time targets, access block and length of stay. A validated and verified simulation model was built to model the real life system. This enabled detailed analysis of resources and flow without disruption to the actual ED. A wide range of different policies for the ED and a variety of resources were able to be investigated. Of particular interest was the number and type of beds in the ED and also the shift times of physicians. One point worth noting was that neither of these resources work in isolation and for optimisation of the system both resources need to be investigated in tandem. The ED was likened to a flow shop scheduling problem with the patients and beds being synonymous with the jobs and machines typically found in manufacturing problems. This enabled an analytic scheduling approach. Constructive heuristics were developed to reactively schedule the system in real time and these were able to improve the performance of the system. Metaheuristics that optimised the system were also developed and analysed. An innovative hybrid Simulated Annealing and Tabu Search algorithm was developed that out-performed both simulated annealing and tabu search algorithms by combining some of their features. The new algorithm achieves a more optimal solution and does so in a shorter time.

ACE research briefing paper 003 : international perceptions and aspirations

2010 marked the completion of data collection for year three (Wave 3) of the CAUSEE study. This report uses data from the first three years. Australia's population is noted for its mixed international background. The ABS 2006 census reports showed that almost a quarter of Australian population were born overseas, contributing to a high degree of cultural diversity. This report examines the international background and experience of Australian business founders as well as their aspired and actual participation in international markets. In this research briefing paper, we compare Nascent Firm (NF) and Young Firm (YF) groups and also 'Regular' start-ups in both categories with their High Potential counterparts. When we compare characteristics at one point in time and we compare developments over time. Unless otherwise stated the findings we comment on are 'statistically significant'. That is, there is less than 5 per cent risk that they would appear by chance if there is no true difference in the population form which the samples were drawn.

Engaging the metaphorical city : Brisbane male fiction 1975-2007

Brisbane writers and writing are increasingly represented as important to the city’s identity as a site of urban cool, at least in marketing and public relations paradigms. It is therefore remarkable that recent Brisbane fiction clings strongly to a particular relationship to the climatic and built environment that is often located in the past and which seemingly turns away, or at least elides, the ‘new’ technologically-driven Brisbane. Literary Brisbane is often depicted in the context of nostalgia for the Brisbane that once was—a tropical, timbered, luxuriant city in which sex is associated with heat, and, in particular, sweat. In this writing sweat can produced by adrenaline or heat, but in particular, in Brisbane novels, it is the sweat of sex that characterises the literary city. Given that Brisbane is in fact a subtropical city, it is interesting that metaphors of a tropical climate and vegetation occur so frequently in Brisbane stories (and narratives set in other parts of the state) that writer Thea Astley was prompted at one point to remark that Queensland writing was in danger of developing into a tropical cliché.

Hearing voice and silence during stressful economic times

Purpose - It is ironic that in stressful economic times, when new ideas and positive behaviors could be most valuable, employees may not speak up, leading to reduced employee participation, less organizational learning, less innovation and less receptiveness to change. The supervisor is the organization’s first line of defense against a culture of silence and towards a culture of openness. This research asks what helps supervisors to hear prosocial voice and notice defensive silence. Design/methodology/approach - We conducted a cross-sectional field study of 142 supervisors. Findings - Our results indicate that prosocial voice is increased by supervisor tension and trust in employees, while defensive silence is increased by supervisor tension but reduced by unionization of employees and trust in employees. This indicates that, as hypothesized by others, voice and silence are orthogonal and not opposites of the same construct. Research limitations/implications - The data is measured at one point in time, and further longitudinal study would be helpful to further understand the phenomena. Practical implications - This research highlights the potential for supervisors in stressful situations to selectively hear voice and silence from employees. Originality/value - This study adds to our knowledge of prosocial voice and defensive silence by testing supervisors’ perceptions of these constructs during difficult times. It provides valuable empirical insights to a literature dominated by conceptual non-empirical papers. Limited research on silence might reflect how difficult it is to study such an ambiguous and passive construct as silence (often simply viewed as a lack of speech). also contribute to trust literature by identifying its role in increasing supervisor’s perceptions of prosocial voice and reducing perceptions of defensive silence.

Sample size considerations and augmentation of computer experiments

Computer Experiments, consisting of a number of runs of a computer model with different inputs, are now common-place in scientific research. Using a simple fire model for illustration some guidelines are given for the size of a computer experiment. A graph is provided relating the error of prediction to the sample size which should be of use when designing computer experiments. Methods for augmenting computer experiments with extra runs are also described and illustrated. The simplest method involves adding one point at a time choosing that point with the maximum prediction variance. Another method that appears to work well is to choose points from a candidate set with maximum determinant of the variance covariance matrix of predictions.

Play and heal : randomized controlled trial of Ditto intervention efficacy on improving re-epithelialization in pediatric burns

BACKGROUND: The relationships between pain, stress and anxiety, and their effect on burn wound re-epithelialization have not been well explored to-date. The aim of this study was to investigate the effect of the Ditto (a hand-held electronic medical device providing procedural preparation and distraction) intervention on re-epithelialization rates in acute pediatric burns. METHODS/DESIGN: From August 2011 to August 2012, children (4-12 years) with an acute burn presenting to the Royal Children's Hospital, Brisbane, Australia fulfilled the study requirements and were randomized to [1] Ditto intervention or [2] standard practice. Burn re-epithelialization, pain intensity, anxiety and stress measures were obtained at every dressing change until complete wound re-epithelialization. RESULTS: One hundred and seventeen children were randomized and 75 children were analyzed (n=40 standard group; n=35 Ditto group). Inability to predict wound management resulted in 42 participants no longer meeting the eligibility criteria. Wounds in the Ditto intervention group re-epithelialized faster than the standard practice group (-2.14 days (CI: -4.38 to 0.10), p-value=0.061), and significantly faster when analyses were adjusted for mean burn depth (-2.26 days (CI: -4.48 to -0.04), p-value=0.046). Following procedural preparation at the first change of dressing, the Ditto group reported lower pain intensity scores (-0.64 (CI: -1.28, 0.01) p=0.052) and lower anxiety ratings (-1.79 (CI: -3.59, 0.01) p=0.051). At the second and third dressing removals average pain (FPS-R and FLACC) and anxiety scores (VAS-A) were at least one point lower when Ditto intervention was received. CONCLUSIONS: The Ditto procedural preparation and distraction device is a useful tool alongside pharmacological intervention to improve the rate of burn re-epithelialization and manage pain and anxiety during burn wound care procedures.

Modeling of protein signaling networks in clinical proteomics

Molecular interactions that underlie pathophysiological states are being elucidated using techniques that profile proteomicend points in cellular systems. Within the field of cancer research, protein interaction networks play pivotal roles in the establishment and maintenance of the hallmarks of malignancy, including cell division, invasion, and migration. Multiple complementary tools enable a multifaceted view of how signal protein pathway alterations contribute to pathophysiological states.One pivotal technique is signal pathway profiling of patient tissue specimens. This microanalysis technology provides a proteomic snapshot at one point in time of cells directly procured from the native context of a tumor micro environment. To study the adaptive patterns of signal pathway events over time, before and after experimental therapy, it is necessary to obtain biopsies from patients before, during, and after therapy. A complementary approach is the profiling of cultured cell lines with and without treatment. Cultured cell models provide the opportunity to study short-term signal changes occurring over minutes to hours. Through this type of system, the effects of particular pharmacological agents may be used to test the effects of signal pathway inhibition or activation on multiple endpoints within a pathway. The complexity of the data generated has necessitated the development of mathematical models for optimal interpretation of interrelated signaling pathways. In combination,clinical proteomic biopsy profiling, tissue culture proteomic profiling, and mathematical modeling synergistically enable a deeper understanding of how protein associations lead to disease states and present new insights into the design of therapeutic regimens.

Vision-based simultaneous localization and mapping in changing outdoor environments

For robots operating in outdoor environments, a number of factors, including weather, time of day, rough terrain, high speeds, and hardware limitations, make performing vision-based simultaneous localization and mapping with current techniques infeasible due to factors such as image blur and/or underexposure, especially on smaller platforms and low-cost hardware. In this paper, we present novel visual place-recognition and odometry techniques that address the challenges posed by low lighting, perceptual change, and low-cost cameras. Our primary contribution is a novel two-step algorithm that combines fast low-resolution whole image matching with a higher-resolution patch-verification step, as well as image saliency methods that simultaneously improve performance and decrease computing time. The algorithms are demonstrated using consumer cameras mounted on a small vehicle in a mixed urban and vegetated environment and a car traversing highway and suburban streets, at different times of day and night and in various weather conditions. The algorithms achieve reliable mapping over the course of a day, both when incrementally incorporating new visual scenes from different times of day into an existing map, and when using a static map comprising visual scenes captured at only one point in time. Using the two-step place-recognition process, we demonstrate for the first time single-image, error-free place recognition at recall rates above 50% across a day-night dataset without prior training or utilization of image sequences. This place-recognition performance enables topologically correct mapping across day-night cycles.

Recent advances in modeling the vulnerability of transportation networks

It is well known that, for major infrastructure networks such as electricity, gas, railway, road, and urban water networks, disruptions at one point have a knock on effect throughout the network. There is an impressive amount of individual research projects examining the vulnerability of critical infrastructure network. However, there is little understanding of the totality of the contribution made by these projects and their interrelationships. This makes their review a difficult process for both new and existing researchers in the field. To address this issue, a two-step literature review process is used, to provide an overview of the vulnerability of the transportation network in terms of four main themes - research objective, transportation mode, disruption scenario and vulnerability indicator –involving the analysis of related articles from 2001 to 2013. Two limitations of existing research are identified: (1) the limited amount of studies relating to multi-layer transportation network vulnerability analysis, and (2) the lack of evaluation methods to explore the relationship between structure vulnerability and dynamical functional vulnerability. In addition to indicating that more attention needs to be paid to these two aspects in future, the analysis provides a new avenue for the discovery of knowledge, as well as an improved understanding of transportation network vulnerability.

Development, reliability and validity of the queensland evaluation of wheelchair skills (QEWS)

- Objectives To develop and test a valid and reliable assessment of wheelchair skills for individuals with spinal cord injuries (SCI); the Queensland Evaluation of Wheelchair Skills (QEWS). - Setting Hospital, Australia. - Methods Phase 1: Four Delphi panel rounds with clinical experts were used to develop the QEWS. Phase 2: Intra-rater and inter-rater reliability of the QEWS items were examined in 100 people with SCI. Phase 3a: Concurrent validity was investigated by examining the association between QEWS total scores and physiotherapists’ global ratings of wheelchair skill performance. Phase 3b: Construct validity was tested in 20 people with recent SCI by examining change in QEWS total scores between when they first mobilised in a wheelchair and scores obtained 10 weeks later. - Results Phase 1: The QEWS was developed. Phase 2: The intra-class correlation coefficients reflecting the intra-rater reliability and the inter-rater reliability for the QEWS total score were 1.00 and 0.98, with scores being within one point of each other 96 and 91% of the time, respectively. Phase 3a: The QEWS total scores were comparable with the global rating of wheelchair skill performance (r2=0.93). Phase 3b: The QEWS scores changed by a median (interquartile range (IQR)) of 4 (1 to 6) points over the 10-week period following first wheelchair mobilisation. - Conclusion The QEWS is a valid and reliable tool for measuring wheelchair skills in individuals with SCI. The QEWS is efficient and practical to administer and does not require specialised equipment.

Tracking brand positioning for an emerging destination: 2003 to 2015

Few published studies have monitored destination brand image over time. This temporal aspect is an important gap in the literature, given consensus around the role perceptions play in consumers’ decision making, and the ensuing emphasis on imagery in destination branding collateral. Whereas most destination image studies have been a snapshot of perceptions at one point in time, this paper presents findings from a survey implemented four times between 2003 and 2015. Brand image is the core construct in modelling destination branding performance, which has emerged as a relatively new field of research in the past decade. Using the consumer-based brand equity (CBBE) hierarchy, the project has benchmarked and monitored destination brand salience, image and resonance for an emerging regional destination, relative to key competitors, in the domestic Australian market; and the survey instrument has been demonstrated to be reliable in the context of short break holidays by car. What is particularly interesting to date is there has been relatively little change in the market positions of the five destinations, in spite of over a decade of marketing communications by the regional tourism organisations and their stakeholders, and more recently the mass of user-generated travel content on social media. The project didn’t analyse the actual marketing communications for each of the DMOs. Therefore an important implication is that irrespective of the level of marketing undertaken the DMOs seem to have had little control over the perceptions held in their largest market during this time period. Therefore it must be recognised any improvement in perceptions will likely take a long period of time, and so branding needs to be underpinned by a philosophy of a long term financial investment as well as commitment to a consistency of message over time; which given the politics of DMO decision making represents a considerable challenge.

Robust video stabilisation algorithm using feature point selection and delta optical flow

In this study, the authors propose a novel video stabilisation algorithm for mobile platforms with moving objects in the scene. The quality of videos obtained from mobile platforms, such as unmanned airborne vehicles, suffers from jitter caused by several factors. In order to remove this undesired jitter, the accurate estimation of global motion is essential. However it is difficult to estimate global motions accurately from mobile platforms due to increased estimation errors and noises. Additionally, large moving objects in the video scenes contribute to the estimation errors. Currently, only very few motion estimation algorithms have been developed for video scenes collected from mobile platforms, and this paper shows that these algorithms fail when there are large moving objects in the scene. In this study, a theoretical proof is provided which demonstrates that the use of delta optical flow can improve the robustness of video stabilisation in the presence of large moving objects in the scene. The authors also propose to use sorted arrays of local motions and the selection of feature points to separate outliers from inliers. The proposed algorithm is tested over six video sequences, collected from one fixed platform, four mobile platforms and one synthetic video, of which three contain large moving objects. Experiments show our proposed algorithm performs well to all these video sequences.

Change Point Estimation in Monitoring Survival Time

Precise identification of the time when a change in a hospital outcome has occurred enables clinical experts to search for a potential special cause more effectively. In this paper, we develop change point estimation methods for survival time of a clinical procedure in the presence of patient mix in a Bayesian framework. We apply Bayesian hierarchical models to formulate the change point where there exists a step change in the mean survival time of patients who underwent cardiac surgery. The data are right censored since the monitoring is conducted over a limited follow-up period. We capture the effect of risk factors prior to the surgery using a Weibull accelerated failure time regression model. Markov Chain Monte Carlo is used to obtain posterior distributions of the change point parameters including location and magnitude of changes and also corresponding probabilistic intervals and inferences. The performance of the Bayesian estimator is investigated through simulations and the result shows that precise estimates can be obtained when they are used in conjunction with the risk-adjusted survival time CUSUM control charts for different magnitude scenarios. The proposed estimator shows a better performance where a longer follow-up period, censoring time, is applied. In comparison with the alternative built-in CUSUM estimator, more accurate and precise estimates are obtained by the Bayesian estimator. These superiorities are enhanced when probability quantification, flexibility and generalizability of the Bayesian change point detection model are also considered.